Implementation Science Evaluation of the Glasgow HAT Facility
Research type
Research Study
Full title
An implementation science evaluation of Scotland’s first Heroin Assisted Treatment facility
IRAS ID
272607
Contact name
Andrew McAuley
Contact email
Sponsor organisation
Glasgow Caledonian University
Duration of Study in the UK
2 years, 6 months, days
Research summary
Research Summary
Drug-related morbidity and mortality have reached critical levels in Scotland, with over 1,000 drug-related deaths during 2018 (highest population rate in Europe) and the largest HIV outbreak among people who inject drugs in the UK for over 30 years. As part of the response, a new service, Heroin Assisted Treatment (HAT: the provision of prescribed pharmaceutical grade heroin (diamorphine) under supervision) is being implemented in Glasgow. Previous evidence shows HAT is effective at improving patient outcomes: reducing heroin use; improving retention in treatment; improving mental and physical health; and reducing other issues related to heroin use such as involvement in crime and anti-social behaviours. This research is an implementation science evaluation which will examine how the new HAT service works, for whom, why and in what circumstances. The HAT service will be called the Enhanced Drug Treatment Service (EDTS).
We will interview service users of different types. 15 service users will be interviewed three times each throughout their service pathway in HAT about their expectations and experiences. In addition, five people will be interviewed who are on the HAT waiting list and five who declined the treatment. Using this data, alongside a series of stakeholder engagement events and analysis of routine administrative data, a service manual will be developed in collaboration with those delivering or looking to deliver HAT across the UK and around the world.
Summary of Results
In total, nine out of fifteen people who commenced HAT in its first year were still engaged with the service after one year, a substantial improvement on levels of previous service engagement.
Those who were still engaged after one year had reduced their illicit heroin use and had improved health and social functioning.
Uptake was facilitated by broadening referral routes, tailoring care to individual needs, relationship building between patients and staff, and a flexible, non-punitive approach to treatment.
The Covid-19 pandemic impacted the service in various ways, including limitations on capacity, referral pathways, staff availability and community support.
Other barriers to implementation included the location and layout of the service, the intensity of the treatment, complex needs of patients, and high levels of polydrug use.
Service commissioners investing in HAT must consider individual, service and environmental level contexts and factors when designing and implementing services.
REC name
West of Scotland REC 3
REC reference
20/WS/0022
Date of REC Opinion
6 Mar 2020
REC opinion
Favourable Opinion