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Pharmacodynamic and -kinetic properties of heroin in maintenance treatment for opioid dependence
Maintenance treatment with (co-) prescribed heroin for opioid dependent patients has generally been viewed as successful. However, there are some problems related to the pharmacological nature of DAM. These comprise the following:
Very few is known about the respective effectiveness of different application forms (IV, PO, IM), and of combined treatment with methadone
IV heroin produces transient but pronounced decreases in (cortical) hemoglobin oxygenation in a large part of patients even if subjects are accustomed to their dose. This might be causative for different neurological sequelae increasingly reported from street heroin users
Heroin maintenance might lead to endocrine changes resulting in a blunted libido, infertility, and osteopenia or -porosis
Heroin might lead to cardiac consequences (e.g. arhythmias)
These problems (and others) need to be clarified before maintenance with heroin can be recommended as a routine treatment.