The D'Alliance: Personal Views on Drug Policy

Denmark's First Heroin Assisted Treatment Clinics to Open this Week

Tuesday, March 09, 2010

Denmark is the latest country to offer heroin assisted treatment (HAT). After reviewing trials in Switzerland, the Netherlands, Germany and Great Britain, the Danish parliament determined that HAT was an effective treatment method, and legislators approved the implementation of a Danish program without first mandating another trial. The program's first two clinics, both in Copenhagen, will open Thursday.

Michael Jourdan of Copenhagen's Centre of Alcohol and Drug Research provides more details below:


COPENHAGEN - After many years of debate Denmark is now joining the exclusive club of nations in which prescription of heroin to addicts is possible.

The motion to do so passed through parliament by an overwhelming majority 178-1 two years ago. Now, the preparatory phase of working out the guidelines, training treatment staff and addressing a myriad of devilish details is over. Thursday the 11th of March marks the official opening of the capital's first two heroin clinics. Later this year the cities of Aarhus, Odense - the birthplace of Hans Christian Andersen - and Esbjerg will follow.

The Danish model is not a trial with a closing date and a strict scientific protocol, because yet another trial has been deemed unnecessary. Having closely monitored the heroin trials of Switzerland, the Netherlands, Germany and Great Britain, the Danes have concluded that the evidence is in. Prescribed heroin is feasible, beneficial, safe, cost effective, and yielding better results with some addicts than other forms of substitution treatment.

The international treaties allow for scientific or medical use. By including heroin in the pharmacopoeia for the specific purpose of treatment of addiction the Danes have gone straight for the medical option. A small number of specialist medical doctors have been empowered to make legal requisitions from two appointed suppliers of pharmaceutical heroin (diacetylmorphine). Under the supervision of these specialists medical staff at the 5 treatment centres can adjust dose to fit the individual patients. A target group has been set to 3-400 addicts who have not benefited from methadone and continue injecting illegal drugs with detrimental health effect. Two daily injections are allowed, supplemented by take home doses of methadone. The medical treatment is integrated in a comprehensive treatment programme offering psycho-social support to all users. All prescriptions and outcomes are closely monitored by the Danish National Board of Health.

Even before opening, the clinics have attracted considerable attention. Nationally, support is massive, but critics have voiced concern that the guidelines are too restrictive and the setup of the clinics too burdensome for the users - that in effect the whole effort is set up to fail. However, in the Danish model, adhering to a strict scientific protocol is not an issue. Though one could say from the outset that the many tricky issues of prescribing heroin have been dealt with in a manner that could be described as erring on the side of caution, modification in the form of revision of guidelines and adjustment of practice is possible if and when experience shows need for change.

Perhaps the Danish way of setting up this treatment modality could be dubbed version 2.0. Time will tell whether other nations will set up programs inspired by the Danish approach.

- Michael Jourdan, Centre of Alcohol and Drug Research, Copenhagen