Heroin Prescribing Proposal Raises Questions

A combination of surging heroin overdose deaths and an HIV and hepatitis C epidemic in British Columbia have pushed Canadian officials and the Canadian Psychiatric Association to look favorably on a proposal to prescribe heroin under medical supervision, but not everyone is receptive to the idea.

Herbert Kleber, M.D., is a member of the APA Council on Addiction Psychiatry and medical director of the National Center on Addiction and Substance Abuse at Columbia University. Despite British Columbia's deadly crisis, Kleber is strongly opposed to the proposed trial.

"Heroin is not a good maintenance drug," said Kleber. It is short acting and induces "continual euphoria," making "stable rehabilitation much more difficult." In England, where heroin maintenance is allowed, only 400 of an estimated 150,000 heroin addicts are on prescribed heroin, while 30,000 are maintained on methadone, he added.

"It is not clear why the Canadians would do heroin maintenance when they do not provide adequate availability of known, proven approaches," including methadone, LAAM, naltrexone, and buprenorphine. "Their approach seems driven more by ideology than by science."