To the Minister of Health, Welfare and Sports
P.O. Box 20350
2500 EJ The Hague


Utrecht, February 4, 2002

Re: submission of report

Your Excellency,

The Central Committee on the Treatment of Heroin Addicts (CCBH) has been installed by you and given the task of reporting to you, on the basis of a scientific investigation, on the desirable and undesirable effects of the medical prescription of heroin to heroin addicts who are resistant to current treatments, in order to improve the condition of their health and their social functioning. The Committee should at the same time be concerned with the ethical aspects of this administration and the consequences of the possible discontinuation of the treatment (Decree Centrale Commissie Behandeling Heroïneverslaafden 17 december 1996/nr. GVM/Vz/965074 and Decree hernieuwde instelling Centrale commissie behandeling heroïneverslaafden 26 september 2001/GVM/22/3937).

I am pleased to present to you the first report of the CCBH which incorporates these conclusions and recommendations. An executive summary of the report is available in the Dutch language, the full report is in English. The content of the report has been discussed with international experts, who advise the CCBH.

Following the preparation of the protocols and their approval by the Central Committee on Medical Ethics in the Netherlands, the investigation was implemented in good collaboration with the local authorities of six cities in the Netherlands. The investigation took place in the period between July 1998 - December 2001. From the report, it can be concluded that the investigation progressed smoothly, despite the need for great care, and the innovative aspects of an investigation concerning the medical prescription of heroin.

The CCBH concludes that in chronic, treatment-resistant heroin addicts who are already treated with methadone, the treatment with heroin in combination with methadone is more effective than the continuation of methadone alone. With this additional heroin therapy, the patients can benefit from the treatment with respect to their health and their social functioning. This applies to both intravenous and inhalation administrations of heroin. In a number of patients there is an indication for continuation of treatment. This is especially because discontinuation of the heroin prescription in most patients who benefited from the treatment resulted in a serious deterioration of the health status within two months of stopping. Undesirable effects with regard to the health of the patients and problems associated with control and management during the treatment were relatively scarce. This was also the conclusion of the National Safety Committee and the National Committee on Public Order and Controllability. Based on these grounds, the CCBH concludes that treatment with heroin is practicable, at least under the conditions described in the protocols of the CCBH. The costs of the treatment are presented in the report. Evaluation of the cost-effectiveness and cost-benefit is not yet available. The CCBH concludes that supervised medical co-prescription of heroin may be a useful supplement to the existing treatment options for chronic heroin addicts.

The CCBH advises you to facilitate the availability of prescribed heroin in the Netherlands for the treatment of chronic, treatment-resistant heroin addicts receiving methadone, as a last-resort pharmacotherapeutic option. To achieve this, the registration of heroin as a medicinal product (in both administration forms) is recommended. A good quality control of the implementation and execution of the treatment should be available. The CCBH emphasizes that the treatment with heroin can be implemented only under stringent conditions, this includes a state-of-the-art and accessible methadone maintenance treatment programme. Also treatment should be supervised and executed in separate treatment units which offer an adequate and state-of-the-art medical and psychosocial treatment. The financing of the treatment is a matter for attention. Since the future of the current treatment units is under consideration a decision would be appreciated at short notice. The CCBH is prepared to assist you in the development of these recommendations.

The Central Committee on the Treatment of Heroin Addicts,

Jan M.van Ree, chair