They receive heroin as medicine – does it help?

At two clinics in Oslo and Bergen, a small group of patients have been given a new treatment option for opioid addiction. Twice a day, they receive heroin as medication under close supervision from healthcare workers.

“With heroin-assisted treatment, patients receive medical heroin within a structured, interdisciplinary setting,” says Desiree Eide.

She is a researcher at the University of Oslo's Norwegian Centre for Addiction Research (SERAF).

The treatment, abbreviated as HAT, was offered to people with severe heroin addiction who had previously undergone addiction treatment that had not been sufficiently effective.

The standard treatment is opioid agonist treatment (OAT). Patients are given drugs such as methadone or buprenorphine instead of heroin.

“HAT is an offer for a small, highly burdened and vulnerable group, where ordinary OAT has not been sufficiently beneficial. HAT is typically not the first choice,” Eide says.

More than medication

The Norwegian Directorate of Health launched a national pilot project involving HAT. After four years, the programme has now been evaluated.

The evaluation concluded that it is not just the heroin medication itself that has an effect, but the whole treatment framework around it.

In addition to medication, patients receive medical follow-up and help with mental health problems, drug use and social challenges such as housing, finances, and social networks.

The aim is to improve patients' health, create more stability in their everyday lives, and reduce the number of fatal overdoses.

“Both patients and staff describe the treatment as 'more than a medicine.' They point out that the close, intensive monitoring is an important part of what works,” Eide says.

Measurable positive effects of HAT

Several patients describe the treatment as lifesaving. They say that HAT has meant a lot to them and has changed their lives for the better.

“We have not been able to measure mortality directly in this project, as there have been too few patients involved for such calculations to be adequate,” says Thomas Clausen, a professor at SERAF.

He nevertheless stresses that patients who enter drug treatment and become stabilised have a lower risk of dying from overdoses, partly because they use fewer narcotics.

“Many feel that this treatment has meant a lot and changed their lives positively. Those who offer the treatment have received good feedback. We also see that many people experience measurable positive effects from the treatment,” says Clausen.

Has led to gradual improvement in health and quality of life

The people who start HAT have complex problems. They have a severe, long-term substance abuse disorder, and have problems with both their physical and mental health.

Many of them are socially marginalised, have unstable housing situations, and have been unemployed for a long time.

“Among the most important things we see is how the treatment leads to a moderate and gradual improvement in health and quality of life for most people,” Clausen says.

At the same time, the picture is nuanced:

“Some say their life has been turned around, they have begun working, and describe their everyday life as completely changed. Others report more subtle changes, but still experience improvements after being in HAT,” he says.

The evaluation also shows that patients use less illegal heroin while they are in treatment, and they also report less criminal activity over time.

Not a lifelong solution, but a transition

HAT is not necessarily a permanent treatment for everyone. For many, the programme functions as a transition to ordinary treatment.

As many as 88 per cent of the patients who were discharged as planned went on to receive ordinary OAT.

“This suggests that HAT both stabilises patients and can act as a bridge to less intensive treatment,” Clausen says.

HAT reaches its target group, but is expensive

The HAT model, however promising, requires a lot of resources. The clinics have high staffing levels so that they can provide close monitoring throughout the treatment and to handle the patients safely.

Non-fatal overdoses were relatively common during the project period. Although these are serious incidents, they show that the treatment is reaching some of the most vulnerable patients.

It also suggests that overdoses are detected and managed within a controlled treatment environment instead of occurring on the street, where the outcome can often be more serious or, in the worst cases, fatal.

The treatment is also expensive, with a high cost per patient.

“Based on the evaluation, we do not recommend that the offer be expanded nationally. We consider it too expensive. We still believe that HAT is a relevant offer that should be continued in the two cities where it has already been established, and where, most likely, the most patients in need of this type of treatment reside,” says Clausen.

What will happen next?

The project was controversial when it began. The Norwegian Directorate of Health therefore asked SERAF to conduct a thorough evaluation of the project using several methods. The researchers were also asked to provide clear recommendations for the way forward.

The researchers have closely followed HAT throughout the entire period, from its inception until now.

“It's important that new treatment measures are thoroughly evaluated, so that we can learn more about what works and what doesn’t. Then the course can be adjusted if it's necessary,” says Clausen.

For the researchers, the discussion is no longer about whether the treatment works, but to what extent it should be implemented in Norway.

Eide notes that while they know HAT helps patients, how it should be implemented moving forward is a political question.

“The evaluation shows that HAT can be a beneficial and intensive alternative for a small group of people. But the future of the offer depends on how it's organised, how it's integrated with other services, and how it's weighed against the wider needs in drug treatment,” she says.

Reference:

Eide et al. Evaluation of heroin-assisted treatment in Norway (PDF), Norwegian Centre for Addiction Research Report, 2026.

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Read the Norwegian version of this article on forskning.no

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