The Dutch heroin experiment has begun

by Elly Tanis

The experiment to supply clients with medically prescribed heroin in the Netherlands has begun at last. It involves the cities of Amsterdam and Rotterdam. To begin with, 25 clients in both cities will receive a dose three times a day which they must inject or smoke on the spot. Eventually, 750 addicts referred to as ‘patients’, spread over seven cities, will take part in the experiment. This is an experiment that is linked to a scientific investigation. From this, it should become clear whether prescribed heroin leads to an improvement in the health and social functioning of addicts - more than conventional methadone treatment does.

The Minister of Public Health views prescribing heroin as "a last chance" for long-term addicts who, in spite of the health care programmes and supply of methadone, are in bad shape. The experiment will take one and a half years.

 

Who will be taking part in the experiment?

The addicts who will take part in the scientific experiment have been selected using strict criteria. There are around five thousand hard drug users in Amsterdam. Of these, about one thousand addicts have many physical, psychological and social problems. The clients chosen to receive prescribed heroin have been using hard drugs for over fifteen years and have been involved in a methadone programme for more than five years (without success). For these chronic addicts, whose average age is 38, kicking the habit is not a major concern. Their treatment focuses on creating peace and order in their lives. There is then enough time left over for them to eat well and to get sufficient sleep. It is expected that the client will appear three times a day, that he is registered in the city and that he has given his written consent.

The background to this experiment

The Netherlands has been trying to get this experiment off the ground for around twenty years. Earlier attempts foundered. However, the Dutch government has finally changed tack to follow the Swiss example. Supplying prescribed heroin to 1100 chronic addicts was begun four years ago in Switzerland. A year ago, following an evaluation of this experiment it appeared that the mental health of the participants had improved, the number of crimes in this group had decreased and that some of the addicts had a permanent address and had found employment. The result of this experiment has led the Swiss Minister of Public Health to amend the law so that the supply of heroin has a legal basis. However, the Swiss experiment has not made it clear whether the supply of heroin was the sole cause of the improvement of the clients’ physical and mental condition. It so happens that psychosocial assistance was being given and work and accommodation were being offered while the experiment was running.

CCBH

The CCBH (Central Commission for the Treatment of Heroin Addicts) was set up in 1996 in the Netherlands. This commission developed a proposal for a scientific experiment. The aim of this experiment is to demonstrate 20% improvement in the clients’ physical and mental health, social integration and reduced criminal activity by the end of the trial period. In addition, other research topics will be addressed such as:

  

In the end, a number of scenarios is possible:

The aim of the Dutch experiment is not for the clients to kick their habit. The intention is that they will improve, that they will become more approachable and be less of a nuisance.

The CCBH will report to the Minister of Public Health on the possible trouble the supply of heroin causes the neighbourhood. People living in the neighbourhood of the clinics can lodge complaints at a special centre or at the local police station. It is not expected that there will be many complaints as the local residents are already familiar with methadone clinics.

Cocaine

It is known that many addicts use cocaine as well as heroin. However, it is thought that, by supplying heroin, the addicts will become calmer and, as a result, will be better able to tackle their problems.

During the experiment it will be emphasised that it is not just about handing out heroin. The participant will also receive intensive counselling and other medical and psychological help.

Amsterdam and Rotterdam

The project will first take place in Amsterdam and Rotterdam. After an evaluation of the first 3 months the number of clients could be increased in both cities. For the time being, the practical problems that the experiment may pose will be looked into. To obtain more insight into this, a possibly more definite decision to supply medically prescribed heroin will be made only after a year and a half.

Expectations

It is expected that the heroin experiment will yield a number of important advantages for the client as well as his surroundings. Noticeable improvement of the clients’ physical and mental condition is expected. He will become more stable, whereby he will be better able to tackle his other problems. The neighbourhoods will experience less trouble from the client. The doctor will be able to administer treatment better targeted to the patient and he will also have the opportunity to put the treatment that is the most desirable for an individual patient into effect.

How does the selection take place?

  • The clients must fulfil the following criteria:
  • Methadone treatment unsuccessful
  • Addicted for at least five years
  • Have received at least 60 mg methadone for a month
  • Have had at least 50 contacts with a methadone programme
  • Use illegal heroin daily
  • Poor health (Addiction Severity Index>5 concerning health)
  • Heroin is the main addiction
  • >25 years old
  • Registered in the city for at least three years
  • Able to cooperate
  • Have given written consent

 

The criteria for exclusion are:

  • Aggressive behaviour
  • Pregnancy
  • Prison sentence
  • Short life expectancy
  • Unwillingness to use on the spot
  • More than 150 mg required per day
  • More than 1 g heroin used per day

 

If you have any questions or if you would like further information, please contact: CCBH

Universiteitsweg 100
Gebouwstratenum
5th floor
3584 CG Utrecht
The Netherlands

back to contents no. 15