Where the Nurse Prescribes Heroin

https://www.nytimes.com/2019/11/27/world/europe/heroin-scotland-drug-use.html

Version 0 of 1.

LONDON — Homeless drug users in Scotland will be allowed to inject pharmaceutical-grade heroin twice a day under the supervision of medical officials as part of a new program intended to reduce drug deaths and H.I.V. infection.

From 9 a.m. to 5 p.m. seven days a week, a $1.5 million facility in Glasgow that opened on Tuesday will allow a handful of drug users to receive doses of the drug alongside other treatment for their physical and psychological health, according to Glasgow City Council.

The pilot project, known as heroin-assisted treatment, is the first such licensed operation in Scotland, a country that has been called the “drug death capital of the world.” It has struggled to cope with high rates of fatal drug overdoses and its worst H.I.V. outbreak in decades.

The program will target those with the “most severe, longstanding and complex addiction issues,” the City Council said.

It aims to reduce the risk of overdoses and the spread of viruses such as H.I.V. by prescribing diamorphine — the clinical name for pharmaceutical-grade heroin — for patients to inject in a secure clinical room under the supervision of trained medics.

The clinic opened in Glasgow, Scotland’s largest city, after Britain’s Home Office granted it a license, and follows a similar initiative that began in Middlesbrough, England, last month.

Up to 20 patients are expected to take part in the first year of Glasgow’s program, with the number set to double in the second year.

“Heroin-assisted treatment is a much more clinical service aimed at getting people stable,” Andrew McAuley, a senior research fellow on substance use at Glasgow Caledonian University, said in an interview on Wednesday. “The program is a significant step forward, albeit for a very small number of people.”

The program, called the Enhanced Drug Treatment Service, is intended for those who have exhausted other treatment options such as residential rehabilitation, methadone and community addiction services. It is available only to drug users already involved with the city’s team fighting addiction among homeless people.

The program is not intended to be long-term, with research suggesting that clinical benefits can be seen after six weeks of treatment.

It requires patients to visit the city clinic twice a day, seven days a week, a demand that may be too much for those not used to such a routine, Mr. McAuley said.

“It’s a large commitment,” he said.

Glasgow has ambitious plans to support its residents with drug-addiction issues, but Scottish officials say it has been hindered by Britain’s 1971 drug law.

Glasgow officials have pushed for years to establish consumption spaces in the city where drug users could inject their own drugs in a safe, clean environment, but their efforts have been rebuffed by the British government.

Britain’s Misuse of Drugs Act, the 1971 law, stipulates that anyone “concerned in the management of any premises” or any occupier who knowingly allows drugs to be prepared there can face prosecution.

“It is still illegal to have safe consumption sites, which puts us out of sync with most Western countries,” said Mr. McAuley, whose research group will evaluate the Glasgow program. “Glasgow is arguably the most compelling case for a drug consumption site.”

Austin Smith, a policy officer at Scottish Drugs Forum, a national resource of expertise on drug use issues, said, “This part of the law was to stop people opening up opium dens and was never intended to stop safe services, but that is what it does.”

More than 100 supervised consumption services have been established in countries like Australia, Canada, France, Switzerland and Germany, according to the Drug Policy Alliance, a New York-based organization that campaigns to end America’s “war on drugs.”

A report on Scotland’s drug problem that was released this month by the British Parliament’s Scottish Affairs Committee endorsed the treatment method.

“Safe drug-consumption facilities are proven to reduce the number of drug-related deaths and can act as a gateway to further treatment,” said Pete Wishart, the committee’s chairman. “Every drug death is preventable, and these centers could play a vital role in addressing Scotland’s drug crisis.”

Scotland’s drug problem has worsened in recent years, and official statistics indicate that drug-related deaths there are at a record high. Fatal drug overdoses have been highest among older users.

The number of deaths directly caused by drugs has risen in Scotland almost year on year since records began in the mid-1990s. And the number has climbed drastically: to 1,187 drug-related deaths last year from 244 in 1996, according to the National Records of Scotland.

Scotland’s drug death rate is nearly three times that of Britain as a whole and is the highest in the European Union.

By some measures, Scotland has even surpassed — by a small margin — the United States’ rate of 217 drug-related deaths per million of the population.

The number of homeless drug users with H.I.V. in Glasgow also increased in recent years, which one study attributed to the sharing of needles and other equipment. City health workers say the outbreak has still not been contained.

“This challenging social issue demands innovative treatments,” the chairwoman of Glasgow’s Alcohol and Drug Partnership, Susanne Millar, said in a statement on Tuesday.

“People might question why health services are spending money providing heroin for people with addictions,” she said. “The answer is we can’t afford not to.”