Canadian harm reduction guidelines and manuals
Guidelines and manuals provide front-line service providers with evidence-based recommendations and models for their decision-making and program delivery by synthesizing research evidence, the consensus of experts in the field and practice-based knowledge and experience. In the previous issue of Prevention in Focus we reviewed Canadian HIV guidelines. This article highlights Canadian guidelines and manuals on harm reduction.
Harm reduction basics
For those looking to inform their work with a solid understanding of harm reduction principles, CATIE has developed a toolkit on harm reduction fundamentals. The toolkit provides foundational information on harm reduction for service providers working with people who use drugs (including support workers, outreach workers, nurses and workers with lived and living experience). It contains four units that can be accessed individually or completed together for a more comprehensive overview of harm reduction.
The four units are as follows:
- Setting a foundation for harm reduction
- Harm reduction principles and practices
- Drug use, health and harm reduction
- Supporting harm reduction service provider capacity
Working with people who use drugs
People who use drugs should be at the centre of harm reduction programs, both as service users and service providers. These guides and manuals provide insight on the respectful and equitable engagement of people who use drugs or have lived experience of drug use in the delivery of harm reduction programs. Many of the other guides and manuals in this article also include and are centered in best practices for working alongside people who use drugs.
Guidelines for partnering with people with lived and living experience of substance use and their families and friends – Canadian Centre on Substance Use and Addiction
Hear us, see us, respect us: Respecting the expertise of people who use drugs – Canadian Association of People Who Use Drugs (CAPUD), Canadian Drug Policy Coalition
Peer engagement principles and best practices: A guide for BC Health Authorities and other providers – British Columbia Centre for Disease Control
Best practice manual for supporting peers/experiential workers in overdose response settings: A Guide for BC Health Authorities and other service providers - The Peer2Peer Research Team
Indigenous approaches to harm reduction
Indigenous approaches to harm reduction are grounded in Indigenous knowledge and traditions. They also recognize and address the ongoing impact of colonization on Indigenous people. These resources explore and provide a framework for incorporating Indigenous approaches to harm reduction into programs and services for Indigenous people who use drugs.
Indigenous-centred approaches to harm reduction and hepatitis C programs – CATIE
Indigenous harm reduction = Reducing the harms of colonialism – Interagency Coalition on AIDS and Development (ICAD), Communities, Alliances & Networks (CAAN)
Safer injecting and smoking supplies and practices
Distribution of safer injecting and smoking supplies is a highly effective strategy to prevent hepatitis C, HIV and other drug-related harms. These guides and manuals address the distribution and use of safer injecting and smoking supplies and the engagement of people who use drugs who are accessing these resources in broader health-related services.
Best practice recommendations for Canadian programs that provide harm reduction supplies to people who use drugs and are at risk for HIV, HCV, and other harms: 2021 – Working Group on Best Practice for Harm Reduction Programs in Canada
Connecting: A guide to using harm reduction supplies as engagement tools – Ontario Harm Reduction Distribution Program
Harm reduction satellite sites: A guide for operating harm reduction hubs from the homes of people who use drugs – Parkdale Queen West Community Health Centre, South Riverdale Community Health Centre
Safer tablet injection: A resource for clinicians providing care to patients who may inject oral formulations – British Columbia Centre on Substance Use
For more information and resources, see the Safer injecting and smoking supplies resource collection on the CATIE website.
Supervised consumption services and overdose prevention sites
Supervised consumption services (SCS) and overdose prevention sites (OPS) provide a supervised space for people to use pre-obtained drugs, as well as safer drug use supplies, education and referrals. These guides provide direction on planning and operating an SCS or OPS.
Supervised consumption services: Operational guidance – British Columbia Centre on Substance Use
This tent saves lives: How to open an overdose prevention site – Canadian Association of People who Use Drugs
BC overdose prevention services guide – British Columbia Centre for Disease Control
Housing overdose prevention site manual – Vancouver Coastal Health
Implementing supervised injection services – Registered Nurses’ Association of Ontario (RNAO)
For more information and resources, see the Supervised consumption services/Overdose prevention sites resource collection on the CATIE website.
Opioid agonist therapy
Opioid agonist therapy (OAT) refers to a treatment approach for people who have been diagnosed with an opioid use disorder. It involves the prescription of long-acting medications (e.g., methadone, buprenorphine) as a substitute for illicit opioids. The Canadian Research Initiative in Substance Misuse (CRISM) has developed guidelines for the use of OAT, including specific guidance on injectable OAT.
CRISM national guideline for the clinical management of opioid use disorder
Injectable opioid agonist treatment (iOAT) for opioid use disorder: National clinical guideline
For more information and resources, see the Opioid agonist therapy (OAT) resource collection on the CATIE website.
Drug checking allows people to check the chemical composition of drugs to better understand what the substances they are intending to use contain. These guides can be used to learn more about drug checking and what is involved in setting up a drug checking service.
The Drug Resource and Education Project: A holistic approach to drug checking
Drug checking at music festivals: A how-to guide – ANKORS
Drug checking: Operational technician manual – British Columbia Centre on Substance Use
Safe supply and prescription alternatives
Safe supply reduces the harms of using potentially contaminated, unregulated substances by providing access to an alternative supply of safer, regulated substances. Safe supply has been developing as a harm reduction practice in recent years and these documents present guidance and potential models for the delivery of safe supply programs.
Safe supply: Concept document – Canadian Association of People who Use Drugs (CAPUD)
Safer opioid supply programs (SOS): A harm reduction informed guiding document for primary care teams
Implementing the Victoria SAFER Initiative: A practice brief – Co/Lab
Heroin compassion clubs: A cooperative model to reduce opioid overdose deaths and disrupt organized crime’s role in fentanyl, money laundering and housing unaffordability – British Columbia Centre on Substance Use
Risk mitigation in the context of dual health emergencies: Update to interim clinical guidance – British Columbia Centre on Substance Use
Overdose prevention and response
Many of the guides and manuals in this article include considerations on the profound impact that the current overdose crisis has had on the delivery of harm reduction services in Canada. These resources provide additional guidance on overdose prevention and response.
BCCDC Toolkit: Responding to opioid overdose for BC service providers – British Columbia Centre for Disease Control
Reducing harms: Recognizing and responding to opioid overdoses in your organization – Canadian Mental Health Association Ontario
Overdose prevention and response in washrooms: Recommendations for service providers – Vancouver Coastal Health
For more harm reduction guidelines and manuals, visit the CATIE website or the Canadian Substance Use Resource and Knowledge Exchange Centre (SURE).
About the author(s)
Erica Lee is CATIE’s manager of website content and evaluation. Since earning her master of information studies, Erica has worked in the health library field, supporting the information needs of frontline service providers and service users. Before joining CATIE, Erica worked as the Librarian at the AIDS Committee of Toronto (ACT).