ARTICLE ORIGINAL New aspects in the treatment of heroin dependence with special reference to neurobiological aspects Dieter Ladewig 1 *, Kenneth M. Dürsteler-MacFarland 1,2 , Erich Seifritz 1 , Christoph Hock 3 , Rudolf Stohler 2 1 Department of Psychiatry, University of Basel, Wilhelm Klein-Strasse 27, CH-4025 Basel, Switzerland; 2 Department of Psychiatry, University of Zürich, Militärstr. 8. CH-8021 Zürich, Switzerland; 3 Department of Psychiatric Research, University of Zürich, Lenggstrasse 31, CH-8029 Zürich, Switzerland (Received 31 January 2001; accepted 15 May 2002) Summary – The Swiss trials on medical prescription of injectable diacetylmorphine (pharmaceutical heroin) for “severe” heroin dependence provoked very controversial commentaries. Despite methodological shortcomings, the evaluation of the Swiss heroin trials yielded some interesting findings. Study participants showed substantial improve- ments in health and well-being and noticeable declines in illicit drug use and criminal activities. Heroin prescription may thus be helpful for some of those who continue to regularly use illicit heroin while maintained on methadone or who refuse other available treatment options. However, research-based evidence suggests that the intravenous (IV) application of heroin under medical supervision may have untoward side effects. Recent studies have shown that heroin injections produce transient, but significant decreases in systemic and cortical oxygenation most likely secondary to respiratory depression. Among others, these effects are the subject of ongoing studies. © 2002 Éditions scientifiques et médicales Elsevier SAS Heroin / IV maintenance treatment / Neurobiology / Deoxygenation / Near-infrared spectroscopy INTRODUCTION The Swiss trials on medically prescribed injectable heroin for chronic and treatment-refractory heroin- dependent individuals were conducted between 1994 and 1996. Afterwards, intravenous (IV) heroin pre- scription became a regular treatment option for long- term heroin dependence. The primary goals of the Swiss heroin trials were: – to offer a treatment option for those heroin- dependent individuals who could not benefit from or be reached by existing treatment options; – to improve the physical and social conditions of the participants, including the reduction of risk-taking behaviour as a first step towards abstinence; – to collect useful information about the effects of narcotics and their suitability for therapeutic purposes. SUMMARY OF THE OUTCOMES OF THE SWISS HEROIN TRIALS The Swiss heroin trials were evaluated with regard to a wide range of aspects, including parameters of illicit drug use, somatic and psychiatric health, criminal *Corresponding author. Tel.: +41-61-325-5132; fax: +41-61-325-5583. E-mail address: dieter.ladewig@pukbasel.ch (D. Ladewig). This article was presented at 5th AEP symposium, November 13-14, 1999, Strasbourg, France. Eur Psychiatry 2002 ; 17 : 163-6 © 2002 Éditions scientifiques et médicales Elsevier SAS. All rights reserved S0924933802006442/FLA