Between 2015 and 2020 we saw a rise in drug deaths in our services from virtually none, to a year on year increase resulting in a high of 21 deaths. 17 of these deaths in our residential services. We’d never experienced anything like it and the impact on our staff of losing someone they cared for and often being the ones who found them, was horrendous. We needed to do something but there was no obvious or simple solution.

Our approach was, do what we can where we can. Dave Brialsford, Director of the Sky Cycling Team, was perhaps the most well known architect of ‘marginal gains’. A process of reviewing every aspect of what you do and looking for that one small improvement. In itself not a game changer but combined with others you can make a real and discernible difference. So, that is what we did.

• We started with our staff, creating bespoke resilience training so they had the tools to care for themselves.
• We trained everyone, including volunteers in the use of Naloxone.
• We trialled the use of doppler radar in services that could detect an overdose.
• We created and self funded a new post to lead the policy and practice of harm reduction.
• We created unique best practice guides on every aspect of harm reduction.
• We introduced Naloxone Safety plans with residents. 
• We trained staff and issued IEP (injecting equipment) directly in services and on the streets
• We created harm reduction champions in every service to work with staff and the people we support in driving change, care and safety
• We developed an App called By My Side and through this involved women across Scotland in creating harm reduction resources for women by women.
• We worked with international partners to create digital resources for women – as virtually no women specific resources existed.
• We created a safe environment in our services for people to use drugs and have the support they needed to stay safe.

All of these actions led us to implementing what we initially called a High Tolerance approach to harm reduction, but acceptance is so much better than tolerance so we frame our approach as an Enhanced Harm Reduction model.

Of all the elements of our approach the one that was most important was our own form of ‘decriminalising’ drug use in services. We don’t exclude, condemn or refuse people who use drugs, rather we work with them where they are at, in the moment. What we have found is that once you accept people for who and where they are, there is a trust that builds and a relationship that allows for open conversations on everything from past trauma to daily drug use. In our residential services we have seen our drug deaths drop from 17 to only one the following year. Our Enhanced Harm Reduction approach works. But we’re not finished.

We continue to work with the people we support to improve our understanding and approach to keeping them safe. Today we’re working with partners on a unique drug alert function for people who use substances, we’re exploring wearable technology that can keep people safe, we’re working with women to create safe injecting guides that are unique to them and we’re having daily conversations with people who were once afraid to talk about their drug use.

What makes the difference? Care and compassion, continuous improvement and listening to the voices of the people we support.