Critically analyse the arguments for and against the controlled prescription of pharmaceutical heroin.

by jm1291 (student)

Joshua Marshall

CRM3330 – Drugs, Crime & Criminal Justice

M00298914

Critically analyse the arguments for and against the controlled prescription of pharmaceutical heroin.

The prescription of substitution drugs, together with appropriate psychosocial support, is an integral part of today’s mainstream approach to treating heroin dependence. This has come about because over the last two decades, an increasing body of high-quality research has demonstrated the efficacy of using drugs such as Diacetylmorphine in the treatment of heroin addicts. Substituting drugs on prescription, alongside psychological, social and medical support is an important part of the treatment and rehabilitation of heroin abusers. This approach is the main one in the attempt to treat heroin abusers; substitutes such as Methadone are the first to be offered in the treatment of heroin abusers. This is due to the thorough research and testing into heroin dependence. This research has shown that Methadone and buprenorphine help treat those that are reliant on heroin. Some people may say that replacing one opiate with another is not at all treatment, but swapping one addiction for another, but the evidence, statistics and reports have all shown that substituting heroin with methadone is highly successful in the treatment of drug addiction. The professionalism involved in the treatment of heroin, have ensured that all safeguards are cared for and any unintentional mistakes do not happen. The quality of the professionalism is important, as the abuse of Methadone via prescription could be a potential problem. Methadone, although successful, has a few people of whom do not respond to the drug the way they need to in order to fully treated from heroin addiction, but this is the same with all drugs, not everybody reacts the same way to all drugs which is why a 2nd, or backup is available. Although only a small number of people are “non-responders” to drug treatment using methadone, they are still an important sub-population of people that also need and want treatment from drugs. This minority may be small, but the health, and social implications of heroin abuse are still there and the help they need is harder to access as they do not respond to the first line of treatment for heroin abuse. Those failing to respond to methadone or other substitutes are given diacetylmorphine as a strictly regulated treatment programme, which is also successful. Should the people of the United Kingdom be supporting the use of supervised injectable heroin treatment for those who have failed to respond adequately to other approaches? And if so, what are the clinical management issues necessary to ensure that this therapeutic option can be delivered in a manner that avoids the obvious risks associated with such an intervention? For the most effective treatment, heroin abuse should be tackled as early as possible. Various treatments are available, depending on the individual, but methadone (an opiate that blocks the effects of heroin and prevents withdrawals) has proven to be a success with the majority of heroin addicts. There are other pharmaceutical alternatives to methadone, such as buprenorphine, behavioral therapy, and rehabilitation centres, which are also effective, but Methadone seems to be the most successful so far. Buprenorphine is a recent addition to the array of medications now available for treating addiction to heroin and other opiates. This medication is different from methadone in that it offers less risk of addiction and can be prescribed in the privacy of a doctor's office. Buprenorphine/naloxone (Suboxone) is a combination drug product formulated to minimize abuse.

Heroin is universally used in most countries. Around 8% of the worlds population have used heroin in the past year. Heroin is seen as the worst of all illegal drugs, as the extremely addictive drug is not only very unhealthy, but it can easily be over-taken which can lead to over dosage and death. ‘Coming off’ requires extensive rehabilitation and a lot of hard work and will power, as it is one of the most addictive illegal drugs available worldwide. Treatment and rehabilitation includes helping the affected person to overcome their addiction and to slowly re-integrate the addicted person back into society. But with the easy access and it readily available from drug-dealers the addict can easily fall back into the trap of heroin abuse. A daily dosage of methadone for users can help their cravings subside slightly but the high and the euphoria may be the thing that the addict is missing therefore relapsing into this never ending spiral in which the addict either ends up dead, seriously ill, or best case scenario, in rehabilitation. Nonetheless, a high percentage of methadone users have succeeded in gaining a stable life from using it and slowly weaning themselves off it with help from doctors, nurses and drug counselors. , Does methadone help in the reduction of heroin abuse but it consequently improves health and social behavior as being addicted to a drug like this is similar to having a full-time job, all your time and effort is used on working out how to get your next batch. Using Heroin pharmaceutically would require widespread and all-inclusive research into everything from the drug, the social implications, past attempts and many more important factors. Although heroin is a very addictive Class-A drug and at this present moment, it is highly illegal, it has been proven to be a greatly successful painkiller. When using Heroin pharmaceutically, the dosage would obviously be a lot less than what “street heroin” would be and it would be tweaked and experimented until the best version became available for medicinal purposes. Many of the side affects and problems with heroin are the fault of an impure type of heroin that may have been spiked with other substances to make it stronger. Also, the use of unsterile needles, or other people’s needles, also leads to diseases such as AIDS, hepatitis and many more. The UK’s Department of Health established in 1926 the prescription of Diacetylmorphine (heroin) to users. This continued for around 40 years (until 1959) until a rapid increase in users forced the Brain committee to only allow specialised doctors, in specialised centres would be allowed to prescribe the drug. This is because the number of addicts doubled every 16 months over 10 years. In 1968, the law was made more restrictive and more controlled, until the use of diacetylmorphine was very rarely used in the medicinal setting, replaced with the use of methadone, which is still being used by a number of recovering heroin addicts today. Heroin is a central nervous system depressant, which relieves pain and induces a relaxed state or even sleep. It also, apparently produces a ‘dream state’ and warmth and well-being, which causes the addicted person to want to keep taking it. When something makes you feel that good and happy, it will make the person want to do it over and over again. Especially if the person is not happy with their own life. Constricted pupils, nausea, respiratory depression are to name, only a few of the side affects associated with heroin use. It activates parts of the brain, which releases euphoria, and feelings of extreme happiness. Which is exactly how it is both physically and psychologically addictive. Not only is the persistent craving for the drug always with the user, but also a tolerance gathers which means the longer you take it the more you need to take as your body grows a tolerance against the drug. But when, for some reason, the addicted person cannot access heroin, the withdrawal symptoms grow, which include, insomnia, nausea, muscle cramps, chills and panic and anxiousness.

As diacetylmorphine is very rarely used in medical practice these days, the best information is from decades ago when it was used widely as a painkiller for people suffering from serious illness’. Besides the fact that there was a rather significant increase of heroin abuse during the time it was used mainly as a medicinal substance, it was a widely successful drug that, to this day, people still believe should be available, obviously strictly monitored and controlled, on the pharmaceutical market. Clinical trials have been started in the Netherlands, and there are ongoing debates about trials in other countries, ...

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When using diacetylmorphine pharmaceutically, it could also be used in the treatment of opiate dependence. Giving a recovering addict a significantly smaller dosage of clean controlled heroin regularly could help an addict slowly recover from their addiction. There are many arguments surrounding the legalisation of diacetylmorphine on the pharmaceutical market, as some heroin addicts may worry about the side effects of methadone, or may refuse to try it altogether. Using diacetylmorphine could attract people into treatment, because they know that the drugs used will actually work, not only will it attract more addicts but it may persuade the users to stay in a treatment programme for longer. By giving a user diacetylmorphine, they are also getting safe medical treatment where the user can be looked after and it can also reduce crime, as the crime used to afford their habit will no longer be needed. Profits gained from illegal drug selling will also be significantly reduced if people see that safe, medical grade diacetylmorphine is available when in treatment. Also, medical grade heroin is guaranteed clean, safe and readily available when a part of a treatment programme. Pharmaceutical heroin will also reduce the risk of infection as the injections are immediately disposed of after each use; this also eradicates the risk of overdose as qualified professionals give injections. Users may assume that applying for a treatment programme may ensue legal implications but discreet, supervised injections could see the use and abuse of heroin rapidly decrease. The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) wrote a report on heroin assisted treatments in April 2012, part of this report stated “Findings from international trials now suggest that the supervised use of medicinal heroin can be an effective second-line treatment for this small, and previously unresponsive, group. In this latest EMCDDA Insights report, experts describe the development as ‘an important clinical step forward’ (emcdda). The report provides the first state-of-the-art overview of research on the subject, examining the latest evidence and clinical experience in this area in Europe and beyond.” This suggests that although methadone and other opiate substitutes may be working for the mainline of addicts, but the small sub-group of people that find methadone unhelpful, may very well respond a lot better to small doses of diacetylmorphine on a regular basis.

Commonly criticised and well known side effects and problems associated with heroin misuse are commonly due to the unprofessional administration of the drug, including dosage, equipment sanitation, or impure produce. Most of the time it is not the heroin itself that is the problem, it’s the heroin abuser not administering the drug the correct way or the right hygienic standard. Environment also affects the heroin, when buying heroin on the streets from drug dealers, the produce is obviously impure, as pure heroin is rare as most drugs are “cut” with something else to make the effects different or to make the size bigger to sell at a higher price, either way when heroin is cut, the drug being taken is not just heroin anymore which immediately makes it a lot worse for your body, the substance that cut the heroin is probably the major factor in which people get seriously ill when taking drugs.

Diacetylmorphine usage in the pharmaceutical market can potentially be as helpful and hold the same pain-killing powers as morphine does but the high addiction rate and potential side effects outweigh the positive attributes it could bring to our pharmaceutical market. I think if Diacetylmorphine was controlled extremely strictly with constant monitoring and checks on the drug, I believe it could be a highly successful painkiller. Although Cons seem to Outweigh the pros so to speak, I believe in our era, with amazing scientific skills we could experiment on this drug, and make it better, so Diacetylmorphine without the addictiveness and side effects.

There are downsides to using pharmaceutical heroin (diacetylmorphine) for example; giving heroin addicts heroin seems like taking one step forward and 2 steps back, the dependency is still there, and withdrawals will still occur if cravings are not treated. Giving heroin-to-heroin addicts may make them more reluctant to try different alternatives, such as methadone; they may feel there is no point in trying substitutes when they can get the real substance, legal and free. It also may dissuade people to stop abusing heroin, unquestioned access could cause people to join the treatment purely for the free heroin, people may use it for free, go and buy some more to satisfy their cravings, and go back the next day for their free shot. Continued use of injections could be a risk to long-term users, whose veins are probably on the brink of collapse, causing even more health complications on top of the complications heroin abuse brings.

It is a highly controversial idea, which needs thorough discussion, trialing and debate. But the fact still remains; giving heroin-to-heroin addicts is still not, definitively a beneficial move, especially when there are so many alternatives available on the pharmaceutical market such as the successful, methadone. Although heroin has a substantial benefit and use on the pharmaceutical market, if legalized, it may be a slippery slope towards the legalization of other drugs; marijuana has uses medically and is legally available medically in many cities and countries, such as the State of California in the USA. In Amsterdam, marijuana is fully legal and can be smoked openly in coffee shops. Some drugs do have medical benefits but the pros and cons of each definitely need to be weighed and discussed at length. Yet since there is not one treatment that is effective for a core group of people, prescribing diacetylmorphine may be the best solution we have so far.

This is not meant to imply that full prohibition or legalization is needed, as having heroin controlled, as a medical substance has been quite successful in the long run. Although heroin is a class A drug, it is not as dangerous as many other drugs available illegally, cocaine, methamphetamine and even tobacco cause serious health implications, but heroin seems to be the darkest and the taboo of the drug world. Although it is highly addictive and dangerous, it has wonderful medical benefits that could change the life of many people who may need an extremely strong painkiller in order to live a normal life on a regular basis.

Although using heroin for medicinal purposes could be successful, in the treatment of opiate addicts and in the relief of pain for people with serious illness’ that cause intense pain. I believe that widespread usage of diacetylmorphine could lead to an increase of people addicted to opiates in the UK. There are already countless people addicted to prescription drugs, such as sleeping pills, in England. Widespread availability of this drug, for medicinal reasons or not, could lead to the illegal buying of the substance online, or on the street. If people are prescribed diacetylmorphine by a doctor and their prescription expires, that doesn’t always mean the patient has recovered from their illness. The temptation to by heroin from drug dealers may trump their common sense. When in pain and desperate people may do things they may not normally do. So if they did decide to buy heroin from ma drug dealer, it would most likely be an impure substance. When taken with no supervision the likelihood of addiction is substantially higher, alongside the risks of infection, illnesses and over dosage. As previously stated, the potential of diacetylmorphine being used medicinally is limitless, the lives people could lead after taking the drug could be amazing, people who were once, too ill and in pain to even leave their hospital bed could lead a normal life. This debate could go on forever, the benefits of taking diacetylmorphine are endless and it could change people’s lives for the better, but it can also cause the complete opposite effect. I believe the way in which we use diacetylmorphine in this present day is the best solution we have as of yet. The cautious attitude doctors have in relation to the prescribing of this drug is good. I believe diacetylmorphine should only be used as a last resort in the treatment of patients and drug users if it were any more available pharmaceutically it could cause an unwanted, but significant increase in heroin abuse. There are drug black markets everywhere, in every country, every city, and even online, people can order pretty much any drug they want online if they know where to look so if people develop a reliance on diacetylmorphine they could order more as soon as their prescription runs out. The implications of this drug could ruin many people’s lives, but could save the same amount easily. Even when considering how diacetylmorphine could help recovering heroin addicts. The slow weaning off heroin, using a weaker albeit purer strain of the same substance, although effective, it almost seems pointless.

I believe we, as a nation should stick to the way we control and use diacetylmorphine the way we do now. Using it in any other form of medicinal treatment could cause a spike in the use of illegal heroin abuse therefore causing a downward spiral of drug abuse in the UK, in particular, heroin. Diacetylmorphine is an amazing, highly effective drug that has multiple uses, but even so, the many implications and risks involved in using this drug in the widespread medical world of the UK seems to be a high risk that many are unwilling to take. The risks and the benefits are equal in weighting, therefore unless a new, medical safe strain was created, using this anymore that we already do could pose a risk to the welfare and overall health of the UK population.