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BMJ 2006; 332 doi: (Published 08 June 2006) Cite this as: BMJ 2006;332:1383
  1. Kristina Fister (, associate editor

    Harm reduction helps heroin addicts

    Harm reduction programmes have been criticised for giving a false impression to adolescents that heroin use doesn't have to be associated with as much harm to the individual as is traditionally thought. Switzerland has had a liberal policy towards harm reduction. And a recent study shows that the incidence of heroin misuse has been falling under an extensive harm reduction programme, which includes methadone substitution with low threshold of illicit use.

    Credit: LANCET

    The researchers analysed an anonymised treatment register of almost 80% of the heroin addicts treated between 1991 and March 2005 in the canton of Zurich, which included more than 7000 people. Using the conditional lag time distribution, they estimated the proportion of addicts not yet in substitution treatment programmes and modelled the overall prevalence of heroin misuse as a function of incidence and cessation rate.

    Credit: ANN INT MED

    After its all time peak in 1990, the incidence of regular heroin use declined fourfold in the next decade, more than in any other country with data permitting such analysis. The data showed a decline, by 4% a year, in the population of problematic heroin addicts, defined as people who sought and entered treatment. However, the rates of cessation (leaving the substitution programme and not re-entering within a decade) in Switzerland are among the lowest recorded.

    Ventricular fibrillation or tachycardia are not “good” cardiac arrest rhythms in children

    Children who had ventricular fibrillation or tachycardia before the onset of cardiac arrest have better prognosis than children in cardiac arrest who develop ventricular fibrillation or tachycardia during cardiopulmonary resuscitation. This finding is from a multicentre register study of more than 1000 consecutive children with cardiac arrest. It contradicts previous evidence, which was based on studies from single institutions with small sample sizes, and the traditional view that ventricular fibrillation and tachycardia are “good” cardiac arrest rhythms.

    Children who develop ventricular fibrillation …

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