STAGE 4. Selecting the theoretical approach

What steps should be completed?

Step 1: Select the theoretical approach or approaches on which the intervention will be based


What are their bases?

The observation that some heroin users repeatedly fail in their treatment attempts (either in drug-free programmes or with opiate substitute maintenance programmes) or do not wish to participate in them, has fostered a search for new care formulas, including the controlled dispensation of heroin. These programmes allow user demands to experience their drug addiction in a controlled, unproblematic way, abandoning marginality and illegality, to be met.

These programmes have their own clinical specificity in relation to other programmes with agonists: 1) diversified and individualised prescription of opioid agonists supported by diacetylmorphine (heroin), 2) use of the intravenous treatment route is suited to the user’s psychological dynamic (approximation to the pleasure inherent in heroin use) and, 3) the intensity of the follow-up, usually with several daily contacts with the person, enables a global and interdisciplinary treatment programme to be established.

Practical implications

Like other treatment programmes with opioid agonists, heroin prescription is accompanied by health, psychological and social interventions, which are integrated into personalised treatment programmes. Its clinical objectives include: attracting and retaining the most severely affected drug addicts in the public health system, encouraging cessation of illegal heroin consumption, preventing infectious diseases by intravenous or sexual means, and improving physical, psychological and social integration.



1. Strang J & Gossop M. (1996). Heroin prescribing in the British System: Historical Review. European Addict Research. 2: 185-93.