"Opioid substitution therapy (OST) is an evidence-based treatment for opioid dependency, with treatment engagement shown to be protective against drug related deaths (Santo et al., 2021). In England, the primary OST medications prescribed are methadone and buprenorphine, with provision ranging from daily supervised consumption at pharmacy services to take-home weekly doses. There were an estimated 261,294 people dependent on opioids in the England in 2017 (Hay, Rael de Santos, Reed, & Hope, 2017) with approximately 140,599 (or 54%) receiving OST (OHID, 2021). Barriers to ‘treatment engagement’ for the 46% of those who are not receiving OST can include concerns regarding disclosure; experiences or fears of stigmatising treatment; geographical isolation; reluctance or inability to engage with often inflexible treatment requirements; poor treatment access/availability and/or dislike of medication effects (ACMD, 2015; Harris & Rhodes, 2013; Marshall, Maina, & Sherstobitoff, 2021). People who are multiply marginalised, including women who use drugs, those who are unstably housed, living with multiple social problems, and/or cycling through the criminal justice system can face additional barriers to treatment access and be at highest risk of a drug related death (Medina-Perucha et al., 2019; Public Health England, 2018). It is crucial therefore, that treatment systems are more responsive and innovative to engage the most vulnerable, reduce health harms and risk of premature mortality."


Poulter, H. L., Walker, T., Ahmed, D., Moore, H. J., Riley, F., Towl, G., & Harris, M. (2023). More than just 'free heroin': Caring whilst navigating constraint in the delivery of diamorphine assisted treatment. The International journal on drug policy, 116, 104025. doi.org/10.1016/j.drugpo.2023.104025