Drug harm continues to be a significant problem in the UK, with 19 per cent of people who inject sharing needles according to the most recent Unlinked anonymous monitoring (UAM) report from the UK Health Security Agency. And drug-poisoning deaths have hit the highest level in 30 years – fuelled by a 30 per cent rise in fatalities involving cocaine and the introduction of synthetic opioids such as nitazenes into the drug supply (DDN, November, page 4).
For the London Borough of Hackney, an area with a diverse population and pockets of severe need, these issues mean that not only is investment in harm reduction services vital – so is innovation in how they work. This led to the creation of the Hackney Harm Reduction Hub last year.
The service was set up by the London Joint Working Group on Substance Use and Hepatitis C (LJWG) and The Hepatitis C Trust, and is funded by Hackney Council and NHS England. At the heart of the project is a peer-driven model that draws on lived and living experience of substance use in its design, and among its staff and volunteers.
A new lease of life
‘Before I got involved with hepatitis C work and the Hackney hub, I knew about needle use and the liver risks, and I had family affected by it, but I felt isolated and alone,’ says Anne-Marie, a volunteer with the service. ‘Volunteering with the hub has given me a new lease of life – I can get out there and meet others. That’s what I like about the service. We’ve knocked on doors in the hostels and gotten groups of people to come along. It brings people together.’
The goal is a welcoming and inclusive environment where those seeking support can be met where they are – physically and emotionally – to access all the equipment they need, be signposted to other services, and receive support from peers who understand their circumstances. This came about after a scoping report highlighted the loss of services that provide needle and syringe programmes (NSP) (DDN, February 2022, page 5), as well as issues with quality and stigma even in those that remained.
Using a van and trailer provided by Hackney’s community wellbeing team, the service would be operating in Ridley Road Market in the centre of the borough for a day a week, before adding another day and branching out to other sites. The hub’s team scoped hotspots where drug use was most common, identifying consistent sites so that clients knew where the van and trailer would be running. By providing high-quality harm reduction services in familiar settings, the team can engage people who might otherwise avoid other service offers and locations.
Once embedded in communities, the hub provides resources like needle and syringe provision, hepatitis C testing, naloxone and testing strips to enable people to check for nitazenes, fentanyl and xylazine. ‘The service means people can test their heroin before putting it in their body,’ says peer coordinator with The Hepatitis C Trust, Richard Jacklin. ‘There had been a wave of seven overdoses when we started. There are fewer now – it’s going to take time, but the message is getting out there. And the community have started to tell us “try this area, try that hostel”. They’re worried about the overdoses too.’
Expanding brief
The scope of the service has expanded as the year has gone on, including work to develop a wound care pathway for people who find services difficult to access, referrals for housing needs and engagement with partner organisations to test for other blood-borne viruses, making every contact count. The hub’s staff and volunteers have made links with local charities in the substance use, sexual health, and homelessness spaces, and with the Greenhouse Practice, a GP surgery that specialises in supporting the homeless population in the borough.
The hub is led by a strategy group, which includes representation from both providers and commissioners, and a volunteer strategy group that ensures service user insights are continually shaping delivery and outcomes. The hub has supported 170 people with equipment or advice, and also supports the wellbeing team in providing meals and hot drinks as a means to build a rapport and sustain engagement.
In between the hub’s core service days, its team have fanned out into hostels to find and reach clients as a regular part of their outreach. A recent visit to a hostel near London Fields saw five people tested for hepatitis C, all of whom were positive, as well as the provision of harm reduction advice and equipment. The team from the Hackney Harm Reduction Hub engaged 12 residents during a 12-hour session, and then laid plans to return and introduce new lived experience peers to the residents.
Mobility continues to be a key theme as the service evolves. The hub’s team are exploring options like Zipcars, bicycle rentals and public transport vouchers to increase the mobility of its peer volunteers and clients. A new freephone line has also been set up for people to request delivery of supplies to wherever the person requires or alert the team to drug waste hotspots, so that the hub can help clean up dangerous waste in the borough.
Tackling risk
While the Hackney Harm Reduction Hub has made strides, efforts to distribute safer inhalation devices such as pipes remain a point of legal contention. A survey of people visiting the Hackney hub found demand for this type of equipment – many people are using pipes for both crack and heroin, and use of homemade pipes is putting people at significant risk. This has driven a joint submission from LJWG, Haringey Council public health team, The London School of Hygiene and Tropical Medicine and Release to the Metropolitan Police for a ‘letter of comfort’, that gives permission for safer inhalation pipes to be distributed.
The project faced other trials as well, but has been able to adapt. People who use drugs were relocating due to increased police presence during scoping exercises, for example, so outreach planning now avoids overlaps with enforcement activity. Managing living experience volunteers’ conflicting commitments was proving a challenge, so The Hepatitis C Trust’s volunteer coordinator introduced a tailored support package and volunteer time prioritisation plans.
Looking forward
Looking forward, the service is strengthening its data collection to gain deeper insights into the demographics, health needs, and service preferences of its clients, to better shape and guide the service. A further survey, incentivised with vouchers, will gather feedback from service users to make sure the needs of some of Hackney’s most vulnerable residents are being met without asking too many questions when initiating relationships.
As we continue to aim to eliminate hepatitis C as a major public health concern and support people to understand the risk of harm posed by drugs – including synthetics – the Hackney hub represents a new way of tackling harm reduction. Through a community-led and rooted approach and close partnerships among voluntary and public bodies, Hackney is setting an example for cities across the UK and beyond on how to approach substance use with dignity and support.
Elliot Bidgood is at Principle Consulting working with the Hackney Harm Reduction Hub