TREATMENT
Heroin Assisted Treatment (HAT)
is showing dramatic progress in
transforming lives. DDN reports
‘L
ife was shit. I would rob Peter to pay Paul. I’d cry every day
and was at rockbottom, living on people’s settees, doing
drugs whenever I could.’ ‘Julie’, Middlesbrough, 2020
If Julie was living in middle class society in Britain before
the 1960s she might have been prescribed heroin for her
addiction problem. Until the Dangerous Drugs Act of 1967,
this was seen as a suitable treatment, but overprescribing by doctors and
diversion to illicit markets changed all that.
The preferred treatment became newly developed oral methadone – a
more comfortable option for doctors and clinics to prescribe, as it was
specifically for ‘addicts’. Via the Misuse of Drugs Act 1971, heroin became
class A – among the most ‘dangerous’ drugs.
The new wave of heroin use in the ’80s spread throughout Europe,
accompanied by the spread of HIV and AIDS. While Britain was an early
adopter of harm-reduction measures including needle exchange, oral
methadone was established as the main form of maintenance prescribing.
Switzerland tried a different approach to harm reduction, and in the early
1990s the government allowed a new heroin assisted treatment model –
HAT. The idea was to offer a reliable supply and clean injecting equipment,
and to combine it with healthcare and access to services. The medical grade
heroin was seen as the best incentive to engage people with treatment.
The first Swiss HAT clinics opened in 1994 as part of a three-year trial,
which was then expanded with public support. Participants’ health was
found to have improved significantly
– and crucially for the viability of the
project, their criminal activity had
decreased, giving net savings on the
cost of their treatment. Members
of the public were keen to see the
programme continue as it reduced
drug use on the streets, while
medicalising heroin had the added
benefit of reducing its appeal to
young people.
By 2009 Germany and the
Netherlands had conducted their
own trials and included HAT in
their health systems. A German
study showed significant long-
term improvements in mental and
physical health after two years, and
8 • DRINK AND DRUGS NEWS • MARCH 2020
A HELP
the EMCDDA concluded that HAT
could lead to ‘substantially improved’
health and wellbeing.
A decade later, the year-on-year
increase in drug-related deaths
has prompted the UK to reconsider
the evidence. At the RCGP/SMMGP
conference in January, Dr Saket
Priyadarshi explained that HAT had
been incorporated into Glasgow’s
new Enhanced Drug Treatment
System (EDTS).
‘We’ve been making the case for a
long time without getting traction
politically,’ he said. The game
changer had been an outbreak of
HIV, where the common factors
were injecting heroin and cocaine in
public spaces. A report, Taking away
the chaos, led to a formal health
needs assessment and brought in
the international evidence – and
among the recommendations were
‘The participants
had committed 943
crimes that were
detected at a cost of
£3.7m – you can see
how the arguments
stack up in support
of this scheme.’
PCC Barry
Coppinger
‘James’ talks to BBC Tees reporter
Andy Bell: ‘This might not work
for everyone, but it’s worked for
me and for the other people on
the programme. There’s not many
of us on it but it’s the chance of
a lifetime and you can see the
difference in everyone.’
WWW.DRINKANDDRUGSNEWS.COM