Harm Reduction & Treatment An Unholy Union?

1. Harm Reduction & Treatment An Unholy Union?

2. What I am motivated by… I not only want drugs to stop being demonised, but for us to also put them in their rightful place (they’re only drugs – let’s take them or not take them and get on with our lives!). I want humanity to eventually come to terms with itself, the planet it lives on and the universe it is part of. I want people to stop using scapegoats as a means to feel better about themselves – be happy within yourself because of the life you live, not because you are pointing the finger at others. If ignorance is bliss, then such people have lost the right to complain – about ANYTHING. The laws that harm reduction offsets are carried on the shoulders of too many people, day-in, day-out, and those who receive resources to reduce drug-related harm must prioritise the needs of harm reduction’s constituency above all else – BUT STILL HAVE A LIFE. If I wanted to make $$$ and achieve ‘status’, I’d be in marketing etc.

3. Background • A funded harm reduction program for People Who Inject Drugs (PWID) was established during the heroin glut of the late nineties. • Program was originally called Barwon Drug Health & Education Program (BDHEP) and was comprised of a night-time mobile NSP service, Mobile Drug Safety Worker (MDSW), community education officer and a program co-ordinator. • In 2002, BDHEP was disbanded followed by integration with the DAS and the night-time service continued alongside the secondary CHC sites.

4. Background The night-time service was then disbanded in 2008 to address a consistently overblown budget and also enhance services for PWID in the Barwon region – the idea has been to form a team during business hours who can then collaborate with other services and support the secondary NSP services. As I presented at the Anex conference last year, the transition process could have been much smoother and certainly far better for the consumers, but Barwon Health acted upon the recommendations of ‘peak bodies’ that was nothing short of callous.

5. Background • As part of DAS, a pharmacotherapy clinic had been established in the mid-nineties and a pharmacotherapy support position later complemented GPs that had moved over from their private practices. • Essentially, since the GPs have transferred to Barwon Health their administration costs are covered and they receive support from the harm reduction team who are funded from various sources, not just from pharmacotherapy dollars.

6. A New Model • A progressive change over the last decade. • Admittedly, I brought baggage with me carried over from widespread Victorian notions of harm reduction. • Indeed, there were teething pains, but over time I realised that matters weren’t straightforward.

7. A New Model (for me, anyway) I came to realise that personal experiences with drug use are more widespread than I thought – this makes sense really. ‘Treatment’ staff can realign and readily incorporate harm reduction into their practice, as people are provided some form of assistance, no matter what. Co-location of harm reduction has potentially led to ‘treatment’ staff embracing harm reduction more readily. Harm reduction has assisted ‘treatment’ staff to understand the complexity of the drugs issue and has helped to wind people down from the pressure of churning out ‘drug-free’ people. Co-location has allowed harm reduction staff to experience first-hand the complexities of ‘treatment’ (esp. alcohol & ABI) and the comparison between those that are abstinent and those who continue to use.

8. Where has harm reduction got it wrong? • Harm reduction is considered infallible – not just about closed mindedness • Identity politics reliant on platitudes • Elitism and sectarianism • Inaccurate analysis of Prohibition & drug law reform, consequently affecting practice • Lack of media activism • Lack or absence of earnest community-based work (both PWUID & others)

9. Where has harm reduction got it wrong? Examples: “I have wondered whether endless supplies of heroin and other drugs on the table in the waiting area would solve the problems of our clients, but over time I have realised that this isn’t what will actually help the people we are working with.” - paraphrased from the Anex 2009 conference in relation to the MSIC in Kings Cross, Sydney • Misunderstanding of drug law reform, even by those participants in harm reduction who are experienced and in positions of authority.

10. Where has harm reduction got it wrong? Examples: “Yes, this person may always be really out of it in meetings, but he/she always makes contributions that are right on the mark.” - paraphrased from conversation with colleague, 2011 • The discourse concerning the importance of treating PWUD like ‘everyone else’ has been distorted, whereby different standards are expected to be accepted – if PWUD are to be treated equally, surely PWUD need to adhere to the same standards as everyone else? Or are PWUD actually different, in which case PWUD need to also be treated differently?

11. Where has harm reduction got it wrong? Examples: “What I do behind closed doors or with my body is my own business and no-one has the right to say what I can and can’t do” • Harm reduction is not about people having the right to do whatever they want without consequences. Reporting something to the police does not automatically make someone or an organisation a ‘dog’, for example. Also, one of the aims of drug law reform is to reduce and control access to certain drugs by people in the community, not merely to reduce the influence of the ‘black market’.

12. Where has treatment got it wrong? • Over-valuing of credentials over genuine empathy (sometimes disregard for latter) • Lack of critical analysis of Prohibition and dominant discourses e.g. DSM IV • ‘Medicalisation’ of issue • Lack of insight into drug-using experience esp. illicit drugs • Pandering to media-generated hysteria

13. Where has treatment got it wrong? Examples: “Harm reduction has come from a background of peer workers, and the area has needed to become a more professional one and this is a good thing. It’s interesting” - paraphrased from conversation with withdrawal nurse, 2010 • Fairly widespread notion of peer vs. professional dichotomy, without recognition of the complexity that exists – yet again, it is not a ‘black-and-white’ matter.

14. Where has treatment got it wrong? Examples: • Telephone call from distressed uni. student who had been smoking cannabis for a total of 5 months and had had a very unpleasant “hallucination” and was seeking ‘treatment’. • Had seen a GP, who was not his regular doctor, who effectively sent him away with the phone number of the local AOD service, stating that he was unable to properly assist him until the student had been abstinent from cannabis for one month. • The student explicitly stated to me that his experience with the GP was very uncomfortable and following the appointment he felt very concerned about his situation, esp. his mental health. • Complete disregard by treatment staff of the vitality of genuine empathy and a sound knowledge base (incl. the pleasure aspect of drug use).

15. Where have both got it wrong? • The gap between PWUD and services/ funding bodies/ training orgs/ peak bodies/ NGOs has become too large – positions of importance have become ‘out-of-touch’. “It would make sense that the reduction in the quality of MDMA that has occurred over the last few years would mean that there would be more people out there injecting their ‘Ecstasy’ pills.” During the re-structuring of the Barwon Health NSP, there was not one single recommendation from any organisation or individual ensuring that the needs of the previous program’s consumers were protected i.e. an adequate transition process.

16. Where have both got it wrong? • Misapprehension by those who have had fairly minimal engagement with PWUD that, consequently, they have a comprehensive understanding of the relevant issues. “Something that has become apparent to me during my time in the sector is that the vast majority of clients who enter NSPs actually want to stop using drugs.” “What is the point of providing education for street-based injecting drug users when the NSP Survey last year showed that over two-thirds of participants last injected in someone’s home?!”

17. Where have both got it wrong? • An implicit understanding has developed over time that ‘success’ in the sector is defined by an absence of contact with PWUD. Think of the organisations that you know of who, actively or indirectly, dissuade PWUD from entering their premises. Think of the organisations that you know of who continue to house toilets without disposal units for injecting equipment. Think of organisations that you know of whose staff members rely solely on second-hand information regarding PWUD but who are bestowed with the responsibility for making significant decisions that affect the lives of PWUD.

18. What should be happening? • Articulate, knowledgeable, innovative and astute leaders who are accountable and active. • Nuanced and progressive mindset. • Absence of ‘territorialism’ and unabated corporate philosophy. • An adherence to the ethical obligations of the sector – reasonable use of resources, fair prioritisation & consistent consultation. • Greater communication and interaction between harm reduction & treatments services/ orgs.

19. What should be happening? • If you choose to participate and remain in this sector, regardless of whether you have had personal experience with the issues or not, then it is only fair that you should be expected to genuinely care about achieving the best outcomes for both people who use drugs and the communities that they are a part of.

20. Thank you kindly for your time. E: josephki@barwonhealth.org.au

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