If you know me, you know how frustrated it makes me that we have evidence-informed harm reduction strategies that are not being used to the extent that we need. We need to treat people who use drugs so much better.
When I bring up harm reduction, sometimes even to others working in healthcare, I find myself having to make some clarifications. So, I want to make it clear what harm reduction is and why it is so important as part of the solution in addressing the opioid crisis, at least in the short term.
Harm reduction can be applied to a variety of settings, but for the majority of this post, I will be referring to it in the context of drug use.
What is Harm Reduction?
The most straightforward way that harm reduction can be explained is that it reduces the harm that drug use and drug policy cause people who use drugs. This means accepting that they will continue to use drugs as they may not be ready to commit to abstinence but can do so in safer ways. This involves preventing complications such as overdoses or blood-borne diseases that can occur with behaviors associated with drug use. For example, preventing or reversing accidental overdoses can be addressed through supervised injection sites (City of Toronto, 2019). No one has died of an accidental overdose in a supervised consumption site in the world! (Drug Policy Alliance, 2021; Ng et al, 2017). Keep an eye out for a future post on supervised injection sites in the 'harm reduction' tab under 'content'.
Further isolating those experiencing addiction is not helping anyone, connection is necessary for recovery. Yet this is what we do when we criminalize behaviours associated with drug use. This not only contributes to stigma, but makes care more difficult to access and plays a role in the increasingly toxic drug supply. Not everyone is ready for abstinence. Harm reduction acknowledges this in various ways because saving lives is more important than stopping drug use (Szalavitz, 2021).
Harm reduction is not only applicable to drug use. Using a condom is harm reduction – still engaging in the activity (sex) but in a safer way to prevent unwanted outcomes (pregnancy and STIs). Other examples include seat belts, sunscreen, cigarette filters, and birth control.
Examples of harm reduction strategies: Supervised injection sites, drug checking programs (fentanyl test strips), safe supply, naloxone distribution, syringe exchange programs and sharps disposal, good Samaritan policies. |
Harm reduction is a public health strategy, but it is also an approach to providing care. It means meeting people where they are at in a non-judgmental manner. It is a partnership built on respect, collaboration, acceptance, and empowerment. This is because harm reduction is not one single thing; it isn’t one-size-fits-all advice, that's the point.
Harm Reduction and Health Equity
Harm reduction is also about creating a society that promotes access to positive health choices for all. Various interconnected issues relate to one’s likelihood of being affected by addiction and/or what recovery looks like, and must be addressed accordingly. It is necessary to note that for this reason, one intervention is not going to be successful on its own in the long term. For example, supervised injection sites can help prolong life by preventing accidental overdoses, but changes to public policy (ex. Decriminalization) can have a more wide-ranging effect. We need to change society’s response to drug use.
Dispelling Myths of Harm Reduction
Myth #1: “Harm Reduction Encourages Drug Use”
Harm reduction is not ‘encouraging’ the behavior of drug use. It is realistic as it acknowledges that we can help people who were already going to use, use more safely. It is about respecting their personal goals. Abstinence-only approaches often prove to be unsuccessful (Drug Policy Alliance, 2020; Knopf, 2019; Henssler et al, 2021), so this approach helps decrease the stigma of behaviors associated with drug use, which is one of the most significant barriers for drug users to access care. As a result, harm reduction strategies help people who use drugs feel heard and begin their unique, nonlinear path to healing. Individuals that participate in harm reduction services are actually more likely to engage in continuous treatment as a result of accessing these services (Canadian Mental Health Association, n.d.).
Myth #2: “Drug Criminalization is Based in Evidence”
The criminalization of drug use is not helpful to the healing of people who use drugs. Unfortunately, this is purposeful – the root of drug laws is racism rather than evidence (Virani & Haines-Saah, 2020). Keep an eye out for a future post on the need for decriminalization in the ‘harm reduction’ tab under 'content'. Additionally, it presents barriers to effective care for drug users while offering inadequate rehabilitation or preparation to return to the world. Prison isn’t meant to treat addiction and it contributes to stigma. Furthermore, the trauma of incarceration and then having to function in the world with a criminal record affect one's ability to get a job, which may lead to homelessness and food insecurity, which impairs mental health, which can lead to relapse, and so on. As you can see, our social context affects our physical and mental health. Keep an eye out for a future post on the social determinants of health in the ‘health equity’ tab under 'content'.
Myth #3: “Supervised Injection Sites and Needle Exchanges Will Result in More Drug Paraphernalia on the Street"
The current evidence disproves this. The more harm reduction strategies implemented together, the more harm is avoided. The rate at which needles are turned in is often the same as or higher than the rate at which they are handed out. For example, a NEP operated in the City of Vancouver reported that across three separate years, more needles were turned in by than were handed out (Canadian Centre on Substance Use and Addiction, 2004). Harm reduction reduces harm for everyone.
You don’t have to agree with someone’s choices to understand that they are struggling, and you don’t have to understand to respect them as a human being. |
Implementation of one evidence-informed harm reduction strategy isn’t enough for change. The Canadian opioid epidemic is a multifactorial problem and thus requires a multifaceted approach. Harm reduction is part of the solution and it’s time the government acknowledges that. We must fight together to end the stigma surrounding drug use and advocate for policy change. But we also must fight to ensure that the social determinants of health are addressed, like homelessness and food insecurity, to improve quality of life for all Canadians.
Box – There has been an overall steady increase in opioid overdose deaths in Canada since the early 2000s (Canadian Institute for Health Information, 2019). The Government of Canada (2021a) reported that there were 22,828 apparent opioid toxicity deaths between January 2016 and March 2021 (Government of Canada, 2021a). This would be even higher without harm reduction techniques in places. We need short and long-term solutions to prevent these devastating outcomes. The evidence is there (Government of Canada, 2021b); it is time for action. |
Check out the ‘resources’ tab at the top of the site for more information on harm reduction and understanding addiction.
Until next time,
Raquel
References
Canadian Centre on Substance Use and Addiction. (2004). Needle exchange programs (NEPs) FAQs. Retrieved from https://www.ccsa.ca/needle-exchange-programs-neps-faqs
Canadian Centre on Substance Use and Addiction. (n.d.). Stigma. Retrieved from https://www.ccsa.ca/stigma#:~:text=What%20Is%20Stigma%3F,discriminatory%20attitudes%2C%20beliefs%20and%20behaviours.
Canadian Institute for Health Information. (2019). Opioids in Canada. Retrieved from https://www.cihi.ca/en/opioids-in-canada
Canadian Mental Health Association. (n.d.). Harm reduction. Retrieved from https://ontario.cmha.ca/harm-reduction/
City of Toronto. (2019). Supervised consumption services. Retrieved from https://www.toronto.ca/community-people/health-wellness-care/health-programs-advice/supervised-injection-services/
Clarke, K., Harris, D., Zweifler, J. A., Lasher, M., Mortimer, R. B., & Hughes, S. (2016). The Significance of Harm Reduction as a Social and Health Care Intervention for Injecting Drug Users: An Exploratory Study of a Needle Exchange Program in Fresno, California. Social work in public health, 31(5), 398–407. https://doi.org/10.1080/19371918.2015.1137522
Drug Policy Alliance. (2020). Real drug education. Retrieved from https://drugpolicy.org/issues/real-drug-education#:~:text=Abstinence%2DOnly%20Drug%20Education%20Doesn't%20Work&text=don't%20give%20students%20the,drug%20information%20coming%20from%20adults.
Drug Policy Alliance. (2021). Overdose prevention centers. Retrieved from https://drugpolicy.org/issues/supervised-consumption-services
Government of Canada. (2021a). Opioid and stimulant-related harms in Canada. Retrieved from https://health-infobase.canada.ca/substance-related-harms/opioids-stimulants/
Government of Canada. (2021b). Supervised consumption sites and services: Explained. Retrieved from https://www.canada.ca/en/health-canada/services/substance-use/supervised-consumption-sites/explained.html
Henssler, J., Müller, M., Carreira, H., Bschor, T., Heinz, A., & Baethge, C. (2021). Controlled drinking-non-abstinent versus abstinent treatment goals in alcohol use disorder: a systematic review, meta-analysis and meta-regression. Addiction, 116(8), 1973-1987. doi: 10.1111/add.15329
Knopf, T. (2019). Switzerland couldn’t stop drug users. So it started supporting them. North Carolina Health News. Retrieved from https://www.northcarolinahealthnews.org/2019/01/21/switzerland-couldnt-stop-drug-users-so-it-started-supporting-them/
Ng, J., Sutherland, C., & Kolber, M. R. (2017). Does evidence support supervised injection sites? Canadian Family Physician, 63(11), 866. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5685449/
Szalavitz, M. (2021). Undoing drugs: The untold story of harm reduction and the future of addiction.
Virani, H.N., & Haines-Saah, R.J. (2020). Drug Decriminalization: A Matter of Justice and Equity, Not Just Health. American Journal of Preventive Medicine, 58, 161-164. https://doi.org/10.1016/j.amepre.2019.08.012, 10.1016/j.amepre.2019.08.012
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