Briefly Noted

Providing supervised access to pharmaceutical heroin to people whose use continues after trying multiple traditional treatments has been successful in other countries and should be piloted and studied in the United States, according to a RAND Corporation study released Dec. 6. “Given the increasing number of deaths associated with fentanyl and successful use of heroin‐assisted treatment abroad, the U.S. should pilot and study this approach in some cities,” said Beau Kilmer, leader of the project and co‐director of the RAND Drug Policy Research Center. “This is not a silver bullet or first‐line treatment. But there is evidence that it helps stabilize the lives of some people who use heroin.” The RAND findings appear in five related RAND publications and are based on experiences in other countries, including Canada, where Vancouver has that country's only heroin prescription. To assess the effectiveness of heroin‐assisted treatment and supervised consumption sites, RAND researchers reviewed scientific evidence and talked to more than two dozen stakeholders in Canada, the Netherlands, Switzerland and the United Kingdom to learn about their experiences with the approaches. They also spoke to more than 150 people in New Hampshire and Ohio, two states hard hit by opioid overdoses. The researchers found the documentation supporting supervised injection sites to be less solid than that supporting medical‐grade heroin provision. “Persistence does not imply effectiveness, but it seems unlikely that supervised consumption sites — which were initially controversial in many places — would have such longevity if they had serious adverse consequences for their clients or communities,” Kilmer said. For example, supervised consumption sites currently supervise a very small proportion of all injection sessions even in cities where they are well‐established. “It may even be worth asking whether the benefits of supervised consumption sites depend on there being a physical brick‐and‐mortar site, which may become a lightning rod for opposition, or if the key is just that consumption is supervised and whether there are other ways to get more opioid consumption supervised,” said Jonathan P. Caulkins, a report co‐author and a professor of public policy at Carnegie Mellon University. Caulkins said it also is possible that supervised injection of hydromorphone — a prescription opioid medication — may achieve similar benefits as offering supervised injectable heroin for those with heroin use disorder, but with fewer regulatory barriers in the United States, where heroin is illegal. The report, Considering Heroin‐Assisted Treatment and Supervised Drug Consumption Sites in the United States , is available at www.rand.org . Funding for the study was provided by RAND Ventures, which is supported by gifts from RAND supporters and income from operations.

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