No assessment has been made on patient outcomes for those undergoing heroin detoxification using buprenorphine long-acting injection, branded Buvidal, compared to methadone specifically. The Office for Health Improvement and Disparities is currently undertaking analysis of National Drug Treatment Monitoring System data to look at the comparative outcomes between Buvidal and other opioid substitution treatment medicines generally, not just methadone. This work is currently incomplete.

Treatment decisions are taken between a person and their clinician to ensure the right option for them, and long-acting injectable buprenorphine, branded as Buvidal, oral buprenorphine, and methadone should be offered as part of a package of care, alongside the usual talking therapies and recovery support that can help people stay off drugs. Local authorities are responsible for commissioning drug and alcohol services according to local need, and this includes the provision of buprenorphine long-acting injections.

Heroin assisted treatment (HAT) or diamorphine assisted treatment (DAT) is a clinical intervention supported by the 2017 United Kingdom-wide drug treatment guidelines. Local authorities in England are responsible for commissioning drug treatment services, including whether to commission HAT services. Local authorities’ individual financial allocations and assessments of local need will determine if HAT is a viable intervention. The Government supports areas which pursue HAT where the relevant licences are obtained from the Home Office. In 2021, the former Public Health England provided additional guidance on commissioning and developing a HAT service if local authorities choose this approach.

The 10-year drug strategy is supported by a new investment of £780 million, including £532 million for local authorities to invest in treatment and recovery services in addition to the Public Health Grant. This allows local authorities to determine which interventions could augment current treatment systems. The Office for Health Improvement and Disparities provides oversight of local delivery and continues to monitor implementation against the aims of the drug strategy.

Drugs devastate lives, ruin families and damage communities. The Government is committed to driving down drugs supply in the UK through tough law enforcement, which is reflected in increases in drug seizures in recent years. Each seizure is stopping illegal drugs reaching our streets which bring misery to our communities. We support partnership working between the National Crime Agency, Border Force, and local policing, using intelligence and technology to keep our borders safe and secure, prevent drug trafficking and bring those responsible to justice.

In the event that contamination in supply raises the risk that drugs present, the National Crime Agency, police and The Office for Health Improvement and Disparities (OHID) - formally Public Health England - work together, monitoring the situation to understand the factors involved and deliver a rapid response to reduce harm and help prevent drug related deaths.

In August 2021, Public Health England issued an alert to all public health and drug services, following a number of deaths linked to possible heroin contamination. The NCA worked closely with the National Police Chief’s Council, Public Health England and others, to share intelligence, assess the situation and take decisive steps to prevent further loss of life.

The drug strategy is currently under development. Heroin assisted treatment (HAT) is an option open to local areas under the existing legal framework. The Government allows areas to provide HAT where the need is demonstrated and where the relevant licences are obtained from the Home Office.

Injectable opiate treatment programmes compliant with legislation and clinical guidance are supported by the Home Office and Public Health England and are in scope for Project ADDER funding. The Home Office and Public Health England have worked closely with delivery partners in each of the pilot Project ADDER areas to develop a delivery plan based on local need to provide a whole-system response to drugs misuse and drug-related harms locally.

No assessment has been made on the adequacy of the availability of naloxone for preventing death caused by heroin overdose.

Local authorities are responsible for assessing local needs and commissioning drug prevention, treatment and harm reduction services to meet these needs. This includes making sure they have sufficient coverage of naloxone to prevent drug-related deaths.

Spending on health care, including drug treatment services is a devolved matter. In England, local authorities are responsible for the commissioning and uptake of drug treatment services. They are funded to do so through the public health grant. In 2019-20, £3.1 billion has been provided for public health services, including drug treatment.

Any death related to drug use is an avoidable tragedy. Heroin-related deaths are rising across the United Kingdom, including in Bristol. This increase is linked to an ageing group of older heroin users with multiple and complex needs and in increasingly poor health. Half of opiate-related deaths occur among those who have never – or have not for several years – been in drug treatment.

Information on the level of provision of heroin assisted treatment is not centrally collected.

The Home Office collects and holds data on crimes recorded by the police in England and Wales, and outcomes recorded for these crimes. The table below shows the number of charge/summons outcomes recorded for offences of the supply or intent to supply of heroin.

Local authorities are responsible for assessing local needs and commissioning drug prevention, treatment and harm reduction services to meet these needs. This includes helping to prevent drug-related deaths from the misuse of heroin and morphine in coastal communities. Public Health England (PHE) supports local authorities to do this by providing advice, guidance and tools.

Locally, PHE is supporting the South East substance misuse network, which includes Portsmouth, to review a range of opportunities to prevent drug misuse deaths including engaging more people at risk in treatment, improving the physical and mental wellbeing of people in treatment, improving access to naloxone, developing local arrangements for reviewing deaths and near misses, and developing drug alert and early warning systems.

Nationally, the Department and PHE have made it easier for drug services to supply naloxone, published updated clinical guidelines for drug treatment and worked with a network of treatment providers to establish good practice guidance on managing drug-related death risk factors and to improve partnership between treatment providers and other healthcare services. Updated clinical guidelines can be viewed at the following link:

https://www.gov.uk/government/publications/drug-misuse-and-dependence-uk-guidelines-on-clinical-management

Heroin Assisted Treatment (HAT) can be an effective way of treating individuals for whom other opioid substitutes have not been effective. This is an option open to local areas under the existing legal framework. Given that funding decisions on drug and alcohol treatment have been devolved, it is for local areas to decide whether to commission HAT services based on an assessment of local need.

Local authorities are responsible for making decisions on how to spend their allocation of the public health grant based on the needs of their local population. Local authorities are responsible for commissioning drug treatment to meet those needs, including heroin assisted treatment services.

The 2017 Drug Strategy sets out a comprehensive approach for local, national and international stakeholders to tackle the challenges illicit drugs place on society. The Strategy recognises the support needed for ageing heroin users and outlines a targeted approach for evolving and emerging threats such as those posed by the emergence of new psychoactive substances. There are no plans to develop separate individual written strategies on these issues.

No comparative assessment has been made of the rates of recovery from heroin addiction through methadone in the United Kingdom and other countries.

There has been no estimate made of the general rate of methadone usage in the last three years.

An assessment of the heroin supply route via the Indian Ocean to East and Southern Africa is provided in the 2018 National Strategic Assessment of Serious and Organised Crime published by the National Crime Agency in May 2018.

The UK continues to enjoy close and longstanding cooperation with the governments and law enforcement agencies of both regions in tackling this threat.

Health is a devolved matter, and as such is wholly the responsibility of the Scottish Government.

However, the Government support a range of evidenced-base approaches to reduce the health-related harms associated with drug misuse. For example, availability of injecting equipment through needle and syringe programmes to prevent blood borne infections including HIV.

We have also amended the Misuse of Drugs Regulations 2001 to permit needle exchange programmes to distribute foil for heroin smoking and we are committed to widening the availability of Naloxone to prevent drug-related deaths.

We also recognise that, for many people who become dependent on heroin, opioid substitution therapy (OST) will be an important part of their pathway to recovery. For those where opioid substitutes have not been effective, Heroin Assisted Treatment (HAT) provides an alternative and effective way of treating individuals.

The table below shows the count of finished admission episodes with a primary diagnosis and primary or secondary diagnosis of poisoning by heroin for the years 2012-13 to 2016-17. The table shows activity in English National Health Service Hospitals and English NHS commissioned activity in the independent sector.

Source: Hospital Episode Statistics, NHS Digital

The number of deaths registered in England and Wales where heroin and/or morphine were mentioned on the death certificate are in the table below:

These figures were published by the Office of National Statistics in the Statistical Bulletin Deaths related to drug poisoning in England and Wales:2016 registrations (published August 2017) and are available at:

https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsrelatedtodrugpoisoninginenglandandwales/2016registrations