It’s where you’re at…

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Harm reduction should be about ‘meeting people where they’re at’, according to the recent HIT Hot topics conference. Jamie Bridge reports.

 

 

Last month HIT hosted their second Hot topics conference in Liverpool, sponsored by Martindale Pharma. This national harm reduction event attracted 140 delegates from across the country and beyond, with a multi-themed programme making for an engaging day but a challenge in terms of summarising proceedings here! As rapporteur for the event, I tried to draw on one key message that came across strongly – that harm reduction is about ‘meeting people where they are at’.

The morning presentations demonstrated that ‘where people are at’ is changing, however. Dr Adam Winstock drew on data from the Global Drug Survey and Drugs Meter (DDN, July, page 12) to show the increasing use of new drugs and growth of the internet as a ‘drug market without borders’. As we learn more about these drugs, their effects and potential harms, we need to adapt our messages, services and approaches accordingly. Concerns have been raised about dependence levels perceived by those using mephedrone, for example, as well as the severity of comedown after use and the impact of banning the substance in terms of diverting people to other drugs or leaving them in the hands of an illegal street market.

The presentation confirmed that ‘the UK is still a powder-loving country’ and that a fifth of 18-22 year-olds admitted using an unknown white powder in the past twelve months. Basic harm reduction messages are not always reaching these groups, a point developed further by Matt Gleeson from UnitingCare ReGen in Australia, who made the case for ‘web 2.0-enabled harm reduction services’ that can take full advantage of social media and other new technologies.

The web allows for two-way communication with people who use drugs, advocacy and mobilisation, learning and sharing information, myth busting and facilitating peer support, yet this work continues to go unfunded in most cases and is often seen as a ‘productivity killer’ by bosses. Adapting the way we think about this work is a core cultural challenge for services.

Stephen Heller-Murphy from Healthcare Improvement Scotland then outlined the work being done in Scotland to provide harm reduction in prisons, and the frustrations encountered, particularly with the continued absence of prison needle and syringe programmes. Foil is also proving hard to come by for prisoners looking to smoke their drugs – with foil-wrapped biscuits being banned in some prisons – leading to even higher rates of injection.

Mat Southwell from the Gold Standard Team then provided a fascinating account of the dynamics of ketamine use, the varied profile of users, and the emerging risks. Again, simple harm reduction advice – around hydration, safe use environments and the development of tolerance – is often failing to reach these individuals.
Later in the day, delegates heard presentations from Martin Chandler of Liverpool John Moores University and Dave Crosland on the widespread use of performance and image enhancing drugs, which now account for up to 80 per cent of the clientele in some local needle and syringe programmes. While the body building community continues to be comparatively well self-policed, emerging patterns of use among relatively naive gym-goers – particularly young people and those going through ‘mid-life crises’ – is a big concern.

While these presentations pointed to unmet needs and unreached groups, the afternoon session highlighted the ongoing needs of the more ‘traditional’ harm reduction clients – particularly those injecting heroin and crack cocaine. Nigel Brunsdon from HIT provided insight into the deeply ingrained rituals – or ‘foreplay’ – of drug preparation and why these can be so hard to challenge and change. John Campbell from Glasgow Addiction Services presented on the provision of injecting equipment kits, which reach around 13,000 clients through 74 outlets in the city. The kits now include plastic 2ml ampoules of sterile water for injection – a newly available harm reduction product – and have been very well received in service evaluations.

Dean Linzey from Reading DAAT then presented on efforts to improve and expand HIV and HCV testing, using rapid oral swab tests that can be easily administered by key workers on the ground. Faced with low testing uptake and a medical model that was like ‘speaking in tongues’ to clients, these services have overhauled themselves to deliver a much more flexible approach that met people’s needs.

Sara McGrail gave an impassioned presentation on the government’s recent Putting full recovery first document, pointing out that although the document has been criticised by many of the signatory agencies in private, none has stepped back from it publicly, and it remains both an influence for commissioning and a yardstick of the current government’s outlook.

Delegates also heard that whereas the term ‘recovery’ has been a source of empowerment and strength in the mental health field, it has been hijacked in the drugs field in a ‘victory of moral determinism, greed and self-righteousness over evidence’. Instead of the language of recovery being used to empower people who use drugs to determine their own goals and improve the range and quality of services they receive – especially given widespread unhappiness at a one-size-fits-all treatment system that had developed under the NTA – this government’s idea of recovery has come to embody one imposed goal for all: total abstinence from all drugs.

According to McGrail, this hijacking of recovery language is down to three related factors – the broader push for austerity and funding cuts, the development of ‘big business’ treatment charities focused less on individuals in their care and more on tenders, contracts and profit, and several years of highly efficient political lobbying from residential treatment providers and the conservative Christian right. Together they have created a ‘hierarchy of worthiness’ – with abstinence placed above all other successful treatment outcomes – which has been translated into a system that ‘measures the success of drug treatment by the absence of people in drug treatment’.

McGrail predicted that deaths, infections and stigma would increase as a result of this shift, and called on delegates to recognise the weaknesses of the previous treatment systems and maintain their focus on reducing harm. ‘We are needed now more than ever,’ she said, emphasising the need to meet people where they’re at, rather than where we are being told they should be.

Jamie Bridge is senior policy and operations manager at the International Drug Policy Consortium.