Here is a BBC report of the "RIOTT " pilot trials of prescribing injectable heroin.. I understand that the group who had heroin prescribed had to inject it in the clinic itself, watched by the nurses, and the obvious constraints of this would not be everybody's idea of a good free life.
I think Tony's suggestion of grabbing the motivation get free of it all, would be of course a brilliant idea.
I think these clinics were a final straw type solution for those unable to escape from the dependancy in any other way.. and I see that the person quoted in this article is saying that he has started reducing and hoping to get off it, so his plan at least is not for life long heroin.
I was not part of these pilots, so don't know of the longer term plans, but at the bottom of the article it suggests that the supervised heroin turns out far more expensive than methadone.. though the outcomes for this small group seem to have been good from the Home Office's target of reducing crime. Maybe others know more about this.
I had one patient who had prescribed heroin many years ago, and after a few years he decided to do a detox.. has now been opiate free for around 15 years.. In the end, although he preferred the heroin to the methadone, the best solution for him was to get free of opiates altogether.
And here is a more recent report by King's College London, , describing the Lancet paper published following the trials.
and from that, here is John Strang talking about it.
I have attempted to refer people to local psychs for heroin treatment but have been told they need to be resident in that locality.
Rolling out heroin prescribing as a result of the success of RIOTT was supposed to be part of the 2008 strategy, but not sure what happened to it in latest strategy - anyone?
We've had diamorphine prescribing in Cornwall for a little over 5 years now, and we've just reassessed our protocols.
It is a very expensive service to provide. At the last count we had 46 service users, and you have to balance the fact that you could probably treat a lot of people with methadone for every one on diamorphine. The people I see are receiving an average of 4 x 30mg daily, which means it's around £15 a day.
Because injectable diamorphine is very tradeable we have some restrictions that users have to aogree to. For example, they have to return their empties to the pharmacy (we pay pharmacies to monitor this) and there is less slack in our approach to missed pickups. This doesn't seem to dampen demand and there is a rigorous assessment process.
My personal view (which my colleagues may not share) is that it has worked well for a number of clients once they got used to the idea that it won't be forever. We have recently adopted a policy that says there will have to be very exceptional circumstances before we supply this for more than five years, and I think the evidence is suggesting that there is a break point at around 2 years when you can predict the outcome. By then, users should have started to get their lives in order, stopped any criminal behaviour, started to keep relationships (other than with their dealers), and all the other things you'd expect. They may not have got there, but if it isn't under way, they're not likely to benefit in the long run. It can be very enabling for users whose life was in a mess, particularly if they love the needle. Of course, it needs supporting therapies and a lot of social support, but so far as I can monitor we haven't seen the scale of abuse of the prescribed drug that some worried about.
I must commend you for this approach Graham, it all sounds like good sense, good common sense.
5 years tho 2 being a potential sliproad onto other interventions. Great stuff. Wraparound of course imperative. The pharmacy monitoring empties all great answers to detractors.
I tried to find you on that face book thing but I couldnt, you can email or m s n me at johnnyleedsuk at yahoo dot co dot uk if you get what i mean, hope to be able to havea chat to you sometime, also anyone else who is interested then drop me a line.
I will PM (personal message my email or it could be in my profile.
Unless you really mean it I would edit your last post and remove your email. You can PM anyone who you want to discuss further stuff with. Best to be safe.
Hoe you are keeping well
Take care and have a great wknd
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NTA have posted an alert on their website with template posters etc which might be helpful .. http://www.nta.nhs.uk/who-healthcare-reducing.aspx
I live in a small town outside Luton and the gear here has returned to normal and if its good here then its got be getting better out there.
Not that I take gear any more I just know loads of people who do indulge
The road of excess, leads to the palace of wisdom. W.Blake
Hi Will-C. Good to see you here again.
A more normal supply of heroin seems also to have found its way back to Birmingham, though the price is still higher than before the "drought", and bags are often still 0.1gms rather than 0.2gms.
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