what does harm reduction have to with me anyway

WHAT DOES HARM REDCUTION HAVE

TO DO WITH ME ….

OR MY ORGANIZATION?

Barbara Ross RN HV BA MBA

Provincial Harm Reduction Supervisor – Alberta Health Services

WHO NEEDS HARM REDUCTION?

Inequities in access to services are prevalent for those

who use drugs, and that these disparities are further

exacerbated by the social determinants of

health, including inadequate

housing, poverty, unemployment and the lack of social

support

Harm Reductionl 2013

HARM REDUCTION - FOR ALL

“It works”

“We’re here to make you feel better”

“It does what it says on the label”

“The taste of success”


WHY HARM REDUCTION?

Harm reduction provides skills in self-care (and

care for others), lowers personal

risk, encourages access to treatment, supports

reintegration, limits the spread of

disease, improves environments and reduces

public expense.

It also saves lives.


WHAT DOES IT DO?

• Recognizes that both legal and illegal substance use are enduring features of human existence

• Focuses on decreasing the adverse consequences of substance use while building non-judgmental, supportive relationships

• Includes abstinence as an option if and when the person is ready, while recognizing that abstinence is not always realistic


WHAT ABOUT HUMAN RIGHTS ?

Human rights apply to everyone.

People who use drugs do not forfeit

their human rights, including the right

to the highest attainable standard of

health, to social services, to work, to

housing and to be part of a

community.


DOES THIS LOOK FAMILIAR ?

• Provide safe, compassionate, competent and ethical services

• Promote health and well-being

• Promote and respect informed decision-making

• Preserve dignity

• Maintain privacy and confidentiality

• Promote justice

• Be accountable.


CRITICISMS OF HARM REDUCTIONIt doesn‟t work International evidence strongly supports HR interventions as effective

methods of preventing HIV transmission and improving the lives of

injecting users.

Keeps addicts stuck in their substance use Only part of a continuum of prevention and treatment strategy.

Consistently performs better at

retaining people in programs and reducing drug use

Fails to get people off drugs Drug treatment programs requiring abstinence for entry reach only

20% of active users. HR programs designed to reach the other 80%

Encourages Drug Use Studies and clinical trials have found the provision of needles does

not cause a rise in drug use or injection

There is no scientific evidence Endorsement by the United Nations General Assembly, UNAIDS, the

UN Office of Drugs and Crime, the World Health Organization and

many others.


UNDERSTANDING DRUG USE

No one “contemplates”

addiction and no one becomes

or remains addicted because of

harm reduction interventions.

(WHO 2012)


UNDERSTANDING ADDICTION

“It is impossible to understand addiction without

asking what relief the addict finds, or hopes to find,

in the drug or the addictive behaviour.”

“Not why the addiction but why the pain.”

“Why do we despise, ostracize and punish the drug

addict, when as a social collective, we share the

same blindness and engage in the same

rationalizations?”

• . -


WHY PEOPLE USE DRUGS

Substance use, especially illicit drug use is often highly stigmatized and misunderstood.

People generally use drugs to:

1. To feel good

2. To feel better

3. To do better

4. Curiosity or social interaction


STEPS TO A HARM REDUCTION APPROACH

• Develop a Policy or Position Statement that includes: program specific definition of harm reduction, a statement that commits your service to respective treatment of people who use substances, define what specific measures will be taken to implement a harm reduction approach

• Provide training and education on harm reduction to your team. Communicate your commitment to your staff and the clients you serve

• Identify specific actions that support the principles and practice of harm reduction

• Support the principles of GIPA/MIPA and encourage participation of PWUD in developing harm reduction practices – “Nothing About Us Without Us”

Harm Reduction 2013

GOAL 1

Harm reduction does not require at-

risk practices be discontinued while

focusing on promoting

safety, preventing death and

disability, and supporting safer use

for the health and safety of all

individuals, families and

communities.

Harm Reduction 2013

GOAL 2

Provide non-judgmental care to

individuals and families affected by

substance use, regardless of setting,

social class, income, age, gender or

ethnicity

Learn not to judge people based on their

life decisions

Harm Reduction 2013

GOAL 3

Recognize human rights and the

importance of treating all people with

respect, dignity and compassion,

regardless of drug use.

Harm Reduction 2013

GOAL 4

Recognize the power of positive change.

Stigmatizing behaviour is not a motivator for positive change.

Harm Reduction 2013

COLLABORATIVE ASSESSMENT or ASKING THE RIGHT QUESTIONS

• What would you like to change regarding your drug use?

• How important are these things to you?

• Which change(s) would you like to work on first?

• How would you like to make the changes you desire

Harm Reduction 2013

GOAL 5

Fight ignorance – raise awareness

and share knowledge with your

clients, colleagues, teams and

communities

Harm Reduction 2013

WE’RE ON OUR WAY

• Primary goal to engage and retain the client in the service

• Embrace the client “as is”

• Lower the threshold for access to services

• Incorporate user-centered practices

• Negotiations are made possible when the source(s) of difficulty are better understood

• Know what resources are available – tell your clients

• Respect is a two way street

• Listen and learn


HEALTHCARE

ASSUMPTIONS

• Clients are usually “drug seeking”

• Healthcare should be dependent on abstinence or it will not be successful

RESPONSE

Treat all people with respect, dignity and compassion to reduce the stigma associated with drug use.

• Stigma and judgmental attitudes encourages clients to reject heath interventions and/or lie about their drug use

• Leaving AMA predisposes individuals not only to poor health outcomes due to inadequate treatment but also to major disruptions in the patient-provider relationship


HOUSING

ASSUMPTIONS

• Abstinence is the only realistic model for successful community integration

• Giving homeless people apartments before they were “housing ready„” is setting them up for failure

• Housing PWUD put the rest of the community at risk

• One size fits all

RESPONSE

• Supported housing is essential to good health and recovery from addiction and mental illness.

• Fostering a sense of self determination and social inclusion empowers clients to make informed decisions

• Adapted to the needs of the client – not efficiencies or expertise in service delivery

• Minimise attrition and “drop-out “rate

• Positive impact on urban neighbourhood


SCHOOL/YOUTH HEALTH

ASSUMPTIONS

• The “Just say no” abstinence model works

• Allowing drug use will increase drug use among homeless youth who are not currently using drugs or create a drug-oriented culture among youth using general shelter/program services

RESPONSE

• Provide staff with training opportunities that help build harm reduction practice skills

• Provide strategies to prevent or delay the start of substance use and promote awareness about safer use

• Display up to date, youth friendly, accurate information on harm reduction


MENTAL HEALTH

ASSUMPTIONS

• Many people think of harm reduction initiatives in relation to safer injection rooms or legalizing cannabis

• Supporting a harm reduction approach enables clients to continue high risk behaviour

• Continued relapse means the client is not interested in changing their drug use

RESPONSE

• Commitment to a client-centred "therapeutic alliance

• Discuss short terms goals to decrease immediate risks

• Motivate client towards positive change

• Review of treatment goals is on-going between client and worker.

• Strengths and weakness and resilience of client are appreciated built upon


PROMOTE COMMUNITY INVOLVEMENT

• Build rapport and a trusting relationship with the community

• Raise awareness about prevention, care and social services for HIV/AIDS, STD‟s, drug use and homelessness

• Educate the community about resources and current services within the community

• Support communities and build self esteem among targeted communities

• Respect the community and the people within it


“NICE PEOPLE USE DRUGS”

People who use drugs are human beings – not just

clients or patients; not victims or service users.

Like all of us, people who use drugs are unique

individuals with hopes, dreams and potential.

“We could be your daughter, your sister, your brother, your

nephew, your niece, your whatever. And what if we were your

brother, or your sister or your mother? How would you feel?

People have feelings, we have feelings?”

. Harm Reductionl 2013

what does harm reduction have to with me anyway

Health & Medicine