Liverpool: Back to the Roots of Harm Reduction (Sub: ENG, RUS, SPA, HUN, ROM, POR)

Liverpool – Back to the Roots of Harm Reduction 20 years ago health care providers in Liverpool started to experiment with innovative approaches to drug problems. They distributed sterile needles to drug users to protect them from *** and provided *** users with a substitute drug called methadone to reduce crime and the risk of overdose. This approach was eventually named harm reduction. 20 years later at the International Harm reduction conference, we asked the pioneers of Liverpool about the beginning. Well, in the 80s obviously because of the high unemployment things weren’t too good and the Tory government at the time a lot people became disaffected from society really, and started using ***. The main problem we had in the early days in Liverpool, before harm reduction, there was noting really. We had a drug clinic that might see 5 people a year. There was nothing really for drug users. Around the mid-80s there were lots of people in authority were becoming aware that *** and AIDS were about to become a big problem. At first it was seen as a problem for gay people. And then quickly people began to realise that people sharing needles who injected drugs were going to spread this virus between themselves and then sexually, to the heterosexual population. The first needle exchange opened in Liverpool in the Mersey Drug Training and Information Centre in Liverpool City Centre in October 1986 and we had to do it from a toilet. We had two toilets in the building and one of them was made into a needle exchange room. People came in who had been injecting heroine for 25 years and had never been to a drug service - never been. We could get in between two people who were about to pass a syringe to each other get that infected syringe out of circulation and put a clean one in its place. But it became broader than that; it became a way of engaging with people who had been marginalised, disenfranchised, vilified, people who saw themselves outside of society. We found that quite a successful bridge – getting people off the streets and into treatment. We actually started to take those services out to people and build up trust. It was Allan and I that came of with this concept of harm reduction and the concept that it is best to reduce harm than to reduce drug use. This is not to say that we don’t want people to stop using drugs – we do! We need to prevent people from starting to use drugs We need to help people get off drugs as well. This is what we call abstinence oriented policy or abstentionism. And harm reduction and abstentionism are two sides of the same coin. There is no evidence at all that harm reduction encourages people to use drugs In fact, the evidence is opposite to that. Harm reduction is about human rights, about respecting everyone’s human rights The main problem with using drugs, particularly opiates, is you have to find the money for it. You don’t know whether the drug that you are taking is clean or it is contaminated. You get involved with a whole range of other drugs and a whole negative drug scene What methadone does is allow you to get the effect of opiates without having to commit crime to do it. So it is not only a way of protecting the drug user, it also protects society from the crime that drug users might create. Methadone programs at first were very short and then they started to make the methadone programs much longer in order to reduce crime more than anything. There was one guy in particular we knew - I will tell you his first name, he was called Tommy. We got him into the needle exchange first, so to make sure he was using clean needles. When, he had stabilised on a heroine prescription, he switched to methadone. He then reduced his methadone dose over a very long period of 10 to 15 years. I just heard at this conference that he is still alive, all his drug problems are now behind him. If we had not given him needles and prescribed drugs, I am very, very sure that Tommy would be dead. The rest of the country based on these abstinence models found that they had nothing to offer drug users. So they took an interest in what we were doing, and then it snowballed. As harm reduction has developed, it has gone beyond needle exchange, substitute prescribing, to these new intervetions like, like drug consumption rooms, in some countries. I think that we have made great progress because there are 92 countries that use the word harm reduction in their policies. It is helpful to have a listing of countries that have harm reduction accepted in national policy. That in no way reflects the scale of the accessibility of those programs, whether they are properly funded, the degree to which people who use drugs are able to access those. Only four percent of injecting drug users have access to ARV treatment. Globally on average, an injecting drug user received 22 needles per year. I think we face the most important issue, which is funding, scaling up and making sure that we can achieve a coverage and that we can make a difference. At the end of the day, we are all human beings and everyone has a right to remain healthy, and to make informed choices to stay well. Because once you are dead, you cannot recover, you cannot stop doing what you are doing. Subtitles: Arielle Reid