One could argue that the best way to reduce and prevent harms from substance use is for everyone to stop using psychoactive substances. Similarly, one could argue that the best way to eliminate traffic fatalities and injuries is for everyone to stop driving. Rather, we adopt harm reduction strategies like seat belts, encourage people to obey road signs and not to drink and drive. When I ride my bike, I wear a helmet as that has been shown to prevent injuries. Shouldn’t everyone have access to evidence based strategies that reduce harms related to licit and illicit substance use? The Supreme Court of Canada definitely thinks so. In 2011 they granted Insite, North America’s first and only supervised injection site, an immediate exemption from federal drug laws, upholding BC Supreme Court decision that supervised injection is a health care service.
Harm reduction is a respectful nonjudgmental approach to reducing harms of drug and alcohol use that meets people “where they are at,” in relation to substance use without the expectation of eliminating or reducing use. The goal is to reduce harm, both for the individual using a substance and for those influenced by other people’s use. Harm reduction philosophy and principles stem from a pragmatic understanding that substance use is a feature of human existence – it is a part of our world and we can work to minimize its harmful effects rather than simply ignore or condemn them (see www.ihra.net). Participation and social inclusion of people who use substances in harm reduction responses are important principles of harm reduction. Within an overall philosophy of harm reduction, there is a wide range of evidence based harm reductions strategies that reduce the harms of alcohol, tobacco and illicit drugs such as heroin, cocaine and crack.
Much of the focus in harm reduction has been on reducing the harms of illicit drug use such as blood borne diseases, overdoses, public disorder and crime. For example, strategies like the provision of clean injection supplies or safer crack use kits, supervised injection, naloxone, methadone maintenance, and heroin prescription programs have been shown to reduce these harms especially among disadvantaged populations . Street based harm reduction services often emphasize the importance of a trusting relationship with clients to reduce stigma and to increase referrals and access to other health, housing and social services.
We sometimes hear the argument that restricting or prohibiting the establishment of harm reduction services will reduce harm to the community and is therefore harm reduction. But this is often based on fear or misinformation rather than evidence. Harm reduction services reduce harms by their presence not their absence. Illicit drug use is often feared and highly stigmatized with incarceration as a response; treating substance use as a criminal rather than health issue. This is why many are calling for drug policy reform and the decriminalization of currently illegal drugs..
Providing information and education about safer use of drugs and alcohol is also part of a harm reduction approach (e.g. safe use of prescription drugs, safer drinking guidelines or safer injection techniques). Harm reduction strategies are part of public health, substance use and treatment services complementing withdrawal and abstinence based approaches. So why are some harm reduction strategies seen as more controversial than others even though there is a strong evidence base? Societal understanding of harm reduction is expanding and more work is being done on alcohol harm reduction and harm reduction approaches tailored to youth and women. Get ready for future blogs that address these and other issues.
Author: Bernie Pauly RN, Ph.D, Associate Professor, School of Nursing, Scientist, Centre for Addictions Research of BC, bpauly@uvic.ca