2. Heroin on the NHS? (matter for discussion)

Cambridgeshire Branch

That this meeting of RCN Congress discusses whether heroin should be provided on the NHS as an alternative to current drug misuse treatments.

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Progress report

Council Committee: NPPC
Committee decision: No work required
Council member/other member/stakeholder involvement: Harvey Morgan
Staff contact: ian.hulatt@rcn.org.uk

The discussion at Congress covered a wide range of views. This is replicated in the public debate on the same issue. There are however some indications that for a very select few clients prescription heroin is the most effective means of reducing harm and ensuring compliance. The evidence is complex and subject to several long term research studies. Despite the media interest, policy changes in this area are a long way off.

Debate report

Clare Topham-Brown from the Cambridgeshire Branch proposed this matter for discussion.  She started the debate by saying that 75 per cent of the public believe drug treatment programmes are a good use of public money and that with short term management, comes long term recovery.

Ann Cooper, Mid-Yorkshire Branch, said that money should be put into emergency access and better resources to help people off heroin, and that health care provision should be proactive, not reactive.

Gail Brooks, UK Safety Representatives Committee asked “can our NHS afford this?”, while one member responded that access to GPs and nurses would mean safer needles, with lower rates of hepatitis B and C. GPs and nurses would also be able to make referrals to other rehabilitation services, ultimately saving money in the long term.

Tom Bolger, Suffolk Branch said we can’t afford not to do this; that it’s important to start prescribing heroin. He went on to say “we know the risks, we will save money and improve lives”.

The proposer finished the debate by saying that there was a clear need for further discussion and a clear strategy on this issue. 

Background

In 2006 a Home Office report revealed the toll of hard drug abuse in England and Wales was more than £15 billion a year in terms of economic and social costs. The figure incorporated drug-related crime costs as well as a complex raft of treatment costs for substance users.

In 2002 radical proposals for those resistant to traditional programmes were first advocated by the then Home Secretary David Blunkett. These gave rise to a new therapeutic trial programme in England in which users inject themselves with pharmaceutical diamorphine, imported from Switzerland, under medical supervision at centres in London, Brighton and Darlington. Aberdeen has been considered as a potential future pilot location in Scotland.

The results of the pilot trials conducted in England show that crimes committed by substance users receiving prescribed heroin dropped by two-thirds after six months. Three-quarters of users ‘substantially reduced’ their use of street drugs, while their spending on drugs fell from £300 to £50 a week. The number of crimes they committed fell from 1,731 in three months to 547 in six months.

Harm reduction is a similar area of innovation which, whilst initially controversial, is now seen as a pragmatic intervention that enables the pursuit of better health outcomes for substance users. Initially resisted by health professionals, it has now become an accepted model of practice.

Could the provision of heroin on the NHS become accepted practice in the pursuit of positive outcomes for people who have been unable to benefit from any other intervention currently offered?

Similar programmes are already gaining acceptance internationally – last year the Swiss people voted by a two-thirds majority to ratify their successful heroin prescription programme which has been running for 15 years in special clinics.

References and further reading
National Treatment Agency for Substance Misuse (2007) The NTA’s 2006 survey of user satisfaction in England, London: NTA.
www.nta.nhs.uk/areas/research/current_projects.aspx