2.8.1 Objective of the treatment

The medical co-prescription of heroin to heroin addicts is regarded as an extension of the current medical treatment provided to heroin addicts in the Netherlands. The objective of the prescription of heroin is, therefore, connected to one of the main objectives of current care: to improve the health status and psycho-social functioning of addicts who do not sufficiently benefit from the currently available treatments and to prevent further deterioration. For those addicts who - by means of the prescription of heroin and the initiation of medical and social care - become or can be motivated to terminate their drug use, the achievement of abstinence becomes the primary goal of treatment. It should be emphasized that drug users are not "given up" when prescribing heroin, nor that it is accepted that these persons will remain addicted for the rest of their lives. Heroin prescription may be a new hold for heroin addicts for whom there has been no adequate treatment so far. By enabling drug users to return to their original intoxication through medically prescribed heroin, also the use of illicit drugs other than heroin may be reduced (Uchtenhagen et al., 1997; Perneger et al., 1998; Rehm et al., 2001). Most heroin addicts in the Netherlands consume a variety of illicit drugs in addition to heroin. In recent studies, it is estimated that 80-90% of the opiate addicts is also using cocaine, often in the form of crack (Blanken et al., 1996a, 1999; NDM, 2001). In this combination, illicit heroin is sometimes used to reduce the strong stimulating effects resulting from the use of cocaine. Benzodiazepines and alcohol are often used as a relatively cheap substitute for heroin (Benschop et al., 1997). In addition, through the prescription of heroin, medical and social care may be initiated and efforts may be undertaken to help these addicts to structure their lives, and - for some addicts - to achieve abstinence from drugs. For example, 10% of the patients admitted to the Swiss heroin program (22% of all discharges) left the program to start abstinence oriented treatment (Rehm et al., 2001).