Transcript the Future, 1990-2010: the changing face of harm

Back to the Future
1990-2010
The changing face of harm reduction
Russell Newcombe
Director, 3D Research, Liverpool, England
[email protected]
Special Anniversary Event: 21 Years of Harm Reduction
What is harm reduction (HR)?
HR is a policy/intervention which prioritises the
prevention of drug-related risks & harms above
the prevention of drug use per se [abstentionism].
HR and abstentionism (eg. recovery) are complementary – 2 sides of the same drug services ‘coin’.
The original four cornerstones of harm-reduction:
• Needle exchange (NX) & drug-use equipment
• Primary health-care for drug users
• Prescribing – esp. methadone maintenance
• Information on safer drug use
The history of harm reduction
Foundations: 1870 to 1984
First Generation
Stage 1 85-87 Local: Liverpool > Mersey > NW
Stage 2 87-88 National: ACMD (NX & MM)
Stage 3 89-90 International: IJDP, ICDRH
Subsequent Generations: 1990s + 2000s: IHRA etc.
Next Generation: 2010 onwards
What are the foundations of HR?
Home (UK):
Pharmacy laws from 1870: regulated drug provision
The British System (Rolleston 1926) - prescribing of
heroin etc. to addicts if they can ‘lead a normal life’
Abroad:
USA: San Francisco model; Zinberg & Weil’s theories
Netherlands: needle exchange, decriminalisation
Around the world:
Social policies on safer drinking, safer sex, risky sports
The 3 sources of drug-related harm
l
drug policy
help
laws
body
place
m
DRUG
mind
SET
time
SETTING
DRUG = contents & consumption
Source: Zinberg (1984)
What is one of the major
causes of drug-related harm?
Drug Prohibition
i.e. laws which criminalise the production, supply
and possession of drugs – which simply abdicate
responsibility for drug control to gangsters
Why Liverpool/Merseyside ?
It is hard to say why HR ‘kicked off’ here, but I
can think of three important reasons:
(1) anti-authoritarian culture of scousers
(2) unprecedented levels of drug use in 80s
(3) coincidental coming together of maverick
professionals & drug users with shared beliefs
The First Generation of HR?
Stage1: Mersey Model (1985-87)
Roll of Honour
Howard Seymour & John Ashton & Supt. Peter Dearie
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Allan Parry & Dr. John Marks & Russell Newcombe
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Lyn+Alan
Jeremy
Pat
Mike
and many
Matthews
Clitheroe
O’Hare Linnell
others…
[NX & OR] [pharmacy]
[training & info]
apologies!
Harm Reduction 1990-2010
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Safer clubbing/dance-drug use
Overdose prevention (eg. naltrexone)
Drug consumption sites
Illicit drug testing services (eg. E-kits)
Alcohol & tobacco HR interventions
Prescribing of heroin, stimulants, etc.
Drug law reform (esp. decriminalisation)
Harm Reduction:
The Next Generation
Internationalize – take HR into more countries, esp.
the four core interventions: needle exchange,
health-care for drug users, substitute prescribing,
& information on safer use
Develop new interventions to reduce the most serious
and costly harms – deaths, diseases, crime, etc.
Start moving from prohibition to regulation of drugs
Develop Theory – to plan, deliver and evaluate HR
“Experience without theory is blind” (Kant 1787)
So what would an HR theory do?
Improve communication between various groups
Help design and develop policies & interventions
Organise and interpret research findings
Evaluate effectiveness of interventions/policies
Map out the territory and identify the gaps
In short:
it’s time to stop making it up as we go along
To conclude ...
E M Forster said ‘2 cheers for democracy’ – because
it does not deserve 3, though beats any other system.
I say ‘2 cheers for HR’: it’s not perfect, but under
Drug Prohibition it’s the best policy we have to help
people who start using or continue to use drugs.
So here’s to the Next Generation of HR – because, to
extend the Star Trek metaphor even further:
Harm Reduction is a drug policy which boldly goes
where no drug policy has gone before.
Two cheers
for harm
reduction!