Danny Ahmed is a registered mental health nurse prescriber and integrative psychotherapist who has spent over 20 years supporting people who use drugs and alcohol problematically. Danny is the Clinical Director of Cranstoun and Clinical Partner at Foundations.

Despite the wealth of evidence available supporting the efficacy of DAT it has been unavailable for many people who require it. 2019 saw the introduction of a DAT clinic in Middlesbrough, England provided by Foundations and in 2022 in a city in the West Midlands, England, provided by Cranstoun.

The Middlesbrough service was independently evaluated and further research on the subjective experience of providing and receiving DAT due in 2023. The clinic was introduced as a direct response to the significant levels of drug related deaths, the highest in England at that time. The participants attend the service for 2 doses of diamorphine under medical supervision 7 days a week.

The evaluation found: (1) Engagement was excellent; (2) Street heroin use was reduced by 80%; (3) Uptake of psychosocial interventions went from 0 to 100%; (4) Improvement in mental health by 218%; (5) Improvement in physical health by 100%; (6) Improvement in quality of life by 261%; (7) Crime reduced by 60% and the severity of crime reduced by 60%.

Patients involved with service saw their housing status significantly improve. Many were street homeless at the beginning and all were supported to access stable housing. The clinic has seen several people successfully complete the programme returning to either less intense forms of treatment or successfully detoxifying and completing rehabilitation programmes. 2 patients have gone on to volunteer in the substance use field.

The programme has been identified as a bastion of good practice. Despite the wealth of evidence behind it and the impact locally, DAT has been subjected to restrictive guidelines and short, non-recurrent, funding streams.

This presentation will outline the process and challenges of implementing DAT and the treatment outcomes as outlined above and how the lessons learned in Middlesbrough have shaped the service delivered in the West Midlands.