Foundations

• Foundations aims to support people who are socially excluded across our sites.

Heroin Assisted Treatment – Why now, Why Middlesbrough?

Middlesbrough is the Local Authority

containing the highest proportion of areas

which are considered the ‘most deprived’.

Of the wards in Middlesbrough, North

Ormesby is the most deprived, and is the

second most deprived in England.

49% of areas in Middlesbrough fall into this

‘most deprived’ category.

Middlesbrough Local Authority is the most

deprived local authority in England

Heroin Use in Middlesbrough

Rates of opiate users in Middlesbrough are 57% higher than in the

North East region, and 66% higher than the England rate.

Middlesbrough has the highest rate in the country – 21% higher

than the next highest local authority.

Drug Related Deaths

2016-18 Numbers Rate 2017-19 Numbers Rate

1 Blackpool 69 17.7 1 Blackpool 73 18.9

2 Norwich 52 13.6 2 Middlesbrough 60 16.3

3 Barrow-in-Furness 24 13.4 3 Hartlepool 39 15.5

4 Hartlepool 34 13.1 4 Scarborough 32 11.9

5 Middlesbrough 48 12.8 5 Stoke-on-Trent 82 11.5

6 Burnley 30 12.4 6 Norwich 44 11.4

7 Liverpool 151 11.5 7 Barrow-in-Furness 20 11.1

8 Scarborough 28 10.7 8 Liverpool 145 11.0

9 Gosport 25 10.3 9 Redcar and Cleveland 40 11.0

10 Gateshead 60 10.1 10 Gosport 25 10.6

Stockton-on-Tees 56 10 13 Stockton-on-Tees 57 10.1

Redcar and Cleveland 35 9.4

• Field visits

• Licenses acquired

• Funding acquired

• Public/Media engagement

Heroin Assisted Treatment – Middlesbrough – 2 years of preparation

Heroin Assisted Treatment: Aims and Outcomes

Heroin Assisted Treatment : Patient Selection

• Patient Selection:

o Engaged in treatment in

Middlesbrough Recovering Together

(MRT)

o With chronic injecting heroin

dependence

o Standard treatment has not been

successful

o Partnership approach to selection

o 15 participants

• Go Live Date – 15th October 2019

• 12mth operating

• Specialist Clinic

• Twice daily administration of

medication

• Wrap-around support

Programme Implementation

• Heroin assisted treatment walkthrough

Programme Implementation

Heroin Assisted Treatment: Evaluations

• The social and environmental impacts of the HAT programme over a 6 month period.

• Impact on the criminal justice system 6 months prior vs 6 months post intervention.

• Outcomes such as weight, housing status, engagement with other psychosocial interventions, wellbeing, and street drug usage.

• Due to be completed November 2020.

Research Activities 2021-2022

• Funding has recently been obtained from NIHR-ARC to allow research team to build on the small year 1 evaluation.

• Led by Teesside University (Professor Tammi Walker) working collaboratively with experts from Durham University (Professor Graham Towl) and the London School of Tropical Medicine (Dr Magdalena Harris).

• The funding will explore the experiences of individuals who have completed, discontinued or refused to engage with the HAT pilot programme and other key stakeholders such as delivery staff.

• This research is the first of its kind in the UK and will examine issues relating to treatment outcomes, impact, retention and acceptability.

Cohort Information

Total number of clients

that have received

treatment on the

programme to date:

13

8

1

1

1

1

1

Client voluntarily left

HAT after one week

of treatment

Treatment ended due

to client receiving a

custodial sentence

during treatment

Treatment paused

due to client being

held on remand whilst

being investigated for

suspected offending

Currently receiving treatment

Client status:

Treatment paused

whilst client receives

treatment for their

mental health

Treatment has been

suspended on

clinical advice

Control Group Selection

To assess the impact of Heroin Assisted Treatment; we have formulated a control group, to more accurately demonstrate the client’s treatment journey This group chosen – 6 clients over 29 weeks – combines a sizeable group of clients who have been on the course for many weeks.

Control group size: • 46% of all HAT clients to date

• Current client data goes up to July 2020

6

Time on HAT

(Weeks)

Cohort Size

38 1

37 2

35 3

34 4

29 6

26 7

22 8

19 9

18 10

5 11

1 13

Offending History & Reoffending

Total number

of detected

crimes prior to

commencing

treatment

541

Number of

detected crimes

whilst receiving

treatment on

HAT

3

Source: Cleveland Police data

We have been able to verify all

detected crime up to 29/07/2020

Sum of detected

crime costs prior

to commencing

treatment

Sum of detected

crime costs for

offences

committed whilst

receiving

treatment

£2,111,600

£15,700

23,741 Client

Sum of Detected

Crime Costs

HAT 2 £268,100

HAT 3 £58,600

HAT 5 £558,700

HAT 6 £69,200

HAT 7 £977,400

HAT 9 £179,600

Total £2,111,600

Offending Information & Client Updates Number of offences

prior to HAT Number of offences whilst

receiving treatment Client treatment/ progression updates

HAT 3 14 0

HAT 5 146 0

HAT 6 20 0

HAT 7 239 2

HAT 9 55 1

HAT 2 67 0

Client #

Completed probation order

Improved compliance with probation

Improved compliance with probation

Improved compliance with probation

Begun reducing their dosage

Client had not gone longer than two weeks between prison

sentences prior to HAT. The client has now spent a sustained

period of time in the community

Improved compliance with probation

Completed probation

The most recent Proven Reoffending Statistics states that in the Cleveland area; each reoffender commits an average of 6.03 further offences (Office for National Statistics)

This table highlights the average number of offences each client has committed over every six month period of their criminal career (and not just the previous six month period), and how these have reduced over their time on HAT 67% of the sample cohort have ceased their offending entirely The two clients that have offended whilst on HAT, have reduced the frequency of their offending

Reoffending Average

number of

offences per six

months prior to

starting HAT

Average number

of offences per

six months whilst

receiving

treatment % Change

HAT 3 <1 0 -100%

HAT 5 4 0 -100%

HAT 6 1 0 -100%

HAT 7 6 2 -67%

HAT 9 3 1 -67%

HAT 2 2 0 -100%

Client #

Attendance

Clients attend HAT twice a day, seven days a week, to receive their heroin substitute

98% Total treatment session

attendance rate:

HAT has been able to sustain its effective engagement rates despite the challenges of delivering services during the COVID19 pandemic

Positive Test Results Negative Test Results

Urine Tests As part of their treatment, HAT clients are urine tested weekly to test for traces of illicit street heroin in their

system. A positive test indicates that they have consumed the substance recently .

There is only data for five tests for ‘Week 1’ as a client had to pause their treatment after a couple of days for health reasons. This occurred before a urine test could be conducted.

2 2 3

2 2

0 1

2

0 1

0 1

3

0 0 1

0

2 1

0 1 1 1

2 1 1 1 1 1

3 4 3

4 4

6 5

4

6 5

6 5

3

6 6 5

6

4 5

6 5 5 5

4 5 5 5 5 5

Treatment Outcomes Profile (‘TOPS’) are drawn up for every new client and conducted after each additional month of treatment. All responses are self declarations by the client TOPS scores highlight how quickly a client’s health and overall quality of life improves during HAT, and how this continually develops over their time in treatment

Treatment Outcomes Profile (TOPS)

Psychological Health

Physical Health

Overall Quality of Life

2.8 9.5

5.3 11.2

4.0 9.3

Scoring criteria: 0 'Poor’ - 20 'Good’

Score

at entry

Score after

one month

of treatment

Score after

seven months

of treatment

12.0

12.8

13.7

Change in score

between entry and

seven months of

treatment (%)

329%

142%

242%

• With the exception on alcohol, tobacco, and cannabis; the use of most substance falls after just one month of treatment (*the cannabis score raising is the result of the small sample size and one client scoring the maximum total of ’28’ for their month 1 assessment)

• After seven months of treatment; total substance use has fallen by an average of 54%

Maximum Score per Substance: 28 (Higher scores indicate higher use)

Alcohol

Opiates/ Opioids (Illicit)

Crack

Cocaine

Amphetamines

Cannabis

Other Substance

Tobacco

5.3 6.3

27.5 7.0

10.3 5.2

10.3 1.2

1.5 0.3

2.2 4.7

15.2 9.2

25.0 27.2

Score at

Entry

Score after

one month

of treatment

3.5

0.3

5.5

0.2

0.3

0.2

6.7

28.0

-34%

-99%

-47%

-98%

-80%

-91%

-56%

+12%

Score after

seven months

of treatment

Change in score

between entry and

seven months of

treatment (%)

Treatment Outcomes Profile (TOPS)

Social Warwick-Edinburgh Mental

Wellbeing Survey Scores

The Social Warwick-Edinburgh Mental Wellbeing Survey is a self assessment survey, which comes in two parts, and is completed on a monthly basis by each client The first part of this assessment asks clients to reflect on the following aspects, and to then score themselves in each regard:

• ‘I’ve been feeling optimistic about the future’

• ‘I’ve been feeling useful’

• ‘I’ve been feeling relaxed’

• ‘I’ve been dealing with problems well’

• ‘I’ve been thinking clearly’

• ‘I’ve been feeling close to other people’

• ‘I’ve been able to make up my mind about things’

Response range: '1' None of the time, '2' Rarely, '3' Some of the time, '4' Often, '5' All of the time

Social Warwick-Edinburgh Mental

Wellbeing Survey Scores

After one month of treatment the average scores increased for each survey question when compared the scores at entry

The largest changes related to: • ‘I’ve been feeling close to other people’ (a 175% increase in the first month of treatment)

• ‘I’ve been feeling useful’ (a 133% increase in the first month of treatment)

The area that showed more resilience was: • ‘I’ve been able to make up my mind about things’, which saw a more modest increase on

21% after the first month of treatment

There was a decrease in total scores between months five and seven, which coincides with the COVID19 outbreak and quarantine measures being implemented

85% 72% Change in total scores

between entry and seven

months of treatment:

Change in total

scores after one

month of treatment:

Community Feedback

I have known the HAT participant for the last 15 years. They have been addicted

to drugs and involved in criminal behaviour for this entire time period.

They looked the best I had seen in years. They weren’t wanted or suspected and they were talking positively about the

future. I could not believe the difference and I am so pleased for them.

Heroin Assisted Treatment is making a

real difference.

(Police officer, Cleveland Police)

All of my volunteers were so stressed with his behaviour through drug use. Now he is a changed man,

full of hugs and love. It’s amazing to see him now, so caring from very badly behaved. He has been housed

as part of the programme.

(Community Worker)

Participants feedback

Patient clips and info