Medical co-prescription of heroin to chronic, treatment-resistant methadone patients in the Netherlands

This paper begins with a brief description of the epidemiology of heroin ad diction in the Netherlands and an overview of the current treatment system, with special emphasis on oral methadone maintenance. If is followed by a s hort history of the debate over the prescription of heroin to addicted pati ents. This history reveals that alternatives to methadone have been viewed as essential in the Netherlands since the early 1980s. Earlier experiments with intravenous morphine, intravenous methadone and oral dextromoramide (P alfium(R)) were not as successful as had been hoped and precluded their int roduction in daily practice. Finally, recent experiences in Switzerland wit h the medical prescription of heroin facilitated the decision to initiate a scientific study of the medical co-prescription of heroin in the Netherlan ds. The paper provides a detailed description of the randomized clinical tr ial regarding the effectiveness of co-prescribed heroin that is now underwa y in the Netherlands. If concludes with a brief discussion of the likely co nsequences for future treatment options of different study outcomes.