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Addicts Rewarded With Shopping Vouchers For Staying Clean

In a trial of almost 700 heroine addicts, shopping vouchers for supermarkets will be awarded if the user is able to stay clean or if they complete a course of vaccinations. The trial follows a smaller study from the King’s College London that suggests financial incentives encourage drug users to do just that.

Although hepatitis B (HepB) isn’t considered very common in England, about a fifth of users who inject drugs into their systems suffer from it, and about a quarter of those have the untreated, chronic version of the infection which, though it can be slowed, cannot be completely cured and results in the patient dying from liver disease.

A study of 210 heroin addicts published in The Lancet found that by offering up to £30 in supermarket vouchers, the users were much more likely to undergo a course of three vaccinations over the period of a month to prevent HepB.

The authors of the study said that although the study and subsequent  trials (hopefully leading to a widespread plan across the country) will be run on the NHS, and that members of the public may have a problem with giving away money in this manner, it could actually save a lot of money in the long run. Right now it costs about £4,000 per patient, per year, to treat HepB, which vastly outweighs the cost of providing the vouchers, so the spending would be justified.

“There’s a clear health benefit to the individual in terms of reducing the risk of infection,” stated Dr Tim Weaver, from Imperial College London’s Centre for Research on Drugs and Health Behaviour. “There’s also a public health benefit, reducing the risk of transmission to others.”

Without the voucher incentive, less than 10% of the users in the study attended all three vaccination appointments. However, when presented with the possibility of earning the vouchers – £5 for attending the first clinic, £10 at the next and £15 at the final appointment – attendance rose to almost half in the study, evening out at 45%.

“Why would you not want to do a vaccination programme when you get 45% uptake?” asked Professor John Strang who led the study. He conceded that there would, of course, be some concern that the participants would trade in their vouchers for money, but previous studies carried out in overseas countries indicated this would not actually be the case. “If this was cash I would agree with the public anxiety,” he added, “but in the same way that a child suffering bed wetting might be given a star chart, this is about using incentives as a behavioural tool.”

Following this study, 700 addicts, all of whom want to give up the drugs and become clean, have been recruited for a larger trial. During a 12-week programme, covering 33 different sites in the UK, the members of the study will take a urine test every week. If the test shows them to be drug-free for that week, the participant will be awarded a £10 voucher, meaning they could effectively earn up to £120. Others in the trial will be rewarded for completing the HepB vaccination course, as well.

The results from the trial won’t be immediate – it could take up to two years – and full details won’t be released until the trial is concluded, but there is an overall feeling that this kind of scheme could really make a difference, and that’s where it counts.


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