In 1987 , the late great Russell Newcombe coined the phrase ‘ high time for harm reduction ’, urging policymakers to focus on reducing the harms from drug use rather than solely on cessation . Thirty-seven years later , UK policy has not significantly shifted from futile attempts to eradicate drug use , with an inadequate focus on harm reduction remaining .

Since 2010 , the UK strategy has not supported any modernised approaches to harm reduction , instead focusing on abstinence and crime reduction as the primary drivers for change . The 2021 drug strategy mentions harm reduction only once , alongside targets for reducing deaths and increasing treatment availability . The

strategy did not introduce any significant changes in approach or key harm reduction strategies , such as diamorphine-assisted treatment , expanded needle and syringe programme ( NSP ) provision , overdose prevention centres or drug checking .

HOT TOPICS

At the eleventh HIT Hot Topics conference in Liverpool , we were once again given hope that the harm reduction wilderness days may be over in other parts of the world – with global recognition of its importance continuing to emerge . Niamh Eastwood , executive director at Release , called for harm reduction hubs separate from drug treatment services – dedicated , safe spaces to engage people in a way that meets their needs . We imagine this space would include access to NSP , advice and harm reduction interventions to reduce people ’ s vulnerability to BBVs , bacterial infections and a range of other harms and importantly a chance to engage around wider health needs . Does this remind you of anything ? ( Specifically thinking about the NTA ’ s Models of Care ).

As discussed previously in DDN ( Dec-Jan 2024 , page 20 ), the replacement of tiered

models of care with integrated recovery services has made many people reluctant to engage with NSP services located in treatment services also delivering prescribing . The one-stop shop approach has highlighted that many people who inject drugs miss and prefer the confidential , anonymous approach to NSP provided by tier 2 services .

Hot Topics also featured senior public health practitioner Alan McGee , part of the team that developed the Mersey model of harm reduction . He presented a critical analysis of past and present drug policy and historic activism examples , including a mobile van in late ‘ 80s Liverpool that distributed injecting equipment to peers for secondary supply . There are other examples from across the UK where harm reduction activism created a public health approach which undoubtedly reduced the harms and threats of HIV and other communicable diseases , but much of that best practice has been lost over the years .

Two other speakers highlighted progressive practices outside the UK . Sam Rivera discussed how overdose prevention centres ( OPCs ) in New York created a safe harm reduction space , while Dr

Nabarun Dasgupta from the Remedy Alliance for the People in North Carolina spoke about drug checking and naloxone development , underpinned by true altruism .

We enviously listened to these stories of activism and courage , including Lynn Jefferys from EuroNPUD ’ s description of how Jeremy Kalicum and Eris Nyx – co-founders of the Drug Users Liberation Front ( DULF ) – jeopardise their own liberty to save lives in Canada by offering a safe supply in response to a public health crisis .

WHAT NEXT ?

The question remains : what do we do next in the UK ? It ’ s vital that we address the regression in harm reduction and we call for a change in policy – just as Russell did back in 1987 . The call to action for more dedicated harm reduction hubs is timely , urgent , and crucial if we are to have any hope of catching up with our international colleagues and reducing DRD rates .

Considering the lack of discreet , dedicated harm reduction interventions and the gaps created by losing tier 2 services , it stands out how the needs of people who inject drugs – those who do not want