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Published: 15 November 2011

Heroin-assisted treatment

Heroin-assisted treatment is provided to a total of about 1 100 problem opioid users in five EU Member States (Denmark, Germany, Spain, Netherlands, United Kingdom) and 1 360 problem opioid users in Switzerland. This treatment is not proposed as a first-line option, but is reserved for patients who have not responded to other approaches, such as methadone maintenance treatment. All injectable doses (typically about 200 mg diamorphine per injection) are taken under direct supervision, in order to ensure compliance, safety and prevention of any possible diversion to the illicit market: this requires the clinics to be open for several sessions per day, every day of the year.

Six randomised clinical trials examining the outcomes and the cost-effectiveness of this type of treatment have been conducted over the last 15 years (see EMCDDA, 2011). All trials included chronic heroin-dependent individuals who have repeatedly failed other treatment approaches, and who were randomly attributed to heroin-assisted treatment or to oral methadone treatment. The studies used different methods and outcome variables, and their results are therefore only moderately consistent. Overall, they indicate an added value of supervised injectable heroin alongside supplementary doses of methadone for long-term opioid users for whom other approaches have not succeeded. Patients use less street drugs and appear to achieve some gains in physical and mental health functioning.

Heroin-assisted treatment is estimated to cost EUR 19 020 per patient per year in Germany and EUR 20 410 in the Netherlands (adjusted to 2009 prices). This is substantially higher than the cost of providing a patient with one year’s oral methadone treatment, which is estimated to be EUR 3 490 in Germany and EUR 1 634 in the Netherlands. The cost difference between heroin-assisted and methadone treatment is largely due to the higher staffing requirements for specialist clinics. Despite its higher costs, heroin- assisted treatment has been shown to be a cost-effective intervention for a selected group of chronic heroin users (EMCDDA, 2011).

EMCDDA (2011), Cost and financing of drug treatment services in Europe, Selected issue, Publications Office of the European Union, Luxembourg.

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The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) is the reference point on drugs and drug addiction information in Europe. Inaugurated in Lisbon in 1995, it is one of the EU's decentralised agencies. Read more >>

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Page last updated: Friday, 28 October 2011