On Thursday 20th September, HIT hosted their second "Hot Topics" conference in Liverpool, sponsored by Martindale Pharma. This national harm reduction event attracted 140 delegates from across the country and beyond, and was a great success. The programme was abstract-driven and multi-thematic, which made for an engaging day – but makes summarising proceedings in a few hundred words a challenge! In rapporteuring the event, I tried to draw on one key message that came across strongly to me: that harm reduction is about "meeting people where they are at".
The morning presentations demonstrated that "where people are at" is changing. Dr Adam Winstock drew on data from the Global Drug Survey and www.drugsmeter.com to show the gradually increasing use of new drugs – and the widespread use of the internet as a "drug market without borders". As we learn more about these drugs, their perceived effects and potential harms, we need to adapt our messages, services and approaches accordingly. For example, concerns have been raised about dependence levels perceived by those using mephedrone, the severity of comedown after use, and the impact of the recent banning of this substance – potentially diverting people to other drugs or leaving them in the hands of an illegal street market. Adam confirmed that "the UK is still a powder loving country", and that a fifth of 18-22 year-olds admitted using an unknown white powder in the past twelve months! Basic harm reduction messages are not always reaching these groups, and Matt Gleeson from UnitingCare ReGen in Australia developed this point further – making the case for "Web 2.0 enabled harm reduction services" that can take full advantage of social media and other new technologies. The web allows for two-way communication with people who use drugs, advocacy and mobilisation, learning, sharing information, myth busting, and facilitating peer support. Yet this work continues to go unfunded in most cases and is seen as a "productivity killer" by bosses. Adapting the way we think about this work is a core cultural challenge for services.
Stephen Heller-Murphy from Healthcare Improvement Scotland then outlined the work being done in Scotland to provide harm reduction in prisons, and the frustrations that have been encountered – particularly with the continued absence of prison needle and syringe programmes. Foil is also proving hard to come by for prisoners looking to smoke their drugs – with foil-wrapped biscuits being banned in some prisons – leading to even higher rates of injection. Mat Southwell from the Gold Standard Team then provided a fascinating account of the dynamics of ketamine use, the varied profile of users, and the emerging risks. Again, simple harm reduction advice – around hydration, safe use environments and the development of tolerance – is often failing to reach these individuals. Later in the day, delegates also heard presentations from Martin Chandler (Liverpool John Moores University) and Dave Crosland on the widespread use of performance and image enhancing drugs – which now accounts for up to 80 percent of the clientele in some local needle and syringe programmes. While the body building community continues to be well self-policed, emerging patterns of use among relatively naive gym-goers (particularly young people and those going through mid-life crises!) is a big concern.
While these presentations pointed to unmet needs and unreached groups, the afternoon session highlighted the ongoing needs of the more "traditional" harm reduction clients – particularly those injecting heroin and crack cocaine. Nigel Brunsdon from HIT provided insight into the deeply-engrained rituals (or "foreplay") of drug preparation, and why these can be so hard to challenge and change. John Campbell from Glasgow Addiction Services presented on the provision of injecting equipment kits in Glasgow – reaching around 13,000 clients through 74 outlets. The kits now include plastic 2ml ampoules of sterile water for injection (a newly available harm reduction product), and have been very well received in service evaluations. Dean Linzey from Reading DAAT then presented on efforts to improve and expand HIV and HCV testing, using rapid oral swab tests that can be easily administered by key workers on the ground. Faced with low testing uptake and a medical model that was like "speaking in tongues" to clients, these services overhauled themselves to deliver a much more flexible approach that met people's needs.
The highlight of the day was an impassioned keynote speech by Sara McGrail on the government's recent "Putting Full Recovery First" document. Although the document has been criticised and denounced by many of the signatory agencies in private, none has stepped back from it publicly. It remains an influence for commissioning and a yardstick of the current government's outlook.
Whereas the term 'recovery' has been a source of great empowerment and strength in the mental health field, it has been hijacked in the drugs field in a "victory of moral determinism, greed and self-righteousness over evidence". The language of recovery could have been used to empower people who use drugs to determine their own goals and improve the range and quality of services they receive – especially given widespread unhappiness at a one-size-fits-all treatment system that had developed under the NTA over the years. Instead, this government's idea of recovery has come to embody one imposed goal for all – total abstinence from all drugs (or "full recovery"). According to Sara, the hijacking of recovery language is down to three related factors: the broader push for austerity and funding cuts; the development of "big business" treatment charities focused less on individuals in their care and more on tenders, contracts and profit; and several years of highly efficient political lobbying from residential treatment providers and the Conservative Christian Right. Together, they have created a "hierarchy of worthiness" – with abstinence placed above all other successful treatment outcomes – which has been translated into a system that "measures the success of drug treatment by the absence of people in drug treatment".
Sara predicted that deaths, infections and stigma would all increase as a result of this shift. She called on the audience to recognize the weaknesses of the previous treatment systems, learn from the successes and weaknesses, and maintain their focus on reducing harm: "we are needed now more than ever". Sara's speech brilliantly emphasised the need to meet people where they're at, rather than where we are being told they should be.
Sara is a long time commentator on UK drug policy and spoke about the governments document 'Putting Full Recovery First' and the reaction to it from the drugs field.
Dr Adam Winstock
Adam is the founder of the Global Drug Survey
, he spoke about the survey findings and changes in global drug habits.
Mat presented about the development of the 'K-Check' tool that helps GP and other workers do practical work and screening of ketamine users while also avoiding stigma.
Stephen who has a history of delivering harm reduction interventions in prison environments spoke about this work and the healthcare in prisons and how this works with substance use.
Nigel is HIT's Community Manager
and he runs the Injecting Advice website, he spoke about using peoples own drug use rituals to help instigate change.
John who works in Glasgow spoke about the changes in equipment they've been doing in the area and how this has improved their ability to deliver harm reduction messages..
Dean is a nurse consultant in BBVs at Reading DAAT, he spoke about delivering HIV and HCV interventions in 'hard to reach' communities.
Matt works at ReGen
in Victoria (Australia), he spoke about the use of social media by people who use drugs, and why we need to remember to meet people where they are at.
Martin Chandler and Dave Crosland
Martin and Dave spoke about performance and image enhancing drugs, with Martin focused on theory and Dave giving the point of view from his position as a competing bodybuilder.
We had a side event for smaller topics that we called the Unconference, this took place next to where the refreshments area was.
As well as his presentation (above) Nigel also gave a short presentation about the making of the 'Naloxone is Childs Play' video, this included outtakes from the film.
Chris Rintoul and Iain 'Buff' Cameron
Chris and Buff presented about the overdose app that they've developed for iPhone and Android phones..
Joanne spoke about training of workers by drug users and how this effects the existing power imbalances..
Stephen gave a slideshow presentation talking about his visit to the Insite supervised injecting facility and the surrounding area.
Dr Russell Newcombe
Russell spoke about a possible future of drug use that includes 'chemputers' and other technological highs.