Projects

Heroin Assisted Treatment Intervention (HATI): A qualitative exploration

Lead Investigator: Tammi Walker

Research Theme: Prevention, Early Intervention, and Behaviour Change

Host University: Teesside University

Research Summary

The North-East of England has the highest rates of drug-related deaths in the country. In Middlesbrough, drug misuse is a major health issue, with people more likely to die from drug-related causes than car accidents.

Heroin Assisted Treatment (HAT) is a specialised treatment for people with severe opioid dependency who have not responded to standard treatments. HAT involves providing pharmaceutical-grade heroin, which patients self-administer under clinical supervision twice daily.

Opioid dependency is a long-term condition linked to various health and social problems, such as infections, homelessness, and crime. International evidence shows that HAT can improve health and social outcomes better than standard treatments. In October 2019, Middlesbrough launched the UK’s first HAT pilot programme, partly funded by the local police and crime commissioner.

This study aims to explore the experiences of those involved in the HAT pilot, including professionals, stakeholders, and patients.

It will use innovative methods like photo elicitation to understand treatment outcomes, impact, and acceptability. The findings could significantly inform policies on harm reduction and crime prevention.

Further background

The North-East has the highest rates of drug misuse deaths in England. In Middlesbrough, most drug-related deaths involve men using opiates. HAT is a second-line treatment for those who do not respond to standard drug replacement therapies. Previous studies, including the Randomised Injectable Opiate Treatment Trial (RIOTT), have shown HAT’s effectiveness. Despite its benefits, only a small percentage of people worldwide receive HAT.

The Middlesbrough HAT pilot, which started in October 2019, is the first in the UK. It uses a whole systems approach, involving the police and health services. This study will explore how this approach affects participants and stakeholders. It will compare the Middlesbrough pilot with a similar project in Glasgow, which is purely health-focused.

Aims

This project aims to improve health and care by understanding behaviour change in opioid dependency. For a significant portion of the treatment population, standard treatments are ineffective and costly. Understanding why people engage or disengage with HAT can help reduce health and social care demands and save money. The research will also explore the integration of health, police, and public health services in delivering HAT.

The project involves collaboration between Teesside and Durham Universities and Public Health Middlesbrough. It will highlight innovative work in the Tees Valley and provide valuable insights for national policy and practice.

Relevance to practice or policy

UK drug policy has shifted from harm reduction to a recovery-led approach, which has been criticised for increasing drug-related deaths. Understanding the debates around HAT within the context of a whole systems approach in Middlesbrough can significantly influence national policy.

Qualitative research will improve HAT and share insights on what works, aiding the rollout or scaling up of this treatment. HAT also contributes to public health approaches to crime, particularly in areas with high deprivation and crime rates like Middlesbrough.

Failure to generate high quality qualitative research with participants who have (dis)engaged in the first year of HAT, limits the potential for improvement.

Understanding drivers of retention and acceptability is imperative to being able scale up, roll out or cease operation, and could substantially improve national outcomes for harm reduction services in the UK.

Project update – findings overview

We conducted in-depth interviews with service providers and users of the Middlesbrough HAT service between September and November 2021. Data from each group were thematically analysed and reported separately. This paper details the experiences of the twelve heroin dependent men and women accessing HAT.

Results

Participants’ accounts of HAT treatment evidenced a tension between the regulatory constraints and uncertainty of treatment provision, and the positive outcomes experienced through supportive service provision and an injectable treatment option. Limited confidence was held in treatment efficacy, longevity of funding, and personal capacity for treatment success. This was counteracted by a strong motivation to cease engagement with the illicit drug market. While attendance requirements placed restrictions on daily activities, participants also experienced benefits from strong, supportive bonds built with the service providers through their continued engagement.

Conclusions

The Middlesbrough HAT programme provided benefits to a high-risk population of opioid dependent people who were unable or disinclined to participate in conventional opioid substitution treatments. The findings in this paper highlight the potential for service modifications to further enhance engagement. The closure of this programme in 2022 prohibits this opportunity for the Middlesbrough community, but holds potential to inform advocacy and innovation for future HAT interventions in England.

OUTPUTS

Research paper – ‘This is hardcore’: a qualitative study exploring service users’ experiences of Heroin-Assisted Treatment (HAT) in Middlesbrough, England | Harm Reduction Journal | Full Text (biomedcentral.com) – May 2023

Project presentation – December 2020

FUNDING

This work was funded through a grant from the NIHR ARC NENC Open Funding Competition

Image: Royalty free, Pexels