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bulk purchases of pipes – then channelling the profits to those with the fewest resources. Finally he took the decision to leave AHOPE and concentrate on Smoke Works full time.‘ We’ re doing this from harm reduction up, not public health down – that’ s what’ s made the difference,’ he said.‘ We cultivated access to safer use supplies by offering them, only to reveal that the need was there the entire time – we just weren’ t asking.’
This meant that it was vital to expand the definition of harm reduction, he said.‘ We have risk mitigation, and then we have the approach we use to make it accessible, and we can widen both. We can meet more people where they’ re at, and we can have that impact on more lives.’
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KEY PLAYERS‘ Our world has several players,’ harm reduction consultant Mark Gilman told the conference –‘ research, policy and practice, and then commissioners, providers, and the people who use drugs. I’ ve been in all of those spaces over the last 40 years, but the one I’ ve been in the longest is somebody who’ s used drugs.’
From 14 to 19 he’ d been‘ insanely drunk most of the time’, he said.‘ Alcohol is a drug, let’ s get that out of the way.’ Soon after, taking LSD had changed his life‘ immeasurably for the better, as it meant I could put down the drink for a bit and embrace
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psychedelics.’ He’ d then gone to India and discovered opium.‘ I liked it a lot, and there was a safe supply. I got physically dependent, which had its own problems, but it certainly dealt with my spiritual malady or whatever I had.’
A war on drugs was a war on drug users, he said.‘ And we die, in the thousands. The numbers are terrifying, and are only going to get worse with the polluted opioid supply.’ But the schism between harm reduction and recovery was a‘ false war’, he added.‘ When you’ re dead, there’ s no more war then.’ Too often people‘ sing to the choir and just get applause from their own people,’ he said.‘ But you don’ t get change that way.’
Some of the key people in harm reduction worldwide were personally 12-steppers, he pointed out.‘ It’ s usually managers of orthodox services who say“ we can’ t put people in
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12-step abstinencebased recovery in a harm reduction setting – it’ ll trigger them”. But what does the‘ Big Book’ say?“ We carried alcohol for the new recruits, we went into sordid places”.’
Mutual aid was straightforward, he told delegates.‘ It’ s me helping you, you helping me, in community, together, for free, 24 / 7, 365. What’ s not to like?’ In this game we survive together and we die alone. Connection is the opposite of addiction. I’ m encouraged by the growth in mutual aid, particularly Cocaine Anonymous.’
UNCONDITIONAL SUPPORT‘ Meet people where they’ re at’ was a phrase that was heard all the time, he said.‘ But it has to be unconditional. If we meet people where they’ re at and then tell them where we want them to go, that’ s conditional. If we genuinely mean meeting people where they’ re at, then it has to be unconditional. Imagine being an outreach worker and going out to the 50 per cent of people
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‘ In this game we survive together and we die alone. Connection is the opposite of addiction.’
MARK GILMAN
not in treatment and asking them, yet again, what they want. They say,“ what have you got?” And you say“ methadone or methadone or methadone or buprenorphine”.’
However, in places like Scandinavia, Switzerland and elsewhere, heroin-assisted treatment was paying dividends.‘ A lot of exciting things are happening in terms of diamorphine. Not just the injectables, but they’ ve got the 200mg tablet, a nasal spray for those people with venous sclerosis. It’ s a safe opioid supply. And it’ s beginning to happen here.’ DDN
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