Do British Columbians Support Harm Reduction?

Harm Reduction is a public health response to substance use that minimizes death, disease, and injury from drug use by promoting safer drug use practices. However, the media regularly publishes articles about harm reduction in a negative light – we  hear controversies about harm reduction services in the political arena, and passionately discuss the topic around the dinner table. But are we, the public, really that spilt in our opinions about harm reduction? A recent public attitudes study found the majority of the public in BC supports harm reduction services.

In December 2013, the BC Centre for Disease Control published a research article on the attitudes of British Columbian’s towards harm reduction strategies and services in the Journal of Substance Abuse Treatment Prevention and Policy. The study found over three quarters of British Columbians surveyed support harm reduction. Of those surveyed 72% support needle distribution and 65% support needle distribution in their own community. These results are encouraging for those working in harm reduction roles, whose work supports and promotes harm reduction activities in BC, and for those whose lives depend on harm reduction services.

The BC survey found that people who were younger, female and had completed at least a high school education were more likely to support harm reduction. Those who resided in the Fraser Health region were less likely to support harm reduction but even here 69% supported it. Targeting messages towards segments of the population who may have misconceptions about harm reduction may help gain further support for services that improve the health of, and reduce stigma towards, people who use drugs. Messages should inform the public that harm reduction has economic and health benefits and helps individuals, families and communities to be safer and healthier. Studies and experience has repeatedly found harm reduction programs do not promote illegal drug use but, in fact, decrease use and increase access to drug treatment programs. Platforms such as the media, city council meetings, and community forums should be utilized to share this information and bring awareness of the benefits of harm reduction services to all British Columbians.

It is important to note that regardless of some vocal media and local municipality opposition, British Columbians care about people with substance use issues and support harm reduction services. This brings into question why some policies are in place in BC that contradicts the benefits of harm reduction services and the public’s support. Are city councillors being swayed by a vocal minority? Or, are decisions being made for reasons that are not evidence-based? In the light of BC’s recent public attitudes survey, we encourage all policy-makers to re-evaluate their harm reduction policies in order to meet best practice recommendations, save people’s lives, and represent the public’s support for harm reduction services across the province.



Authors: Despina Tzemis (left), Harm Reduction, Health Promoter, and Jane Buxton, Harm Reduction Lead, BC Centre for Disease Control (right)

What is harm reduction?

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 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,