The case for implementing Supervised Injectable Heroin in the UK
PHE ePoster Library. Dorey L. Sep 12, 2019; 274507; 66
Dr. Lucy Dorey
Dr. Lucy Dorey
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Abstract Introduction
People with chronic dependence on heroin who do not respond to usual treatment, such as oral methadone maintenance, are at high risk of overdose, poor health and low social functioning. The provision of supervised injectable pharmaceutical heroin offers an alternative approach, but is rarely available in the UK. A rapid review of the literature was undertaken, to evaluate the evidence of effectiveness, acceptability and cost-effectiveness of this intervention; it was intended that this review would inform local service decision making by Southampton City Council.
A systematic search of the peer reviewed literature using three databases (MEDLINE, EMBASE and Web of Science) from 2009- January 2019 identified randomised trials, systematic reviews, economic evaluations, and qualitative studies relevant to this intervention (thirty-six included studies).
Based on six trials, the evidence for the implementation of Supervised Injectable Heroin (SIH) is considered to be strong in engaging this group of people in treatment (n=1377), reducing street heroin use, and influencing a range of health improvements. SIH can offer hope, facilitate engagement with psychosocial interventions, and has potential to assist clients to rebuild family and societal relationships; these changes can often require long-term provision over many years. SIH is resource intensive due to the costs of pharmaceutical heroin and of providing supervised injecting. However, benefits to the individuals, their families and to wider society (as evidenced in cost-effectiveness studies) provide a strong case for implementation.
Long-term provision of SIH should be considered; sustained funding is the main barrier to be overcome. External funding details
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