Time for a new normal - A guest blog by Mat Southwell

26 June 2020
By Mat Southwell - Project Executive for EuroNPUD

“We are being led by the science” is the new mantra from Ministers seeking to justify their actions. This line of defence earns hollow laughs from the drug user movement, as we have been collectively burned. We have experienced politically motivated decisions leading to disinvestment from drug and alcohol services and undermining the coverage and quality of our harm reduction and drug treatment services.

Harm reduction

In the early days of the HIV response, the UK could truly claim to have been driven by the science. The Advisory Council on the Misuse of Drugs (ACMD) was charged with evaluating the evidence and producing three highly influential HIV and Drug Misuse reports, which promoted harm reduction practice with linked specialist funds that invested in innovation and creativity.

New Labour took us on a journey of defining drug policy and practice not on the basis of the science but on the basis of what their focus groups told them the public would accept. This led to OST being justified as a crime reduction not a public health measure. Community mobilisation was redefined first as service user involvement (you only have value as the clients of our services) and then recovery (you only have value if you stop being drug users). This was an insult to the many drug user activists and groups who had played a pivotal role overcoming HIV through the 80s and 90s.

This ideological drift only worsened under following Governments with a combination of localism, budget cuts, incentivising drug free outcomes, and demonising high dose and maintenance OST prescribing, all creating a hostile environment for harm reduction. The quality of programmes dropped as services were repeatedly retendered, staff were TUPED from service to service, and training budgets were axed.

We were already fully aware of the high-risk consequences of this ideologically driven approach. The Glasgow HIV outbreak and our ever-rising drug deaths (now 25% of all drug related deaths in the European Union) had already caused a re-think among policy makers and programmers leading to discussions of Heroin Assisted Treatment and Drug Consumption Rooms. However, while discussing these cherrys on the cake is long overdue, we need to get the basics right. Basic harm reduction is dangerously depleted. We don’t even count how many NSPs there are in the UK let alone the number of needles and syringes given out per person who injects drugs. This means the UK fails to gather a global quality indicator of harm reduction.

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"The sector has had to restrict services in order to introduce physical distancing but has also shown great flexibility and innovation to sustain support for people who use drugs."

Response to coronavirus

COVID-19 exposed the limitations of our drug policy and practice. However, COVID-19 also emphasised the natural instinct of the sector to return to its harm reduction and community mobilisation roots when faced with a crisis. The sector has had to restrict services in order to introduce physical distancing but has also shown great flexibility and innovation to sustain support for people who use drugs. The sector should feel justly proud of this response.

EuroNPUD’s Support Don’t Punish poster for 2020 highlights the many positive gains that people who use drugs have secured due to the arrival of the COVID-19 virus – rapid access to treatment, week+ take home doses, online and virtual support and housing the street homeless. In addition, drug user groups have played key roles in scaling up access to naloxone through peer-to-peer distribution and sustaining access to harm reduction commodities through secondary needle and syringe schemes. Drug user groups have also shown great flexibility and creativity in providing mutual aid and self-support during the lockdown.

UK drug user groups have a difficult history with the period from 1999 to 2004 being a case study in how a Government can disempower and treat a marginalised community with utter tokenism and disrespect. It has taken COVID-19 to overcome this history and bring drug user activists back together in the UK. The newly formed UK Drugs Consortium has championed peer-led harm reduction, ensured a new focus on OST treatment literacy and rights, and helped gather and analyse intelligence about drugs and drug services working with our friends and allies at Release.

Senior policymakers and programmers are all saying that this change is just the beginning of a transformative process. EuroNPUD’s role in coordinating UK drug user groups has been widely welcomed as a means to revitalising peer-led harm reduction and promoting dignified and respectful treatment. It feels risky to allow the embers of belief and optimism to reignite given the historic loss and hurt. However, on Support Don’t Punish Day of all days, we should trust each other and work together so this really is “Time for a New Normal”.