From the Front Lines: First Do No Harm
Liam Michaud and Barb Panter report on harm reduction programs in Canada.
Peer support and mutual aid have always played a role for people who use drugs—from reducing the risks of drug use and preventing overdoses to sharing critical information. In the 1980s, in the face of the AIDS crisis, harm reduction took to the stage as an approach to reducing the risk of HIV transmission through injection drug use.
Harm reduction refers to policies, programs and approaches that aim to minimize the potential harms of drug use. It recognizes that doing recreational and street drugs can be an individual choice and that some people may be unable or uninterested in stopping. Harm reduction is about providing people with the tools they need to survive, be as healthy as possible and live with dignity.
Many harm reduction advocates are themselves drug users. The slogan Nothing about us without us insists that people who use drugs be involved in every level of harm reduction initiatives—from setting priorities to deciding where resources go to doing the work itself. In this spirit, we take a look at five initiatives across the country that offer various kinds of support to people who use drugs.
Peer outreach in Cape Breton
While we’ve long known that sharing needles can spread blood-borne infections like HIV and hepatitis C, people who inject drugs don’t always have easy access to new needles, not to mention healthcare and information on safer using. This is where natural helpers come in.
Research has shown that one of the best ways to serve marginalized communities like people who use injection drugs is to connect them with “natural helpers”—people with a deep personal understanding of that community to whom others naturally turn when they need support. The Natural Helpers of the AIDS Coalition of Cape Breton’s needle exchange (SANE) work to reach as many injection drug users as possible. They either have used injection drugs themselves or are family members and friends of people who do.
Natural Helpers work to prevent HIV and hep C by providing people who use drugs with new injection equipment, biohazard containers for the safe disposal of used needles, and information on how to use safely. They extend SANE’s reach by distributing equipment in rural and remote regions that may only be visited by an outreach van once a month, or not at all.
Natural Helpers also report back to SANE about new or bad drugs on the market and ways that harm reduction information is being used on the street. This helps the program remain relevant to the people who use it.
aidscoalitionofcapebreton.ca / 902.539.5555
Promoting safer partying
Torontovibe.com, hosted by the AIDS Committee of Toronto, provides the gay/bi/ queer community with information about safer drug use. The website was launched to respond to substance use concerns such as the risk of overdose and how street drugs can interact with HIV drugs.
The site provides visitors with facts about drugs—from alcohol and pot to cocaine, crystal meth, E and K—so that they can make informed decisions about their drug use and reduce the risks. For each drug, there is information about the risks, how it can affect sex, and how HIV meds and other drugs can interact with it.
Torontovibe.com boasts a few unique features, such as a place to report and read up on bad drugs in the community so that people can avoid them. The site also lists known interactions between recreational drugs and HIV meds. Clearly there is a need for this kind of information, as last year alone 36,970 people visited the site.
Blood Tribe Naloxone Program
Preventing overdose death
In recent years the Blood Tribe, or Kainai First Nation, has faced a wave of overdoses. At times, hospitals were seeing three overdoses a day. The cause? The powerful opiate/painkiller fentanyl, which is being used in more and more communities across Canada. This surge in overdose deaths led the Blood Tribe, in southern Alberta’s BloodReserve, to declare a state of emergency.
In response to the crisis, in 2015 the Blood Tribe partnered with the HIV community organization ARCHES and the local health authority to distribute naloxone kits and train healthcare workers and community members to administer it. Naloxone is a medication, usually given by injection, which stops people from overdosing from opiates long enough to get them to a hospital, buying precious time.
The Blood Tribe program was the first on-reserve naloxone distribution program in Canada. Workers inform and educate people about fentanyl and related risks. They work to expand supports for people dealing with opiate dependencies. This includes improving access to Suboxone, a prescribed substitution therapy widely recognized for reducing HIV and hepatitis C transmission.
Thanks to the leadership of the Blood Tribe, and Drs. Esther Tailfeathers and Susan Christenson, who dispense the take-home naloxone, a number of lives have already been saved.
bloodtribe.org / 403.308.0760
Cactus Montreal’s Pipe Distribution
Reducing the risks of smoking crystal meth
In the past few years, the staff of Cactus Montreal has seen crystal meth use soar among people who use its services. The community centre runs a fixed site to distribute equipment for injecting drugs and using crack.
Crystal methamphetamine—meth, Tina, T—is a stimulant that can be sniffed, smoked or injected. As with many drugs, the sharing of pipes and injection drug equipment carries a risk of transmitting HIV and hep C. Montreal has seen an increase in people injecting crystal meth, as opposed to inhaling or sniffing it. (As people’s tolerance to the drug increases with regular use, many start injecting it because this produces a stronger and more immediate high.) Many people who are new to injection drug use and aren’t tapped into harm reduction programs don’t have access to the same prevention information and are more likely to share or reuse their pipes and needles.
To respond to the growing number of people using meth, Cactus staff started distributing crystal meth pipes. This allows them to disseminate information about how to prevent hep C while providing people with new equipment. Plus, if people who smoke switch to injecting, they will have the know-how and material needed to do so more safely.
Cactus charges $5 per pipe. They hope to eventually be able to offer them for free. The Fixed Site is open seven days and nights a week.
cactusmontreal.org / 514.847.0067
Eastside Illicit Drinkers Group for Education (EIDGE)
Harm reduction for drinkers
In Vancouver’s Downtown Eastside, Rob Morgan and John Skulsh were seeing their peers and friends dying at an alarming rate, but it wasn’t from the causes people usually associate with the neighbourhood. These deaths were related to illicit alcohol consumption and a lack of services for people who drink. Illicit alcohol is alcohol not intended for human consumption (such as mouthwash and hand sanitizer), homemade alcohol (like moonshine) and alcohol consumed in ways considered criminal (for example, drinking in public). It is cheaper and often easier to procure.
The deaths that Morgan and Skulsh were seeing were sometimes due to the effects of illicit alcohol on the body but were often not directly alcohol-related—pneumonia and exposure to cold from sleeping on the street, sometimes the result of cutbacks to the number of shelter beds. Zero tolerance policies among social services and many shelters for people under the influence also play a role.
With the support of the Vancouver Area Network of Drug Users (VANDU), Morgan, Skulsh and other drinkers got together to start EIDGE. The group meets once a week to build awareness and to push hospitals, police and health services to change policies. A main focus of EIDGE is the creation of a non-residential managed alcohol program (MAP), a place where alcohol users can go to drink safely and access services, such as counselling and referrals, without fearing altercations with police. MAPs are recognized harm reduction tools that exist in cities across Canada. “If we had a place where members could drink safely,” Morgan says, “we’d be able to prevent a lot of these deaths.”