The current status of heroin prescription treatment for heroin dependence.

Heroin prescription (HP) to treat severe heroin dependence has been available to few patients in the UK for several decades with limited, but generally favourable, evaluation. In the last decade, large trials have been reported from two countries, are presently underway in three other countries and under consideration in several other countries. The standard pharmacological treatments for heroin dependence, methadone and buprenorphine, attract and retain many more drug users than other pharmacological or nonpharmacological treatments and are strongly supported by evidence of efficacy, effectiveness, safety and cost effectiveness. On present evidence, HP is feasible and safe with limited, but increasing, evidence of efficacy and effectiveness. Although HP is more expensive than methadone, there is some evidence of cost effectiveness. HP is, at present, only considered a therapeutic option for a small minority of treatment refractory, severely heroin-dependent persons in developed countries with comprehensive treatment systems.