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Diamorphine-Assisted Treatment

Methadone and buprenorphine are among the first-line responses to the treatment of opioid dependence, alongside psychosocial approaches. A large body of research evidence shows that this approach is effective at stabilising drug use and preventing associated health and social problems. However, a small but important minority of chronic heroin-dependent individuals repeatedly fail to benefit from this kind of intervention. This group often experience particularly severe health and social consequences, and effective treatment of these individuals therefore has the potential to have a large impact on the health costs associated with drug dependence. (SSA - Society for the Study of Addiction, UK, April 2018)

Kanada. Feds ease restrictions on prescription heroin to address opioid epidemic

OTTAWA — Access to treatment for opioid addiction is about to get easier as the federal government promises changes to drug laws that would do away with some of the obstacles preventing doctors from offering prescription heroin and methadone. (Vancouver Sun, 26.03.2018)


Diamorphingestützte Behandlung in Deutschland

Adressen der Ambulanzen und Praxen, in denen die diamorphingestützte Behandlung angeboten wird


Facing fentanyl: should the USA consider trialling prescription heroin?

Pardo, Bryce et al.

The Lancet Psychiatry , Volume 0 , Issue 0 , Published: 22 March 2018, doi.org/10.1016/S2215-0366(18)30103-2


Understanding Heroin Overdose: A Study of the Acute Respiratory Depressant Effects of Injected Pharmaceutical Heroin.

Jolley CJ, Bell J, Rafferty GF, Moxham J, Strang J (2015)

PLoS ONE 10(10): e0140995. https://doi.org/10.1371/journal.pone.0140995


Berlin. Berliner Praxis „Patrida“: Heroin auf Rezept für Suchtkranke

„Dr. Peschel hat mir das Leben gerettet.“ Was nach Pathos klingt, meint Thomas ernst. Der 57-Jährige ist seit mehr als 30 Jahren heroinabhängig. In der Berliner Praxis „Patrida“, die der Psychiater Thomas Peschel vor fünf Jahren eröffnet hat, bekommt er zwei Mal am Tag Diamorphin auf Rezept - reines Heroin. Bis heute ist die Praxis die einzige ihrer Art in der Hauptstadt, obwohl der Bedarf größer wäre. (Berliner Kurier, 21.03.2018)


Oral heroin in opioid-dependent patients: pharmacokinetic comparison of immediate and extended release tablets.

Perger L, Rentsch KM, Kullak-Ublick GA, Verotta D, Fattinger K.

Eur J Pharm Sci. 2009 Mar 2;36(4-5):421-32. doi: 10.1016/j.ejps.2008.11.008.


Eligibility for heroin-assisted treatment (HAT) among people who inject opioids and are living with HIV in a Canadian setting.

Klimas J, Dong H, Fairbairn N, Socías E, Barrios R, Wood E, Kerr T, Montaner J, Milloy MJ.

Addict Sci Clin Pract. 2018 Feb 7;13(1):3. doi: 10.1186/s13722-017-0104-y.


Treatment effectiveness of injectable hydromorphone and diacetylmorphine for severe opioid use disorder and its relationship with gender in the SALOME clinical trial

Heather Palis, Lisbon Addictions 2017, Second European Conference on Addictive Behaviours and Dependencies, Lissabon, 24.-26.10.2017

http://www.emcdda.europa.eu/system/files/attachments/6833/11H00_2_Heather Palis.pptx

USA. New Mexico Passes Legislation to Examine Administering Pharmaceutical-grade Heroin or Other Opioids by Medical Practitioners to People Struggling with Long-term Addiction

With Growing Interest by Elected Officials, Academic Researchers, and Clinicians, New Mexico is Positioned to be one of the First States to Open a Supervised Injectable Opioid Treatment Program.

Supervised Injectable Opioid Treatment Remains Unutilized in the United States, But Proven Effective Around the World Including in Canada, Switzerland, the Netherlands, Germany, and Denmark. (Drug Policy Alliance, 14.02.2018)


Schweiz. Heroingestützte Behandlung in der Schweiz - Resultate der Erhebung 2016

Hiltebrand, Damian; Dey, Michelle; Bolliger, Heidi; Schaub, Michael P

Zurich Open Repository and Archive, University of Zurich (ZORA), doi.org/10.5167/uzh-140487


Safety profile of injectable hydromorphone and diacetylmorphine for long-term severe opioid use disorder.

Oviedo-Joekes E, Brissette S, MacDonald S, Guh D, Marchand K, Jutha S, Harrison S, Janmohamed A, Zhang DZ, Anis AH, Krausz M, Marsh DC, Schechter MT.

Drug Alcohol Depend. 2017 Jul 1;176:55-62. doi: 10.1016/j.drugalcdep.2017.02.021.



Heroin Assisted Treatment: the case for expanding uptake - Dr Alex Wodak puts forward the case to increase uptake of Heroin Assisted Treatment (“HAT”). 

HAT has now been evaluated in trials involving a combined total of over 1,500 subjects in seven countries (Switzerland, the Netherlands, Spain, Germany, Canada, the United Kingdom and Belgium).

The modern era HAT of began in Switzerland in 1994. HAT evolved from heroin maintenance, which had been developed in England decades earlier.  Heroin maintenance was evaluated in a trial compared to methadone maintenance with mixed results and published by Hartnoll, Mitcheson and colleagues in 1980. But HAT differed from heroin maintenance in a number of very important ways. HAT involves much higher doses of heroin, patients are involved in selecting their dose, intensive psychosocial assistance is provided, all doses are supervised by health professionals and only treatment refractory, severely heroin dependent subjects are included. (IDHDP, 30.10.2017)


UK. West Midlands addicts to be prescribed heroin under bold plans to combat 'scourge of drugs'

West Midlands police commissioner announces "fresh ideas" to tackle drug problems.

Users offered heroin in drug consumption rooms and if other forms of treatment fail.

Move welcomed as drug use increasingly considered public health issue rather than criminal. (IB Times, 12.02.2018)


Kanada. Guidance for Injectable Opioid Agonist Treatment for Opioid Use Disorder

British Columbia, Ministry of Health and British Columbia Centre on Substance Abuse, 2101


Positionspapier: Einrichtung einer Clearingstelle Diamorphin (Deutsche Suchtgesellschaft – Dachverband der Suchtfachgesellschaften (DSG)

Die aktuelle gesetzliche Regelung im BtMVV zur diamorphingestützten Behandlung schwerst-opiatabhängiger Menschen gibt klare und strenge Ein- bzw. Ausschlusskriterien vor Aufnahme eines opiatabhängigen Patienten in das Diamorphinvergabeprogramm vor. Die aktuelle Version sieht keinerlei Ausnahmeregelungen vor.

Der Dachverband der Deutschen Suchtgesellschaften (DSG; Mitglieder: Deutsche Gesellschaft für Suchtmedizin - DGS, Deutsche Gesellschaft für Suchtforschung und Suchttherapie - DG-Sucht e.V., Deutsche Gesellschaft für Suchtpsychologie dgsps) stellt in Kooperation mit der Arbeitsgemeinschaft der Diamorphin-Substitutionsambulanzen in Deutschland fest, dass hierdurch immer wieder Menschen der Zugang zu dieser Behandlungsform verwehrt werden muss, obwohl mit dieser Behandlungsform eine konkrete Gefahr für die betroffene Person abgewendet werden könnte. (Hamm, 15.05.2018)


Why Australia should provide Heroin Assisted Treatment to severely dependent heroin users after all other treatment options haven’t worked.

Heroin Assisted Treatment involves supervising prescribed pharmaceutical heroin self-administration with intensive psycho-social help to a minority of people with severe heroin dependence who have not benefitted from multiple other treatments.

The signatories of this letter include senior clinicians and researchers, major health organisations , peer based organisations and people with long standing experience and expertise in the fields of law enforcement, drug policy and drug treatment. (Harm Reduction Australia, August 2017)


Die diamorphingestützte Substitutionsbehandlung in Deutschland - Ein Überblick über die gegenwärtige Entwicklung des stark diskutierten Behandlungskonzeptes

Von Stud. iur. Christopher Bendek, Tübingen

HRRS - Onlinezeitschrift für Höchstrichterliche Rechtsprechung zum Strafrecht, Dezember 2016, 17. Jahrgang


Heroin Maintenance for Persons with Chronic Heroin Dependence [Internet].

Dalsbø TK, Steiro AK, Hammerstrøm KT, Smedslund G.

Oslo, Norway: Knowledge Centre for the Health Services at The Norwegian Institute of Public Health (NIPH); 2010 Jun.


Supervised Injectable Heroin: A Clinical Perspective.

Bell J, Waal RV, Strang J.

Can J Psychiatry. 2017 Jul;62(7):451-456. doi: 10.1177/0706743716673966.



Heroingestützte Behandlung (HeGeBe)

FOSUMOS – Forum Suchtmedizin Ostschweiz, Themenseite