The community impact of RIOTT, a medically supervised injectable maintenance clinic in south London

Abstract

Background: One of the major issues facing treatment services for alcohol and other drug users (current or ex-) around the world is community backlash, which has led to the closure of some much-needed drug treatment services.

Aims: This study investigates the impact on the local community of a Medically Supervised Injectable Maintenance Clinic (MSIMC) implemented as part of the Randomised Injectable Opioid Treatment Trial (RIOTT), a trial into the effectiveness and efficacy of the provision of injectable opioids versus conventional oral methadone. The clinic model is based around a small number of the most entrenched and refractory patients (approx. 30) being treated by the service at any one time.

Methods: The clinic and the trial were conceived primarily over 2002–2005, and the clinic began actual clinical operation in October 2005. The research was conducted between July 2005 and October 2007. Methods involved: pre-trial community key informant interviews; two-year follow-up key informant interviews; and analysis of Metropolitan Police crime statistics.

Results: The most common concern raised by key informants in the local community was that the RIOTT would have a ‘honey-pot effect’, resulting in increased numbers of drug users coming to the area. At follow-up, key informants reported no such effect on the local community. Metropolitan Police figures show no significant changes in monthly or average annual crime levels in the local area.

Conclusions: Community fears of negative social effects of the RIOTT clinic appear to have been unfounded, based on subjective and objective criteria, where such a project operates with the highly structured clinical and monitoring framework and with small patient numbers.

Keywords:

• addiction
• community impact
• crime
• heroin
• prescription heroin

Acknowledgements

This study was funded by the Austin and Hope Pilkington Trust, GlaxoSmithKline and Action on Addiction. PM was jointly funded by the J. Paul Getty Junior Charitable Trust and The Pilgrim Trust. NL was funded by an Australian government NHMRC Neil Hamilton Fairley Clinical Research Fellowship during the development of the study. The authors would like to acknowledge Lesley King Lewis, Annabel Kennedy, Amanda Thomson and staff at Action on Addiction, staff and clients at South London and Maudsley (SLaM) NHS Foundation Trust. We would particularly like to thank David Johnson who helped us setting up this study and introduced us to many of the key people and themes surrounding this topic. Solomon Brown assisted with data entry and analysis for this study and Julie Latimer was endlessly helpful in supplying us with detail and context of the street drinking issue. Marcia Martins (formerly Community Link Worker for Marina House) conducted some interviews. We would like to thank all of our key informants for giving their time and knowledge freely. Thank you also to the anonymous reviewers for the very helpful comments.