Infectious diseases and public health: Risk-taking behavior during participation in the Swiss program for a medical prescription of narcotics (PROVE)

The medically controlled prescription of narcotics program (PROVE) followed a uniform protocol from January 1, 1994 until December 31, 1996. The progr am included 800 slots for heroin prescription, 200 slots for intravenous me thadone prescription, and 200 slots for intraveneous morphine. Admission cr iteria were age 20 and above, minimum 2-year duration of daily heroin consu mption, failure in at least two previous treatments, and documented social and/or health deficits. There was a very high seroprevalence of hepatitis B (73%) and hepatitis C (82%) among the 1035 entrants. The rate of HIV (15%) was also high compared with prevalence of infection in other therapy progr ams (methadone program, inpatient therapy). The prevalence of HIV and hepat itis B/C increased with the duration of drug dependence and cocaine use. Du ring treatment, use of street heroin and cocaine could be reduced substanti ally. After 18 months of continued participation in the program, 74% of pat ients reported no illegal heroin consumption, and the rate of cocaine absti nence increased from 15% at entry to 41%. Significant declines in visits to the drug scene, illegal income, and needle sharing were also observed. The high prevalence of HIV and hepatitis B and C confirm that a group of drug dependence with severe medical problems was reached in accordance with the admission criteria for the studies. During treatment, a significant reducti on in risk-taking behaviour was observed in a target population of heroin d ependent persons who failed in previous treatments.