Source: British Medical Journal 
Section: News
Author: Déirdre Cooper-Mahkorn, Bergisch Gladbach, Germany
Pubdate: Sat, 04 April  1998
Edition: BMJ No 7137 Volume 316


Heroin should be distributed to a select group of longstanding addicts, the
German Medical Council unanimously decided last week. The council has now
applied to the minister of justice to enable opiates to be legalised in a
strictly medically controlled context. 

Dr Ingo Flenker, a member of the German Medical Council, said that the
decision had been influenced by the recent results from Switzerland that
showed the effectiveness of such an approach. Several other countries,
including Australia, Denmark, Luxembourg, and the Netherlands, are also
considering following Switzerland's example.

The Swiss trial was initiated by the department of social and preventive
medicine at the University of Zürich in 1992. The project included more
than 1000 heroin misusers who were all aged 20 or younger, had been
addicted to heroin for at least two years, and were resistant to treatment. 

The results showed that it is feasible to provide heroin by intravenous
injection at a clinic, up to three times a day, seven days a week. This was
done while maintaining good drug control, good order, client safety, and
staff morale (BMJ 1998; 316:639). Conditions such as depression,
malnourishment, and anaemia decreased during the study period.
Simultaneously, social conditions were much improved: by the end of 1996
unemployment among the group in question had dropped from 44% to 20% and
full time employment had risen from 14% to 33%. Six months into the study,
homelessness in the group had ceased to be an issue. 

In the Swiss trials, heroin was prescribed as part of a comprehensive
social and psychological intervention. Dr Flenker stressed that such a
multidisciplinary approach was essential for such a programme to work - a
concept rarely successful in Germany. Those who will be included in the
German programme will have a longstanding addiction to opiates, had several
unsuccessful attempts at withdrawal, be in acute danger of social damage,
and be compliant with treatment. 

The German public's response has been positive. According to the newspaper
Die Woche, 55% of Germans agree with the idea of heroin misusers receiving
the drug directly from a doctor. The German minister of health, Horst
Seehofer, disagrees with the council's decision and feels that methadone
substitution is a better approach. However, his opinion will not influence
the decision of the minister for justice.