Hit Hot Topics

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Stigma, misunder­standing and a lack of communication cloud our policy and practice on drugs, said speakers at HIT Hot Topics. DDN reports on their ideas for a fresh approach. Photos by Nigel Brunsdon

‘As long as drug users are marginalised and stigmatised there are going to be harms,’ said Pat O’Hare, opening HIT’s annual Hot Topics conference. The question was, how could we tackle this against a backdrop of disinvestment, where harm reduction was being ‘dismantled bit by bit’?

Alex StevensAlex Stevens, professor at the University of Kent, used statistics to show how drug deaths were misused, ‘to scare and to support ineffective policies’. The attention on new psychoactive substances (NPS) had brought ‘the most radical departure in drug policy’ – but meanwhile heroin deaths had increased by 64 per cent.

‘So why aren’t we focusing on heroin? Because of who these people are,’ he said.

Death rates were particularly linked to deprived areas in the north of England, and specifically to men who had lost industrial jobs in the 1980s and ’90s and turned to heroin use as ‘it was all there was’. This group was now middle aged and becoming very vulnerable.

Looking at how deaths were reported in the national papers gave a snapshot of how different drug users were perceived. Following deaths from NPS, descriptions typically included the words ‘brilliant, student, gifted’. Heroin or methadone deaths were more likely to contain language related to ‘junkie’.

This discrimination was used to support ineffective policies, the psychoactive substances bill, prohibition in general, cuts and churn in services, and recommissioning, he said. Not only were people were being written off as ‘not useful’, but ‘the shortage of public funds is being used as an excuse for lack of action,’ he said.

So how could we try to change public perception – and therefore change policy?

Carl HartUS professor and research scientist, Carl Hart, threw a challenge to the audience to embrace ‘the three Cs’ – their convictions, capability and courage. Commenting that ‘you British are very controlled’, he said ‘I’m going to ask that you get a little more angry.’

‘Drugs are used as scapegoats,’ he said, quoting examples such as a newspaper headline from the 1930s: ‘Negro cocaine fiends are a new southern menace’…‘I hope this gives you conviction to change our narrative,’ he said. Using capability and courage involved critical thinking and calling on the facts to challenge exaggerated science.

‘One of the facts that people ignore is that 80-90 per cent of drug users do not have a problem,’ he said. ‘You have to have courage to tell people we have exaggerated the harmful effects of drugs. You have to have courage to challenge scientists in a public space.’

It was not a formula for popularity, he acknowledged. ‘Be prepared to lose funding, friends, professional achievements and respect… but history will judge you favourably because you are right.’

‘Hold them accountable with the facts,’ he added. ‘You have to publicly embarrass people. If you don’t, our people quietly suffer.’

Bengt Kayser, teacher and researcher at the University of Lausanne, Switzerland, explored the topic of doping to demonstrate a culture of exaggerated responses and moral panic. ‘Myths get a ring of truth because they are published in a scientific journal,’ he said. ‘Debunking this type of myth is important.’ Responses could become exaggerated and moral panic could too easily turn into a moral crusade.

‘Sebastian Coe is dangerous for harm reduction in England because he pushes zero tolerance,’ he said. There were risks, he acknowledged, but it was important to keep them in proportion, ‘or people will run away from us.’ Harm reduction was the answer, coupled with evidence-based policy-making. To have any hope of changing the narrative, we needed to spread clear and effective messages, according to Jamie Bridge and Nigel Brunsdon, who gave insight into using photo-based campaigns. ‘Back in the old days, campaigning was left to the TV,’ said Brunsdon, showing images of some of the most effective public health campaigns, such as ‘Charlie says’ (child safety), ‘Don’t die of ignorance’ (Aids) and ‘Coughs and sneezes spread diseases’. Back then there was no immediacy, with months of lead-up time for publishing in magazines. Modern devices, however, brought the opportunity of hashtags and hundreds of immediate hits.

Recalling the ‘Support. Don’t punish’ Facebook page, he said: ‘I can join in an international campaign just like that. All the barriers are taken away from me.’ The #SupportDon’tPunish campaign had borrowed from successful campaigns such as #NoH8 (against anti-gay marriage legislation), #NotinMyName (young Muslims showing solidarity against terror attacks) and the #BeTheGeneration Global Fund campaign, to create a global day of action around the world, added Bridge.

‘We constantly struggle with the stigma of our cause,’ he said. But if you had a sellable idea you could keep finding reasons to bring it back into public consciousness. ‘Keep pushing,’ he urged, ‘you need to bring it to people.’ Brunsdon gave tips and tricks to help change the narrative through viral campaigns. ‘You can’t force a campaign to go viral, but you can nudge it along,’ he said. ‘Give people the tools and tell them what you want them to write. The more barriers you remove to action, the more likely it is to happen… Have simple messages, be original, have goals and targets. Have good simple hashtags.’

Brunsdon illustrated this with a preview of his new website, harmreductionisbeautiful, due to go live in a few weeks. The site aimed to overturn the way drug use and harm reduction were perceived.  ‘It’s about changing the narrative – it’s always depressing images of injecting in alleyways, and never celebratory. The idea is simple – you put up messages and have a selfie with it. Any of you can contribute to this and can download any of the images to use.’

Ethan NadelmannEthan Nadelmann of the Drug Policy Alliance brought a perspective from the US that zoomed in on Liverpool, the conference venue, as ‘the birthplace of harm reduction’.

‘Americans have no interest in what’s happening outside our country,’ he said. ‘We continue to fall tragically short in areas where you have led the way… areas like physician independence in prescribing.’ But, he continued, ‘when I hear how bad it is here right now, with the decimation of resources, the demonisation of people who use drugs, the sense of fear of people trying to do the right thing, the indifference to human life that this government is demonstrating, I know that place very well.’ We needed to keep pushing forward while playing good defence as well, he said, and this involved ‘addressing the fears of those who oppose us.’

The US was still involved in ‘the horrific drug war’ of the late 1990s, which had perpetuated incarceration. We had to think ‘how do we shift public views?,’ he explained. Nadelmann used the example of cannabis – medical marijuana – to show how the nature of debate could be shifted, and how ‘we could play ball in the big league of US politics’.

‘We changed the image of a marijuana user, from a kid to an older woman recovering from breast cancer, or someone recovering from Aids,’ he said. ‘When the pictures were shown, they touched the hearts of the hardest Republican. We focused on what we had in common.’

Equally important was finding ‘what drives our opposition’ – ‘Fear is the driving element of the war on drugs, fear of not knowing how to deal with diversity,’ he said. This involved using their language (‘pivotally important’) and exploring common ground: ‘We’re doing recovery and it works. “Grant us the serenity…” That is the prayer of the drug policy movement as well.’ It was about taking ‘unlikely voices and allies’ and embracing common values, Nadelmann told the audience.

‘Being as open and responsive as possible will lead you out of this dark period and restore you as the leader of the world in dealing with drugs.’

Concluding a thought-provoking day enhanced by plenty of audience interaction, Pat O’Hare concluded: ‘Drug policy reform is the best harm reduction. Keep the faith, keep the passion.’