Post on 18-Dec-2021
Heroin Assisted Treatment – Why now, Why Middlesbrough?
Middlesbrough is the Local Authority
containing the highest proportion of areas
which are considered the ‘most deprived’.
Of the wards in Middlesbrough, North
Ormesby is the most deprived, and is the
second most deprived in England.
49% of areas in Middlesbrough fall into this
‘most deprived’ category.
Middlesbrough Local Authority is the most
deprived local authority in England
Heroin Use in Middlesbrough
Rates of opiate users in Middlesbrough are 57% higher than in the
North East region, and 66% higher than the England rate.
Middlesbrough has the highest rate in the country – 21% higher
than the next highest local authority.
Drug Related Deaths
2016-18 Numbers Rate 2017-19 Numbers Rate
1 Blackpool 69 17.7 1 Blackpool 73 18.9
2 Norwich 52 13.6 2 Middlesbrough 60 16.3
3 Barrow-in-Furness 24 13.4 3 Hartlepool 39 15.5
4 Hartlepool 34 13.1 4 Scarborough 32 11.9
5 Middlesbrough 48 12.8 5 Stoke-on-Trent 82 11.5
6 Burnley 30 12.4 6 Norwich 44 11.4
7 Liverpool 151 11.5 7 Barrow-in-Furness 20 11.1
8 Scarborough 28 10.7 8 Liverpool 145 11.0
9 Gosport 25 10.3 9 Redcar and Cleveland 40 11.0
10 Gateshead 60 10.1 10 Gosport 25 10.6
Stockton-on-Tees 56 10 13 Stockton-on-Tees 57 10.1
Redcar and Cleveland 35 9.4
• Field visits
• Licenses acquired
• Funding acquired
• Public/Media engagement
Heroin Assisted Treatment – Middlesbrough – 2 years of preparation
Heroin Assisted Treatment : Patient Selection
• Patient Selection:
o Engaged in treatment in
Middlesbrough Recovering Together
(MRT)
o With chronic injecting heroin
dependence
o Standard treatment has not been
successful
o Partnership approach to selection
o 15 participants
• Go Live Date – 15th October 2019
• 12mth operating
• Specialist Clinic
• Twice daily administration of
medication
• Wrap-around support
Programme Implementation
• Heroin assisted treatment walkthrough
Programme Implementation
Heroin Assisted Treatment: Evaluations
• The social and environmental impacts of the HAT programme over a 6 month period.
• Impact on the criminal justice system 6 months prior vs 6 months post intervention.
• Outcomes such as weight, housing status, engagement with other psychosocial interventions, wellbeing, and street drug usage.
• Due to be completed November 2020.
Research Activities 2021-2022
• Funding has recently been obtained from NIHR-ARC to allow research team to build on the small year 1 evaluation.
• Led by Teesside University (Professor Tammi Walker) working collaboratively with experts from Durham University (Professor Graham Towl) and the London School of Tropical Medicine (Dr Magdalena Harris).
• The funding will explore the experiences of individuals who have completed, discontinued or refused to engage with the HAT pilot programme and other key stakeholders such as delivery staff.
• This research is the first of its kind in the UK and will examine issues relating to treatment outcomes, impact, retention and acceptability.
Cohort Information
Total number of clients
that have received
treatment on the
programme to date:
13
8
1
1
1
1
1
Client voluntarily left
HAT after one week
of treatment
Treatment ended due
to client receiving a
custodial sentence
during treatment
Treatment paused
due to client being
held on remand whilst
being investigated for
suspected offending
Currently receiving treatment
Client status:
Treatment paused
whilst client receives
treatment for their
mental health
Treatment has been
suspended on
clinical advice
Control Group Selection
To assess the impact of Heroin Assisted Treatment; we have formulated a control group, to more accurately demonstrate the client’s treatment journey This group chosen – 6 clients over 29 weeks – combines a sizeable group of clients who have been on the course for many weeks.
Control group size: • 46% of all HAT clients to date
• Current client data goes up to July 2020
6
Time on HAT
(Weeks)
Cohort Size
38 1
37 2
35 3
34 4
29 6
26 7
22 8
19 9
18 10
5 11
1 13
Offending History & Reoffending
Total number
of detected
crimes prior to
commencing
treatment
541
Number of
detected crimes
whilst receiving
treatment on
HAT
3
Source: Cleveland Police data
We have been able to verify all
detected crime up to 29/07/2020
Sum of detected
crime costs prior
to commencing
treatment
Sum of detected
crime costs for
offences
committed whilst
receiving
treatment
£2,111,600
£15,700
23,741 Client
Sum of Detected
Crime Costs
HAT 2 £268,100
HAT 3 £58,600
HAT 5 £558,700
HAT 6 £69,200
HAT 7 £977,400
HAT 9 £179,600
Total £2,111,600
Offending Information & Client Updates Number of offences
prior to HAT Number of offences whilst
receiving treatment Client treatment/ progression updates
HAT 3 14 0
HAT 5 146 0
HAT 6 20 0
HAT 7 239 2
HAT 9 55 1
HAT 2 67 0
Client #
Completed probation order
Improved compliance with probation
Improved compliance with probation
Improved compliance with probation
Begun reducing their dosage
Client had not gone longer than two weeks between prison
sentences prior to HAT. The client has now spent a sustained
period of time in the community
Improved compliance with probation
Completed probation
The most recent Proven Reoffending Statistics states that in the Cleveland area; each reoffender commits an average of 6.03 further offences (Office for National Statistics)
This table highlights the average number of offences each client has committed over every six month period of their criminal career (and not just the previous six month period), and how these have reduced over their time on HAT 67% of the sample cohort have ceased their offending entirely The two clients that have offended whilst on HAT, have reduced the frequency of their offending
Reoffending Average
number of
offences per six
months prior to
starting HAT
Average number
of offences per
six months whilst
receiving
treatment % Change
HAT 3 <1 0 -100%
HAT 5 4 0 -100%
HAT 6 1 0 -100%
HAT 7 6 2 -67%
HAT 9 3 1 -67%
HAT 2 2 0 -100%
Client #
Attendance
Clients attend HAT twice a day, seven days a week, to receive their heroin substitute
98% Total treatment session
attendance rate:
HAT has been able to sustain its effective engagement rates despite the challenges of delivering services during the COVID19 pandemic
Positive Test Results Negative Test Results
Urine Tests As part of their treatment, HAT clients are urine tested weekly to test for traces of illicit street heroin in their
system. A positive test indicates that they have consumed the substance recently .
There is only data for five tests for ‘Week 1’ as a client had to pause their treatment after a couple of days for health reasons. This occurred before a urine test could be conducted.
2 2 3
2 2
0 1
2
0 1
0 1
3
0 0 1
0
2 1
0 1 1 1
2 1 1 1 1 1
3 4 3
4 4
6 5
4
6 5
6 5
3
6 6 5
6
4 5
6 5 5 5
4 5 5 5 5 5
Treatment Outcomes Profile (‘TOPS’) are drawn up for every new client and conducted after each additional month of treatment. All responses are self declarations by the client TOPS scores highlight how quickly a client’s health and overall quality of life improves during HAT, and how this continually develops over their time in treatment
Treatment Outcomes Profile (TOPS)
Psychological Health
Physical Health
Overall Quality of Life
2.8 9.5
5.3 11.2
4.0 9.3
Scoring criteria: 0 'Poor’ - 20 'Good’
Score
at entry
Score after
one month
of treatment
Score after
seven months
of treatment
12.0
12.8
13.7
Change in score
between entry and
seven months of
treatment (%)
329%
142%
242%
• With the exception on alcohol, tobacco, and cannabis; the use of most substance falls after just one month of treatment (*the cannabis score raising is the result of the small sample size and one client scoring the maximum total of ’28’ for their month 1 assessment)
• After seven months of treatment; total substance use has fallen by an average of 54%
Maximum Score per Substance: 28 (Higher scores indicate higher use)
Alcohol
Opiates/ Opioids (Illicit)
Crack
Cocaine
Amphetamines
Cannabis
Other Substance
Tobacco
5.3 6.3
27.5 7.0
10.3 5.2
10.3 1.2
1.5 0.3
2.2 4.7
15.2 9.2
25.0 27.2
Score at
Entry
Score after
one month
of treatment
3.5
0.3
5.5
0.2
0.3
0.2
6.7
28.0
-34%
-99%
-47%
-98%
-80%
-91%
-56%
+12%
Score after
seven months
of treatment
Change in score
between entry and
seven months of
treatment (%)
Treatment Outcomes Profile (TOPS)
Social Warwick-Edinburgh Mental
Wellbeing Survey Scores
The Social Warwick-Edinburgh Mental Wellbeing Survey is a self assessment survey, which comes in two parts, and is completed on a monthly basis by each client The first part of this assessment asks clients to reflect on the following aspects, and to then score themselves in each regard:
• ‘I’ve been feeling optimistic about the future’
• ‘I’ve been feeling useful’
• ‘I’ve been feeling relaxed’
• ‘I’ve been dealing with problems well’
• ‘I’ve been thinking clearly’
• ‘I’ve been feeling close to other people’
• ‘I’ve been able to make up my mind about things’
Response range: '1' None of the time, '2' Rarely, '3' Some of the time, '4' Often, '5' All of the time
Social Warwick-Edinburgh Mental
Wellbeing Survey Scores
After one month of treatment the average scores increased for each survey question when compared the scores at entry
The largest changes related to: • ‘I’ve been feeling close to other people’ (a 175% increase in the first month of treatment)
• ‘I’ve been feeling useful’ (a 133% increase in the first month of treatment)
The area that showed more resilience was: • ‘I’ve been able to make up my mind about things’, which saw a more modest increase on
21% after the first month of treatment
There was a decrease in total scores between months five and seven, which coincides with the COVID19 outbreak and quarantine measures being implemented
85% 72% Change in total scores
between entry and seven
months of treatment:
Change in total
scores after one
month of treatment:
Community Feedback
I have known the HAT participant for the last 15 years. They have been addicted
to drugs and involved in criminal behaviour for this entire time period.
They looked the best I had seen in years. They weren’t wanted or suspected and they were talking positively about the
future. I could not believe the difference and I am so pleased for them.
Heroin Assisted Treatment is making a
real difference.
(Police officer, Cleveland Police)
All of my volunteers were so stressed with his behaviour through drug use. Now he is a changed man,
full of hugs and love. It’s amazing to see him now, so caring from very badly behaved. He has been housed
as part of the programme.
(Community Worker)