In a red brick bar, aptly named ‘Revolución de Cuba’, in Liverpool, the speakers of the HIT conference shared drinks and stories of the drugs revolution. I arrived at the point where rosy-cheeked conversations were shifting away from Foucault and slide notes towards discussions about the UK snus market and someone’s DIY shed museum.
The HIT Hot Topics Conference is an international event that brings together some of the best minds in drug harm reduction. With 600,000 people dying from drug deaths worldwide, the need for effective and life-saving action is urgent. Many of the conference’s attendees are on the frontlines of this effort, taking action where governments across the world have failed to protect people who use drugs.
It was fitting that this year’s 2024 conference was held in Liverpool, home of the innovative Mersey Model of harm reduction. The Mersey Model was one of the first British needle and syringe programmes, which gained international recognition for its transformative work in the city in the mid-1980s.
A conference of hope and solutions
The opening session of the day focused on unmasking drug policy with Alan McGee, one of the pioneers of the Mersey Model, laying out the foundations of how we ought to define ‘harm reduction’. He explained how this term has been co-opted and often used by governments to define what they class as a ‘problem’ rather than supporting those suffering from harm.
Juan Fernández Ochoa, from the International Drug Policy Consortium (IDPC), provided context by explaining how harm reduction practices across the world trace their foundations to community practices of care. He emphasised the risks of understanding harm reduction as top-down policy, as the machinery of state power often sustains, rather than contests, systems of oppression.
The following speaker, Nabarun Dasgupta – co-founder of Remedy Alliance For The People – highlighted the need to provide services to people on an unconditional basis. While working as a street drug scientist at the University of North Carolina, he set up an anonymised drug testing service where, unbeknownst to the university’s legal team, people came in, collected drug testing kits to dissolve and post drug samples to his lab – with results made available through QR codes. Crucially, no data was ever kept on users by their team, highlighting the service’s confidentiality.
Concerned by high naloxone prices, Dasgupta also began a buyers’ club for the drug to ensure it could be sold at massively reduced prices to people using opiates, along with other supplies like oxygen. While no data was collected from their work, people would often report back on their experiences, revealing further insights on how people managed overdoses. For example, people highlighted that oxygen wasn’t being used in the event of minor overdose, as recommended; instead, it was used to reduce harms from other drugs like stimulants or to help expose blood vessels for safer injection.
Another key theme of the conference was harm reduction for women. The film ‘The Forgotten Ones’ (unpublished yet) left many in the room in tears, as Rain, a young girl from Newcastle, was interviewed on her experiences in drug services alongside her mother in the early 2000s. She spoke about her experience of the service’s waiting room and its intimidating feel, with pictures of needles and no supervision. The film revealed the importance of making services appropriate for people to attend with their children.
The role of police in support services
After lunch came a panel discussion from four different perspectives on harm reduction for women who use drugs and sex workers. Paula Kearney explained how SAOL’s approach to supporting women who use drugs had to adapt during the pandemic, due to an increase in domestic abuse. The DAVINA project was launched, led by those with lived experience to help women who are in abusive situations access drug services.
Stella Kityo criticised services that focus on curating a ‘hero’ story, leaving behind those who aren’t perfect models of service users. Julie Smedley explained how she created a model of best practice for future harm reduction services through the IRIS project.
This talk bought up one of the most polarising discussions of the conference: whether police should be involved in providing support services for communities like people who use drugs and sex workers. Smedley argued that part of IRIS’ success came from inviting trained police in plain clothes to ‘break down barriers’ and build a relation between groups.
Two years ago, the Metropolitan Police of London were revealed to have been regularly assaulting sex workers in the station and joking about it on their WhatsApp chats, leading to the resignation of the force’s commissioner. Grace Sumner started her speech reminding the conference of this reality, explaining how policies that aim to reduce harm to sex workers that aren’t led by sex workers themselves can often lead to more harm, further segregating sex workers from other women.
Lynn Jeffreys, a Canadian drug activist working with EuroNPUD, began their speech with a moment of silence for the 47,162 people who died from contaminated drug supplies in Canada between Jan 2016 and March 2024. While substitution therapies like methadone and buprenorphine exist for those using opiates, none currently exist for people using stimulants. In absence of a safe supply of drugs, Jeffreys shared how preliminary research from Cezchia showed promising results of using methylphenidate (an ADHD medication) to support people using methamphetamine. While results were encouraging, Jeffreys spoke of a 2021 Canadian survey which showed that 59% of people using methamphetamine preferred it over any alternative substance. It was a reminder that, while alternatives to illegal market substances are useful, safe supply of illegal drugs is a key model of access that ensures people are given options to use what substances work best for them. There is no point in offering a safe supply of substances if people will not use them. This is key if drug policy’s objectives are to reduce deaths from a contaminated drug supply.
In the UK, where crack pipes are not an approved form of harm reduction supplies, Casey Sharpe, a researcher from the London School of Hygiene and Tropical Medicine, talked about their development of a safer use inhalation pipe, and how they integrated feedback from those using it to refine its size and shape. They spent a long time getting local letters of comfort from the police in Bristol to guarantee their work wouldn’t be disrupted by police operations.
Hope from America
“I’m you, I just got here first,” Sam Rivera said, his presence invigorating the room with his earrings of naloxone bottles swinging with his words. Aware of the need for safe consumption sites in the UK, Rivera, the Executive Director of OnPoint in New York, shared his experiences of creating the first safe consumption site in New York, which has now operated for three years without any interruptions from the police or the state.
Since opening in 2021, they have attended around 1,700 overdoses, created $45,000,000 in health savings, reduced the number of syringes found in public parks from 13,000 to 1,000 and zero deaths within the safer use site.
Rivera explained the key factors that kept them open. For them, it had been essential to find a landlord who was on board with their work. For those running the site, they avoided watching people inject or directly helping them use drugs (to avoid legal complications), although they had mirrors in injection booth to help them see if someone was unwell and needed assistance. Another key factor was to gain good PR around the room’s existence: Rivera shared that thanks to a reduction of needles in public spaces, a local children’s park was re-opened, connected to OnPoint’s presence – a reminder of how such spaces don’t just benefit those using drugs – they benefit the whole community.
Many of the conference’s speakers showed that, in the absence of government support, many life-saving interventions can still run, hidden from the eyes of the law. Through legal loopholes or acting in the shadows, harm reductionists are working tirelessly around the world to save their communities’ lives.
