Heroin-Assisted Treatment, and Making Sense of Addiction, with Prof Sir John Strang

Flourishing After Addiction with Carl Erik Fisher

In the weeks prior to this episode, the story broke that the UK’s Middlesbrough clinic, which offered a pioneering Heroin Assisted Treatment (HAT) program, is slated to close because of budget cuts. Patients were allowed to self-administer medical-grade heroin (officially, diamorphine) under medical supervision. One of the key scientific studies that supports this intervention is the RIOTT Trial—“Randomised Injectable Opiate Treatment”—and I got to speak to the principal investigator of that trial, a giant in the field of addiction research, and the first knight to appear on the Flourishing After Addiction podcast: John Strang.
Prof Sir Strang is a pioneering addictions researcher and practicing physician who, over the course of his distinguished career, has made major contributions to national and international policy. Of particular interest to those of us who are fascinated with the intellectual and cultural history, he’s had a front-row seat to the scientific and cultural evolution of views on addiction, including studies under his mentor, Griffith Edwards, another major figure in the addictions field who was instrumental in shaping modern medical definitions of substance use problems.
We cover a lot of ground in this one, and while we tackle some weighty topics, ranging from fundamental principles in addiction treatment to the very definition of addiction, Prof Sir Strang has a gift for explaining these concepts in clear, articulate terms—a skill no doubt honed by years of interfacing with governments and departments of health. Above all, I think he does a fantastic job of returning to some of the key, pragmatic questions raised by these topics: what does it mean to have an addiction problem, and how do I make sense of my issues? What is the point of medications and other treatments for addiction? What are the core principles in addiction care? And in the end, just what kind of contribution can science make to better public policy and practice? I hope you find this conversation as useful as I did.
Professor Sir John Strang is a physician and an academic. He’s the Director of the National Addiction Centre (NAC) and Head of the Addictions Department at King’s College London. He has been an addictions psychiatrist for nearly 40 years, and has led the group at the Maudsley Institute since 1995. He has published more than 500 scientific papers in the addiction field and has contributed to national and international policy, chairing policy committees and expert groups. In 2016, he was awarded a Knighthood in the Queen’s Birthday Honours for ‘services to Medicine, Addictions and Public Health’. Read more at his faculty page, and for more about the King's College London addiction center, see this link.
In this episode:
- the RIOTT trial
-Griffith Edwards and some of his writing on the dependence syndrome
-Drug Policy and the Public Good
-Setting Limits: Gambling, Science and Public Policy
- BBC: "Pioneering Middlesbrough heroin addiction clinic to close"
- Gerald Klerman: Psychotropic Hedonism vs. Pharmacological Calvinism
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