What happens when addiction treatments don’t stick, and people continue using dangerous opioids like heroin and illicit fentanyl anyway? That’s the central question behind a new report by the RAND Corporation, reports Vox. The review of research looks at two harm reduction interventions that try to help people who aren’t in conventional treatment: prescription heroin and supervised drug consumption sites. Both approaches are used in Australia, Canada, and Europe but are very controversial and have yet to earn official approval in the U.S. Prescription heroin, called heroin-assisted therapy (HAT) in the RAND report, is a concept that may seem counterintuitive at first. At prescription heroin sites, people with opioid addictions are directly provided medical-grade heroin.
The idea is that if some people are going to use heroin no matter what, it’s better to give them a safe source and a safe place to inject it, rather than letting them pick it up on the street — where it could be laced with dangerous fentanyl — and possibly overdose without medical supervision. Patients can not only avoid death by overdose, but otherwise go about their lives without stealing or committing other crimes to obtain heroin. Supervised consumption sites take a tamer, but similar, harm-reduction approach. In these sites, people can use drugs with sterile injection equipment and the supervision of trained staff, who are ready with the opioid overdose antidote naloxone if anything goes wrong. The report, the most comprehensive look at research on both prescription heroin sites and supervised consumption sites, concluded that the research for prescription heroin is fairly strong, backed by randomized controlled trials (RCTs). The evidence for supervised consumption sites is much weaker, with only nine quasi-experimental studies available, and none of them particularly strong in methodology.