Subj: German doctors vote to prescribe heroin to misusers

Date: Apr 4, 1998

Source: British Medical Journal

BMJ No 7137 Volume 316

German doctors vote to prescribe heroin to misusers

Heroin should be distributed to a select group of longstanding
addicts, the German Medical Council unanimously decided
last week. The council has now applied to the minister of justice
to enable opiates to be legalised in a strictly medically controlled
context.

Dr Ingo Flenker, a member of the German Medical Council,
said that the decision had been influenced by the recent results
from Switzerland that showed the effectiveness of such an
approach. Several other countries, including Australia,
Denmark, Luxembourg, and the Netherlands, are also
considering following Switzerland's example.

The Swiss trial was initiated by the department of social and preventive
medicine at the University of Zürich in 1992. The project included more than
1000 heroin misusers who were all aged 20 or younger, had been addicted to
heroin for at least two years, and were resistant to treatment.

The results showed that it is feasible to provide heroin by intravenous
injection
at a clinic, up to three times a day, seven days a week. This was done while
maintaining good drug control, good order, client safety, and staff morale
(BMJ 1998; 316:639). Conditions such as depression, malnourishment, and
anaemia decreased during the study period. Simultaneously, social conditions
were much improved: by the end of 1996 unemployment among the group in
question had dropped from 44% to 20% and full time employment had risen
from 14% to 33%. Six months into the study, homelessness in the group had
ceased to be an issue.

In the Swiss trials, heroin was prescribed as part of a comprehensive social
and psychological intervention. Dr Flenker stressed that such a
multidisciplinary approach was essential for such a programme to work - a
concept rarely successful in Germany. Those who will be included in the
German programme will have a longstanding addiction to opiates, had several
unsuccessful attempts at withdrawal, be in acute danger of social damage, and
be compliant with treatment.

The German public's response has been positive. According to the newspaper
Die Woche, 55% of Germans agree with the idea of heroin misusers receiving
the drug directly from a doctor. The German minister of health, Horst
Seehofer, disagrees with the council's decision and feels that methadone
substitution is a better approach. However, his opinion will not influence
the
decision of the minister for justice.