Evidence from trials of heroin assisted treatment (HAT) in Canada and Europe indicate that supervised injectable sites can offer benefits among individuals, a new study by the Rand Corporation found.
Data for 2017 showed that there were more than 47,000 opioid-involved overdose deaths in the U.S., and one in eight adults now reports having had a family member or close friend die from opioids, the authors noted. Therefore, increasing the availability and reducing the costs of approved medications for those with an opioid use disorder (OUD) is “imperative,” they said.
Observing supervised heroin injection sites in Canada and Europe, researchers concluded that HAT — with optional oral methadone — is beneficial over oral methadone alone for treating OUD among individuals who have tried traditional treatment modalities, including methadone, multiple times but are still injecting heroin.
They also said that, although heroin cannot be prescribed in the United States because it is a Schedule I drug, it would be legal to conduct a human research trial with HAT.
“Given the severity of the opioid crisis, there is urgency to evaluate tools that might reduce its impact and save lives.”
Significantly, many supervised consumption sites have been operating for 15 to 30 years, and while persistence does not imply effectiveness, it seems unlikely that these sites — which were initially controversial in many places — would have such longevity if they had serious adverse consequences for their clients or communities, the authors said.
Yet, there are still significant legal issues surrounding the implementation of supervised consumption sites in the United States, authors concluded.
They made these policy recommendations:
- Given the increased mortality associated with fentanyl, the fact that some people who use heroin may not respond well to existing medications for opioid disorders, HAT’s successful implementation abroad, and questions concerning whether the success would carry over to the United States, HAT trials should be conducted in some U.S. jurisdictions that already provide a spectrum of social services and good accessibility to medication treatments for opioid disorders.
- Conducting trials with HAT and hydromorphone are not mutually exclusive, and it may make sense to include both in the same study, as was done in Canada. Assessing the impact of injectable hydromorphone via clinical trials (with or without a HAT arm) would inform future regulatory decisions about using it as a medication treatment for opioid disorders.
- Some researchers and advocates believe that, during an emergency like the present opioid crisis, the absence of a large downside risk for an intervention that has strong face validity may be sufficient for some decision makers to proceed, rather than waiting for further evidence. Nevertheless, if attempts to implement supervised consumption sites in the U.S. are successful, a strong research component should be incorporated into these efforts.
A full copy of the report can be found here.