Heroin #Addiction Treatment (HAT and SIH)

Drug ImpactsI recently wrote about a ‘new’ addictions treatment service that is being piloted in Middlesbrough (see here).

My piece primarily focused upon the ‘mischievous’ efforts of our mainstream and social media, in the perpetuation of unhelpful stigma. Something that is nearly always problematic.

Additionally, Russell Webster also looked at the service in his blog on the Heroin Assisted Treatment Programme; from a stance that was perhaps a little more objectively holistic than mine (see below).


Despite the claims from Barry Coppinger, the Cleveland Police Crime Commissioner, this is not a ‘new’ form of treatment.

I can accept it’s new to the Cleveland area and it could be seen as ‘innovative’, especially in our sociopolitical climate. But, people who work in the field of addictions treatment and support know; Heroin Assisted Treatment (HAT) and Supervised Injectable Heroin (SIH) methodology isn’t something that is ‘new’ but hasn’t been widely used previously.

The prescription of substitution drugs, such as methadone and buprenorphine, has become a mainstream, first-line treatment for opioid dependence, with around 700 000 of Europe’s 1.3 million problem opioid users receiving substitution treatment today. But a small minority of entrenched opioid users repeatedly fails to respond to interventions of this kind. Findings from international trials now suggest that the supervised use of medicinal heroin can be an effective second-line treatment for this small, and previously unresponsive group. (EMCCDA)

HAT/SIH is probably under utilised due to being politically unpopular, in addition to being widely misunderstood by our society… People who generally see the process as – “giving free gear to junkies” – another stereotypical perception perpetuated by the media. Something at the root cause of my previous blog on the subject.

HAT/SIH Benefits

SIH is found to be an effective way of treating heroin dependence refractory to standard treatment… This intensive intervention is for a patient population previously considered unresponsive to treatment. Inclusion of this low-volume, high-intensity treatment can now improve the impact of comprehensive healthcare provision. (Strang J et al)*

According to the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA); “Supervised injectable heroin (SIH) treatment was “first introduced in Switzerland in the mid-1990s in the face of a growing national heroin problem.” The new approach was an additional step on from prescribing heroin to those impacted by addiction without supervision. Something that was practised both in the US in the early 20th century and in the UK throughout that century.

‘While SIH may be a useful addition to our treatment “toolbox” for opioid users, it is not a solution for the heroin problem’, concludes the report. ‘But for those among whom the benefit is observed, there are major gains for themselves, their families and society’. (2012 EMCDDA Report)

Webster summed up by observing; we need to “wait and see how the pilot performs but many in the law enforcement and drug treatment circles will be hoping that it succeeds. With the current levels of drug-related deaths across the UK, that could well be something of an understatement.

We all want something that could help to reduce the crime around problematic use of drugs however; even more important for many of us is a reduction to the recent surge in drug-related deaths. We need to do something radical to save life, those dying are human beings.

In the context of this particular project, something is being done, to support people and change the likely outcomes, for some of those at the highest risk of death. This ‘new’ project is providing targeted treatment and support for those most at risk. I fail to see how any caring person could see this as fundamentally wrong.

It is worth noting; people who have developed a range of complex physical and mental health problems, underpinning their entrenched problematic addictive behaviours, are rarely ever adequately supported by our society or the politicians. The fact that so many of the above issues can find their root in societal and trauma induced causal factors is mostly immaterial to many in our society… “it was their choice!”

But hey, perish the thought we should ever understand science and fact… at the expense of populist politics and a ‘good’ emotive tabloid press headline. Let alone try to support vulnerable people towards a better life. Eh?


*Strang, J., Groshkova, T., Uchtenhagen, A., Van den Brink, W., Haasen, C., Schechter, M., . . . Metrebian, N. (2015). Heroin on trial: Systematic review and meta-analysis of randomised trials of diamorphine-prescribing as treatment for refractory heroin addiction. British Journal of Psychiatry, 207(1), 5-14. doi:10.1192/bjp.bp.114.149195

EMCDDA INSIGHTS (11) New heroin-assisted treatment. Recent evidence and current
practices of supervised injectable heroin treatment in Europe and beyond (Download in pdf from EMCDDA)