What are the fundamental principles of harm reduction and how can they be applied to many areas of human activity? How can tobacco harm reduction be integrated into mainstream practice to reduce the harms of smoking for those most at risk – illicit drug users, those with poor mental health and others marginalised through economic and legal constraints? What are the obstacles to integration and how might we address and overcome these?
Transcription:
Marginalised and hard to reach populations
2026-06-04 · 11:30-13:00 (Europe/Warsaw) · Global Forum on Nicotine 2026
David MacKintosh 0:00:03
Okay, good morning. It's nice to have a decent audience for this session. My name's David MacKintosh. I'm one of the directors at Knowledge•Action•Change. And this workshop is looking at how tobacco harm reduction can engage marginalised and hard-to-reach populations. That's the title of the session.
I'm going to make the point, and I know some other people on the panel might refer to it, that when we talk about hard to reach populations, a very common term certainly in the UK, what we actually often mean are populations that we haven't really designed services for or haven't thought about what the needs of those populations are.
Some hard to reach populations are actually really very easy to find if you know where to look and you have an idea of what you're trying to do. We're going to look in this workshop at some of the fundamentals harm reduction.
We've got a tremendously knowledgeable panel here, and we're looking at traditional harm reduction and how tobacco harm reduction can possibly work alongside some of that.
Quite a few people here have got backgrounds around policies and practice and services around drug treatment, but obviously there are many other groups, people who are experiencing mental health issues, people who live in poverty. There is no shortage of populations that could do with better services.
And just interestingly enough, many, many of them have much, much higher rates of smoking than you would find in the general population. So a very quick introduction to the panel. We have Adriana Corrado from Portugal. Portugal, as many of you will know, has got a great history in terms of developing harm reduction approaches.
And Adriana's done an awful lot of work in this field, and I think I have known some of your work going back at least four or five years now, including development of drug consumption rooms and has a great interest in community-based projects. We have Dee Cunniff at the end here. I've only known Dee around two decades. Sometimes it seems longer.
I've worked with Dee on projects around hepatitis C, and Dee could be said, actually, in England, is leading something of a renaissance in actual proper harm reduction services, which don't do harm reduction on the side, but have harm reduction as their core purpose. I have Alexei Lakoff here.
who has got tremendous experience, worked for a range of organisations, many of which involve people who are and have been using drugs, and he brings a tremendous range of knowledge across the region. Currently based in Germany, but you've worked in Russia and various other countries in the Eastern European area. Last but not least, we have Dr.
Mariana Hoyo from Mexico, who is doing some very interesting work around cannabinoid science. Also has a great interest in harm reduction lifestyle medicines, but also has an interest in autonomy and patient-centered approaches.
There is also other key participant in this session, and that's you out there, some of whom I can see, and some of whom are lost somewhere in the glare, and when I get to trying to get you to engage with us, if you're sitting in this bit and I'm squinting, stand up, wave, shout or something.
What I'm going to do is ask the panel members to do a sort of brief introduction, make some key points, and we will take it from there. So, Adriana, you're up first. Away you go.
Adriana Curado 0:04:16
Thank you. It's working? Yeah. So first of all, I want to thank you the invitation. It's a pleasure to be here for the second year in a row and to have the opportunity to share experiences, to learn, and to unite efforts for change. So by the end of yesterday, I felt quite optimistic, even if the world doesn't give us many reasons to be optimistic.
But listening to the discussions here, I felt there is a growing understanding that change is probably inevitable. So the question is to make sure that this change does not leave behind people who are most affected by smoking. The question for this panel is how tobacco harm reduction can engage marginalised and the so-called hard to reach populations.
David already made a note on this, but I would like to say that for me, hard to reach should never mean individual blame. should not be used to suggest that people are difficult or irresponsible or unwilling to care for their health. And should not be used to justify punitive or restrictive approaches. Instead, this expression should make us ask a different question.
Who is not being reached by services, policies, programmes? Who is being left out? So these are the questions we need to make. For me, harm reduction is not about the ideal. It's about the possible. Almost everything we do in life involves risks.
And what matters is whether people have information, resources, and conditions to reduce those risks, and whether they have access to safer options. Of course we need policy change. Say for nicotine, products need to be available and more accessible than the most harmful ones. But when we talk about people in situations of deep vulnerability, this may not be enough.
So the people most affected by smoking are often the people with the least access to support. They may live in homelessness, poverty, criminalization, violence, mental health problems, and daily drug use. In those contexts, making products available does not mean that people can afford them, can maintain them, or incorporate them into their daily lives. But this is possible.
History of armed reduction teaches us that we can learn with We learned this with needle and syringe programmes, opioid treatment, hepatitis C treatment, drug consumption rooms. People can and do protect their health when the right conditions are created.
So today I would like to reflect briefly on women who use drugs based on our community experience in Lisbon with groups of women and homeless people.
So in these groups, we gave the opportunity to people to try safer nicotine products for free and with support weekly. In the women's group, Many participants were living in extremely precarious situations, living on the street, engaging in sex work, surviving sex work, long histories of drug use, experiencing many forms of violence, and with limited access to support.
What became clear is that smoking was not just an habit. It was a way to deal with stress, fear, conflict, anxiety, and sometimes allow them moments of autonomy. A pause, a way to breathe, a way to manage emotions. At the same time, what we saw was not resistance or lack of interest.
Many women were curious, wanted to try safer nicotine products, wanted to talk, wanted to understand whether this could help them to reduce cigarettes, to manage cravings, or even to avoid risky practices like sharing cigarettes or picking up butts in the street. So in the end they wanted to feel better.
This is why gender perspective is important in tobacco harm reduction. Not because women are a separate issue, but because gender helps us to see and understand the links between smoking, poverty, drug use, mental health, and so on. And perhaps this is my main point.
Tobacco harm reduction should not reproduce the same gaps we have often seen in other areas, whether research, data, services, programmes, policies are often designed around men's experiences. So if we want tobacco harm reduction to reach those, and this was the question of the panel, those most affected, the gender cannot be ignored. Thank you.
David MacKintosh 0:11:17
Thank you, Adriana, that was a really powerful foundation that I think we explore, and the point that we don't want to replicate the existing errors in services is a very good one. Dee, over to you.
Dee Cunniffe 0:11:33
Hello, everybody. It's good to be here to talk a little bit about experiences that I have had starting going back to the 1990s and into the early 2000s with harm reduction.
And I'd never thought before I started to engage with the GFN and the work that's happening about how tobacco needs to fit into this, how the use of how tobacco is used by people is part of the whole picture. I'd like to go back to, I was mentioned, so I commission and lead a service which is a harm reduction service. It's called Swerve.
And that name was created by the lived and living experience. We have living experience people in our service that volunteer. People who currently use drugs, they do it. And they created the name, Safe Ways to Engage, Volunteer Resource and Empower. So they spent a lot of time on that to be the name. So that's the service.
We are not part of the drug and alcohol service in our area. In London, in the UK, often the harm reduction services Any harm rejection that's happening happens within the drug and alcohol service. So we're completely separate.
The London Joint Working Group partners with the Hepatitis C Trust, who people know all across the world, to create this service, which is in City and Hackney.
So the background to that is really quite important to look at tobacco issues So the principles of harm reduction, I was sort of looking at what people have written about the principles of harm reduction, and it does come down to, I do agree with those principles, that there needs to be some pragmatism and realism.
This harm reduction is, and the need for that is part of its enduring feature of society. And you cannot force total abstinence of anything. And people have tried this with drugs. It doesn't work. That is the experience. So also, which I know some of colleagues will talk about as well, meeting people where they're at.
So one of the things that we have been doing was when we were given this piece of work, we created the service based on learning that we got from the 1990s and early 2000s before harm reduction was the end of it.
People will say there was harm reduction, pharmacies would give out packs of NSP, needle syringe provision, but what was happening before the sort of round out 2005, was really effective, comfortable areas for people to come, community, wide-ranging holistic support for harm reduction, then reduced to going into a pharmacy and picking up a pack, an NSP pack.
And it was linked to politics. You know, there was a whole move towards recovery. And... I believe in recovery for people that are ready for it. And I have experienced myself of stopping drugs and alcohol because I needed to. But the people that I work with in the community, we don't call them clients either and we don't call them service users.
They are the people in our community and they don't want to stop taking drugs. Okay, so meeting people where they're at we met people who were Really had become been forced into almost being like an underclass and people just were not accessing any service So we've been measuring who attends the drug services in the area.
And the very first quarter, there were 82% of people we saw did not access the drug service. It's now evened out at around about 60% of the people we see do not go to the drug and alcohol service. Even though drug and alcohol services have got great people and they really, really want to be engaging, the whole idea is there are people who do not want to give up using drugs.
OK, so it's important, I've heard here being discussed for my colleagues, autonomy and dignity. People who use drugs, use drugs now and do not want to give them up are human beings. They have a human right to be treated like human beings, which has not been happening. And that's important. OK, so...
So participant involvement is the other, when I was sort of exploring what the overall view of principles is. And so we have the lived people who've used drugs previously, but we also have living experienced people. I went to a conference and there was a lot of talk about lived.
And when I presented about the living experienced people that come to our service, there was a living experienced person in the audience. It was a homeless conference. And he said, I'm so glad to hear this because all the lived experience people, they don't know where, what's happening now. They don't know where the crack house is.
They don't know where the communities are meeting. They don't know what's happening because they are lived. And it might be years of it. I've got no idea, as lived, no idea. We need living experience, and we need to be willing to recruit into staff.
We have many volunteers who are living experience, and we hope that we'll be able to help them to come through with the support they need to be able to be there, as be able to be staff. Okay, so regarding tobacco harm reduction, In the middle of all this, I went to a meeting which David was leading in London at the Guildhall and brought along...
One of our staff members is our women's coordinator. So our service has a van and a trailer. It has a... a hub, which is comfortable with couches and stuff. All of this creation did come out of focus groups and speaking with the community, not just because Dean knew it from the 1990s. We didn't do that. Thank goodness.
And some things have changed, but a comfortable place for people to be where they're treated like human beings is central. And then we started a women's specialist service. So our women's specialist service lead coordinator, she came along And she has brought, since that meeting, she has brought into harm reduction into our main practice. It's part of our holistic service.
We're very new at this. We know that people who use drugs, there's a higher rate of people, I think the measurement was actually in people in treatment rather than people just in a harm reduction service, but 44% of people smoking as opposed to around 10% in the general population. So we know there's a lot of people smoking.
We also know, which was mentioned as well before about mental health, we did an insight survey. We know that 69% of people that we help, that come for support, are in mental health services. Okay, and the last thing is obstacles to integration. So, okay, harm reduction with tobacco. It needs to be the whole holistic. It needs to be part of everything.
And at the moment, we've got barriers already seen. There's an NHS service that is smoking cessation, and we're engaging with them. But we can't give out the vapes. We have to meet the person, get them to go and have an appointment. We need to move past that. We need to be able to give out the vapes. We can apparently give out pods as long as we record that.
We want to record stuff anyway because we want to learn from it. And we have issues because, of course, snooze is illegal to sell in the UK, although it's... Even though there's minimal side effects, I didn't even know there were minimal side effects, you know, until I started engaging with you guys. I had no idea. I thought there was mouth cancers. You know, I thought that.
OK. Cost of vaping equipment and inaccessible. So I think I would just like to finally say I hope that for tobacco, we learn from the ineffectiveness of prohibition, the war on drugs. Hello, have we won this war? No, no way. To use that term has just been so destructive and people have just been pushed underneath. Do not push people. Do not push people who smoke down.
They will go and they'll hide. And then they will often be harmed. OK, and all I'll just say, the final word is, please don't just focus on people being abstinent from people, as in drugs. Focus on reducing harm, and I believe you'll get to look after the human being. Thank you.
David MacKintosh 0:22:44
APPLAUSE Thank you, Dee. You can breathe now. I can say, just having been to where Swerve's based and meeting some of the people there, there is an energy and an atmosphere around it, which is rather wonderful. We did used to have a few more services like that, and it's good to see them reappearing in London. Now, moving a little away from London, Alexei, over to you.
Alexei Lakhov 0:23:14
Thank you very much. I have a presentation, a short presentation, just several slides to show what is going on and what I will be talking about. My name is Alexey Lakhov. I am working with CO-ACT, Technical Support Agency, and European Network of People Who Use Drugs.
When it comes to tobacco harm reduction, I am actually a newcomer, and I am only just beginning to learn about it, so I am here today as much to listen as to speak. But what I can bring today is what I do know, how we reach people who use drugs where they already are today. And this is online, basically. And why something as small as a safer smoking pipe can matter for them.
And on this slide, you are looking at a drug shop in Warsaw that is open 24 hours a day. It's inside Telegram, a popular messaging app, and this is an app that at least some of us have on our phone, I believe. So if you want this link afterwards, please reach out to me. I needed to make this joke, sorry. And this shop is built like any e-commerce app that you have used.
So basically you pick your city, in this case it's Warsaw, but there are other Polish cities in this shop. So there is a profile, there are reviews, loyalty points, even a referral bonus. And there is a fixed menu, you can see it on the screen, fixed prices in Zloty for cocaine, methadrone, alpha-PVP, ketamine, MDMA, you name it.
And you can pay for it in crypto or by other means, like by your credit card, for example. There is also a medical assistance button, and the market itself recognizes that its customers have health needs as well. So how does this delivery work? There's no dealer. The drugs are hidden in a public spot behind a loose brick, for example, under a tree, on the pavement.
And the buyer just gets a photo and a GPS pin. And for example, if I order it now from here, these drugs can be delivered somewhere nearby so that I can go afterwards, have my coffee, and pick up this stash. And in the region of Eastern Europe and Central Asia, we call these dead drops zaklatki. And in the whole transaction, nobody ever meets anyone.
So basically, I do not know who will bring this stash. And that's exactly why our services can't find these people, because there is no door that we could knock on. So if the deal itself leaves no human contact, the only place left to reach people is online. And that's what we call web outreach.
It's what outreach has always done, making contact, counseling, engaging, keeping people connected to services, but through the digital tools they already use every day. So it's messengers, bots, darknet forums, social media, dating apps, and it actually works.
And just one example from my own experience on the darknet market forum Hydra, It used to be the largest darknet marketplace in the world at some point. I had a thread on hepatitis C. It was run with the administrator's approval. And it got over 100,000 views. And people were really engaging. They were really asking questions.
And at some point, they even did an interview with me and published it on their website. Telegram channel, it wasn't blocked yet, and it had over 200,000 views, and we did see an increase in the amount of clients who went to our harm reduction services. It was in Russia.
And as another example, we also built a telegram bot on overdoses, so how to recognise overdoses, how to do CPR, what to do before the ambulance arrives, and it was used by more than 20,000 people over the years. I think it's also a good example.
And the colleagues in the region, in the Eastern Europe and Central Asia region, they have also shown what this work looks like in practice. So in Kyrgyzstan, there was a web outreach project implemented by FU Kyrgyzstan, and it reached several thousand people, most of whom smoke or snort their drugs, not even inject them.
And Telegram bots and channels, they helped deliver and learn about harm reduction kits, From there, people came in for testing and support. And in the kit, you can see an HIV self-test, condoms, lubricants, lip balm, healing ointment, vitamin C, chewing gum, and at the center, a heat-resistant glass stem, a safer pipe. So basically, it's a pipe for safer smoking.
And why does that matter? Because in their data, among clients who shared pipes, only 24% had ever received any harm reduction materials before. So the pipe was one of the entry points. And this pipe, it does actually three things.
First, it opens the door, and in the recent English safe inhalation pipes provision study, 86% of people walking into a drug service for the very first time, they came in for this specific pipe kit that you see on your screen as well.
And second, it prevents pipes, because street pipes, they are made from tin cans or light bulbs, and they can burn leaves, they can cut mouths, and actually hepatitis C virus, it survives on the pipe for over 24 hours. That's why the message is keep your pipe personal. And third, it offers a safe route. Smoking instead of injecting lowers blood-borne risks.
And it's actually ironic, I think, to talk about it at the forum on smoking cessation. But at the same time, you know, it's also another harm reduction tool that can be utilised. So here, as a conclusion, here is my message. The principles do not change, and the previous speakers have already spoken about it.
It's pragmatism, it's dignity, and it's meeting people where they are. What changes, basically, is the channel. So today, meeting people where they are sometimes means a telegram bot and the pipe for safer smoking. And actually, coming forward, we do not know what will happen, because the main topic of the conference is prohibition.
and public health and when governments start prohibiting safer nicotine use tools, maybe we will find them online next time, you know, and the same goes for snus, you know, and for some other products. We have already seen it with the prescription drugs. Actually, one of the most popular medications that is being sold via these dead drops or stashes in Russia is Viagra.
Yeah, and also some antidepressants, tranquilizers, and other medications. So you never know what will come up on these online markets next time, but we should be ready for it, and we should be knowledgeable about how to reach these people who spend most of their time online. Thank you.
David MacKintosh 0:31:24
That was fascinating. I hadn't seen some of that before. Just if anyone's interested, we will be monitoring people who are going around lifting up loose bricks, looking underneath things, in and around the presidential later. There are cameras everywhere at GFN. But I think some of that about how we've, you know, entirely different ways of reaching people where they are.
That was fascinating. So, to Mexico now, Mariana.
Mariana Hoyo 0:31:55
Okay, ready. Well, thank you again. I'm really excited not to be a panelist, not just an attendee, and I'm happy to share this panel with very interesting sites and perspectives. I would like to say that we have specifically some topics to cover in Mexico, but no, we have a lot to cover. Mostly the whole population, I believe, is hard to reach, not just vulnerable population.
That's the truth and the sad story right now in Mexico. So I would like to point out some of the of the relevant things that I believe it's important to have in mind, at least in our perspective in Mexico and Latin America, where they're very similar contexts.
So I would start to reframe the concept of hard to reach, not just placing the problem on the population, but on the system, because that's where we are. We are not reaching out any people, as I just said. And it's a matter of having something worth staying for, for the people, and we're not giving them that.
We're just not retaining them, or we're giving, or we're missing, or they're having a lot of gaps between what we're offering as healthcare providers, because we don't have the the adequate training, we are missing the gap in the policy and the public health messaging, which is also a very challenging thing now.
Because even though very few of us are trained on harm reduction and we have this perspective, the system keeps, I don't want to say being anti-harm reduction, but it seems like that, or that's what we perceive. So it's their voice against ours. So it gets a lot of confusion for the population, right? So who should I believe, my doctor or the whole system, right?
Now we know that vaping is banned on the constitution. So we're getting the 100% of the market into the illicit market, and they're having the best commercial relationship ever, right? And we're missing all the revenue, which is not getting invested on cessation programmes or harm reduction or any other strategies that would make an actual difference. So that's one.
They're tools, but we're not using them. Or the people don't know about them or don't believe, as it was religion sometimes. It's really funny. They don't look at evidence as a science thing. And another thing, it's the difference between adopt and access, right?
We can have legal products, but very inaccessible, if it's with a stigma, if it's costs, if it's not knowing of your healthcare providers or lack of information. Or we can have prohibited or banned products, but very well adopted throughout the population, like now the vaping. We saw 2020, we started with this prohibition, and we saw that at least in the youth, it has doubled.
the numbers on vape users. So it's not going anywhere, and it's getting a really big concern in public health so far. And well, again, there is a lot of shared barriers with drug users or substance users, mental health, poverty, prisons. We all have the same fragmented services which are not reaching out, lack of information.
Yeah, that is just not reaching out how we would like to, to make actually the difference and have positive outcomes. So we're not having any outcomes. The population that it's most of the smoking rates haven't changed in the past decades. We're still the same.
And still we have nowadays 14 million people smoking, and being very positive, we have around 100 people dying every day in Mexico, so that doesn't make anything to the system apparently. So, and... building or coming into some solutions. We're working or we're making big efforts onto getting a more effective communication, getting people trained on harm reduction.
We're trying to get THR and harm reduction in general into the medical education curriculum. so that it has changed in the beginning or in between or within the start, sorry, so the medical or the clinical encounter can change because if the training is just, okay, you just go with your patient and when they, or when you talk about tobacco, you just say, okay, quit.
And that's it. That's the only tool that the med schools give us, right? They don't ever talk about anything else or alternatives or anything. So we need to update. We need to be open. And that's one thing. And again, coming back to the banning of the products and what just happened, or its base, it comes from the precautionary principle, which it is, OK, let's prohibit this.
Let's ban these that we don't really know about. But it cuts both edges, right? We're obligated to act on what we do know. But then again, we're not doing much there. So we're trying to bridge the gaps that are there. And looking at some cases, like successful cases like Canada or the UK, at some point I was listening to some stories that it's going not very well as I thought.
or Japan or New Zealand, that they've been making or looking for strategies to actually meet the patients where they are and actually giving them options and alternatives, and you're seeing outcomes.
But, well, that one point that I've seen, it's that you bring healthcare providers to the conversation, and then to the decision, and then to build evidence-based pathways to have good outcomes or success stories or cases.
So I'm willing that we are going to have that with the little efforts that we're making as health care providers and advocates and some other people, which is not a very big group in Mexico. We're a few. We're solid, I believe. But yeah, we need more on that.
And yeah, again, it's about, I believe, meeting people where they are, like they're doing literally, and speak their language, and speak without the stigma, because The stigma, it's one of the biggest barriers and which is kind of invisible, which in Mexico, they're really conservative.
But then again, judging the person who smokes, even worse than with other substances, let's say cannabis or psychedelics or other substances. substances. With tobacco, it's been a greater challenge. So when I came into these tobacco harm reduction, I thought, OK, it's going to be easy-peasy after working with other substances. And no, it's been harder.
It's been more challenging. And even with my friends and colleagues are like, OK, you're crazy. Why are you doing this? But with the other stuff, it's like, way to go. You keep going. But with this, it's just like, I don't know, it's kind of frustrating at some point, but hopefully we'll make something happen there. So yeah, I think that's what I wanted to say right now.
That's the point. Thank you.
David MacKintosh 0:40:35
Thank you for that. And I think there's a lot of us who may have worked in drug harm reduction remain somewhat confused and frustrated by how difficult it is to then take things that are well evidenced approaches and apply it to what is essentially just another substance.
I want to pick up directly something that you talked a little bit about and then take it out to the wider group.
You were talking about you having some success I think in getting training into the medical curriculum and I guess I'd like to be interested in that, but then the wider point is people's experience with your peers, your colleagues in the organisations and where you work about how do we get people to think about smoking and tobacco when often people haven't considered that a priority.
But are you making any progress in getting tobacco issues and harm reduction into the medical curriculum?
Mariana Hoyo 0:41:38
Now I'm doing a project which is called Freedom to Choose Tools to Care. And it was designed firstly for healthcare providers, but I have not the success that I was hoping for. There is more general population interested in this course, in this pilot.
And what I'm doing in private unis, in my uni, which I'm a professor too, I started with cannabis, cannabis medicine or cannabinoid medicine, and we are trying to enter with a harm reduction first in general, not just tobacco harm reduction, but in general. And we're waiting to see if they accept that.
It's a very conservative and Catholic university, but they accepted cannabis. So we are positive that we might have that. And I think this year we're trying to get onto the public universities, Tulum or Bali, to have at least some talks or some spaces to spread the word.
David MacKintosh 0:42:38
We all obviously wish you luck with that. And that's a great example of integrating, trying to fit tobacco harm reduction alongside the other approaches.
But What about other people, do you find your colleagues, to an extent we have a self-selected group of people who have gone, oh yes, there's something in this tobacco harm reduction thing, but how is it going with your colleagues?
Dee Cunniffe 0:43:06
Can I just bring up that when I first, because I've known David for years, like we've just said, and he suggested to come down to our service. And my first thought was, gosh, you know, the harm reduction manager smokes. You know, we've got people that are in the staff that smoke and smoke combustible cigarettes, you know.
So I was like, well, this isn't going to go down very well. Now, in fact, it was OK. I believe that it sort of opened the door to discussion. I think that being aware that... Again, not stigmatising. You mentioned stigma there. People that are currently smoking in your staff, in your organisation, be aware that they are, and it's not about picking them out.
But he hasn't stood in any way to stop anything that we're doing, and it's been really helpful. But just be aware that some people are still smoking combustible cigarettes because as something I realised, which I hadn't thought of as much until yesterday, I thought of it years ago when I was actually using drugs, but was the enhancing effect. impact on smoking, on using drugs.
So if somebody is in living experience, they may want to be having that enhancement for those different drugs. I'd love to learn more about that. Because I remember that being, especially, you know, and cannabis, you know, smoking with cannabis, with tobacco, being, you know, part of a routine, you know, after a night out at the club, you know what I mean?
And it's all part of a ritual which people enjoy. So bringing all that into what you're doing and accepting people like they are, I think, is important.
David MacKintosh 0:45:07
Just before I come across to you, many people in the audience will possibly know this, but actually in the services at work, with a lot of the populations where you see very high smoking rates, like people who are using drugs, people who are rough sleeping, all those agencies, their staff also have way above average smoking rates.
And I was talking to a former colleague of mine who was a drug worker, and she was saying, you're reminding me of when I started work in the 1980s, that she got an allowance of tobacco each week to use with the clients when she was meeting them. And I can see Gerry going, who's that? It was with Phoenix House, so we can name and shame.
It was one of the UK's, you know, big service providers at the time. You know, the drugs workers got a tobacco allowance to kind of share with... the people coming through the door. But yes, anyway, back to trying to persuade colleagues.
Adriana Curado 0:46:02
So I agree. There is a growing interest in tobacco harm reduction, also because people working in the field are also smokers or are doing the transition to safer nicotine products. And there is increasing interest in training in this area.
And we are also having the second pilot in Lisbon for tobacco harm reduction, targeting people in nightlife settings, festivals, young people, more young people. So these are very, very good news, I would say.
And there is, let me add this, there is now a working group composed by some former politicians, a law professor, some people from NGOs like me, that are working together to write down a kind of a white paper about regulation of these products in Portugal, taking into account these different communities and populations. So these are good news from Portugal, I believe.
Thank you.
David MacKintosh 0:47:31
going to have to talk to you afterwards more about that project pilot in the nighttime economy, but Portugal continues to lead the world, it seems, on harm reduction. Alexei, how would you find colleagues that you work with thinking about tobacco harm reduction? Is it something they consider that fits with what they're doing already?
Alexei Lakhov 0:47:52
Here I could lean on my personal experience of working, of being both a patient in a rehab and working there. So for us, it has always been, you know, like to go for a smoke, it was like a reward. The last reward that we had left, you know, after... We were left without, I don't know, drugs, without alcohol, so going for a smoke. And this is still the case.
And in my personal experience, I used to be a very recovery-oriented person, you know, like a 12-stepper until my death or so, I thought. So I was against methadone, you know, and all the other harm reduction tools. And I remember...
how I even spoke about it in some interview, you know, and I was actually protesting against drug consumption rooms, you know, and telling the audience that it was like the very last thing that should appear in our country. But then, five years later, I changed my view because I started reading scientific literature, you know, I started visiting these programmes in person.
And when I saw what has been done, what has been going on on the ground, that's when I changed my views and, like... Ten years after this interview against drug consumption rooms, I was chairing a meeting at the Commission on Narcotic Drugs on drug consumption rooms.
So it was like a very long way for me, but it shows that when you have data, when you have evidence, when you see it with your own eyes, that's when your opinions start changing. I can't say that... I know much about tobacco harm reduction. I still have a lot to learn, and I think that a lot of people have a lot to learn about this. So the door is still open, so to speak.
So yeah, let's see what comes out of it. Thank you.
David MacKintosh 0:50:00
It's a really good reminder that there are hearts and minds to be won out there when we can get to people and show them the evidence.
One of the things I do want to touch on is funding, because A lot of what we do, you know, you're funded to deal with people who've got opiate problems or you're funded to deal with people who are sleeping rough on the streets or you may have funding to deal with people's mental health problems.
How easy is it or is it even possible to then get, often quite modest amounts, but to get the additional money you need to be able to do anything particularly around tobacco? I thought you might go first, Dee.
0:50:41
Yeah.
Dee Cunniffe 0:50:42
He knows because I had a conversation earlier about this. It's actually been amazing to get any funding at all for this. It took five years of doing some focus groups, getting a little bit of funding for this, a little bit of funding for that, to convince commissioners in the way in the UK, in London...
you have boroughs and each borough you have like a commissioning you know commissioners and each borough is different in the way they approach it and it took five years even with good-hearted people to be able to get somebody to step out and give some money specifically to Basically, we can, I, with the London Joint Working Group, I didn't mention that's the name of our organisation, with the Hepatitis C Trust, together, we can start this up and we can make it work.
And the person who's done it has actually stepped out. Now, I can't mention the name of this, but we did a report a year afterwards where, at the end of a year for the success, because it has been very successful in accessing people, improving lives. We believe reducing drug-related deaths and overdose, non-fatal overdose, we believe that we're doing that.
And we have another borough which has asked us to come and do it. but the funding is really tight, you know, and even it's wonderful we've got the funding. I'm now in, yeah, but we're worth it now. You know, we need this in order to have, in order to be able to do what the right thing is.
If we start bringing in tobacco, combustible cigarettes, and, you know, it's an extra thing for people to do and for the staff to record and everything like that. So funding's difficult, and I will say, As far as I know, mostly across the UK, I'm sure somebody may have a different situation they can report on.
You have a drug service of a bigger organisation than us, the organisation that has a pot of money and in there you need to provide harm reduction. You might have a cupboard, you might even have a room, you might be better than that. You might even go out on outreach and everything like that, but it's all part of the recovery service.
So it's quite stepping out there for this original commissioner to say, right, I'm going to do this. And the commissioner that is now in the other borough who is about to commission us, I can't mention it because it's not done yet. was because there were 34 cases of non-fatal overdose in their area, and they suddenly realised, oh my gosh, we really need...
There's nitazines and there's synthetic drugs that are like opiates, and they're much stronger, like up to 500 times stronger than heroin. So, you know, suddenly people are listening, but... Even to get them to do the initial amount of a block of funding rather than a room, and can you do this within what you're doing? This is a block of money for you to do it.
It's really hard. Now I'm in a, hold on, you're giving me this? How am I going to be able to do what you would like and what's working? So it's a challenge, but do try if you've got influence. Thank you.
Adriana Curado 0:54:20
So yes, funding is always an issue. I think we are in a bad moment, not specifically in Portugal, because there are no recent changes in that, but in the European context at least. that I know better, that we are seeing less and less money for armed reduction in general. And this might be linked with international funding being cut by the U.S., for example, or other countries.
but also because of the rise of the populism. This is also a threat for armed reduction in general, but of course, tobacco is also affected in the sense that is even less, probably less programmes. So for us, it's difficult to find the money to add nicotine on our service. And the main reason is that we need to buy the products to give them out for free.
So I don't see any other way in our context. traditional harm reduction programmes that our populations are really living in poverty. So of course we can train, we can give information, but if we don't give the products in the end, it doesn't work. So this is the main problem. And we don't accept money from the industry because industry money could be an option.
but it's not because of the advocacy efforts. And if you want to have a voice, independent voice, you cannot accept money from the industry.
David MacKintosh 0:56:17
So very specifically, you were talking about some of the work you did with women and that you were being able to provide harm reduction products. Are you able to do that out of your main harm reduction budget? Were you able to pay for vapes from that?
Adriana Curado 0:56:32
That was the KAC scholarship.
David MacKintosh 0:56:38
That sounds like a very good use of the scholarship money.
Adriana Curado 0:56:41
It was used for that. And now we are not doing it. We are continuing. The advocacy and the conversation with people, of course, but without products. I think we are very limited in that sense.
David MacKintosh 0:56:56
Okay. And I'm going to guess in Mexico it's kind of an abstract concept because the products would be illegal, so how could you? Yeah. A question, the importance and the value of autonomy, I think, came up from all of you, really. And I certainly know people in public health, people in the mainstream drugs world would all say that autonomy is important.
And people are often quite sympathetic, sometimes empathetic towards drug users. But my observation is that very rarely seems to extend to the smokers. literally we will have people who would vigorously defend substitute prescribing for someone who's, you know, a person who's coming into services, but would actually find it quite challenging to say, oh, yes, they're smoking.
We should see what we can do about that. And would they fall back to they should just stop? So we'd be back to the, you know, the prohibition there. Why is... and there should be a prize for the best answer for this.
Why is it that smokers are the last group even that is acceptable to kind of stigmatise and show that kind of lack of empathy towards, even when they're actually also a member of another group where it would be considered unacceptable? You wouldn't talk about someone's drug use in that way. You wouldn't talk about the fact that someone's living on the street in the same way.
But, you know, a smoker, well, they just smoke... They should stop. It's, you know, you shouldn't be picking up butts on the street to make your own cigarettes. You can see the horror. I mean, you know, you can tell I'm recording conversations I've had. Why is it? How is it we've got to a position where the smoking element is the most, you know, it puts people beyond help?
Dee Cunniffe 0:59:08
I don't know if I agree with you on some of that. I've been trying to find something that we could have a little bit of a back and forth on. I don't know if it is...
accepted about people using drugs i don't think okay so there might be a little bit more of an acceptance of people that have gone into treatment um you know on methadone and you know a little bit more about that but we've only just come out in the uk of a of a a recovery agenda which I'll call an agenda which was like get people reduced down off methadone you know oh gosh look at people they've been parked the word parked you know those sorts of things So I do feel one of the things when we were offered the additional amount of funding, I was told to be very careful about anything that was going to be published that we'd said or anything we might write because the councillors might not like it.
And we have within, so you have like an area or a borough and people that run, the way that everything works, including public health, is through councillors. So be careful. And we've just had a vote in for the green councillors now coming in. So we've got hope that we might be more accepted.
So I just think your premise there about it being all right, and accepted is, I don't think it is. I think dirty drug users is like the thought, don't give money to them. That's why we've only got a little amount of funding. Okay, well maybe for treatment because at least they're coming off being parked.
But the idea of making someone's life comfortable, to have joy, to have to meet friends, to sit down and use your drugs and be able to be safe and not die from using the new synthetic drugs, I just think it's not... I still think there's an undertone of dirty drug users, and we need to get past that. And then smoking might be able to join in, you know, so, okay.
Mariana Hoyo 1:01:30
Me, I don't have the right answer, I guess, and my perspective is just, as I said, we're just, as healthcare professional, the only tool that we have, as I said, is just the quit or not quit, the quit or die, right? We don't have any other alternatives, and we're not based on... Or we are based more on a paternalistic model. Like, you know what, you should do this.
And if they don't want, it's like, OK, patient has no motivation to do it, or patient is not adhering to the recommendations. So we just have that. So it's like not paying attention and what we're not focusing in is in the patient goals. We're just not asking, okay, what do you want? When they say, okay, I smoke, yes. Have you tried to quit? Yes, no, that's it.
And it's not, what do you want? Do you want to quit? Do you want to diminish your use? Do you want to switch? What do you want? And help them to meet their goals. So that's what we're missing in this paternalistic and more retrograde model. Yeah, I think that.
1:02:57
Yeah.
Adriana Curado 1:02:59
Let me just say that I agree with Dean. So, in terms of perspective of public health intervention, harm reduction for illicit drugs is well accepted, and for tobacco, no. From a general perspective and general attitude from society, people who use drugs are blamed and are not well treated, are stigmatised, are shamed. So, and this is worse than for tobacco, for smokers. Yeah.
Alexei Lakhov 1:03:46
I can say that I think it depends on the context. First of all, because, for example, in Russia, where the opioid substitution treatment has been banned since the 90s, and it's still prohibited, you know, and in general harm reduction, it's a very, like, it's a dirty word, actually, and it also exists in several cities only.
But when it comes, for example, to harm reduction, tobacco harm reduction, this is the term that is being used even by healthcare professionals, you know, and the same goes for the alcohol harm reduction.
You know, so it seems like, and I know for sure that in some countries of Eastern Europe and Central Asia as well, when people smoke, you know, or use Naswai or something like this, It's kind of socially acceptable, but when it comes to using drugs, especially the new psychoactive substances like the so-called salts, then these people are totally crazy and you shouldn't even come close to them.
And I think, yeah, it's also public shaming because we know that people who smoke, you know, they are such a high burden on the healthcare systems, you know, on the economies that it's better to shame them and it's better to shame them into quitting, you know, than doing some harm reduction for them, at least from some government's perspectives. Yeah.
David MacKintosh 1:05:30
Thank you for those responses. I think it's really important, actually. There's a lot of people, particularly at an event like this, people go, if only tobacco harm reduction could be as widely accepted as general harm reduction.
Actually, harm reduction still has to make its case in most countries most of the time, even though, as Dee was saying, in the UK, long established, you wouldn't get anyone public health-wise say we shouldn't do harm reduction. But the politicians and the policymakers are not necessarily signed up, do not understand it.
So we need to keep making the case and we should try to find allies wherever we can. Now, over to you as an audience for questions. So who's got a question? If there are no questions, there will be no lunch. And some of you probably craving carbohydrates after last night. Fiona, I can see you. People could just introduce themselves.
Fiona Patten 1:06:31
Hi. Fiona Patten from Australia. I was very interested in the project in Portugal handing out tobacco harm reduction products, but obviously the cost and expense and also in the U.K., Is it unethical or is it impossible to consider seeking sponsorship from industry partners for these types of pilot projects?
Dee Cunniffe 1:07:05
I couldn't have got to the stage of running a harm reduction service. As I say, tobacco has come in later with what we're doing without some initial support through the pharmaceutical industry. So we did some pilots to do with harm reduction of homeless people getting tested for hepatitis C in pharmacy. And then we also got to write a report about harm reduction.
So we would get a pot of money from the pharmaceutical industry We had to be careful about that. And even now, I mean, we also, so the London York Working Group, we are setting up a conference, a harm reduction conference for London. And we need funding from pharmaceutical industry. So, yes, we do go there. But when it comes to, you could get a pilot going.
But if you want to, we've just won a tender within one of these boroughs. We have to, you know, we needed to go through a process of being piloted by public health, which is an unusual thing. But, yeah, we can do that. Just need to be aware that people will... There's judgements. People always judge on stuff. But, yeah, we wouldn't be able to do it without...
Mariana Hoyo 1:08:31
I know you didn't ask about what can we do, but I think, and for me, it's an actual concern, and I have a lot of doubts. I don't have many years in THR, so I'm starting to get to know everyone, the groups, and how it's the environment here. And what I've been talking with a couple of colleagues in Mexico is, just about that.
Why won't we approach the industry and say, hey, help us to reach out these people with the actual products? But we've been very cautious in thinking about it because our credibility. We don't want us to say, oh, you're bought by the industry. So that's a thing that I have not completely come to. Can I do it? Should I do it?
Fiona Patten 1:09:28
And it's hard in Mexico where the product is prohibited as well. The same as in Australia. The only legal product is a completely ineffectual product. So it would be a waste of time trying to do it here.
Mariana Hoyo 1:09:43
Well, with the vaping, yes, but we have the nicotine pouches and the heated tobacco products. So those are the alternatives that we've been thinking, but we're a bit scared to make the approach because of this. So we are, I don't know, hopefully we get some advice on that.
David MacKintosh 1:10:05
And then we'll come to you next, and then over here.
Mark Tyndall 1:10:08
I'm Mark Tyndall from Canada. Really appreciated all your comments. I think jumping from regular harm reduction in other drugs to tobacco harm reduction, we're sort of underselling the concept. So, you know, when we give people condoms to prevent HIV, it's like... risk elimination. Like there's no transmission if you use a condom.
If you give people a clean needle, there's no transmission of HIV when you use a clean needle. It's zero, pretty much. And a supervised injection site, there's never been a death, an overdose death in a supervised injection site in Canada. Millions of people have been observed. So With tobacco, if you give people a safer nicotine product, you eliminate the risk of lung cancer.
You basically eliminate COPD. You basically eliminate heart disease. So we should think of these as treatments. Vaping is a treatment for cigarettes. And so it's not harm reduction. It's harm elimination. You're... we have to really approach this much more boldly of how important this intervention is. And it's not just like it's a little bit better.
The term harm reduction, the harm we're leaving in that term is the drugs. Like we think that it's impossible to say it's a safe thing to do because you're still using drugs. But with nicotine, basically it's a safe thing to do. And so we're eliminating, totally eliminating the risk.
And so we should be much more bold in our claims about this and how important it is for people. And I got into this because I was dealing with cohorts of people using other drugs, and they weren't dying of HIV anymore or hepatitis C. They're all dying of tobacco. And so I felt I needed to do something.
But it is so effective and it's so much, you know, I also get frustrated with this continuum of risk. Like there's cigarettes and then there's everything else. And there's, it's a different experience altogether as far as health risks go. And I think we should be just much more bold when we're making these claims. We're saving people's lives.
And that, and back, you know, just, sorry. Yeah. saying too much, but the asking industry, like the industry has a treatment for the thing that they sort of caused. And so we should demand that they pay for it. Like the industry should be handing this stuff out, especially to people who have no access or can't afford it. And like, it's their obligation, basically.
They're sitting on, it's like they have a vaccine for COVID and they're saying, we're not going to give, we can't give it out to anybody. And we're making regulations that disallow them from doing it. But we should. This is the treatment for cigarettes. We should make it highly available, and especially for marginalised groups who otherwise could never afford it.
David MacKintosh 1:13:15
Thank you. I mean, that deserves a round of applause, yes. Does anyone want to respond to that very powerful promotional statement from the floor?
Mariana Hoyo 1:13:25
Thank you. Yes, thank you.
David MacKintosh 1:13:27
OK.
Sundramoorthy Pathmanathan 1:13:28
The gentleman at the... Good afternoon. Sorry, good morning. My name is Murtin. I'm from Malaysia. Dear, I just agree with you what you said about you can't eliminate things. You can minimise and control things.
problems related to drug dependency, nicotine, and I think this is a misconception among some groups that they want to eliminate smoking, they want to eliminate vaping, etc. I think the key concept here is to control and minimise. And two, Mexico, I'm just amazed how Mexico amends its constitution. It to deal with dangerous drugs like fentanyl and more recently with vaping.
Typically, we amend criminal laws. How does that operate? Because you can't reverse most of the time when you amend a constitution. I'm just curious to hear your thoughts. But anyways, thank you.
Mariana Hoyo 1:14:32
I'm not a legal expert. I hope it can revoke it at some point, as some countries have done, like New Zealand and now Argentina. Of course, following a specific line so it doesn't go into a chaotic state. But, I mean, it's super recent. The government...
I think it's super narrow-minded and it's going in the same, it's of the same party since the last, I don't know, eight years or something like this. So I don't know how it happened, but I can introduce you to someone that can answer you better in that aspect.
Sundramoorthy Pathmanathan 1:15:15
I missed out one thing. The topic today was on how do you deal with harm reduction marginalised group, and I wish there was more elaboration from all of you. When I think of marginalised group, I think of the underprivileged, the less privileged, based on ethnicity, the aborigines, the lower income group.
I was looking forward very much to hear that you all touched on it, but no specifics were given about marginalised groups, because the challenges are very diverse with different marginalised groups. Anyways, sorry, not to offend anybody, but I wanted to hear that really.
David MacKintosh 1:15:53
I am sure, one, I'll let people respond, but there will be opportunities over lunch, I'm sure, to go into some of that in more detail. There's a lot of expertise here in how to engage with those communities, but please, Alexei.
Alexei Lakhov 1:16:07
Yes, I can actually respond straight away because, for example, when it comes to harm reduction and if you receive funding from presumably an industry, then you are a marginalised group in the view of some agencies or some healthcare professionals. And it means that nobody can work with you anymore or invite you to some working groups on policies or whatever.
In terms of other groups, for example, from when I used to work in one of the harm reduction programmes, so we had a low threshold medical center, and one of our former beneficiaries, she was an administrator of the telegram shop on drugs, and she sent their clients to us, And if they came to us, you know, and had these medical checkups, then they received discounts for the products of these shops.
It's a very legally gray and ethically gray zone. But from my own perspective as a harm reductionist, you know, we were doing harm reduction at their, like, at its... Not best, but it's like an essence of harm reduction. When you work with people who supply drugs, for example, and you call them this way instead of calling them dealers, for example.
When people who come to you receive discounts for their drugs, you know, but at the same time they receive healthcare services. What is it? Is it harm reduction or is it, I don't know, drug promotion? Does it make us marginalised or does it make these people marginalised? So these are very tough ethically and legally great questions.
I guess it depends on what view you have on this. Thank you.
Dee Cunniffe 1:18:22
Yeah, very short response because I couldn't present everything, but you're absolutely right. So we have two things. One is a success and one is not yet a success. One is women. So we were finding the very low...
access for women, so we specifically recruited a coordinator, we created a space, a specialised space, and we're also working with a sex worker organisation, the NHS, and now we're seeing over 50% of the people that we are seeing are women, which is really outside.
However, on global majority, black and global majority, We are not accessing as many as in relation to Hackney's population. One of the things, I won't go into, we could talk about it afterwards, is that we can't give out pipes at the moment, but we are looking at ways for crack smoking and inhalation, but we are looking at ways that we might be able to do that legally.
We can't legally do it at the moment, but a majority of black community are smoking. Okay, thank you.
David MacKintosh 1:19:32
Just on the incentivisation side of things, because you triggered, in the UK they provided a fund to encourage women who smoke who are pregnant to engage with services and directly pay them. You get incentivised, contingency management is the posh phrase, isn't it?
But it caused outrage in the media, because all these people should give up anyway, for God's sake, because they're pregnant. What are they thinking of? But actually, all the evidence I've ever seen is that contingency management works really well. And if you want to get people in, it is very, very contentious. To my friend, before he pulls my arm off.
Timur Abdullaev 1:20:10
Thank you, and I will try to make it quick. My name is Timur Abdullaev. I'm a TB HIV advocate from Uzbekistan, and I have a big deja vu. When I came to TB, it wasn't because I wanted to, it's because I got TB. And I realised that with my HIV background, there is one thing that really triggers everybody. It's when we compare TB response to HIV response.
And then immediately there would be people saying like, oh, young men, please, these are very different things. And now I see the same thing with drug harm reduction, which is recognised, and tobacco harm reduction, which is like, oh, this is very different. I keep on hearing this. This is tiring and exhausting.
And another thing is I think I'm somehow attracted to areas where finances is a big question. And TB was the last thing. Now it's tobacco harm reduction. And of course, people who control the money, they would love to paint anybody taking money from the industry as, ah, they sold themselves to the industry. And that's magnificent, isn't it?
That discourages people from even trying to get money from the industry or from anyone who's affiliated with the industry or from anyone who's affiliated with someone who's affiliated with the industry. This is bullshit. And here I'm coming to the point. I really loved your reference to, you know, people, not really clients, but like people.
And this is what we very often forget. I come from TB. We love calling people cases. Just love it. And when I stand up and say, can you please call us people? Like I'm not a number. And then they will, yeah, you're so right. You're so right. So this year, 10,000 cases were like. So I realised that in TB, it helped when we mobilized community of people affected by TB.
That wasn't my brilliant idea. I mean, I have many brilliant ideas, but this wasn't mine because I came from HIV where this bloody worked. And HIV response transformed completely because of community. TB response is now transforming completely. You know what it was called before? TB control. Sounds familiar?
Yeah, some people in those three-letter organisations, they think that control is the way, right? So no, response is the way. And here is my two cents. We need more community here as well. This is my first conference when I don't see space specifically for communities. This is one big conference which is beautiful.
We don't have our little corner where we can be pushed away so that we don't mess around with the serious people from the science and the good people and communities on their own. This is not what we need to do here. I really like the format where everybody is together. where we don't have the corner for the communities and then for everybody else.
No, this is not what we need, but we do need something for specifically enabling community people, including folks like ourselves. It's not just about consumers, it's about anyone who's affected by smoking. And then maybe finally when we have people, crazy people like ourselves, we are crazy in a good way. Hi.
And then maybe someone will be able to say to WHO's face that they should stop their freaking crap. I don't understand. I don't understand it. Seriously, I don't understand why it goes on because this is stupid. there is a brilliant letter going to WHO completely falling off, like bouncing off the wall.
It really is like, it's not about anything reasonable, it's ideology, and I think we need more crazy people to call WHO on their bullshit. Thank you.
David MacKintosh 1:24:21
Thank you. A second passionate statement. Does anyone want to respond to that call for more crazy people? Yeah, good. Thank you. We are getting very close to lunch. I don't know, was there anyone else who had a short-burning question? Okay, last question there. Thank you.
Magdalena Bartnik 1:24:42
Yeah, thanks. Magda Bartnik from Poland. Thank you for an interesting discussion. Just a comment echoing what was said. I would say we need to start the conversation within harm reduction community, drug harm reduction community and movement.
because it's still hesitant and it's not unified in its position because smoking is so normalised and drug use is criminalized and stigmatised. I do believe the smoke is invisible. It's transparent. It's just like a normal thing. People just smoke. That's the way it is.
And absolutely agreeing, we do need community and we need to go hand in hand with harm reduction as understood as a whole. And one fun fact for you all, Polish president Karol Nawrocki is openly and in public promoting harm reduction.
He's using nicotine pouches on TV And any time he's there, visible with people in debates, but I'm sure he would never consider himself as a harm reductionist. And we reach out to him saying, let's open the debate. But, you know, no answer till now. Thank you.
David MacKintosh 1:26:07
Thank you very much for that. That's it, we're out of time. I've got a red light come up on here, which means I'll be in trouble. So I'm going to attempt to sum up very quickly. There was, I think, a very important call there that we should be more positive in our promotion of harm reduction.
There's a lot there about helping educate our peers and colleagues and having those conversations, and we need to think how we can support that. And I think the key thing was keep the focus on people, individuals, and people collectively in the community. Don't forget, if you've got any urgent orders, you can get the telegram details from Alexa.
We hope you enjoy your lunch and that some of you manage to get some sleep before Saturday, if you follow that. But please join me in thanking what's been an excellent panel. Thank you very much.