Does Prescribing Heroin to Heroin Addicts Reduce Heroin-related Crimes?

Heroin (opiate) overdose has long been a major cause of overdose-related deaths. Many European countries conduct Opiate Substitute Treatment (OST) on heroin addicts, and have received significant success. The traditional OST prescripts methadone or buprenorphine as replacement drugs to heroin addicts. A problem with the traditional treatment is that patients heavily addicted to heroin sometimes have no reaction the replacement drugs and tend to drop out of the program.

A study released in 2009 shows that treating heroin addicts with heroin prescription is more effective than methadone treatment. Later that year, Germany legalized heroin-assisted treatment and included the new OST into their mandatory health insurance. However, despite the positive result of the study, not many countries in Europe have taken the same action. Does the legalization of prescription heroin actually have significant effect on heroin-related crimes? Or does the idea of treating heroin addicts with heroin somehow increase people’s incentives to use the drugs? To find out the answer, I compared heroin-related law offences in Germany and Italy before and after 2009, when the heroin-assisted treatment was legalized in Germany.

I collected the data from European Monitoring Centre for Drugs and Drug Addiction, which publishes annual European Drug Report and has the most comprehensive drug-related data for Europe. The data ranges from 2004 to 2012. It started 5 years before the legalization of heroin-assisted treatment. Hopefully it can provide some evidence of common trends for the two countries I chose. The data ends at 2012, 4 years after the new policy was enacted. The time range should be long enough for us to observe the effect of the policy. 

The study is designed to be a difference-in-difference research. I chose Italy as a control group in comparison to Germany mainly for two reasons. First, the two countries had close rates of heroin-related crimes before 2009 as shown in Figure B below. There were only slight changes in heroin-related offences rates in both countries before 2009. For Germany, however, the percentage started to drop at a comparatively greater rate after 2009.

Source: European Monitoring Centre for drugs and Drug Addiction

Second, both countries have traditional OST programs and they use similar substitute drugs—methadone, buprenorphine, and buprenorphine-naloxone combination. Germany and Italy also have similar regulation towards prescription of these replacement drugs. Both doctors in specialized drug treatment centers and any other medical doctors can prescript replacement drugs. In most European countries that also have OST, only doctors in specialized treatment programs are allowed to do so.

 Table 1. Average Effect of Legalization of Heroin Substitute Treatment

on Heroin-related Offences in Germany

DV: Heroin-related Offences	Pre-Treatment	Post-Treatment	Difference
Germany	30879.99	21098.75	-9781.24***
Italy	8893.8	10032	1138.2
Difference	21986.2***	11066.75***	-10919.45**

Note: Differences-in-differences estimates. *, **, *** indicate statistical significance at the 10%, 5%, and 1% level respectively.

Source: European Monitoring Centre for drugs and Drug Addiction

Table 1 shows the average effect of legalization of heroin substitute treatment on heroin-related offences after comparing data from Germany and Italy in 2004-2012. I estimate that the new OST program reduced, on average, 10919.45 cases of heroin-related crime, as the data indicates. The finding is statistically significant (p<0.01), meaning that there is less than 1% possibility that the observed effect happened purely by chance.

The positive effect of legalization of heroin-assisted treatment on heroin-related crimes may be explained two different views. First, the heroin substitute treatment is more effective than the traditional OST program and less patients relapse after the treatment, resulting in less demand of the heroin market in Germany. However, the observed effect could also happen because the new program created legal access to heroin, and thus the illicit business started to shrink. It is true that the legal heroin is only meant for treatment purpose, but it is hard to determine whether the prescription heroin is used elsewhere.

I would also like to address two potential problems with the research. First, the observations in the research are not large enough due to limited data. The finding should be more persuasive if there is comparative information at sub-national level, like heroin-related crime rates at county level. Second, the heroin-related offences include heroin trafficking, which is mostly cross-border criminal activity. The legalization of heroin-assisted treatment in Germany could have direct effect on the drug market in Italy, and it requires further research to determine the actual effect. 

Appendix

Table 1. Summary Statistics

	Mean	Std. Dev.	Min.	Max.	Description
Germany (Cases)	26532.78	6523.35	13902	33493	Number of cases of heroin-related offences in Germany from 2004-2012
Germany (%)	11.23	2.29	6.3	12.6	Percentage of heroin-related offences in all drug law offences in Germany from 2004-2012
Italy (Cases)	9399.67	1335.55	7481	11142	Number of cases of heroin-related offences in Italy from 2004-2012
Italy (%)	12.61	1.23	10.9	14.5	Percentage of heroin-related offences in all drug law offences in Italy from 2004-2012
Year	N/A	N/A	2004	2012	Year of heroin-related offences
Pre	N/A	N/A	0	1	Dummy variable (1 before 2009)
Post	N/A	N/A	0	1	Dummy variable (1 after 2009)
Treat	N/A	N/A	0	1	Dummy variable (1 if Germany)
Control	N/A	N/A	0	1	Dummy variable (1 if Italy)
Observations	18

 Sources: European Monitoring Centre for Drugs and Drug Addiction (www.emcdda.europa.eu)