The New Norm of Harm Reduction

Harm Reduction Is Help

Written by and for people with Lived Experience - Port Alberni Community Action Team - Families Helping Families

Today's Learning Moment – 02 14 22 Issue: The New Norm of Harm Reduction

During my career as a Mental Health and Substance Use Clinician and now as a volunteer who runs a family peer support group, I've noticed with families that harm reduction is just becoming an acceptable term among people. But cautiously so. It seems just a few short years ago and even now amongst some folks that Harm Reduction meant enabling a person to use drugs. Well, that's just not true and never has been. 

The only things harm reduction practices enable is the safety of the person, the family and the community. Harm reduction is designed to reduce the harm that can be caused by drug use without requiring abstinence. Of course, abstinence itself is also a form of harm reduction. Harm reduction reaches the person where they are at and respects their dignity and abilities. If they're ready for abstinence, it might be the right choice for them. The difference we understand today is that not everyone is prepared for complete abstinence when they reach out for help.

Often it's a journey to get to; however, in today's world, we now know that there are many other options of harm reduction we can start with to help them along the healing path.

Harm reduction provides services that decrease medical issues for the individual and the community. Harm reduction allows access to needed services when the person is ready for them. In the meantime, it keeps the person safe and alive until they are ready. It also provides a safety net for anyone who may have had abstinence and then relapsed. Harm reduction is not about quitting drug use and never has been. It is about safety, wellbeing, dignity, trust, and motivation.

How do I know this? I practised it in my work. In 1988, I worked as a counsellor in one of Saskatchewan's detox and stabilization facilities. There, we practised abstinence-only strategies. When we admitted a person, all medication other than heart or diabetic medication was immediately taken from them. As you'd expect, withdrawals in the centre were brutal. Thankfully, for the most part, the majority of withdrawals were non-life-threatening. However, there were folks that had to be hospitalized, and we even had two patients drop dead at the facility in the two years I worked there. We all just shook our heads and said to each other, "that's what happens."

Now, of course, we know better. Many of our withdrawal management facilities are now practising harm reduction strategies. This includes opiate agonists as well as opiate replacement therapies. Something we scoffed at in 1988. In addition, in our harm reduction strategies, we now include supervised consumption sites and overdose prevention sites where absolutely no deaths have occurred at any time anywhere in the world since their inception. Add in needle exchange and the consequent reduction in HIV, Hep C and other transmissible diseases. Add in intravenous opiate replacement programs and supervised alcohol consumption programs, and you have strategies that meet people where they are at and save lives. These people now treated through all these programs are generally the ones that fell through the cracks and were judged for not being ready or not having hit rock bottom yet. Today rock bottom is death.

During the last year of my career, the Intravenous opiate replacement program (IOAT) was introduced. This program allowed a person that had not had success with opiate agonists and other treatment models to access services designed to meet them exactly where they were at. It did not require any form of abstinence. Two of my clients were the first on the program based on their urgency and history.

Both of those clients changed almost overnight. 

One of the fellows had a major depressive disorder. He would hardly talk except to lament his life of addiction and crime and where he would get his next fix. His daily routine had become immensely complicated to keep his increased tolerance and withdrawal symptoms at bay. It was the only way for him to survive another day. After difficult and complex activities to obtain his supply, he would often just isolate himself. His room was dark, curtains drawn, not messy, but little food or items that would be considered entertaining or distracting.

He would attend the program twice a day which he admitted was always a challenge for him. I visited him about a week after he began the program. It was like seeing a brand new person for the first time. He was talkative, his eyes were open and clear, he was more animated in his gestures, and his tone was, well, almost happy. I couldn't get over the transformation. However, the one thing that stood out for me in that conversation and the ones that continued over that year was that he was so relieved and grateful that he no longer was doing the petty crimes he would have to do to obtain his fixes for the day. 

As he progressed, he started an adult education program. He also participated in a community vocational program that would open up other opportunities to earn some extra money in the community. All this while he continued to use his drug of choice in a controlled environment. Now that was a success!

The other fellow admitted to the program had an almost identical story. His ongoing crimes were a little more serious, but those behaviours immediately stopped when he was placed on the IOAT program. His relief was immense and tearful. His room was transformed from a dark mess to a clean and inviting place. He had food in the fridge. His speech improved, his health improved. All this while he was still using his drug of choice. With this fellow, his journey progressed even more, and after checking in with him a year after my retirement, he had told me that he was totally abstinent from all substances, including any opiate replacement. He was so happy with himself

Substance Use practices have changed and evolved to address what had not been addressed by abstinence-only programs. They have done so to save lives and protect the community. I now encourage people to consider harm reduction practices in their homes if that is something that is appropriate for their families. Sometimes it isn't, but harm reduction can be supported even if the person lives outside the home.

Today, with the toxic drug poisoning crisis, harm reduction is more important than ever. Not only does it reduce crime in our communities and reduce the spread of transmissible diseases, Harm reduction policies now save thousands of lives every day that otherwise were lost in the past. Through the progressive programs we have going and the progressive thinking amongst clinicians and peers, harm reduction is and should always be considered a part of the spectrum of treatment.

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Author: Ben Goerner – Ben is a retired counsellor and advocates for people with substance and mental illness 

Families Helping Families is an initiative of the Port Alberni Community Action Team. We regularly send out "Learning Moment" articles to help folks understand substance illness. Knowledge is vital in understanding the disorder of our family members. You may copy, distribute or share our articles as long as you retain the attribution. Add yourself to our distribution list by dropping us a note at - albernihelp@gmail.com