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‘This is hardcore’: a qualitative study exploring service users’ experiences of Heroin-Assisted Treatment (HAT) in Middlesbrough, England

Riley, F.; Harris, M.; Poulter, H.; Moore, H.; Ahmed, D.; Towl, G.; Walker, T

‘This is hardcore’: a qualitative study exploring service users’ experiences of Heroin-Assisted Treatment (HAT) in Middlesbrough, England Thumbnail


M. Harris

H. Poulter

H. Moore

D. Ahmed


Background: Heroin Assisted Treatment (HAT) is well evidenced internationally to improve health and social outcomes for people dependent on opioids who have not been helped by traditional treatment options. Despite this evidence base, England has been slow to implement HAT. The first service outside of a trial setting opened in 2019, providing twice-daily supervised injections of medical-grade heroin (diamorphine) to a select sample of high-risk heroin users in Middlesbrough. This paper explores their experiences, including the negotiation of the strict regularly controls required of a novel intervention in the UK context. Methods: We conducted in-depth interviews with service providers and users of the Middlesbrough HAT service between September and November 2021. Data from each group were thematically analysed and reported separately. This paper details the experiences of the twelve heroin dependent men and women accessing HAT. Results: Participants’ accounts of HAT treatment evidenced a tension between the regulatory constraints and uncertainty of treatment provision and the positive outcomes experienced through supportive service provision and an injectable treatment option. Limited confidence was held in treatment efficacy, longevity of funding, and personal capacity for treatment success. This was counteracted by a strong motivation to cease engagement with the illicit drug market. While attendance requirements placed restrictions on daily activities, participants also experienced benefits from strong, supportive bonds built with the service providers through their continued engagement. Conclusions: The Middlesbrough HAT programme provided benefits to a high-risk population of opioid dependent people who were unable or disinclined to participate in conventional opioid substitution treatments. The findings in this paper highlight the potential for service modifications to further enhance engagement. The closure of this programme in 2022 prohibits this opportunity for the Middlesbrough community, but holds potential to inform advocacy and innovation for future HAT interventions in England.


Riley, F., Harris, M., Poulter, H., Moore, H., Ahmed, D., Towl, G., & Walker, T. (2023). ‘This is hardcore’: a qualitative study exploring service users’ experiences of Heroin-Assisted Treatment (HAT) in Middlesbrough, England. Harm Reduction Journal, 20, Article 66.

Journal Article Type Article
Acceptance Date Apr 16, 2023
Online Publication Date May 12, 2023
Publication Date 2023
Deposit Date Apr 18, 2023
Publicly Available Date Jun 21, 2023
Journal Harm Reduction Journal
Publisher BioMed Central
Peer Reviewed Peer Reviewed
Volume 20
Article Number 66


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