The drugs project at St Annes Shelter and Housing Action has aroused controversy ever since it was set up in 1994.  Its latest development - training for drug users on safer, healthier and more considerate injecting practices - is certain to raise some eyebrows. Liz Butcher, the project’s co-ordinator, takes it all in her stride as she talks to LAF about the past and the future of the service. 

Liz Butcher began as a counsellor with the drugs project at St Anne's Shelter and Housing Action when it was established in 1994. Along with other staff at St Anne's, she quickly realised the futility of trying to provide a purely counselling-based service to people whose health and housing situation made progress impossible. “There was a cycle that many people were stuck in. They were drug users with no permanent home. They would sleep rough or squat and at some point they end up in a hostel. After a while they are back out and so the cycle continued.”


Many were also sharing needles and their health was often deteriorating. Not only was the project witnessing a failure of existing provision to offer a realistic way out of this downward cycle, but also the prospect of a catastrophic spread of HIV amongst injecting drug users in the city.

Staying alive

The emphasis of the project was soon shifted from a primarily counselling-focused service to something much more diverse. Improving the survival prospects of those injecting became a priority and the planning and lobbying for a needle exchange service began. At the time, the nearest exchange service to the city centre was a pharmacy in Chapletown, an area which at that time had very little association with the injecting of drugs.

In 1997 a needle exchange programme was finally established, despite widespread scepticism. Doubters thought that there simply wasn’t enough demand for the service. Liz smiles about it now. “We struggled and argued for years to get the project off the ground. We said that 50 people would use the service a week, but many thought that number was too high.” The needle exchange now has over 100 people through its doors on a busy day and is used by well over 1,000 people a year.

To ensure the widespread take-up of the needle exchange service, which is based at the St Anne's Resource Centre near the Leeds bus and coach station, an outreach service has been developed. The outreach service offers the same harm reduction advice and equipment exchange as the central service - barrels, needles, swabs, citric, pocket bins and condoms - but operates across Leeds, including home visits. This is coupled with a mobile harm reduction service operating in parts of the city that works with local communities on all aspects of drug use.   (Note: West Leeds Community Drugs Service covers the Bramley/West Leeds area with a similar service. Contact details are opposite).

The needle exchange has been an overwhelming success, and has mirrored the success of similar projects elsewhere in England. Liz’s belief that this would probably be the single most effective activity that could improve the survival prospects and curtail the spread of HIV amongst injecting drug users has since been confirmed by research. Most recently, a report published in the prominent health research journal Addiction shows that where there is adequate needle exchange and complementary services the prevalence of HIV among injecting drug users is low, stable and may even be in decline. This is in stark contrast to other areas where there is no needle exchange provision and there is an alarming upward trend in HIV infection among injecting drug users (Parsons et al, 2001).

Reaching out

The exchange service is just part of the project’s provision, which also includes one-to-one counselling, pre-detox support, advice about treatment options, complementary therapies and training. The basic aim of the project is to reduce the harm associated with drug use. The project works to maintain and improve the health and well being of drug users until such time that they are ready and able to undertake treatment and backs this up with preventative work, awareness raising, training and public health issues such as placing sharps bins in the city centre.

The project works extensively with a whole range of other agencies, including St Anne’s own accommodation services, other service providers, health agencies, social services and so on. This work includes advice and information, training, referrals and collaborative work.

Safer streets

Since 1998, the project has been placing sharps bins around the city. Poorly discarded sharps are a potential health risk, particularly for those involved in cleaning the city and maintaining the planted areas. Discarded sharps were also an unsightly problem for many local businesses. Discreetly placing sharps bins around the city and publicising their whereabouts is a simple and effective way of reducing the problem. As Liz was keen to point out, people who inject drugs generally have no wish to harm or annoy others. If sharps bins are available and sensibly placed, people will use them.

Entrenched

The age profile of the needle exchange users may surprise many of us - the media stereotype of a heroin user is often the troubled and penniless teenager. Around sixty percent of the exchange’s users are aged over 25 years old while around forty percent are between 18 and 25 years old. Just a tiny minority are aged under 18 years old.  This suggests that younger people are not injecting heroin on a large scale, but also that older people are not finding a way out of their addiction. In fact, many are still in the same entrenched cycle that existed when the project was set up in 1994.

When asked why people were still falling through the net, there was clear frustration. “There’s only so much we can do as a drugs project. These are real people and somewhere along the line things have gone very wrong for them. It only takes a short time for things to go badly wrong for someone, but it can take years to set it right again. There needs to be an acceptance that working with homeless people can often mean working with drug users, and everyone needs to look at their policies and practices again to see if they are preventing that work from taking place.”

Liz gave little credibility to the suggestion that the Wintercomfort case may have made projects wary. “That case was about a very badly managed and run project. There’s no suggestion that a well run and managed project with sensible and clear policies and a good working relationship with other services and the police should ever have any problems like that. There are several accommodation projects in the city working explicitly with injecting drug users. They have no problem in doing that and neither does the police.”

What’s next?

The project is now developing a four session training programme for injecting drug users which covers preventing an overdose, preventing the initiation of others into injecting drugs, safer injecting and safer disposal of equipment. The project is still working hard to get the take-up of sharps bins increased around the city, including exploring possibilities with Metro to have some kind of provision on some of their sites. Clearly after eight years, and a growing use of drugs in the city, the staff at St Anne's see the work as having just begun.