Opioids are drugs naturally derived from the opium poppy plant, or synthesised in a lab, and are generally used for pain relief. Due to their addictive nature, there have been and still are opioid addiction epidemics in various countries such as the US and England. Although patients may be admitted to rehabilitation centres, a less popular method known as heroin-assisted treatment (HAT) is becoming increasingly prevalent with trials undergone in six regions over the past 15 years: UK, Switzerland, the Netherlands, Germany, Spain, and Canada. As of current, there are several counties such as Denmark and the Netherlands with official HAT schemes but trials in England are still under process.
After it was identified that the drug-related death rate in Middlesbrough had doubled from 23 people in 2011-13 to 48 people in 2016-18, it was decided that this issue had to be targeted. 15 people were chosen to participate in the trail, all of which had addictions which were either harmful to society, or relatively unaffected by other forms of treatment such as methadone maintenance treatment.
Methadone Maintenance Treatment
Methadone is also an opioid drug, but its effects are longer-lasting than heroin meaning it can be taken less frequently for a similar effect to be achieved. The aim of this treatment is to maintain an intake level before removing the reliance on opioids completely, which involves taking a pill or liquid to prevent withdrawal symptoms whilst reducing cravings. There are several benefits presented by this treatment including; a lower risk of HIV transmissions due to oral intake, the opioid will have a known purity so is safer and there would be less petty theft as this is a free programme for participants.
The mechanism of methadone involves mimicking the endorphin peptide hormones which are responsible for reducing pain and enhancing pleasure in the brain. In this way, its side effects are similar to those of opioids but due to the increased time taken to enter and leave the body, the euphoric sensations are lower than when taking heroin.
Heroin Assisted Treatment
A common belief before the introduction of this seemingly counter-intuitive scheme, in multiple nations, was that it would lead to an increase in overdose-related deaths but this was not the case. Switzerland was the first nation to introduce this scheme, meaning that they had to collect data to present to the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) before this commenced.
Since the introduction of the four drug pillars in 1994, including the legalisation of the HAT scheme, the results and data have been extremely promising; there have been fewer new drug users, overdose related deaths have decreased by 64 percent, HIV infections dropped by 84 percent, home thefts dropped by 98 percent, and the Swiss prosecute 75 percent fewer opioid-related drug cases annually. Although there are high costs associated with this scheme, mainly due to the staffing and 365-day opening times, this makes up for the large sum no longer invested in incarcerating individuals repeatedly for theft and illegal drug use. 
Inspired by the results of this scheme, Danny Ahmed proposed this was introduced in Middlesbrough due to it having one of the highest drug-related mortality rates in England. The 15 proposed participants were trapped in a cycle of drug use and incarceration (caused by a lack of money to fuel their drug addiction) and this affected their quality of life immensely, as well as the community. Unfortunately, 5/15 people declined to participate as they did not feel they could commit to visiting so often but for all 15 ‘cycles’, this cost an estimated £2m when considering the social services used, prison funds and profit lost by shop owners.
This trial started in late 2019 and was proposed to continue for 12 months, but due to the success already observed a further 12 months have been added. Every day for the past year individuals have attended the clinic twice daily for their doses of self-injected medical-grade diamorphine – a medical professional is on standby to ensure none of this is removed from the venue.
There are various benefits of this scheme; needles aren’t reused so risk of communicable diseases decreases, participants are also provided with social support (eg housing and counselling), and members of the community are benefited too (less spent on prisons, less theft). After one year, some participants have left after committing crime or medical reasons, but seven still remain in the scheme. It is evident that in the area anti-social crime and theft have both reduced, leading to an increase in social stability. One participant states that she no longer shoplifts to fund her addiction, and this scheme allows her to focus on other aspects of her life, allowing her to have more control over her time, instead of it being controlled by drugs.
Whilst the trial in England is still in process, it is evident that benefits are already being proposed by it. Although it seems counter-intuitive, this scheme proves that sometimes the most unexpected methods can be the most effective, and a lot of this is influenced by how patients are treated – not as criminals but as people who deserve to have their addiction treated directly instead of being convicted for something they can’t control.
- Alex Metcalfe, ‘Middlesbrough’s opioid crisis to go under the microscope in new probe’, Gazette Live, September 1, 2019
- ‘Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings’, 2009
- ‘Methadone’, Drug Science
- Taylor Knopf, ‘Switzerland Fights Heroin With Heroin’, North Carolina Health News, January 28, 2019
- Alex Metcalfe, ‘Middlesbrough’s heroin shooting clinic opens next week – here’s where it’ll be’, October 10, 2019
- ‘Middlesbrough heroin injection scheme hailed a success’, BBC, November 09, 2020