of the questions I often get asked is why Middlesbrough , and why now ?’ said Daniel Ahmed , clinical partner at specialist GP practice Foundations and who runs England ’ s only diamorphine treatment programme in Middlesbrough ( DDN , December 2020 / January 2021 , page 4 ). ‘ We ’ ve got a perfect storm .’ Not only was Middlesbrough the most deprived local authority in England , it also had the country ’ s highest number of heroin users per head of population and high rates of drugrelated deaths .

The average age of patients at Foundations was 38 , he said , ‘ so a relatively young group of people . But their prevalence of significant health conditions is staggeringly increased compared to the national average . We ’ re looking at medieval levels of life expectancy within this patient population , which is why we need to be exploring all the available treatment options to support the complex needs of this group .’

In preparation for the diamorphine-assisted treatment programme , he and his colleagues had looked at around 20 people who had been ‘ caught in a cycle of failure to benefit from treatment ’, sometimes for decades . Managing the group through the criminal

justice system alone cost around £ 2m , he said – a cost that ‘ wasn ’ t improving the outcomes of anyone involved ’.

All of this meant there was an argument for addressing their needs in a different way , and there was strong evidence that supervised diamorphine as a second-line medication for people failing to benefit from treatment was highly effective . The principle was the same as in any other area of medicine , he said . ‘ If you ’ re treating someone with an antibiotic and it fails to benefit , you might change it for one that ’ s a bit stronger and more targeted .’

The team began a programme of engagement with the public and media to share the evidence and explain why the intervention was needed . ‘ It was relatively successful , although the Daily Mail approached a number of our neighbours and suggested we were giving away free heroin .’ In fact , a key early mistake had been use of the word ‘ heroin ’, he said . ‘ It has connotations for the public , other professionals and patients , so we ’ ve moved to “ diamorphine-assisted treatment ”.’

Funding was initially secured to treat 20 people , with the programme going live in October 2019 . People turn up twice a day , seven days a week , requiring a huge level of commitment , he

said , and the service was currently funded for ten people . ‘ Their drug use is stable , and their treatment concordance is excellent .’ However , the clinic was still in discussions around what level of funding it would receive to continue the work . ‘ This is where we ’ re coming across some interesting attitudes in senior public health figures . I think there are some really ingrained negative perceptions about the programme , and the argument that all treatment interventions need to be targeted at a large population .’

The programme was under constant independent evaluation , he said , ‘ and we have no problem with that because it just adds to

Daniel Ahmed ( right ) and the Cleveland police and crime commissioner Barry Coppinger launched the UK ’ s first heroin assisted treatment pilot in Middleborough , in 2019 . Credit : PA Images .

the body of evidence .’ Research by Teesside University found that some people were stabilising more quickly than expected and soon asking to be moved from two to one dose a day , with some successfully finishing treatment . ‘ They ’ re completely drug-free and looking at being an ambassador for the wider treatment system .’

Chrisp543 | Dreamstime . com

22 • DRINK AND DRUGS NEWS • APRIL 2022

WWW . DRINKANDDRUGSNEWS . COM