Прочел интересный обзор из Medscape:
[Ссылки доступны только зарегистрированным пользователям ]
и вспомнил про соотв. топик в вашем форуме. Может быть,
вам будет интересно. Статья опубликована в "Ланцете" за 3 июня 2006.
Судя по статье, количество героиновых наркоманов за время проведения программы заместительной терапии ( с 1990) снизилось в четыре раза. Популяция героинщиков снижалась на четыре процента каждый год. Примерно на второй год люди переходили с героина на заменители. Правда, все это в Швейцарии.
=============================
"Medicalization" of Heroin Abuse Associated With Reduction in New Users
By Karla Gale
NEW YORK (Reuters Health) Jun 01 - A drug policy designed to improve the safety of heroin use while increasing the free treatment of drug addiction appears to have reduced the incidence of heroin use four-fold since 1990, investigators in Switzerland report.
According to Dr. Carlos Nordt and Dr. Rudolf Stohler from the Psychiatric University Hospital in Zurich, the Swiss approach, initiated in 1991, provides drug consumption rooms, needle-exchange services, methadone or buprenorphine programs whose only requirement for treatment is heroin use, and heroin-assisted treatments.
"Heroin can be prescribed to people who have failed two former therapies," Dr. Stohler told Reuters Health. The practice is to give addicts 1 gram/day.
This helps, he explained, because heroin bought off the street may be impure or the addicted individual may use much larger quantities of the drug.
"As a result (of heroin-assisted treatments), people can lead normal lives, go to work, not obsess about buying the drug, when they know they can relieve their craving legally."
Detractors of this approach feared that this liberal strategy would fail by attracting new users and lengthening periods of heroin addiction.
To explore these issues, Dr. Nordt and Dr. Stohler obtained data regarding heroin use from the case register of substitution treatments in the canton of Zurich for 9518 patients who underwent approximately 24,000 uninterrupted treatment episodes between 1991 and 2005. They report their findings in the June 3rd issue of The Lancet.
They estimate that the population of problematic heroin users declined by 4% per year. Their results showed that approximately half of regular heroin users enter substitution treatment within 2 years, and they predict that by 2010, 64% of users will be in treatment.
The researchers calculate that, since 1990, the incidence of regular heroin use has declined by 82%, even though the prevalence rate remained fairly constant.
Their estimations of decreased heroin use are bolstered by the decline in mortality due to drug abuse in all of Switzerland and a decrease in the confiscation of heroin.
"As the Swiss population supported this drug policy, this medicalization of opiate dependence changed the image of heroin use as a rebellious act to an illness that needs therapy," Drs. Nordt and Stohler write. "Finally," they add, " heroin seems to have become a 'loser drug,' with its attractiveness fading for young people."
Dr. Matthew Hickman, from the University of Bristol in the UK, and his associates seem to be a bit skeptical in their accompanying editorial.
"Although the imaginative use of ecological data can be helpful in epidemiology, ecological studies are generally limited in their ability to refute or support a particular causal hypothesis," they write. Therefore, "comparisons with other countries are necessarily speculative."
They also indicate that the study fails to show whether or not the policy actually reduced the risk of harm.
On the other hand, Lancet editors report in their commentary that mortality rates from drug abuse have increased more in the UK over the past decade than in any other European country.
They write that, in 2002, the option of "drug consumption rooms," also called "safe injecting houses," was rejected by the British government, based on "lack of evidence of benefit, adverse public reaction, and legal issues as their rationale."
They also note that a report last week by an independent working group has again recommended the use of drug consumption rooms. "After 4 years, and thousands of needless drug-related deaths, a thorough trial of drug consumption rooms is a requirement the Government cannot afford to refuse a second time," they conclude.
Lancet 2006;367:1792,1797-1798,1830-1834.
===================================