Chris Rintoul is the Innovation and Service Lead for Cranstoun, a harm reduction and social justice charity in the UK. He lives in Northern Ireland and has worked in drug treatment and homelessness services since the early 1990s. He has a specialist interest in overdose prevention and responses.

1980s Liverpool, England became a birthplace of harm reduction. These approaches spread broadly across the UK from 1985-2010 ensuring HIV prevalence remained low among PWID. Since then a government backed abstinence agenda has dominated UK drug treatment. The most at-risk polysubstance users disengaged from treatment services which typically offered short term, sub-optimal doses, of opioid agonist. The UK has one of the highest overdose rates in Europe, particularly in Scotland.

Cranstoun has provided drug treatment services across England since 1969. A change in CEO in 2020 catalysed a renewed focus on harm reduction and social justice. Harm reduction activists were attracted to work for the organisation. Relevant policies were reviewed to bring into line with evidence and best practice, including those on overdose and injecting equipment provision. Multiple harm reduction champions from across services were seeded in order to ensure the impacts were felt in all areas served. They were equipped with new training materials such as those on naloxone administration. Wider staff training needs were also identified and addressed.

The organisation underwent a rapid change in focus from abstinence to harm reduction. A rebranding and new website allowed us to communicate this focus to a wider audience, causing a stir within British drug treatment circles. This was particularly evident when we addressed the need for drug law reform to a regulated market, revealed our intentions to set up Overdose Prevention Centres, commenced diamorphine assisted treatment and developed 2 peer-led community networks of active drug users to provide naloxone.

A mantra of ‘system change by doing’ has enabled a range of new innovations such as overdose response pouches and a phone app for PWID ensuring there is someone who could assist them with a pre-agreed rescue plan if they overdose alone.

“We are bringing harm reduction back home.”