Reducing the Harm Associated with Injection Drug Use in Canada

5. A Harm Reduction Approach

To achieve results in the long term, it is important to strengthen our efforts to prevent the misuse of all drugs and to enhance treatment, rehabilitation, care, and support. Actions which are successful at preventing or reducing drug use in the first place can be viewed as contributing in the long-term to a reduction in the overall harm associated with injection drug use. However, the urgency, seriousness, and reality of injection drug use in Canada requires a national response that also focuses on addressing the immediate risk factors for people who are injecting drugs as part of a continuum of addiction interventions. To this end, this report contains recommendations for initiatives and programs that provide opportunities for people who inject drugs to reduce the harms to themselves without the prerequisite of reduction or cessation of use.

There is a lack of consensus on the definition of the term "harm reduction". However, the concept has provided an initial rationale for a variety of innovative approaches to drug issues. Some people would restrict harm reduction to policies and programs that focus on reducing the adverse consequences of use without necessarily restricting use per se. However broad or narrow the continuum may be, it is clear that few dispute the desirability of reducing drug-related harm. Some discussions suggest that it may be more effective to adopt an empirical definition of harm reduction; interventions are considered harm reduction only in so far as they actually reduce drug-related harm.³⁷ As such, it is difficult to determine whether a program is harm reduction without examining evidence of its impact. In keeping with this conceptualization, harm reduction can be viewed as the middle ground where persons with widely differing views on drug policy can agree with one another regarding practical, immediate ways to reduce drug-related harm.

Experience in other countries and in Canada shows that addressing the harm associated with injection drug use reduces drug-related health risks to individuals, their families and communities, improves the social and economic status of individuals, and subsequently reduces the health, social, justice and enforcement costs. Use of harm reduction strategies reduces the likelihood that people who use drugs will contract or spread HIV, the hepatitis C virus, and other pathogens, overdose on drugs of unknown potency or purity, or otherwise harm themselves or other members of society.

Other countries have tested and implemented various innovative approaches to reducing the harm associated with injection drug use. Canada should look to the experiences and evaluation results of other countries and test and evaluate initiatives that apply to the Canadian context.

A detailed description of national and international experiences is presented in Appendix B.

Goals

• This report proposes four goals to guide the reduction of harms from injection drug use:
  
• increasing efforts to address the determinants of health and underlying factors associated with drug misuse;
  
• reducing injection drug-related mortality and morbidity;
  
• reducing the incidence and prevalence of injection drug use; and
  
• reducing the costs and other health, social, and economic consequences of injection drug use.

Principles

The following key principles underpin the approach to injection drug use outlined in this paper:

• injection drug use should be regarded first and foremost as a health and social issue;
  
• people who inject drugs should be treated with dignity and have their rights respected;
  
• services should be accessible and appropriate and should involve people who inject drugs in all aspects of planning and decision making;
  
• programs and policies should take into account diversity among the injection drug using population such as gender, culture, age, geographic location and polydrug use; and
  
• the community and stakeholders should be involved in the responses.