What's the craic with crack? Do heroin treatment programmes work?
In 1964, Dole and Nyswander treated 22 heroin addicted patients in New York with methadone, a drug previously known as a potent, addictive painkiller. They demonstrated that coupled with psychosocial interventions all these patients stopped heroin use and could resume family and social responsibilities. Since then methadone has been widely used in heroin addiction treatment programmes throughout the world. Whilst working as a pharmacy assistant in Hull over 15 years ago, I remember seeing heroin addicts coming to collect methadone and other opiate replacement therapy. I was struck by the scale of the social and public health problem, but I was also left questioning whether the treatment programmes worked.
In 2006–07, for every 1000 adults in England, 8 were heroin users and 5 were crack cocaine users, and 29%of people in treatment programmes were using both drugs.In 2008/09, £800million was spent on national drug treatment services, a tripling in spending over the decade, with particular focus on methadone treatment and specialist counselling. Therefore the question of whether treatment programmes are effective in reducing heroin addiction has never been so pertinent.
Using data from the National Drug Treatment Monitoring System (NDTMS), the follow-up of nearly 15 000 heroin or crack users enrolled in treatment programmes was studied in 2008/09. One third of heroin users and half of crack cocaine users had abstained from drug use after 19 weeks of treatment. A higher proportion of users of heroin only abstained than did users of both heroin and crack cocaine. There was an overall reduction of 15 days of heroin use and 8 days of crack cocaine use.
The authors of this study acknowledge that longer-term follow-up studies are needed to look at the effectiveness of treatment programmes over a longer timescale, particularly with respect to psychosocial interventions. The National Treatment Agency for Substance Misuse recently reported that among 18 to 24 year olds, the number newly presenting for treatment for heroin and crack has fallen 30% since 2005/06, whereas in the over 35s, there has been a 20% increase in those seeking treatment, suggesting that the problem is declining among younger people. Given the scale of the heroin use in the UK, more data is required, particularly relating to cost-effectiveness and the long-term reduction in heroin addiction.