Substance Use and Harm Reduction
Overview: Checking in Substance Use in Canada Surveillance and Response Introduction to Harm Reduction Stigma and Substance Use Principles of Harm Reduction Harm Reduction in Practice Why Harm Reduction Works Harm Reduction in Health Care Questions & Check Out
Caring for Ourselves and One Another Please note that this lecture contains potentially sensitive content for some of us here. Let’s take care of ourselves and one another by learning from a place of empathy and compassion. Feel free to leave the room if needed or request a one-on-one debriefing after the lecture.
Substance Use In Canada Tobacco Alcohol Cannabis Prescription Drugs Illicit Drugs
Raise Your Hand If… You’ve used sunscreen You’ve worn a bike helmet You’ve worn a seatbelt You’ve had a designated driver You’ve used a condom You’ve been to a bar You’ve worn a face mask
Why are we talking about this today? Stats In Canada: In the first quarter of 2023, Canada saw an average of 21 deaths per day due to drug poisonings – almost one death per hour 90% of drug poisonings in 2023 have been in British Columbia, Alberta, and Ontario Peterborough consistently experiences per capita drug-related deaths above the provincial average 81% of drug toxicity deaths have involved fentanyl, most of which has come from the unregulated street supply (Opioid- and Stimulant-related Harms — Canada.ca)
Substance Use and Harms Tool | Public Health Ontario
Substance Overdose Profile Dashboard
Canadian Drugs and Substances Strategy: Overview - Canada.ca
The Four Pillar Approach
HKLN Drug Strategy Recommendations for Action
Good Samaritan Drug Overdose Act
Harm Reduction: “Harm reduction is an approach or strategy aimed at reducing the risks and harmful effects associated with substance use and addictive behaviours for the individual, the community and society as a whole. It is deemed a realistic, pragmatic, humane and successful approach to addressing issues of substance use. Recognizing that abstinence may be neither a realistic or a desirable goal for some users (especially in the short term), the use of substances is accepted as a fact and the main focus is placed on reducing harm while use continues.” - Homeless Hub
Stigma Fear and misunderstanding often lead to prejudice against people who use drugs. • Individuals who experience stigma and discrimination are less likely to seek treatment, harm reduction services, and health care services. • Public and societal stigma → self- stigma.
Explore the following expressions and your reactions to them. Do they differ from each other? If so, why? Did any of your reactions surprise you? If yes, reflect on how your personal values may influence your professional practice. A homeless alcoholic Needle exchange program Abstinence-based treatment Problem drinker Methadone treatment Parent with hangover IV drug user Crack dealer Professor smoking marijuana Pregnant methadone client Crystal meth addict Chain smoker Cocaine user Drunk driver Gas sniffer Underage drunk Person with HIV Coffee drinker 19-year-old buying alcohol/cannabis for younger sibling
Stigma and Substance Use Common Drivers of Stigma: Belief that substance use is a reflection of poor willpower or moral failure. Belief that people who use substances are dangerous and reckless. Belief that substance use is not a real illness and people “could choose to stop”.
Stigma and Substance Use What Stigma Can Look Like: Negative media portrayals. Social avoidance and exclusion by others. Failure to accommodate employees who use substances. Discrimination in health care, housing, criminal justice system, etc. People who hold societal power (including nurses) judging PWUD as untrustworthy, disruptive, and responsible for their health problems
Experiences of care for PWUD From local research: “Like a switch gets flipped” when substance use disclosed “that look that makes you not want to be there” “in a small town the stigma lasts forever” • (Hardill, 2019)
Why is harm reduction in health care important? Harm reduction as an inherently anti-stigma practice (…this does not mean that harm reduction service providers are inherently free of stigmatizing biases!!! We need to be constantly asking ourselves why we are here and what are the motives behind the choices we are making when we serve PWUD) Outcomes and Impacts of Stigma in Health Care: Delayed or decreased use of health and social services and poorer quality of services received. Concealment of substance use. Loss of work and limited access to leadership positions. Increased risk of homelessness. Health-harming coping strategies and behaviours. Increased risk of poorer physical health, quality of life, and psychological outcomes. Poorer outcomes for substance use treatment. STIGMA KILLS.
Harm Reduction as a Philosophy, a Political Movement, and an Approach to Services: Founded on principles of autonomy, dignity, choice, acceptance, universal respect and unconditional positive regard Champions social justice and equity by shifting power and resources to people most vulnerable to structural violence. A set of fundamental beliefs that guide how we provide services
Principles of Harm Reduction Accepts for better or worse, that licit/illicit drug use is part of our world Establishes quality of individual and community life and well-being. Ensures that people who use drugs and those with a history of drug use have a real voice Recognizes context and intersectionality Understands drug use is complex Non-judgmental and non-coercive provision of services Affirms people who use drugs Does not attempt to minimize or ignore the real and tragic harm and danger that can be associated with illicit drug use.
What does harm reduction look like?
Practices of Harm Reduction Needle Exchange Programs/Needle Syringe Programs Overdose Prevention, Recognition, and Response Programs (naloxone, NORS hotline, community training) Street outreach Education Meaningful involvement of people with lived and living expertise Replacement Therapies (Methadone, Suboxone/Sublocade, Kadian) Consumption and Treatment Services (or Supervised Consumption Sites, Safe Injection Sites, Overdose Prevention Sites) Safer Supply/Prescribed Alternatives Programs Decriminalization of illicit substances
Harm Reduction is NOT about “fixing” people.
Why Harm Reduction Works
Why Harm Reduction Works
Why Harm Reduction Works
Harm Reduction in Health Care Why is a harm reduction approach important in health care? What could harm reduction look like in a hospital setting? In a clinic setting? What are the impacts on people who use drugs when we don’t employ a harm reduction approach? What kind of service provider do you want to be?
CHN – Guiding Principles Person Centred Inclusiveness Non- Stigmatizing Knowledge and Best Practices Total Community Collaboration
RNAO: Best Practice Guideline Harm reduction: ■ Is an alternative to the disease causation model of substance use; ■ Accepts that at any given time some people are not ready to choose abstinence; ■ Accepts that substance use occurs in society and works to minimize its harmful effects; ■ Accepts that people who are substance-dependent should have a voice in the creation of programs and policies designed to serve them; ■ Values patient autonomy; and ■ Does not exclude abstinence as an option (Beirness, Jesseman, Notarandrea, & Perron, 2008; CNA, 2011).
Harm Reduction in Health Care Examples of harm reduction in hospital settings: • Prioritizing access to peer supports for people presenting with substance use-related concerns • Prescribing adequate, realistic doses of preferred medications for people who are staying in hospital, without judgment • Providing access to safe consumption rooms on site • Distributing harm reduction supplies within the hospital • Non-punitive approach to drug use on hospital grounds • Using respectful non-stigmatizing language with patients and in their charts
Language Matters The words we use to describe people who use drugs can be a barrier to them seeking care Labels such as “addict” dehumanize people and take away from our individual identity. We are not defined by our health conditions. The words we use reflect our personal beliefs and values. What beliefs and values do you want guiding and representing your work?
Language Continued: Try:Instead of: Try: Addict, junkie, drug-seeker Person who uses substances Dirty needle/Clean needle Used needle/New needle or Sterile needle Drug offender Person arrested for a drug violation Ex-addict/Clean/Straight/Sober Person in recovery/Person with lived experience
Harm Reduction in Health Care – A Philosophy of Care, a Practical Approach Focus on their immediate health concerns and needs without judgment of their substance use Prioritize reducing harms associated with their substance use rather than the substance use itself A positive experience with health care providers will increase their likelihood of seeking care in the future if/when needed YOU can be that positive experience
Reminder of why we are talking about this today: The Unregulated Toxic Drug Poisoning Crisis Canada (Government of Canada): Average of about 19 deaths/day 40,000+ since 2016 Ontario (Public Health Ontario) Average of about 7 deaths/day 2500+ in 2022 Peterborough City and County (Peterborough Public Health) Average of one death every 5 days 78 deaths in 2023
What can we do? PWUD want genuine, trusted allyship within health care What can health care providers do, within the limitations of criminalization and prohibition, to preserve and promote life for their patients who use drugs? (Hint: we have access to prescription pads, but also so much more!) What are the impacts on people who use drugs when we don’t employ a harm reduction approach?
Public Health Policies
Peterborough Safer Supply Program: What they had been seeing: Data analysis in progress: Most (> 80%) have significantly reduced their use of illicit fentanyl, including some (about 35%) who have completely stopped using fentanyl on stable SSP doses Some have reduced use of other substances eg crystal methamphetamine, cocaine Dramatic reductions in ODs, medical complications compared to baseline Enthusiastic update of primary care (treatment for chronic disease incl. mental health issues, hep C tx, vaccines, referrals, counseling, etc) Many use support of case manager and systems navigators for counseling, court support, ID Harm reduction supplies, teaching (e.g. safer D8 injection)
Final thoughts… PWUD remain one of the most demonized and stigmatized populations in Canada. The fight for human and health care rights often stops short with us Right now, in 2025, political polarization is threatening not only the funding for harm reduction programs, but also the core values and integrity of harm reduction as a philosophy and practice. Please use your critical thinking skills when you read the news; look for the evidence, not the catchy headline. The way you speak about harm reduction and PWUD matters. We need allies now more than ever.
Questions? What are your throughts?