Harm reduction measures can be seen as controversial within the wider population, but isn’t confronting public fears an essential stage in moving the agenda on? DDN reports ‘How radical can harm reduction be?’ asked Dr Ingrid van Beek at the City health 2016 conference in London. Van Beek was part of the team that established what still remains Australia’s only drug injecting facility, in King’s Cross, Sydney in 2001. The fact that no other Australian facilities have been set up in the last 15 years makes the King’s Cross site appear more radical than it really is, she argued. The site was chosen as there was a large amount of street use in the area, and was established as an extension of needle exchange services. While these services are now seen as mainstream, with more than 90 countries providing needle exchanges, establishing safe clinical settings for people to inject drugs is still sometimes seen as ‘a step too far’. ‘What did you think was happening with all the needles being given out?’ was a question van Beek had asked politicians and local residents also opposed the scheme. Lobbying against a backdrop of cheap heroin, rising drug-related deaths, and an increasing amount of visible street users, she had finally persuaded politicians to confront the problem and agree a trial period for the new facility. Despite the scheme being the most evaluated medical facility in the world, with its positive outcomes in reducing both fatal overdose and street use validated by independent assessment, its trial status remained for nine years before it finally became a permanent service. It’s not enough to just present the evidence, van Beek told delegates – you also have to engage with the values and morals of those who oppose it. Shutting it would ultimately have resulted in an increase in overdose deaths, something that opponents needed to be reminded of. ‘I think we should keep people alive, and make no apology for it’, she said. Harm reduction facilities are never more needed than in times of austerity – but unfortunately the short-term costs could prohibit establishing these interventions, said Dr Konstantinos Farsalinos, of the Onasis Cardiology Centre in Greece. Providing delegates with a perspective on Greece since the financial crisis, Farsalinos talked of the massive reduction of GDP and huge increase in unemployment, which had especially hit young people and the poor, and had seen an associated rise in drug and alcohol use, accompanied by more cases of blood-borne viruses and mental health issues. One of the problems was that effectiveness of harm reduction services could often only be proven over the long term. Coupled with a lack of public sympathy for some client groups, this could make it hard to secure initial funding, said Farsalinos. Professor Neil McKeganey of the Centre for Substance Use Research urged caution around seeing harm reduction as a universal panacea. Interventions should be limited by both evidence of cost effectiveness over a long term, and also the moral and political limitations required by the wider population, he said. Harm reduction was not a call to arms but an important societal movement, said McKeganey, and it was important that it was judged with the same critical measures used on any other health intervention. One of the main challenges according to Jamie Bridge, of the International Drug Policy Consortium, was that ‘people who use drugs are now widely seen as criminals, not as people who need support’. Campaigns such as Support. Don’t Punish were proving successful at bringing grassroots partners into the debate and gaining the attention of the media – both vital in reaching new audiences and influencing policy. Drug policy had been ‘a public health disaster around the world’, he said, and decriminalisation was the only way forward. Why wait for the death toll to rise, asks Nigel Brunsdon With overdose deaths recorded every week in the UK, safer spaces were disappearing fast but needed more than ever, Nigel Brunsdon told the National Substance Misuse Conference, Breaking down barriers. Needle exchanges were closing all over the country and transferring to pharmacies, and the lack of political will to open consumption rooms in the UK made no sense: ‘There have been zero deaths in them anywhere in the world, and they’ve been open since 1986,’ he said. Slowing slides of filthy and unhygienic spaces full of needle litter, close to where the conference was being held, he added ‘Birmingham has an overdose fatality every week’. Beyond reducing deaths, the facilities were also shown to reduce blood-borne viruses and increase access to treatment, housing and other forms of engagement. ‘We have the highest levels of drug use ever and many people who’ve never been in treatment,’ he said. ‘So why aren’t drug services clamouring to do this?’ More reports from the NSM conference in next month’s issue.