Debate
This year’s Hit Hot Topics asked,
how can we give harm reduction
most impact on the frontline?
DDN reports, pics by Nigel Brunsdon
NANNA GOTFREDSON
SUE MCCUTCHEON
The word on
The sTreeTs
‘W
hat the heck are we doing, criminalising people for what
they do to themselves?’ Nanna Gotfredson is the
founder of Gadejuristen, the ‘Street Lawyers’ of
Denmark. She brings legal outreach to homeless people
and witnesses the ‘constant war on drug users – the
constant fight between doves and hawks’.
‘Denmark is a welfare country – but the welfare system is designed for middle
class people,’ she told the HIT Hot Topics Conference. With her team, she brought
harm reduction, outreach and legal aid services – ‘and hugs, because we also
need love’ – to people on the streets. It brought her into confrontation, and then
‘a critical dialogue’, with the police – but it also brought progress. Denmark now
has five heroin clinics and has had drug consumption rooms since 2012, all with
vein scanners.
‘You can get so well within a month,’ she said, adding, ‘We can’t have a situation
where people choose between HIV and a penalty.’
Sue McCutcheon is all too familiar with these issues – and the gap between
poor engagement with services and the potential for radically improved health.
Working as a nurse with the Homeless Primary Care Team in Birmingham, she looks
for the substance users who need help but are not coming forward. Her job is about
‘taking the service out to them, so they have healthcare’, working for four hours a
day on the street.
‘Rough sleepers generally have multiple healthcare concerns,’ she said, ‘and
many present late in the pattern of illness. Health concerns will have gone on for
weeks and months, until it becomes a health emergency.’ Many will have had a
history of very poor engagement with services and poor care or treatment, which
often colour the way they use services.
DELON HUMAN
8 | drinkanddrugsnews | December/January 2018
JOSEPH KEAN
EMMA ROBERTS
Homeless people suffered the same illnesses and challenging conditions as the
rest of us, she pointed out. ‘But imagine managing diabetes when you are
homeless on the street, dependent on soup kitchens and without benefits.’
Within the last 18 months she had noticed skin lesions that looked like
impetigo. When swabbed they turned out to be group A strep, potentially serious
for those whose immune systems are poor, and PHE Birmingham confirmed there
had been outbreaks. Sharing spliffs and bottles and sleeping next to someone
infected made such conditions easy to spread and hard to contain, but information
in drop-in centres and ‘simple things like hand washing and hand gels in hostels’
were effective in stopping the spread of disease.
Another simple and effective measure had been the widespread introduction of
take-home naloxone, equipping people with the skills to manage resuscitation from
overdose and minimise harm.
‘I can’t talk about homelessness without talking about NPS,’ she added. ‘In
Birmingham, it’s “mamba” – what we’ve seen in the last six to 12 months is
shocking. One day last week we dealt with four people who were unconscious,
vomit in their mouth.’ Others suffered cardiac arrest in the street. ‘And people say,
“it’s just mamba”.’
Most people that McCutcheon saw and supported were groin or neck injectors –
people who tended to say ‘I’m alright’ when they weren’t. ‘It’s your role to make
sure they’re alright,’ she said. ‘It’s about being vigilant around healthcare issues.’
The reality for many was grim, living and using out in the cold, surrounded by
faeces and vomit. ‘We have to look at all possible options to make a difference,
including consumption rooms,’ she said. ‘I have a duty as a nurse to minimise harm.
We need to look at every option that might produce a better outcome for people.
It’s about building relationships… finding ways to deliver healthcare.’
PATRIIC GAYLE
NAOMI BURKE-SHYNE
www.drinkanddrugsnews.com