Disclaimer: The following blog post is not a reflection of the University of Wisconsin-Madison’s opinion on the below topics.
In the mid-1980’s Merseyside, the county in Northwest England containing Liverpool, was hit with two major problems: heroin addiction and AIDS. An economic downturn left the area with a high unemployment rate that was driving youths to heroin use and earned Liverpool the nickname “Smack City.” Because heroin was being injected, local health officials began to worry about the spread of blood-borne illnesses often caused by needle sharing or unprotected sex. This was happening at the same time that HIV, the blood-borne virus which causes AIDS, was tearing through gay communities around the world. Public health officials in Merseyside decided that in order to stop the spread of HIV they would have to implement a radical new technique called harm reduction.
For Merseyside, harm reduction would take the shape of providing the community with unadulterated drugs, clean needles, condoms, and education on best practices for avoiding AIDS and other complications associated with intravenous drug use (drugs taken by injection). More broadly, harm reduction is a movement which seeks to give people the safest options for engaging in high risk behaviors instead of trying to fully eliminate them. In Merseyside, it was not possible to make everyone immediately stop doing drugs, so, in their minds, this was their best shot at stopping the spread. Because of this, two places were created right next door to each other to help drug users in the county: the Liverpool Drug Dependency Unit (LDDU) which prescribed clean drugs, and the Mersey Drug Training and Information Centre (MDTIC) which taught members of the public and professionals information about drugs and eventually provided a needle exchange.[1]
However, as the program began, there were several obstacles which they would have to overcome. The 1971 Misuse of Drugs Act had specifically prohibited the prescribing of heroin in most cases and had given police the right to confiscate drug paraphernalia like needles. Luckily, some psychiatrists across the country, like John Marks who began the LDDU in 1985 were still allowed to prescribe heroin and detoxification drugs like methadone on a limited basis.[2] That same year Allan Parry, an ex-drug user and community activist, set up the MDTIC.[3] In 1986, the MDTIC was ready to begin its needle exchange scheme, so Parry and others who worked there reached out to the Liverpool Police Drug Unit and their local newspaper The Liverpool Echo.
For this experiment in harm reduction to work, they needed the police not to confiscate clean needles from those who used their services and to minimize public involvement until they could say whether or not it worked. They believed they may fail before they got off the ground because of low public and law enforcement support. It was believed at the time that another city in the UK, Edinburgh, had an uptick in HIV because their police force was arresting people and taking their clean needles, forcing them to turn to more dangerous methods.[4] There was also a fear that groups for parents of narcotics users, who focused mostly on drug abstinence, would keep their children from using the services if there was no evidence that it was a safer way to handle the situation.[5] Fortunately, the police agreed to not confiscate needles and the Echo promised not to publish anything until the LDDU and MDTIC were ready.[6]
Once they did decide to release the information, there was local outcry, but surprisingly factions of the Thatcher government encouraged them. Much of the backlash came from the Labor Party in the Liverpool City Council. They believed that instead of the LDDU’s and MDTIC’s stated goals, they were actually trying to oppress the local workers through weakening them with drugs.[7] In fact, they called on the national government to put an end to the program which was receiving funding through the National Health Services.[8] Much to their chagrin, a 1988 report revealed that the government had decided to focus their efforts on stopping the spread of HIV and was interested in continuing needle exchange schemes like the one implemented in Liverpool through a pilot program.[9] This is probably because long term costs of needle exchanges are less than long term care for those infected with HIV.
The real success of the MDTIC though was their inclusion of on-the-ground women’s services, spearheaded by Lyn Matthews. Female intravenous drug-users, and especially those who are also sex workers, face some of the highest risks. They are more likely to share needles and thus more likely to contract bloodborne illnesses, more likely to be imprisoned, and less likely to seek traditional treatment options because many fear their children will be taken away.[10] Alan Matthews, Lyn’s husband and an outreach worker, noticed their services were not attracting sex workers he knew in the community and when he asked them why, they responded that they were avoiding it because they would have to walk by the police station.[11] Alan Matthews and Allan Parry decided they needed a woman the sex workers would trust and landed on Lyn as the perfect one for the job.[12] Lyn was great because she was approachable and relentless. Much like Allan Parry, she was embedded in the community as an outreach worker and former drug-user, which gave her credibility.[13] Her own unfortunate experiences of having her friends dying of AIDS at the time also added to her earnestness and fueled her to compassionately go out at night and help women in the community.[14] Lyn would follow women, convincing them to take condoms and health advice, or come into the MDTIC to learn about safe injecting practices. As recently as last February, the 70 year old Lyn was still publicly advocating for people to use health services to catch HIV before it can become AIDs.[15]
The Mersey Harm Reduction Model, with its joint services and community collaboration, is a great example of nonviolence in action. Outreach workers actively fought to keep drug-users out of restrictive and violent situations like the carceral system through seeking deals with police and bringing services to where they were most needed. They also helped the community from self-harm by providing resources which taught and facilitated safer drug and sex practices. Most excitingly, it worked. By giving the people in their community a chance to take responsibility through learning and using resources instead of treating them like they were helpless, those people wanted and actively tried to make better choices.[17] Intravenous drug users in Merseyside were far less likely to have HIV by 1991 as compared to the national average, the MDTIC was receiving more needles than it was giving away, and they became an international blueprint for how harm reduction services should work.[18][19][20] Harm reduction, as a means of nonviolence through community care, will continue to be a strategy to help those society leaves behind like drug-users.
[1] Toby Seddon, “Prescribing Heroin: John Marks, the Merseyside Clinics, and Lessons from History,” International Journal of Drug Policy 78 (April 2020): 3.
[2] Pat O’Hare, “Merseyside, the First Harm Reduction Conferences, and the Early History of Harm Reduction,” International Journal of Drug Policy 18, no. 2 (March 2007): 142.
[3] Ibid.
[4] Steven Hayle, “The Politics of Harm Reduction: Comparing the Historical Development of Needle Exchange Policy in Canada and the UK between 1985 and 1995,” The Social History of Alcohol and Drugs (2018) 32: 88.
[5] Ella Glover, “The Oral History of the Mersey Model: How ‘Smack City’ Halted an HIV Epidemic,” Huck, March 18, 2021.
[6] Ibid.
[7] O’Hare, “Merseyside, the First Harm Reduction Conferences, and the Early History of Harm Reduction,” 143.
[8] Hayle,“The Politics of Harm Reduction,” 93.
[9] “HIV Top Priority, Says Official Report,” Druglink (May/June 1988): 14.
[10] Sophie Pinkham and Kasia Malinowska-Sempruch, “Women, Harm Reduction and HIV,” Reproductive Health Matters 16, no. 31 (2008): 171-173.
[11] Glover, “The Oral History of the Mersey Model: How ‘Smack City’ Halted an HIV Epidemic.”
[12] Ibid.
[13] Ibid.
[14] Paul McAuley and Danny Rigg, “Pioneering City Couple Were ‘instrumental’ during the Aids Crisis,” Liverpool Echo, February 6, 2023.
[15] Danny Rigg, “Heartbroken Woman Watched Friend Disco Dance in His Deathbed,” Liverpool Echo, February 13, 2022.
[16] McAuley and Rigg, “Pioneering City Couple Were ‘instrumental’ during the Aids Crisis.”
[17] Tuukka Tammi and Toivo Hurme, “How the Harm Reduction Movement Contrasts Itself against Punitive Prohibition,” International Journal of Drug Policy 18, no. 2 (March 2007): 85.
[18] Glover, “The Oral History of the Mersey Model: How ‘Smack City’ Halted an HIV Epidemic.”
[19] Janette Carr and Steve Dalton, “Syringe Exchange: The Liverpool Experience,” Druglink (May/June 1988): 14.
[20] Pinkham and Malinowska-Sempruch, “Women, Harm Reduction and HIV,” 173-176.