Consultation on Northern Ireland drug strategy
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New Strategic Direction for Alcohol and Drugs (2006- 2011)
The United Kingdom Harm Reduction Alliance UKHRA is a campaigning coalition of drug users, health and social care workers, criminal justice workers and educationalists that aims to put public health and human rights at the centre of drug treatment and service provision for drug users.
The UK Harm Reduction Alliance welcomes the opportunity to comment on the consultation draft New Strategic Direction for Alcohol and Drugs (2006- 2011).
UKHRA has an active membership group in Northern Ireland who meet regularly to promote harm reduction. While this consultation document describes Harm Reduction as a pillar of the NSD it would appear that there is no specific focus on developing harm reduction services and little recognition of the history of insufficient provision of harm reduction services throughout Northern Ireland.
Harm reduction defined:
Paragraph 8.5.3 offers a definition of harm reduction that is flawed and varies from the most widely accepted international definition. The International Harm Reduction Association (www.ihra.net) defines harm reduction as “policies and programs which attempt primarily to reduce the adverse health, social and economic consequences of mood altering substances to individuals drug users, their families and their communities”. In its discussion of how harm reduction has variously been described in the past, IHRA makes the observation that “Defining harm reduction as a composite of supply reduction, demand reduction and risk reduction is…unsatisfactory, as it does not specify what overarching objective is being pursued. This definition is also inherently tautological as harm reduction is being defined here to include itself. Furthermore, supply reduction sometimes increases rather than diminishes harm.” In UKHRA’s view it would be misleading and mistaken to include a definition that varies from this international consensus and which is therefore a misappropriation of the term ‘harm reduction’.
While there has been progress in relation to the provision of injecting equipment supply, Dr Mc Ellrath's research Drug Use and Risk Behaviors among Injecting Drug Users (DHSSPSNI, 2005) clearly identifies that needle exchange is operated in a restrictive and limiting environment. The failure to resource needle exchange beyond pharmacy environments was highlighted by UKHRA in 2003 in oral evidence to the NI affairs committee and is included as one of the committee’s recommendations.
…The scheme must not be limited to community pharmacies and the aim must be to discourage high-risk behavior amongst injecting drug users and provide a gateway to other support and treatment services. (HMSO, 2004)
UKHRA executive committee members met with Rob Phipps -
The failure to recognize that there is an urgent need to develop and expand needle exchange services throughout Northern Ireland is particularly concerning given the recent information published by the Health Protection Agency. According to the current figures, Northern Ireland has the highest rate (36%) of direct sharing of needles and syringes among injecting drug users in the UK. This is all the more concerning in the light of recent reports from the same source that “The prevalence of HIV infection among injecting drug users (IDUs), in England & Wales at least, has probably increased in recent years”. Our strong cultural ties with England and Wales and the mobility of our population means that we cannot assume we are isolated from this trend, and only serves to heighten concern and the imperative for immediate and comprehensive responses.
The short-term outcome 1 on page 84 of the NSD refers to a possible extension of needle exchange. While UKHRA welcomes this statement it is not specific and does not offer any commitment to resource an expansion of needle exchange. The statement does not recognise the need for needle exchange to be developed beyond fixed pharmacy sites. Needle exchange was funded in Northern Ireland in April 2001 and there has been little development in almost 5 years. The UKHRA recommends that the NSD give a clear commitment to develop Needle exchange and implement the recommendations made by Dr Mc Ellrath in her recent research Drug Use and Risk Behaviors among Injecting Drug Users (DHSSPSNI, 2005) Urgent consideration should be given to the following recommendations.
Recommendation 4: It is recommended that outreach services be expanded to other areas of Northern Ireland, and that different strands of outreach are needed.
Recommendation 5: It is recommended that some pharmacy-based schemes should offer a greater degree of privacy.
Recommendation 6: It is recommended that the number of needles/ syringes should be increased to 30 per visit, and that further incentives should be developed to encourage return supplies of used injecting equipment.
Recommendation 8: It is recommended that the DHSSPS develop additional methods to distribute new injecting equipment to IDUs.
Recommendation 9: It is recommended that the DHSSPS develop different forms of information, support and advocacy for IDUs.
Recommendation 12: It is recommended that treatment modalities for cocaine and crack use are identified and implemented.
Recommendation 13: It is recommended that the DHSSPS identify the prevalence of hepatitis B and C and HIV among IDUs in-contact and not-in contact with drug services.
Recommendation 15: Considerable work is needed to address the needs of women injectors. It is recommended that the DHSSPS adopt the recommendations in the Home Office report, Women Drug Users and Drugs Service Provision: Service-Level Responses to Engagement and Retention (Becker and Duffy, 2002).
House of commons NI Affairs Committee, Government Response to the Committee’s Eighth Report on the Illegal Drugs Trade and Drug Culture in Northern Ireland: HMSO 2004.
Mc Ellrath, K, Prevalence of Heroin Use in Northern Ireland (2002), Pg 28: Drug and Alcohol Information & Research Unit.
Mc Ellrath, K, Drug Use and Risk Behaviors among Injecting Drug Users (2005), Drug and Alcohol Information & Research Unit.
Health Protection Agency, Shooting Up Infections among injecting drug users in the United Kingdom 2005 An update: October 2005, http://www.hpa.org.uk/infections/topics_az/injectingdrugusers/shooting_up.htm