Evaluation of the Middlesbrough Heroin Assisted Treatment Pilot

Project: Research

Project Details


The UK has the largest reported opioid-using population in Europe (1). Opiate Dependency (OD) is a complex, multi-faceted, public health and social issue. This problem results in significant harm to the individual, their families and wider society, in addition to high associated costs to the public purse. In the past 12 years, the number of opiate users over the age of 40 years presenting to treatment services has tripled (2). 

The current treatment model in the UK for OD is oral Opiate Substitute Treatment (OST), or Methadone, which is effective for the majority of individuals (3). However, for 5-10% of people who present to treatment services with OD, OST is ineffective (4). Heroin Assisted Treatment (HAT) addresses the treatment gap for individuals who have failed to benefit from the standard treatment offer. HAT involves offering synthetic heroin (diacetylmorphine) twice daily, under the supervision of medical staff to inject the drugs in a controlled and safe environment; it is also referred to as supervised injectable heroin (SIH). The supervised nature of this treatment is important as it ensures monitoring, compliance, safety and regulation so that none of the prescribed substance can enter the illicit market (5). 

In October 2019, after a number of years developing a HAT pilot offer, a steering group was established between Foundations, the Office of the Police and Crime Commissioner for Cleveland, Probation (Durham Tees Valley CRC and HMPPS) and South Tees Public Health to drive forward the agenda and became the first area in the country to obtain Home Office licenses and deliver the service. 

This HAT project contributes to the evidence base for public health approaches to crime and situating this intervention in Middlesbrough which suffers significant deprivation and high levels of crime (6) will provide rich learning for crime prevention with national impact. This evaluation provides a snapshot of health, psychosocial and offending behaviour of the first HAT pilot cohort in the UK.

(1) European Monitoring for Drugs and Drug Addiction. (2019). European Drug Report 2019: Trends and Developments. Retrieved from https://www.emcdda.europa.eu/publications/edr/trends-developments/2019

(2) Advisory Council for the Misuse of Drugs (ACMD). (2019). Number of older opiate users in treatment has tripled. London: Advisory Council for the Misuse of Drugs (ACMD).

(3) Strang, J., Manning, V., Mayet, S., Ridge, G., Best, D., & Sheridan, J. (2007). Does prescribing for opiate addiction change after national guidelines? Methadone and buprenorphine prescribing to opiate addicts by general practitioners and hospital doctors in England, 1995-2005. Addiction, 102(5), 761-770. doi: 10.1111/j.1360-0443.2007.01762.x

(4) Byford, S., Barrett, B., Metrebian, N., Groshkova, T., Cary, M., & Charles, V. et al. (2013). Cost-effectiveness of injectable opioid treatment v. oral methadone for chronic heroin addiction. British Journal Of Psychiatry, 203(5), 341-349. doi: 10.1192/bjp.bp.112.111583

(5) Groshkova, T., Metrebian, N., & Strang, J. (2012). New heroin-assisted treatment. EMCDDA Insights.

(6) Office for National Statistics. (2020). Crime in England and Wales: year ending March 2020. Retrieved from https://www.ons.gov.uk/peoplepopulationandcommunity/crimeandjustice/bulletins/cri
Short titleHAT Year 1 Evaluation
Effective start/end date1/07/191/03/21


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