How did you become involved in supporting harm reduction for drug users?
Firstly I must be clear that the harm reduction ethos does not just relate to those living with drug addiction issues or substance users. It is also concerned with the issues that surround addiction more generally and a number of other related and non related issues, public health issues, social and economic issues, evidence based policies, fighting stigma, reducing risk of blood-borne viruses (BBVs), safe rights of sex workers etc. (this list is not exhaustive).
Harm reduction is self explanatory in its title and can relate to anything that is harmful to the individual or the community in general. Its core is firmly based in practical rather than idealistic beliefs. Harm reduction (harm minimisation) can also be used in relation to human behaviours and actions towards either themselves or other human beings.
Some of the issues addressed by the harm reduction ethos may be illegal and may cause controversy when looked at through uneducated or biased eyes. However, the whole process is firmly grounded in the safety and education of those who may come into contact with any form of support that has its origins in the harm reduction culture and, ironically some would say, those who look on through tainted eyes.
Whole communities are affected by negative actions and behaviours, and the harm reduction community is dedicated to reducing the effects in any way possible resulting in individuals, whole communities and inevitably society benefiting from the desired outcomes: reduced crime, reduced drug use, reduced drug related fatalities, reduced health risks and costs, reduced stigma against disadvantaged groups who are isolated and vilified due to being different or struggling with addiction, homelessness, unemployment etc.
Harm reduction has come under fire over the last few years by some as providing a safe environment for those who use substances to carry on using, thus producing no positive outcomes. I beg to differ looking at the bigger picture. Speaking as someone who came into abstinence kicking and screaming – thankfully with my health intact – after a number of chaotic years in addiction, I have to say with my hand on my heart that I would not have got this far if I had not spent a number of years being educated around the risks of my chosen lifestyle and gently guided through the years of chaos with a non-judgemental and non-enforced guiding hand of harm reduction. Those who reached out to me during that time carried me through some of the most destructive years of my life and kept me safe when no one else took the time to care. So being alive and healthy is actually quite a significant positive outcome in my opinion.
My own personal experience is how I became involved in carrying a message that there is a way out should you choose to take it and if not, you are still a valued and respected member of the community who deserves to be treated the same as every other member of that community, if not with more respect and due attention.
To put it plain and clear terms, there is a war on drugs and in war we do not shoot our wounded; we care for them and nurse them back to health or recovery. No matter what it takes or how long it takes, regardless of who they are or what they stand for, we overlook the divide and provide the care needed at a pace that supports the individual safely and humanely back to a place where they feel comfortable with their life and its surroundings. For some this may not mean complete abstinence, and who am I to judge their preference. My aim is to support them in any way I can to achieve whatever it is they set as their goal in the safest way possible.
What draws you to support and advocate for people with addiction issues?
The years I spent living with addiction and all its related issues, as did my family and everyone who came close to me over the years. Addiction is not an isolated issue and its ripple effect can be as far reaching as it is deep.
There are those among us who can use safely and those who can remain recreational users. I take my hat off to them and have a, some might say controversial but, very real respect for them and an underlying jealousy if I’m honest. I was not one of them and the result was years of unadulterated chaos everywhere I went. Years of feeling like I did not belong anywhere, years of searching for connection, and years of battling stigma and isolation.
The feelings I lived with for those years were almost debilitating and I became trapped in a cycle of addiction where the pain of being was overwhelming and the substances dulled the pain of being, not a nice experience in any way, shape or form. Don’t get me wrong, I had some amazing times on substances but the effect it was having on my loved ones and significant others eventually added to the pain and became part of the downward spiral. I ended up alone and destitute. The feelings I went through are still quite clear in my mind and the depths of despair I reached are still ingrained in my core. This is not everyone’s truth, but unfortunately it was mine.
Those feelings and the memories of feeling so alone are at the heart of everything I do in the field today. The empathy towards those who are living with the same feelings and fighting against the same demons and stigma that I felt during those years drives me to stay connected to those who are living with addiction and all its surrounding issues, whatever way they manifest themselves, and attempt to reduce those same, at times, debilitating feelings from taking over their lives.
I have a personal and deep rooted connection with the community I represent. Sometimes I take a spiritual approach and other times, a more active and outspoken platform. When it comes to civil and human rights I feel almost compelled to make a stand and make my voice heard, and provide platforms for others to do the same.
There are a number of different campaigns and actions that I support, or have views on, such as the current need for consumption rooms to provide safer injecting facilities for those who inject their substance. This is something I openly advocate for due to the benefits of such a facility to individuals and communities. I also advocate for the provision of Naloxone as a life saving medication that would reduce the fatalities in the drug using communities dramatically. This list is endless. I am passionate around the work I do because I have firsthand experience of what it is like to be looked down on for advocating my human right to put illicit substances into my body and being demonised for it.
What does your work in this area involve?
I am fortunate to have gained employment in the field of addiction and recovery. The service I work for provides the treatment element of the journey towards ‘recovery’. However, there are a number of services within its remit covering psychosocial interventions, pharmacological prescribing, housing, employment, training, education, family and friends support, introduction to a number of mutual aid support networks, group work, signposting and a number of other treatment related support options for those seeking support for current addiction issues.
We also supply clean equipment for those still injecting and harm reduction advice in that setting to support those who may not be ready to initiate change. This is actually quite a significant part of the overall service provision and at times, a single point of contact for the more chaotic among our communities. This is where some of the most positive work can be carried out in creating a solid foundation on which to build a sustainable platform for change. From that point, and throughout the journey through the treatment phase, a full and comprehensive package of care can be introduced and implemented.
Outside of my employment I am involved in a number of different projects that are autonomous to my employment and connected to the overall provision of safety and support for the community. With support from some of the guiding lights in the harm reduction community I hold events in my local area that are focused on all aspects of the journey both through the treatment phase and beyond. Some of these events have brought a number of regions together such as unity days, involvement days, information sharing events, remembrance days, and fun days.
I am involved in a Harm Reduction Cafe that highlights current issues within the community. The most recent is the provision of Naloxone / Prenoxad and looking at ways of reducing the fatalities connected with the drug using communities. Drug related deaths affect whole communities and a number of them are preventable through the provision of life saving medications such as Naloxone.
There are a number of campaigns that I openly advocate for such as the consumption rooms I mentioned and also anti-stigma campaigns. I am a trustee for the UK Recovery Walk, which is a charity set up to make recovery visible by arranging mass walks in major cities yearly. Another passion is providing platforms for grass roots mutual aid involvement groups and creating communities both in reality and virtually to offer support beyond treatment. Again the list is endless as to my involvement and added passions.
What legal improvements or changes would help to ensure harm reduction?
There are a number of improvements and changes that I would advocate for in the sector at the minute: the most obvious would have to be to eradicate the fundamental element that is simmering away in the undergrowth between recovery activists and harm reduction activists. And also the competitive element that is becoming clear between nationally recognised services and the more successful of the grass roots organisations that are now moving up into the community interest company (CIC) or registered charity level on their journeys. My opinion is that this is what we should all be working for and recognising as the ultimate end game for mutual aid organisations/groups, and this should be supported at all levels, not eliminated as a potential threat.
Another element that I have briefly mentioned but will go into more depth with now is consumption rooms. My opinion on these is that there should be one in every town. The benefits of these facilities by far outweigh the fears that are feebly standing in the way of their progress.
Drug consumption rooms provide a safe place where dependent injecting drug users can administer their substance in supervised, hygienic and medically monitored conditions. There are approximately 65 drug consumption rooms in operation in eight countries around the world, but for some reason there is still resistance in the UK.
The UK has had the highest number of drug-related deaths in Europe consistently for the past decade at least. There is a high prevalence of BBVs, drug-related litter and paraphernalia such as used syringes dropped in public places, and this in turn has a considerable impact on local residents and communities as a whole. The costs on communities’ health care systems and legal systems is also high.
Chaired by Dame Ruth Runciman, the Independent Working Group included UK experts from the police, legal and health sectors. For 20 months, the group reviewed the growing body of evidence, commissioned research where data was lacking, visited drug consumption rooms in five countries and interviewed relevant witnesses.
Ruth Runciman said: “Setting up and evaluating drug consumption rooms would be a rational and overdue extension to UK harm reduction policies. This approach would offer a unique and promising way to work with the most problematic users, in order to reduce the risk of overdose, improve the health of users and lessen the damage and costs to society. While millions of drug injections have taken place in drug consumption rooms abroad, no one has died yet from an overdose. In short, lives could be saved.”
Highlighting associated health problems such as blood-borne viruses, abscesses and cellulitis, Ruth Runciman stressed how often these result in hospitalisation which could be avoided. She also spoke of the UK’s substantial population of homeless drug users who often inject in public places causing distress to their local communities.
The working group also considered the legal issues. Ruth Runciman said: “From our close scrutiny of national and international legal frameworks we do not see any insuperable legal obstacles to the piloting of drug consumption rooms in the UK.”
The group found that drug consumption rooms:
- can avert drug-related deaths, prevent needle-sharing and improve the general health of users;
- can decrease injecting in public places and reduce the number of discarded, used syringes and drug-related litter;
- do not appear to increase levels of acquisitive crime;
- were generally not associated with public order nuisance or other problems, especially with good interagency co-operation in place;
- are mostly used by local drug users.
Ruth Runciman added: “We conclude that well-designed and well-implemented drug consumption rooms would have an impact on some of the serious drug-related problems experienced in the UK.”
Another relevant issue I am passionate about is the provision of Naloxone, which is a prescription-only medicine (POM) that can temporarily reverse the effect of opioid. It does this by removing the opioid from the receptors, which assists with the restoration of breathing. In hospitals, doctors and nurses have been administering Naloxone for years to reverse post-operative respiratory depression and respiratory and central nervous system depression from opioid administration during labour and child birth. Within communities, paramedics also use it to reverse the effect of (accidental) opioid overdose.
Facts from naloxone.org.uk:
- Naloxone does not get a person intoxicated/stoned/high, quite the opposite;
- Naloxone is not poisonous, and causes no harm if swallowed;
- Naloxone is very safe, but does have some contraindications;
- Naloxone is a prescription-only medication and is currently only licensed in the UK for administration by subcutaneous, intramuscular or intravenous injection. In Scotland, Naloxone is also supplied to people under a Patient Group Direction (PGD). The PGD for supply of Naloxone is a special document, agreed by senior clinicians, nurses and pharmacists, so that they can legally supply the medicine to people who might be at risk of opioid related overdoses without first looking at the person’s medical record or consulting a doctor, who would normally be responsible for writing a prescription;
- Naloxone comes in various presentations (pharmacy speak for packages, concentrations and doses). In the UK Naloxone comes in ampoules, pre-filled syringes and ‘mini jets’. It is manufactured in two different concentrations: 0.4mg per ml and 1mg per ml. In Scotland, it has been decided to use a 1mg per ml concentration that comes in a 2ml pre-filled syringe, meaning that people are supplied with 2mlg of the medication.
A current issue I’ve recently blogged about is my concerns over national organisations swallowing up grass roots groups rather than supporting them. The article can be read here and feedback on this would be of value to me and a number of others who have already commented on another platform – please feel free to comment.
These are a few of the personal things I support when looking at the public health risks in our communities. The whole UK policy needs revisited and rewritten to be honest, but I would end up with a book rather than a blog if I were to sit down and really start discussing the current state of play.
For anyone else who wants to be involved, what can other people do to help?
There are a number of ways people can get involved. Support your local mutual aid groups; if there aren’t any, think about starting one up. Join online forums and add your voice to the already existing campaigns. Run events in your area. Get out there in your community and talk to people, find out what’s missing. Look for the deficits and fill them. Your community can always be improved. Asset map your community, don’t try and reinvent the wheel, just build more spokes from what is already there. Provide platforms for those in your community to have their say – local forums, local events to raise awareness. Attend conferences and find out what is going on nationally then take it back to your local community and adapt to fit your local needs.
What are your plans for the future?
To keep doing what I’m doing and keep carrying the message that change is possible, to advocate for positive change wherever the chance arises and allows me to openly advocate. And to challenge stigma in every way I possibly can.
Where can people find out more about you?
Please don’t hesitate to contact me if you have any questions regarding any of the topics mentioned here or any other related topics. If I don’t have the answers then I’m sure I can put you in contact with an expert on the topic you raise.
Thanks for reading and thanks Ruth for giving me the opportunity to rant. It was a pleasure.
Recommended sites for further information:
- In the Booth with Ruth – Coati Mundi, Musician
- The Policing of Sex Work in West Yorkshire: An Interview With Rosie Campbell OBE
- ‘Death in the Desert’: Josh Evans Discusses His Latest Film Along With Star Michael Madsen
- 22 Sept Canadian Sex Workers & Sex Worker Activists in London
- In the Booth with Ruth – Jonathan Tarplee, Singer/Songwriter
- ‘No Human Involved’: Filmmaker PJ Starr Discusses Her Documentary Telling Marcia Powell’s Story
- ‘Criminalising the Purchase of Sex: Lessons from Sweden’ – Dr Jay Levy Discusses His New Book
- In the Booth with Ruth - Coati Mundi, Musician
- Chong Kim, a Survivor of Sex Trafficking, Talks About Eden, The Newly Released Film Based On Her Life
- Dr Jay Levy, Researcher and Consultant, Discusses the Outcomes of the Criminalisation of the Purchase of Sex in Sweden
- ‘Criminalising the Purchase of Sex: Lessons from Sweden’ - Dr Jay Levy Discusses His New Book
- The Policing of Sex Work in West Yorkshire: An Interview With Rosie Campbell OBE
- Ruth Jacobs