Harm Reduction and Recovery in the UK: lessons learnt, hope for the future.

Author: Tracey Kemp, Peter Furlong

Theme: Models of Care Year: 2023

In the 1980’s the UK established a proactive response to the threat of an HIV epidemic by introducing needle & syringe programs (NSP) starting in places like Liverpool and Peterborough. This harm reduction movement influenced major changes in thinking/practice in reducing the harms associated with drug use in the UK and internationally. In 2010, a shift in UK policy resulted in the Recovery/Abstinence agenda taking precedent in treatment services with PHE targets imposed on providers for people to exit treatment drug free. The resultant harms and neglect this then had on a range of issues included the lack of effective engagement for people who inject drugs (PWID) staff knowledge/competencies, NSP activity, low threshold prescribing and working with PWID not in treatment.

The promotion of the Recovery agenda and intended versus actually benefits to the English drug treatment provision which coincided with a continuing rise in drug related deaths (DRD) with rates in 2022 at the highest ever rate since records begun. The UK drug strategy released in 2022 although still grounded in crime reduction/recovery calls for 1000 less DRD in the next three years and 54,000 more new treatment places. This most significant financial investment seen over the last decade now offers an opportunity to return to some of the harm reduction practice lost during the Recovery era. Yet the lessons learnt will include a current system that may not be equipped to meet some of the targets with factors such as an ongoing recruitment crisis, staff competencies and knowledge and attitudes to harm reduction versus recovery models.

There are lessons to be learnt from the UK switch in policy and the promotion or over focus on abstinence outcomes .The new funding announced in the UK following the Black review that also informed the new UK Drug Strategy ‘Harm to Hope’ brings the biggest investment in drug treatment on record and a once in a generation opportunity to regain some of the core harm reduction approaches that put the UK on the Global harm reduction map originally.

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