Is Dr Frank there? A heroin question, I'm afraid?
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Answers:
Prescribing heroin to addicts in UK is against prescribing policy. Heroin prescriptions, like all prescriptions issued by every GP are monitored and any excess is quickly picked up and the GP contacted. Any prescriptions issued in this way would initially be honoured by the pharmacist, as they would be legal, however as soon as they were noted by the prescribing bureau the GP would be asked to justify his prescriptions.
There are a number of countries that due use prescribed heroin for addicts, including Switzerland, and some consider it preferable to methadone.
Because heroin is BAD FOR YOU!!!
First, I don't know if doctors can prescribe HEROIN ...
Second, street heroin is very bad for you. That is why they are dispensed methadone in a controlled environment.
Heroin is still prescribed in Britain and places in Europe (e.g. the Netherlands). Diacetylmorphine is not available in Canada or the US, however certain harm reduction programs I am aware of provide teaching on how to properly inject into a vein, etc. and the service I am aware of ("Streetworks") provides needle exchange.
Heroin is changed to morphine in the brain and passes the blood-brain barrier more quickly than morphine. It provides the same histamine release (rush) as morphine, only its onset of action is much quicker. Heroin is not inherently bad, however, street heroin may be contaminated with compounds that can produce talc lung when injected. Some street heroin is actually fentanyl, sufentanil or other similar analogues.
Back to the original question ... doctors can and do prescribe heroin to addicts, but not in Canada or the US. Some canadian physicians provide morphine to heroin addicts before oral methadone syrup to prevent acute withdrawal (cold turkey) effects. The reason they don't is because there is the possibility that family members of the addict may sue the physician.
Morally, and ethically, physicians should not prescribe morphine or heroin to new, non-terminally ill addicts; however, I don't see a reason why the provision of morphine or heroin should not be prescribed to terminally ill addicts as a humane 'end of life care' option to these people.
So, physicians so rarely prescribe heroin (or morphine, or analogues) to addicts because of the risk of losing their licence to practice. Also, to prescribe narcotics (in Canada), a physician must obtain "triplicate prescriptive authority." The majority of hospitalists and non-hospitalist practitioners do not obtain this because it requires yearly updating and puts them at an increased risk of being sued. I remember a case in which a person addict to heroin whose methadone had been stolen (or sold, or whatever), came to our emergency department in need of methadone (as she was going through acute withdrawal). None of the emergency physicians could prescribe her the methadone (as methadone prescriptive authority is difficult to obtain and maintain and is rarely used by non-pain-service physicians). An anesthesiologist who was on the pain service was consulted in order to provide a script for methadone.
As and emergency nurse who has volunteered at Streetworks, I understand addiction. I don't judge. There but for the grace of [whatever/whomever] go I; however, I also understand how few physicians in the Americas will prescribe narcotics to addicts because of the inherent risk of being sued by agencies such as AADAC or sometimes addicts' family members or other "concerned" parties. An excellent physician I know about lost licence to practice for precicely this reason. This person, a true humanitarian, will never be able to practice medicine again. Please consider that as well.
Mr. Laws: To ask the Secretary of State for Health how many doctors are licensed to prescribe heroin to drug misusers; how many pilot trials relating to the prescription of heroin for drug misusers are being undertaken; how many drug misusers are part of these trials and being prescribed heroin; and when the trials (a) started and (b) are expected to end. [134011]
Caroline Flint: Secretary of State forHealth: There are currently 129 doctors licensed to prescribe diamorphine (heroin) for the treatment of addiction in the United Kingdom.
14 May 2007 : Column 590W
The Randomised Injectable Opiate Treatment Trial is currently under way in two sites in Darlington and London. The National Addiction Centre, supported by Government, is examining injectable diamorphine, injectable methadone and oral methadone treatments in a randomised controlled trial. The aim is to recruit 150 persons to participate in the trial, so approximately 50 will be prescribed diamorphine. The trial is due to be completed in 2008, and it started in 2005. The results on outcomes will be published after completion of the trial and following independent peer review.
its not the drug the dr,s are bothered about,its the class.As heroin is class a diamorphene or methadone,its a lot of bother with the home office ect for one pacient and they usually dont have the time,thats why they send you to the cdt.Basically there all **** bags,most wont even prescribe anadin...dex-amphet script,me lol steve
As far as l know Doctors prescribe methadone to heroin addicts.
l have heard of cases where doctors prescribe diamorphine to addicts but most doctors do not want to prescribe injectables!
l have a friend that l have known for years and years and they are a substance abuser and they go to a drug clinic and get lots of medicines to help them so they dont use heroin!
lt does annoy me a tad though cos my friend gets disability allowance and l cannot see how the system can justify giving a heroin addict shed loads of money in disabilitiy allowance!
l think yes they should be given benefits but the amount of money my friend gets is outrageous!
The majority of GPs do not prescribe heroine to addicts. There are a few exceptions as the study you quoted suggests.
The main reason this is not done is because drug rehabilitation programs aim to reduce addiction, not support it. Diamorphine is administered intravenously and will give the same high as street bought heroine. Methadone on the other hand has a slower release and doesn't give the same high, but prevents the withdrawal symptoms.
The aim of a rehabilitation program is to help people stop
(1) Injecting as the complications of this are the main causes of illness.
(2) Stop the association of feeling high with taking opiates.
(3) Slowly wean an addict off methadone without causing withdrawal symptoms.
Prescribing diamorphine would not support any of these aims. Only a select few of GPs with the support of a drug team prescribe diamorphine and only to a select group of addicts.
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