Editing Harm reduction (section)

======Heroin maintenance programmes (HAT)======
{{Main|Heroin assisted treatment}}
Providing medical prescriptions for pharmaceutical heroin (diacetylmorphine) to heroin-dependent people has been employed in some countries to address problems associated with the illicit use of the drug, as potential benefits exist for the individual and broader society. Evidence has indicated that this form of treatment can greatly improve the health and social circumstances of participants, while also reducing costs incurred by criminalisation, incarceration and health interventions.<ref>{{Cite web |last=Uchtenhagen |first=Ambros |date=February 2002 |title=Background |url=https://sencanada.ca/content/sen/committee/371/ille/presentation/ucht-e.htm |url-status=live |archive-url=https://web.archive.org/web/20100120061027/https://sencanada.ca/content/sen/committee/371/ille/presentation/ucht-e.htm |archive-date=20 January 2010 |access-date=15 March 2020 |website=Heroin Assisted Treatment for Opiate Addicts – The Swiss Experience}}</ref><ref>{{Cite journal |vauthors=Haasen C, Verthein U, Degkwitz P, Berger J, Krausz M, Naber D |date=July 2007 |title=Heroin-assisted treatment for opioid dependence: randomised controlled trial |journal=The British Journal of Psychiatry |volume=191 |pages=55–62 |doi=10.1192/bjp.bp.106.026112 |pmid=17602126 |doi-access=free}}</ref>

In Switzerland, [[heroin assisted treatment]] is an established programme of the national health system. Several dozen centres exist throughout the country and heroin-dependent people can administer heroin in a controlled environment at these locations. The Swiss heroin maintenance programme is generally regarded as a successful and valuable component of the country's overall approach to minimising the harms caused by illicit drug use.<ref>{{Cite web |last=Uchtenhagen |first=Ambros |date=February 2002 |title=Epidemiology |url=https://sencanada.ca/content/sen/committee/371/ille/presentation/ucht-e.htm |url-status=live |archive-url=https://web.archive.org/web/20100120061027/https://sencanada.ca/content/sen/committee/371/ille/presentation/ucht-e.htm |archive-date=20 January 2010 |access-date=15 March 2020 |website=Heroin Assisted Treatment for Opiate Addicts – The Swiss Experience}}</ref> In a 2008 [[Swiss referendum, November 2008#Revision of the federal statute on narcotics|national referendum]], a majority of 68 per cent voted in favour of continuing the Swiss programme.<ref>{{Cite web |last=Urs Geiser |date=30 November 2008 |title=Swiss to agree heroin scheme but say no to dope |url=http://www.swissinfo.ch/eng/archive/Swiss_to_agree_heroin_scheme_but_say_no_to_dope.html?cid=7071120 |url-status=dead |archive-url=https://web.archive.org/web/20140407103938/http://www.swissinfo.ch/eng/archive/Swiss_to_agree_heroin_scheme_but_say_no_to_dope.html?cid=7071120 |archive-date=7 April 2014 |access-date=21 May 2013 |website=Swissinfo.ch |publisher=Swiss Broadcasting Corporation}}</ref>

The [[Netherlands]] has studied medically supervised heroin maintenance.<ref>{{Cite book |last1=van den Brink |first1=Wim |url=http://www.ccbh.nl/rapport_engels_html/index.htm |title=Medical Co-Prescription of Heroin: Two Randomized Controlled Trials |last2=Hendriks |first2=Vincent M. |last3=Blanken |first3=Peter |last4=Huijsman |first4=Ineke A. |last5=van Ree |first5=Jan M. |date=2002 |publisher=Central Committee on the Treatment of Heroin Addicts (CCBH) |isbn=9080693227 |id={{NCJ|195635}} |access-date=21 March 2024 |archive-url=https://web.archive.org/web/20060517080050/http://www.ccbh.nl/rapport_engels_html/index.htm |archive-date=17 May 2006}}</ref> A German study of long-term heroin addicts demonstrated that [[diamorphine]] was significantly more effective than [[methadone]] in keeping patients in treatment and in improving their health and social situation.<ref>{{Cite journal |vauthors=Haasen C, Verthein U, Degkwitz P, Berger J, Krausz M, Naber D |date=July 2007 |title=Heroin-assisted treatment for opioid dependence: randomised controlled trial |journal=Br J Psychiatry |volume=191 |pages=55–62 |doi=10.1192/bjp.bp.106.026112 |pmid=17602126 |doi-access=free}}</ref> Many participants were able to find employment, some even started a family after years of homelessness and delinquency.<ref>{{Cite web |date=2 May 2010 |title=Heroin (diamorphine) supported treatment in Germany: Results and problems of implementation |url=https://www.hri.global/files/2010/05/02/Presentation_20th_C12_Michels.pdf |access-date=21 March 2024 |website=Commissioner on Narcotic Drugs |publisher=German Federal Ministry of Health}}</ref><ref>{{Cite web |url=http://relaunch.bundestag.de/bundestag/ausschuesse/a14/anhoerungen/113/stllg/ZIS.pdf |access-date=9 September 2009}}{{dead link|date=December 2021|bot=medic}}{{cbignore|bot=medic}}</ref> Since then, treatment had continued in the cities that participated in the pilot study, until heroin maintenance was permanently included into the national health system in May 2009.<ref>{{Cite web |last=Smith |first=Phillip |date=5 June 2009 |title=Europe: German Parliament Approves Heroin Maintenance |url=https://stopthedrugwar.org/chronicle/2009/jun/05/europe_german_parliament_approve |url-status=live |archive-url=https://web.archive.org/web/20090925024329/http://stopthedrugwar.org/chronicle/588/germany_approves_heroin_maintenance |archive-date=25 September 2009 |access-date=11 August 2016 |website=StoptheDrugWar.org}}</ref> As of 2021, the country offers heroin-assisted treatment by prescribing medical-grade heroin is typically prescribed in combination with methadone and [[psychosocial]] counseling.<ref>{{Cite journal |last1=van der Gouwe |first1=Daan |last2=Strada |first2=Lisa |last3=Diender |first3=Bob |last4=van Gelder |first4=Nadine |last5=de Gee |first5=Anouk |year=2022 |title=Harm reduction services in the Netherlands: recent developments and future challenges |url=https://www.trimbos.nl/wp-content/uploads/2022/02/AF1973-Harm-reduction-services-in-the-Netherlands.pdf |url-status=live |journal=Netherlands Institute of Mental Health and Addiction |publisher=Trimbos-instituut |pages=10 |archive-url=https://web.archive.org/web/20240114115012/https://www.trimbos.nl/wp-content/uploads/2022/02/AF1973-Harm-reduction-services-in-the-Netherlands.pdf |archive-date=14 January 2024 |access-date=21 December 2023}}</ref>

A heroin maintenance programme has existed in the United Kingdom (UK) since the 1920s, as drug addiction was seen as an individual health problem. Addiction to opiates was rare in the 1920s and was mostly limited to either middle-class people who had easy access due to their profession, or people who had become addicted as a side effect of medical treatment. In the 1950s and 1960s a small number of doctors contributed to an alarming increase in the number of people who are experiencing addiction in the U.K. through excessive prescribing—the U.K. switched to more restrictive drug legislation as a result.<ref name="rachel">{{Cite web |last=Rachel Lart |title=British Medical Perception from Rolleston to Brain, Changing Images of the Addict and Addiction |url=http://www.drugtext.org/library/articles/92333.html |url-status=dead |archive-url=https://web.archive.org/web/20110610141829/http://www.drugtext.org/library/articles/92333.html |archive-date=10 June 2011}}</ref> However, the British government is again moving towards a consideration of heroin prescription as a legitimate component of the National Health Service (NHS). Evidence has shown that methadone maintenance is not appropriate for all people who are dependent on opioids and that heroin is a viable maintenance drug that has shown equal or better rates of success.<ref>{{Cite web |last1=Stimson |first1=Gerry V |last2=Metrebian |first2=Nicky |date=12 September 2003 |title=Prescribing Heroin: what is the evidence? |url=https://www.jrf.org.uk/prescribing-heroin-what-is-the-evidence |url-status=live |archive-url=https://web.archive.org/web/20060209071303/http://www.jrf.org.uk/knowledge/findings/socialpolicy/943.asp |archive-date=9 February 2006 |website=Joseph Rowntree Foundation}}</ref>

A committee appointed by the Norwegian government completed an evaluation of research reports on heroin maintenance treatment that were available internationally. In 2011 the committee concluded that the presence of numerous uncertainties and knowledge gaps regarding the effects of heroin treatment meant that it could not recommend the introduction of heroin maintenance treatment in Norway.<ref>{{Cite web |date=29 March 2012 |title=Nyheter – Norges forskningsråd |url=http://www.forskningsradet.no/no/Nyheter/_For_svakt_grunnlag/1253968771212?WT.ac=forside_nyhet |archive-url=https://web.archive.org/web/20120329042435/http://www.forskningsradet.no/no/Nyheter/_For_svakt_grunnlag/1253968771212?WT.ac=forside_nyhet |archive-date=29 March 2012}}</ref>

Critics of heroin maintenance programmes object to the high costs of providing heroin to people who use it. The British heroin study cost the British government £15,000 per participant per year, roughly equivalent to average person who uses heroin's expense of £15,600 per year.<ref>{{Cite web |title=Treatable or Just Hard to Treat? |url=http://www.actiononaddiction.org.uk/news_and_campaigns/news/160_untreatable-or-just-hard-to-treat |url-status=dead |archive-url=https://web.archive.org/web/20100808085211/http://www.actiononaddiction.org.uk/news_and_campaigns/news/160_untreatable-or-just-hard-to-treat |archive-date=8 August 2010 |access-date=8 January 2011}} 2009</ref> Drug Free Australia<ref name="DrugFreeAustralia">{{Cite web |title=Arguments for Prohibition |url=http://www.drugfree.org.au/fileadmin/Media/Global/Taskforce_Arguments_for_Prohibition.pdf |url-status=dead |archive-url=https://web.archive.org/web/20110706124952/http://www.drugfree.org.au/fileadmin/Media/Global/Taskforce_Arguments_for_Prohibition.pdf |archive-date=6 July 2011 |access-date=20 April 2010 |page=3}}</ref> contrast these ongoing maintenance costs with Sweden's investment in, and commitment to, a drug-free society where a policy of compulsory rehabilitation of people who are experiencing drug addiction is integral, which has yielded to one of the lowest reported illicit drug use levels in the developed world,<ref>{{Cite web |title=World Drug Report 2000 |url=http://www.unodc.org/unodc/en/data-and-analysis/WDR-2000.html |url-status=live |archive-url=https://web.archive.org/web/20100417180244/http://www.unodc.org/unodc/en/data-and-analysis/WDR-2000.html |archive-date=17 April 2010 |access-date=4 May 2010}} 2001 pp. 162–65 (see aggregated average for each OECD country in Harm Reduction Discussion page).</ref> a model in which successfully rehabilitated people who use substances present no further maintenance costs to their community, as well as reduced ongoing health care costs.<ref name="DrugFreeAustralia" />

[[King's Health Partners]] notes that the cost of providing free heroin for a year is about one-third of the cost of placing the person in prison for a year.{{Dead link|date=May 2011}}<ref name="KHP">{{Cite web |title=Untreatable or Just Hard to Treat? |url=http://www.kingshealthpartners.org/khp/2009/09/15/untreatable-or-just-hard-to-treat/ |url-status=dead |archive-url=https://web.archive.org/web/20100328081543/http://www.kingshealthpartners.org/khp/2009/09/15/untreatable-or-just-hard-to-treat/ |archive-date=28 March 2010 |access-date=20 April 2010}}</ref><ref>{{Cite journal |last=Lintzeris |first=Nicholas |year=2009 |title=Prescription of heroin for the management of heroin dependence: current status |journal=CNS Drugs |volume=23 |issue=6 |pages=463–476 |doi=10.2165/00023210-200923060-00002 |pmid=19480466 |s2cid=11018732}}</ref>