There is no doubt that every community in Canada has been impacted by the opioid epidemic. With approximately 4000 opioid related deaths in 2017, Dr. Theresa Tam, Canada’s chief public health officer, has labelled it a “major public health crisis”. Continued opioid use puts individuals at heightened risk of overdose death and certain diseases, such as HIV, Hepatitis B and Hepatitis C. Also, not only is the drug user put in harm’s way, so too is the general population, who might contract these diseases from drug users as well.
Furthermore, open drug use, discarded needles and drug-related criminal activity can compromise public safety. Drug abuse can also significantly increase the risk that individuals will lose their jobs, face homelessness and have to deal with social isolation. Although abstinence and de-addiction is the main goal of any drug rehabilitation program, many individuals dealing with addiction may not be in a position to immediately stop taking drugs or access treatment. These are humans that come from families that love them and are worthy of being saved. These sentiments are at the core of the “harm reduction” approach to drug use.
Harm reduction refers to programs, practices and policies that attempt to reduce the harms associated with drug abuse on individuals, their families and their communities, without requiring a decrease in drug use. It recognizes that continued drug use is inevitable: time and again, it has been found that it is practically impossible to completely stop illicit drug abuse in society.
The ‘Mersey Harm Reduction Model’ was first introduced at the International Conference on the Reduction of Drug Related Harm in Liverpool, England in 1990. Since then, many harm reduction strategies have been studied and found to be effective in the scientific literature as well as in practice. The vision of these harm reduction programs is to reduce the stigma around drug abuse and provide drug users with non-judgmental access to medical and social services. The overall goal is the prevention of Hepatitis B, Hepatitis C, and HIV, alongside overdose prevention and treatment with safer opioid options.
Around the world, needle exchange program (NEP) and methadone maintenance treatment are the most established harm reduction programs. NEP involves the distribution of sterile syringes and the collection of used needles. Studies have shown that the provision of these items can decrease the risk of contracting Hepatitis C and HIV by as much as 50 to 80%. On the other hand, methadone maintenance treatment involves using methadone, which binds to the same receptors in the brain as other opioids. Substituting opioids with methadone reduces drug users’ cravings for opioids and because there is no “high” associated with it, people do not get addicted to it. Moreover, it is safe compared to other opioids and since it is taken orally, there are no injection-related risks.
Other harm reduction practices that have proven to be helpful are low threshold addiction services, which provide drug users with a safe place to live and eat while helping them reduce drug-related harms. Slowly, as drug users build trust with service providers, they are referred to the appropriate treatment services. This program was implemented in the 90’s in Switzerland and currently, over 65% of active drug users are involved in some form of drug treatment.
Novel harm reduction practices that are still in the experimental stage in Canada are Supervised consumption facilities (SCFs). These facilities offer drug users a place to use heroin and other narcotics under medical supervision. This environment allows for improved injection hygiene, curbs overdose related deaths, and more importantly, connects the most marginalized drug using population to medical and social services, expanding their access to addiction treatment. An example of this supervised injection facility is Vancouver’s Downtown Eastside, where no overdose deaths have been reported thus far.
Alongside providing treatment access and overdose prevention, harm reduction strategies support people to make informed, healthy life choices. Outreach services distribute educational materials on safer injection techniques, overdose prevention, and condom use to target drug users. This counselling work is often done by peer drug users, who have adopted safer drug-use techniques. By sharing in their lived experiences, they are able to connect with the drug users and help limit their needle sharing.
While harm reduction respects the basic rights of people who use drugs, it poses some concerns. One such concern is that it prevents drug users from escaping their addiction. However, studies have shown that harm reduction actually helps drug users to connect to healthcare and social services. Other concerns are that harm reduction might promote drug use among non-users while threatening public safety by attracting drug dealers. Again, scientific research has found no association between increased drug use and harm reduction programs. In addition, there is conclusive evidence that showcases the positive impact that these programs have on drug users’ health.
Despite current research that supports harm reduction as a means of addressing the opioid crisis, the very factors that led to the opioid epidemic to begin with should not be forgotten. Something that was key in starting this epidemic was the labelling of pain as fifth vital sign; the introduction and over prescribing of opioids; and the introduction of OxyContin and other opioids for pain control. Moreover, reassurance by pharmaceutical companies of the non-addictive nature of opioid pain relievers contributed in some way or another to the present situation. The talk around harm reduction continues to be highly controversial, with mixed sentiments from politicians and the public. Yet, the reality is that an epidemic continues to unfold across North America, and harm reduction is one of the most promising ways of dealing with it.