Substitution therapy for heroin addiction

James Bell*, Alain Dru, Benedikt Fischer, Shabtay Levit, M. Aamer Sarfraz

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

34 Scopus citations


Substitution treatment for heroin addiction, defined here as maintenance prescribing of opioid agonist drugs to opioid dependent subjects, has increased in the last decade. The recent history of substitution treatment in five countries-Canada, the U.K., Australia, Israel, and France-is reviewed. In all five countries, the critical issues around substitution treatment are similar. The first key issue concerns the balance between making treatment accessible and attractive, and minimizing diversion to the black market. The second issue concerns the role of primary health care in delivering MMT. In general, there has been increasing involvement of primary health care, with training and support for practitioners. However, there remains uncertainty and official ambivalence over whether treatment should be restricted to specialist clinics and practitioners, or available through primary care. Most importantly, underlying these issues is the problem of stigma being associated with both addiction, and with substitution treatment. The underlying problem that treatment is often at odds with community values places enormous strains on substitution treatment, and makes the treatment system vulnerable to shifting community support and abrupt, politically-driven changes in policy.

Original languageAmerican English
Pages (from-to)1149-1178
Number of pages30
JournalSubstance Use and Misuse
Issue number8-10
StatePublished - 2002
Externally publishedYes


  • Buprenorphine
  • Heroin
  • Methodone
  • Substitution treatment


Dive into the research topics of 'Substitution therapy for heroin addiction'. Together they form a unique fingerprint.

Cite this