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Science 21 May 1999:
Vol. 284. no. 5418, pp. 1277 - 1278
DOI: 10.1126/science.284.5418.1277
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Policy Forum

DRUG ABUSE:
The Heroin Prescribing Debate: Integrating Science and Politics

Gabriele Bammer, Anja Dobler-Mikola, Philip M. Fleming, John Strang, Ambros Uchtenhagen

People dependent on heroin who do not respond to other treatments have been treated by a combination of heroin and methadone. In this Policy Forum, Bammer et al. argue that the debate about the merits of this treatment could be substantially informed by clinical trials that meet rigorous scientific standards. Because of the complexities of working with the dependent user population and the social and individual risks associated with this potential treatment, a series of interlocking trials with various designs and control groups are essential, and social impacts must also be monitored. Heroin will always be a second- rather than first-choice treatment, and if trials show that it has any value, the political outcome will be medicalization, not legalization.

G. Bammer is with the National Centre for Epidemiology and Population Health, Australian National University, Canberra ACT 0200, Australia. E-mail: Gabriele.Bammer{at}anu.edu.au. A. Dobler-Mikola is with the Addiction Research Institute, Konradstrasse 32, CH-8005 Zürich, Switzerland. E-mail: isfdomi{at}isf.unizh.ch. P. M. Fleming is at the Portsmouth City Drugs and Alcohol Service, 130 Elm Grove, Southsea, Portsmouth, Hampshire PO5 1LR, UK. E-mail: PhilipFleming{at}compuserve.com. J. Strang is at the National Addiction Centre, Institute of Psychiatry, London SE5 8AF, UK. E-mail: j.strang{at}iop.kcl.ac.uk. A. Uchtenhagen is at the Addiction Research Institute, CH-8005 Zürich, Switzerland. E-mail: uchtenha{at}isf.unizh.ch.

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THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES:
Heroin-assisted treatment for opioid dependence: Randomised controlled trial.
C. Haasen, U. Verthein, P. Degkwitz, J. Berger, M. Krausz, and D. Naber (2007)
The British Journal of Psychiatry 191, 55-62
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Medical prescription of heroin to treatment resistant heroin addicts: two randomised controlled trials.
W. van den Brink, V. M Hendriks, P. Blanken, M. W J Koeter, B. J van Zwieten, and J. M van Ree (2003)
BMJ 327, 310
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Discriminative Stimulus Effects of Intravenous Heroin and Its Metabolites in Rhesus Monkeys: Opioid and Dopaminergic Mechanisms.
D. M. Platt, J. K. Rowlett, and R. D. Spealman (2001)
J. Pharmacol. Exp. Ther. 299, 760-767
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