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‘ Gone are the days when you could only get treated in treatment centres . We ’ re rocking up in car parks and at people ’ s doors ’ to make sure of not losing people .’
TRACEY KEMP
With support from the Drug Policy Alliance , she became chief petitioner for decriminalising small amounts of all drugs . It resulted in a transfer of millions of dollars in tax from the legalised cannabis market to create a harm reduction programme across the state from naloxone rollout to distributing crack pipes . A peer-led council (‘ over half of people on it have been incarcerated and there are no cops ’) was deciding where the money goes and there had already been ‘ great progress ’ in distributing naloxone and crack pipes . The council ’ s work was not easy , as it was ‘ a messy process – messy and passionate ’ with untrained people , she says . ‘ But we have a lot of passion and the potential is amazing ’.
Distributing crack pipes was also a hot topic in the UK , as Dr Magdalena Harris of the London School of Hygiene and Tropical Medicine explained . The safe inhalation pipe provision ( SIPP ) project had been driven by the significant rise in crack use
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alongside neglect of the relevant harm reduction . There was ‘ little incentive for people who use crack to go through the door of services ’, she said .
Prohibition of crack pipes had led to an increase in pipe sharing and crack injecting , which were both associated with ‘ a lot of health harms ’. People were also resorting to making their own pipes , which might not be heat resistant , have sharp edges and result in vapour inhalation being overly hot – all significant issues ‘ in relation to a vulnerable population ’.
The project was working to try and change the law and had police and crime commissioner support , but she was feeling frustrated at the hurdles to get it off the ground . ‘ Efforts have stalled – people are not certain about the legality ,’ she said . ‘ We have to demonstrate that it won ’ t cause harm , but we can ’ t do it as it ’ s against the law .’ The Ethics Committee was concerned it would cause undue harms to a vulnerable population , but as a qualitative researcher she was excited at being able to address people ’ s needs and urged anyone interested to get involved in the collaborative project .
HEP C ELIMINATION As a project with the full weight of UK government – and World Health Organization – support behind it , the goal of hepatitis C elimination by 2025 seemed to be within reach . But as Tracey Kemp , Change Grow Live ’ s harm reduction lead explained , much of the significant progress was down to working with invaluable Hepatitis C Trust peers , ‘ a force to be reckoned with ’ and part of ‘ an army of us working
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together ’ to test and treat . Harm reduction pathways were ‘ the golden thread ’ in making testing and treatment accessible to all , and this meant ‘ meeting people where they ’ re at ,’ she said . ‘ Gone are the days when you could only get treated in treatment centres . We ’ re rocking up in car parks and at people ’ s doors ’ to make sure of not losing people who were not in structured treatment . Sustaining elimination would depend on having adequate harm reduction , including syringe provision , and collaboration and partnerships – including working with other providers to engage people in treatment .
UNCOMFORTABLE QUESTIONS With a clear evidence base for effectiveness , the project was meeting clearly defined goals . So hearing about Danny Ahmed ’ s experience with the diamorphine assisted treatment ( DAT ) programme in Middlesborough raised many uncomfortable questions . The programme , also known as heroin assisted treatment ( HAT ), had been celebrated as a highly successful intervention , but was being discontinued through lack of funding from the local authority .
As the programme ’ s clinical lead at Foundations , Ahmed had seen ‘ huge levels of engagement – 97 per cent ’ from the people involved . Middlesborough had the highest number of people using heroin in the country and with half of its wards deprived , there was ‘ no better place to look at alternatives to traditional treatment models ,’ he said . Patients were relatively young ( an average age of 38-40 ) and had ‘ medieval levels of life
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expectancy ’ as well as being likely to have mental health issues and be impacted by early trauma . ‘ It was obvious we needed to do something ,’ he said .
Starting in October 2019 the programme operated for three years , using two rooms with injecting booths and offering wraparound support ( DDN , November 2019 , p5 and DDN November 2020 , online news ). Many individuals became completely abstinent from street heroin , and many reduced their use of alcohol and street tablets . Furthermore , he says , ‘ the biggest outcomes were the connections , not related to drugs … there were vast increases in physical health , mental health and wellbeing . Staggering changes … people were able to get their own housing .’ There was also a 60 per cent reduction in crime .
At £ 16.50 per person per day , he was told that DAT was too expensive . But on what terms ? Of those who didn ’ t take part in the programme , six died and 43 had custodial sentences . ‘ We heard that the programme has failed ,’ said Ahmed . ‘ But it hasn ’ t . Commissioning has failed , the drug strategy has failed and people who use drugs have been failed .’
‘ We hear that there ’ s no demand from treatment services for this treatment ,’ added Niamh Eastwood . ‘ We need to tell OHID that there is . Fifty per cent of people who are dying aren ’ t in treatment .’
Hearing throughout the day about such dynamic work to scale seemingly insurmountable challenges certainly demonstrated a harm reduction community ready to fight for its lives . DDN
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