Leaving on the US to Pilot Programming Heroin Program: Scenes



In a number of European countries and Canada, patients with long-term opioid exercise on heroin prescribe a prescribed medicine level as clinics in Medical Medical in Berlin. Some widespread scientists want to make similar test programs in the US.

Picture Alliance / Photo Alliance through Getty Image


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Picture Alliance / Photo Alliance through Getty Image

In a number of European countries and Canada, patients with long-term opioid exercise on heroin prescribe a prescribed medicine level as clinics in Medical Medical in Berlin. Some widespread scientists want to make similar test programs in the US.

Picture Alliance / Photo Alliance through Getty Image

The US drug crisis does not appear to be released. The country has a huge impact on 47,000 opioid pre-sharing deaths in 2017. There is powerful, voluntary driving as a driver in driving. They have spread into the drug supply illegally, and in response communities have been trying to make a difference between the interventions, Increasing naloxone trains to build up medicine resources.

But a new analysis of the policy idea, Rand Corporation, is about to come to an end that it is time to come. In order to guide the approach to the outside of the USA: a & # 39; Provides heroin medication – heroin – is a medicine method for heroin users for a long time that is not successful with other remedies. He is already in a number of European countries and in Canada. But it would challenge culture, laws and customs in the US.

"This is a controversial interventions," says Beau Kilmer, who coordinates RAND's drug policy research center. "Some people who do not even want to talk about this. But when we work with opioid deaths of nearly 50,000 and die nearly 30,000, it is important that discussions Our interventions are based on the research and the ground in the experiences of other countries. "

Here's how programs offered by heroin, or heroin-assisted medicine (HAT), are working. Patients usually get a regular dose, is a measure of a medicine heroin – called diacetylmorphine or diamorphine – and is thrown under close medical guidance within a named clinic. It is their idea; If people have a heroin's legal source, they will not be less likely to dispose of street drugs, spend less time and energy to try to get their next step, and instead to do it; Focusing on the most fundamental drivers.

"This is just another medicine that can help to reinforce life," said Kilmer.

It does not mean for all. Medicines such as methadone, buprenorphine and naltrexone are the most effective medicines that are operated in different ways to address tolerance and withdrawal of symptoms or to prevent the effects of drugs. But these first remedies do not work for some long-term opioid users. In Canada's main research on heroin training, patients had been trying to stop heroin as usual as 11 times.

Heroin by order as a means of maintenance management dates back to the early 1920s in the UK, and was re-created in the 1990s in other parts of Europe. (Even in the US there was a bit before the militarized drug law that was scattered in the early 20th century).

Cure with heroine support differs from the concept of guided spending sites, where patients include their own drugs illegally and then spell them while & # 39 ; s medical staff are present, ready to respond if there is a compliance. There is growing debate in the US as at least twelve major cities.

Kilmer says that heroin research was investigated more rigorously. Several randomly controlled examinations in Canada, the United Kingdom and the Netherlands found that heroin-like people benefited from the approach, according to RAND analysis. They were more likely to stay in cure compared to those who took meatadone, and were less likely to come back to their, using illegal heroin. There is also evidence that suggesting that heroin may be taught to be more effective than methadone in a & # 39; reducing criminal activity and patient health and mental health improvement.

For Dr. Chinazo Cunningham, a specialist expert at Albert Einstein Medical College and the Montefiore Medical Center in Bronx, has other important approaches, but she is think it's harder in the US to focus on what it's going to do; see what's the most important issue at the moment: "We have a cure that works, we need to provide it in a way that is accessible to people," she says.

As it stands, it does not have a & # 39; Most people who can benefit from first-line remedies for disorders can use opioid, even a problem that can be done; Driving as a black market for cure.

"It's hard for me to think of cure with heroin support because I'm still thinking about being able to talk about getting more normal medicine such as methadone, buprenorphine and naltrexone for people, the stigma is already, "said Cunningham.

As part of the analysis, RAND's focus groups and interviews in several New Hampshire and Ohio areas made a tough deal with the eighteen crisis. The idea of ​​heroin was a new tutorial for many and a disruption was made in terms of what it gets from health professionals, local leaders, and those who were treated. People were worried that healing with heroin support could enable drugs to be able to; affecting communities.

And there is a great legal obstacle. Heroin is a standard controlled drug that is preserved in Table 1 which means that doctors can not prove it. It is lawful to investigate Table 1 drugs, but as can be seen by investigating medical marijuana, it is a difficult process to agree with a number of governmental organizations; including the DEA. Human tests are not currently carried out for heroin, according to the National Institute of Bad Drugs. However, the RAND report says that a pilot program could provide a vision in terms of whether the overseas output could translate.

The report says again, maybe opioid communities, telephone phones, which are used for pain in the US. It would be less of a bad move to & # 39; set up a pilot program. A study in Vancouver found that heroin was less effective in educating, and now there are at least seven sites in Canada that offer hydromorphones that are easily accessible to patients.

Despite this, there is a likelihood of at least some fluctuating experts in the USA In New York, Chunningham's colleague at Albert Einstein Medicine College, Dr. Aaron Fox says he is open to him. In fact, it costs early part of the next year for permission to & # 39; Heroin tutoring in other countries, hoping "to show how we will pilot" back in the US.

He says he does not see him as a silver leaflet, but that's not usually how healing works for other diseases, either.

"People need extra options for something like a cancer. If people have to cure treatment, there are other medications," said Fox. "If people can not stop or cut down their heroin use when they are methadone or buprenorphine, we need other choices for people."

What is being seen to see patients, as a recent woman, did not have a & # 39; successful with other treatments. He remembers asking her to return to her & # 39; The previous methadone program, but she was struggling and hers. damaging him. He did not want to give it.

"I'm not going to say," I did the best thing, that is, "when these other devices have proved to be effective in other countries," he said. "Why not use this in the US?"

Elana Gordon (@elana_gordon) is a health reporter and Knight Science Journalist Companion at MIT 2018-2019.


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