Different Paths and Potentials to Harm Reduction in Different Welfare States: Drug Consumption Rooms in the United Kingdom, Denmark, and France

Jauffret‐Roustide, Marie; Houborg, Esben; Southwell, Matthew; Chronopoulou, Daphné; Granier, Jean-Maxence; Frank, Vibeke Asmussen; Stevens, Alex; Rhodes, Tim

doi:10.2105/ajph.2022.306790

Cited by 6 publications

(7 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…For many participants, engagement in HAT also waylaid fears about serious physical damage, overdose and drug related death. This supports evidence of the harmreducing potential of supervised drug consumption rooms (11), in which PWID can experienced enhanced safety and protection from DRD and other related harms. As such, HAT was described by service users as health saving and even lifesaving.…”

Section: Criminal Activity and Physical Healthsupporting

confidence: 70%

“…Over the past 30 years, UK drug treatment policy has oscillated between abstinence-oriented treatments and harm reduction services, which were initially designed to reduce drug-related harms such as disease transmission and criminal offending, without enforcing abstinance (11,12). Support for maintenanceoriented harm reduction approaches diminished in the 2010s, with government guidelines re-enforcing abstinence as the primary goal of drug treatment (11,13). This shift preceded a decade of steadily increasing DRDs and decreasing numbers of people in treatment (14).…”

Section: Drug Treatment In the Ukmentioning

confidence: 99%

See 1 more Smart Citation

‘I feel like I found myself again’ – Rethinking ‘recovery’ in a qualitative exploration of Heroin Assisted Treatment (HAT) service users’ experiences

Riley

Harris

Ahmed

et al. 2022

Preprint

View full text Add to dashboard Cite

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.

show abstract

Section: Criminal Activity and Physical Healthsupporting

confidence: 70%

Section: Drug Treatment In the Ukmentioning

confidence: 99%

‘I feel like I found myself again’ – Rethinking ‘recovery’ in a qualitative exploration of Heroin Assisted Treatment (HAT) service users’ experiences

Riley

Harris

Ahmed

et al. 2022

Preprint

View full text Add to dashboard Cite

show abstract

“…This raises important questions about the ethics of discontinuing established medical care for particularly vulnerable, high-risk individuals. Given the evidenced benefits of maintenance treatment [ 13 – 15 ] and the potential consequences of treatment cessation [ 49 , 65 ], HAT should be considered a long-term treatment solution for opioid dependency, with ongoing service user needs and input paramount to funding decisions. Long-term or permanent funding would enable HAT service users to undergo treatment with a secure expectation of continued care.…”

Section: Discussionmentioning

confidence: 99%

“…Although harm reduction policy and practice differ across UK countries, drug treatment policy in England and Wales has shifted over the past three decades from a harm reductionist response towards an abstinence-based model of service provision [ 13 – 16 ]. The former approach aims to reduce health and social harms associated with the criminalised use of substances, such as blood-borne virus acquisition, criminal engagement and fatal overdose, without expectation of drug use cessation [ 13 – 15 ]. Injecting equipment provision and maintenance opioid substitution treatment (OST), such as methadone and burprenorphine, fall under this remit [ 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

‘This is hardcore’: a qualitative study exploring service users’ experiences of Heroin-Assisted Treatment (HAT) in Middlesbrough, England

et al. 2023

View full text Add to dashboard Cite

Background Heroin-Assisted Treatment (HAT) is well evidenced internationally to improve health and social outcomes for people dependent on opioids who have not been helped by traditional treatment options. Despite this evidence base, England has been slow to implement HAT. The first service outside of a trial setting opened in 2019, providing twice-daily supervised injections of medical-grade heroin (diamorphine) to a select sample of high-risk heroin users in Middlesbrough. This paper explores their experiences, including the negotiation of the strict regularly controls required of a novel intervention in the UK context. Methods We conducted in-depth interviews with service providers and users of the Middlesbrough HAT service between September and November 2021. Data from each group were thematically analysed and reported separately. This paper details the experiences of the twelve heroin dependent men and women accessing HAT. Results Participants’ accounts of HAT treatment evidenced a tension between the regulatory constraints and uncertainty of treatment provision, and the positive outcomes experienced through supportive service provision and an injectable treatment option. Limited confidence was held in treatment efficacy, longevity of funding, and personal capacity for treatment success. This was counteracted by a strong motivation to cease engagement with the illicit drug market. While attendance requirements placed restrictions on daily activities, participants also experienced benefits from strong, supportive bonds built with the service providers through their continued engagement. Conclusions The Middlesbrough HAT programme provided benefits to a high-risk population of opioid dependent people who were unable or disinclined to participate in conventional opioid substitution treatments. The findings in this paper highlight the potential for service modifications to further enhance engagement. The closure of this programme in 2022 prohibits this opportunity for the Middlesbrough community, but holds potential to inform advocacy and innovation for future HAT interventions in England.

show abstract

“…In the U.S., the conversation about crack cocaine has focused on race, while the French discourse has been framed as a social and urban disparity problem [ 25 , 26 ]. Nevertheless, policymakers in both nations have also stated concern about people who use crack cocaine in political terms favoring repressive responses that often leave out the possibility of social services and racial justice to address the underlying structural vulnerabilities [ 34 ].…”

Section: Commentarymentioning

confidence: 99%

A cultural and political difference: comparing the racial and social framing of population crack cocaine use between the United States and France

Goulian

Jauffret‐Roustide

Dambélé³

et al. 2022

Harm Reduct J

Self Cite

View full text Add to dashboard Cite

Different Paths and Potentials to Harm Reduction in Different Welfare States: Drug Consumption Rooms in the United Kingdom, Denmark, and France

Cited by 6 publications

References 27 publications

‘I feel like I found myself again’ – Rethinking ‘recovery’ in a qualitative exploration of Heroin Assisted Treatment (HAT) service users’ experiences

‘I feel like I found myself again’ – Rethinking ‘recovery’ in a qualitative exploration of Heroin Assisted Treatment (HAT) service users’ experiences

‘This is hardcore’: a qualitative study exploring service users’ experiences of Heroin-Assisted Treatment (HAT) in Middlesbrough, England

A cultural and political difference: comparing the racial and social framing of population crack cocaine use between the United States and France

Contact Info

Product

Resources

About