Healthy Communities Through Harm Reduction

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In part two of this three part series, Sarah outlined a difficult tension in many social service agencies’s work. Agencies like House of Friendship often walk with people using drugs or struggling with their mental health, which can manifest in behavior likely to be deemed “difficult.” When so-called difficult people are barred or restricted from service, those agencies cannot fulfill their mandate, and individuals who might need the most support receive the least, if any. In this final installment, Sarah picks up on this idea, and explores creative alternatives.

Besides barring people, what might possible alternatives to dealing with substance use or conflict in a social service agency look like? One particular framework seems to offer a different, more inclusive approach. So, today I’ll examine why increasing available harm reduction services, and adopting a harm reduction approach to working with people who use substances may be beneficial for individuals and communities.

Harm reduction is… what?

Harm reduction” means different things to different people, but I’ll say here that it is any policy or program designed to reduce drug-related harm without necessarily requiring the cessation of drug use. In other words, you need not be clean to access services, or whatever. The focus instead is on reducing the harmful consequences associated with drug use. So, harm reduction approaches and practices could include needle exchange programs, methadone clinics, crack pipe kits and “wet shelters,” all of which aim to mitigate harms without requiring abstinence.

From CATIE

The Canadian Harm Reduction Network’s communications often includes the following quotation: “to act and not be acted upon is the essence of joy.” Harm reduction is an active process, or practice. Individuals must engage in self-management, and determine (with support) realistic goals that minimize risk. It is an approach that embraces working with people where they’re at and works to provide access to services regardless of a person’s substance use.

Harm reduction works

There is evidence that programs that reduce the short and long term harm to substance users benefit the entire community through reduced drug-related crime, and have a positive impact on neighborhoods where street-level substance use is concentrated. Harm reduction is preventative, in that it decreases the risk of overdose, transmittable infections and illnesses, and other health complications related to drug use. It is also more cost effective than other reactionary health care responses (i.e. emergency room and hospital care) to problems that arise from unsafe drug use.

Including oft-marginalized community members brings other benefits. Communities are safer, and healthier. By supporting people who use drugs to make empowered choices that reduce risk, the overall health of communities improves, because there are fewer people engaging in risky behaviour.

From the Austin Harm Reduction Coalition

 

Harm reduction strategies typically are also part of what might be called a “systems approach” to addictions or mental health. What this fancy academic-speak means is that these are complicated problems, and to best support people we need to involve basically everyone in our communities: the police, addictions services, hospitals, housing and transportation officials, food security people, people who can create meaningful leisure opportunities, etc. etc. etc. Harm reduction’s emphasis on choice and client-centred strategies that cater to various people and communities, each with their own unique strengths and challenges, demonstrates higher success rates for recovery and community integration.

No harm reduction without harm reduction training

Despite the proven benefits of harm reduction, it can still be difficult for some agencies to adopt this approach and practice. It may not fit with agency values, many of whom came of age in an abstinence only culture. Other agencies lack resources, staff, and training. This is an important point: when agencies lack those resources, they are, of course, underequipped to work effectively with people who are actively using substances. Readers from Kitchener-Waterloo might here think of the Out of the Cold saga last year, where volunteer run emergency shelters struggled to support community members using drugs. This story is much more nuanced than the cash-strapped CBC’s coverage suggests, but it is true that volunteers were not trained in harm reduction, and that that was a problem. (And, the saga continues!)

Harm reduction enables bad behavior?

Many misunderstand harm reduction as “enabling” mal-adaptive behaviours, like drug use. This argument takes different forms, but typically seems to suggest that “by assisting people who are already using drugs to remain healthier, avoid problems and stay alive, people who do not use drugs will regard drugs as safe and decide to start using drugs themselves.” Perhaps. But perhaps is as generous as I’m willing to be, because:

numerous scientific studies have shown no evidence that the introduction of needle exchange or other harm reduction strategies increase drug use. Though some people feel that providing needles may encourage others to start using drugs, this view underestimates the complexity of factors that shape people’s decisions about whether to use drugs.

If harm reduction is a gateway to anything, it’s treatment and support. For many people who use drugs, harm reduction is the first or only link to our health and/or social services.

Health and safety through harm reduction: no time like the present

It’s true that there might be times when a person’s substance will interfere with their ability to engage in some services. For example, counseling is difficult when a person is under the influence of drugs or otherwise incoherent. Nonetheless, harm reduction demands that access to programs, especially those providing essential human needs such as food and shelter, should be provided regardless of a person’s substance use.

From the Canadian Drug Policy Coalition

Ideally, as this idea gains more traction, and as government and social services continue to digest the impressive body of supporting research, agencies will be supported financially to implement and adopt harm reduction practices. Harm reduction works, but staff must be well equipped to do this vital work.

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