Beyond the fear factor

October 5th 2015

There have been proposals for drug consumption rooms in Dublin as part of the response to escalating heroin problems in the city. This is a perfectly valid and evidence-based harm reduction approach, but it is also a reminder that often very little is done to help people with serious drug problems unless it is closely associated with making the world a safer place for the rest of us.

If you look at the history of most if not all harm reduction initiatives across the world – Canada, Australia, Denmark, Switzerland and elsewhere, they have all been ultimately funded by what I call here the fear factor and concerns for wider community safety. Just taking  England as an example; before the advent of HIV and the fear that injecting drug users would spread the disease to the rest of us, most new service users (at least in London) were on 28 day reducing doses of methadone and that was it. I’m sure there will be some readers who will think – “and good job too” – except users were voting with their feet. One survey done in London in the early 80s showed that for every heroin user in drug treatment, five users were not. And given the scale of rising heroin use at the time, there is every chance that those figures would have got much worse, but for the sudden and urgent need to attract people into treatment.

And then in the next decade – the crime agenda kicked in – “we need a huge investment in treatment to stop drug users lifting your video/DVD/mobile phone”. I remember hearing Paul Hayes berate conference delegates time after time for moaning that it was all about crime and not public health. People were right to complain, but as Paul pointed out it was all about real politik – to paraphrase “if it wasn’t for the drive to break the link between drugs and crime, your budgets would look as sad as those poor buggers working in alcohol treatment”.

So where are we now? Well for a start – it is all about public health – trouble is that public health as now defined, concerns itself with preventing wider population health problems – not about more micro-health issues like drug dependency. And on top of that, the public and political fears around blood born viruses and crime in relation to drug use have both receded significantly. Not only are these cards much harder to play, but the agenda has moved to ‘recovery’ – it’s all about the good news, that people can recover, but they need jobs, training and somewhere to live. And that’s where you hit the buffers, especially in a time of acute austerity at the local level where all the money is – or what little there is of it. No longer does the government need to invest out of fear; instead it is the field that is saying, ‘please invest to help get peoples’ lives back on track’.

There are all kinds of social enterprises and community initiatives going on to help people either build or rebuild lives for themselves and that’s how it will have to be because there will be precious little help coming from anywhere else. And welfare reforms may even make that job harder. You could reasonably argue that it doesnt matter why care is funded, so long as it is. But even so, it is depressing that on the one hand, so many people in this field have been fighting for years to combat discrimination and prejudice against some of our most vulnerable citizens. Yet the only time when there is serious government investment to actually help people is on the back of the very fears that fuel that negativity in the first place.