Provision of diamorphine (heroin) by prescription for drug dependency: Issues and recommendations

Existing evidence for the efficacy of diamorphine treatment of heroin dependence is presented, focusing first on 'gold standard' randomised controlled trials and then on other forms of evidence. The evidence strongly suggests that diamorphine treatment may be of some value and that further trials are warranted. Nevertheless, there are a range of risks associated with diamorphine trials and these are also discussed. It is recommended that: (i) extensive trialling of the efficacy, safety and cost-effectiveness of diamorphine should be undertaken; (ii) trials should be conducted to the highest scientific standards, but the standards should be realistic; (iii) the risks associated with diamorphine prescribing must be taken seriously and included in trial planning and evaluation; (iv) competing moral positions about diamorphine prescribing should be spelt out and debated; and (v) diamorphine prescription should be viewed as only one of a number of treatment options and should be investigated as part of a pluralist approach to the treatment of heroin dependence.