Understanding Harm Reduction

Harm Reduction and Substance Use

Harm reduction acknowledges that many individuals coping with addiction and problematic substance abuse may not be in a position to remain abstinent from their substance of choice.

The harm reduction approach provides an option for users to engage with peers, medical and social service in a non-judgmental way that will “meet them where they are”.

Policies, programs, and practices that aim to reduce the harms associated with the use of alcohol or other drugs.

CORE COMPETENCIES:

Pragmatism: Harm reduction recognizes that substance abuse is inevitable in a society and that it is necessary to take a public health-oriented response to minimize potential harms.

Humane Values: Individual choice is considered, and judgment is not placed on people who use substances. The dignity of people who use substance is recognized.

Focus on Harms: An individual’s substance use is secondary to the potential harms that may result in that use.

(Canadian Mental Health Association 2020. Ontario.cmha.ca)

Harm Reduction Approach

“When working with people with substance abuse, a compassionate, trauma-informed approach is one that starts by acknowledging that people may use substances, such as drugs or alcohol as a survival skill as the result of trauma. Without considering that perspective, health-care and service providers will not be able to effectively provide help.”  (Trauma-Informed Care and Why It Matters | Psychology Today Canada)

Harm reduction aims to reduce the negative impact of addiction or problematic use/behavior on the individual’s health, including socioeconomic circumstances and relationships, without the individual necessarily stopping use or the behavior.

Abstinence may not be part of the treatment program or even the end goal as some people lack the internal motivation for change to occur and some do not have the resources to stop use at a particular time.

Harm reduction approaches do not presume a specific outcome, which means that abstinence-based interventions can also fall within the spectrum of harm reduction goals.

Essentially, harm reduction supports the idea that those with addiction or substance use issues should be treated with dignity and respect and have a wide selection of treatment options in order to make an informed decision about their individual needs and what would be the most effective for them, while also reducing the harms. (Harm Reduction (cmha.ca)

Principles of Harm Reduction

  • Non-judgmental approach that meets people where they are at
  • Treating all individuals with dignity, compassion, and respect
  • Opposition to the stigmatization of substance use disorder
  • Use of evidence-based policy and practice
  • Accepting behavior change as an incremental process. Small gains for many people have more benefit for a community than large heroic gains achieved for a select few. People are much more likely to take multiple tiny steps, rather than one or two huge steps
  • Inclusion of individuals in active addiction, in recovery, and within the community to shape policies and practices
  • Focus on quality life improvements over abstinence
  • Commitment to universal human rights
  • Empowerment of the individual as the primary agent responsible for reducing the harms related to their substance use

Harm Reduction Programs

  • Needle exchange programs are a harm reduction tactic to reduce the risk of infection among injection drug users by preventing infection transmissions through sharing needles. The intent is to reduce the harm of infection, not to stop the drug use.
  • Safe consumption sites
  • Using a nicotine patch instead of smoking
  • Drinking water when using alcohol
  • Access to take-home-naloxone for anyone at risk of an opioid overdose

Drug Therapy

Agonist therapy is a pharmacological treatment also known as substitution or maintenance therapy. Agonists mimic the substance by stimulating receptors involved in the addiction.  Methadone and nicotine replacement are examples of agonist therapy.

Cross dependence occurs when withdrawal symptoms from one drug in a class/ category can be relieved by administering another drug from that class: for example, when diazepam is used to assist in alcohol withdrawal.

Partial agonists stimulate receptors (at low doses) and block them (at high doses) to produce weaker biological responses similar to that created by the substance. Examples include Champix (trade name for varenicline) for nicotine replacement.

Antagonists are used to block the neurotransmitter and the anticipated reward. When the reward repeatedly is blocked, the substance use loses its appeal because it no longer is providing the desired effect. An example is naltrexone used to help in alcohol and opioid dependence.

Addictions Foundation of Manitoba (AFM)

AFM uses person-centered care and promotes a client-centered care approach to delivery of all programs and services.

The Biopsychosocial Spiritual (BPSS) model is an integral component of this approach and, therefore, the determinants of health and social determinants of health are considered in person-centered care.

Person-centered care empowers the client because it is based on:

  • Client needs
  • Client concerns
  • Client goals
  • Client rights, voice and self-determination

As a result person-centered care tailors treatment to the individual client needs, concerns and goals. It advocates safety and harm reduction as treatment guides towards the client’s ultimate goal.

AFM’s Person Centered Care

Among the many advantages of person-centered care is that it can be incorporated at any point in service provision. The main principles of person-centered care practices are:

  • Respect for the client’s wishes, concerns, values, priorities, perspectives and strengths
  • Consideration for the client as a whole, unique human being, not as a problem or diagnosis
  • Understanding that the client knows him or herself the best, and knows what they need
  • Care providers follow the lead of the client around providing information, making decisions and involving others in their treatment and recovery
  • The client defines the goals that determine the practices of the health care team, and all team members support the client in achieving these goals
  • Care is founded on continuity and consistency of care and caregiver
  • The needs of the client and communities deserve a prompt response
  • Care is universally accessible and responsive to the client’s needs
  • The client’s rights are essential to good care

Street Connections

Street Connections is a mobile public health service in Winnipeg.

Their goal is to reduce the spread of sexually-transmitted and blood-borne infections (STBBIs), including hepatitis C and HIV, and reduce other drug-related harms.

They are part of Healthy Sexuality and Harm Reduction in the Winnipeg Regional Health Authority’s (WRHA) Population and Public Health Program.

Public health nurses and outreach workers staff their van, which drives around the city every evening except Sunday. You can also find them during the day from Monday to Friday in their office on the main floor of 496 Hargrave St.

They base their services on a harm reduction philosophy. This means that they support programs and policies that improve the health of people who use drugs and support people in their efforts to keep themselves and the larger community safe, without judging people for their sexual or drug use practices.

Street Connections Mobile Van

The Street Connections van is out:

Monday to Thursday from 6:00pm to 11:30am,

Friday from 5:00pm to 11:30pm

Saturday from 5:00pm to 10:30am.

For current locations and times visit: https://www.streetconnections.ca/content.php?navigation_id=2278

Harm Reduction Strategies for Clients

Buy less so you use less. Buying large amounts of a drug may be cheaper, but you could end up using more than you want to simply because it’s there.

Set a time limit before you start. If you choose, say, to stop drinking at 10:00 p.m., watch the time, remind yourself of your time plan, and stick to it. Have some juice ready.

Eat a meal before you start, and avoid snacking on salty foods, especially if you’re drinking. You may drink more out of thirst.

Lower your dosage and frequency. In other words, drink, smoke or inject in smaller amounts—and less often—than you do now. When it comes to alcohol, this could mean choosing light beer or other low-alcohol drinks, or alternating drinks with water or pop.

Choose the least harmful method of use. Injecting a drug carries more risk than smoking, snorting or swallowing it. (If you do inject drugs, avoid the neck area.) When it comes to cannabis, using a vaporizer or smoking a joint (with a rolled-up cardboard filter) is safer than using a bong and some pipes.

Plan out some drug-free days. The fewer days in a row you use a drug, the better. If you use the drug every day, try cutting back your use to every other day, and try not using it at all for two to three days. (Make sure you have in mind other ways to spend your time and energy so you don’t end up sitting around and thinking about how you miss getting buzzed.

Use at your own speed and don’t feel pressured from others to pick up the pace.

Find someone caring and understanding to talk to when you’re struggling to stick to your reduced use plan.

Read self-help books that feature stories about people who have successfully cut down on or quit using a drug.

Put condoms in your pocket before you start using a drug, even if you’re not planning to have sex. You might change your mind.