Diamorphine Assisted Treatment (DAT) is a treatment offer for individuals with Opiate Dependency (OD), who have failed to benefit from standard treatment. Self-administered injectable synthetic heroin (diacetylmorphine) is offered to participants twice daily, under the supervision of medical staff in a controlled and safe environment. This case report evidences outcomes from the first DAT service implemented in the UK. Data from participants who engaged with year 1 of operation ( n=14) is presented detailing engagement, harm reduction, psychosocial outcomes, and criminal behaviour of the cohort. We present this work as an example of bottom-up policy making within the context of UK drug treatment and implications for practice discussed.

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Background Heroin Assisted Treatment (HAT) is an enhanced harm reduction programme designed for treatment-refractory opioid dependent individuals. The first HAT service in England was established in 2019, involving twice-daily supervised injections of medical-grade heroin (diamorphine). International research has produced promising evidence for HAT in reducing a range of intravenous drug-related harms and promoting myriad social benefits such as reduced criminal activity, increased social engagement and improved wellbeing. However, strict regulatory controls may constrain service users’ opportunities for social re-integration, inadvertently prioritising abstinence-focused treatment goals and definitions of ‘recovery’. The impact of HAT delivery from service user’s perspectives is not well documented, and this is the first qualitative research conducted within a fully operational HAT service in England. Methods We conducted semi-structured interviews with HAT service users in a North-East England drug treatment service (N=12). Data was subjected to thematic analysis, with common themes emerging inductively from the data. Results Participants overcame barriers to engagement and retention through self-motivation and commitment, supportive staff relationships and de-stigmatising treatment experiences that increased service users’ self-efficacy and sense of belonging. They reported multiple physical, emotional and social impacts, including minimised street heroin use and criminal behaviour, improved physical health, increased social engagement and emotional wellbeing. Conclusions Physical, social and psychological healing interacted throughout the course of HAT to facilitate holistic improvements in quality of life and wellbeing. However, HAT’s intensive treatment schedule was restrictive of patient’s daily activities, which could be mitigated through greater flexibility in treatment regulations. Middlesbrough HAT is an example of innovative drug treatment that offers continuing opportunities for success within a broad definition of recovery, in which abstinence sits on a spectrum alongside diverse forms of social, physical and psychological recovery from drug-related harms.