The community impact of RIOTT, a medically supervised injectable maintenance clinic in south London

Background: One of the major issues facing treatment services for alcohol and other drug users (current or ex-) around the world is community backlash, which has led to the closure of some much-needed drug treatment services. Aims: This study investigates the impact on the local community of a Medically Supervised Injectable Maintenance Clinic (MSIMC) implemented as part of the Randomised Injectable Opioid Treatment Trial (RIOTT), a trial into the effectiveness and efficacy of the provision of injectable opioids versus conventional oral methadone. The clinic model is based around a small number of the most entrenched and refractory patients (approx. 30) being treated by the service at any one time. Methods: The clinic and the trial were conceived primarily over 2002-2005, and the clinic began actual clinical operation in October 2005. The research was conducted between July 2005 and October 2007. Methods involved: pre-trial community key informant interviews; two-year follow-up key informant interviews; and analysis of Metropolitan Police crime statistics. Results: The most common concern raised by key informants in the local community was that the RIOTT would have a 'honey-pot effect', resulting in increased numbers of drug users coming to the area. At follow-up, key informants reported no such effect on the local community. Metropolitan Police figures show no significant changes in monthly or average annual crime levels in the local area. Conclusions: Community fears of negative social effects of the RIOTT clinic appear to have been unfounded, based on subjective and objective criteria, where such a project operates with the highly structured clinical and monitoring framework and with small patient numbers.