At heart I'm a harm reduction kind of person. I've spent the last decade working in needle programmes, running a website that provides injecting advice and presenting sessions at conferences promoting harm reduction. For me this work has always had as one of its goals the idea of helping people who want to stop using drugs achieve this. And for the people who don't want to stop, it's been about helping them stay safer and, if I can, 'nudging' them to the idea of stopping at some time in the future.
So the idea that harm reduction and recovery are somehow opposite ends of drugs work has been something I've always found confusing. To me recovery is harm reduction and harm reduction is something that sits perfectly in recovery – even the original ACMD document statement that kicked off needle programmes in the UK had as one of its stated goals 'increase abstinence'.
For some people though, this false dichotomy is an advantage. The press rarely has an interest in stories where people agree that working together is a good way to help people stay alive and healthy. What they want is an element of conflict. This is something that some members of our community – and I include both harm reduction and recovery here – have taken full advantage of to make sure they stay in the public eye. But the other week I attended and spoke at the UKRF Recovery Summit (UKRF11) and was pleased to see that there are so many people who understand that not only would it be a good idea for the two camps to work together, but that it's necessary.
Recovery has many paths to it and I know from experience that a number of those paths are made possible by harm reduction based services, which are, as Stephen Bamber has stated, 'the vanguard of recovery'. Currently drug services are being asked to give more robust evidence that they are helping people make changes and move towards recovery and this is to be welcomed in my opinion – after all it's what I've been doing for years.
Back when I started working in drug services, our area had a ten-month waiting list for treatment. The people coming into the needle programme where I worked got sterile equipment but also received advice and support on reduction strategies and self-detox. I can remember many times when people would stop using drugs without ever needing to engage in 'structured treatment'. But up till now needle programmes have rarely been asked for this kind of data. Instead, all DAATs have been interested in is the number of needles given out – it's almost as if all they think we do is just throw needles at people and never actually talk to them. So yes, I'm all for evidencing the work we do better.
But that's not enough. We need more people from the recovery community to be actively involved in harm reduction. When I spoke at UKRF11 I asked the people attending my session about their experience of overdose interventions in rehabs. I've since asked the same question to other people both online and off. I always get the same kind of answer – 'there was no mention of overdose' or 'there was no overdose advice'.
Previously I've been told that this is because talking about overdose with people in the early stages of recovery is 'difficult', and that it would mean implying that they may return to using substances, which could act as a trigger for using. I do understand this point, but as anyone who understands the Cycle of Change could tell you, there is always going to be a portion of the rehab community that returns to substances.
This is especially true in the early stages of recovery when rehab can be an intimidating place full of strange new situations and difficult questions people have to ask themselves. And it's exactly this situation – people dropping out of rehabs and support services – that poses the greatest risk of overdose. Tolerance is reduced, stresses are high and people often return to the old coping strategy of drug use. Personally I would love to see overdose interventions becoming one of the first things discussed for people entering recovery.
We are losing over 1,000 people a year to overdoses in the UK. This is a number that needs to be reduced and in my mind the only real way we can do that is to all work together. It's not harm reduction or recovery, it's harm reduction AND recovery.
Note this article was first published in DDN magazine.
Nigel Brunsdon is the owner of Injecting Advice.com. He's been working in harm reduction since the 1990's, although he's previously a frontline needle programme worker he now spends most of his time developing online resources for drugs workers and users.