From local to global
a short history of Harm Reduction Pat O’Hare 30 31
I
n the mid-1980s the Mersey Health Region, which consisted of the counties of Merseyside and Cheshire in the UK, became the focus of attention because of its radical and pioneering approach to dealing with the problems connected with drug use. It was mainly focussed on Liverpool, the biggest city in the region. Liverpool has a proud history of public health and was the first city in the world to appoint a Medical Officer of Health in 1847. At the time, it was known as the unhealthiest city in Britain. In the early to mid-1980s, John Ashton of the University of Liverpool’s Department of Public Health and later Mersey Regional Director of Public Health, and Howard Seymour, Head of Health Promotion of the Mersey Regional Health Authority (MRHA), had been developing the ideas of the New Model for Public Health. This brought together the old ideas of environmental change, prevention and therapeutic interventions, but went further and recognised the importance of “those social aspects of health problems which are caused by lifestyles. In this way, it seeks to avoid the trap of victim blaming” (Ashton
Professor Pat O’Hare started working in the drug field in the mid-1980s when he became Director of the MDTIC (later renamed HIT) in Liverpool. In 1989 he founded the International Journal of Drug Policy and was Editor from 1992-2000 and started the First International Conference on the Reduction of Drug Related Harm in 1990. In 1996, along with colleagues, he founded the IHRA, now known as Harm Reduction International and was Executive Director until 2004. From 2004 until 2010, he was Honorary President. He is now Executive Director of HIT in Liverpool and Visiting Professor in Drug Use and Addiction at Liverpool John Moores University.
& Seymour, 1988). They were interested in applying it to a then-emerging public health problem: drugs and AIDS. In the mid-1980s, an influx of cheap brown heroin gave Liverpool another bad reputation as ‘smack city’. ‘Smack’ is a colloquial term for heroin. So ‘smack city’ was a place where heroin was widespread and the nickname given to Liverpool. Other parts of the Mersey Region, including the areas of Wirral and Bootle had similarly high levels of heroin use (Parker et al., 1998). It was estimated that there were about 20,000 drug users in the region in a population of about two and a quarter million (Drugs and HIV Monitoring Unit 1985). Services were much as they were in the rest of the UK, with detoxification being the prevalent treatment, which was not very effective. A new approach, harm reduction, was pioneered based on public health principles that influenced the later historic recommendations of the UK’s Advisory Council on the Misuse of Drugs report (Raistrick D 1994). Services were created from 1985 involving the consumer that gave drug users the information and the means to protect themselves, especially drug injectors who were most at risk. The Mersey Harm Reduction Model was taking shape. In 1985, the Mersey Drug Training and Information Centre (MDTIC), which later became HIT, was opened in direct response to a request from, among others, the two Archbishops of Liverpool. It was a drop-in centre. Its brief was to give clear information to anyone who requested it, and training to the public and professionals. The creation of the MDTIC preceded the awareness of the risk of HIV in the region. It was situated next door to the Liverpool Drug Dependency Unit (LDDU),