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20 years ago health care providers in Liverpool started to experiment with innovative approaches to drug problems.

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They distributed sterile needles to drug users to protect them from HIV

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and  provided heroin users with a substitute drug called methadone to reduce crime and the risk of  overdose.

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This approach was eventually named harm reduction.

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20 years later at the International Harm reduction conference,

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we asked the pioneers of Liverpool about the beginning.

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Well, in the 80s obviously because of the high unemployment 

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things weren’t too good and the Tory government at the time

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a lot people became disaffected from society really, and started using heroine.

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The main problem we had in the early days in Liverpool, 

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before harm reduction, there was noting really.

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We had a drug clinic that might see 5 people a year.

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There was nothing really for drug users.

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Around the mid-80s there were lots of people in authority were becoming aware

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that HIV and AIDS were about to become a big problem.

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At first it was seen as a problem for gay people.

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And then quickly people began to realise that people sharing needles who injected drugs

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were going to spread this virus between themselves and then sexually, to the heterosexual population.

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The first needle exchange opened in Liverpool 

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in the Mersey Drug Training and Information Centre in Liverpool City Centre

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in October 1986 and we had to do it from a toilet.

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We had two toilets in the building and one of them was made into a needle exchange room.

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People came in who had been injecting heroine for 25 years 

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and had never been to a drug service - never been.

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We could get in between two people 

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who were about to pass a syringe to each other

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get that infected syringe out of circulation

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and put a clean one in its place.

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But it became broader than that;

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it became a way of engaging with people who had been marginalised, disenfranchised, vilified,

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people who saw themselves outside of society.

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we found that quite a successful bridge – getting people off the streets and into treatment.

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We actually started to take those services out to people and build up trust.

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It was Alan Lye that came of with this concept of harm reduction

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 and the concept that it is best to reduce harm than to reduce drug use.

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This is not to say that we don’t want people to stop using drugs – we do!

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We need to prevent people from starting to use drugs

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We need to prevent people from starting to use drugs

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We need to help people get off drugs as well.

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This is what we call abstinence oriented policy or abstentionism.

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And harm reduction and abstentionism are two sides of the same coin.

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There is no evidence at all that harm reduction encourages people to use drugs

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In fact, the evidence is opposite to that.

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Harm reduction is about human rights, about respecting everyone’s human rights  

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The main problem with using drugs, particularly opiates, is you have to find the money to for it.

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You don’t whether the drug that you are taking is clean or it is contaminated.

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You get involved with a whole range of other drugs and a whole negative drug scene

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What methadone does is allow you to get the effect of opiates 

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without having to commit crime to do it.

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So it is not only a way of protecting the drug user, it also protects society from the crime that drug users might create.

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Methadone programs at first were very short 

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and then they started to make the methadone programs much longer

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in order to reduce crime more than anything.

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There was one guy in particular we knew - I will tell you his first name, he was called Tommy.  

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We got him into the needle exchange first, so to make sure he was using clean needles.

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When, he had stabilised on a heroine prescription, he switched to methadone.

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He then reduced his methadone dose over a very long period of 10 to 15 years.

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I just heard at this conference that he is still alive, all his drug problems are now behind him.

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If we had not given him needles and prescribed drugs, I am very, very sure that Tommy would be dead.

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The rest of the country based on these abstinence models found that they had nothing to offer drug users.

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So they took an interest in what we were doing, and then it snowballed.

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As harm reduction has developed, it has gone beyond needle exchange, substitute prescribing, 

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to these new intervetions like, like drug consumption rooms, in some countries.

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I think that we have made great progress because there are 92 countries 

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that use the word harm reduction in their policies.

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It is helpful to have a listing of countries that have harm reduction accepted in national policy.

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That in no way reflects the scale of the accessibility of those programs,

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whether they are properly funded, the degree to which people who use drugs are able to access those.

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Only four percent of injecting drug users have access to ARV treatment.

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Globally on average, and injecting drug user received 22 needles per year.

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I think we face the most important issue, which is funding,

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scaling up and making sure that we car achieve a coverage and that we can make a difference.

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At the end of the day, we are all human beings and everyone has a right to remain healthy,

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and to make informed choices to stay well.

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Because once you are dead, you cannot recover, you cannot stop doing what you are doing.