Drink and Drugs News DDN 1805 | Page 8


The National Needle Exchange Forum focused on some vital harm reduction issues , as DDN reports . Photography by Nigel Brunsdon

Straight to the point

A29-year-old kid dying of sepsis in 2018 in the UK ’ s second city .’ This was just one drug-related death of many , said National Needle Exchange Forum chair Philippe Bonnet , and reinforced why the focus on harm reduction must not waver and why the work of the NNEF was more vital than ever .

Back after a break in holding its annual event , the NNEF presented a packed conference programme that brought together speakers from health , criminal justice , drug treatment , legal services and policy .
With the first UK drug consumption rooms feeling like a distinct possibility and ever more influential voices and organisations joining the call for decriminalisation , the issues on the programme were bringing back an essential focus on harm reduction .
First speaker to the platform was West Midlands police and crime commissioner David Jamieson , who recently spoke out on the need for treatment over punishment ( DDN , April , page 6 ).
‘ We ’ ve got to move away from a polarised binary position – soft or hard on drugs ,’ he said . ‘ We need new dialogue and thinking .’ Was spending £ 1.4bn a year in the West Midlands on the ‘ war on drugs ’ a good use of resources , he asked . Jamieson had launched a strategy to divert people away from the courts and into treatment , through a series of recommendations that recognised drug dependence as a health issue over a criminal justice one .
As a former detective sergeant and undercover drugs operative , Neil Woods had developed an informed perspective of policing the illicit drug market . ‘ Locking up nasty people ’ was a ‘ constant narrative for the public and press ’, he said , but the market was so huge that this had a ‘ tiny impact ’ and ‘ the process of policing drugs makes drug dealers more violent ’. The growth of ‘ county lines ’ was involving children in gangs and causing more violence .
His experience had made him evaluate how police operations increased problems for many vulnerable people in society and conclude that the answer was harm reduction .
‘ It ’ s the time to be drastic , the time to be brave ,’ he said . ‘ Criminalisation of drugs will be looked back on with as much disgust as criminalisation of homosexuality .’
Public Health England ’ s drugs and alcohol manager , Tony Mercer , had been asked to comment on the arguments of harm reduction versus abstinence – a ‘ polarised debate ’ that worried him .
‘ Ideology can get in the way of interventions ,’ he said . ‘ We need workers who are happy to provide whatever ’ s needed at the time .’ Spending energy on a debate that couldn ’ t be solved meant taking our eye off the ball , he added . ‘ It ’ s a debate that can ’ t be resolved , so we need to reframe it .’
Referring to William White ’ s work on the need for different interventions , he said ‘ The aim of everything should be to reach and engage people .’

Effective engagement was a central theme for all of the speakers , with the prospect of the first UK drug consumption rooms . They would be a unique part of engaging people , though not a panacea , according to the Scottish Drugs Forum ’ s Kirsten Horsburgh . ‘ We need a whole range of different things ,’ she said . Looking at the situation in her Glasgow neighbourhood demonstrated very clearly the difference they would make .

‘ You don ’ t have to go very far from the main shopping areas to find needle litter and discarded injecting equipment ,’ she said . ‘ We ’ re already providing sterile injecting equipment but not the rooms to use in .’ People needed to inject in public places – back alleys , toilets , or on the streets . In many cases they would be thrown out of hostels if they were caught injecting on the premises .
The constraints on where people could inject made them do it hurriedly – and the need for speed left them vulnerable to violence , stigma , and dangerous injecting practice , said Dr Magdalena Harris , associate professor at the London School of Hygiene and Tropical Medicine .
Urgent injecting led to venous damage and could easily transition to the groin as this was ‘ quicker and easier in a low light ’. She shared the experiences of two people involved in her research : Emma had told her about her transition to skin popping ( injecting under the skin ), which intensified the harms by causing infection . Gary had described injecting while blood was pouring out of his groin – and had seen this as the only viable option to being misunderstood and mistreated at hospital .
Safe injecting spaces would be ‘ a place for opportunistic care ’, said Harris – a place for food , healthcare , and a shared space for other support services such as benefits and housing . The facilities also made sound financial sense , as people were being hospitalised for preventable conditions such as sepsis and gangrene and not seeking treatment early enough .
‘ Soft tissue infections exacerbate social exclusion ,’ she added . ‘ They give problems with mobility and have a massive impact on people ’ s lives .’
8 | drinkanddrugsnews | May 2018 www . drinkanddrugsnews . com