[Trigger warning: This article contains reference to needles, drug use and abuse]
Tucked away on the bustling Broad Street, is a place you might not have noticed unless you’ve needed to - The Health Shop. With their inclusive drug and sexual health services, they have established a legacy in harm reduction going back to the HIV epidemic. A vital part of this is their needle exchange - which has kept people in Nottingham safe for more than thirty years.
“It’s more than just a needle exchange,” Lou tells me. “It's more than giving a transaction. It's care, it's kindness, it's compassion, it's understanding, it's respect. I respect my service users so much. They've taught me so much, and I'm really grateful to them for that”.
Lou is Team Leader at The Health Shop on Broad Street, which hosts a number of services including STI testing, sexual health advice, and a needle exchange - providing local people with harm reduction interventions, like safe injecting equipment.
“Our service users who come for needle exchange are really diverse”. These include people who use drugs like heroin, crack, and to a lesser extent amphetamine and ketamine. But Lou also sees people using performance enhancing drugs like anabolic steroids and increasingly, people self-sourcing hormones as part of gender affirming care.
Another key method of support is naloxone - a life saving medication that reverses opioid overdose. “We give out naloxone to service users to take away, so if someone overdoses at home or outside, then they can save each other's lives until the ambulance comes,” explains Lou. “By not providing somebody something doesn't mean they're not going to do it. We're here to reduce risk. Everything we give out has a purpose. It’s all harm reduction.”
Lou shows me some of the equipment. Needles of different sizes for different parts of the body, so that people don’t damage their veins unnecessarily by using needles that are too big, blunt or used.
“Infections get passed blood to blood, things like HIV, hepatitis B, hepatitis C. If we don't give people new equipment, they'll reuse and reshare.”
She shows me sachets of citric acid, which is necessary to dissolve heroin into a liquid that makes it injectable. She knows people who, if they don’t have this, use kettle descalers or vinegar instead. She shows me a little filter, which people might swap out for tampons, or bits of sock, which pass dangerous fibres into the blood.
“We're not just a needle exchange,” she says again. “We really care.”
Lou tells me that needle exchange is seen as one of the blueprints of good harm reduction. Set up in the height of the HIV epidemic, alongside other initiatives that were fundamental during this crisis, the needle exchange has been on Broad Street for more than thirty years. In that time, Lou has seen rates of blood borne viruses “go down massively”, because of the impact of testing, access to treatment and needle exchange.
“If someone continues to use drugs, they're okay too. It's not like people who stop using are good and people who don't are bad. I think a lot of people, when they come to the service, they think somebody's going to tell them to stop doing something or to make better decisions. We don't really do that. We believe in autonomy. We just need to keep them safe, really. Because someone dying in a cold car park by themselves is horrific. Anything that reduces that is so important.”
Lou explains that people who use drugs are surrounded by negative and derogatory stigma and shame. Her team have even witnessed an internalised stigma in service users who inject heroin, “that transition from smoking to injecting is massive for some people, and how they feel about themselves.”
It's very interesting, isn't it, that perception of good and bad. We don't look at somebody else who drinks a glass of wine on Friday night who's had a crap week at work in the same way
“It's very interesting, isn't it, that perception of good and bad. We don't look at somebody else who drinks a glass of wine on Friday night who's had a crap week at work in the same way.” Lou says.
She gives me a brief picture of life for some of the service users who inject heroin, and it becomes clear why the ‘support don’t punish’ movement exists. “Heroin is a really good blocker of emotional and physical pain. Not everybody, but a lot of our service users who use heroin have gone through awful times. Quite often, it's the system's fault. The care system, safeguarding domestic and sexual violence, a lot of them have witnessed horrific stuff. But then they are punished for using a drug that blocks all that stuff out.”
“I think penalising people for just trying to survive is really wrong,” Lou says, referring to the way people who use drugs are pushed out of sight, while everyone else goes about their lives.
“If I go to the pub, I can drink out of a clean glass, it's been washed. I can wash my hands. I can go to the toilet. My service users, if they're going to use heroin, it's cold in a car park where there might be someone having a poo round the corner. They've not washed their hands for five days. There's nowhere to wash them, the toilets have been locked since COVID. They've got no choice, and they're punished for all of that, really.”
Lou explains that a few years ago, Afghanistan reduced their heroin growing by around 90%, causing a shortage, bulked up by nitazenes. “For the first time, synthetic opioids called nitazenes were introduced in the heroin supply. If heroin has a relative potency of one, fentanyl is fifty, and nitazines are between fifty to 500 times stronger than heroin. So we had some significant overdoses nationally, and sadly our area is no different. Our service users have got no way of knowing how strong something is until they've taken it.”
For The Health Shop team, challenges like these demonstrate the necessity for the needle exchange, but importantly also, the encompassing service it brings people into.
“We've managed to do loads of work because we can see people. If we see them, we can help. When someone comes into the service, they get offered everything. Access to drug treatment, going on something like a methadone script, stabilising, securing accommodation, contraception, STI testing. You see people's journey. We’re part of someone's life, sometimes a little bit, and sometimes a lot. Like Mary Poppins, I always think. There for a short period or long period, whatever someone needs.
“People come here when they don't know where else to go. We're a constant. Some people haven't got contact with family. Recently, because I said ‘who's in your life?’, someone said, ‘you're in our lives’. We are their protective factors, because we are there every day for people.”
Lou says needle exchange is a lifeline. She shares a quote from a friend that resonated: “‘Dead people don't recover’. So if we can't keep people alive, then how do they stand a chance?”
The Health Shop is located at 12 Broad St, Nottingham NG1 3AL.
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