As expected, drug-related deaths (DRDs) across the UK have tragically increased again, with no clarity in the recent ONS statistics on the timeline of many records. As a leading harm reduction collective, we advocate for a return to standalone harm reduction hubs, policy changes, and a refocus on commissioning specifications to engage those most at risk of harm and higher mortality rates.
In 1987, the late great Russell Newcombe coined the phrase ‘high time for harm reduction’, urging policymakers to focus on reducing the harms from drug use rather than solely on cessation. Thirty-seven years later, UK policy has not significantly shifted from futile attempts to eradicate drug use, with an inadequate focus on harm reduction remaining.
Since 2010, the UK strategy has not supported any modernised approaches to harm reduction, instead focusing on abstinence and crime reduction as the primary drivers for change. The 2021 drug strategy mentions harm reduction only once, alongside targets for reducing deaths and increasing treatment availability. The strategy did not introduce any significant changes in approach or key harm reduction strategies, such as diamorphine-assisted treatment, expanded needle and syringe programme (NSP) provision, overdose prevention centres or drug checking.
Hot Topics
At the eleventh HIT Hot Topics conference in Liverpool, we were once again given hope that the harm reduction wilderness days may be over in other parts of the world – with global recognition of its importance continuing to emerge. Niamh Eastwood, executive director at Release, called for harm reduction hubs separate from drug treatment services – dedicated, safe spaces to engage people in a way that meets their needs. We imagine this space would include access to NSP, advice and harm reduction interventions to reduce people’s vulnerability to BBVs, bacterial infections and a range of other harms and importantly a chance to engage around wider health needs. Does this remind you of anything? (Specifically thinking about the NTA’s Models of Care).
As discussed previously in DDN (Dec-Jan 2024, page 20), the replacement of tiered models of care with integrated recovery services has made many people reluctant to engage with NSP services located in treatment services also delivering prescribing. The one-stop shop approach has highlighted that many people who inject drugs miss and prefer the confidential, anonymous approach to NSP provided by tier 2 services.
Hot Topics also featured senior public health practitioner Alan McGee, part of the team that developed the Mersey model of harm reduction. He presented a critical analysis of past and present drug policy and historic activism examples, including a mobile van in late ‘80s Liverpool that distributed injecting equipment to peers for secondary supply. There are other examples from across the UK where harm reduction activism created a public health approach which undoubtedly reduced the harms and threats of HIV and other communicable diseases, but much of that best practice has been lost over the years.
Two other speakers highlighted progressive practices outside the UK. Sam Rivera discussed how overdose prevention centres (OPCs) in New York created a safe harm reduction space, while Dr Nabarun Dasgupta from the Remedy Alliance for the People in North Carolina spoke about drug checking and naloxone development, underpinned by true altruism.
We enviously listened to these stories of activism and courage, including Lynn Jefferys from EuroNPUD’s description of how Jeremy Kalicum and Eris Nyx – co-founders of the Drug Users Liberation Front (DULF) – jeopardise their own liberty to save lives in Canada by offering a safe supply in response to a public health crisis.
What next?
The question remains: what do we do next in the UK? It’s vital that we address the regression in harm reduction and we call for a change in policy – just as Russell did back in 1987. The call to action for more dedicated harm reduction hubs is timely, urgent, and crucial if we are to have any hope of catching up with our international colleagues and reducing DRD rates.
Considering the lack of discreet, dedicated harm reduction interventions and the gaps created by losing tier 2 services, it stands out how the needs of people who inject drugs – those who do not want to engage with structured treatment or who want that treatment separate from their injecting practice – have been neglected throughout the recovery policy decade. While it’s great news that Scotland has overcome opposition from Westminster to open a life-saving overdose prevention centre, in England it remains a political barrier. But it’s within our ability now to provide commissioned and much needed low threshold enhanced harm reduction hubs that can also help save lives.
Tier 2 harm reduction services were successful due to being part of a mandated four-tiered commissioning model under the NTA’s Models of Care. So, in looking to regain some of this protected space for harm reduction interventions, is it local conversations that are needed to readdress the needs of people who inject drugs, or a redirection in national strategy?
Tier 2 services have remained in Northern Ireland, referred to as low threshold services commissioned by the Public Health Agency (NI), and separate to prescribing services provided by the five NHS trusts. As a result, expertise in harm reduction has been maintained and developed. These low threshold services are provided by the voluntary sector, and almost all have their roots in providing services for people experiencing homelessness – who face a range of life-challenges and that services with higher thresholds struggle to engage with.
We know that some places, such as Bristol, continue to provide stand-alone harm reduction services. Through several re-commissioning cycles, Bristol Drugs Project (BDP) have retained a specialist team of harm reduction workers, offering a drop-in advice centre, NSP and a clinic where people can get wound care and other nursing services. Structured treatment services are kept separate, and the benefits are clear.
Enhanced hubs
Release have shown leadership in the opening of their harm reduction hub and the peer led approach to NSP in Hackney by the London Joint Working Group on Substance Use and Hepatitis C are good examples of activism in action. Enhanced harm reduction hubs unattached to treatment services could offer drug checking, a safe consumption space and accessibility for marginalised groups such as women, sex workers and homeless people.
Integrated recovery services offer important structured clinical treatment, things like individual placement and support (IPS) and group work to a certain group of people motivated for change. But focus has been lost on the offer for the many other at-risk people needing access to the range of low threshold interventions described.
More services have now reverted to clinical vans, mobilising the offer and widening the reach of service delivery – realising that people are not hard to reach, but that services and their configurations can be unattractive or inaccessible to marginalised individuals. Could it be that this full-circle approach back to assertive action, engaging peers, and working within communities is part of the answer?
One thing is certain. Without swift action, changes to commissioned models, wider collaboration, and more lobbying for change, the rising deaths and increasing harms faced by those most at risk will continue. The need for spaces to attract people into enhanced harm reduction is loud and clear.
Iain ‘Buff’ Cameron is project manager, harm reduction services at Extern; Jon Findlay is national harm reduction lead at Waythrough; Peter Furlong is national harm reduction lead at Change Grow Live; Deb Hussey is national safer lives lead at Turning Point; Lucy O’Hare is training manager at HIT; Maddie O’Hare is deputy director at HIT; Chris Rintoul is innovation and harm reduction lead at Cranstoun.