Treatment or harm reduction?
237. In many cases of drug use, treatment is
not immediately possible. This may be because effective models
of treatment do not exist—for example, in relation to crack
cocaine users—because treatment places are not available,
or because a user does not come forward to access treatment, however
often it is made available to him or her. A new user who has not
yet experienced problems with his or her use may simply not see
any reason for treatment, or feel that it is necessary. Mr Danny
Kushlick of Transform used an analogy with tobacco smoking:
"We need to get it out of our heads this
idea that everyone who is hooked on drugs wants to get off them.
A lot of people who smoke tobacco just continue to smoke, they
are not anxious to seek treatment all the time".[220]
238. Where, for whatever reason, a user is not
taking up treatment, there is still an urgent need for harm reduction
actions, which may themselves be a bridge to treatment, to reduce
the risks of the user's habit. Harm reduction spans many different
interventions, and is an umbrella term for pragmatic action taken
to reduce the harm caused by drug use without the necessary predication
of abstinence as an end goal or imperative. If abstinence is not
immediately possible, appropriate or likely, it is still necessary
to deliver interventions which will reduce harm caused, on the
basis of humanity to the user and benefit to the community. This
is not in conflict with the aim of treatment for users who can
take it up; both a treatment strategy and a harm reduction one
are necessary, as Mr Nelles of the Methadone Alliance told us:
"It is very important that we have harm
reduction initiatives and prescribing approaches for people who
are not able to give up and we have rehabilitation and detoxification
approaches for people who do want to give up".[221]
239. Professor Gerry Stimson of Imperial College
School of Medicine, reiterated this point:
"treatment is only relevant for a very small
proportion of the population. Even for those hard drug users who
would benefit by treatment there is a long time lag between the
development of their drug problem and when they come into contact
with treatment services".[222]
240. Harm reduction actions include needle exchanges,
the provision of safe injecting rooms where injecting users can
take their drugs in hygienic conditions, and advice on safer injecting
and using techniques. Harm reduction is based on the idea that
improving the health and lifestyle of the user who poses a danger
to him/herself or to others is more important than abstinence.
In the words of the UK Harm Reduction Alliance:
"Harm reduction is a pragmatic approach that:
- accepts (while not necessarily condoning) drug
use;
- recognises the poor results of drug supply and
demand reduction policies (desirable as these may be); and
- targets achievable changes in the way drugs are
used".[223]
241. Harm reduction is becoming a matter of some
urgency in relation to blood-borne viruses—particularly
Hepatitis C—amongst drug users. Similarly, preventable overdose
deaths could be targeted by concerted harm reduction:
"the number of overdose deaths caused by
illegal drug use in this country is unacceptably high. Most injectors
take their drugs in isolated, unsanitary conditions so that where
an overdose occurs, first aid responses that could save a life
are rarely available. In some areas of the country, innovative
schemes have had a big impact on death rates. For example distribution
of naloxone, first aid training for users. (Injection rooms established
in other countries are also showing promising early results.)"[224]
242. Several witnesses pointed out that it was
through harm reduction that the UK managed to stave off a major
AIDS epidemic in the 1980s and early 1990s:
"Between 1987 and 1997 Britain led the world
in developing a harm reduction approach to drug use. The clearest
achievement was in the prevention of HIV infection among people
who inject drugs (by heeding advice outlined in the 1988 report
of the Advisory Council on the Misuse of Drugs). The UK has thus
far averted an epidemic of HIV infection associated with drug
injecting and there is evidence that harm reduction has resulted
in lower rates of Hepatitis C Virus (HCV) infection than found
in comparable countries".[225]
243. While we welcome the continued acceptance
and promotion of harm reduction principles by the Department of
Health and the National Strategy, we believe that not enough emphasis
has been explicitly placed upon this approach. Mr Trace, former
Vice UK Anti Drugs Co-ordinator, told us that "the drug strategy
did not prioritise action in this area because it was felt that
existing actions were sufficient". In his opinion, it has
now become clear "this area of activity does need further
attention, as new generations of injectors who have not been exposed
to previous campaigns emerge". He proposes that the strategy
should add a fifth key objective of "reducing the number
of deaths and infections relating to injecting drug use, with
a well-resourced programme of actions aimed at reducing infections
and overdoses".[226]
244. Mr Ainsworth told us: "we are looking
at introducing to a greater extent in the Drug Strategy the concept
of harm minimisation"[227]
as part of the stock-taking review. The UK Harm Reduction Alliance
suggested adding a specific target along the following lines:
"Individual and Public Health—To minimise
harm to the health of individuals and communities arising from
drug use".[228]
245. We recommend that a target is added to
the National Strategy explicitly aimed at harm reduction and public
health, in addition to the Treatment objective. This target
should be measured through two indicators: to reduce the number
of overdoses (measureable through Accident and Emergency records)
and to reduce the number of new infections through injecting of
HIV and Hepatitis (measureable through medical records of drug
users).
201 
