Heroin-Assisted Treatment

Heroin-assisted treatment (HAT), refers to the prescription of pharmaceutical-grade heroin (diacetylmorphine) to people with severe heroin use disorders who have not responded well to more traditional forms of treatment like methadone or buprenorphine. Typically, clients are provided injectable or inhalable heroin 2-3 times per day by prescription, and they consume it on-site in a medically-supervised clinic setting. Some of these programs also provide access to hydromorphone (known by brand name Dilaudid®) as an option to patients. In clinical research trials, participants preferred heroin or hydromorphone equally.

HAT provides legal access to pharmaceutical-grade heroin in order to prevent patients from buying it on the illicit market where it may be adulterated, or mixed, with unknown drugs or substances. Patients are given access to harm reduction interventions, connections with substance use disorder treatment and medical services, and social supports such as housing assistance. 

HAT is available in six European countries - Denmark, Germany, Luxembourg, the Netherlands, Switzerland, and the UK - and in Canada.

Drug user activists in Vancouver, British Columbia, Canada have been advocating for a “safe supply” of illicit drugs for years, and they recently secured a victory in light of COVID-19. People who use drugs are now able to receive prescriptions for opioids and stimulants instead of engaging with illicit drug markets where they are at higher risk of contracting COVID-19. Watch our COVID-19 discussion on Regulation and Safe Supply to learn more.

Benefits of HAT

Over a decade of research of existing programs has established the positive impacts of HAT, including:

  • Improved health, social functioning, and quality of life
  • Reduced overdose risk
  • Reduced use of illicit heroin and other drugs
  • Improved treatment retention
  • Reduced crime
  • Reduced demand and drug markets
  • Cost-effectiveness

Barriers to HAT

No HAT programs exist in the U.S. due to a host of political and ideological barriers, including: 

  • Stigma and lack of information among clinicians, treatment providers, the public, and patients about the efficacy of the approach
  • Regulations and policies that make it difficult for clinicians to prescribe controlled substances 
  • Challenges with insurance coverage and pharmaceutical dispensing of controlled substances

There can be a lack of community support based on fears that HAT will cause an increase in drug use and crime. These fears are unfounded. In areas surrounding existing HAT sites, there has been no evidence of increased community drug use, initiation of injection drug use, or drug-related crime. Instead, research has shown that HAT actually decreases these.

How DPA is Fighting for HAT

The Drug Policy Alliance has been advocating for HAT pilot programs in the U.S. for many years. While gaining acceptance for a U.S. facility will be an uphill battle, we are committed to challenging the stigma surrounding drug use and introducing political leaders and the public to the health and societal benefits that HAT programs bring to local communities.

Drug Treatment