EVERYDAY HARM REDUCTION

At present, harm reduction (Autumn 1992) is a term that is largely used at management level. Hardly anyone uses it at the grass-roots level. Odyssee Hadon, the Rotterdam outreach programme, has used harm reduction as part of tertiary prevention.

Actually, fine-sounding expressions such as 'harm reduction' are not important to field workers. Their concern is to support daily users of cocaine and opiates in the 'struggle for life'. Sometimes this means that Hadon field workers help addicts kick the habit. But they only do so at the express request of the people concerned.

The reduction of drug-related harm covers a very large field. Field workers are involved every day in a very basic way with giving shape 'to harm reduction. It often involves relieving immediate needs. In that sense it means treating the symptoms. It is less often that damaging situations can be tackled structurally.

We will try to present a picture of what everyday harm reduction involves using quotations from the Odyssee Hadon logbook.

One of the standard activities is providing and exchanging clean needles. Every outreach worker carries several types of clean needles, alcohol-impregnated wipes and a disposal container

Friday 13 March 1992. Central Station. Professor Eddy came up to me to exchange needles. He handed one over and asked for one in return. I asked him if one needle was enough for the whole weekend. The answer was no, so I gave him four more 2cc needles.

The field workers also have regular contact with dealing addresses. If the dealer allows his or her customers to shoot up on the spot, we supply clean needles and sharp-safe containers.

Wednesday 26 February 1992. Jonas is an illegal immigrant from Morocco. He is about 22 years old and runs a dealer's joint near Central Station. Most of his clients are Belgian and French and prefer using l cc needles. They only use 2 cc needles in emergencies. l gave him 10 needles and promised I would bring him a box of l cc needles tomorrow.

Supplying individuals with clean needles is therefore a matter of everyday routine. If we have an opportunity we also talk to users about safe use.

Wednesday 26 February 1992. Spangen. I made it clear to Mario that I am not a doctor or nurse. But he still calls me doctor. Since last time two of his abscesses have healed and the cellulitis has disappeared completely. I am pleased that he has followed my instructions so well. Today I helped him to prepare a shot of white and brown. It went easily and quickly because of my help but he doesn't have many veins left and I can understand why shooting up is so difficult for him.

As well as providing help and advice with safe injections, field workers also provide first aid as the following incident shows.

Monday 16 March 1992. Central Station. As usually Central Station was very busy. Mark, an important Surinamese dealer, was owed money by a tall Dutch youth with a full head of curly hair. Apparently 'Curly' had no money again, and Mark suddenly punched him on the nose. I helped him to stop the bleeding. When I had finished Mark told him to clear off in a very threatening way so the guy left pretty quickly.

The field workers also provide other forms of first aid, for example, if an addict is 'spaced out'. Usually this means people who are paranoid and frightened because of coke and people who have consumed too many tranquillisers (and alcohol).

Monday 12 October 1992. Central Station. I sat down next to Marie who had been taking pills and drinking. She had a cheap bottle of fruit wine between her knees and was very spaced out. Her purse had fallen open on the ground and her things were lying on the street. I put them back in her bag and put the bag under her. 'Thank you,' she said with difficulty. Her face was covered with slime and snot and one or two bystanders made rude remarks about it. I fetched a damp cloth from the reception centre and wiped her face clean. I said to the onlookers that I would wipe their faces too, if they ever needed it. Fat James mumbled, 'Sorry'.

People who have been using a lot of cocaine for a long time often see imaginary creepy crawlies and suffer from anxiety and paranoia. Several methods are used on the drugs scene to make the come-down easier. Heroin is the most commonly used drug but diazepam (Valium) produces a similar effect. 9

Friday,18 September 1992.1 went to see Wendy at home because she upsets other users. She is in a manic period again and is using a lot of speed. She screams involuntarily and her motor functions are peculiar. I advised her to take Valium but she didn't want to. l will inform her methadone programme so they can make sure she sees a psychiatrist.

When something happens on the dealing scene at Central Station that we find unacceptable we take action. The police don't interfere with us. We try to warn users by word-of mouth but we also hang pamphlets in the reception centre at Central Station. We also distribute them to all of the methadone programmes and other places where lots of users congregate.

Wednesday 28 October 1992. John comes up to me and shows me a blue tablet. He says 'What is this?'. I reply without hesitation, 'Valium'. 'Wrong,' says John, 'it's Haldol. At Central Station they're selling it as Valium.' I am shocked but several bystanders confirm that it's true. John gives me the Haldol tablet and I promise to do something about it.

Two days later a warning is issued in French and Dutch.

The price of heroin and cocaine in Rotterdam is relatively low (cocaine from 50 guilders for half a gram, heroin from 40 guilders for half a gram), but many people become ill through using dope every day. People steal and rob every day to feed their habit. There are rows every day between dealers and customers about quality and quantity. The last two quotations illustrate that it doesn't always have to mean trouble.

Tuesday 18 August 1992. Central Station. Bert looks terrible. He confirms that he is not doing very well. 'If things are going badly I come to Central Station.' He says the atmosphere at Central Station is much harder than it used to be. At least they help you at a dealing address if you're sick, here they just let you rot. I know that if things are going badly with Bert he switches from smoking to injecting, so I give him eight 2cc needles.

Monday 26 October 1992. Central Station. John is sitting in a corner very sick, no money, no dope. 'Can you lend me ten guilders till Thursday....' I decided that he was in such a state that I had to do it for once. But I wanted him to eat something because he has so many physical ailments at the moment. I slipped him ten guilders and we went over to Brian, the dealer. A ball of brown heroin costs precisely ten guilders. Luckily I know Brian quite well and said 'He's only got ten guilders and he still needs to eat'. He let the coveted ball go for 7.50 guilders. John left quickly and Brian said 'You've cost me money' and he asked if I really thought John would buy food. 'I did what I could,' I said.

With thanks to the field workers of Odyssee Hadon for their work and for the extra effort they make by recording their experiences in the log book every time.

Cas Barendregt

Stichting Odyssee, Project Hadon, Rotterdam, The Netherlands