Giving hard-core addicts free heroin on the NHS seems to have a beneficial effect for the individual and for society as a whole. Health Editor Barry Nelson investigates a North-East initiative which could become a model for the UK.

AT first, it might seem strange that Darlington was chosen as one of three centres to test out a radical new approach to managing a hardcore of heroin addicts.

For the past three years, the town, along with Brighton and south London, has been piloting a controversial treatment regime which involves heroin addicts being given up to two free shots of “NHS heroin” every day.

Forty-five carefully selected addicts are enrolled in Darlington, which involves them visiting a clinic, in an undisclosed location ten minutes walk from the town centre, where they inject heroin under supervision in special booths.

It doesn’t mean that Darlington has a particular heroin problem; the reality is that every town and city in the UK has a heroin problem.

And that problem leads to increased levels of crime, shoplifting, prostitution and human misery.

The main reason why Darlington is one of three centres involved in the pilot scheme is because a number of consultant psychiatrists in the area have a particular interest in trying out this Swiss model of treatment.

Dr Tom Carnwath, a long-serving but now retired consultant psychiatrist, was involved at the beginning. He and his colleague, Dr Soraya Mayet – who now leads the project in Darlington – are both strong advocates of using injected heroin as a way to manage the most difficult to reach addicts.

A few weeks ago, researchers who studied the project confirmed that the best way to reduce crime levels and use of illegal street heroin among addicts receiving treatment was to put them on injectable NHS heroin.

The research showed a dramatic reduction in crime committed by addicts on injectable heroin treatment.

There was also a big drop in the amount of illicit drugs purchased by people on the scheme.

Dr Mayet says the experience in Darlington certainly bears this out.

“Some of those being treated have told me they were at death’s door before enrolling on this course. They were buying street heroin and committing crimes to fund their addiction.”

But Dr Mayet says many of these previously chaotic lives have been turned around because they know they don’t need to steal, or prostitute themselves, to get their next fix.

It also means they can have medical problems treated, be given somewhere decent to live and be re-united with their often estranged families.

“They have a more structured life. They come to the clinic twice a day. They also stop using street heroin, which helps with so many health problems caused by sharing dirty needles,”

says Dr Mayet, who was involved in the launch of a similar project in south London, before moving north to take over the scheme in Darlington when Dr Carnwath retired.

“One of the most important aspects is that the service users get to see their family again.”

This more structured life leads to some addicts reducing the amount of heroin they inject and even switching to oral methadone, a bright green linctus.

Says Dr Mayet: “Being on the course is like a stepping stone. The injecting side is like an intensive care treatment, but once they are stable, they can start making progress, reducing their heroin dose or switching to oral methadone.”

Dr Mayet stresses that the scheme – the Randomised Injectable Opioid Treatment Trial, or Riott for short –is only suitable for a small number of addicts who have failed to respond to other forms of drug treatment.

“It is the way forward for a minority of patients where treatment has not worked before,”

the consultant adds.

It costs about £15,000 per addict, per year, but experts point out that it costs £44,000 to keep someone in jail for a year – and that is where many heroin addicts end up, if they don’t die prematurely.

VICKY, 36, from Darlington, is one of the success stories of the programme.

A heroin addict since she was 24, she has thrived on the course, getting the medical treatment she needs, getting somewhere decent to live and being able to resume regular, normal contact with her family.

“Everyone who has been on this course makes progress. It is not just drugs it is your whole life that improves,” says Vicky, who has spent time in prison after shoplifting to feed her addiction.

“People have a proper, secure accommodation.

They are eating properly. When I was using street heroin, I used to go a couple of weeks without a wash. Everything takes second place to heroin. Being on the Riott programme means you can have a normal life again.”

Vicky has managed to halve the amount of heroin she injects and says many other addicts on the course do the same.

She is delighted that being on the course has brought her back in regular touch with her family.

“Things are better with my mum than they have ever been. My Grandma, who is 91, loves the scheme because it has brought me back to her. It is an all-round winner – it really is.”

Vicky is also full of praise for the staff who run the Riott clinic.

“The staff are really good. You get the feeling they are not just coming in here to pay the bills. They really want us to get clean and sort out our lives,” she adds.

Looking back, Vicky is horrified at the way she lived before enrolling on the scheme.

“I started using drugs when I was 15, but didn’t start heroin until I was 24,” she says.

When she first became addicted she lost her job in a factory and turned to shoplifting to raise the £50 a day she needed to buy heroin. Then, in 2002, she was caught and jailed.

“It was really terrible, I couldn’t believe I was in jail,” she recalls.

While in prison, Vicky was given a standard drugs detox, but it didn’t work.

“I remember ringing my dealer from the train station when I got back to Darlington from prison,” she reflects.

At her lowest ebb, Vicky was reduced to prostituting herself to buy the drugs she craved.

Now, she can’t understand why there are not Riott clinics in every town and city in the country.

Dr Mayet would certainly like to see similar treatment programmes set up in places such as Middlesbrough and Newcastle.

“When you see the change in people who have been on the course it is amazing,” she adds.

The ball is now firmly in the court of the Department of Health, which has said it is “right to explore a range of approaches” to helping people who are dependent on drugs.

The Darlington clinic is funded until March next year.