An appeal for expert opinion yielded the following replies

1. “My advice - if you are doing schools based drug education - don't call it 'harm reduction'. There's lots of scope to deliver sensible/balanced drugs education within UK guidance. Politically, it's going to be difficult to get broad support for harm reduction in schools.”

2. “I think this is just the typical problem of terminology. It is for this reason that we only use the classification of the Institute of Medicine (universal-selective-indicated). What is being described here is nothing more than selective prevention in schools (for pupils that already consume alcohol and maybe other drugs as well). There is no point here of talking about harm reduction only because just 20 % of pupils are abstinent. I consider it very important to limit the term "harm reduction" to where it derives from: interventions for problematic drug users without a primordial aim of reducing drug use. And this is not only for reasons of political caution. The term is also so ill-defined, that it could be used for every kind of intervention: At the end, all prevention could be seen as "harm reduction". So, if we target drug-using (or -experimenting) pupils in school-based prevention interventions, this is selective prevention and this is done naturally in many EU member states, being an important and sensible strategy, also for youth that has already intensive experiences with alcohol (aiming at promoting controlled, responsible or reduced consumption). ... But this is (according to the description given) not at all "harm reduction", which would target problematic, dependent drug users, just preventing secondary health risks.”

3. “Drug and Alcohol education are delivered as part of the National Curriculum in schools in a Personal, Health and Social Education lesson. It is the responsibility of the teaching staff to plan and deliver such lessons. The lesson will deal with the consequences of Alcohol and Drug use so there will be an element of harm reduction built into the lesson. Each Local Education Authority on Merseyside has a PHSE co-ordinator with specific responsibility for ensuring that Drug and Alcohol Education is delivered in the schools. They have access to a range of publications on the issue which they forward to schools for use in the PHSE lessons.”

Drug Education in Schools in England

1. Drug, alcohol, and tobacco education is an explicit, non-statutory component of personal, social and health education (PSHE) and citizenship at key stages 1 and 2; non-statutory framework of PSHE for key stages 3 and 4; and the citizenship programmes of study for key stages 3 and 4 (Table 1)

2. Aspects of drug, alcohol, and tobacco education are included in the statutory teaching requirements for science

3. It is up to individual schools to decide what drug, alcohol, and tobacco education is provided beyond that required by the programmes of study for science

4. In primary schools OFSTED will evaluate and report on drugs, alcohol, and education within PSHE and citizenship although a separate subject section is not required; in secondary schools this will be inspected as part of PSHE. Inspectors will also judge the effectiveness of a school’s policy for managing drug related incidents.

5. The development of an integrated whole school programme is supported by the National Health Schools Standard. Drug Education is one of its 10 themes.

6. There is a harm reduction focus for alcohol education especially in KS4 which includes teaching the recovery position

Table 1 Statutory and non-statutory drug, alcohol, and tobacco elements of Key Stages 1-4

Responding to a drugs incident in school

1. Schools should have policies that describe their approaches to dealing with drug related incidents (Circular 4/95, DfEE). Most schools have a drugs policy in place.

2. Schools do not legally have to tell the police about a drug incident and they don't have to tell the parents of the child, at least not in the first instance. But schools will generally involve parents and police before things get out of hand.

3. Key objectives of the drug policy should be:

• Clarify the legal requirements and responsibilities of the school

• Reinforce and safeguard the health and safety of pupils and others who use the school

• Clarify the school’s approach to drugs for all staff, pupils, governors, and parents/carers, external agencies and the wider community

• Give guidance on developing, implementing and monitoring the drug education programme

• Enable staff to manage drugs on school premises, and any incidents that occur, with confidence and consistency, and in the best interests of those involved

• Ensure that the responses to incidents involving drugs complements the overall approach to drug education and the values and ethos of the school

• Provide a basis for evaluating the effectiveness of the school education programme and the management of incidents involving illegal and other unauthorised drugs

• Reinforce the role of the school in contributing to local and national strategies.

4. Examples of school resources (alcohol) which use a harm reduction flavour:

Alcohol Support and Guidance for schools - Alcohol Concern

Consequences - Alcohol Advice

Drunk in charge of a body - Alcohol Concern

Effects and Hazards of Alcohol - WRS

Finding out about drinking alcohol - Portman Group

How to become an Alcoholic - Viewtech

PSHE: Alcohol - Folens

Survival guide to drinking - Health Ed Scotland

The truth about drinking - WRS

Think before you drink - Gogglebox

Thinking about drinking - KS1,2 and 3 - BNTL

Thinking about getting pissed tonight - ESHP

What young people should know about alcohol - Scriptograph

Where is the harm - Lancashire

You and alcohol - just good friends - Concorde Video Council

5. Drugs: Guidance for Schools (DfES 2004)

Given prevalence of alcohol and increased vulnerability of young people, educating pupils about effects and how to reduce alcohol related harm is a priority for schools. Alcohol education should start early at primary school before drinking patterns become established. A harm-reduction approach. Drugs: Guidance for Schools (DfES 2004)

6. “ I suppose it depends on how we define the term Harm Reduction. If we aren’t using harm reduction as an approach then we are promoting abstinence. However, we don’t seem to say that. We do talk about informed choice but often those we say that go on to say that the choice is "not to use" or use the term "in an ideal world" and that is abstinence whichever way you look at it. There is no way that we are going to tell young people not to drink alcohol so we must give them harm reduction messages i.e. how to use alcohol safely   even if we say don’t drink it until you are 18!  Why do we then separate those drugs that we say are illegal   and do we say you don’t use them just because they are illegal. Informed choice seems to be the message given but I really don’t think we are honest about what it means, and where do medicines come into that - SSRI’s for example?”

References

1. Canning U, Millward L, Raj T, Warm D (2004) Drug use prevention among young people: a review of reviews

2. Department for Education and Skills (2004) Drugs: Guidance for schools. London, DfES

3. Qualifications and Curriculum Authority (2003) Drug, alcohol, and tobacco education: curriculum guidance for schools at key stages 1-4. London, QCA.