WE NEED TO TALK ABOUT ...
THE HISTORY OF HARM REDUCTION
Harm reduction ’ s history . History ! I suspect there ’ s a whole lot of eye rolling going on out there . I mean , who cares ? It ’ s all in the past and harm reduction has much bigger problems in the here and now , right ?
Well , no . History matters a lot , but we ’ ll get into that later . First things first – let ’ s have a look at the orthodox history of harm reduction . According to the accepted version , harm reduction appeared in a blinding flash of light in mid ’ 80s Liverpool as a result of wildly escalating drug use spawned by Thatcher ’ s economic ‘ reforms ’. Harm reduction became the ‘ Mersey model ’.
There ’ s only one problem with this – it ’ s not true . I can tell you , definitively , that harm reduction wasn ’ t created , discovered or born on Merseyside . I can say that because I predate the mid ’ 80s and back then I had only visited Merseyside to score rather than learn . Yet I ’ d already received a full harm reduction education – wound care , safe injection , and so on .
What happened in Liverpool in
We can ’ t have the future we want without properly understanding the past , says Nick Goldstein
the mid ’ 80s was not the creation of harm reduction , but instead the adoption of a harm reduction model by the state – as an attempt to improve public health by reducing the harms associated with drug use . Harm reduction as a philosophy has been around , I suspect , since man came down from the trees , started eating plants and discovered some made him feel really good . Ever since then users have been helping each other with harm reduction . I came across an old Georgian recipe for milk mixed with soot the other day , which is supposed to stop the shakes that come with gin DTs . I doubt it works , but without a doubt it ’ s harm reduction and without a doubt it predates the 1980s .
There ’ s a big difference between harm reduction and the adoption of harm reduction as a public health model . And the impact of this misremembering of history has had some serious effects on drug policy and treatment provision , not to mention the poor longsuffering drug user .
There ’ s lots of quotes on the nature and importance of history , ranging from Aristotle to George
Santayana , but my all-time fave comes from Rudge in Alan Bennett ’ s The History Boys . He ’ s asked to define history to which he responds , ‘ History ? It ’ s just one fucking thing after another ’. Hard to argue with that . The problem comes when you get those ‘ fucking things ’ – those events – in the wrong order . You get lost because those events are like a chain linking the past to the present and future . If you don ’ t know your past , your future becomes even more hazy and at this time of changing patterns of drug use , harm reduction getting ‘ lost ’ is about the last thing drug users need .
I have nothing against Liverpool . It ’ s a great northern city , but harm reduction wasn ’ t created there and if we allow this orthodoxy to persist it can only damage the development of harm reduction . If we accept the orthodoxy we wipe out the centuries of harm reduction history and learning that came before . So who developed harm reduction over these centuries ? Drug users ! Harm reduction used to employ a peer-to-peer model – one user teaching another user how to use drugs and survive . Now obviously , when the state adopted harm reduction ( in desperation ) in Liverpool in the ’ 80s it was a generally a positive development , but the state-adopted model was fundamentally different to the old peer-to-peer model . For
example , if I got my hands on some opiate or opioid I ’ d never come across before , back in the day , one of my peers would tell me the equivalent dose of drug so I could use and not overdose . I have never seen this done in modern state-run harm reduction , because giving dosage advice is not seen as appropriate .
In fact the old peer-to-peer model covered a lot of ground the modern version doesn ’ t . How to make money , how to not be arrested , how to scam doctors . The reason for this is obvious , but worth stating – the modern version of harm reduction isn ’ t really for drug users . Its aim is to protect society from drug users , and that ’ s a very different beast .
This misremembering of history never ends well because history is the roots of the future . If we fail to remember harm reduction ’ s past , its future looks bleak . Without an appreciation of the peer-to-peer based model and all it achieved , how can we evaluate or improve the state-sponsored model we employ today ?
Patterns of drug use are changing rapidly . Different groups of people are using new and different drugs in new ways . We need a clear , focused philosophy of harm reduction to be flexible enough to cope with new challenges – the age of giving out works and condoms and a little education are long gone . The philosophy of harm reduction is still the best answer , but it needs to change and develop and for that to happen we need to learn from the past .
If we ’ re not careful , harm reduction will morph from drug users helping each other to what – a means of state control ? Business ? The future is up to us . Let ’ s not mess it up by forgetting the past .
Nick Goldstein is a service user
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