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Archived Comments for: Policy makers ignoring science and scientists ignoring policy: the medical ethical challenges of heroin treatment

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  1. Policy makers ignoring science not only in Canada: Current State of Heroin-assisted treatment for opiate addicts in Spain.

    Eugenia Oviedo-Joekes, Andalusian School of Public Health

    16 May 2006

    Dr. Small analysis addresses key issues that concern all those involved with the real protagonists of opioid addiction. As the article well said, we have more than enough evidence on the efficacy and feasibility of medical prescription of injected diacetylmorphine in the treatment of opioid-dependent people who do not benefit for the available therapies. Nevertheless, even having that international evidence, Governments say: More trials are needed due to context differences. It is not a contradiction to propose randomized controlled trials (RCT) to ‘control’ context differences? Should not be those differences assessed with more ‘pragmatic’ research designs? After the heroin RCT in Andalusia, the Spanish Minister of Health, denied the approval of the treatment because: "The small sample size does not allow endorsing any action to be generalized" (Newspaper El Mundo, Wednesday 9 of March of 2005, page 25).

    It is crucial and urgent to extend the pharmacologic alternatives in the treatment of opioid-dependency, in order to provide a more flexible and individualized intervention. Yes, with evidence based medicine, but RCT is not the only way to obtain such evidence. The Autonomic Governments of the Basque Country and Andalusia (among others) openly support the heroin prescription. Not to evaluate their efficacy and feasibility (widely proven), but their effectiveness: i.e. pilots programs who allow knowing how, for whom and in what conditions the heroin can be prescribed. However, the Spanish Ministry of Health denies all type of studies that are not a RCT. The heroin prescription is arriving 10 years late, and the Governments should promote and facilitate the implantation of this and other treatments for opioid-addiction among the Public Health Care System, without greater delay. The high mortality rates among the affected cohorts, related to illegal use and the co-morbidity that this situation carries (i.e. HIV, HCV), underline the urgency of this implementation.

    Eugenia Oviedo Joekes


    Andalusian School of Public Health

    Ioseba Iraurgi Castillo, MPH

    MAPs Rekalde - Mental Health Service

    External Consultant of Drug Dependence Office of Basque Country Government

    Emilio Perea Milla


    Chief of Research Department. Costa del Sol Hospital.

    Competing interests

    None declared