The Enhanced Harm Reduction Working Group is a consortium of scientific experts, academics, policy makers, treatment providers and advocacy groups, working collaboratively to reduce the harms of intravenous drug use.

Aim

To develop the evidence base for reducing drug-related harm by facilitating enhanced harm reduction services in the UK. Such services include overdose prevention centres, drug checking, and high tolerance housing.

Objectives

Rationale

There is a well-developed evidence base for established harm reduction practices, including opioid agonist treatment, and needle and syringe programmes; however further steps need to be taken to reduce record levels of drug-related deaths in the UK. We need to go further if wish to meet global aims to eliminate the transmission of HIV and Hepatitis C among people who use drugs.

Our aim is to develop the evidence base for reducing drug-related harms by enabling enhanced harm reduction services in the UK. This collaborative initiative will evaluate whether establishing such services would prove to be cost-effective, reduce crime, improve public health, reduce drug litter, and increase engagement in treatment services.

The EHRWG encourages the use of a participatory development approach in the design and development of harm reduction services. Ensuring co-production in the design, development and implementation is key to ensuring that they work, are community-friendly, and hold the confidence of local drug-using communities. This helps to ensure high quality, non-judgemental service provision, acceptability and reduced stigma and the discrimination experienced by people who use drugs.

People who use drugs are sadly familiar with experiencing discrimination in health and social care settings. As such, those developing new services need to actively demonstrate their commitment to non-judgemental, rights-based approach and participatory development is a good starting point. When a community owns and supports harm reduction, this ensures effective service user recruitment, quality management and advocacy.

Academic Experts

Prof Alex Stevens (Chair)

Professor of Criminal Justice

Prof David Nutt

Professor of Neuropsychopharmacology

Roz Gittins

Drug Science Scientific Committee

Dr Andy Mcauley

Reader in Public Health,
Glasgow Caledonian University

Prof Fiona Measham

Professor of Criminology 

Dr Magdalena Harris

Associate Professor in the Sociology of Health

Dr Adam Holland

Chair of the Drugs Special Interest Group
at the Faculty of Public Health

Ben Scher

DPhil student
Social Intervention and Policy Evaluation

Prof Charlie Lloyd

Professor of Social Policy and Criminal Justice

Dr Euan Lawson

Editor of the British Journal of General Practice

Dr Gillian Shorter

Reader in Psychology

Dr Tim Williams

Consultant Addiction Psychiatrist

Policy Specialists

Shayla Schlossenberg

Drugs Service Coordinator, Release

Mat Southwell

Managing and Technical Director, Coact

Colleen Daniels

Deputy Director, Harm Reduction International

Jason Kew

Former Detective Chief Inspector, Thames Valley Police

Martin Powell

Head of Partnerships, Transform

Kirsten Horsburgh

Strategy Coordinator, Scottish Drugs Forum

Niamh Eastwood

Executive Director, Release 

Amber Moore

Diversion Scheme Policy Lead, User Voice

Treatment Provider Representatives

Claire James

Deputy Director of Clinical Practice
Change Grow Live

Paul Hughes

Executive Medical Director
With You

Martin Blakebrough

CEO
Kaleidoscope

Rob Barker

Campaigns and Communications Lead
Barod

Peter Krykant

Project Lead
Cranstoun

Lee Wilson

Regional Director
Humankind

Danny Ahmed

Clinical Partner
Foundations

Tony Duffin

Chief Executive Officer
Ana Liffey Drug Project

Paula Byrne

Chief Executive Officer
Merchants Quay Ireland

Treatment Providers

The Enhanced Harm Reduction Working Group is supported by treatment providers to ensure that the stakeholders who would be delivering these services are consulted throughout. 

The Case for Overdose Prevention Centres in the UK

Part One – Quantitative Data 

In Part One of this report, we describe the quantitative and geographic indicators. We estimate that there may be over 250 people in Sandwell who are in the population group that is most likely to benefit from an enhanced harm reduction service; people who inject drugs who are homeless or unstable housed.

This report strongly suggests a need for a place where people can inject drugs out of the public gaze, in a hygienic and supervised environment. This would improve the quality of life of all the residents of Sandwell, whether they inject drugs or not. It would reduce the risks of drug-related death and help to meet the complex needs of a group of people who are highly vulnerable to multiple physical and mental health problems. It would also reduce concerns about litter and other problems related to street-based injecting.

Part Two – Qualitative Data 

In Part Two, we discuss the participatory consultation and research we have carried out with people who use drugs in Sandwell.

We recruited and trained a team of volunteer peer researchers, who named themselves the Sandwell Community Outreach Resources Education, or SCORE, and worked with them to find out about patterns of street-based injecting and related needs in Sandwell.

Qualitative research is essential to understand a specific local context or problem from the perspective of the impacted community.

This environment provided an ethical space within which street-based drug use could be investigated, community mobilisation deployed, and models of enhanced harm reduction discussed.

Part Three – A Rapid Evidence Review

At the core of this review lies an exploration of Overdose Prevention Centres as community facilities designed to provide a safe, hygienic, non-judgmental environment for individuals to consume their own drugs. Operating under the primary principle that supervised drug consumption enhances safety and reduces the likelihood of fatal overdoses, this review highlights the evidence that OPCs are also able to facilitate a secondary function: to promote voluntary access to a range of social, health, welfare, and drug treatment services. The synthesized research also suggests that many of the feared unintended consequences such as increased crime and increased drug use do not occur in locations where OPCs are implemented. The range of OPC models explored in this review are typically characterized as being low-threshold services—free at the point of access with minimal demands—making them inclusive and accessible to often marginalised people who use drugs.

As a concluding note, the review emphasizes the continual need for robust evaluations of OPCs to improve our understanding of how, why and for whom do such forms of enhanced harm reduction work for.

Educational Resources