Shannon Riley | March 17th, 2017
Harm reduction, as it relates to people with dependencies on substances, is a philosophy that supports people. It does this by guiding people in order to reduce other harms in their life, even if that means continuing to consume a substance that is potentially causing them harm. I would argue much of the actual harm that people with dependencies on illicit substances endure are actually the fault of archaic drug laws. The harm is not actually intrinsic to the substance itself. For example, if I had to wake up each morning to steal or perform survival sex work in my community in order to get my daily dose of unregulated (street-grade) insulin, I would also be in a harmful situation. The harm would come both from not knowing if what I was buying was actually insulin, and also the personal risks I was taking in order to obtain it.
In the news
Jeremy Devine, a medical student from the University of Toronto’s Faculty of Medicine, wrote an opinion article to the National Post on Mar. 2, 2017 entitled Harm reduction programs like safe injection sites don’t beat addiction. They just sustain it.
You can find it here.
In summary Mr. Devine wrote how the harm reduction movement ‘doesn’t beat addiction it sustains it,’ though he offered no laudable alternative. He evidently felt justified in writing this stigma-laden piece in order to prove some nebulous point. Mr. Devine’s article is targeting the most vulnerable people, people who have had severe histories of alcohol and opioid dependence. He questions, ‘Is their drug use no longer a problem because they’re off the street? And where exactly do the patients go from here?’
I can tell you.
About the patients
The people who are now in managed alcohol programs are fortunate people. They are no longer living on the street drinking non-beverage alcohol because that is all they can afford. They are sleeping indoors and they are getting the regulated alcohol medicine they need to be alive and not be at risk of death on a daily basis. They now have a chance to live with dignity by being housed in a system of care designed for their needs. I have known many beautiful people with severe alcohol dependency who have died alone on the street or in a hotel room because of our society’s inability to house them with a model of care that is needed in order to keep them safe and alive. Programs that provide alcohol to people with alcohol dependencies create healing communities.
Harm reduction works
The patients of the Crosstown Clinic, are also in a similar situation. At this clinic, patients who have failed on every treatment western medicine has to offer for a person with an opioid use disorder, receive either injectable hydromorphone (Dilaudid) or Diacetylmorphine (heroin). They are provided with the regulated medication they need to be well. If you have not seen the video about the patients in the Crosstown Clinic, I can see how you might not understand how drastically life has improved for these patients, especially if you have never had any exposure to this model of care. But take a few minutes to watch this video and honestly tell me that you can still doubt that this model of care is not in these patients’ “best interest” – a point which Mr. Devine suggests is “highly questionable.”.
A few weeks ago I was attending the Canada-wide Supervised Consumption Conference in Vancouver, when I heard about Raffi Balain’s overdose death. My colleagues in attendance who knew this inspirational man were absolutely devastated. He was the heart of their community. I unfortunately never had a chance to meet him, but I have since learned that through his work that he inspired and taught many people to treat people who use drugs with the dignity and respect they deserve in the face of a stigmatizing point of view that Mr. Devine perpetuates through his writing. Raffi’s death is not proof that harm reduction does not work. It is federal drug policies that do not work. Prohibition does not work now, nor has it ever.
Let’s move beyond stigma
Mr. Devine’s op-ed raised serious concerns for me about how patients can be stigmatized by health care professionals based on the substances they use, even if those substances help them to survive each day. How will patients have open and honest conversations with providers? I believe as health professionals we must move beyond Mr. Devine’s way of thinking and fight for the dignity and respect that all humans deserve. Only together can we shift this paradigm and change the drug laws that continue to harm our friends and families every single day.
What are your thoughts on this issue? Post your comment below.