Heroin addicts who do not give it up should be able to access the drug through the Canadian taxpayer-funded health system, according to a recent paper in BMJ. Standard treatments for heroin drug addiction include detoxification, abstinence programs and methadone maintenance.

Obviously some people never give it up and the paper argues that is a medical failure, that if doctors cannot provide effective treatments for these patients they will remain "outside the healthcare system" and there is "overwhelming" evidence that they will relapse into using heroin and suffer immeasurably while costing society a fortune, according to Professor Martin T. Schechter of the School of Population and Public Health at University of British Columbia.

Heroin is a dangerous street drug because its dose and purity are unknown and users face the risk of overdose and death. Because the drug is illegal, many users engage in unsafe practices, for example, using contaminated syringes that increase the risk of life threatening infections such as HIV and hepatitis, and its use can lead to crime.

Many users are often in and out of hospitals and prisons for these reasons,
Schechter
explains, adding that they can be "deeply affected by the illness of the addiction and its consequences."

So government-funded heroin should be offered to them, he argues, because giving them heroin would improve outcomes, reduce harm and lower societal cost in the form of savings for the health care system. Currently, this type of treatment is illegal although a small group of participants are given the drug after after a clinical trial.

Schechter notes six randomized controlled trials that found heroin assisted treatment to be more effective than standard treatments for people who are not going to give it up, and a recent Cochrane Collaboration review that concluded that it can help to decrease illicit substance use, criminal activity, incarceration and possibly reduce mortality and increase compliance with treatment. He also claims that the direct cost of heroin assisted treatment is four times that of traditional treatments, so it works out to be cheaper when accounting for all associated costs when compared to other interventions.

For example, a trial in the Netherlands showed that heroin assisted therapy made overall savings of around €13,000 ($14,100) per patient per year when compared to methadone, even when taking into account the direct cost of treatment. So it's cheaper to let them continue to use drugs than to try and cure them if a cure will not work. Schechter claims even better outcomes at a lower societal cost compared to methadone maintenance, while British researchers found that heroin assisted therapy was more cost effective than oral methadone. 

"Treatments like this represent the holy grail of medical research seeking to support a sustainable health system: they achieve better outcomes at lower overall cost," he argues.

And such savings could be used in addiction prevention programmes and other important priorities, he notes, adding that "the key question is not whether we can afford this new treatment, but whether we can afford the status quo."

Conventional treatments should remain the first preference for patients with heroin addiction, but if these do not work, diamorphine should be prescribed to patients by doctors at specialized clinics to ensure safety, he concludes.