Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Mar 11;18(1):15.
doi: 10.1186/s13722-023-00367-0.

Feasibility, safety, and acceptability of intranasal heroin-assisted treatment in Switzerland: protocol for a prospective multicentre observational cohort study

Jean N Westenberg  1   2   3 , Maximilian Meyer  1   2 , Johannes Strasser  1 , Michael Krausz  2 , Kenneth M Dürsteler  1   4 , Luis Falcato  5 , Marc Vogel  6
Affiliations

Feasibility, safety, and acceptability of intranasal heroin-assisted treatment in Switzerland: protocol for a prospective multicentre observational cohort study

Jean N Westenberg et al. Addict Sci Clin Pract. .

Abstract

Background: Heroin-assisted treatment (HAT) is a proven effective treatment option for individuals with severe opioid use disorder (OUD). In Switzerland, pharmaceutical heroin (diacetylmorphine, DAM) is available in tablet form or as injectable liquid. This creates a large barrier for individuals who require the rapid onset of effect but are either unable or do not want to inject, or who primarily snort opioids. Early experimental data has demonstrated that intranasal DAM administration can be a viable alternative to the intravenous or intramuscular route of administration. The purpose of this study is to assess the feasibility, safety, and acceptability of intranasal HAT.

Methods: This study will assess intranasal DAM using a prospective multicentre observational cohort study design in HAT clinics across Switzerland. Patients will be offered to switch from oral or injectable DAM to intranasal DAM. Participants will be followed-up over 3 years, with assessments at baseline, and after 4, 52, 104 and 156 weeks. The primary outcome measure (POM) is retention in treatment. Secondary outcomes (SOM) include prescriptions and routes of administration of other opioid agonists, illicit substance use, risk behaviour, delinquency, health and social functioning, treatment adherence, opioid craving, satisfaction, subjective effects, quality of life, physical health, and mental health.

Conclusions: The results derived from this study will generate the first major body of clinical evidence on the safety, acceptability, and feasibility of intranasal HAT. If proven to be safe, feasible and acceptable, this study would increase the accessibility of intranasal OAT for individuals with OUD globally as a critical improvement in risk reduction.

Keywords: Diacetylmorphine; Heroin; Observational study; Opioid use disorder; Prospective study; Protocol.

PubMed Disclaimer

Conflict of interest statement

MV has received consultation and speaker fees from Camurus. The other authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Barrel and mucosal atomisation device for IN DAM administration
See this image and copyright information in PMC

References

    1. Nordt C, Vogel M, Dey M, Moldovanyi A, Beck T, Berthel T, et al. One size does not fit all—evolution of opioid agonist treatments in a naturalistic setting over 23 years. Addiction. 2019;114(1):103–111. doi: 10.1111/add.14442. - DOI - PubMed
    1. Strang J, Groshkova T, Uchtenhagen A, van den Brink W, Haasen C, Schechter MT, et al. Heroin on trial: systematic review and meta-analysis of randomised trials of diamorphine-prescribing as treatment for refractory heroin addiction. Br J Psychiatry. 2015;207(1):5–14. doi: 10.1192/bjp.bp.114.149195. - DOI - PubMed
    1. Strasser J, Vogel M. Die Zukunft der heroingestützten Behandlung aus klinischer Sicht in der Schweiz [The future of heroin assisted treatment from a clinical point of view] Suchtmedizin Forschung Praxis. 2013;15(5):274–279.
    1. Vogel M, Strasser J. Alternativen in der Behandlung mit im Zentralnervensystem rasch anflutenden opioiden. Suchtmedizin. 2017;19(5):267–274.
    1. Dürsteler-MacFarland KM, Vogel M, Wiesbeck GA, Petitjean SA. There is no age limit for methadone: a retrospective cohort study. Subst Abuse Treat Prev Policy. 2011;6(1):9. doi: 10.1186/1747-597X-6-9. - DOI - PMC - PubMed

Publication types