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.