HIV in Canada: A primer for service providers

Harm reduction

Key Points

  • Harm reduction refers to policies, programs and projects that aim to reduce the health, social and economic harms associated with the use of drugs.
  • The opioid overdose crisis has sparked a movement towards more supervised injection/consumption services in Canada.
  • Recommendations for best practices for harm reduction programs in Canada have been developed.

Harm reduction refers to policies, programs and projects that aim to reduce the health, social and economic harms associated with drug use and the criminalization of drug use and drug possession. Harm reduction does not exclude abstinence as a goal for individuals, but rather provides people with a range of pragmatic choices, which can include efforts to limit or manage use. Harm reduction helps to engage people and motivate them to make contact with treatment and healthcare providers if and when they are ready. Examples of harm reduction include needle and syringe distribution, opiate substitution or opiate agonist therapy (such as methadone or suboxone), outreach, crack-pipe distribution, user empowerment projects, safer drug use sites, prescription of pharmaceutical-grade heroin (diacetylmorphine), the distribution of naloxone (an antidote for opiate overdose) and other advocacy efforts for the rights of people who use drugs.

Evidence-based harm reduction efforts, such as needle and syringe distribution programs, have proven to be a significant tool for reaching populations that use drugs by improving their health and stemming the spread of HIV, hepatitis C and other infectious diseases. Moreover, these programs build the trust necessary for users to engage in treatment if they so choose. People who inject drugs should play an important role in the development and delivery of HIV and hepatitis C prevention programming.

In 2013, Canada’s first legal supervised injection site (SIF) marked its 10th anniversary. Extensive research conducted on its impact has shown that it has had remarkable successes including reductions in HIV transmissions and overdose deaths. SIFs have since opened in Montreal and several more are expected to open in Toronto in 2017. A number of other municipalities are now planning for SIFs. Other Canadian cities (including Victoria, Surrey, Edmonton, Thunder bay, London, Hamilton, Chilliwack, Calgary and Saskatoon) are working towards the establishment of supervised consumption services, to address the public health crisis of opioid overdoses.

To legally operate a safe injection site, an exemption from the Controlled Drug and Substances Act is required. In 2015, Bill C-2 (known as the Respect for Communities Act) became law under the Conservative government, which outlined a laborious process and the extensive documentation the government required from groups seeking this exemption. However, in late 2016, the Liberal government tabled legislation that would eliminate the 26 restrictions under the Respect for Communities Act making it easier for approval to operate a supervised injection site in Canada. In 2017, a new bill, Bill C-37, replaced Bill C-2’s 26 conditions for opening a SIF with five conditions, thus simplifying the path to opening a SIF.

From 2013 to 2015, a Canada-wide team of researchers, service providers, policy-makers and people with lived experience developed an updated and comprehensive set of best practice recommendations. The documents include recommendations on needle and syringe distribution, handling and disposal of used drug equipment, safer drug use education, distribution of safer crack cocaine smoking equipment, opioid overdose prevention (education and naloxone distribution) and more.

Resources

Best Practice Recommendations for Canadian Harm Reduction Programs that Provide Service to People Who Use Drugs and are at Risk for HIV, HCV, and Other Harms: Part 1

Best Practice Recommendations for Canadian Harm Reduction Programs that Provide Service to People Who Use Drugs and are at Risk for HIV, HCV, and Other Harms: Part 2

Harm reduction training manual: A manual for frontline staff involved with harm reduction strategies and services – BC Harm Reduction Strategies and Services.

Harm reduction at work: A guide for organizations employing people who use drugs – Open Society Foundations

Sources

  1. Government of Canada. National anti-drug strategy. Available from: http://www.nationalantidrugstrategy.gc.ca/
  2. Hunt N. A review of the evidence-base for harm reduction approaches to drug use. 2003. Available from: http://www.ihra.net/files/2010/05/31/HIVTop50Documents11.pdf
  3. International Harm Reduction Association. What is harm reduction? 2010. Available from: http://www.ihra.net/files/2010/08/10/Briefing_What_is_HR_English.pdf
  4. Health Canada. Vancouver’s INSITE service and other supervised injection sites: What has been learned from research? Ottawa: Health Canada; 2008. Available from: https://www.canada.ca/en/health-canada/corporate/about-health-canada/reports-publications/vancouver-insite-service-other-supervised-injection-sites-what-been-learned-research.html
  5. Wodak A, Cooney A. Do needle syringe exchange programs reduce HIV infection among injecting drug users: a comprehensive review of the international evidence. Substance Use & Misuse. 2006;41(6):777–813.
  6. Urban Health Research Initiative of the British Columbia Centre for Excellence in HIV/AIDS. Drug situation in Vancouver. Vancouver: British Columbia Centre for Excellence in HIV/AIDS; 2013. Available from: http://www.bccsu.ca/wp-content/uploads/2016/08/dsiv2013.pdf
  7. Kerr T, Mitra S, Kennedy MC, McNeil R. Supervised injection facilities in Canada: past, present, and future. Harm Reduction Journal. 2017;14:28. Available from: https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-017-0154-1