Harm reduction: ‘Meeting people where they’re at’

In September 2012, I was invited to rapporteur for HIT’s second “Hot Topics” conference in the UK, which attracted 140 delegates from across the country. In my closing presentation, I drew on one key theme that had come across throughout the day – that harm reduction is about ‘meeting people where they are at’.

The morning presentations demonstrated that ‘where people are at’ is changing: data from Drugs Meter show increasing use of new, synthetic drugs and the 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 – basic harm reduction messages are not always reaching these groups. Other presentations covered drugs such as ketamine, performance and image enhancing drugs (which now account for up to 80% of service clients in some areas) – as well as heroin and crack cocaine. All of the presentations are available on the conference website.

The highlight from the day was an impassioned keynote speech from Sara McGrail, who reviewed and critiqued the UK government’s moves toward drug policy rhetoric focused on “full recovery” (i.e. a state-imposed goal of total abstinence from all drugs). Whereas the term ‘recovery’ has been a source of empowerment and strength in the mental health field, it has been hijacked in the drugs field in a “victory of moral determinism, greed and self-righteousness over evidence”. The drug policy dialogue in the UK continues to be represented as a dichotomy of abstinence and recovery versus harm reduction. In reality, this is not a helpful approach – the best results will be achieved through a balance of both approaches, with harm reduction helping to lay the foundation for a recovery that is defined and owned by the individual. Thankfully, there are signs that this middle ground is being forged – such as a recent report from Professor John Strang and the “Recovery Orientated Drug Treatment Expert Group” which clearly outlines the place that methadone and buprenorphine can play in supporting an individual towards recovery.

Without this balance being achieved, Sara McGrail predicted that deaths, infections and stigma would increase as a result of the drug policies being espoused by the UK’s coalition government. She told the conference participants: “We are needed now more than ever” and emphasised the need to meet individuals where they’re at, rather than where we are being told they should be.

This blog is adapted from the full rapporteur report, which was published in Drink and Drug News.

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