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Heroin on the NHS

It’s good to hear that the Middlesborough health service, alongside the police, is trying a new way to help people with severe heroin addiction. In a groundbreaking move, 15 people with heroin addictions are going to be provided with free Diamorphine ( medical heroin ) twice a day. Once they are stabilised, they will also be given help to manage other mental health issues, and help to find work and housing. 

People working in rehabs are often horrified at the prospect of sufferers being given ‘free’ drugs, or even being provided safe places to use ( shooting galleries, as they are sometimes known ) in case this encourages or prolonging the course of addiction. 

Even though abstinence is the best outcome, we need to be able to interact with sufferers before they come to that realisation for themselves and, even more essentially, we need to keep them alive. 

Critics might think that this approach is putting the cart before the horse. Most clinics work on the good principle of getting people abstinent first before working on all the other areas needing attention but for people at the extremes of society, extreme poverty and even extreme wealth, it can prove to be more effective to stabilise their use, build up their other resources ( sometimes referred to as ‘recovery capital’), and then move on to work on the detox further down the line. It’s also crucial to keep them alive! About 10% of the population took a recreational drug last year, 5% took cocaine for example. Only 0.5% took opiates but 75% of drug misuse deaths were due to opiates ( 2,208 deaths last year ). This is why we should look at this specific drug with a slightly different perspective. 

If we look at the experience of America during its recent opioid addiction epidemic, it has been painful to witness resistance to harm minimisation approaches which could have saved many lives. In comparison, Portugal has led the world with its practice, taking opiate addiction problems away from the criminal justice system and putting it clearly in the health arena, where they belong. 

The overarching lesson has to be that we should be careful to avoid dogma when it comes to helping people with mental health problems. We naturally have to have good guiding principles to the way we work but there are also many nuanced cases where we must be more flexible. The most important measure we should always be using to judge how we operate is whether an approach moves a specific individual towards better health and wellness, or away from it.

This will be an interesting project to follow.



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