After a six-year gap, the National Needle Exchange Forum (NNEF) returned with a renewed focus on the need for standalone, specialist harm reduction services. Opening the Birmingham event, chair Philippe Bonnet led a minute’s silence for those lost to drug-related deaths and reflected on the changes since the last gathering. ‘Back then we didn’t have crack pipe schemes or drug consumption rooms,’ he said. ‘Some things have changed – but there is a lot more that needs to be done.’
Speaking on behalf of a group of harm reduction advocates, Chris Rintoul argued that specialist harm reduction had been squeezed by integration into treatment services. Tracing its roots back to 1980s Liverpool, he said harm reduction had since been absorbed by recovery-focused systems that weren’t always equipped to deliver it well. ‘One-stop shops can work,’ he said, ‘but when harm reduction is bolted to treatment you miss everyone who’s not in treatment.’ He warned that many newer staff had had little exposure to harm reduction expertise, as experienced workers and dedicated roles had steadily disappeared.
NITAZENE WAVE
Retired GP Dr Judith Yates presented death data gathered from coroners in the West Midlands, identifying more than 1,000 drug-related fatalities between 2009 and 2023. The last three years were particularly concerning, she said, with nitazenes driving a new wave of deaths. A single Birmingham batch was believed to have killed 30 people, while barriers to toxicology testing meant they were often misidentified as fentanyls. Two key at-risk groups who were not engaged with services were teenagers buying pills online and people in temporary accommodation using contaminated heroin, she warned.
Eleanor Clarke from the UK Health Security Agency (UKHSA) presented an early-stage pilot looking at NSP provision across 31 services. Between November 2024 and February 2025, nearly 1m needles were dispensed, with blue packs most common. The average user was a 43-year-old white man, she said, with more than 500 people reporting using image- and performance-enhancing drugs (IPEDs). She described the pilot as a first step in ‘a big piece of work’ to improve national understanding of NSP activity.
LIVED EXPERIENCE
Reflecting on the power of lived experience in harm reduction, The Hepatitis C Trust’s Stuart Smith said his organisation employed more than 100 peers and had five harm reduction hubs designed and run by people with lived experience. A 2023 pharmacy mapping project had reached 1,400 pharmacists, with further outreach and FOI work underway to assess the shrinking footprint of pharmacy-based NSPs. Danny Morris described how peer-led NSP outreach was engaging with people outside of services, with large numbers testing positive for hep C. ‘Some people are scared to pick up injecting equipment in case they lose their OST script,’ he said. New agreements with services allowed peers to distribute supplies and return anonymised data, helping to close the gap.
DYNAMIC MODELS
Sue McCutcheon, a harm reduction nurse in Sandwell, outlined the DEMO (Dynamic Evolving Model of Outreach) model, funded by Cranstoun, and challenged the idea that people ‘don’t want’ to engage. ‘They want help – but they want it how and when they need it,’ she said. DEMO provided nursing care, street prescribing, harm reduction and other essentials, with a focus on those with complex needs. ‘It’s shocking how much reused equipment we see,’ she stated. ‘It’s causing infections, wounds, and suffering.’ Peter Furlong of Change Grow Live echoed the message: ‘It’s our responsibility as services to go out and find people.’
Jamie Poole from Bridge the Gap Surrey challenged services to reflect on whether they were truly designed around the people who use them. Linking services – including housing, physical health, and mental wellbeing – was essential to creating systems that people could actually engage with, he said.
A BROADER VISION
Speakers throughout the day emphasised the importance of trauma-informed design, lived experience leadership, and truly integrated care across housing, mental health and physical wellbeing. The discussion around drug consumption rooms (DCRs) was a focal point of this broader vision for inclusive harm reduction. Ryan Connolly shared insight from Ireland’s first medically supervised injecting facility in Dublin, which had recorded more than 800,000 visits and responded to 98 overdoses without a single death. Naloxone and oxygen were on hand and the model was built on low barriers – there were no restrictions to access and people could come and go as needed, he pointed out.
From Scotland, Lynn MacDonald presented Glasgow’s Thistle DCR, which opened without a change in law when the country’s Lord Advocate confirmed that possession inside the facility would not be a police priority. Operating every day from 9am to 9pm, the service placed strong emphasis on lived and living experience, which had shaped its development. ‘We don’t have “interview rooms” – that sounds like the police,’ she explained. ‘We have chat rooms.’ The centre also included practical facilities, from a washing machine to vein-finding support.
With 362 individuals registered – a large percentage of whom injected cocaine – the Thistle had overturned 30 overdoses and required seven ambulance call-outs. Staffed by nurses and health workers, the service continued outreach efforts to understand why some eligible individuals were not yet using it, and was working to build public trust through community engagement.
Progress had been slower in England, said Release’s Shayla Schlossenberg. The Home Office still maintained that DCRs were illegal under the 1971 Misuse of Drugs Act but wouldn’t clarify reasoning, she said, citing ‘privileged information’. Campaigners were exploring two possible routes forward – either legislative reform or local agreements backed by ‘letters of comfort’ from police forces to enable pilot projects to proceed. She stressed the need for community buy-in and political courage. ‘Policymakers are worried about negative headlines,’ she said, ‘but the evidence and the need are clear.’
The message throughout the day was that harm reduction needed to be rebuilt – not just as a set of services, but as a specialist, evidence-led discipline capable of responding to a fast-changing drug market. And it must be built with – not just for – the people using it.