Okay, the heading doesn’t make much sense. I was looking for something catchy and this was the best I could come up with. Don’t be too hard on me, I’m an old man.
What is Harm Reduction?
When I was sixteen I had a moped, which was a bit like a motorised bicycle with a top speed of about 30 miles an hour (with the wind behind you). Anyway, I was working at a local co-op, either Strawberry Gardens or Fairfield Road, and I was using the moped to go backwards and forwards to work. One day when I was riding home a dog ran out in front of me near the bottom of Smithy Lane in Heysham (I was told this afterwards as the incident is a total blank). I came to in the Queen Victoria Hospital in Morecambe and was allowed back home after, I think, a couple of days, with no after effects as far as I can tell. Had I been wearing a crash helmet, which was voluntary in those days, perhaps I would have escaped without injury. I’ve mentioned this incident because it seems to me to be a good example of where harm reduction (the wearing of a crash helmet), would have made a difference.
If people are going to use drugs (and it seems that, whatever laws we have in place and whatever drugs education we provide), they are, then making that drug use as safe for them and for the wider society seems to me to be eminently sensible.
I know the arguments against harm reduction – “It just encourages them to take drugs”, “drugs are dangerous, why are we helping them to take them?” etc. Well, riding a moped is dangerous so should we just ban the riding of them? Or provide harm reduction in the form of crash helmets, road signs etc.? As far as drugs are concerned it seems that people are going to use them whatever we do. Our laws on drug use are pretty tough but more people are using more drugs and the legality or otherwise of those drugs doesn’t, for most drug users, seem to make much difference. And if we’re going to ban drugs because they’re harmful then alcohol and tobacco are long overdue for being made illegal. On nearly any measure you choose to look at alcohol is the most harmful drug in our society.
I got sober in AA, which is very much focused on abstinence, and I have to say that, for me, abstinence is the only way. For a number of years I thought that abstinence was the only way for anybody who has a problem with alcohol or other drugs. But over time, and especially when I started working as a trainer/educator around drugs and alcohol for the NHS, I started to see that there were other ways of dealing with drug problems. Firstly, not everyone who has a problem with drugs is an addict. Some people seem to just use too much too often and it ends up causing difficulties – for them (health, money, crime) and for the people around them. Or they turn to drugs as a way of dealing with some particular difficulty and, when the difficulty is dealt with, the drug problem goes away. Secondly, addiction isn’t just one thing, it’s a continuum and individuals need different things in order to recover (whatever we mean by ‘recover’; I’ve already written about this here).
This became clearest to me in the last few years of my working life, up until I retired two-and-a-half years ago. In that period I worked as part of a drug training team at a place called The Jarman Centre in Blackburn
Our team – John, Hasan, Claire and me – were in the room above the window on the right. Downstairs to the left of the door was the needle exchange with the training room on the right. Behind our room was the sexual health team and, on the second floor was the sex education team, our manager Angela, Tony, the manager of the harm reduction service and, at the back, our library.
This was, without doubt, the happiest place I have worked. We all worked as a team, supporting each other and sharing knowledge, skills and experience, and there was a wealth of all those things to share. The Needle Exchange was a classic example of harm reduction in action. It was anonymous, friendly and people could come in and get what they needed without any hassle. There was also the opportunity to chat with a nurse or volunteer (these were often people who were in recovery), and get help around blood borne viruses or other health problems. As a training team we delivered training about all aspects of drug and alcohol use – the new drugs, working with drug users, recovery, alcohol use, harm reduction, young people’s drug use, blood borne viruses and so on. At the heart of all the training we did was harm reduction.
Sadly the Jarman Centre is no more, a victim of the obsession with recommissioning services every few years. This seems to be a way, not to get better services, but to save money while at the same time keeping staff and the people who use the services in a constant state of uncertainty.
I think I retired at the right time. There was already a move towards what is called ‘The Recovery Agenda’ while I was still working and, as far as I can see, it goes on. This seems to be a move away from harm reduction and towards abstinence as the only goal of drug treatment.
I’m sure I’ve more to say on this subject but I think that’s enough for now. I’m sure there will be some disagreement with what I have written but all I can say is that these views are based on my knowledge and experience.