Delegates at the National Needle Exchange Forum\u2019s annual conference heard inspiring examples of taking harm reduction to the next level. James Pierce reports. Photography by nigelbrunsdon.com More than 200 delegates from all over the UK returned to Birmingham for the National Needle Exchange Forum\u2019s (NNEF) annual meeting in December. Perhaps the most important part of the day was the call to action to raise support for the inclusion of drug treatment services in the Health and Social Care Act, to ensure that local authorities provide at least a \u2018minimum package\u2019 of NSP and harm reduction services. There was significant support from attendees and the NNEF planning group agreed that this is something that the NNEF will be campaigning for in 2020. The first speaker of the day was Jane Bailey of West Midlands Police, who spoke about trials of intranasal naloxone \u2013 the first time police officers in the UK have carried the kits. There have been at least two successful reversals of opiate overdoses, and the West Midlands force is planning to share the results nationally to help build the evidence base. Next up was Stuart Smith, director of community services for the Hepatitis C Trust. He spoke about the move towards elimination of the virus and the importance of NSP and harm reduction services in achieving this. \u2018Unless we continue to provide good harm reduction services then we are never going to reach elimination,\u2019 he said. There was rousing applause for Daniel Ahmed, clinical partner at South Tees Hospitals NHS Foundation Trust, as he spoke about the heroin-assisted treatment (HAT) they are now providing in Middlesbrough (DDN, November 2019, page 5). He discussed the complex health needs of the ageing cohort in treatment services and the difficulty in selecting just 20 people to receive diamorphine treatment, when many more are failing to benefit from traditional treatment offers and are stuck in a cycle of using and criminality. The scheme appears to be successful and Daniel reported that \u2018we have just seen a complete shift in how people are living their lives\u2019. Claire Smiles presented an overview of her research into chemsex and issues around the knowledge and confidence of NSP staff in offering advice or even discussing the chemsex scene. Her research identified a significant knowledge gap, with some very poor and potentially dangerous advice offered by practitioners and discussions of pleasure and drug use being seen as challenging by some. However she also identified opportunities for services to think differently about how they offer intervention to the chemsex community and for a wider focus on inclusivity for LGBTQ communities. Dr Magdalene Harris of the London School of Hygiene & Tropical Medicine followed, describing her research into injecting and risk, particularly from the types of \u2018water\u2019 that some people who inject might use, risking skin and soft tissue infections. \u2018Water\u2019 could mean \u2018tap water, bottled water, puddle water, surface water on cars, water from toilet cisterns, whisky, cider, coca cola, saliva, lemon juice\u2019, she stated. Sunny Dhadley, representing Anyone\u2019s Child, spoke about his journey from a life of problem drug use to his work as a freelance consultant and his time developing a peer-led service in Wolverhampton. Current drug policy was \u2018unfair, immoral and unethical\u2019 and was \u2018harming far more people than it ever should\u2019, he said. Dr Steve Taylor, consultant at Birmingham Heartlands HIV Service, then offered an update on the new HIV testing taking place on an outreach basis targeting hard-to-reach communities. James Pierce is writing in a personal capacity as an NNEF member \u2018We\u2019ve never had so many people on the streets in wheelchairs,\u2019 said Sue McCutcheon from Birmingham & Solihull Mental Health Foundation Trust, as she spoke about her work providing outreach healthcare to the city\u2019s homeless and rough sleeping populations. She powerfully described the challenges of her work and the rise in infections and viruses among the people she treats, many of whom are using a variety of drugs but are not engaged with any drug treatment services.