Infectious diseases and public health: risk-taking behavior during participation in the Swiss program for a medical prescription of narcotics (PROVE).

The medically controlled prescription of narcotics program (PROVE) followed a uniform protocol from January 1, 1994 until December 31, 1996. The program included 800 slots for heroin prescription, 200 slots for intravenous methadone prescription, and 200 slots for intraveneous morphine. Admission criteria were age 20 and above, minimum 2-year duration of daily heroin consumption, failure in at least two previous treatments, and documented social and/or health deficits. There was a very high seroprevalence of hepatitis B (73%) and hepatitis C (82%) among the 1035 entrants. The rate of HIV (15%) was also high compared with prevalence of infection in other therapy programs (methadone program, inpatient therapy). The prevalence of HIV and hepatitis B/C increased with the duration of drug dependence and cocaine use. During treatment, use of street heroin and cocaine could be reduced substantially. After 18 months of continued participation in the program, 74% of patients reported no illegal heroin consumption, and the rate of cocaine abstinence increased from 15% at entry to 41%. Significant declines in visits to the drug scene, illegal income, and needle sharing were also observed. The high prevalence of HIV and hepatitis B and C confirm that a group of drug dependence with severe medical problems was reached in accordance with the admission criteria for the studies. During treatment, a significant reduction in risk-taking behavior was observed in a target population of heroin-dependent persons who failed in previous treatments.

HIV and hepatitis virus infections among injecting drug users in a medically controlled heroin prescription programme.

BACKGROUND: In Switzerland, 1,035 patients were accepted for admission to the medically controlled prescription of narcotics programme (PROVE) from 1 January 1994 until 31 December 1996. Heroin, methadone, and morphine were prescribed. This paper presents the prevalence and incidence of HIV and hepatitis B/C infections in the sociomedical context of the participants. METHODS: Admission criteria were a minimum age of 20 years, at least a two-year duration of daily heroin consumption, a negative outcome of at least two previous treatments, and documented social and health deficits as a consequence of their heroin dependence. The patients were examined at admission and every six months. A serological test was carried out at the same time for HIV and hepatitis B/C. RESULTS: Serological testing on admission could be performed in more than 80% of the entrants and documented a very high seroprevalence of antibodies against HBcore (73%) and HCV (82%). The prevalence of HIV and hepatitis B/C increased with duration of drug intake. In the follow-up analysis of seronegative individuals, a halving of the risk of viral hepatitis infection was shown when comparing the first six months with the period greater then six months after PROVE entry. CONCLUSION: The tests conducted showed high prevalence and incidence rates of HIV and hepatitis B/C among patients who had consumed intravenous drugs for years. The descriptive analysis in heroin-assisted treatment showed a reduction in infection risk for viral hepatitis corresponding to the lower risk behaviour of patients.

[Heroin-assisted treatment of opiate addicts--former and current research emphasis]. / Die heroingestützte Behandlung von Opiatabhängigen--bisherige und aktuelle Forschungsschwerpunkte.

Heroin-assisted treatment has been examined broadly in Switzerland since 1994 within the context of scientific studies. The goal was to clarify the suitability of this treatment for opiate addicts whom previous therapy had failed to reach. Results of the initial research phase show that the target group could be reached for treatment extending 18 months with a satisfactory retention rate of 69%. The patients could improve their health and social situation during treatment and reduce illegal consumption of narcotics. Studies during the initial years primarily examined the viability of heroin-assisted treatment and its effects on the patients' psychosocial and somatic development. A second study phase ongoing since 1998 pursues the specific importance of medical and psychosocial treatment for patients' health and social development in heroin-assisted treatment. The focal point is the effort to optimise treatment of patients with comorbidity of psychiatric disorders and severe somatic diseases, particularly AIDS. Investigations carried out in Switzerland have been discussed broadly at an international level. Studies on heroin-assisted treatment are also being conducted at present in various countries. In future, co-operation should be further intensified with researchers on an international scale.