Harm minimisation for rough sleepers
Current UK policy prevents the implementation of beneficial services for homeless people with drug and alcohol addictions
HEALTH, CARE & SUPPORT
Image: Istock
Catherine Romney
Policy and Research Officer, Campbell Tickell
Catherine Romney
Policy and Research Officer, Campbell Tickell
Issue 67 | September 2023
The relationship between harmful drug and alcohol use and homelessness can be cyclical – substance abuse can be both a cause and an effect of homelessness. It is not surprising then that the misuse of drugs and alcohol is so prevalent within the UK’s homeless population.
The Rough Sleeper Drug and Alcohol Treatment Grant (RSDATG) funds local areas to “implement evidence-based treatment and support” to address this issue, leaving local authorities asking what the evidence actually tells us about the most effective approach to addressing substance misuse among rough sleepers.
Campbell Tickell’s review for one such local authority revealed harm reduction as a largely practicable and highly effective intervention.
Harm reduction over abstinence
Rather than simply ignoring or condemning drug use, harm reduction rejects abstinence as an absolute goal and aims instead to address drug users’ often complex health needs. Examples include:
- pharmacological interventions such as opioid substitution therapy (OST) and heroin-assisted treatment (HAT)
- supervised drug consumption rooms (SDCRs)
- distribution and training in the administration of Naloxone for individuals at risk of overdose or witnessing an overdose
- needle exchange programmes (NSPs)
- managed alcohol programmes (MAPs)
- drug checking facilities
Harm reduction programmes also typically include services such as counselling for coping with addiction and support with navigating housing and benefits systems, and thus often address psychological and financial harms associated with addiction too.
Such programmes are usually designed under partnership models and link up a wide range of treatment options. Clients are encouraged and, if desired, referred by practitioners to treatments as well as educated on health and addiction support. As such, harm reduction acts as a stepping stone into more sustained recovery.
Portugal decriminalised possession and use of drugs more than 20 years ago
Evidence from around the world
Several countries have implemented effective harm minimisation interventions, including (but not limited to) Switzerland, the Netherlands, Austria, Canada and Portugal.
Evidence from places like Portugal – the first country to decriminalise possession and consumption of all illicit substances (2001) – reveal the impact of harm reduction techniques. Benefits include:
- lowering the incidence of overdose and drug-related deaths
- reducing ill-health among rough sleepers
- remedying criminal activity and drug-related litter in public spaces; and ultimately
- saving public money
The climate for harm reduction in the UK
Several critical harm minimisation services do exist in the UK. These include NSPs and OST pathways as well as drug checking facilities in drugs hotspots.
One example of drug-checking interventions includes a city-centre drug checking pilot run by the Loop in Bristol, which reported harm reductions including 27.8% of clients lowering their dosage, and 9.7% disposing of their substances entirely.
Nonetheless, many of the options for harm minimisation remain highly contentious in the UK and some remain unsanctionable by law. For instance, many policymakers, as well as the general public, are seemingly resistant to supervised drug consumption rooms, believing these facilities enable and indeed encourage illicit drug use. And even in the case of existing services there is continued resistance. The Loop has, since the time of CT’s evidence review, fallen victim to new Home Office licensing stipulations that have spelled closure for their drug checking facilities.
There is clear and overwhelming evidence to suggest that harm minimisation not only delivers for its client group but is broadly beneficial to society as well. If we are to truly reap these benefits, we must find ways to hold policymakers to account for their resistance to the evidence base and call for our future political leaders to commit to a drug and alcohol strategy that matches the good practice of the UK’s European neighbours.
“Many policymakers, as well as the general public, are seemingly resistant to supervised drug consumption rooms, believing these facilities enable and indeed encourage illicit drug use.”
