‘ Brown’ powder heroin began to arrive in the UK in the early 1980s and was increasingly popular among the young and unemployed. For working class people with an addiction there was only one solution – methadone. Photos:‘ Heroin screws you up’ – 1986 government posters. Contraband Collection / Alamy
workforce can then reach out to the most marginalised and disenfranchised users and be reminded that they have nothing to offer … bye bye.
Funding for HAT expansion has been precarious. For example, the Middlesbrough heroin assisted treatment
( MHAT) programme ran for three years until closing on the grounds of cost in 2022. There are currently HAT programmes in Scotland and the West Midlands, and there are also some‘ legacy’ patients scattered around who have managed to hold on to their diamorphine prescriptions.
It’ s tempting for advocates of HAT to argue the case primarily on the grounds of crime reduction. However, the UK is currently facing an epidemic of drugrelated deaths. HAT can reduce these deaths, lengthen lives and improve the quality of those lives. We can now access regular supplies of diamorphine in different formats that expand the offer and may reduce cost. As well as injectable diamorphine, there are 200mg tablets and a nasal spray.
HIGH RISK GROUPS One of the features of those at highest risk of premature death is recycling in and out of opioid substitution treatment( OST). For this group, methadone does not hold enough attraction to ensure retention and buprenorphine does not provide enough of an anxiolytic effect to treat a lifetime of trauma. Heroin is very effective at suppressing trauma-related feelings of being exposed, anxious and vulnerable.
Daniel Ahmed( right) and the Cleveland police and crime commissioner Barry Coppinger launched the Middlesbrough heroin assisted treatment( MHAT) programme in 2019. It ran for three years until closing on the grounds of cost. Photo: PA Images / Alamy
In March 2022 Scottish drugs policy minister Angela Constance visited the heroin assisted treatment programme in Glasgow and reiterated her intention to expand HAT services to other areas. Photo: @ scotgovhealth
This means that the most marginalised people who use drugs are not being offered suitable opioid agonist maintenance treatment( OAMT) options that would support them to move off street opioids. Harm reduction is undergoing a renaissance in the UK as we see the limits and dangers of forcing people out of treatment and into unwanted states of abstinence.
If we’ re serious about addressing drug related deaths, it’ s time for a new HAT.
Mark R Gilman is a consultant on substance use at Harm Reduction Research, Policy & Practice. He will be leading an interactive session at the DDN Conference on 10 July, www. drinkanddrugsnews. com / ddn-conference-2025 /
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