1. Back to the Future 1990-2010 The changing face of harm reduction
Russell Newcombe
Director, 3D Research, Liverpool, England
Special Anniversary Event: 21 Years of Harm Reduction

2. 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

3. The history of harm reduction
Foundations: to 1984
First Generation
Stage Local: Liverpool > Mersey > NW
Stage National: ACMD (NX & MM)
Stage International: IJDP, ICDRH
Subsequent Generations: 1990s s: IHRA etc.
Next Generation: onwards

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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!

10. 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)

11. 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

12. 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!

13. Two cheers for harm reduction!