Heroin trials and other new trends in substitution

Session: Tues- 12.13

By Isabel Renscher

Alison Ritter (Australia)

New pharmacotherapies for the treatment of heroin dependance are examined in Australia to diversify treatment options. In Victoria, there are approximatly 7'000 dependant users, 4'500 are in methadone treatment. The project aims to examine which drug treatment is the most useful for Victoria to explore. Included substances are LAAM, slow release oral morphine, Buprenorphine, Naltrexone.

The key issues are :

1) impact of greater choice, 2) models of addiction treating, 3) treating clinicians, 4) acceptability to clients, 5) diversion/misuse, 6) clinical guidelines

» ITÆs a revolution in treatment in Australia

» Drug users have been actively involved in the project from the start

Richard Blattler (Switzerland)

Decreasing cocaine misuse in opiate us1rs treated with prescribed heroin : The study is a naturalistic cohort study, the sample are people in heroin trials. Many heroin user in heroin trials use also cocaine. Since there is no substitute for cocaine, a behavioural component to achieve integration or reintegration.

Irene Kuo (USA)

The research design of a joint project between the USA and Canada called NAOMI (North american opiate medication initaitive) was presented. Why a heroin treatment now ? The situation in North America is different from the European situation in what regards the number of people in treatment. In North America only approximatly 25% of drug users are in treatment. The aim of the project is to reach » treatment resistant or » treatment naive people. Among the aspects that will be examined figure retention rate, drug use and criminal behaviour.

Beatrice Stambul (France)

Substitution treatment in France has only more recently been accepted. However, methadone is available mostly only in centers. After long discussion Buprenorphine (Subutex) was introduced at larger scale in 1996 as substitute. Today this substance leads to important street deal, Subutex tablets are used for injections. Injecting conditions are very bad.

» Subutex has become an easy access drug

» Subutex kills

Miguel Marset (Geneva)

Presentation of findings in the context of the PEPS (Heroin prescription programme). Analysed were pschiatric comorbidity and harm reduction in an experimental heroin prescription programme.