Heroin-assisted treatment (HAT) was introduced in Oslo and Bergen in 2022, as a new treatment option for people with severe, long-standing opioid dependence for whom existing interventions have not provided sufficient benefit. HAT offers supervised intake of pharmaceutical heroin (diacetylmorphine) within a structured, multidisciplinary program with twice-daily dosing and access to medical and psychosocial follow-up. The evaluation, led by SERAF at the University of Oslo in collaboration with RusForsk, the Addiction Clinic at Haukeland University Hospital, and the user organization ProLAR Nett, has followed patients, services, and outcomes over four years.

The findings show that HAT has recruited a small, vulnerable group and contributed to gradual improvements in health, substance use, and self-reported criminal involvement for many participants. At the same time, the treatment is resource-intensive, with a high staff to patient ratios and per-patient costs.

The report concludes that HAT provides positive results for patients, but can be an intensive option for a narrow patient group and recommends continued operation in Oslo and Bergen with the exploration of closer integration into the existing treatment services for OAT, aiming at cost-reductions. At the same time the report warns against reducing the content and quality of the treatment, as the resource intensive approach, with sufficiently high qualified staff, and the structured program, is also what has supported the observed improvements among the patients.

Based on international trends and treatment demand in the past 4 years, it is expected that the future treatment demand for HAT may be decreasing, rather than increasing. In the report it is therefore also proposed to develop “enhanced addiction outpatient services” that build on key elements of the HAT model, for a broader patient group, but which more flexibly can adapt to changing drug use patterns and complex patient needs, than what the current HAT clinics do. This would mean aiming intensified clinical resources towards function levels and needs, rather than specific substances, such as heroin. 

The report concludes that HAT has beneficial effects for patients who remain in treatment over time, and the report provides an evidence-based foundation for decision-making. Decisions about the future of HAT in Norway must be made at the system and political levels, where priorities and the use of resources in OMT and the broader substance abuse field are viewed in context.