Pubdate: Fri, 29 Nov 2019
Source: New York Times (NY)
Copyright: 2019 The New York Times Company
Author: Anna Schaverien and Allison McCann


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

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

"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

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."
- ---
MAP posted-by: Matt