Editing Heroin (section)

====Maintenance therapy====
{{Main|Heroin-assisted treatment}}
A number of European countries prescribe heroin for treatment of [[heroin addiction]].<ref>{{cite journal | vauthors = Lintzeris N | title = Prescription of heroin for the management of heroin dependence: current status | journal = CNS Drugs | volume = 23 | issue = 6 | pages = 463–76 | date = 2009 | pmid = 19480466 | doi = 10.2165/00023210-200923060-00002 | s2cid = 11018732 }}</ref> The initial Swiss HAT ([[heroin-assisted treatment]]) trial ("PROVE" study) was conducted as a prospective cohort study with some 1,000 participants in 18 treatment centers between 1994 and 1996, at the end of 2004, 1,200 patients were enrolled in HAT in 23 treatment centers across Switzerland.<ref>{{cite book |doi=10.1159/000062984 |chapter=Preliminary Pages |title=Prescriptions of Narcotics for Heroin Addicts |series=Medical Prescription of Narcotics |year=1999 |volume=1 |publisher=KARGER |isbn=3-8055-6791-X }}</ref><ref>{{cite journal | vauthors = Fischer B, Oviedo-Joekes E, Blanken P, Haasen C, Rehm J, Schechter MT, Strang J, van den Brink W | title = Heroin-assisted treatment (HAT) a decade later: a brief update on science and politics | journal = Journal of Urban Health | volume = 84 | issue = 4 | pages = 552–62 | date = July 2007 | pmid = 17562183 | pmc = 2219559 | doi = 10.1007/s11524-007-9198-y }}</ref> Diamorphine may be used as a [[heroin maintenance|maintenance drug]] to assist the treatment of opiate addiction, normally in long-term chronic intravenous (IV) heroin users. It is only prescribed following exhaustive efforts at treatment via other means. It is sometimes thought that heroin users can walk into a clinic and walk out with a prescription, but the process takes many weeks before a prescription for diamorphine is issued. Though this is somewhat controversial among proponents of a [[zero-tolerance]] [[drug policy]], it has proven superior to [[methadone]] in improving the social and health situations of addicts.<ref name="haasen">{{cite journal | vauthors = Haasen C, Verthein U, Degkwitz P, Berger J, Krausz M, Naber D | title = Heroin-assisted treatment for opioid dependence: randomised controlled trial | journal = The British Journal of Psychiatry | volume = 191 | pages = 55–62 | date = July 2007 | pmid = 17602126 | doi = 10.1192/bjp.bp.106.026112 | doi-access = free }}</ref>

The UK Department of Health's [[Rolleston Committee]] Report<ref>{{cite web|title=Rolleston Report|url=http://www.drugtext.org/Table/Rolleston-Report/|publisher=Departmental Commission on Morphine and Heroin Addiction, United Kingdom|access-date=28 January 2011|year=1926|url-status=live|archive-url=https://web.archive.org/web/20110417125310/http://www.drugtext.org/Table/Rolleston-Report/|archive-date=17 April 2011}}</ref> in 1926 established the British approach to diamorphine prescription to users, which was maintained for the next 40 years: dealers were prosecuted, but doctors could prescribe diamorphine to users when withdrawing. In 1964, the [[Brain Committee]] recommended that only selected approved doctors working at approved specialized centres be allowed to prescribe diamorphine and [[cocaine]] to users. The law was made more restrictive in 1968. Beginning in the 1970s, the emphasis shifted to abstinence and the use of methadone; currently, only a small number of users in the UK are prescribed diamorphine.<ref>{{cite web| vauthors = Goldacre B | year =1998| url =http://www.badscience.net/?p=327| title =Methadone and Heroin: An Exercise in Medical Scepticism| access-date =18 December 2006| url-status=live| archive-url =https://web.archive.org/web/20070304065723/http://www.badscience.net/?p=327| archive-date =4 March 2007}}</ref>

In 1994, Switzerland began a trial [[heroin-assisted treatment|diamorphine maintenance]] program for users that had failed multiple withdrawal programs. The aim of this program was to maintain the health of the user by avoiding medical problems stemming from the illicit use of diamorphine. The first trial in 1994 involved 340 users, although enrollment was later expanded to 1000, based on the apparent success of the program. The trials proved diamorphine maintenance to be superior to other forms of treatment in improving the social and health situation for this group of patients.<ref name="haasen"/> It has also been shown to save money, despite high treatment expenses, as it significantly reduces costs incurred by trials, incarceration, health interventions and [[:wikt:delinquency|delinquency]].<ref>{{cite web|url=https://sencanada.ca/content/sen/committee/371/ille/presentation/ucht-e.htm |title=Heroin Assisted Treatment for Opiate Addicts – The Swiss Experience |publisher=Parl.gc.ca |date=31 March 1995 |access-date=12 October 2013 |archive-url=https://web.archive.org/web/20100120061027/https://sencanada.ca/content/sen/committee/371/ille/presentation/ucht-e.htm |archive-date=20 January 2010}}</ref> Patients appear twice daily at a treatment center, where they inject their dose of diamorphine under the supervision of medical staff. They are required to contribute about 450 Swiss francs per month to the treatment costs.<ref>{{cite web| vauthors = Nadelmann E | date =10 July 1995| url =http://www.drugpolicy.org/library/tlcnr.cfm| title =Switzerland's Heroin Experiment| publisher =Drug Policy Alliance| access-date =22 October 2006| archive-url=https://web.archive.org/web/20041129115253/http://www.drugpolicy.org/library/tlcnr.cfm| archive-date=29 November 2004}}</ref> A [[Swiss referendum, November 2008|national referendum in November 2008]] showed 68% of voters supported the plan,<ref>{{cite news |title=Swiss approve prescription heroin |url=http://news.bbc.co.uk/2/hi/europe/7757050.stm |work=BBC News Online |date=30 November 2008 |access-date=30 November 2008 |url-status=live |archive-url=https://web.archive.org/web/20081130052931/http://news.bbc.co.uk/2/hi/europe/7757050.stm |archive-date=30 November 2008}}</ref> introducing diamorphine prescription into federal law. The previous trials were based on time-limited executive ordinances. The success of the Swiss trials led German, Dutch,<ref>{{cite news| url =http://news.bbc.co.uk/2/hi/health/4607233.stm| title =Heroin prescription 'cuts costs'| work =BBC News| access-date =22 October 2006| date =5 June 2005| url-status=live| archive-url =https://web.archive.org/web/20060628053230/http://news.bbc.co.uk/2/hi/health/4607233.stm| archive-date =28 June 2006}}</ref> and Canadian<ref>{{cite web| url =http://www.naomistudy.ca/| title =About the study| publisher =North American Opiate Medication Initiative| access-date =22 October 2006| url-status=dead| archive-url =https://web.archive.org/web/20061104035153/http://www.naomistudy.ca/| archive-date =4 November 2006}}</ref> cities to try out their own diamorphine prescription programs.<ref>{{cite journal | vauthors = Nordt C, Stohler R | title = Incidence of heroin use in Zurich, Switzerland: a treatment case register analysis | journal = Lancet | volume = 367 | issue = 9525 | pages = 1830–4 | date = June 2006 | pmid = 16753485 | doi = 10.1016/S0140-6736(06)68804-1 | url = http://www.cesda.net/downloads/lancet1.pdf | url-status = dead | s2cid = 46366844 | citeseerx = 10.1.1.190.1876 | archive-url = https://web.archive.org/web/20100203001705/http://www.cesda.net/downloads/lancet1.pdf | archive-date = 3 February 2010 }}</ref> Some Australian cities (such as Sydney) have instituted legal diamorphine [[Safe injection site|supervised injecting centers]], in line with other wider [[harm minimization]] programs.

Since January 2009, Denmark has prescribed diamorphine to a few addicts who have tried methadone and [[buprenorphine]] without success.<ref>
{{cite web |date=November 2008 | url=http://www.dn.se/DNet/jsp/polopoly.jsp?d=3561&a=857991 | title=Danmark redo för skattebetalt heroin | trans-title = Denmark ready for tax-paid heroin | language=sv | access-date=30 November 2008 |archive-url=https://web.archive.org/web/20081203104630/http://www.dn.se/DNet/jsp/polopoly.jsp?d=3561&a=857991 |archive-date=3 December 2008}}</ref> Beginning in February 2010, addicts in [[Copenhagen]] and [[Odense]] became eligible to receive free diamorphine. Later in 2010, other cities including [[Århus]] and [[Esbjerg]] joined the scheme. It was estimated that around 230 addicts would be able to receive free diamorphine.<ref>{{cite web | date=January 2010 | url=http://www.information.dk/221689 | title=Gratis heroin klar til danske narkomaner | work=Information | trans-title = Free heroin ready for Danish drug addicts | language=da | access-date=14 February 2010 | url-status=live | archive-url=https://web.archive.org/web/20110430110231/http://www.information.dk/221689 | archive-date=30 April 2011}}</ref>

However, Danish addicts would only be able to inject heroin according to the policy set by [[Danish National Board of Health]].<ref>{{cite web | vauthors = Dahlin U | date=February 2009 | url=http://www.information.dk/182783 | title=Heroin-behandling bliver kun i kanyler | trans-title = Heroin treatment stays only in needles | publisher=Information | language=da | access-date=14 February 2010 | url-status=live | archive-url=https://web.archive.org/web/20090220152740/http://www.information.dk/182783 | archive-date=20 February 2009}}</ref> Of the estimated 1500 drug users who did not benefit from the then-current oral substitution treatment, approximately 900 would not be in the target group for treatment with injectable diamorphine, either because of "massive multiple drug abuse of non-opioids" or "not wanting treatment with injectable diamorphine".<ref>{{cite report | date=October 2007 | url=http://sundhedsstyrelsen.dk/Udgivelser/2008/Prescription%20of%20injectable%20heroin%20for%20drug%20users.aspx | title=Prescription of injectable heroin for drug users | publisher=Danish National Board of Health | access-date=14 February 2010 | archive-url=https://web.archive.org/web/20110429192839/http://sundhedsstyrelsen.dk/Udgivelser/2008/Prescription%20of%20injectable%20heroin%20for%20drug%20users.aspx | archive-date=29 April 2011 | url-status=live }}</ref>{{Update inline|date=January 2015}}

In July 2009, the German [[Bundestag]] passed a law allowing diamorphine prescription as a standard treatment for addicts; a large-scale trial of diamorphine prescription had been authorized in the country in 2002.<ref>{{cite web| date = 28 May 2009| url = http://www.bmg.bund.de/ministerium/presse/pressemitteilungen/2009-02/durchbruch-fuer-die-behandlung-von-schwerstopiatabhaengigen.html| title = Durchbruch für die Behandlung von Schwerstopiatabhängigen|trans-title=Breakthrough for the treatment of heavily addicted opiate users| language = de| publisher = Bundesministerium für Gesundheit (German ministry of health)| access-date = 28 April 2014| url-status=live| archive-url = https://web.archive.org/web/20140429045558/http://www.bmg.bund.de/ministerium/presse/pressemitteilungen/2009-02/durchbruch-fuer-die-behandlung-von-schwerstopiatabhaengigen.html| archive-date = 29 April 2014}}</ref>

On 26 August 2016, [[Health Canada]] issued regulations amending prior regulations it had issued under the [[Controlled Drugs and Substances Act]]; the "New Classes of Practitioners Regulations", the "Narcotic Control Regulations", and the "Food and Drug Regulations", to allow doctors to prescribe diamorphine to people who have a severe opioid addiction who have not responded to other treatments.<ref name="gazette2016">{{cite web| date=7 September 2016| url=http://www.gazette.gc.ca/rp-pr/p2/2016/2016-09-07/html/sor-dors239-eng.php| title=Regulations Amending Certain Regulations Made Under the Controlled Drugs and Substances Act (Access to Diacetylmorphine for Emergency Treatment)| publisher=Canada Gazette Directorate| access-date=19 September 2016| url-status=live| archive-url=https://web.archive.org/web/20160918215019/http://www.gazette.gc.ca/rp-pr/p2/2016/2016-09-07/html/sor-dors239-eng.php| archive-date=18 September 2016}}</ref><ref>{{cite web| date =14 September 2016| url =http://www.cnn.com/2016/09/14/health/prescription-heroin-canada/index.html| title =Prescription heroin gets green light in Canada| publisher =CNN| access-date =19 September 2016| url-status=live| archive-url =https://web.archive.org/web/20160918230920/http://www.cnn.com/2016/09/14/health/prescription-heroin-canada/index.html| archive-date =18 September 2016}}</ref> The prescription heroin can be accessed by doctors through [[Health Canada]]'s Special Access Programme (SAP) for "emergency access to drugs for patients with serious or life-threatening conditions when conventional treatments have failed, are unsuitable, or are unavailable."<ref name="gazette2016" />