Anna McVinish was the nurse clinical lead for Australia’s first trial of SIOT and subsequently travelled to survey heroin-assisted treatment models internationally. At home she works with the agency for clinical innovation and is project managing the implementation of a drug checking study at Sydney’s Medically Supervised Injecting Centre.

Despite abundant evidence, the availability of heroin or hydromorphone assisted treatments (HAT) for opioid dependence remains limited and a stigmatised, political and
regulatory challenge internationally. And so after completing Australia’s first clinical trial of injectable hydromorphone, it became imperative to learn from sites internationally for future implementation success.

Australia’s Churchill Trust sponsored a study tour where I visited 13 HAT sites and many expert practitioners and participants to discuss practice considerations and investigate an ‘intensive care’ model of OAT that all agreed, is substantiated by much more than the medicines prescribed. Key themes included the understanding that medicine is at once prescribed pharmacotherapy and a safe and regulated supply that can stabilise harmful opioid use. Yet, HAT participants and practitioners consistently reported that the therapeutic engagement made possible by an intensively relational and non-punitive treatment approach significantly benefitted the quality of life and social enfranchisement that many program participants reported.

Undertaking this survey also provided an opportunity to draw together a network of frontline nurses and harm reduction workers whose collective
expertise represents immense value for a future model development that can supplement medications to engage, retain and benefit program participants.
Furthermore, collating and contrasting the strengths of local site practices mandates the creation of more relationally dignified spaces and
interventions that PWUD have asked for and should expect, both with HAT and conventional OAT.

Despite multiple sites in select countries, HAT remains a boutique intervention that has not been well-scalable to larger populations. In considering novel approaches to the treatment
of opioid dependence, our work considers how to most effectively mobilise the HAT modality in the absence of consensus guidelines. And, harness the collective expertise of a workforce delivering a treatment that continues to challenge precedents, regulators and stigma; to increase the quality of life of PWUD.