Submitted by The United Kingdom Harm
Reduction Alliance (UKHRA)
We wish to address two issues raised by the
Does existing drugs policy work?
The effectiveness of the 10-year
National Strategy on Drug Misuse.
1. UKHRA is a campaigning coalition of
health and social care workers, drug users, criminal justice workers
and educationalists,1 established in March 2001 as a direct
response to inadequacies of the UK national drug strategies.2
2. The objectives of UKHRA3 are to:
preserve and build upon the developments
of harm reduction in the UK;
encourage UK Governments to maintain
and strengthen harm reduction and public health initiatives and
to include these in national drug policies;
provide support and direction to
harm reduction thinking and initiatives in the UK;
build a working alliance between
drug users, health workers, criminal justice workers, educationalists
and others committed to harm reduction across Northern Ireland,
Wales, Scotland and England; and
work with international and organisations
in other countries to promote harm reduction.
3. We believe that that a drugs strategy
should be based on the principle of reducing drug related harm
(often known as "harm reduction") and that policy
and legislation should be judged by the contribution they make
to reducing harms to individuals and communities.
4. The UK national drug strategies are structured
around four similar key aims, focused on young people, communities,
treatment and availability. Although to some extent the prevention
of individual and public harm to health is present in the national
strategies (more so in Wales and Scotland than in England), there
is no key aim which brings together public health issues and harm
reduction. This is a major deficiency.
5. 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)4.
The UK has thus far averted an epidemic of HIV infection associated
with drug injecting5 and there is evidence that harm reduction
has resulted in lower rates of hepatitis C virus (HCV) infection
than found in comparable countries.6
6. Harm reduction is appropriate for
reducing potential problems with the use of all drugs (such
as heroin, cocaine and crack-cocaine, ecstasy and amphetamine
type stimulants, LSD, and cannabis) and by all routes of administration
(injecting, smoking, inhaling, or swallowing).7
7. Harm reduction is a pragmatic approach
accepts (while not necessarily condoning)
recognises the poor results of drug
supply and demand reduction policies (desirable as these may be);
targets achievable changes in the
way drugs are used.
It is similar in principle to public health
and social policy attempts to limit the potential damage from
a wide range of behaviours (such as motor vehicle driving, sport
8. The emphasis of the current drug strategy
on drugs and crime has meant that harm reduction has slipped down
the agenda. The strategy belittles the importance of the health
of individual drug users: the UK Anti-Drugs Coordinator's Annual
Report 1999-2000 and the Second National Plan do not mention HIV
and HCV8. There has been a minimal investment in new harm reduction
initiatives: £0.25 million for the "Making Harm Reduction
Work" programme of seminars and materials on HBV immunisation,
preventing injecting and overdose, compared with spending on new
crime reduction initiatives such as £220 million for Crime
and Disorder Partnerships and the £45 million anticipated
cost of urine testing under the Criminal Justice and Court Services
Act. This lack of a central lead encourages local authorities
to give essential harm reduction services such as needle exchange
a low priority.
9. In no other sector of health and social
care does service provision prioritise the needs of other members
of society above the health and welfare needs of its clients (as
the focus on crime prevention does with drugs). This violates
the principle of providing services in ways that prioritise the
needs of the patient or client and undermines the relationship
between services and their clients.
10. A potentially dangerous situation
is now present where HIV transmission through injecting drug use
could rapidly escalate, as has occurred in some other countries.9
There are indications of an increase in risk behaviours among
injectors.10 Hepatitis B remains endemic among injectors, despite
the availability of an effective vaccine. There is a major epidemic
of HCV infection in the UK. Estimates suggest that 400,000 of
the population of the UK have been infected with HCV, 80 per cent
of whom are believed to have obtained this infection through injecting
drug use. The ACMD 2000 report, Reducing Drug Related Deaths,
recognises that overdose, often involving the use of opiates in
combination with alcohol and other drugs, is a major cause of
premature death among drug users.
11. Aspects of current legislation and
policy can maximise rather than minimise harm. Examples include,
the laws on drug paraphernalia, the provision in the Criminal
Justice and Court Services Act to sentence people to be abstinent
from drugs, the revised section 8 of the Misuse of Drugs Act in
which drug paraphernalia may be used as evidence of drug use on
premises, and the failure to implement methadone maintenance in
prison. The climate of current policy with "war on drugs"
rhetoric central in 2000 to the speeches of the Prime Minister
and the previous Home Secretary, is one that marginalises, excludes
and scapegoats drug users. This particularly affects problem drug
users who are already disadvantaged and creates a situation in
which it is harder to contact and work with people to promote
health. A "war on drugs", is a war on drug usersand
that is a war on a majority of the young adult population.
12. In the light of these circumstances
we believe that:
the underlying basis for all policy
and legislation must be its contribution to reducing drug-related
measures to reduce the social,
psychological, and medical harms from drug use should be an integral
part of all treatment and care;
all drug users must have access
to advice on how to reduce their risks of potential harms from
drug use; and
all new drugs legislation and
policy must be evaluated against its positive or negative impact
on the health of drug users.
13. Individual and public health should
be the underpinning principle of our national drug strategy. We
urge that as a minimum measure a "fifth" aim should
be added to national drug strategies:
Individual and Public HealthTo
minimise harm to the health of individuals and communities arising
from drug use.
14. We have set out a number of detailed
suggestions for immediate policy change in the accompanying document
"Harm reduction and the national drug strategies of the United
1 The current steering committee is:
Prof. Gerry Stimson
Centre for Research on Drugs and Health Behaviour,
Imperial College, London. (Chair).
Gill Bradbury (RGN)
Director of Services, Powys Drug and Alcohol Centres,
Harm Reduction Writer and Trainer, Liverpool. (Vice
Chair and Media).
Dr Chris Ford
General Practitioner, Lonsdale Medical Centre, London.
The Stockwell Project, London.
Lecturer, Kent Institute of Medicine and Health Sciences,
University of Kent at Canterbury.
Writer, Researcher and Activist, Liverpool. (Webmaster).
Harm Reduction Writer and Trainer, Dorset. (Treasurer).
Area Pharmacy Specialist-Drug Misuse. Greater Glasgow
Primary Care Trust.
The Harm Reduction Team, Lanarkshire Primary Care
Lecturer in Pharmacy Practice, University of Bath.
Drug Users Development Agency, London.
Dr Tom Waller
Chair, Action on Hepatitis C, Specialist in Substance
Misuse in Ipswich, Suffolk.
2 Stimson, G V (2000) Blair Declares War: the
unhealthy state of British drugs policy. International Journal
on Drug Policy 11, 4, 259-264.
3 More information will be found at http://www.ukhra.org.
4 Advisory Council on the Misuse of Drugs (1988)
Report. AIDS and Drug Misuse Part 1. HMSO.
5 Stimson G V (1995) AIDS and injecting drug
use in the United Kingdom, 1988-1993: the policy response and
the prevention of the epidemic. Social Science and Medicine,
41, 5, 699-716.
6 Hope, V D, Judd, A, Hickman, M, Lamagni, T,
Hunter, G, Stimson, G V et al. Prevalence of hepatitis C virus
in current injecting drug users in England and Wales: is harm
reduction working? American Journal of Public Health 91,
7 eg the Good Practice Guide on the Implementation
of the Public Entertainments Licenses (Drug Misuse) Act 1997produced
by Association of Chief Police Officers (ACPO); the extensive
range of harm reduction materials for all the commonly used drugs
produced by organisations such as Lifeline, HIT and Exchange Publications.
8 Cabinet Office, Tackling Drugs to Build a
Better Britain, Second National Plan 2000/2001; 1999/2000 Annual
9 Strathdee S A, Patrick D M, Currie S L, et
al. Needle exchange is not enough: lessons from the Vancouver
injecting drug use study. AIDS 1997, 11:F59-65.
10 Report from the Unlinked Anonymous Prevalance
Monitoring Programme (2000) Prevalence of HIV and hepatitis infections
in the United Kingdom, 1999, Department of Health.