There are a lot of angry folx in our community. They are victims of crime, and harassment and are seeing the effects of addiction and homelessness on their doorsteps.
This does make me angry. These things are not okay. People are also seeing how complicated the systems in place can be to navigate, and the lack of resources available at times. There have been calls for heavy investment in treatment opportunities and mental health resources — things I completely agree with.
Mental health resources are lacking. Provincially funded treatment options are lacking. However, I’ve also heard a lot of the blame being placed on harm reduction — that it kills, enables and is a waste of money. These statements simply aren’t true.
Instead of examining the intersectional effects of housing, income, mental health, education, trauma and a long list of other things that contribute to the cycle of addiction, a lot of the blame is being placed on harm reduction.
There has been a gross misrepresentation of what harm reduction is and why it is important.
Now I will say that I am a harm reduction nurse, so yes, I am biased. But I also base my work around science and facts, as well as the lived experience and testimonials of those I work with.
I believe in harm reduction. I love people who use drugs. People who use drugs are important to me. I understand the anger of the community, but I think some of it is misplaced and misinformed.
Now there is no universal definition of harm reduction, but it generally speaks to some of the same principals across different organizations. I view harm reduction as a public health approach that aims to reduce the negative social, legal and health impacts associated with substance use.
At its core, harm reduction supports any steps in the right direction. It is individual in its nature, non-judgemental, supportive and evidence-based. It can include everything from abstinence, treatment, nicotine patches, methadone, housing, naloxone and consumption and treatment services (CTS).
It recognizes that people who use substances deserve dignity and respect when it comes to their decision making, and does not have abstinence as a precursor for accessing vital health care services. Most importantly, harm reduction focuses on keeping people alive so that they have another day to have a chance to make a change if they are ready for it.
While keeping people alive is my favourite part of harm reduction (the consumption and treatment services site has reversed 131 overdoses since October 2019), there are many other societal benefits as well.
Needle syringe programs are one of the most cost-effective public health measures we have. There are numerous global studies that show that for every $1 spent on these programs there is an average savings of $2.50-$4.00 to the health care systems.
These programs, as well as places like the CTS also decrease the transmission of diseases like Hepatitis C and HIV, which accounts for millions in cost savings to our health care system.
Naloxone programs are cost-effective in preventing overdose deaths. CTS provides return on investment: In 2009, Canadian researchers concluded that Insite, Vancouver’s supervised injection facility, provided a societal benefit of US$6 million per year after implementation costs were accounted for. I could keep going because there is never-ending research to support harm reduction as a framework.
While I think harm reduction is great and I have seen it save lives, I also know, that it is not the ultimate solution, but a piece in a complex puzzle. Drug use is complicated, varying, and individual in its nature in that no two substance users will have the same journey or require the same approach.
There are hundreds of reasons why someone uses substances, and just as many more for continuing to use. Do we need more treatment and mental health resources? Absolutely! However, that is not the only solution either, and it can’t come at the expense of losing harm reduction programs.
The community needs a systemic approach that encompasses things like housing first, safe supply, treatment, universal basic income, and less punitive legal consequences that limit employment opportunities to name a few. Treatment can’t be the only option. Treatment can’t exist without harm reduction. People must be ready to accept treatment as a part of their lives.
Harm reduction doesn’t minimize that in reality there are obvious health implications that come with using drugs. Instead, it tries to minimize the risk of those health implications while respecting the personal autonomy of people who use drugs.
People who use drugs don’t have to get clean to make others feel better about themselves. In fact, they don’t ever have to get clean if they don’t want to. That doesn’t mean they deserve to die, face barriers to accessing health care or be treated with any less dignity or respect then your mom or dad or neighbour.
People tend to look only at the behaviour of people who use drugs (and yes sometimes that is negative). Far less attention is paid to the how or the why. Often, the non-using community doesn’t care to know or examine the intense personal traumas that might have caused someone to start using drugs, or the continued failed drug policies that keep them grounded in poverty.
There is the lack of affordable and supportive housing that would provide stability for these folx, and inadequate social programs leave some people with only $400 a month to live on. Again, crime and harassment are also terrible things for our community but harm reduction is not the cause.
Most importantly, harm reduction doesn’t kill, it saves lives. If you take away harm reduction programs, people will die.
Treatment is great for those who want it, we need it to exist, but it can’t exist on an island. And you can’t get someone into treatment if they are dead.
Emma Horner RN BScN is a harm reduction nurse working in Waterloo Region with people who use drugs and people experiencing homelessness.
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