More than two thirds (68%) of Swiss voters in Sunday’s national referendum supported making heroin-assisted treatment a legal option for severely dependent heroin users who have not responded to multiple other treatments.
This vote follows four highly favourable randomised controlled trials (Switzerland, the Netherlands, Germany and Spain) in the last decade. Preliminary results from a Canadian randomised controlled trial were recently announced and are also highly favourable. But these Canadian results have not been published yet. We know from good science that heroin-assisted treatment brings huge health, social and economic benefits to people with severe problems who have not benefited from multiple other treatments.
Heroin-assisted treatment is now available, generally only as a last resort option, in three countries (United Kingdom, Switzerland, the Netherlands).
All major parties in Denmark recently decided to support establishing heroin-assisted treatment soon and without the need for additional research. The Spanish government has decided not to establish heroin-assisted treatment despite the positive results of their trial. Discussions are still proceeding in Germany. A stable 5% of heroin users in treatment in Switzerland receive heroin-assisted treatment.
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Although heroin-assisted treatment is more expensive than other forms of treatment, benefits are still double the costs. The small minority considered for heroin-assisted treatment account for a substantial and disproportionate share of drug-related crime (and presumably other drug-related problems) in the community.
A trial of heroin-assisted treatment was investigated scientifically in Australia for six years. But on 19 August 1997, Prime Minister John Howard ensured that Federal Cabinet pulled the plug on any further consideration of a trial because he claimed: “It would send the wrong message”.
Major Brian Watters of the Salvation Army, a major campaigner against a scientific trial of heroin-assisted treatment, had only recently opined, “When it comes to addiction, there are worse things than death”.
But other church leaders have different views. Father Peter Norden recently said, “When I was hungry, you gave me to eat; when I was in prison you visited me”. Jesus today would have included: “When you were addicted you stood by me”.
Extensive research shows that methadone and buprenorphine treatment attract, retain and benefit the overwhelming majority of severely dependent heroin users seeking pharmacological treatment.
But the big problem is that there are no votes in funding these treatments adequately.
Australia currently has 38,000 citizens in methadone and buprenorphine treatment, while another 41,000 wait for treatment slots to become available. But people on these treatments are forced to find a massive co-payment — about 25% — from their generally low incomes. No other group with a chronic health condition has to fork out that sort of money to pay for their own treatment.
Medicine works exceptionally well when policy and practice is based on research evidence. Good outcomes are usually achieved for affordable costs. But it’s a different matter when policy and practice is based on what works politically.