ABSTRACT
Treating dependence with the drug of dependence may seem like an odd
notion, but has, in fact, been practiced for some dependencies since the
early 1900s. Most documentation of these initial practices comes from
the United States of America and the United Kingdom.1,2 Diamorphine
(pharmaceutical heroin) prescribing became illegal in the US after
19191 and fell out of favor in the UK in the late 1960s.3 The advent of
HIV/AIDS in the 1980s provided a stimulus for re-examining diamorphine
prescription.4,5 This was in response to recognition that unsafe injecting
practices placed illicit drug users at heightened risk of contracting
HIV/AIDS, and also that getting users into treatment markedly reduced
unsafe practices. Interest in diamorphine prescribing has also come from
those who have advocated innovation in drug treatment and policy. While
other short-acting opioids, such as morphine, codeine, and fentanyl, and
other injectables, such as injectable methadone, have also been suggested
as possible treatments and used in some countries, the focus of this
review will be on diamorphine, as considerable evidence on this treatment
option has been amassed in recent years.
