Description:
<jats:sec><jats:title>Accessible summary</jats:title><jats:p><jats:list list-type="explicit-label">
<jats:list-item><jats:p>For some heron addicts, heroin‐assisted treatment is more efficacious than methadone treatment.</jats:p></jats:list-item>
<jats:list-item><jats:p>Seven European countries have implemented outpatient centres where patients self‐administer pharmaceutical heroin under close supervision.</jats:p></jats:list-item>
<jats:list-item><jats:p>Nurses deliver pharmaceutical heroin and supervise administration. The two main concerns are overdosing and smuggling.</jats:p></jats:list-item>
<jats:list-item><jats:p>Nurses are convinced of the utility of this treatment for severe heroin addicts.</jats:p></jats:list-item>
</jats:list></jats:p></jats:sec><jats:sec><jats:title>Abstract</jats:title><jats:p>Heroin‐assisted treatment (HAT) is a solution for improving the condition of treatment‐resistant heroin addicts. Since 1994, six randomized controlled trials have concluded that HAT is more efficacious than oral methadone for severe heroin addicts. We visited seven HAT treatment centres in four countries in order to observe diacetylmorphine (DAM) administration and to study the main concerns of the staff. Nurses were concerned by the risk taken if a previously intoxicated patient received his dose of DAM. Another concern was the smuggling of DAM doses. The HAT centres face a dilemma: treating patients while at the same time allowing their risky street habits in the centre.</jats:p></jats:sec>