While some may say the association with drugs is detrimental to the image of Bristol, for others, it’s a proud celebration of its harm reduction history. Bristol is home to an ecosystem of people using drugs from all walks of life, living alongside one another with a foundation built from mutual understanding and care. You may find the resident harm reductionists in smoky pubs; in sweat-dripping clubs; in pricey Clifton conservatories; in twilight graveyards; at raging sex parties; in science labs; on street corners; in prisons; in supermarket toilets; in council offices or in your kitchen at 7am.
The city’s leadership has also pushed the city’s vision forward, declaring Bristol the UK’s first “harm reduction city”, looking to treat drug use as a health issue first by increasing treatment access, freeing up resources and reducing drug harms.
At the heart of this is the Bristol Drugs Project (BDP), which for 40 years, has provided the city harm reduction rooted in compassion, acceptance and meeting people where they are at. This is why it was so special that this year’s National Harm Reduction Summit, which happened in September and was led by BDP and The Hepatitis (Hep) C Trust, was held here.
A changing landscape
“Harm reduction shouldn’t depend on your postcode, and at the moment it does in England. If I was a drug user, I would probably choose Bristol” – Stuart Smith, Director of Community Services, The Hepatitis C Trust.
The landscape of drug use across the country is evolving at a rapid and worrying rate. Mark Roberts from the Hep C Trust shared data from their yet-unpublished 2026 INSIGHT survey of 846 people across the country actively using drugs. It revealed a steep rise in people injecting powder cocaine, particularly in the Northeast of England and North Cumbria.
According to Government wastewater analysis, cocaine is the most consumed drug in the country, with England consuming around 123,000 kg of cocaine per year. Related harms have also spiked: cocaine-related deaths nearly doubled from 2020 to 2024, nearly 11 times more than in 2011.
However, treatment options for those using cocaine and other stimulants remain few and far between. In the same survey, Hep C Trust found 23% of respondents not engaged in any treatment service, with most saying they found nothing relevant to their needs.
Trusting the packet
Dean Acreman from WEDINOS, the anonymous postal drug checking service and database, told at the conference that 44.3% of substances they tested had different contents than what was purchased.
“If the label can’t be trusted, what does that do to a person’s ability to judge the dose?” Acreman said.
Across the UK, there’s been an influx of new and unexpected substances in people’s drug supplies: such as nitazenes, novel benzodiazepines and medetomidine were found in heroin, pressed benzo pills and more. Widespread and low-threshold drug testing across the country is essential now, more than ever.
The rise of ketamine use by young people has been broadcast across national news and while deaths remain relatively low, harms are increasing, such as damage to the bladder, biliary system, stomach and nasal passages. There are state-led efforts to further criminalise the drug to crack down on its image and use; however, Mat Southwell highlighted that this may increase harms and a better approach would be coordinated education and service provision.
Who should be providing harm reduction?
We learned from drug treatment services across the country that pharmacies are not providing consistent care to people who use drugs – particularly needle exchange services and opioid substitution therapy. This has pushed drug services and charities to pick up the operational slack, forcing greater funding competition between them to deliver support. This raises a difficult policy choice: should resources be focused on repairing pharmacy provision, or towards specialist drug services that are already connected with drug-using communities?
According to the Hep C Trust’s research, more than twice as many people preferred accessing needle and syringe provision (NSP) through peer-led services rather than pharmacy provision, this was because peers build trust over time. Their survey found that 64.6% of people had naloxone on them with more than half feeling very confident in using it, showing how good education and supply of resources mean that people can feel empowered to reduce harm in their communities, easing pressure on services. Good harm reduction spreads.
We repeatedly heard how important it is for community members and those with lived and living experience to be involved in harm reduction services. Many of the speakers at the conference had come through the doors of drug services at some point and spoke of the value and nuance they brought to service work and drug-related research due to their experiences.
What should harm reduction services look like?
“Harm reduction has a radical history. It’s rooted in communities responding to systems and institutions that were failing them.” – Seda, Safe Only CIC.
The room was especially eager to hear from Saket Priyadarshi, head of The Thistle – the UK’s only officially sanctioned safer consumption facility. Since its opening in January 2025, it’s had more than 22,500 visits, with approximately 1 managed emergency (usually an overdose) per 128 injections. Priyadarshi spoke of how the Thistle’s community living room was arguably the most important part of the service as it allowed people to build trust and remain engaged in harm reduction.
The value of brick-and-mortar services that feel like a safe space was further emphasised during the women’s and the LGBTQ+ panel as Vicki Beere, from Yorkshire’s Project 6, explained their plans to set up trans-inclusive, women specific drug services. Independent peer-led harm-reduction centres such as Release’s Harm Reduction Hub in London are crucial to this. The Hub’s “living room” has become a non-judgemental centre where people can use a safe space without any obligations with access to a wide variety of harm reduction supplies available when needed. In Bristol, BDP runs a peer-led monthly drop-in for trans people called Project 4T – this specialised service is the first charity in the UK to offer blood testing for people doing DIY hormone-replacement therapy (HRT).
In the conference, speakers emphasised the importance of mobile NSP and harm reduction services to account for people’s health issues and large commuting distances. Vans can distribute naloxone, wound care, blood-borne virus testing, links to treatment and housing, food, water, clothing, phone access, advocacy and practical support. In Birmingham city centre, one mobile harm reduction outreach service even stepped in to fill a supply hole left when pharmacies providing sterile needles.
What does the future of harm reduction look like in the UK?
“The future must be youth-led, peer-informed, properly researched, accessible, meeting people where they already are, in festivals, community spaces, online meaning to maintain non-judgemental, low-barrier spaces where people can access information, naloxone and any vital resources they may need without fear of stigma.” – Cerys, Youth RISE.
In an environment of declining resources and increased competition for the same funds, organisations are often pushed to see others as adversaries. But the National Harm Reduction Summit was an opportunity for many to come face-to-face and be reminded of their shared passion and purpose. Hearing from one another reinforced how many have a shared mission to end the UK’s postcode lottery system of patchwork harm reduction.
Why can’t there be a Thistle everywhere it’s needed? Why can’t we provide pipes to people who smoke crack? Why can’t we provide testing services freely? Why can’t we provide accessible blood testing to everyone doing HRT? The Summit highlighted how across different groups working in isolated areas, the same questions keep being posed to the Government: why don’t we have the funding and space to do what’s needed to save lives? When so many harm reductionists are together in one room, the silence of the Government’s policy inaction is deafening.
