Clamour grows for heroin on the NHS

By BrownStreakRailroad · Sep 16, 2009 · Updated Sep 17, 2009 · ·
  1. BrownStreakRailroad
    Experts call for national network of 'shooting galleries' after hailing successful trials
    By Jeremy Laurance, Health Editor

    Monday, 14 September 2009
    The programme was modelled on one in Switzerland where introduction of injecting-clinics "medicalised" heroin use
    A group of government-appointed drug experts will call for a nationwide network of "shooting galleries" to provide injectable heroin for hardened drug addicts across the country.
    A pioneering trial programme prescribing heroin to long-term addicts has shown "major benefits" in cutting crime and reducing street sales of drugs. Results of the programme are to be presented at a conference in London tomorrow. An expert group set up by the National Treatment Agency for Substance Misuse to assess the programme has concluded that the approach should be adopted nationwide.
    The prescription of heroin to hardened addicts is one of the most controversial in medicine. Giving addicts drugs such as heroin on a maintenance basis, rather than weaning them off them, turns existing policy on its head and presents a challenge to ministers.
    Critics say giving addicts the drugs they were previously scoring on the street is not "treatment", and the cost at £15,000 a year per head cannot be justified when NHS patients are being denied the latest cancer drugs. But addiction experts say this is about "harm reduction", not cure.
    Long-term heroin users are among the hardest addicts to treat and impose huge costs on the medical and penal systems. Ten per cent of drug addicts commit three-quarters of all acquisitive crime in the UK, official figures show. The existing government drugs strategy includes a commitment to roll out the clinics, subject to the findings of the trial programme.
    The trial started three years ago and yielded benefits within months. Early results showed crimes committed by the addicts dropped from about 40 to six a month, after six months of treatment. A third of the addicts stopped using street heroin and the number of occasions when the rest "scored" dropped from every day to four to five times a month.
    The programme was modelled on one in Switzerland where introduction of injecting-clinics "medicalised" heroin use, removing its glamour and transforming it from an act of rebellion to an illness requiring treatment. Last year, Swiss voters backed the scheme in a referendum, proving it could be a vote-winner. Similar clinics have also been established in France, Germany and Canada.
    The first British injecting clinic, run by the Maudsley Hospital, opened on a south London high street in 2005. Heroin addicts who had failed on all other treatments and served repeated prison sentences for shoplifting and other crimes attended twice a day and received a dose of diamorphine (pharmaceutical grade heroin) which they injected themselves, under supervision.
    Two further clinics were opened, in Darlington in 2006 and in Brighton in 2007. For the trial, 150 addicts received drugs at the clinics, one third of them heroin. Their experience was compared with two other groups who received either oral or injectable methadone under the same conditions.
    The strict rules allow no "take-away" from the clinics, to avoid the users selling their drugs on the streets. All injections are witnessed at the clinic. The approach introduces routine and drudgery by forcing the users to attend for their twice-daily fix.
    There are an estimated 280,000 drug users in the UK, most taking heroin and crack cocaine, and about 2,500 deaths a year. The scheme, targeted at the 3,000 to 6,000 long-term, hardcore addicts, operates seven days a week, 365 days a year.
    Professor John Strang, head of the National Addiction Centre at the Maudsley, who led the study, said the findings had sent a ripple of excitement through the addiction treatment community, which is unused to seeing progress with hardcore heroin addicts. He would not comment yesterday on the panel's recommendations, but before, speaking about the early successes of the trials he said: "This is genuinely exciting news. These are people with a juggernaut-sized heroin problem and I didn't know whether we could turn it around. We have succeeded in people who looked as if their problem was unturnable, and we have done it in six months.
    "It is 'intensive care' for drug addicts, more expensive than standard treatment but a third of the cost of sending them to prison at £44,000 a year. And they become re-addicted on release. We are dealing with a profound drug hunger and trying to medicalise it to break the link with street heroin use and crime."
    War on drugs: The liberal experiments
    Doctors have been allowed to prescribe heroin since the 1920s but very few do so. Most prefer to prescribe methadone, a heroin substitute, which is taken orally once a day. Its effects are longer-lasting but duller. Many addicts continue to buy heroin. There are currently three "shooting galleries" operating across the country which may now be extended.
    Throughout the mid-1990s the Swiss were at the forefront of trialling prescription heroin schemes and the country has seen a major reduction in crime and better rehabilitation success rates. For years the main "shooting gallery" was in Zurich but last year Swiss voters approved a nationwide rollout of prescription heroin in a referendum.
    Portugal has the most liberal drugs policy in Europe. In 2001, it took the radical step of abolishing criminal penalties for drugs. Anyone caught with drugs was referred through the civil, rather than criminal, courts and either fined or put into treatment. Critics predicted that narcotics use would spiral out of control but addiction rates fell.

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  1. missparkles
    Sparky thinks the name should be changed.
    "Shooting galleries" sounds like "one hit kits" and we all know how well that went down, don't we?
    It evokes images of the funfair, of people with families, enjoying themselves. She wonders why these idea are given such catchy names?
    It's setting this brilliant harm reduction scheme up to fail, the public are anti heroin, so why give them even more to bitch about?
    Just saying.
  2. chillinwill
    Shooting galleries for drug addicts reduced crime

    A scheme which created “shooting galleries” for heroin addicts has led to big reductions in the use of street drugs and crime.

    The pilot, part of which was carried out in Brighton, saw users administered the drug or a substitute in supervised NHS conditions.

    The results, which were published today, showed those who were injected with heroin made “marked improvements” in their general health.

    Leaders behind the project are now asking Government ministers to set up further trials to tackle misuse in the city, which was recently declared the drugs death capital of Britain.

    Morag Murray, of the Sussex Partnership, who helped run the project, said: “These findings show that it is possible to effectively treat those people with a severe and enduring crime-funded heroin addiction, who previously found it difficult to engage with services.

    “Participants who received clinical injectable heroin during the trial were long-term drug users, previously spending about £300 a week on street heroin to fund their addiction.

    “They are now spending on average less than £50 a week, with a significant proportion completely cutting out their use of street heroin altogether.

    “There was also reduced use of other drugs, such as crack cocaine, and marked improvements in both physical and mental health and social functioning.

    “We now need to wait for policy makers to decide how to best apply these findings.”

    The Randomised Injecting Opioid Treatment Trial (RIOTT) programme involved more than 100 users nationally in centres in Brighton as well as London and Darlington.

    Many of the clients, who were all self-referred, had been identified as the hardest to treat.

    During the trials, a third of addicts were given methadone, a heroin substitute, orally and another third had it injected under supervision.

    The remainder, observed by nurses, injected themselves with diamorphine - unadulterated heroin - imported from Switzerland.

    Psychological support and help with housing and social needs was also offered.

    After six months, the heroin injecting group had committed two-thirds less crimes - a fall from 1,731 to 547.

    Project leaders say the scheme, which costs £15,000 per user every year, is cost effective as it helped avoid “expensive” prison sentences.

    Independent expert group The National Treatment Agency for Substance Misuse said there was enough "positive evidence of the benefits" to merit further pilots.

    By Tim Ridgway
    September 15, 2009
    The Argus
  3. BrownStreakRailroad
    sorry dunno what hotlinks are so i just deleted the image, sorry if that was wrong of me.....
  4. Alfa
    an hotlinked image is when an image links to a web page. It is wanted to add images to news articles, but please upload them to your post, instead of pasting. When you paste tuf in, then a lot of unintended code can mess up your post.
    Also, the title has H1 code in it, which causes a [top] link. (see right of the title)
  5. BrownStreakRailroad
    cool, thanks for that, ive tried to follow the procedure but can only get the pic to the usless at this stuff so im leaving it at that unless anyone can fill me in how to enlarge it on the main post....
  6. chibi curmudgeon
    Makes you wonder how much of this is psychological. Has anyone documented the users' reasons for stopping or cutting back, exactly?
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