Out of Harm’s Way

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Peter Furlong is Change Grow Live’s new national harm reduction lead. Here he talks about his career journey and the need to focus on saving lives.

After working for Change Grow Live for more than 12 years in various roles I am now starting in the new role of national harm reduction lead, and I fully share the organisation’s ambition and commitment to ensuring harm reduction is a priority in our response to the new UK drug strategy. Reducing harm and drug-related deaths must be at the forefront of our minds.

I hope that the debate around abstinence vs harm reduction has run its course, as both approaches can play an important role in drug and alcohol treatment. As we respond to meeting the objectives set out in the strategy, I would like to see harm reduction beliefs and practice at the heart of treatment services, alongside the confidence and hope that abstinence is possible if chosen as a treatment goal. Harm reduction interventions and meaningful support towards abstinence can of course sit within the same continuums of care, with many of the Dame Carol Black report’s recommendations reminding us of the need to revisit areas lost to disinvestment or policy changes.

Early days

Starting as a volunteer for Merseyside Drugs Council (MDC) in 1996, I knew I that wanted to learn more about drugs and hopefully help some people close to me with their challenges around substance misuse. This was particularly driven by the arrival of cheap brown powder heroin in the ’80s and crack cocaine in the ’90s. My thoughts and feelings about drug and alcohol treatment at that time included anger and frustration, and of course compassion for the people involved – this anger largely stemming from seeing some people very close to me not getting the support or treatment they needed. This included losing an uncle to an avoidable death from him contracting HIV through his injecting drug use – in the early ’80s his illness was treated like a shameful event surrounded by mystery. I came to the stark realisation that better, more humanistic basic treatment and access to clean injecting equipment could have helped prevent his death.

My own rapid affiliation with harm reduction approaches and interventions was again led by poor treatment access in the ’90s. It was common to see five-year waiting lists to access specialist substitute prescribing when I began volunteering in Merseyside. Keeping people as safe as possible from all of the harms associated with drug use at the time centred around increasing access to clean injecting equipment, and safer injecting advice. It also involved promoting then-new messages around the risks of BBVs and sharing paraphernalia, as well as outreach methods to seek out people who did not have access to basic health care and support. As an outreach worker and non-clinician, I often found myself sitting with people who had to share drugs to avoid withdrawal, or were forced to attempt self-detox with no clinical support. By default I was providing advice and guidance on things like their injecting practice, more hygienic drug use, and promoting peer-to-peer support and advice when possible.

From volunteering I started work in the well-known Maryland Centre in Liverpool, where I had the opportunity to learn from some great people in the field. I also worked with the activists who established the now globally famous ‘Mersey model’ of harm reduction and went on to train others in what I see now as an approach grounded in the Hippocratic Oath of ‘first do no harm’.

Harm reduction heroes

Some of these harm reduction heroes, such as Professor Pat O’Hare, Alan Parry and Alan Mathews, led the way in the late ’80s, and much of my own learning came from great tutors and influencers such as Alan McGee, Jon Dericott, Andrew Bennet, and many more. The Maryland Centre opened up a whole new world of learning for me. It taught me about working with the most marginalised and vulnerable groups of people, the many benefits of needle and syringe programmes, street outreach work, low-threshold prescribing and HIV prevention. This experience has stayed with me throughout my career.

For the next 20-plus years I have worked in the third sector in various roles. Thankfully, I’ve seen significant positive changes and improvements in the delivery and quality of drug and alcohol treatment in the UK. My excitement and ambition for the new role of national harm reduction lead in Change Grow Live are huge, as is the organisation’s commitment to reducing drug-related deaths and improving quality of life for people who use substances. We are determined to ensure that people across the sector and partner agencies are informed, confident and competent in offering harm reduction interventions where every contact counts.

We are committed to invaluable cross-sector workstreams such as providing more life-saving naloxone, encouraging more people into treatment, and more outreach, especially for people living alone or isolated from support. More and more evidence points towards the harm that untreated or undiagnosed long-term health conditions can bring to people who use drugs or alcohol, and we want to ensure that people are able to access the mainstream healthcare treatment they deserve.

Meeting ourselves where we are

The terminology and language we use to describe approaches and strategy often changes. I personally like ‘meeting people where they are’ in their own journey and ensuring we provide individualised interventions for each person’s presenting needs.

The sector has changed a lot over the last few decades, and harm reduction has not always been as much of a focus as it should have been. Noticing the sector’s changing shape, with budgets increasing then shrinking with treatment targets/outcomes changeable and more focused on discharges, and the casualties of staff development, training and key competencies around some harm reduction interventions have not always been as high as we would envisage or aim for.

We must look at the UK and the rest of Europe’s approaches to harm reduction, learn what we can from the pandemic, and take on board the recommendations of the Dame Carol Black review. Then we can refocus and revitalise our collaborative approach to harm reduction principles and help to improve the experiences of the people who use our services.

The pandemic stopped us all in our tracks. Every day new situations tested our ability to keep vulnerable service users safe. The very harm reduction principles that have improved our practice over time became more important than ever, and demonstrated the real importance of safe clinical practice.

The new UK strategy allows us the financial and strategic re-investment to ensure the support we offer is grounded in the guiding principles of reducing the harms associated with drugs and alcohol, and helping people to change the direction of their lives.

Peter Furlong is national harm reduction lead for Change Grow Live

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