Diamorphine assisted treatment in Middlesbrough: a UK drug treatment case study

ABSTRACT

Introduction

Diamorphine Assisted Treatment (DAT) is a treatment offer for individuals with Opioid Dependency (OD), who have failed to benefit from standard treatment model (Opioid Substitution Therapy [OST]). In the Middlesbrough DAT service, self-administered injectable synthetic heroin (diacetylmorphine) is offered to participants, twice daily under the supervision of medical staff in a controlled and safe environment. This case report evidences outcomes from the first operational DAT service in England outside of a research trial.

Method

Descriptive quantitative data from participants who engaged within the first year of operation of DAT (n=14) is presented detailing engagement, harm reduction, and psychosocial outcomes, and criminality of the cohort.

Results

The DAT service was associated with high engagement, a large reduction in positive toxicology screens for street heroin, reduced homelessness, increased engagement with psychosocial interventions and a substantial reduction of criminal offences. Poly-drug use (specifically the consumption of street tablets) impacted treatment engagement for a proportion of the sample.

Conclusions

We present this work as an example of bottom-up policy making within the context of UK drug treatment and implications for practice discussed.

KEYWORDS:

• Diamorphine Assisted Treatment (DAT)
• supervised injectable heroin
• harm reduction

Acknowledgments

The team would like to acknowledge Chris Guttridge from the Police and Crime Commissioners Office for his support with the data collection for this project.

Disclosure statement

Danny Ahmed works as clinical lead for Foundations Medical Practice which delivers HAT in Middlesbrough. Danny Ahmed was not part in the evaluation project data collection or analysis, but supported with the write up of this manuscript after the results of the evaluation were published in April 2020.

Ethics approval and consent to participate

The project was approved by a Teesside University Ethics Committee for the School of Social Sciences Humanities and Law (Ref: 2020 Oct 1328 Poulter). Secondary data from the delivery service was used, but delivery team obtained consent to use the data for research and evaluation purpose prior to collection data.

Consent for publication

All authors consent to the material being published

CRediT statement

Poulter, Hannah: Conceptualization, Funding acquisition, Methodology, Formal Analysis,  Investigation, Writing – Original draft preparation, Project Administration, Writing – Original Draft, Writing – review & editing

Crow, Rob: Methodology, Formal Analysis, Validation, writing – review and editing

Ahmed, Danny: Conceptualization, Writing – review and editing

Moore, Helen: Conceptualization, Funding acquisition, Writing – Reviewing and Editing. 

Walker, Tammi: Writing-Reviewing and Editing

Data availability statement

The dataset(s) supporting the conclusions of this article is (are) not included due to the low sample size leading to possible secondary disclosure.

Notes

1. Crime data analyzed all crimes committed by participants in their offending career prior and during the DAT pilot.

2. After three days, an individual has to be retitrated to an entry dose of diamorphine and taken as “opioid naïve.”

3. Short Warwick Edinburgh Mental Wellbeing Scale (SWEMWBS) © NHS Health Scotland, University of Warwick and University of Edinburgh, 2008, all rights reserved.

Additional information

Funding

Teesside University was funded by Cleveland Police and Crime Commissioner in Cleveland between 2019 and 2020 to complete a pilot evaluation of HAT in Middlesbrough. Danny Ahmed was not part in the evaluation process but supported with the write up of this publication after the results of the evaluation were published in April 2020.