 20 years ago, healthcare providers in Liverpool started to experiment with innovative approaches to drug problems. They distributed sterile needles to drug users to protect them from HIV, and provided heroin users with a substitute drug called methadone to reduce crime and the risk of overdose. This approach was eventually named harm reduction. 20 years later, at the International Harm Reduction Conference, we asked the pioneers of Liverpool about the beginning. Well, in the 80s, obviously, because of the high unemployment and, you know, things weren't too good under the Tory government at the time, a lot of people became disaffected from society really, you know, they started using heroin. The main problem we had in the early days in Liverpool, before harm reduction, there was nothing really. We had a drug clinic that might see five people a year. There was nothing really for drug users. Around the mid-80s, lots of people and authorities were becoming aware that HIV and AIDS were about to become a big problem, and at first it was seen as a problem for gay people, and then quickly people began to realise that people sharing needles who injected drugs were going to spread this virus between themselves and then sexually to the heterosexual population. The first needle exchange opened in Liverpool in the Mersey Drug Training and Information Centre in Liverpool City Centre in October 1986, and we had to do it from a toilet. We had two toilets in the building and one of them was made into a needle exchange room. People came in who'd been injected in heroin for 25 years, never been to a drug service, never been. We could get in between two people who were about to pass a syringe to each other, get that infected syringe out of circulation, put a clean one in its place, but it became broader than that. It became a way of engaging with people who'd been marginalised, disenfranchised, vilified, people who saw themselves outside of society, and we found that quite a successful bridge, getting people off the streets and into treatment. We actually started to take those services out of people and build up trust. There was Alan and I who came up with this idea of harm reduction and this concept that it's best to reduce harm than to reduce drug use. This is not to say that we don't want to stop people using drugs, we do. We need to prevent people from starting to use drugs, we need to help people get off drugs as well. This is what we call abstinence-oriented policy or abstentionism, and harm reduction and abstentionism are two sides of the same coin. There's no evidence at all that harm reduction encourages people to use drugs. In fact, the evidence is opposite to that. Harm reduction is about human rights, about respecting everyone's human rights. The main problem with using drugs, particularly opiates, is you have to find the money for it. You don't know whether the drug that you're taking is clean or it's contaminated. You get involved with a whole range of other drugs and a whole negative drug scene. What methadone does is allow you to get the effect of opiates without having to commit crime to do it. So it's not only a way of protecting the drug user. It protects society from the crime that drug users might create. Methadone programs at first were very short and then they started to make the methadone programs much longer in order to reduce crime more than anything. There was one guy in particular we knew who I'll tell you his first name. He was called Tommy. We got him into the needle exchange first so to make sure he was using clean needles when he'd stabilized on a heroin prescription he switched to methadone. He then reduced his methadone dose over a very long period, 10 to 15 years. And I've just heard at this conference that he's still alive. All his drug problems are now behind him and if we hadn't given him needles and prescribed drugs I'm very, very sure Tommy would be dead. The rest of the country based on these absence models found they had nothing to offer. Drug users, so they took an interest in what we were doing and then it snowballed. As harm reduction has developed it's gone beyond needle exchange and substitute prescribing to these new interventions like drug consumption rooms in some countries. I think we've made great progress because there are 92 countries that use the word harm reduction in their policies. Well it's helpful to have a listing of countries that have harm reduction accepted in national policy that in no way reflects the scale of the accessibility of those programs whether they're properly funded, the degree to which people who use drugs are able to access those. Only 4% of injecting drug users have access to a v-treatment. Globally on average an injecting drug user receives 22 needles per year. I think we face the most important issue which is funding, scaling up and making sure that we can achieve a coverage that it can really make a difference. But at the end of the day we're all human beings and everyone has a right to remain healthy and to make informed choices and to sort of stay well. Because once you're dead you can't recover, you can't stop doing what you're doing.