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Harm Reduction

Purpose & Aims

The aim of the group, is to bring together drug and alcohol commissioners, from across the country, to discuss evidence-based actions and interventions that support the delivery of harm reduction initiatives in local communities across England.

The group is a place for commissioners to share information, learning and good practice from across the country and to develop resources for the sector.


  1. Share local/regional approaches to harm reduction: successes, challenges, barriers.
  2. Review and endorse harm reduction approaches, interventions and initiatives on behalf of the English Substance Use Commissioners Group.
  3. Provide a platform for researchers, practitioners and advocates to inform commissioners and to seek support for initiatives.
  4. Produce guidance for commissioners/implementation leads on various harm reduction approaches and initiatives that the group supports.
  5. Host information and resources for commissioners and the wider sector.

Definition of Harm Reduction

The group uses the following definition of harm reduction from Harm Reduction International:

‘Harm reduction refers to policies, programmes and practices that aim to minimise the negative health, social and legal impacts associated with drug use, drug policies and drug laws.

Harm reduction is grounded in justice and human rights. It focuses on positive change and on working with people without judgement, coercion, discrimination, or requiring that people stop using drugs as a precondition of support.’

Safer Inhalation Toolkit/Crack Pipe Distribution: Letter of Comfort

During summer 2023 the group surveyed members of the ESUCG to ask of their experiences in obtaining letters of comfort to enable the distribution of crack pipes/safer inhalation kits in local areas, both to support engagement with people who smoke crack cocaine and to reduce the harms associated with smoking crack cocaine. The survey return led to the development of a template letter of approach to engage local police leaders on the issue, requesting that a letter of comfort be issued.

The template letter can be downloaded for free below and is for use by any Public Health commissioner in England.

The Harm Reduction Group note that safer inhalation packs increase the supply of ready made, safe and reusable pipes thus reducing risks associated with home-made pipes which are often in short supply and widely shared. The distribution of these packs could also reduce the risk of people choosing instead to inject crack cocaine and thus negates the risks and harms associated with intravenous drugs use and potential needle sharing.

Download Template

REACT Improving Vein Care & Reducing Pain Toolkit

In March 2023 the group supported the dissemination of the REACT ‘Improving Vein Care & Reducing Pain’ toolkit for people who inject drugs. The toolkit was co-produced by researchers from the University of Bristol, people who inject drugs, the Bristol Drugs Project and other partners.

Alistair Flowers, Chair of the English Substance Use Commissioners’ Group (ESUCG) Harm Reduction Working Group, said:

“The ESUCG is glad to be able to support the dissemination of the REACT Toolkit to commissioners across England. The Harm Reduction Group feel that the toolkit is engaging and able to be used in a variety of settings from clinical and outreach settings, through to use by and for peer networks. The ESUCG supports a sector-led improvement approach to commissioning and it is fantastic to be able to share this toolkit and to promote it as a model of good practice. The toolkit supports problem solving conversations and can be a useful resource to protect and improve the health of people who inject drugs.”

The toolkit and associated training material can be downloaded and disseminated for free, here.

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