Back to the Future 1990-2010 The changing face of harm reduction Russell Newcombe Director, 3D Research, Liverpool, England russell@newcombe666.freeserve.co.uk 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 Generation Stage 1 85-87 Local: Liverpool > Mersey > NW Stage 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 provision The 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 Its roots

The 3 sources of drug-related harm drug policy l m help laws DRUG body mind time place SET SETTING DRUG = contents & consumption Source: Zinberg (1984) 5

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 I REALIZE THAT THIS ISSUE DIVIDES HARM REDUCTION SUPPORTERS DOWN THE MIDDLE, SO I WILL MOVE ON

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! In the 1990s, both John and Allan exited the drugs field, but I’m still here. Also at the conference: Andy Bennett, Julian Buchanan

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) AND MANY OTHERS!

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 MY PAPER AT THIS CONFERENCE PRESENTS A STARTING POINT FOR A THEORY OF HR

To conclude ... E M Forster said ‘2 cheers for democracy’ – because it 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, to extend the Star Trek metaphor even further: Harm Reduction is a drug policy which boldly goes where no drug policy has gone before. NO OTHER SYSTEM IS WORTH EVEN ONE CHEER!

Two cheers for harm reduction!