Heroin Maintenance for Heroin Addicts: Issues and Evidence

American society is again debating whether to allow maintenance doses of heroin in the treatment of heroin addicts. Carefully designed clinical research on the safety and efficacy of heroin maintenance should be undertaken, particularly with addicts not helped by current treatments. Such research would determine whether heroin maintenance is part of the treatment of choice for some addicts and would add to the present quite limited understanding of addiction. Medically administered heroin seems unlikely to cause addicts serious physiologic or mental harm. Moreover, British experience with heroin maintenance suggests that it is not incompatible with psychologic and social rehabilitation. Reducing the crime rate, however, should not be a heroin-maintenance program's major goal, since most urban crime appears unrelated to addiction. Congress has begun to consider legislation to outlaw heroin-maintenance treatment. Informed medical opinion should be contributed to these deliberations.