Small Dan, Drucker Ernest
PHS Community Services Society, 20 West Hastings Street, Vancouver, BC, V6B 1G6, Canada.
Harm Reduct J. 2006 May 2;3:16. doi: 10.1186/1477-7517-3-16.
A decade of research in Switzerland, The Netherlands, Germany, and Spain now constitutes a massive body of work supporting the use of heroin treatment for the most difficult patients addicted to opiates. These trials concur on this method's safety and efficacy and are now serving as a prelude to the institution of heroin treatment in clinical practice throughout Europe. While the different sampling and research protocols for heroin treatment in these studies were important to the academic claims about specific results and conclusions that could be drawn from each study, the overall outcomes were quite clear--and uniformly positive. They all find that the use of prescribed pharmaceutical heroin does exactly what it is intended to do: it reaches a treatment refractory group of addicts by engaging them in a positive healthcare relationship with a physician, it reduces their criminal activity, improves their health status, and increases their social tenure through more stable housing, employment, and contact with family. The Canadian trial (NAOMI), now underway for over a year, but not yet completed, now faces a dilemma about what to do with its patients who have successfully completed 12 months of heroin and must be withdrawn from heroin and transferred to other treatments in accordance with the research protocol approved by Government of Canada, federal granting body and host institutions. The problem is that the principal criterion for acceptance to NAOMI was their history of repeated failure in these very same treatment programs to which they will now be referred. The existence of the results from abroad (some of which were not yet available when NAOMI was designed and initiated) now raises a very important question for Canada: is it ethical to continue to prohibit the medical use of heroin treatment that has already been shown to be feasible and effective in numerous medical studies throughout the world? And while this is being worked out, is it acceptable to require patients who have been successfully treated with heroin in Canada, to be forced to move back to less effective treatments (treatments that failed to be efficacious in the past)? This essay discusses this dilemma and places it in the broader context of ethics, science, and health policy. It makes the case for continuation of the current successful patients in heroin treatment and the institution of heroin treatment to all Canadian patients living with active addictions who qualify.
瑞士、荷兰、德国和西班牙长达十年的研究现已形成了大量的研究成果，支持对最难治疗的阿片类成瘾患者采用海洛因治疗。这些试验在该方法的安全性和有效性方面达成了共识，目前正作为欧洲各地临床实践中采用海洛因治疗的前奏。虽然这些研究中不同的海洛因治疗抽样和研究方案对于关于每项研究可能得出的具体结果和结论的学术主张很重要，但总体结果非常明确——而且始终是积极的。他们都发现，使用处方药用海洛因完全达到了预期效果：通过与医生建立积极的医疗关系，它接触到了一群治疗难治的成瘾者，减少了他们的犯罪活动，改善了他们的健康状况，并通过更稳定的住房、就业以及与家人的联系增加了他们的社会存续期。加拿大的试验（NAOMI）已经进行了一年多，但尚未完成，现在面临一个两难境地，即对于那些已成功完成12个月海洛因治疗的患者该如何处理，根据加拿大政府、联邦资助机构和主办机构批准的研究方案，这些患者必须停用海洛因并转至其他治疗。问题在于，被纳入NAOMI的主要标准是他们在这些即将被转介回去的治疗方案中曾多次治疗失败的病史。国外的研究结果（其中一些在NAOMI设计和启动时还没有）的存在现在给加拿大提出了一个非常重要的问题：在全世界众多医学研究中已被证明可行且有效的海洛因治疗，继续禁止其医疗用途是否符合伦理？而在这个问题得到解决之前，要求在加拿大已成功接受海洛因治疗的患者被迫转回效果较差的治疗方法（过去未能产生疗效的治疗方法）是否可以接受？本文讨论了这一两难境地，并将其置于更广泛的伦理、科学和卫生政策背景下。文章主张让目前正在接受海洛因治疗且治疗成功的患者继续接受治疗，并为所有符合条件的患有活跃成瘾症的加拿大患者提供海洛因治疗。
