From The Trenches: Harm Reduction In Action

As a community health nurse in downtown Ottawa, I frequently rely on the harm reduction model when working with people living with substance use disorder. It has helped many people I have encountered in my practice. Unfortunately, though, it does not work for all.  

The harm reduction model meets individuals right where they’re at in their substance use journey. It does not insist they stop using drugs if this is not yet possible for them. It engages and helps people by reducing risks to their health with the eventual long-term goal and belief that the challenges of substance abuse can be gradually overcome. This model gives people living with substance use disorder hope that their life path can be changed and recovery is possible.  

According to the Canadian Mental Health Association “harm reduction is an evidence-based, non-judgmental approach to helping people decrease health risks associated with substance use.”  

Since 2016 a total of 90 countries have been using harm reduction interventions to varying degrees. The countries that support the harm reduction model view substance use disorder as an urgent public health problem and a chronic illness, so instead of locking up individuals caught with illegal drugs, they provide them assistance.  

To better understand the harm reduction model, visualize a continuum; at one end is total abstinence from harmful substance use and on the other end is severe substance use disorder. People needing help can be anywhere on this continuum. 

Using the harm reduction model, a healthcare worker would negotiate with a person about what they would be able to do in order to decrease health risks and move down the continuum towards the abstinence end.  

For example, someone who shares needles may agree to use only clean, sterile needles and take advantage of a safe injection site or SIS.  

A safe injection site (SIS) is another example of harm reduction in action. It is a medically supervised facility providing a hygienic, stress-free and legally sanctioned environment in which individuals are able to use illicit drugs intravenously. They are also able to have their drugs tested for potency and impurities before using them.  

The drug testing intervention in itself, and the quick interventions by health professionals with oxygen and naloxone (an antidote to opioids), saves countless lives from overdose. Several research findings have shown that a SIS leads to a decrease in crime in the community and also a decline in risky habits like sharing needles and the accompanying incidences of HIV and Hepatitis C infections.  

Another example of harm reduction is providing prescription narcotics or methadone for people with an opioid addiction, hence reducing the risk of people using tainted street drugs cut with impurities. This greatly helps to stabilize individuals, so they no longer have to hustle for drug money (which can lead to violence and crime), but can begin to build healthier lives by accepting and receiving help.  

Those who are prescribed methadone are more likely to receive treatment as a result of accessing these services. Methadone only works for opioid addiction so for those who use cocaine there is sadly no such help available.  

In one case I was working with a young man living with a chronic illness and an addiction to fentanyl. This individual used the SIS often and was then referred to an addictions medical doctor and prescribed daily doses of a narcotic to help quell his opioid addiction.  

The prescribed narcotic was administered to him regularly throughout the day. The next thing I knew he was keeping his appointments with me and for the first time was able to begin to address his debilitating health issues. Slowly, step by step, his health began to improve.  

Another woman, who also had chronic illness and a substance use disorder, was prescribed a daily suboxone dose. This stabilized her enough to finish high school and find a job. I have witnessed many examples of lives transformed in this way.  

There is a bit of a downside. Despite the strong evidence supporting the harm reduction many people struggle with it, and at times I do as well. A safe injection site can feel like enabling another human to do something detrimental to themselves.  

One could also argue that safe injection sites do nothing to help the person actually recover from a substance use disorder and that the government should not facilitate activities such as illegal drug use. Some think funds spent on safe injection facilities could be put towards proper treatment centers, rehabilitation and half-way houses.  

These are all valid arguments. Yet as a community health nurse I have seen the harm reduction model work for many people and believe it should be allowed to continue to do so. 

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