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Update on proposed Heroin Assisted Treatment in Glasgow

Wednesday, January 24, 2018

Glasgow City Health and Social Care Partnership (HSCP) is pressing ahead with plans to deliver a Heroin Assisted Treatment (HAT) facility in the city centre. 

This work continues while the HSCP maintains a dialogue with the Scottish Government on how best to progress a Safer Drug Consumption Facility (SCDF) in the city in order to tackle the ongoing HIV outbreak affecting people who inject drugs in public.  

No legal exemption is required to provide a HAT programme which can legally be delivered within the framework of existing Medicines legislation.  

Correspondence received from the Lord Advocate further clarifies that a HAT facility could also operate a needle exchange scheme within the bounds of existing prosecution policy.  

There is well-established international evidence of the cost-effectiveness of HAT for chronic Heroin user who have not benefited from other interventions. 

It is the next treatment progression for people for whom current treatments have been ineffective, and who continue to use street drugs, with all the risks that entails: injecting-related infections and overdose. 

The programme is a highly specialised clinical intervention in which diamorphine is prescribed for the treatment of heroin addiction. It can only be undertaken by doctors with a licence allowing them to prescribe the medication. 

Heroin dependent patients aged 18 and over, with previous unsuccessful treatment episodes, would eligible for the service. It is already legal in the UK and has been trialled in London, Darlington and Brighton, and is already widely used in Germany, Belgium and Switzerland. 

Research shows it substantially reduces people’s need for street drugs, reduces drug-related criminal activity, leads to more engagement with healthcare and addictions services, and reduces drug-related litter and public injecting. 

Current estimates suggest there is a group of approximately 500 very vulnerable people who inject drugs in public places in Glasgow city centre. The majority are individuals experiencing homelessness, mental health issues, recent imprisonment and poverty.                                                                                               

These individuals are substantially responsible for the majority of discarded needles in public areas such as alleyways, car parks, parks, public toilets, and closes, putting the general public at risk and contributing to other related public order problems. 

Susanne Millar, Glasgow City HSCP Chief Officer for Strategy, Planning and Commissioning, said: “This public injecting group has high rates of hospital admissions, incarceration and homelessness. 

“Conventional treatment and services have not been as effective as we would want in reducing health risks and the resulting costs. 

“Our ultimate goal is for drug users to recover from their addiction and remain drug free. 

“However, some of our service users have had a number of failed attempts at quitting Heroin. Evidence from other countries has shown HAT to be effective and it is important to keep people as safe as possible while using this service. 

“It is important to stress that HAT will only partially address the issues identified in the Health Needs Assessment as it is designed for a very small subset of the target population. 

“Ongoing dialogue with the Scottish Government has agreed that a SDCF would enable much more harm reduction and engagement work with the at risk group.” 

Drug deaths in Glasgow remain high with 157 occurring in the city in 2015. Heroin and/or morphine was the cause or contributing factor in 73 of these deaths. 

Officers from the HSCP continue to work with officials from the Scottish Government to discuss next steps, including an approach to the UK Government, regarding opening a SDCF. 

This could take the form of requesting either that the UK Government amend the existing Regulations attached to the Misuse of Drugs Act 1971 in such a way as to enable the operation of a SDCF, or that the Scottish Government be given the power to amend the regulations.

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