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It’s where you
16 |
drinkanddrugsnews
| October 2012
Debate |
Harm reduction
www.drinkanddrugsnews.com
L
ast month 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, with a
multi-themed programme making for an engaging day but a
challenge in terms of summarising proceedings here! As rapporteur
for the event, I tried to draw on one key message that came across strongly – that
harm reduction is about ‘meeting people where they are at’.
The morning presentations demonstrated that ‘where people are at’ is changing,
however. Dr AdamWinstock drew on data from the Global Drug Survey and Drugs
Meter (
DDN
, July, page 12) to show the increasing use of new drugs and growth of
the internet as a ‘drug market without borders’. As we learn more about these
drugs, their effects and potential harms, we need to adapt our messages, services
and approaches accordingly. Concerns have been raised about dependence levels
perceived by those using mephedrone, for example, as well as the severity of
comedown after use and the impact of banning the substance in terms of diverting
people to other drugs or leaving them in the hands of an illegal street market.
The presentation 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, a point developed further by Matt Gleeson from UnitingCare ReGen in
Australia, who made 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 and sharing information, myth busting and
facilitating peer support, yet this work continues to go unfunded in most cases
and is often 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 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 heard presentations from Martin Chandler of
Liverpool John Moores University and Dave Crosland on the widespread use of
performance and image enhancing drugs, which now account for up to 80 per
cent of the clientele in some local needle and syringe programmes. While the
body building community continues to be comparatively 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 ingrained 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, which reach around 13,000 clients through
74 outlets in the city. 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
Harm reduction should be about ‘meeting people where they’re at’,
according to the recent HIT
Hot topics
conference.
Jamie Bridge
reports
Delegates at
Hot topics
debate
key harm reductions issues