Lethbridge Harm Reduction
Harm Reduction
Harm reduction is a movement for social justice involving a set of strategies aimed at reducing the negative consequences associated with drug use [1]
These are the four pillars of harm reduction as suggested by Health Canada. These pillars highlight some of the traditional models for dealing with substance use disorder, as highlighted by enforcement being included as one of the main four pillars. We propose that a safe supply of drugs that are not contaminated with other substances and decriminalization would be a better pillar than enforcement. The ‘war on drugs’ has yet to prove as a valuable way to help those living with substance use disorder, as it functions to further punish individuals.
Harm reduction strategies are used in mainstream society all the time. Any time we try to reduce the effects of a behaviour, we are using harm reduction techniques. Like, wearing a helmet while riding a bike, or your seatbelt. Or lately, just washing your hands could be considered harm reduction.
In terms of the Government of Canada’s response to the opioid crisis, harm reduction means meeting the client where they are at. It focuses on reducing the negative effects of a health behavior, in this case, illicit drug use, without requiring abstinence as the end goal [2]. However, just because abstinence isn’t required, does not mean that it is never achieved, or that treatment isn’t received.
Why harm reduction? “In the context of substance use, harm reduction disentangles the notion that drug use equals harm and instead identifies the negative consequences of drug use as the target for intervention rather than drug use itself” [2]. People with substance use disorder have often been traumatized as a child or an adult (such as the trauma inflicted by residential schools). They are often on the fringes of society and have had negative experiences with health care institutions. Many have very complex health problems and often deal with mental illness as well, with little or no access to health care.
Harm reduction strategies provided through ARCHES in Lethbridge include:
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Syringe exchange programs
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Supervised Consumption Services (SCS)
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Overdose prevention programs and policies
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Access to primary health care workers
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Opioid substitution treatment
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Condom distribution
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Provision of risk reduction information [3]
The harm reduction approach opposes the traditional medical model of addiction that “labels any illicit substance use as abuse” [2]. Harm reduction also opposes the moral model, which labels drug use as wrong which means that it must be illegal [2].
The Goals of Harm reduction
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Reduce the negative consequences associated with risk behaviour
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Lower deaths due to overdose
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Increase vulnerable populations access to healthcare and treatment
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Increase community safety
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Decrease neighborhood crime [3]
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Greatly reduce suffering and death
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Promote connection
What harm reduction does NOT do
However, harm reduction will not solve the opioid crisis. As was previously stated, it is only one pillar of four used to address the opioid crisis. Here is a list of other things it will not do
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Give up on recovery
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Creates new users who experiment with drugs
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Create new problems
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Harm reduction will not solve every social problem in Lethbridge
What more is needed?
1) Safe Supply
Individuals with substance use disorder (SUD) are often socio-economically marginalized, and are often experiencing homelessness, which puts them at a greater risk of overdosing due to adulterated unsafe drugs that have illicitly manufactured fentanyl in them along with things like plaster or pumice stone [4]. Many individuals with SUD have had negative experiences with health care and are not receiving treatment [4]. Individuals with SUD are often marginalized individuals with intersectional oppressions [4].
Crenshaw created the term intersectionality because women of colour were experiencing racism differently from their male counterparts [5]. The race-based discourse was not sufficiently shedding light on the problems of a person who was black and also a woman. A black woman faces two kinds of discrimination, sexism, and racism. Neither feminism nor race-based discourse was able to capture them [5]. Individuals with SUD face multiple isms as well. However, as Crenshaw notes, one plus one does not necessarily mean two, the problem is greater than the sum of its parts, “the operative conceptions of race and sex become grounded in experiences that actually represent only a subset of a much more complex phenomenon" [5].
Because of the multiple layers of isms faced by individuals who experience SUD, they experience an increased risk of overdose. What is needed to combat this is access to a safe supply of unadulterated opioids that will not cause more harm. Safe supply falls under the umbrella of harm reduction.
2) Decriminalization
Criminalizing individuals who are traumatized, face intersectional oppressions and are coping through the use of illicit substances, does not help with abstinence or treatment. Fear of repercussions may not be on their radar. What I am trying to say is that there is no repercussion great enough. It is a substance use disorder. It is not rational. Substance use disorder is characterized by behaviours that negatively impact one’s life, yet persist anyways. This is why it is disordered.
Portugal decriminalized possession of illicit drugs for personal use in 2001. Since that time, drug overdoses and HIV infections have decreased significantly while people voluntarily entering into treatment have increased [6]. However, the Portuguese government did not stop at decriminalization. They also implemented strategies to help those with substance use disorders to get treatment if they wished it. There isn’t one solution that solves the opioid crisis. We need to implement a variety of changes that involve stopping the war on drugs.
Supportive Housing
Housing first is a philosophy that places people at risk of homelessness into permanent housing without the need for abstinence [7]. Transitional housing is needed when there are not enough spaces for everyone in permanent housing. However, many clients have greater needs that are not met just by housing. They need supportive housing. Supportive housing “combines rental or housing assistance with individualized, flexible and voluntary support services for people with high needs related to physical or mental health, developmental disabilities or substance use” [8].
Martin Thomsen, the City of Lethbridge’s manager of community social housing said in an interview with the Lethbridge Herald, “A bleeding-of-the-neck need we have is permanent, supportive housing, Or supportive housing in general. We know communities across Canada have been afflicted by the opioid and drug crisis. We know the number-one cause of homelessness is drug and substance abuse. You have to address the root cause: get them to a state of well-being through treatment programs and so forth. When they get out of treatment, they need care and support. Many of them don’t have a place to live; so that’s where that temporary, supportive housing is so critical.” [9] Supportive housing would help individuals with SUD to stop their patterns of maladaptive behaviours related to illicit drug use, and move on to more permanent housing with a higher chance of recovery [10].
“Once on the streets, an individual with substance use issues has little chance of getting housing as they face insurmountable barriers to obtaining health care, including substance use treatment services and recovery supports” [11].
Transitional housing, such as emergency shelters and supportive recovery services, is often offered to people with substance use problems [11]. The problem with these is that they require abstinence (zero drug use) in order for a person to be accepted into their program [11]. “The result is that many people fail to qualify and remain on the streets or in environments that are not conducive to addressing their substance use problems. And even if they do complete treatment, because of a lack of supported housing options, once they are discharged from hospital or treatment center, many people with substance use issues have no place to live, a situation which puts their recovery in jeopardy” [11].
[1] Harm Reduction Coalition. (n.d.). Principles of harm reduction. https://harmreduction.org/about-us/principles-of-harm-reduction/
[2] Hawk, M., Coulter, R. W. S., Egan, J. E., Fisk, S., Reuel Friedman, M., Tula, M., & Kinsky, S. (2017). Harm reduction principles for healthcare settings. Harm Reduction Journal, 14(1), 70. https://doi.org/10.1186/s12954-017-0196-4 (p.1, p.1)
[3] ARCHES Lethbridge. (n.d.). GET INFO SCS – ARCHES Lethbridge. https://lethbridgearches.com/get-info-scs/
[4] Fleming, T., Barker, A., Ivsins, A., Vakharia, S., & McNeil, R. (2020). Stimulant safe supply: A potential opportunity to respond to the overdose epidemic. Harm Reduction Journal, 17(1), 6. https://doi.org/10.1186/s12954-019-0351-1
[5] Crenshaw, K. (1989). Demarginalizing the Intersection of Race and Sex: A Black Feminist Critique of Antidiscrimination Doctrine, Feminist Theory and Antiracist Politics. University of Chicago Legal Forum, 1989(1), 139–167. (p.140)
[6] Drug Policy Alliance. (2019). Drug Decriminalization in Portugal: Learning from a health and human-centered approach (pp. 1–12).
[7] Pauly, B., Wallace, B., & Barber, K. (2018). Turning a blind eye: Implementation of harm reduction in a transitional programme setting. Drugs: Education, Prevention and Policy, 25(1), 21–30. https://doi.org/10.1080/09687637.2017.1337081
[8] Homeless Hub. (2019). Permanent supportive/supported housing. https://www.homelesshub.ca/solutions/transitional-housing/permanent-supportivesupported-housing
[9] Kalinowski, T. (2019, October 7). City has an affordability issue with housing. The Lethbridge Herald. https://lethbridgeherald.com/news/lethbridge-news/2019/10/07/city-has-an-affordability-issue-with-housing/
[10] Pauly, B., Wallace, B., & Barber, K. (2018). Turning a blind eye: Implementation of harm reduction in a transitional programme setting. Drugs: Education, Prevention and Policy, 25(1), 21–30. https://doi.org/10.1080/09687637.2017.1337081
[11] Homeless Hub. (2019). Substance use & addiction. https://www.homelesshub.ca/about-homelessness/topics/substance-use-addiction
