Abstract

Opioid overdoses have dramatically increased throughout the past 20 years. Overdoses and other harms associated with the use of the unregulated opioid supply have resulted in a consortium of approaches to reduce drug-related harms, which for decades has included heroin-assisted treatment, although there remains widespread reticence to implement this approach in spite of ample evidence to support its effectiveness. Heroin-assisted treatment is often reserved for persons who have attempted standard opioid agonist treatments - such as methadone - unsuccessfully in order to be eligible for heroin-assisted treatment in countries and regions where available. To date, heroin-assisted treatment is only available in nine countries, mostly in Europe. Heroin-assisted treatment has higher retention rates than other forms of opioid agonist treatments, is cost-effective, reduces overdose morbidity and mortality, and improves public order. Nonetheless, regulatory structures impede its implementation. The present chapter herein presents further details of the evidence on heroin-assisted treatment and newer treatment modality iterations, such as injectable opioid agonist treatment and safe opioid supply programs.