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Back to the Future1990-2010
The changing face of harm reduction
Russell NewcombeDirector, 3D Research, Liverpool, England
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 complem- entary – 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 GenerationStage 1 85-87 Local: Liverpool > Mersey > NWStage 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 provisionThe 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
SET
body
drug policy
SETTING
DRUG = contents & consumption
DRUG
laws
mind
help
place time
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/ | \
Allan Parry & Dr. John Marks & Russell Newcombe/ | | | \
Lyn+Alan Jeremy Pat Mike and many Matthews Clitheroe O’Hare Linnell others…[NX & OR] [pharmacy] [training & info] apologies!
Harm Reduction 1990-2010
• 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’ – becauseit 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, toextend 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!
