Doctors are likely to require better evidence of the effectiveness of prescribing heroin to addicts before they help the Government to put plans for wider access into effect.

A study from the Joseph Rowntree Foundation welcomes the Government’s willingness to make prescription heroin more widely available for use in treatment. But it argues that a much clearer strategy needs to be in place, including a commitment to major research trials that will evaluate its effectiveness compared with other treatments.

Recent evidence from Switzerland and the Netherlands suggests that prescribing heroin for people with long-term dependency problems can lead to health and social improvements where other treatments have failed. Other possible benefits include opportunities to reduce the size of the illicit drug market and to cut the level of drug-related crime.

However, the Foundation’s overview of research and policy, by Gerry Stimson and Nicky Metrebian of the Centre for Research on Drugs and Health Behaviour at London’s Imperial College, also highights potential risks. These include the possibility that heroin prescription could prolong the time that some users remain dependent.

Although Britain is one of the few countries where heroin can be legally prescribed, actual prescribing is rare. A survey by the authors found 70 doctors licensed to prescribe the drug, of whom only 46 were actually prescribing it to 448 patients. Most doctors treating heroin dependency prescribe methadone, a less expensive synthetic opiate requiring a single daily dose to prevent withdrawal symptoms.

Noting the Government’s intention, announced last year by the Home Office, to improve access to prescribed heroin for all those with a clinical need, the report warns that the continuing lack of evidence on what constitutes ‘clinical need’ presents a major stumbling block.

Nicky Metrebian said: “The dearth of UK or other research in this field means the important questions of who might benefit, and in what circumstances, remain unanswered. Without this evidence, doctors may well remain reluctant to prescribe heroin. It also seems that while doctors have one goal for treatment – an improvement in drug users’ health and eventual freedom from addiction – the Home Office policy makers are focused on the possibility that wider heroin prescription would help to reduce crime.”

The report concludes that without a clear strategy for increasing the provision of heroin prescribing across the UK, access to treatment will continue to be inconsistent and haphazard. It also calls for any expansion in heroin prescribing to be systematically monitored and evaluated, including a major research trial in a number of different locations, where the effectiveness of heroin prescription is compared with standard methadone therapy.

Prof. Stimson said: “A cautious assessment of available evidence suggests that heroin is potentially effective as a treatment for some patients. But the unanswered questions include whether any benefits of prescribing heroin outweigh the additional costs. An expansion of heroin prescribing is generally welcome, but it must be accompanied by a rigorous, scientific evaluation of its value in treatment. It would be a failure of vision if, ten years hence, we have the same, vague system in place and the same list of crucial questions about effectiveness waiting to be answered.”

Note to Editors
Prescribing heroin: What is the evidence? by Gerry Stimson and Nicky Metrebian is published by the Joseph Rowntree Foundation and available from York Publishing Services, 64 Hallfield Road, Layerthorpe, York YO31 7ZQ (01904 430033) price £13.95 plus £2 p&p.

The report and summary of its findings can be downloaded in pdf format from here.

For further information contact:
Gerry Stimson 020-7594 0774
Nicky Metrebian 020-7594 0820

Issued by David Utting, Associate Director (Public Affairs) 020-7278 9665 / david.utting@jrf.org.uk