Turning Point’s harm reduction-focused event invited new thinking on a collaborative approach, as Clare Taylor explains.
Our fourth Safer Lives conference brought together more than 200 individuals and organisations to discuss harm reduction strategies and challenges. It’s about coming together as a sector, listening and learning from each other, and committing to action. The drug market is changing and we realise we need to step up and adapt our approaches.
Last year in England and Wales there were 5,565 drug-related deaths – the highest number since records began in 1993. Elli-Jay McNally, Turning Point’s national harm reduction lead and conference chair, said that each one of these deaths was preventable. ‘Each person is more than a number in a yearly report. They are people who were loved, who had families and friends. People should not be dying simply because help wasn’t available, stigma stood in the way, or policy lagged behind evidence.’
Collaborative work
The National Harm Reduction Group was established by harm reduction leads as a platform to connect and share ideas. Deb Hussey (formerly Turning Point, now Exchange Supplies), Maddie O’Hare (Harm Reduction International), Peter Furlong (Change Grow Live), Chris Rintoul (Cranstoun) and Jon Findlay (Waythrough) described how they came together in 2023 after a sudden spike in drug-related deaths in Birmingham.
Around 30 deaths occurred within two months, most caused by nitazenes mixed into – or sold as – heroin without users’ knowledge. These synthetic opioids can be up to 100 times stronger than heroin, leading to unintentional and often fatal overdoses. The need for progressive harm reduction strategies was clear. ‘In a sector that is predominantly commissioned for recovery and often abstinence-based recovery, I often feel like harm reduction is the afterthought within treatment services, said Findlay.
‘Being a part of this group has allowed me to really challenge the organisation I work with, because there’s a feeling that there’s more support when we stand together.’ In the aftermath of the Birmingham incident, the group was concerned about different messages – some inaccurate – being shared about synthetic opioids. ‘There was a consensus from all of us that we were all saying the same thing and that we should reiterate messages that would reduce people’s risk of overdosing,’ he said.
The group now meets on a regular basis and works on joint campaigns focused on producing easily accessible content that people who take drugs are likely to interact with. One such campaign was Stayin’ Alive, aimed at preventing fatalities by asking people to come up with a plan in case they overdose – it could be as simple as letting someone know that they’re planning to use drugs and checking in on them afterwards. The group provides resources including a credit-sized booklet aimed at preventing drug-related deaths as well as overdose response information.
The work has not been without its challenges – such as being told by a billboard advertising company that they couldn’t use the word ‘naloxone’ in a public-facing campaign. The 2012 Human Medicines Regulations prevent the advertising of prescription-only medicines to the general public – which Furlong described as ‘ridiculous’. However, O’Hare stressed that while there were sometimes ‘systemic failures’, the UK still offered more accessible treatment services than most countries in the world. ‘I love having thought partners, being able to thrash out ideas together and just trying incrementally to make things a little bit better,’ she said.
Law changes
Ray Lakeman, a retired teacher from the Isle of Man, spoke movingly about losing both of his children, Jacques, 20, and Torin, 19, on the same night in 2014, after they both overdosed on MDMA bought through the dark web. Mr Lakeman had spent the last 11 years campaigning for reform of drug laws – striving to replace bans and criminalisation with a regulated legal market. During the inquest it was referenced that there was a standard ‘recreational dose’ for ecstasy to be taken safely.
His sons’ deaths were ‘completely avoidable’ – they had unknowingly taken an amount of MDMA that would have been enough for 30 people. ‘If they were going to take it, they should have known exactly what it was they were taking,’ he said, explaining that he had spent the last 11 years campaigning for drug law reform and a regulated, legal market.
Safer drug consumption
The Thistle had been set up as a confidential service offering compassionate and person-centred care to people who inject drugs in Glasgow, explained Saket Priyadarshi, associate medical director for alcohol and drug services at NHS Greater Glasgow and Clyde. Despite a 13 per cent drop last year, Scotland’s drug death rate remained the worst in Europe.
The facility would give ‘severely marginalised group access to the treatment and support they have been lacking for years,’ he said. It was staffed by a multidisciplinary team of nurses, psychologists, harm reduction workers, social workers, medical staff and admin. Staff were able to offer people safer injection techniques and provide harm reduction advice to minimise the risk of overdose, and would intervene with assistance if it happened.
The look and feel of The Thistle and the rooms within it had been informed by people with lived and living experience, who had also been involved in the recruitment process, providing useful insights and guidance.
By the end of October 2025, 494 individuals had used the service more than 8,236 times, with 5,500 injecting episodes. Cocaine had been used in 80 per cent of visits, so the number of medical emergencies (74) was lower than expected. ‘If it was heroin, we’d be expecting to see far more overdoses than we’re seeing,’ he explained. ‘This chimes with the changes we’re hearing and seeing with data from across the city relating to drug trends in recent years.
Priyadarshi hoped that more cities around the UK would follow Glasgow’s lead by creating safer drug consumption facilities: ‘I am very confident that were a number of these facilities to exist, targeted at populations that have the highest rates of harm and drug-related deaths, then you would see a different picture in Glasgow,’ he said.
Peer-led naloxone
The Scottish Drugs Forum (SDF) were also stepping up action on drug-related deaths by working with external partners to support peer supply of naloxone, both in the community and in prison. Peer-to-peer naloxone training was now running in 12 of Scotland’s 17 prisons. So far 6,499 naloxone kits had been given out, with 73 per cent going to someone for the first time.
Responsible for peer-to-peer naloxone training at SDF, Emir Taha had lived experience and had seen first-hand how the peer-led initiative gave ‘privileged access, increased reach and instant credibility. When I do outreach, I get the immediate respect and understanding that he’s not going to dob me into the authorities,’ he said.
Employment
Andrew Preston is founder and general manager of harm reduction social enterprise Exchange Supplies – a leading inventor and supplier of injecting equipment, drug information and injecting paraphernalia. He spoke of the need for meaningful employment opportunities and recalled that when setting up his company, he recruited people he’d supported as a frontline drug worker in Dorset. ‘If only employers were a little bit more understanding, a little bit more flexible, then there’s all this talent that could be utilised,’ he said.
There were challenges, he admitted, but the initiative had been ‘super successful’. ‘I always say we’ve got a ten-year view on it. It may well be that for the first few years things were a bit messy in terms of punctuality and attendance but then you get it all back because people know that you’re helping them out and they work hard,’ he said. ‘As drug services, we should be employing a lot more people who use drugs.’
Harm reduction innovations
Back in 2010, Sian Roberts was struggling to find a way of getting injecting equipment to a service user living in a caravan in one of the most rural areas of Wales, with a bus just once a week to the nearest town. In her desire to remove barriers in the way of people getting the services they needed, she came up with the idea of Spike on a Bike, where colleagues would deliver clean injecting equipment, naloxone and harm reduction advice by motorbike, straight to their doors.
Lack of funding and support from commissioners meant the project couldn’t get off the ground, but a decade later the COVID pandemic presented another chance as it showed the need to reach people in remote areas. As operations manager for Barod, a charity based in Wales specialising in the delivery of substance use services, Roberts led the work that saw the project – first of its kind in Europe – launched across Dyfed in early 2022.
‘Coming to a needle exchange or a substance use service isn’t always easy – whether it be stigma or issues with mobility or rurality,’ she said. I wanted to make sure that nobody was disadvantaged in terms of accessing a harm reduction service – Spike on a Bike allowed us to level the playing field.’
Young people and nitazenes
Nitazenes have been increasingly present in the drug supply since heroin supplies began to be affected by the Taliban’s poppy cultivation ban in 2022. Services have responded by increasing naloxone provision, issuing contamination warnings, and providing harm reduction advice around adulterated drugs. Fraser Parry, drugs advocacy and support adviser at Release, talked about a growing population who encounter nitazenes and other synthetic opioids not as contaminants, but as their drug of choice.
‘I’m talking about still a fairly small cohort of our general drug use population, but it’s worth thinking about how we respond to this because when new things appear, we’re not always agile, we’re not always able to immediately change what we’re doing,’ he said. ‘People are going to use these drugs intentionally and that may be a small number now, but as we saw in North America with fentanyl, it didn’t take long for it to become people’s drug of choice.’ So ‘we need to think more carefully about how we’re going to support people and how we’re going to keep each other safe,’ he said.
There was added concern for young people, who were more likely to buy drugs online and so had easier access to different markets – especially for benzodiazepines. The Benzo Research Project showed that during 2024, 77 out of 144 samples collected from across England, Scotland and Wales that contained a nitazene were marketed as a benzo.
‘Younger people are less likely to be in treatment, especially if they’re not using opiates generally,’ he said. ‘If they’re just using party drugs and then benzos to come down at the end of the night, they’re not going to have naloxone because they don’t think that they’re encountering any opiates.’ He called for a more targeted approach to educating young people on nitazenes and training them to use naloxone.
Rise in ketamine
The number of people starting treatment for ketamine addiction in 2023-2024 reached 3,609 – more than eight times the amount in 2014-15, according to OHID. The likely age range was 16 to 24, with an estimated use rate of 3.2 per cent in 2023.
Jo Moore, manager at Birchwood House Kaleidoscope’s residential detox and rehab facility on the Wirral, hadn’t encountered a challenge as big as ketamine in more than two decades of working in healthcare and people were arriving with extreme and complex health issues.
‘They’re all presenting with urinary incontinence, some can’t even walk, they’ve lost their muscle tone, some are in wheelchairs, and the crippling pain they’re going through is significant,’ she said.
She called for ketamine-only support services with staff trained to adapt to the needs of ketamine clients. ‘It’s time for fundamental change – the one difference with ketamine is that we don’t have time to allow for many mistakes,’ she said. ‘During the waiting period the body is becoming irreversibly damaged and the window of opportunity is fading. We know that early intervention and harm reduction are key – inpatient stays will not be appropriate for everyone with ketamine use and it’s not sustainable. I believe we have a long way to go but am hopeful that the improvements around the UK are having a positive impact.’
Women’s services
A theme across sessions was the difficulty women face in accessing services. Vicki Beere, former chief executive of Project 6, had based her PhD on how changes in commissioning processes have impacted the drug and alcohol sector – specifically women’s access to treatment – and argued that many drug and alcohol services were ‘set up for men’.
‘Women face unique barriers from stigma and judgement from healthcare professionals to experiences of violence, trauma and caregiving responsibilities, which often make it harder to access support and too often their voices are missing from policy decisions and service design,’ she said.
Her research involved spending time with 30 women with living experience and speaking to commissioners in four different areas. ‘What the women wanted was for services to maintain and develop partnerships with local women’s organisations and sex workers who work to pay for drugs. Make spaces easier for women to walk into – somewhere women can go and find their community,’ she said. ‘We really need to be thinking about women’s health in a much broader way in our homelessness services, our street outreach services and in our treatment services.’
Beere added that she would analyse the data she had collected and develop recommendations aimed at improving the lives of women using drugs.
Clare Taylor is chief operating officer, Turning Point
A shorter version of this article appeared in the December/January DDN Magazine – you can read it here.