‘A harm reduction approach to drug use is still relevant’


Date: 17 November 2010.
‘A harm reduction approach to drug use is still relevant’, says Professor Gerry Stimson

IHRA’s former Executive Director, Gerry Stimson, defended harm reduction from political revisionism in a lecture given at the  London School of  Hygiene and Tropical Medicine on 17th November 2010. 

For a full copy of this lecture entitled ‘Harm Reduction: the Advocacy of Science and the Science of Advocacy’ please click here. (PDF, 344 KB)

The article below is reproduced and available on the Guardian website.

Watch the lecture of Gerry Stimsonin in 4 parts:

or in 4 parts on YouTube

Lecture part 1:

Lecture part 2:!

Lecture part 3:

Lecture part 4:


Harm reduction aims to reduce the risks of drugs, and to mitigate impacts on the individual and the wider society. It is basic good public health and social policy. So, why doesn’t everyone support it? Conservative party ideologues have rewritten the history of harm reduction. They blame it on Labour. But harm reduction has a long history.

One of the commonest measures is the control of product quality and strength. If you drink alcohol in much of Europe you are pretty sure what is in the bottle. Drink driving legislation is also harm reduction, as is smokeless tobaccos. The first controls of drug possession were introduced in the first world war, and in the Dangerous Drugs Act of 1920. Then, prescribing heroin and morphine was regarded as legitimate medical treatment for people who were unable to withdraw; a medical forerunner of the harm reduction we know today – acting cautiously to help the patient lead a useful and fairly normal life.

Margaret Thatcher’s government introduced harm reduction into policy in 1988 in response to the HIV epidemic. A report on Aids and Drug Misuse, from the Advisory Council on the Misuse of Drugs, stated that “the spread of HIV is a greater danger to individual and public health than drug misuse”. Since then, harm reduction programmes for HIV prevention have been adopted in more than half of the 158 countries where people inject drugs.

In the case of alcohol, 82 countries have maximum legal blood alcohol levels for driving and 104 have minimum age limits for consumption.

Drugs harm reduction programmes were guided by the public health model embodied in the World Health Organisation’s 1986 Ottawa charter for health promotion. It stated that health promotion requires supportive environments, strengthening of community actions, developing personal skills and reorienting health services.

Yet prescribing methadone has been portrayed by the UK media and some treatment providers as “parking people on methadone” and giving up on recovery. In developed democracies, drugs policy has to fit with the political zeitgeist. Under Labour – with the idea of “rights and responsibilities” and of being “tough on crime and the causes of crime” – we had an expanded methadone programme for drug users because they were seen to be criminals. Now, harm reduction is seen by the coalition government as part of a Britain broken by Labour, burdened by debt, and over-dependent on the state.

The advocacy challenge is to fit harm reduction within the political zeitgeist. The coalition will shape drug treatment based on a premise that users are a burden on the state. Most treatment providers have already been busy redefining their work as driven by the goal of abstinent recovery.

We need to influence decision-makers so it becomes risky not to promote harm reduction. For too long, public health advocates have focused on the powerless, trying to get drug users to change their risky behaviour. Our target should be the decision-makers who put politics above evidence and are prepared to take risks with other people’s lives.

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