'A Harm Reduction Worker's take on, well, Harm Reduction.'

What do you even mean by Harm Reduction?

Think of Harm Reduction as a sliding scale, because it actually spans all of your life if you take the time to think about it.

Airbags and seatbelts are working towards reducing harm in society, as are nicotine patches and antidepressants. Putting the heating on in the bleakness of January is even Harm Reduction, as is crossing at the zebra crossing and waiting for the Green Man.

However, in this sense I refer to the concept of Harm Reduction associated to substance use disorders. It contains the aim to reduce behaviours that raise the risk of negative outcomes regarding health. For example, needle exchanges offer clean, safe equipment as well as a place to dispose of used needles. Users are also educated on safer practices that aim to reduce the risk of infection, long-term injury, and overdose.

In my own role, I’ve started to see Harm Reduction splitting into at least four areas, and they cross-over a fair bit. These are:

• Health and Well-Being
• Safer Using Practices
• Education and Engagement
• Social Steps

Health and Well-Being: Awareness of and Referrals to clubs / groups that promote better lifestyles, such as Gym & Swim, Better Eating, etc.

Safer Using Practices: New Service Users (and more) can take classes or information packs that promote safer using methods, to avoid infections, etc.

Education and Engagement: The rest of society need to know the signs of use and symptoms of overdose, but also how to engage with Service Users. Outreach work to promote protecting privacy and dignity in SU’s.

Social Steps: Often, multiple bridges can end up crispy and ashy after years of using and the life that comes with it. Let’s help SU’s to build new ones, at places like Badminton Club, Annual Bike Rides, Book Club, and more.

Oh, so is it just encouraging people to use drugs then?

No.

There are people out there who are going to use no matter how many key work sessions they have, or how many times they see posters sponsored by shame. In order, then, to prevent avoidable deaths and illnesses, it only makes sense to help people to learn the ways in which they can keep themselves safe and – ultimately - alive.

By doing this, we actually maximise the amount of time in which somebody can get to the point where they actually choose to engage with Services in a positive and productive way. If you can help somebody get healthy after a long period of being unwell because of their use, we’d say there is a good chance that they could grow to trust you enough to help them to try and take further steps in their Recovery.

Does it work, though?

Yes.

We could leave it there, but we won’t.

Harm Reduction saves lives. It’s a pro-active and pragmatic perspective, and the entire ethos is to try and negate and / or reduce the damage done by substances and certain bad habits that those with substance use disorders may have. Many places that have had a needle exchange program put in place have seen lower numbers in cases of bloodborne viruses, not to mention the decrease in numbers of deaths by overdose where maintenance clinics have been set up for opioid users. This is in comparison to areas that do not have these services set up.

Fine, tell us more.

We can’t even think of any reasons not to like the idea of tackling addictions and their effects on society through the scope of Harm Reduction.

Even choosing abstinence fits under HR, really. IF that’s what you need to do to keep yourself happy, safe, and healthy then so be it. We’re all different. What’s good for the goose is not necessarily good for the turkey, or the duck, or the pigeon. We may not be able to name any more birds than that, but we can go on and on about Harm Reduction and its benefits for society as a whole.

For some Service Users, the idea that they could continue to use but still get healthy and free of infection may once have seemed impossible. They used to not feel sick, but because of their bad using habits, they got sick anyway. We can help them to deal with that, or – hopefully – avoid it completely in the first place. On top of this, and the thought that has gone into the equipment offered at a needle exchange program, is the removal of stigma and other-ism that can be associated with those who use. There is no judgement, only clean works and safe foils, for a lower cost than treating an overdose. This safe atmosphere can encourage people to take other steps towards a fuller Recovery, because any preconceptions of how the Services operate will be abolished, hopefully.

People see results. That’s the point. After engaging with Services and adopting Harm Reduction techniques (including methadone scripts and similar methods used to aid with withdrawals) some service users have gone on to build their own businesses, or pursue creative careers that they once dreamed of long before the fog of addiction took over. For these people, it started with Harm Reduction, because you only truly engage with a Service if you really do want to try and stop the pain of addiction, or just reduce it in some way. Not everybody comes into the Services and engages, but the future looks bright on that front. Harm Reduction outreach roles are beginning to pop up, and the people looking over and managing these new workers have a clear-but-flexible vision for them, and the projects they will be working on in the communities.

What are the ultimate goals of Harm Reduction work?

To keep people alive, and to help to improve health in users, as well as the surrounding environments.

Give an addict a lecture, you’ll see them for a day. Give them a safe space, clean equipment, Naloxone and tips on how / when to use it, a cup of tea, a sleeping bag, and a bit of advice on how to avoid unhealthy, dangerous routines, you’ll see them again and again.

Perhaps not literally, but the sentiment is strong nonetheless, and that’s not us  just fishing around for things to say. Realistically, not everybody can reach or maintain abstinence, especially when at certain points in their life. In 2015, somebody may just have wanted clean syringes and foils, whereas in 2021 they may only just be considering detox, or rehab. That may never happen for some people, and, again, that is okay. Some people carry heavy pain and trauma within them, and using is their only escape from that. For these people, we can at the very least offer them their dignity back, as well as their health (to some extent) and a huge helping of hope.

Obviously, the choice remains with every person. Individual choice is always at the heart of Recovery, and every Key Worker, Peer Support Worker, Clinician, etc in the Services simply help them to maintain it as much as is within their capabilities.

In Summary?

Harm Reduction aims to use a variety of differing strategies to tackle the negative health impacts associated with:

• Bloodborne viruses (BBVs)
• Injecting substances and unsafe practices / habits
• Access to clean equipment
• Sex work
• Mental Health problems
• Overdose
• Isolation
• Lack of awareness of safe practices
• Sexually Transmitted Infections / Diseases
• Medication
• Supervision
• Social assistance
• Health care

Are all drugs legal now?

No, not at all. Most substances are still illicit, and if something is being sold in an alleyway or behind a bin, then I’d hazard a guess and say that it’s probably not legal to buy it. Always check the status of a substance where possible, because even if trials are being done on a substance, for example, it doesn’t necessarily mean that the substance has been cleared for public use. That is the point of the trail, and it may be extremely dangerous to experiment alone at home.

However, government-sanctioned Harm Reduction programs - such as supervised injecting facilities - in other countries like Switzerland and the Netherlands have, in fact, helped to reduce the legal consequences of street using. The use is not happening on the street, because it is being done in a legal facility, all under the care of professional healthcare workers.

Critics are loud.

Some of my comedian friends have had terrible reviews, but I’ve always assumed the reviewer couldn’t do stand up themselves. The same likely goes for Harm Reduction. Those having a go at it are likely not close enough to the hard work and care that goes into providing it, and probably aren’t even sure what they’re actually shouting about. Warnings on Silica Gel, MRI Scans, and fire doors surely don’t annoy these people. If you ask me (and nobody has) ignorance isn’t bliss when it comes to the lives of extremely vulnerable-yet-potentially destructive people. Ignorance is violence when what you’re ignoring is suffering and self-harm.

We’ve tried the absolute War on Drugs, and it hasn’t seemed to work very well. Why don’t we now attempt a War on Harm instead? It does seem more promising that a war like that wouldn’t actually be aimed at any people, only the harm that they put themselves through.

Seems slightly more human of us to do that instead, don’t you think?

 

By Danny Walsh

Build on Belief’s Peer-Led Harm Reduction Worker