Prerequisites for the implementation of a new heroin-assisted centre

Prerequisites for the implementation of a new heroin-assisted centre

Background: TADAM, a randomised controlled trial of heroin-assisted treatment, will begin in Liège, Belgium, in 2010. Heroin-assisted treatment of treatment resistant heroin addicts has been successfully tested in six countries: Switzerland, The Netherlands, Spain, Germany, Canada and United-Kingdom. Each country used a randomised controlled trial to assess this new treatment. It has now a strong evidence-based foundation. However in the peer-reviewed articles, there is little information on the concrete conditions to fulfil before implementing this treatment. With the experience of the other countries and ours, we have listed those conditions.

Methodology: We collected information concerning the randomised controlled trial. This included articles published in international peer-review journals, reports, visits to heroin-assisted treatment centres and information given by researchers who participated in those experiments. We will illustrate our presentation with the example of Liège.

Results: Before all, a political agreement at the national level is mandatory. It is never guaranteed even if it was already given in the past. Methadone treatments must be available and the collaboration with the addiction network will be an advantage for the project. There must be a sufficiently high number of heroin addicted in the concerned area and they must be correctly informed about the heroin-assisted treatment. But even if it is the case, the inclusion of the foreseen number of patients can be more difficult than expected because it is problematic to assess the exact number of patients fulfilling the inclusion criteria and because not all the eligible participants will accept to enter this treatment.

Conclusion: For reasons other than medical or scientific ones, implementing a new heroin-assisted centre is still a challenge.