Drink and Drugs News DDN March 2020 | Page 8

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