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Review
. 1997 Nov-Dec;88(6):367-70.
doi: 10.1007/BF03403907.

The case for a heroin substitution treatment trial in Canada

B Fischer  1 , J Rehm
Affiliations
Review

The case for a heroin substitution treatment trial in Canada

B Fischer et al. Can J Public Health. 1997 Nov-Dec.

Abstract
in English, French

Illicit opiate use in Canada causes considerable harm and social cost. Methadone substitution treatment, which has been proven effective in reducing the negative effects associated with opiate use, has been used in Canada, but so far only on a small scale. Recent research suggests that, while expanding the availability of methadone substitution is certainly in the public health interest, it would not be sufficient in itself to reduce to a minimum the harms from illicit opiate use. On the basis of the epidemiology of opiate use and of related harms, and building on the experience of intervention efforts currently underway elsewhere, this paper argues for the establishment of a heroin substitution trial in Canada. Such a trial should have the goal of investigating the potential of heroin substitution to significantly reduce the health and social costs to Canadians from illicit opiate use.

La consommation illégale d’opiacés au Canada est responsable de méfaits considérables et d’un lourd fardeau social. Le traitement de substitution à la méthadone a fait ses preuves quant à son efficacité à réduire les effets néfastes associés à l’usage d’opiacés. On y a recours au Canada, mais à petite échelle seulement. Des recherches menées récemment laissent supposer que bien qu’il serait dans l’intérêt de la santé publique de multiplier le nombre de programmes de traitement à la méthadone, cette mesure serait insuffisante en soi pour réduire au minimum les méfaits causés par l’usage illégal d’opiacés. Le présent article plaide pour qu’un essai de traitement de substitution de l’héroïne soit tenu au Canada. Il est fondé sur l’étude de l’épidémiologie de l’usage d’opiacés et de ses méfaits, et des interventions mises de l’avant à l’étranger. Un essai semblable aurait pour objectif d’investiguer le potentiel de la substitution de l’héroïne à réduire considérablement les fardeaux sociaux et de santé liés à l’usage illégal d’opiacés au Canada.

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