After a lifetime of visiting cold Northern towns, the furthest place I’ve ever got to with work is Reading, and for all the many nice things you can say about Reading, it’s probably not on most people’s “places to go before I die” list unless you’re a huge Mike Oldfield fan. So when my poster was accepted at the 25th International Harm Reduction Conference which took place in Montreal last month, it was a lifetime’s dream come true of coming into work with my passport. The conference itself has its roots in Liverpool where harm reduction first came on to the agenda in the 80s and in the context of HIV’s appearance in the UK made our city one of the pioneers of a new way of thinking, endorsed by government policy which despite its calculating ruthlessness in other areas, did not want to on balance risk a panicked public fearing for their lives. The Harm Reduction Coalition describes harm reduction as “a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use.”[i] You could argue that the ultimate negative consequence of using drugs is death, and so at the very least, harm reduction if it’s about anything should be about keeping people who use drugs alive. So much of the conference focussed on preventing drug related deaths, and a common theme was the need for promotion of naloxone. Naloxone is a medication used to block or reverse the effects of opioids and used to treat overdose in an emergency situation, and although used in emergency departments since the 1970s, has only recently become more widely available in some areas of the world to the general drug using population and support services, a practice which is widely accepted as being one which saves lives. [ii]
But policy development does not occur in a vacuum and part of the reason for the intense interest around the urgent roll out of naloxone is the massive increase in drug related deaths, both locally and internationally. Drug related deaths recently reached the highest level ever recorded in England and Wales, with 3,674 drug poisoning deaths registered in 2015 including 1,201 heroin related poisonings, a doubling of the 579 deaths recorded in 2012. The picture is the same globally, with opioid overdose deaths in the USA increasing by around 180% since 2002. In Vancouver alone, 174 individuals died in one week in 2017, with fire and rescue services in some provinces stating that they now regularly deal with more call outs for overdose than for tackling fires. [iii]
Canada’s Minister for Health Jane Philpott was invited to speak at the conference opening ceremony and accepted the invitation but was met with a small but significant number of people holding up protest banners and turning their backs to her as she spoke. I turned to my colleague Howard who was out there with me and said something along the lines of “they don’t know how lucky they have it. Can you imagine Jeremy Hunt turning up to a conference about harm reduction?” (Let’s face it, Jeremy Hunt probably doesn’t know what harm reduction is). But then one of the activists spoke – this wasn’t about protest for the sake of protest. They were making a public stand because this wasn’t just something that should be on the agenda, this was an urgent national crisis. If any other group were dying in the numbers that drug users were, people would be up in arms about it. When the SARS disease hit Canada, affecting less than a dozen people, emergency task forces were quickly established and millions of dollars were made available for a rapid national response, billions of dollars in some countries [iv]. And yet here were thousands of people dying, some of the most vulnerable members of the population, and the government’s response was thoughtful and serious, yes, but not anywhere near rapid enough or well enough resourced to potentially do anything about the hundreds of people who would die each week without action.
And so I came away from the conference thinking about the work that we do here at PHI to support local authorities with looking at drug related deaths and what they can do locally to at least attempt to stem the rising tide. Chairing those panels feels like the most important work I do within PHI since for all the data I stare at on a screen each day, these are real life individual cases, people who aren’t here anymore, and they should be but as a country we don’t allocate proper resources to this issue. If it was my brother or a parent or best friend, I’d want to stand up and shout – FFS, do something about this. The war against the poor and vulnerable as we’ve seen in the last two weeks can be a passive thing more than anything. To populations that are hidden away from the general public and whose deaths are so common that they don’t even make the inside pages of newspapers, the problem isn’t a group of activists disrupting a sympathetic conference to shout about it, it’s that more people don’t do that. If we don’t demand action in the same way we would for any other emergency, then those deaths become one more avoidable statistic. Fighting inequality and supporting people to live well is at the heart of public health, so we need to say: this is a crisis which demands national action now.