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Heroin Delivery under Control: feasibility and follow-up study (DHCo)

Research project DR/10 (Research action DR)

Persons :

Description :

Based on the principle of Harm Reduction, drug users treatment programs aim to maintain a contact between a maximum of dependent patients and health providers in order to reduce or to prevent the consequences of their drug addiction both on a health and legal level.

In spite of their great accessibility and their efficacy for a large number of drug addicts, these programs have not always reached severely dependent patients (particularly opiate addicts), or patients with repeated failures with currently available treatments.

To reach these resistants, refractory populations, various experiments on heroin delivery under medical control have been tested in foreign countries (United-Kingdom, Switzerland, Netherlands).

In this perspective, we plan the making of a complete protocol on the following elements:

Sections of the research work:
1. Qualitative analysis: literature review about opiates agonists delivery in the treatment of dependence to opioïds. This review will focus on achieved, current or planned studies and will concern the scientific methodology, the organization of distribution conditions, the inclusion and exclusion criteria for the patients, the insertion of centres in the care system network, the treatment effects on public and mental health, drug use (including diacetylmorphine used dose) and the relationships with other forms of substitution therapies. From this analysis will follow a proposition of criteria for the creation of future heroin delivery under medical control centres.

2. Quantitative analysis: meta analysis, based on the recommendations of the Cochrane Reviews, realized on the currently available and accessible data. It will focus on primary (retention in care system) and secondary (improvement of psychic, somatic and “legal” health) variables.

3. Realization of a feasibility study on a legal and administrative point of view: survey of the (international, national, federal, regional) legal and administrative constrains related to the supply, the transport, the stocking, the transformation and the delivery of diacetylmorphine as stated in the present project. This inventory will allow, if the occasion should arise, to formulate recommendations in order to bring the essential modifications necessary to diacetylmorphine delivery under medical control to the legal and regular framework.

4. Impact studies: a first protocol aiming at drug users professional care-takers will be lead in order to determine the place that a medically controlled diacetylmorphine delivery program may occupy among the existing care system network. A second protocol will focus on the informations that should be given to the population living nearby a delivery centre.

5. Criminological studies: an assessment tool will be built in order to check the impact of a controlled diacetylmorphine delivery program on drug users’ criminality. This tool will evaluate the prevalence, the incidence as well as the nature of criminal acts before and after the users inclusion in the program. Its elaboration will benefit from various indicators used in similar foreign studies.

6. Economic evaluation protocol: based on a review of the literature, this protocol will determine the type of the most accurate economic analysis (cost-benefit, cost-efficiency or minimisation of the cost). This analysis will be comparing heroin delivery and its alternatives. Costs and efficiency may vary according to and within the target groups; this protocol will then have to define the target groups and the cost-efficiency groups, as well as the assessing instruments that shall be used, and their cost.

Documentation :

DHCo. Délivrance d'Héroïne sous Contrôle médical. Etude de faisabilité et de suivi : rapport final  Ansseau, Marc - Gustin, Fréderic - Hodiaumont, Fabienne ... et al  Gent : Academia Press, 2005 (PB6113)
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Délivrance d'héroïne sous contrôle: étude de faisabilité et de suivi (DHCo) : résumé    Bruxelles : Politique scientifique fédérale, 2004 (SP1405)
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Héroïne Afgifte onder toezicht: studie van haalbaarheid en naleving (DHCo) : samenvatting    Brussel : Federaal Wetenschapsbeleid, 2004 (SP1406)
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Heroin Delivery under Control: feasibility and follow-up study (DHCo) : summary    Brussels : Federale Science Policy, 2004 (SP1407)
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