safer injecting facilities and HAT.
The drug consumption room immediately stumbled into difficulties
over its legality – ‘we needed to make a case for it within the existing legal
system’, which involved talking to Westminster. Meanwhile the drug-related
deaths crisis was escalating, so an interim plan looked at implementing HAT.
‘We wanted to show we were offering a whole range of interventions,
not just HAT,’ said Priyadarshi. ‘So we based the service in Glasgow city
centre in the building of a homeless service.’ It was refurbished to be
‘clinically effective’ and to also ‘reassure the Home Office that we were
running a professional and safe service’.
Referrals came from the homeless addiction team and the criteria related
to real life, he explained, unlike the stringent criteria of the RIOTT trials, which
required being abstinent –‘we wouldn’t be able to recruit a single person!’.
With a pre- and post-injection assessment, injecting takes place twice a
day in one of four booths. Crucially, while they are there visitors are offered
injecting equipment, wound management and naloxone. In the pharmacy
at the back of the EDTS, the controlled drug cupboard is operated by
fingerprints and monitored by CCTV, and there is a research and evaluation
programme running alongside the service. ‘We’ve gone overboard to show
we have safe procedures,’ he said.
The first patients – all with ‘severe and multiple disadvantages’ began
treatment last December. Their two doses a day at 300mg-400mg have
achieved stabilisation, during which they were introduced to wraparound
services, including the BBV and mental health teams. Their immediate
health and welfare needs were assessed, with the offer of help with
everything, from housing to looking after their toenails.
Outcomes evaluation so far shows a ‘very promising treatment option’,
particularly for people who have been going in and out of prisons and
hostels for years. Also, crucially for its chance of sustainability, it shows
that the service has already recouped the spend through saving on hospital
admissions, multiple arrests and all the other costs that accompany a
‘complex needs population’.
Meanwhile the North West of England is equally desperate to change its
reputation of having the highest number of drug-related deaths in England.
At the end of February, a team from Middlesbrough proudly announced ‘life
changing’ early findings from their 12-month pilot HAT programme, which
has been running since October 2019.
Twice a day, seven days a week, the 11 participants come to a facility
at the GP practice to inject a dose of medical grade diamorphine, under
the supervision of trained staff. They are then offered access to a range of
‘Julie’: This has given me a life
When I got the phonecall to be
on the programme I refused first
of all. I thought it would be like
another methadone treatment
– get put on it and then 15 years
down the line still be on it.
I was a big shoplifter and doing
a lot of drugs – I just thought it
wouldn’t work. I just can’t believe
how quickly it has worked. I don’t
touch the heroin at all, and I was
doing it for 20 years.
This course has given me a
life. I have disrupted my kids’
lives a lot through the drugs, and
my husband’s life. This is my last
chance and I know I’m on the
This by itself wouldn’t have
worked but everything with it,
it’s working a dream. It’s not just
the two doses a day – it’s much
more than that. The nurses who
are there with us, you can speak
with them anytime and it helps
‘This course has
given me a life.
This is my last
chance and I
know I’m on the
right path... at first
it was scary but
we work together.’
a lot. They’re there with you.
At first it was scary for
everyone, but now we all work
together, it’s a team. This is just
the beginning – I’m not even
close to being recovered yet. It’s
a scary little ride that I’m on, but
I’m strapped in.
MARCH 2020 • DRINK AND DRUGS NEWS • 9