ONE OF THE enduring legacies of my time as a young consultant in emergency medicine in Liverpool, in the 1990s, has been an enthusiasm for the city’s ‘Harm Reduction’ approach in tackling the use of (illicit) drugs.

For those unfamiliar with this now-widespread public health notion, the concept translates into a (1) compassionate and (2) ‘pragmatic’ approach to drug users, that prioritises keeping them alive and well instead of abruptly enforcing abstinence or ‘criminalising’ them by reflexively involving the police when drug use is discovered.

Earlier informal ‘harm reduction’ models did exist (like the ‘crash tents’ at the Isle of Wight or Glastonbury music festivals, the Ana Liffey Drug Project in Dublin in 1982, or the world’s first syringe exchange in Amsterdam in 1984), but the “Mersey Model” in the mid-1980s is widely credited with popularising harm reduction, with the UK’s first major syringe exchange service, a radical new policy by Merseyside Police of not prosecuting people for possessing needles for exchange and the advocacy of pioneers like Dr John Marks for prescribing pharmaceutical alternatives, including Heroin and Methadone, to ‘stabilise’ users’ lives and reduce crime.

And, in 1990, Liverpool (Dublin’s twin city) hosted the 1st International Conference on the Reduction of Drug Related Harm, which led to the founding of the International Harm Reduction Association (now Harm Reduction International).

I have good reason to appreciate the harm reduction model. For most of my career in emergency medicine, I worked in the heart of cities – Dublin, Edinburgh, Liverpool and Cork – with devastating drug problems, and dealt almost daily with the medical consequences, from overdoses to injection site abscesses, cardiac infections to AIDS, as well as the ‘challenging’ behaviour of those battling with addiction, like drug-seeking or pilfering from healthcare stocks.

Does harm reduction mean no responsibility?

Moreover, I’ve always had a particular empathy for the people of the inner city: my grandmother started life in........

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