A scheme which sees heroin addicts given £30 shopping vouchers for agreeing to be vaccinated against Hepatitis B is working and could save the NHS money, according to a study.
Writing in medical journal The Lancet, researchers from the National Addiction Centre say the scheme should be rolled out nationally, and perhaps extended to improve uptake in other forms of healthcare.
Another scheme offers addicts £10 vouchers for each test that shows they have abstained from using drugs.
Drug usage and its treatment are emotive subjects at the best of times. Throw hard-earned taxpayer’s money into the mix, and you have a combustible concoction.
According to some, this is the thin end of the wedge. It’s the straw that will break the camel’s back - the beginning of the end of civilised society as we know it.
The Lancet is one of the most respected medical publications in the world. Work published in it is peer-reviewed, so we can be happy that those who carried out this study know what they are talking about.
The researchers point out that intravenous drug users are a major risk group not only for infection with Hepatitis B virus (HBV), but also transmission of it to others. An effective vaccine exists – the problem is getting users to take it.
When UK studies reveal that addicts were twelve times as likely to attend clinics for a course of three vaccinations over a month when given vouchers, it is clear the incentive scheme is working – though admittedly uptake still needs to improve.
A full 25-30% of the country’s 250,000 heroin addicts already have HBV. Given that the cost of treatment is estimated at £4,000 per patient per year – against around £215 for the vaccines and vouchers together – it is obvious a vast amount of money can be saved.
These are simple facts: fewer addicts infected and potentially passing on infection, and less money spent on treating people with HBV. Win-win.
Not for some people, apparently.
“In a time of austerity this is not the best way of spending taxpayers’ money,” said Joyce Robins of the pressure group Patient Concern – clearly missing the bit where it was explained that the scheme saves cash for taxpayers.
But it is the second set of trials – in which addicts in treatment are offered £10 vouchers for each ongoing test that shows them to be drug-free – that are causing the most controversy.
The study admits that contingency management – the use of financial or other incentives as part of treatment – might still not achieve “long-term behaviour change” in addicts.
But, given the “game-changing” increase in the uptake of treatment for HBV when incentivised, not to mention clinical proof from the UK and abroad that positive reinforcement helps in the treatment of drugs – isn’t it worth trying?
In 2012 the NHS found that 60% of intravenous drug users will quit after six months of treatment. Given that part of the problem is getting them to keep coming to get the treatment, why not incentivise?
They also found that every £1 of taxpayers’ money spent on drug treatment, £2.50 is saved on other NHS costs and in crime reduction.
To repeat: six out of 10 heroin addicts recover after six months of treatment. The more that recover, the less the taxpayer spends on the NHS and crime.
Incentivisation seems to work in getting addicts to undergo treatment. Ergo, it’s worth giving a go, right?
No, was the predictable response from readers of the website of a well-known national newspaper – many of whom are apparently better qualified than the doctors and experts in addiction who are promoting the scheme.
“Shopping vouchers or any other form of bribery is NOT going to work. Are these idiots supposed to be medical professionals? How do they not know this?” was a typical response from someone who didn’t deign to give his or her own medical qualifications.
“How about just throwing them in a concrete cell with no heating, bed, clothing or lighting? It is a very cheap method,” says another, showing both a remarkable lack of compassion and a failure to grasp basic economics.
Given the entrenchment of some people’s attitudes towards drugs, it may be that the health professionals and addiction experts will face an uphill struggle to convince them of the scheme’s benefits.
Me, I can’t see what’s so hard to grasp about “may save lives, will save money”.
Chas Early believes addiction is a sickness, and that you don’t normally prevent ill people from getting better.
This article is the opinion of Chas Early and not necessarily that of BT.