Expand heroin-prescribing scheme ‘across country’, police chiefs’ drugs policy lead says

Heroin-assisted treatment should be rolled out “across the country”, the National Police Chiefs’ Council’s drugs policy lead has said, after the UK’s first fully fledged programme showed “very promising” results in its first year.

The treatment sees the most at-risk and entrenched users – many of whom are homeless, in poor health, and driven to commit crimes to feed their dependency – given medical-grade heroin (diamorphine) two or three times per day in a safe setting alongside access to a range of other services including health and housing, often breaking a cycle of years of disengagement.

While the treatment, used for decades in other countries, is loosely based on Britain’s own history of heroin prescribing and has been piloted successfully several times this century in the UK, a new scheme in Middlesbrough is widely regarded as the country’s first fully-established programme. Another scheme was opened in Glasgow last November.

Of the 14 people chosen for Middlesbrough’s scheme, for whom other treatments had not previously been effective, seven remained at the end of the first year. Analysis of six candidates on the scheme for at least 30 weeks found they had committed just three minor crimes between them during this period, down from a collective total of at least 541 known offences before the scheme began.

These participants, some of whom have taken heroin for 20 years, had an attendance rate of 98 per cent, and scores for their psychological and physical health – based on self-declarations – more than doubled after just one month of treatment. None were homeless after one month, with just two in secure accommodation and two sleeping rough at the outset.

Speaking to The Independent, Jason Harwin – who is drugs policy lead for the NPCC, which represents police chiefs in England and Wales – called on his colleagues to consider rolling out such schemes where they are needed.

“We should look at expanding it across the rest of the country,” said Mr Harwin, who is also Lincolnshire’s Deputy Chief Constable. “Not in every place, not everywhere needs it. But where clearly there’s a heroin problem and particularly drug-related deaths and an impact on criminality and organised crime, it’s clearly a solution that actually helps individuals and the wider communities as well.”

DCC Harwin, who was involved in setting up Middlesbrough’s scheme while serving as Assistant Chief Constable in Cleveland, said he was “delighted” with the results, adding: “Hopefully it’s a flagship for other areas now to follow suit.”

“The Middlesbrough pilot has proven, in line with the already established evidence base, that it can make a difference – it has done,” DCC Harwin said. “Why would you not want to do it in other areas if it shows that benefit? We’ve all got a duty to look after each other, and that includes individuals who have clearly got heroin and drug dependency.”

In a crisis felt most sharply in the Northeast, drug-related deaths are at an all-time high in England and Wales, having risen for seven consecutive years. While the government often attributes this largely to an ageing population of heroin users with compounded health problems, the soaring fatalities and an exodus from treatment services have coincided with a decade marked by austerity, a shift to local funding and a government drugs strategy accused of promoting abstinence at the expense of harm reduction.

Asked whether he believed heroin-assisted treatment was one of the most effective ways to tackle the country’s drug deaths epidemic, DCC Harwin noted that those the scheme targets – “entrenched heroin and crack cocaine users are at greater risk of a drug overdose than anybody else”, adding: “It’s certainly a tool, it’s an option that does make that difference.

“I’m not saying it’s the only option, because there are other things that can be done as well, but certainly from what I’ve seen, heard and been shown, ultimately it’s an evidence-based … treatment that has the effects that we want it to in terms of reducing the risk to the individual, reducing the risk to the wider community in terms of criminality and ultimately reducing the demand for drugs in that community, and therefore reducing the profits for organised crime. So it does all the things from a police perspective that we would hope it to do. 

“The loss of one person’s life – you can never really put a price on that. The reality is we lose far too many people through drug-related deaths, through illicit drugs. Therefore we have got to do something that will actually reduce that risk, and heroin-assisted treatment is part of that.”

The biggest barrier to setting up such schemes is funding, with the costs of setting up Glasgow’s centre estimated to be £1.2m. The annual cost of diamorphine in the form approved by the Home Office has previously been placed at £12,000 per individual, although the drug comes in significantly cheaper types.

Meanwhile, the 541 crimes previously committed by the six individuals analysed in Middlesbrough are estimated to have cost some £2.1m. 

The strain on health services was also significantly reduced. 

According to self-declarations, in the four weeks prior to starting treatment, these six participants required a total of two ambulance calls, two trips to A&E due to infections, and were twice unexpectedly hospitalised as an inpatient.

Over a period of six months while in treatment, this total dropped to just four ambulance calls and two hospital inpatient stays between the six individuals, also according to self-declarations.

“The reality is by not funding it, it’s actually costing the public purse a lot more,” DCC Harwin said.

“It’s also the wider impact on the community. If you were one of the victims of those offences, then you’re less likely to be victim in the future, so surely it makes sense that you’re funding that. 

“It’s not about going soft on crime, it’s about being smarter. It’s a smarter response to criminality that ultimately reduces the risk to the individual, reduces the risk to the wider community and makes sure we take out the opportunities for serious organised crime to profit from it as well.”

While the illicit drugs trade now costs the UK some £19bn a year – more than double its profits – only £600m is spent on treatment and prevention. A landmark review by Dame Carol Black recently estimated that heroin and crack cocaine account for 86 per cent of the trade’s cost to society.

With police forces and health services in the West Midlands and in the Southeast among those looking at setting up centres of their own, some are looking to use money seized from criminals under the Proceeds of Crime Act to set up treatment centres of their own.

“Let’s be honest, in terms of messaging – we’re taking money off criminals who have profited from, not just drugs but significantly from drugs, and putting it back into treatment services that ultimately have been exploited through the use of illicit drugs,” DCC Harwin said. “Which is a good news story for me, I think that’s the right way we should do it.

“That said – we need to make sure it’s mainstream so it can’t just be a case of Police and Crime Commissioners funding it, it should be health-driven. It should be a public health-led response, and therefore should come from public health funding longer-term.”

He added: “The reality is that we’ve taken out of the system and out of our budgets, because the country was in austerity, a significant amount of money – up to 25 per cent of the budget for treatment services, and more in some areas. 

“And therefore we’re wondering why we’re then seeing the effects of drug-related deaths going up. People not accessing [treatment], criminality increasing. It’s not rocket science – just put more money back into it, people can access the relevant services that are evidence based and therefore the effect that we’re trying to deliver by that service is achieved, and therefore we reduce costs longer-term.”

And as drug treatment services have seen their budgets slashed, organised crime groups continue to push heroin and crack cocaine into ever-more remote corners of the country under the county lines model.

“The reason they’re being pushed into those areas now is there’s a demand for it,” DCC Harwin said.

While he believes heroin-assisted treatment can play a role in reducing that demand alongside existing services, he stressed that it is not necessary in “every town and city in the country”, but only where there are entrenched and homeless heroin users.

A key part of the preparation work for launching Middlesbrough’s centre was in assessing how many people were in desperate need of such a programme – which DCC Harwin places at around 60 individuals.

And while those in areas looking to create their own centres are engaged in the same preparation, DCC Harwin reveals that police forces across the country are currently developing their own drugs profiles to assess demand for illicit substances in each part of the country.

While heroin-assisted treatment has been found to significantly reduce participants’ need for illicit drugs and in doing so likely cutting the profits of organised crime groups, Dame Carol’s review found that the drugs trade itself “has never caused greater harm to society”, and that policing efforts not only fail to stem supply but often fuel increased violence in a market which now involves an “unprecedented” number of children.

And last year, Durham’s late Police and Crime Commissioner Ron Hogg told The Independent that police raids “which take months, sometimes years in the planning, do no more than disrupt the supply market for the very shortest of periods”.

Former and current law enforcement agents with campaign group Leap UK have made a similar assessment, declaring the war on drugs doomed to fail.

However, gains have been made during the coronavirus lockdown in clamping down on the drugs trade, while the discovery of secret encrypted app Encrochat this year led to the arrest of hundreds of criminals in the UK, including previously “untouchable” crime kingpins.

Despite these recent gains, DCC Harwin said he agreed with arguments that enforcement efforts can only ever be temporary fixes and are ultimately doomed to fail to stem an evolving drugs trade.

“So there is a part to play with policing when enforcing the law around drugs, I’ve never said there wasn’t. It’s about where we focus our attention,” he said.

“For me, it’s about the whole-system approach, where ultimately we try and take out the need for drugs in the first place. Where we make sure that people who may come into contact with the police, or ultimately don’t, that need treatment services can access that service in a timely manner … which takes out the demand. We need to do that.

“At the same time, we know very well that individuals in our communities, in our country, in other countries, will take the opportunity through the illicit drugs to profit. And that profit will involve the exploitation and trafficking of individuals to grow the drugs, transport the drugs and ultimately distribute the drugs. That’s the bit from a policing service that we need to keep focused on. 

“Not just in terms of policing, but with wider law enforcement – the National Crime Agency, the border forces – to make sure we are targeting those individuals and stripping their assets, and making sure they’re held to account and put before the criminal justice system.” 

But increasingly in the UK, there are calls for more radical changes to drugs policy, with The Independent reporting in December that some of the country’s largest drug treatment providers are now among those urging the government to consider decriminalisation.

While DCC Harwin said he doesn’t believe it’s possible to decriminalise drugs outright, he thinks “it’s a debate that we should be having here” and said that “there is debate around regulation – could we regulate it better?”

Asked whether he feels there is a need to move the national conversation beyond decriminalisation to include legalisation, he said: “Yeah, I think there is. 

“There is a need as a nation – and obviously other parts of the world are having that conversation, and bearing in mind New Zealand have recently decided not to decriminalise cannabis – but it’s that conversation about ‘what would be the implications if we decriminalised? What would be the implications if we regulate it?’

“The reality is that despite the efforts of many, we haven’t got enough money in treatment services to provide the necessary treatment at the necessary level for individuals who clearly need that treatment. And from an enforcement perspective, we’re doing lots of enforcement … but the reality is that whilst there’s ever demand and people want drugs, drugs will get to them, whichever way that may be.”