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

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 complementary – 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

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

i.e. laws which criminalise the production, supply and possession of drugs – which simply abdicate responsibility for drug control to gangsters

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!

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)

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

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.