Opiate Addicts ́ Attitudes Towards Heroin Prescription

Introduction: The competence of opiate addicts to give a valid consent to heroin prescription (HP) has been doubted in principle under the assumption that the pathological urge to use heroin would prevent them from reasonably weighing the pros and cons of HP. This study was done to test whether opiate addicts have a differentiated attitude towards HP which would be a basis for an individual decision to take part in HP. Methods: Opiate addicts were asked to voluntarily and anonymously fill out a questionnaire containing 18 statements pro or contra HP at various health care facilities. There was one question about their willingness to participate in HP. Results: 277 questionnaires were analyzed (methadone maintenance clinics [MMT] 44%, counseling offices 30%, lowthreshold institutions 26%). 56% of all clients wanted to take part in HP. 56% of the clients currently in MMT, but only 20% of the clients in the low threshold services rejected HP. Those who declined saw their chance to achieve abstinence reduced in HP compared to MMT. Patients who accepted endorsed statements such as not being able to abstain from the heroin "kick". Four of these statements predicted the HP decision in a binary logistic regression model, yielding a rate of 78% correct classifications. Discussion: The attitudes of opiate addicts towards HP cannot be reduced to unanimous and inconsiderate acceptance of HP, as rejections are frequent. Attitudes towards HP appear to be based on an individual evaluation of pros and cons, therefore, the consent of opiate addicts to HP should not be considered generally invalid.