10 points for a compassionate approach to wellbeing for people who use drugs
In the next instalment for the Hep C U Later Harm Reduction Series Clare Hatherly, Harm Reduction Coordinator (Inclusion, Midlands Partnership University NHS Trust), outlines ten points for a compassionate approach to wellbeing for people who use drugs. Claire talks about the values required for us all to provide good harm reduction within drug and alcohol services.
1. Choice
The polarisation of the harm reduction vs recovery agenda has the propensity to push people down certain treatment pathways. I have experienced feeling like I have had my choices taken away whilst feeling completely unable to stop using drugs. I felt isolated and unheard. We have a right as humans to take risks, change our minds and make mistakes. Non-judgemental support can make all the difference to make decisions for our health.
2. Pragmatism
People will always want to take drugs. Prohibition has not prevented this. For some people their drug use will greatly impact on their health. We have an inherent understanding that people are on their own journeys and make their own choices that we may not necessarily understand or support. Sometimes people still die or suffer from complications of their drug use, despite interventions, but I like to think we gave them dignity and choice and reduced harm to a good many more people.
3. Social Justice
The framework by which adults are protected from discrimination and provides equity of opportunity, the 2010 Equality Act, does not recognise substance use disorder as an impairment. We have come so far in reducing stigma for other minority groups, but the negative consequences associated with drug use are still considered to be a ‘lifestyle choice’. Checking our own internalised stigma within drug services as well as challenging individuals and organisations that create barriers to wellbeing for people who use drugs is just the start to correcting the injustice. The right to health is a human right.
4. Empowerment
Educating people about the potential risks and safer practices that are associated with their drug use, empowers people to make decisions aligned with their well-being. Providing guidance on safer drug use such as using small amounts initially, avoiding mixing substances, and staying hydrated etc… helps mitigate potential harms. Quick achievable interventions can help people take responsibility for recognising the risks and making plans to keep themselves safer and build on that success.
5. Kindness
The simple act of giving someone something for free without expectation can be powerful. Especially in a world where people are buying drugs and loneliness can prevail. The resources that people need to keep themselves safe such as injecting equipment are given away freely, and we work closely with foodbanks and homeless charities. This opens the conversation to find out what is needed to keep people safe.
6. Evidence Based
Harm reductionists have a wide range of life experiences, approaches and opinions, but a shared goal. It can be hard to know the best use of our time and resources. Drugs are ever changing, as are the risks so our approaches need to evolve to meet them. More research is needed and more feedback from people with living experience of using drugs. It is important that we share information and good practice across agencies, outside of the world of commissioning as this is about life.
7. Community
Advocate coping strategies, self-care, and community support rather than demanding change. Engaging the community in harm reduction efforts fosters a sense of collective responsibility. Community involvement enhances awareness, reduces stigma, and encourages a supportive environment.
8. Health
Encouraging regular testing for infections such as HIV and Hepatitis C helps detect and address health issues early, preventing the spread of diseases within the community. We cannot realistically continue to have Hepatitis C at micro-eliminated levels when the logistical systems for distributing injecting equipment is so lacking. In a world where drugs can be ordered like a Deliveroo we are making it too hard for people to access the things that keep themselves safe. We need to meet people where they are at and provide wound care, health checks, testing, advocacy at health appointments, to truly, reduce the risk of infections and diseases. We have the opportunity to improve general health in an underserved population of people who may face health inequality.
9. Life
As synthetic opioids evolve the risks associated with overdose and adverse health outcomes grow. The challenge is to distribute naloxone on a wider basis.
10. Humanity
Improving health is ultimately more effective than stigmatising or isolating populations when it comes to keeping people alive. In essence, harm reduction is about meeting individuals where they are, without judgment, and supporting them on their unique paths to well-being. It’s a holistic and empathetic approach that values human dignity above all.