heroin-assisted treatment

Transcription

1 heroin-assisted treatment how to start the debate, with whom? Peter Blanken Central Committee on the Treatment of Heroin Addicts (CCBH) Parnassia Addiction Research Center (PARC) Městská a lokální protidrogová politika v éře globalizace 1 October 2010, Prague

2 heroin-assisted treatment: how to start the debate in what countries and contexts has HAT been studied? what have HAT studies shown? why and when should you want to implement HAT? overview of workshop arguments in favour and against HAT comprehensiveness of the addiction (substitution) treatment system target population of treatment-refractory heroin addicted patients political and social support for HAT financial aspects (costs and benefits) strategies conclusions and last remarks

3 heroin-assisted treatment: countries and contexts HAT target population treatment-refractory, heroin-addicted patients

4 heroin-assisted treatment: countries and contexts HAT target population treatment-refractory heroin addicted persons: patients who have (repeatedly) failed in (methadone maintenance) treatment patients with poor physical and/or mental health patients with poor social functioning (including involvement in illegal activities and few social contacts outside the illicit drug scene) patients with (nearly) daily illicit heroin use (injecting or inhaling)

5 heroin-assisted treatment: effectiveness treatment efficacy: HAT versus MMT Relative Risk (95% CI) 0,00 0,50 1,00 1,50 2,00 2,50 3,00 3,50 4,00 SW illicit heroin use 2,33 NL injectable response NL inhalable response 1,79 1,90 SP multidomain 1,16 GE health GE illicit drug use GE combined response 1,08 1,25 1,28 CA retention CA illicit drug use/ activ. CA combined response 1,40 1,63 1,81 UK illicit drug use 2,75

6 heroin-assisted treatment: effectiveness HAT effectiveness HAT is effective in terms of: reducing illicit heroin use improving physical and mental health status improving social functioning, including illegal activities HAT is not without medical risks (ODs, epileptic seizures) HAT is costly, and also cost-effective HAT does not result in (insurmountable) public order or nuisance problems Ferri et al Cochrane; Blanken et al European Neuropsychopharmacology; Dijkgraaf et al BMJ; Lasnier et al International Journal Drug Policy

7 heroin-assisted treatment: work work arguments in favour and against supervised HAT feasible, safe, effective, costly ánd cost-effective treatment situation & treatment population 'cure' as well as 'care' accessibility of treatment (low threshold) affordability of treatment (health care insurance) political and social situation (support for HAT) financial aspects (costs and benefits)

8 heroin-assisted treatment: work work strategies HAT in broader context of treatment innovations Switzerland: "four pillar" drug policy (see: Uchtenhagen 2009 Addiction)

9 heroin-assisted treatment: work Uchtenhagen 2010 Addiction

10 heroin-assisted treatment: work strategies HAT in broader context of treatment innovations Switzerland: "four pillar" drug policy (see: Uchtenhagen 2009 Addiction) The Netherlands: Report of the Dutch Health Council (1995) - improving liaison between legal and treatment system - efficacy of high methadone dosages - efficacy of ultrarapid opioid detoxification with/without anaesthesia - efficacy of heroin-assisted treatment medicalization of the treatment of heroin addicted patients addiction as a "chronic disorder" (or "brain disease") HAT as part of regular health care, addiction treatment treatment facility and personnel (EMCDDA commissioned report) what else? work see for instance: Leshner 1997 Science; McLellan et al JAMA; Hser et al Archives General Psychiatry

11 heroin-assisted treatment what are your conclusions???

12 for more information