Establishing heroin-assisted treatment programs, which provide severely addicted individuals with controlled access to pharmaceutical-grade heroin, could make a significant dent in the number of U.S. deaths from opioid use, according to an expert at Rice University’s Baker Institute for Public Policy.
Katharine Neill Harris, the Alfred C. Glassell III Fellow in Drug Policy, outlined her insights and recommendations in a new Baker Institute blog, “Want Fewer People To Die From an Opioid Overdose? Give Them Heroin (Assisted Treatment).” She is available to discuss the issue with media.
Of the 52,404 drug overdose deaths in the U.S. in 2015, roughly 63 percent involved an opioid, according to the Centers for Disease Control and Prevention (CDC). Prescription painkillers, the most widely used opioids, still accounted for the largest share of opioid overdose deaths — nearly half — in 2015. But over the last few years, the rise in overdose deaths has been driven primarily by a spike in deaths related to heroin and synthetic opioids. From 2014 to 2015, there was a 20.6 percent increase in deaths involving heroin and a 72.2 percent increase in deaths from synthetic opioids other than methadone, particularly fentanyl and its analogues, according to the CDC.
“If current trends continue, we will see an increase in the share of the heroin supply that is not heroin at all but much more powerful opioids like fentanyl,” Neill Harris wrote. “This poses a life-threatening risk to users who, unable to determine the content of drugs they purchase off the street or the internet, are more likely to consume a lethal dose, incorrectly assuming that they are taking an appropriate amount.”
Neill Harris said heroin-assisted treatment, or HAT, is a well-established treatment method that was available in the U.S. until the early 1920s and is currently used in several countries. HAT programs provide severely addicted individuals with access to pharmaceutical-grade heroin (diacetylmorphine) on the grounds that doing so will decrease demand for illicit heroin, reduce criminal activity associated with obtaining heroin, improve patients’ lives, reduce the spread of communicable diseases and reduce overdose deaths by providing unadulterated heroin in a supervised setting.
Germany, Belgium, Denmark, the Netherlands and the United Kingdom all have HAT programs. The most well-known is the Swiss model, which began in 1994 in response to a persistent open-air heroin market and the spread of HIV through needle sharing, Neill Harris said. The Swiss program has demonstrated success in several areas, she said. Criminal activity and new incidences of hepatitis C and HIV among HAT patients have declined significantly. No patient has died of an overdose from heroin received through HAT; this is because of the high quality of the heroin administered and because patients use the drug under supervision, which ensures that someone is available to revive them if they do have an adverse reaction. Switzerland’s HAT did not encourage heroin use, as evidenced by the fact that after its implementation, the heroin-dependent population declined from approximately 30,000 in 1992 to 26,000 in 2002.
If the federal government would allow states and localities to operate HAT programs, it would be an opportunity to see how HAT works in the U.S. on a small scale, Neill Harris said. HAT could initially be made available to people in communities suffering from the highest rates of heroin overdose, she said.
However, political barriers to the adoption of HAT programs are high. “Despite growing understanding of the opioid epidemic, heroin remains one of the most heavily stigmatized drugs in our culture,” Neill Harris wrote. “Such negative perceptions make the suggestion of providing heroin to users seem contradictory to the very idea of drug treatment. But scientific evidence should drive policy decisions, not misguided perceptions. And the evidence available clearly indicates that HAT programs could make a significant dent in deaths from opioid use. This possibility alone should be enough motivation for the U.S. to experiment with HAT programs.”
Source: Rice University