STAGE 5. Defining the action plan

What steps should be completed?

Step 1: Specify intervention actions

OVERDOSE PREVENTION PROGRAMMES, NALOXONE PRESCRIPTION AND HEROIN PRESCRIPTION

Overdose prevention programmes and naloxone prescription

There is moderate evidence that naloxone prescription, along with training for its use, prevents mortality¹ from opiate overdose.

Heroin prescription programmes

A recent Cochrane review² has analysed the results of eight randomised controlled trials of maintenance treatment with heroin (alone or combined with methadone). Comparing the results of maintenance programmes with heroin and substitution treatments with methadone, or any other form of pharmacological treatment for opioid dependence, yields the following conclusions:

• The provision of supervised heroin treatment can provide added value to methadone treatment.
• Taking into account the higher rate of serious adverse events, the eventual benefit-risk ratio of heroin prescription should be carefully assessed before extensive application in clinical practice.
• Heroin prescription should be considered for people who have not been able to stay in other substitution therapies, and this treatment should always be provided in a clinical environment and with appropriate follow-up.

 

References:

1 Baca CT & Grant KJ. (2005) Take-home naloxone to reduce heroin death. Addiction. 100: 1823-1831.

2 Ferri M, Davoli M & Perucci CA. (2011). Heroin maintenance for chronic heroin-dependent individuals. Cochrane Database of Systematic Reviews. Issue 12.