Harm Reduction refers to interventions that seek to reduce the harms associated with substance use (Waterloo Region Crime Prevention Council, 2011). These interventions aim to reduce the spread of communicable diseases, prevent overdose deaths, increase contact with healthcare providers, and reduce consumption of illicit substances in unsafe settings.
4. INCREASE ACCESS TO NALOXONE THROUGH CHANGES IN PRACTICE AND POLICY.
Harm reduction strategies are designed to reduce negative health impacts and other outcomes of opioid misuse and overdose, including death. Naloxone, or Narcan®, is an antidote to opioid overdose. It reverses the effects of opioids by displacing opioids from their receptors, temporarily preventing the opioids from having an effect (Webber, 2016). Naloxone distribution programs have recently been extended to a variety of clinical settings, first responders, and other agencies in some communities (Orkin, et al., 2015). In Ontario, the Ontario Naloxone Program has been implemented in Windsor and Essex County since 2014 and has recently been expanded to allow for free naloxone access through pharmacies and other community service organizations.
- Provide access to naloxone for medical and non-medical staff working in community settings where overdoses occur (e.g. shelters), and provide support for the development of organizational overdose policies and protocols.
- Broaden distribution and ability to use naloxone by first responders (firefighters, police, and paramedics) including the related legal and policy barriers.
- Develop “take home naloxone” program sites for at-risk groups and the general public.
- In community health centres and community-based agencies.
- In acute care settings including emergency departments.
- In substance use withdrawal management and treatment facilities (including Opioid Substitution Treatment clinics).
5. IMPROVE OVERDOSE PREVENTION EDUCATION, TRAINING, AND SERVICES.
Best practice guidelines for these harm reduction approaches include training people who use opioids (and their friends and families) on how to avoid overdosing and how to act if they see another person overdosing. Education involves knowing the signs of an overdose, when to call 911, and how to administer naloxone. Existing evidence shows that overdose education and the distribution of naloxone improves people’s willingness to intervene in an overdose, reduces mortality and is cost-effective (Strike, et al., 2013).
- Educate broader community and target staff in community settings on strategies to prevent, recognize, and respond to overdose.
- Develop and target messages to priority populations by implementing promotional campaigns in areas with high visibility (e.g., bus shelters) or areas where people are likely to use drugs (e.g., public washrooms).
6. DEVELOP A LOCAL EVIDENCE-BASED HARM REDUCTION FRAMEWORK, INCLUDING INCREASED ACCESS TO HARM REDUCTION SERVICES AND SUPPLIES.
The pillar of harm reduction has been restored to the Canadian Drugs and Substances Strategy (Health Canada, 2016), which allows problematic drug use to be primarily recognized as a health issue rather than criminal matter. Yet, there remains work to be done to inform the public and society as whole of the key issues and benefits related to harm reduction approaches. A public education campaign could aim to remove the stigma associated with addiction, and with harm reduction approaches. Addiction needs to be seen as a disease, and a complex social problem. Therefore, it is important when creating campaigns to educate the general public, healthcare professionals, community organizations, and law enforcement about addiction, to provide information on the causal factors and the social determinants that impact opioid use and overdose. The Needle Syringe Program is currently implemented in Windsor and Essex County through a partnership between the Aids Committee of Windsor and the Windsor-Essex County Health Unit. This program provides clean needles and supplies to people who use injectable drugs. The expansion of this program would ensure the equitable distribution of these services across the city and county to additional areas of need. In addition to the needle exchange program, promising practices from Canadian cities like Vancouver and Toronto, have led the Windsor-Essex County Health Unit to begin investigating the feasibility of Safe Injection Sites in Windsor and Essex County. Supervised injection sites (SIS) have been utilized in Canada for some time with the first sanctioned SIS becoming operational in 2003. Recently it has been suggested that the expansion of these programs to new settings would be a practical means to reduce harm and inequities for people who use drugs (Kerr, Mitra, Kennedy, & McNeil, 2017).
- Address stigma through education by promoting a cultural shift toward more positive attitudes related to harm reduction, acknowledging that abstinence is not always possible.
- Develop information resources regarding access to opioid substitution treatment and promote to clients in emergency rooms, community health centres, and physicians’ offices.
- Recognize and support the role that people who use drugs have in reaching others at risk of overdose, and support more peer training opportunities.
- Investigate the expansion of the Needle Syringe Program to areas of need.