Working With Drug Users

• In Ireland Methadone Maintenance Programmes and Nicotine Replacement Therapies are the most common forms of drug substitution therapy.
   
  
• The aim of drug substitution therapy is to minimise drug related harm by taking drug supply out of the hands of criminals and putting it into the hands of doctors and pharmacists.
   
  
• Benefits include
• Reduction in the risks of overdose and other medical complications
• Decline in the motivation and need for drug users to commit crimes to support their habits
• Increased contact with drug treatment and other services
• Increased stability in the lives of drug users.
 
• At least 7,390 of Irelands estimated 14,500 heroin users are on methadone treatment programmes in Ireland [1].
   
  
• Research shows methadone maintenance is associated with lower rates of heroin use, reduced levels of crime and improved social functioning. People using methadone have a lower risk of death or infection from HIV or Hepatitis C [2].
   
  
• There is increasing evidence that other drugs such as buprenorphine and LAAM (Levo-Alpha Acetyl Methadol) have a significant role to play as alternatives to Methadone. For example buprenorphine, widely used in France, appears to be safer than methadone in relation to overdose risk [3].
   
  
• Heroin maintenance (the prescription of medical heroin as a substitute for street heroin) was widely used in Britain between 1926 and 1967. As recently it was back on the agenda in the UK with the British Home Secretary David Blunkett making moves to extend heroin prescribing in 2002 [4].
   
  
• Today, Heroin Assisted Treatments (HAT) are generally targeted at high risk chronic drug users for whom other treatment approaches have repeatedly failed [5].
   
  
• Heroin Assisted Treatments have been extensively researched in Switzerland since the mid 1990's. According to Ali et al (1998) those participating in the Swiss heroin prescribing project reported improvements in their physical and mental health, social functioning, drug use and criminal behaviour. It also achieved reasonable retention levels [6].
   
  
• There promising results of the Swiss trials have led to ongoing pilot projects involving heroin maintenance in Germany, Spain, France, Belgium and Canada [7].