The use of
heroin in Australia results in disproportionate harm. Although the evidence suggests that a relatively low proportion of the population aged 14 years and over have ever used (1.4%)
heroin or have used it in the past 12 months (0.2%),
heroin use remains a significant cause of death, injury, illness and social harm. Research demonstrates that being in treatment leads to less
heroin use, lowered mortality rates and reduced crime.
Pharmacotherapy treatment in Australia involves
methadone and
buprenorphine. Trial data used by Doran and colleagues are used in the current analysis to extend the original analysis of
methadone versus low-dose
buprenorphine to include high-dose
buprenorphine and the
buprenorphine-naloxone combination in the maintenance of
heroin dependence. Adopting a provider perspective suggests that the observed difference between the cost-effectiveness of
methadone and the other treatments was not statistically significant, indicating that high-dose
buprenorphine and the
buprenorphine/naloxone combination can provide a viable alternative to
methadone in the treatment of
heroin dependence. Wider treatment choices provide greater potential to recruit a larger proportion of regular dependent users and retain them in treatment for longer. The forthcoming introduction of
buprenorphine/naloxone to Australia provides an exciting opportunity to enhance the treatment of
heroin dependence in this country.