Volume 176 - Issue 9
In reply: Separating politics and scientific research on heroin prescription
Authors: Wayne D Hall, Richard P Mattick and Jo Kimber
Med J Aust 2002; 176 (9): 450. || doi: 10.5694/j.1326-5377.2002.tb04493.x
Published online: 6 May 2002
Published online: 6 May 2002
In reply: We disagree with Wodak and colleagues in a number of respects.
If the results of a hydromorphone trial were as good as Wodak et al claim a heroin trial would be, then a heroin trial would be unnecessary.
We accept, as did the Dutch and Swiss, that politicians have the authority to make decisions about what medical research is permitted. The heroin trials in Switzerland and the Netherlands were approved by parliament and supported by referenda in cantons and cities in Switzerland.
The Australian survey data cited by Wodak and colleagues indicate that a heroin trial would not have been approved if a referendum had been held in 2001. Nor do we think it would be supported by a free vote in Federal Parliament, as it was not supported by a similar vote at the NSW Drug Summit in 1999.
Wodak et al present no evidence to support their claim that the delivery of a treatment that costs between A$25 000 and A$45 000 per patient per year in the Netherlands1 to less than 5% of the heroin-dependent population would have a detectable impact at the population level.
A hydromorphone trial would provide a way of evaluating the role of injectable opioids in the treatment of heroin dependence. It would not prevent Wodak and colleagues from convincing the community that injectable heroin is the drug of choice to treat refractory heroin dependence.
References
- Medical co-prescription of heroin: two randomized controlled trials. Utrecht, Netherlands: Central Committee on the Treatment of Heroin Addicts, 2002. CBBCCFII
Hospital-Admitted Injection-Related Infections Among Incarcerated People Who Inject Drugs in Australia: A Retrospective Cohort Study
Andrew Palmer, Matthew Carter, Jeremy Yeo, Cecilia Shim, Jason Connor, Jeremy Hayllar, Gerald Holtmann, Naomi Moy, Elliott G. Playford, Naomi Runnegar, Paul J. Clark
The Management of Withdrawal From Alcohol and Other Drugs in Australian Custodial Settings: A Consensus Statement
Grace FitzGerald, Jocelyn Chan, Jon Cook, Mark Stoove, Michael Curtis, Suzanne Nielsen, Rebecca J. Winter, Thileepan Naren
Impact of Prescription Drug Monitoring Program Implementation on Rates and Characteristics of People Seeing Multiple Prescribers in Primary Care: A Controlled Interrupted Time-Series Analysis
Louisa Picco, Monica Jung, Grant Russell, Samanta Lalic, Mahbod A. Fini, Dan I. Lubman, Rachelle Buchbinder, Ting Xia, Suzanne Nielsen
Early Cessation of Acetylcysteine Treatment After Paracetamol Overdose (NACSTOP 2): A Non-Inferiority Randomised Controlled Trial
Anselm Wong, Richard McNulty, Sarah E. Hodgson, Naren Gunja, Andis Graudins
The risk of death after hospitalisation following intentional self‐poisoning: a retrospective observational study (PAVLOVA‐2)
Firouzeh Noghrehchi, Nicholas A Buckley, Rose Cairns
Opioids and the challenges of managing chronic non‐cancer pain in rural Australia: a qualitative study
Jessica A Thomas, Jill Benson, Philip Davidson, Paul R Ward