But administering the drug in a controlled environment in combination with intensive psychosocial care is often the only way to give those affected some support. The Bonn facility was founded 20 years ago in Annagraben. It was part of a model project run by the Bonn University Hospital (UKB) and the Caritas/Diakonie Outpatient Addiction Aid and was the first clinic of its kind in Germany. It has long since proven its worth - and has positively influenced the lives of many addicts.

"I can absolutely understand when people are first sceptical about diamorphine treatment," explains Dr Henrik Rohner, senior physician at the Department of Psychiatry and Psychotherapy at the UKB and the diamorphine outpatient clinic. "But you also have to understand that we only treat those who have been addicted for at least five years and have already tried all other forms of therapy to no avail."

The first thing you have to give these patients is stability, and the outpatient clinic makes that possible. "Here, they receive a pharmaceutically cleanly produced and quality-controlled diamorphine in the right dose for them. In other words, it’s not a contaminated substance, and they also don't have to think about how to get the money get their next shot. This can prevent crime connected with financing an addiction. Such structures are tremendously valuable for severely addicted people, because they once again give them a perspective after numerous setbacks."

The Bonn diamorphine outpatient clinic can treat between 55 and 60 patients from the city at a time. They have to report there two to three times a day to collect their dose, and they also have to attend psychiatric and psychosocial sessions. "These fixed appointments give those affected some stability and perspective," explains Andrea Welskop, a psychiatrist at the diamorphine outpatient clinic. "It doesn't work without these building blocks, and the patients know that very well. We are often the only or at least the first contact they have outside the drug milieu. And they realise that we offer them an opportunity that they won't get anywhere else so soon."

The team supports addicts in coping with their everyday life. They help find accommodation, take care of social, bureaucratic or health problems, and secures medical treatment for chronic infectious diseases such as hepatitis C or HIV, which often accompany heroin addiction.

And there are successes. "I remember a patient who got off alcohol and nicotine during his time in the outpatient clinic and now even stopped using heroin. He has finally found an occupation that gives meaning to his life, and he’s stayed clean. I know that this is a special case because most of those who come to the outpatient clinic ultimately remain heroin addicts even under our control - but nevertheless, a story like this gives hope," says Welskop.

Small steps are tremendously valuable: For example, most of the patients who were homeless now have a permanent home, and many also have a job.

The concept of the diamorphine outpatient clinics has long since proven itself; for ten years now, statutory health insurance funds have been covering the substitution treatment. "We have achieved greater acceptance both in Bonn and throughout Germany than was originally thought," Welskop and Rohner emphasise. Both welcome the destigmatisation of people suffering from an addiction - but they are even more pleased that their patients will be able to participate in social life at least to a certain extent in the future.

Original article: Thomas Kölsch / Translation: Jean Lennox