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NEUROSCIENCE OF PSYCHOACTIVE SUBSTANCE USE AND DEPENDENCE

BOX 4.3

Heroin-assisted treatment of heroin dependence
Heroin prescription for treatment of opioid dependence, practised on a limited
scale in the United Kingdom for many years, gained increased international interest
in the early 1990s, with feasibility studies in Australia and a first national study of
heroin-assisted treatment in Switzerland that started in 1994. This study led to
the establishment of heroin-assisted treatment as one of the treatment options in
Switzerland. The findings of the study showed that there were significant reductions
in illicit drug use, improvement in health status and social integration (Uchtenhagen
et al., 1999). Follow-up results at 18 months documented stability of improvements
also after discharge from the programme (Rehm, 2001).
A review by a WHO expert group supported the main conclusions of the Swiss
study, but also recommended further research in order to better identify the
specific benefits of prescribed heroin (Ali et al., 1999). These recommendations
have been respected in randomised controlled trials: one implemented in 1998-
2001 in the Netherlands (van den Brink et al., 2002), one started in 2002 in
Germany (Krausz, 2002). Other similar research projects are in preparation
(Fischer et al., 2002). The shared objective of the trials is to test an additional
therapeutic option for those heroin addicts for whom other treatments have failed
and who are out of contact with the treatment system. An international network
of scientists, engaged in the projects mentioned above, has emerged and
organised three conferences for an exchange of methodological, therapeutic
and practical problems and experience. The international debate on heroin-assisted
treatment of opioid dependence, initially mainly political and controversial, tends
to become more scientific and evidence-oriented (Bammer et al., 1999).
Sources: Ali et al., 1999; Bammer et al., 1999; Uctenhagen et al., 1999; Rehm et al.,
2001; van den Brink et al., 2002; Krausz, 2002; Fischer et al. (2002).

all of the effects of opiates. The effects are relatively long-lasting, ranging from
1–3 days. This therapy begins after medically supervised detoxification,
because naloxone and naltrexone do not protect against the effects of
withdrawal, and can in fact precipitate withdrawal symptoms in dependent
people. Naltrexone itself has no subjective effects or potential for the
development of dependence. Patient noncompliance is a common problem.
Therefore, a favourable treatment outcome requires that there also be a
positive therapeutic relationship, effective counselling or therapy, and careful
monitoring of medication compliance.

Cannabinoids
Introduction

Among all the cannabinoids contained in Cannabis sativa, delta-9-
tetrahydrocannabinol (THC) is the major chemical with psychoactive effects

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