Over nine days in November 2021 we celebrated the harm reduction movement across the themes of science, justice and pleasure. Constellations Online Festival of Drugs and Harm Reduction, hosted by Harm Reduction International, offered a new way to connect on the big issues with the big thinkers around the world, with 1,000 participants from more than 73 countries.
If you were unable to attend or would like to ‘watch again’ you can find newly-added videos each week on HRI’s Facebook, Twitter, Instagram, LinkedIn and YouTube, and on the Constellations website.
DDN was proud to be a media partner and host some sessions at the event. Below you can read reports from these as well as other sessions that we were able to cover.
DDN SESSIONS
United Front: Tightening purse strings mean that the sector needs to be careful to not drift back to the bad old days of the harm reduction vs recovery wars. Jump to article
Staying Alive: Naloxone Action!, chaired by DDN, explored the vital – and often unpaid – work peers were doing to get naloxone into the hands of people who need it. Jump to article
Body positive: Peers are a group leading the fight against hep C. Jump to article
The Right Dose: An interactive session from Dr Prun Bijral and Peter Yarwood on the vital importance of making sure people were on the dose that suited them. Jump to article
OTHER DDN COVERAGE
On Message: Chemsex can be risky, but how do we get harm reduction messages to people who are young, ‘invincible’ and having fun? DDN reports. Jump to article
Stand up and be counted: Drug users have a civic duty to ‘come out of the closet’ in order to bring about real political change, Professor Carl Hart told Constellations. Jump to article
The Pleasure Principle: The ‘Last night a DJ saved my life’ session at Constellations heard from speakers across four different continents on the subject of drugs and pleasure on the dancefloor. Jump to article
Tightening purse strings mean that the sector needs to be careful to not drift back to the bad old days of the harm reduction vs recovery wars, hears DDN.
‘I’m an unapologetic and passionate harm reductionist, but I also love recovery,’ said Vicki Beere, chief executive of Project Six. ‘Both are extraordinarily important.’ She was addressing DDN’s ‘More to join us than divide us’ session at the HRI online event Constellations. However, she continued, government policy of ‘get them in, keep them in, get them out, keep them out’ when it came to services – coupled with ever-reducing budgets – was a major challenge in terms of meaningfully bringing the two together. ‘We have a really badly damaged ecosystem in drug and alcohol services. We’ve lost those small, community-rooted, passionate organisations – we’ve got a system that focuses on hitting the target but missing the point. There is hope, but we need to support each other to get there.’
Visible Recovery
Visible recovery needed to be a central element of harm reduction services, said Stuart Green, manager of Aspire Drug and Alcohol Service and a member of CLERO – ‘harm reduction and recovery is a spectrum.’ LEROs could play a vital role as they were strength-based and asset-based and recognised that individuals were the experts about themselves, he said. ‘Recovery is a very personalised experience.’
It had been difficult for many in both the harm reduction field and recovery community to separate the recovery movement from the political agenda, said FAVOR UK CEO Annemarie Ward. This ‘political ramping up of language’, along with shrinking budgets and their effect on commissioning, had helped start a shift back to entrenched positions over the last couple of years, with even the word ‘recovery’ becoming tainted in many people’s eyes through its association in some areas with disinvestment. ‘It’s very human to become tribal or fixed to one particular philosophy. But the great thing about both harm reduction and recovery is that they have tremendous principles that everybody could align under if they can see the similarities rather than the differences.’
‘The analogy for me is that if you break your leg you want a doctor mend it but you want someone who’s previously had a broken leg to help you with recovery,’ said Green. ‘There’s a role to play for both,’ and the best intervention was always people with lived experience. ‘With person-centred services and LEROS there’s a different passion there – it’s 24/7, they don’t stop at the weekend. Meaningful change isn’t going to happen once a fortnight in a one-hour key-working session. We might be able to nudge someone, but realistically it’s about what happens in between.’ The beauty of the LERO space was that it became bigger with every person in recovery, he added.
Choices and options
People needed choices and options, said Beere. ‘There’s absolutely a real need to bring back small and medium-sized organisations – and LEROS are brilliant – that can create that flourishing ecosystem’, and commissioners needed to genuinely understand the importance of social value and localism, ‘not just a tick-box on a tender where everybody writes the same thing’. It now took genuine bravery for smaller organisations to challenge the hand that feeds, and the system needed to take account of that, she said.
There were some encouraging signs in commissioning however, said Green. ‘We’re seeing a bit of a paradigm shift. In terms of price versus quality, quality is creeping up more as a percentage of tenders, which is really good news, and we’re seeing longer tenders going out.’
Failure to recognise individual differences – and treatment programmes being too generic – was a major problem, said Ward. ‘It’s not just that there’s a lack of evaluation of all the recovery paths, but a lack of monitoring and real-world data around what is it that helps us get and stay well. Our job as professionals is to make sure that people have access to all the paths that will help them, and not to punish people for one particular path not working for them.’
Lived experience
‘It’s really important that we have that lived experience voice, but what we’re not very good at in our sector is getting the voice of the people who don’t access our services, who don’t get through the door,’ said Beere. ‘They’re the ones I really want to hear from. I think we’ve got a job in our sector to find and listen to that voice, even if it’s really hard to hear.’
This was especially the case in Scotland, Ward stated. ‘Sixty per cent of the people who should be in treatment are missing – they’re not even showing up. It’s not because they’re “hard to reach”. That’s usually the rhetoric, but it’s because services aren’t attractive enough.’
There were people in LEROs who had ‘never touched service land’, said Green, ‘because people do naturally recover.’ LEROs were not for everyone, he acknowledged. ‘But if you look at why people aren’t engaging in services, it’s because we’re offering the wrong thing.’
The Constellations session Staying Alive: Naloxone Action!, chaired by DDN, explored the vital – and often unpaid – work peers were doing to get naloxone into the hands of people who need it.
‘We’ve created an underclass’, said George Charlton, who works across the UK developing peer-to-peer naloxone training and supply programmes. Media headlines about ‘junkies’ had caused a disconnect between ‘some of the most socially excluded and disenfranchised people in our communities’ and the general public, he said. ‘People who do care for drug users are other users, which is why peer-led projects are so important.’
Drug-related deaths were ‘needless and avoidable’, he stated, and the most important people he worked with were those with ‘lived and living experience of addiction’. Naloxone provided a ‘wonderful opportunity to keep people alive. It’s not the whole solution, but it’s part of the solution.’
Privileged access
One of the key strengths of peer-to-peer naloxone programmes was that people who use drugs have privileged access to drug-using venues, supply systems and markets, he said – ‘they have instant trust and credibility.’ However it was vital to ensure that all organisations involved in a project were ‘fit for purpose’, he stressed. ‘We won’t recruit any peers until we’ve made sure that we’ve addressed any of the bureaucracy that could get in the way’, with everyone needing to be fully aware that lived experience often meant active drug use. ‘These aren’t recovery projects, they’re harm reduction projects.’
Community mobilisation involved asking people to ‘own and be part of’ the projects, which often meant building trust as many had been let down in the past. ‘As providers, we have the assets, the naloxone, the governance, the frameworks for peers to work within – the rooms, the teas, the coffees, the expenses. Let’s give them access to all of that, and let’s give them the project. Let’s see what the peers are doing with our support, not what “our” project is doing.’
‘The best way to get this out into the community is for drug users to go into the community,’ agreed Nottingham-based harm reduction activist and longtime DDN associate, Lee Collingham. ‘Unfortunately, the other side of my work is seeing drug users being exploited and not being paid for the work they do.’
‘We firmly believe that we cannot continue with this process of only having peers on a voluntary basis,’ stated Kirsten Horsburgh, who leads SDF’s work on drug-death prevention and is coordinator of Scotland’s national naloxone programme. ‘We absolutely need to drive home the importance of paying peers for the work they’re doing – it’s utterly crucial.’ Criminal record checks could be an unnecessary barrier for many of those eligible for doing the work, however, and while services were often able to work around this it still needed to be urgently addressed.
Scotland’s drug death situation had been described as a ‘public health emergency’ for many years without the major action to address that, she continued. ‘And then something like COVID comes along and you see how quickly things are put in place when a public health emergency is taken seriously – immediate access to resources, changes to practice, fast-tracked law changes, all the things we really require for addressing the drugs death crisis.’
Progressive
The country’s naloxone programme had been in place since 2011, however, supplying more than 100,000 take-home kits. ‘Scotland has been fairly progressive in a number of areas around distribution,’ she said, despite legal restrictions, and with a national awareness campaign in place since August (DDN, September, page 4). ‘The focus for the campaign we were commissioned by the Scottish Government to deliver is about a wider societal response,’ not just targeting people who use drugs or their families – ‘every single person can do something.’ More than 30,000 people had visited the Stop The Deaths website in ten weeks, with much of the feedback – especially from family members and people who use drugs themselves – emphasising that ‘just seeing that on such a public platform, on mainstream TV and across the country, was really powerful – that recognition that these lives matter.’
In the first year of Nottingham’s naloxone programme ‘we spent less than £2,000 and over 100 overdoses were reversed’, said Collingham. ‘That’s 100 families that still had loved ones.’ As one of the faces of the national naloxone billboard campaign (DDN, May, page 12), he was able to choose his own message to go alongside his image. ‘As someone who’s carried both it was clear to me that carrying naloxone is easier than carrying a mate’s coffin. Let’s have our loved ones at home, and let’s carry naloxone.’
Peers are a group leading the fight against hep C, hears DDN.
‘I love what I do,’ Paul Huggett, peer coordinator for the Hepatitis C Trust, told the Positive about being positive session at HRI’s Constellations harm reduction festival. ‘When I give someone the diagnosis that they’re positive but then tell them I’ve had it, they say, “but you look well”. I say, “exactly”.’
There had been a significant year-on-year increase in the number of people being treated since 2017, said Hepatitis C Trust regional manager, Danny Morris, but there was still a long way to go when it came to reducing chronic infections, particularly in the wake of COVID-19. Rates of equipment sharing, meanwhile, were still around 25 per cent – ‘a big, big concern for us’ – and around half of those living with hepatitis C were still unaware of their status. The trust delivered peer projects across the UK, he said, working closely with hepatology teams, drug and alcohol services, homelessness services and prisons, with the majority of staff having lived experience. One vital aspect of their work was modifying and speeding up pathways into treatment, particularly for more marginalised communities.
Individual need
‘That’s a big part of it,’ said Nathan Motherwell, a peer coordinator for the trust. ‘For example, they don’t write to homeless people at the drug service anymore.’ He helped to make sure that treatment was adapted to suit people’s individual needs and coordinated and recruited other peers, using his experiences to build rapport with his clients. ‘I was a very chaotic drug and alcohol user, but all of the things I experienced – even including prison – have ended up being useful in some way. When I talk to people I say, “I used to do that”, and it breaks down some of that shame.’
Elimination was now becoming a reality, partly through treating whole communities of injecting drug users in different locations – ‘we’ve probably significantly reduced the risk of anyone getting hep C in the Medway towns over the last three years.’ The key was to ‘be persistent and don’t take it personally,’ he said. ‘Sometimes people don’t want to engage. I’ve been sworn at when people are busy trying to score, I’ve booked people several appointments and two years later they eventually say they’re ready to do it. They’ll come round in the end.’ There was often an intense level of support needed, particularly for clients with dual diagnosis, and this involved working closely with other agencies. ‘These are the people with the highest risk of reinfecting themselves or infecting others. But we’ve got good outreach teams and they know these people.’
People often lied, he said, partly because of the shame. ‘But if you break down the practice – who they use with, when, where and how, you can often change one little bit and that might help.’ This could be something as simple as getting people to carry their own equipment, spoon or bottle of water. ‘Some of the peers are still on methadone scripts so they’re a lot closer to where people are at, and have managed to engage people that I couldn’t.’ Clients were also encouraged to find other people for testing in exchange for vouchers, he said – ‘sometimes people will turn up with five others.’
Education and prevention
Education and prevention were vital, said Huggett, who was in active addiction for 20 years. ‘We all know it’s full of fear and stigma, but if you start talking about it, it eases all that stuff.’ Having a regular presence at hostels and drop-in centres for testing days was also crucial, he said. ‘If they keep seeing us, eventually they’ll get tested.’ It was about ‘being consistent with love, care and compassion – they’re going to come round and we’re going to get them.’
He coordinated a team of four peers with eight volunteers, and a current project involved target-testing in a pharmacy. ‘The more testing you do, like with COVID, the more positives you find.’ But it was then vital to make sure the right level of support and care was in place to get them through treatment. ‘Gold standard is not knowing they’re positive and leaving them out there.
The Best job
‘It’s about more than hep C,’ he stated. ‘Once they told me I’d got the all-clear it made the impossible possible. It made getting stable on a script seem doable, even sobriety seemed achievable. Because I’d just beaten a killer disease. I’ve got the best job in the world because every week I’m telling people they’ve got the all-clear from hep C.’
The DDN-hosted The Right Dose session at Constellations heard from Dr Prun Bijral and Peter Yarwood on the vital importance of making sure people were on the dose that suited them.
‘Everyone’s individual needs are individual – and unique,’ said Dr Prun Bijral, medical director at Change Grow Live. ‘It’s about the balance of getting that dose right for them. In a nutshell, we’re trying to help people stay comfortable and get some stability in their lives.’
People entering treatment services were often at a very low point, so it was vital to build relationships that were based on trust and honesty in a supportive environment, said Peter Yarwood, founder of Red Rose Recovery and in long-term recovery himself. ‘You’ve got people at different stages, who might not know what’s right for them – that’s got to be a process, it can’t be fixed in one visit.’
Treatment quality
Ultimately, whether people felt they were able to speak honestly came down the quality of the treatment, Bijral told the session. ‘As a doctor I’m not going to be able to do my job if I don’t know what the real issue is. What I will always say to people is, “it’s your treatment”. It’s for us to serve and make that treatment as accessible, practical and useful as possible.’ Clinicians had to recognise that entering treatment was very often a ‘make or break’ situation for people, and it was vital that they did everything they could to make them feel comfortable and informed. ‘You have to be there for them, rather than have some agenda of “I’m going to get you on this or that”.’
It all came down to the quality of the relationship, added Yarwood. ‘Everybody wants to help people improve their wellbeing and get to their destination, but that’s not to say we might not get it wrong. But if we do we need to be mature enough to open up a space to explore that without taking it as a personal criticism.’
Bringing about culture change across the sector and addressing sub-optimal treatment depended on education, said Bijral. ‘Demystifying treatment – it’s not rocket science. Get the dose that helps that person feel comfortable.’ Change Grow Live had made the guidance more accessible to its frontline staff, modified its training and, crucially, showed services what their treatment looked like. ‘Those same issues persisted, people were underdosed, were using when they didn’t want to – we weren’t providing the treatment for the need, it was as simple as that. But when you start showing people that, they automatically start to change and have different conversations.’
Stigma remained a significant issue, however. ‘The solution is broader than a clinical one, it’s a social one,’ said Yarwood. ‘There’s work that needs to be done to educate the community, and then highlight the support available.’ People were now able to put their own stories out on other platforms without needing to go via news outlets, however – ‘we can counterbalance the negative voices.’
Opportunity for Change
The Carol Black report was a crucial opportunity for change when it came to the central role of peers – ‘it’s not about hearing that voice, it’s about enabling people to take control of things like commissioning, of policy,’ said Bijral. This had been one of the few silver linings of the pandemic, he added. ‘We can’t just go, “Yeah, we’re hearing you” now’ – the people most affected by the system and change needed to be the ones shaping it. ‘Then you’re going to have a better system and a better service. It’s not going to be easy, it’s complex – without question – but you’ve got to start at the principles.’
Postcode lotteries remained a recurrent issue, but providers had to make sure their practice was in line with the evidence-based guidance, stressed Bijral. ‘That’s key – not just, “I fancy providing this dose because that’s how I woke up this morning.” Our services aren’t about fancy machines, they’re about people, so you’re going to get differences. But it comes down to awareness and shining a light on the treatment that’s being provided. We’ve got to move more towards a focus on quality and what people deserve, and view it from people’s perspective – not a provider perspective, or a commissioner perspective. It’s got to be about the person.’
Drug users have a civic duty to ‘come out of the closet’ in order to bring about real political change, Professor Carl Hart told Constellations.
‘Drug control has been used as a tool to subjugate, and has its origins in subjugating specific populations – certainly in the US,’ Professor Carl Hart of Columbia University told Harm Reduction International executive director Naomi Burke-Shyne. ‘That’s why it’s important to question the basic assumptions of drug control.’
One of these was that the government ‘does not trust you to make the right decisions about what you can put in your body’, he said, something that was then backed up with vast amounts of money. ‘When you think about all the people who are employed in order to control what you put in your body’ – not just law enforcement and prison authorities, but researchers, physicians, the media – ‘all of these people have their hand in the cookie jar. That’s the real reason this continues, and it helps that the people who are primarily impacted are poor and politically weak.’
Assertions that the ‘war on drugs’ had somehow failed were therefore wrong. ‘It’s been a success for the people in control, and the people they give their fruits to’ – the ‘war on drugs’ was essentially a jobs programme, he said. ‘If we think that the stated policy is to lessen the availability of these substances in our communities, then at some level it did that. But the unstated goal is to increase the budgets of various groups of people, and it worked there as well.’
One useful aspect of cannabis reform in the US, therefore, was demonstrating to the ‘people who have power in our society how they can make money off this endeavour – legally regulating the market,’ he said. ‘We’ve seen how the human rights violations, racial discrimination and targeting of poor people hasn’t been compelling at all. So we need to really think about how we advocate for change.’ There was also a huge amount of people ‘who – although we might not agree on a number of political issues – really understand the concept of liberty’, he stated. ‘At this basic fundamental level of people’s liberty, we agree.’
If governments saw drug users as people with political power and a vote ‘then maybe we wouldn’t have so many repressive laws that have targeted people with less political power’, he said, which was why he tried to encourage people to ‘get out of the closet’ about their drug use as a matter of civic duty. The majority of people using drugs were simply ‘seeking to alter their consciousness,’ he continued, so ‘why aren’t we defending their liberty to take them? The vast majority of users of any drug don’t meet the criteria for addiction.’
On the question of worrying about who would ultimately control the regulated market, there were more pressing concerns, he told the session. ‘We’ve yet to even have a serious conversation about legally regulating the market. The first goal is to take the chains off, then we can worry about who’s controlling it.’
There had always been a disproportionate focus on the negative aspects of drug use and it was time to talk about the positive aspects, such as pleasure, he added. ‘I upset so many people by saying that sort of thing. Pleasure is a good thing, and it’s sad that I even have to say that.’
On the question of changing the language around drug use, while it was as important to be precise ‘we don’t want to get hung up too much on it’, he said. ‘Stay focused on the big issue, which is do people have the right to put whatever drug they want in their bodies. There’s always risk when you’re fighting injustice, but it causes a lot more harm not to do anything.’
The ‘Last night a DJ saved my life’ session at Constellations heard from speakers across four different continents on the subject of drugs and pleasure on the dancefloor.
‘I’m a clubber, and I didn’t feel the experience of clubbing was particularly well-represented in mainstream narratives and discourses,’ senior lecturer in criminology at the University of Greenwich, Dr Giulia Zampini, told the Last night a DJ saved my life: a meaningful discussion on the role of drugs and pleasure on the dancefloor session. ‘There was a lot of stigma and misunderstanding.’
She had launched a project called ‘People and dancefloors’ in order to bring clubbing stories to life, emphasising the positives – including taking drugs. ‘It was quite refreshing to see how people were more than willing to share, coming out about their drug use on camera, which in many contexts – including the UK – can have repercussions in terms of reputations and jobs.’
‘I’ve always been an avid partygoer,’ Ayodeji Ayoola, a Lagos-based cinematographer, told the session. ‘But drug use in Nigeria is generally illegal, including alcohol in some parts of the country where you could get arrested for drinking a bottle of beer.’ There was almost no positive conversation about drug use in his country, he said – ‘and zero conversation about pleasure. It’s sad, but it is what it is.’
‘I share with many drug users and women the pressures of guilt in many everyday situations – the personal is political,’ said Columbia-based Alejandra Medina of the Acción Técnica Social NGO. Her organisation worked closely with partygoers, party organisers and the media on issues of harm reduction and pleasure enhancement, and to get across the message that ‘substance users can actually enjoy themselves without guilt and without risk. As the others mentioned, raving and having fun is stigmatised and seen as immoral, even in the 21st century’. Her organisation was often condemned for being ‘promoters’ of drug use, she said.
Not being honest about the benefits and pleasures of drug use had been a ‘real disservice’ to the harm reduction movement, said Mitchell Gomez, executive director of US-based organisation DanceSafe. ‘People are so heavily propagandised by the drug war, and taught things that are just demonstrably untrue. Even the term “harm reduction” implies that harms are intrinsic to drug use. It’s deeply concerning to me that we focus so heavily on the harms when the vast majority of people are non-problematic substance users – they’re just people who use drugs.’
Many of his organisation’s activities, such as drug checking, were less harm reduction than ‘drug prohibition harm reduction’, he said. ‘If there were legal, regulated markets, then most of what DanceSafe does wouldn’t be necessary. The existing UN declaration on Human Rights is entirely incompatible with governments telling you what substances you can or cannot use – the drug war is fundamentally an anti-human rights policy. As harm reductionists and public health professionals we need to start being very, very honest about the fact that most users benefit and receive pleasure from their drug use.’
‘We need to come out of the psychoactive closet,’ agreed Medina. ‘We want to empower our collective right to have a pleasurable experience, and we need to be able to shake off that guilt that’s more about the lack of market regulations and the political will to accept that a drug-free world is not possible.’
While the dancefloor was one place where pleasure-seeking was more allowed than in others, in wider society there remained a ‘double social taboo’, said Zampini, with both drugs and pleasure itself in many ways still taboo subjects. ‘We keep pleasure as a dirty secret,’ she said, partly because of a religious underpinning that pleasure was sinful and something to be controlled or repressed.
Although manifested differently, this was shared across all cultures, she said. ‘We still carry the remnants of that – this is where we’re still at. But we’re all driven by pleasure, we’re all pleasure-seeking beings.’
People’s perceptions of drugs had been framed by prohibition, but it was fair to say that many pleasurable activities, including sports, carried some risk, she continued, and one way to move away from concepts of guilty and risky pleasures was to foreground mental health. ‘People are passionate about it, and it gives individuals the power to advocate for their own health. So they can say, “My experience of taking ecstasy is that it makes me feel good’. I feel we should really harness that shift to transform the discussion. Maybe then we can start talking about healthy pleasures.’
‘As the years go by there will be change,’ said Ayoola. ‘Whether it’s slow or fast it’s change, and we’ll take whatever it is we get.’
Chemsex can be risky, but how do we get harm reduction messages to people who are young, ‘invincible’ and having fun? DDN reports.
‘A lot of harm reduction information is coming through specialist services, and you have to be quite far down the road before you pitch up at a specialist service,’ – something that applied equally to hepatitis C, drug use or chemsex, said Leila Reid of the Hepatitis C Trust. ‘So how do you reach people at the beginning so that they know to look for harm reduction information?’
People who were ‘younger and feeling invincible and having fun’ wouldn’t necessarily want to hear these messages, said Patriic Gayle of the Gay Men’s Health Collective. Many of the victims of serial killer Stephen Port, however, who used GHB on his victims (DDN, February 2020, page 4) were so unaware when it came to drugs issues that they could ‘be lured into a situation where they could be given fatal overdoses’, said Bob Hodgson, independent advisor with the Metropolitan Police Service.
Service integration
A key point was integration of services, said Reid, not just with drugs and sexual health but across the board, and there had been excellent work in London and elsewhere around integrating HIV and hepatitis C testing and using those chances to deliver harm reduction information. ‘There’s a lot of opportunity when you’ve got that person there. For hep C at the moment there’s a bit more of a focus and energy around it, so maybe we’re reaching people who aren’t normally reachable by health systems. From a general public health perspective, there’s this idea of making every contact count, which is quite well established in some parts of health and social care as well as housing – there are a lot of agencies that come into contact with people at different, difficult times.’
Vital Resources
The Gay Men’s Health Collective had been running a pilot project of making their chemsex resources available in A&E, said Gayle. ‘We know that in one A&E you’re looking at between five and ten admissions on a weekly basis for GHB overdose, and in terms of what they’re rather disparagingly calling “frequent flyers”, they’ll quite often have return visits.’
The material was an accessible, cost-effective tool, and the plan was to roll the programme out further, he said. ‘What we discovered was that staff were saying they could finally give people something to take away with them.’ Healthcare workers often didn’t feel confident discussing certain issues with patients, said Reid – ‘something like this can really open up a discussion in a much easier way’.
Information detailing people’s rights on arrest was also important, said Hodgson, especially when someone overdoses. ‘If someone’s read a “bust booklet” when they’re not already taking drugs and are able to absorb the information then that’s there when they’re thinking “should I or shouldn’t I call an ambulance?” So they know they’re not just subject to the whim of whatever policeman turns up at the door, they have rights and there are protocols and people they can contact. When the paramedics get there you do need to take a leap of faith – you need to tell them what they’ve taken so they can treat them properly – but, with good will and sensible policing and ambulance services, they’ll concentrate on the health needs and not bother about the drug.’
As Dame Carol Black’s report pointed out, sizeable gaps remained around harm reduction when it came to communities who didn’t really identify with the injecting population, said Reid, ‘particularly MSM involved in chemsex, people using steroids and performance-enhancing drugs.’
‘Harm reduction, public health, wellbeing messaging around safer drug use and chemsex would be helpful in terms of hopefully reducing the number of people who end up being admitted to hospital,’ said Gayle. ‘We don’t have that, and it worries me that in the present climate it’s struggling to get traction. I understand why, but if we don’t do something about it we have a perfect storm.’
‘You’re reducing the stress on the police force, the ambulance services,’ said Hodgson. ‘It’s a small amount of money that should save a lot down the line.’
Prevention
Prevention was always vastly more cost-effective than treatment, agreed Reid, but less easy to make the business case for, ‘particularly if it’s a population that a lot of people don’t have a great deal of sympathy for. But if you can engage people you can address mental health and whatever else is there – early intervention and being proactive means you can prevent hep C, HIV and overdose and work really constructively with people. That’s what’s important if we want to really change people’s outcomes on a big scale.’