Pharmacopsychiatry 2003; 36 - 280
DOI: 10.1055/s-2003-825523

Pharmacodynamic and -kinetic properties of heroin in maintenance treatment for opioid dependence

R Stohler 1
  • 1Psychiatric University Clinic, Zurich, Switzerland

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.