[Medical ethics of heroin prescription by physicians]

Due to increasing public health and social issues as secondary problems of opiate dependence (e.g. mortality, risk of HIV- and hepatitis infection, high rate of criminal activities) heroin prescription to opiate addicts has been suggested. Scientific data do not yet allow a solid evaluation of this treatment. As generally accepted, the main criteria for an ethical evaluation of new treatments are a) beneficence (duty to help patients further their important and legitimate interests), b) respect for the patient's autonomy and c) social justice in the allocation of the limited resources of the health care system. Ethical problems of heroin prescription relate to the differentiation between medical concern for the individual patient's health and the public interests in reducing social problems, the problematic capability of addicts of a balanced evaluation of heroin prescription and economic considerations of the costs of heroin prescription in comparison with other forms of treatment of opiate addiction, especially methadone maintenance treatment.