Paper on Harm Reduction

Jase Watford

Department of Social Work, Lakehead University

SOWK – 3415 WDE: Treatment, Drug and Alcohol Abuse

Professor Brenton Diaz

Feb 12^th, 2021

Harm reduction, according to the Canadian Mental Health Association (CMHA)” is an evidence-based, client-centred approach that seeks to reduce the health and social harms associated with addiction and substance use, without necessarily requiring people who use substances from abstaining or stopping. Included in the harm reduction approach to substance use is a series of programs, services and practices. Essential to a harm reduction approach is that it provides people who use substances a choice of how they will minimize harms through non-judgemental and non-coercive strategies in order to enhance skills and knowledge to live safer and healthier lives.” (Thomas, 2005)

When I was homeless and living down on Vancouver’s lower West side, harm reduction was just being introduced. Due to some unforeseen circumstances and my precarious mental health, I lived out of my tent up and down East Hastings Street. Harm reduction was a running joke at the time it was being rolled out, for those of us with addictions anyway. Most of us understood the merits of trying to stop the spread of blood borne diseases (what harm reduction was originally created for). But the mixture of safe injection sites, and social workers asking us “if we could just use or drink or use less” was confusing. Especially when you are on skid row, it emphasizes the place and state (precontemplation) that we, or at least I was in (The Transtheoretical Model of Behavior Change). I have had the privilege and misfortune of having a front row seat in the evolution of harm reduction in Canada. I do my best to remain open minded and nonjudgmental about things, but I wish we knew then, what we do now. Perhaps I wouldn’t have tried out every variation of substance recovery? But if I hadn’t, would I have such a broad perspective into the world of addiction? From spending a month in a wet house in Nanaimo where doors locked at 8pm and we could actively use any substances under supervision as long as we stayed in the building until morning, to working on the front lines at a shelter where the sole requirement of the client is to practice abstinence and be free of any substance for the last 12 hours, I can tell you that I have seen a lot both personally and professionally.

Now if success were as black and white as the government would like us to believe, we would have a need for radical ideas in the harm reduction narrative. If the medical model wasn’t so black and white, these ideas wouldn’t be considered radical. Granted, my recovery was forged in the fires and brimstone of old school treatment techniques (grounded in God and the AA/NA ideology) where the counselors would do their best to break you, break the addict, and build back up the human inside. It was a time and place where pragmatism was eschewed for dogmatism. Kneel, sit, stand, alleluia. The wash, rinse, repeat type of brainwashing that harm reduction struggles to set itself apart from. Freethinkers are chastised for doing so; either convert or you get cast out. Not a single person in self-help groups has the exact same type of recovery, which is what leads a lot of people (including me) for support elsewhere. This Draconian measure of psychology’s operant conditioning (BF Skinner) is the use of reinforcement and punishment as a means to treat addiction and substance abuse. And when a person slips, or relapses the support stops until the individual comes back through the doors sober/clean admitting their wrongs/sins. Within this method substance recovery was toxicity stacked with guilt and shame. Methods that were (and are still in some agencies) commonplace with professionals.

Regarding structuralism flaws and their relations the French philosopher Michel Foucault once stated that “it’s obvious that detention and prison ‘reformation’ don’t reduce delinquency or crime” (p.119). Therefore it makes no logical sense to treat people with a substance abuse disorder like criminals. Unlike crimes or criminal recidivism, addiction recovery or in this case relapses and slips would be steps of progress not to be penalized. Counsellors who began adopting strength-based approaches (in both my personal and professional experience) changed the landscape, where myself and others like me found some footing, and subsequently a better quality of life psychosocially. The stick or carrot routine doesn’t encourage an individual to move along the spectrum without incurring various levels of trauma. Meet a client where they are at, work with them to move along that spectrum and meet their goals no matter how big or small because success looks different to everyone.

We have come a long way societally, in our understanding of the co-morbidity of addiction and mental health (the underpinning socioeconomic factors that impact an individual at risk). What needs to happen now is: expanding social pillars from Maslow’s Hierarchy of Needs to the Social Determinants of Health, connecting the silos, working together federally/provincially in a such a way that agencies can focus on upstream thinking and system navigation, serving the individual and community at risk. Addressing of the systemic barriers and the government who continues to make money off of the backs of vulnerable people, thusly creating a cycle of issues reducing the effectiveness of harm reduction. The government both enables and treats addiction, the government provides the funding for social supports but at the same time profits off tobacco, gambling, alcohol and marijuana sales. This is extremely problematic in the narrative of social progress. The government has made society complicit in socially-assisted addiction and socially-assisted suicide. Locally, considering the high levels of addiction, our city has only one managed alcohol program. It assists 10 of the most severe cases in the city. We have 4 OATC sites, and approximately 10 pharmacies which deal with addiction treatment. In my experience, having worked at an addiction treatment pharmacy for a year, it was evident that they were harm reduction in name only. The goal was to get as many clients on methadone so they would make more money, yet treat individuals with the same cold harshness that lends itself to the reward and punishment model of the past. At times it felt as if we were back in 2007 when the Conservatives replaced Canada’s Drug Strategy with a new National Anti-drug Strategy.

In Thunder Bay, homelessness, addiction and inclement weather are also serious issues. Over the past 2 years I have worked for a couple of agencies that provide shelter from the elements. These are low barrier shelters where each client receives a warm meal, warm bed, laundered clothes, or new clothes during their supervised stay. In the morning they can shower and have breakfast before they are sent on their way. It is unfortunate that a good portion of Thunder Bay opposes these agencies and their operations because they don’t see any (on the surface and immediate) effort towards fixing or changing people and their issues. While they do act like a palliative care unit, they are on the harm reduction spectrum in that they provide an easier time for a person which addresses some of the social determinants of health and grants them time to potentially make some changes in their lives.

Getting society to change their viewing lens is a challenge. Most socialists (me included) will argue that capitalism is a present form of oppressionand if the government was honestly interested in taking action in actual harm reduction it would address all predatory actions. For example: remove all cheap high alcohol percentage booze from the beer/liquor store shelves. Those beverages only serve one purpose, and it isn’t to provide convenience to the consumer, but to monetize the need for consumerism forgoing the social cost. What does it say when the LCBO and Beer Stores are considered essential services? That isn’t to say that we as people aren’t responsible for our choices. But the government should also be accountable for their choices, especially when it comes to the collective well-being of its people.

Presently my city has a functioning crack pipe, needle and syringe exchange program, one supervised consumption site for First Nations individuals, limited street outreach, and a drug substitution methadone maintenance treatment program. But we need more harm reduction services. Unfortunately we are nowhere near where we should be. I sit on a couple Ontario opioid working groups and would like to see Thunder Bay implement the Safer Opioid Supply (SOS) pilot program that Ottawa has rolled out. The SOS “is a low-barrier model intended to reach people who are alienated from other models of health care delivery as a result of structural barriers that prevent those impacted by homelessness, poverty, mental health issues, racism and stigma from accessing needed care. It is administered by a network of primary care clinicians and delivered out of Community Health Centres and primary care clinics.” (p.2)

It is very easy to look at where we are and say that we haven’t got what we need, or we aren’t where we should be. In the last 20 years, both personally and professionally I have witnessed a tremendous amount of progress collectively as a society. But philosophically, not because I am a philosophy major but that I believe the solution to the human condition is on an individual basis, there is no one size fits all, or utilitarian broad brush stroke, especially when it comes to substances. I find harm reduction to be the stable ground in which we can collectively (as agents of change) work together with individuals one on one to provide them with some semblance of consistency and support so that they may reconnect to the collective. Combat the addiction isolation and determine their route, and the process that suits them best.

It is a critical time for harm reduction in Canada. There is a growing overdose epidemic within the present Covid-19 viral pandemic. There are not enough federal political changes that protect vulnerable populations. The types of community supports (environmental, economic, social, mental, physical, and cultural) over the last year dried up. Leaving many agencies where individuals rely for system navigation unable to connect to clients as frequently or not at all. According to the Canadian Association of Mental Health (2021) “Disruptions in mental health and addictions services are affecting people in need of support. People are often experiencing inconsistencies in service provision.” (p.3)

In Thunder Bay specifically; access to addictions counselling just now has come back online (for those who have the luxury of internet and device access). Agencies that provided safety kits (clean needles, pipes etc.) and other various in house supports were not doing so for the first 5 or 6 months of the pandemic. Shelters were either closed, or restricted, there was no treatment centres taking new clients. Self-help groups took a while to get online and provide support through Zoom. Our First Nations community prior to the pandemic was already struggling with their people ingesting large numbers of non-palatables. And with the pandemic access and supply to those items became limited, we had a spike in overdoses because the addiction had to be satiated one way or another. Having worked the last 8 years on the frontlines locally and primarily with First Nations individuals I witnessed what little support they had disappear in what seemed like moments.

Waiting for the pandemic to end, before we go back out there and resume what we were doing isn’t proactive. And as if we weren’t already playing catch up? I can tell you from a frontline perspective personally and professionally that addiction continues to evolve, addiction doesn’t take time off for the pandemic, and if anything it thrives in self-isolation. Harm reduction in theory is upstream thinking and a good start, but the social acceptance and government applications move at half the speed. So until we can match addiction and substance abuse speed for speed we will always be playing catch up. And that is why harm reduction has intrinsic value, it is our acceptance of systemic drawbacks, so it allows for less suffering. We cannot remove addiction outright, but we can at least make it more comfortable while we work on it.

References

CAMH – Provincial System Support Program. (2020). Experience Exchange. Our voice is being

lost: What people with lived experience are saying about equity & human rights responses to COVID-19, 1–7.

Horrocks, C., & Jevtic, Z. (1999) Introducing Foucault. New York, New York: Totem Books.

Lewis, J., Dana, R., & Blevins, R. (2019) Substance Abuse Counseling. Boston: Cengage  Learning Inc.

Safer Opioid Supply Programs (SOS). (2020, April 02). A Harm Reduction Informed Guiding Document for Primary Care Teams. Medium. https://docs.google.com/document/d/e/2PACX-1vTMQEhchBfmTjeBxpDRi6w7pXE5EDuInMiKARuxBcxvFUtjPmqk8l7AFPGYvWn3hOHWkTMo8-m5QPI0/pub?urp=gmail_link&gxids=7628

Thomas, G. (2005) Harm Reduction Policies and Programs Involved for Persons Involved in the Criminal Justice System. Ottawa: Canadian Centre on Substance Use