Supplying addicts with drugs such as heroin on the NHS – an idea supported by Durham police chief Mike Barton – is nothing new. BARRY NELSON and STUART ARNOLD report.
BETWEEN 2006 and 2011 the Tees, Esk and Wear Valleys NHS Trust, took part in a national research project known as the Randomised Injecting Opioid Treatment Trial, or RIOTT for short. This meant that Darlington was one of three sites in the UK, along with Brighton and London, where a hardcore of heroin users were allowed to inject medical grade heroin - known as diamorphine - under supervised conditions.
Results from the RIOTT trial published in the Lancet showed that prescribing pharmaceutical heroin in this way can reduce the use of street drugs and associated levels of crime. It was also shown to improve individuals’ health and quality of life and give them the stability they needed to recover from their dependence on heroin.
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Subsequently a group of national experts headed by Professor John Strang, of the National Addiction Centre at Kings College Hospital, in London, said the results from the three centres offered the Government "robust evidence to support the expansion of this treatment so that more patients can benefit”.
But instead of opening up more Darlington-style shooting gallery clinics the Department of Health decided to back a new approach.
Known as RIO - or the Recovery Injectable Opioid service - the emphasis is now on trying to wean hardcore heroin users off drugs altogether, rather than simply reduce the harm they cause. Now provided from a clinic in Easington - but still one of only three sites in the country to do this - RIO is described by the Tees, Esk and Wear Valleys Trust as a recovery service for patients with chronic injecting heroin dependence, for whom standard treatment has been unsuccessful. It is funded until at least 2015.
The crucial difference is that RIO is time-limited in terms of how long addicts can be on the programme, generally 15 months maximum. Patients attend the Easington clinic once or twice a day, up to seven days a week and recovery plans are discussed at the beginning, during and end of the treatment phase. The Tees, Trust says patients also receive “psychosocial interventions” from keyworkers and medical staff and are given support to access housing, education and the job market.
Dr Tom Carnwath, a retired consultant psychiatrist who has been a strong advocate of using injected NHS heroin as a way to manage the most difficult to reach addicts, was involved in setting up the RIOTT pilot in Darlington. He says Mike Barton’s recent call for the decriminalisation of hard drugs in a controlled environment would be a step in the right direction.
“I would say it’s a good idea," says Dr Carnwath. "It is actually pretty expensive keeping people in prison compared to the cost of keeping them on a programme like RIOTT.”
Dr Carnwath also pointed out that a number of addicts enrolled on the RIOTT programme did successfully come off hard drugs, despite it being more open-ended than its successor. The retired psychiatrist said he remembered addressing a chief constables conference about eight years ago about the RIOTT programme and the scheme "was very well received."
Professor Nick Heather is an emeritus professor of alcohol and other drug studies at Northumbria University. He agrees that there is plenty of evidence that in intractable cases prescribing heroin to addicts can lead to a good outcome.
“In general I am in favour of some kind of alternative to the current policy of criminalisation and prohibition, which as the chief constable says isn’t working,” he says.
“The problem is it is political dynamite to discuss the issue and it’s perceived as a potential vote loser. It’s also impossible to have a rational debate. The arguments are also so parodied and easily-simplified, particularly in the Press. There is commonly an un-thinking response driven perhaps by fear as people are naturally very cautious about it.”
In some countries a step towards what has until now been unthinkable in the UK has happened.
Portugal recently decriminalised all drugs, while in the American states of Washington and Colorado it is legal for adults to smoke cannabis recreationally.
“Nobody is suggesting that if drugs were legalised they would be available in grocery shops and supermarkets – there would also be an element of control,” says Prof Heather.
“It would be able to be regulated in the same way we regulate alcohol. The other thing to make clear is that all psychiatric drugs have some kind of harm associated with them and it is a question of the least worst option. People have to decide whether the harm that comes from consuming the drug itself is worse than the results of its illegality in terms of the criminal enterprise it fosters.
“The main argument for all of this is that you would get rid of that criminality. Some people including myself believe the harm comes mainly from drugs’ illegal status. Drug misuse has fallen, but not by much and it is still causing an enormous amount of harm.
“Some objective debate and a willingness to try something new is needed.”