Innovative Approaches and Barriers to Harm Reduction

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Innovative Approaches and Barriers to Harm
Reduction

• Hon. Carolyn Bennett, M.P., M.D.
• Liberal Critic for Health
• January 17, 2009

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What is Harm Reduction?

• any policy, program or intervention that seeks
  to reduce or minimize the adverse health and
  social consequences associated with drug use
  Canadian Centre for Substance Abuse
• focuses on those policies, programs and
  interventions that seek to reduce or minimize the
  adverse health and social consequences of drug
  use without requiring an individual to
  discontinue drug use Canadian Centre for
  Substance Abuse

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Harm Reduction Facts

• Accepted as one of four components in four pillar
  approach
• Prevention
• Treatment
• Harm Reduction
• Enforcement

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Needle Exchange and Supervised Injection

• Aim is to reduce spread HIV/AIDS Hepatitis C
• Helps prevent overdoses and death

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Toronto Public Health

• Has needle exchange program to prevent spread of
  communicable disease for drug users and sex
  workers
• Offers harm reduction methadone services
• Needs a constitutional exemption under sections 4
  and 5 of the Controlled Drugs and Substances Act
  so it can operate like Insite

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Other Approaches to Harm Reduction

• Methadone Maintenance
• Drug Substitution
• Peer-administered Naloxone
• Street Outreach Programs
• Safer Crack Pipe Programs
• Drop-in Centres and Shelters

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Health Committee Hearing on Harm Reduction

• May 29, 2008
• Witnesses
• Inspector Scott Thompson (Youth Services Section,
  Drug Policy and Mental Health Portfolios,
  Vancouver Police Department)
• Mr. Donald MacPherson (Drug Policy Coordinator,
  Drug Policy Program, City of Vancouver)
• Ms. Liz Evans (Executive Director, PHS Community
  Services Society)
• Mr. Philip Owen (Former Mayor of the City of
  Vancouver, As an Individual)
• Ms. Heather Hay (Regional Director, Addiction,
  HIV/AIDS, Aboriginal Health, Vancouver Coastal
  Health)
• Dr. Colin Mangham (Director of Research, Drug
  Prevention Network of Canada)
• Mr. Thomas Kerr (Research Scientist (Chief
  Researcher for Insite), British Columbia Centre
  for Excellence in HIV/AIDS)
• Professor Neil Boyd (School of Criminology, Simon
  Fraser University)
• Dr. Julio Montaner (Director, British Columbia
  Centre for Excellence in HIV/AIDS)
• Hon. Tony Clement (Minister of Health)
• Mr. David Butler Jones (Chief Public Health
  Officer, Public Health Agency of Canada,
  Department of Health)

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David Butler Jones

• I think the science speaks for itself. The
  debate speaks for itself.

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Clement at WHO International AIDS Conference

• Allowing and/or encouraging people to inject
  heroin into their veins is not harm reduction, it
  is the oppositewe believe it is a form of harm
  addiction - Clement

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REACTIONS

• Its an embarrassment for Canadathe current
  Canadian government is out of step with any
  rational response and out of step with the rest
  of the world Richard Elliott, Executive
  Director, Canadian HIV/AIDS Legal Network
• Regrettably, Clement chose the world stage to
  deliver his vociferous and illogical attack on
  supervised injection sites, declaring these to be
  "harm addition" rather than harm reduction, even
  as he accepts the benefits of needle- exchange
  programs. The characterization is at odds with
  the evidence, and also flies in the face of World
  Health Organization support for such sites as
  part of a comprehensive approach to reducing HIV
  and other harms associated with injection drug
  use, one of the major drivers of the global
  epidemic The Toronto Star

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Clements Speech to CMA

• I find the ethnical considerations of supervised
  injections to be profoundly disturbing
• Is it ethical for healthcare professionals to
  support the distribution of drugs that are of
  unknown substance, or purity, or potency drugs
  that cannot otherwise be legally prescribed?

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My Response!!!

• This guy is insulting the physicians and nurses
  on the frontlines
• Yet another disgusting example of ideology over
  science. Its disgusting. He only talked about
  one thing the whole frickin speech!
• There is a refusal to acknowledge the CMA knows
  more about this than he does

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What the Experts Say

• In rejecting harm reduction as one tool of
  addiction treatment, the minister is abandoning
  the most vulnerable members of society Dr.
  Brian Day, CMA
• We doctors think that we need to take care of
  patients and this is quite different. Hes doing
  politics, were doing health care Dr. Robert
  Ouellet, CMA
• It is contrary to the interests of both
  scientific inquiry and informed public debate to
  categorically reject supervised injection sites
  Dr. Paul Garfinkel, Centre for Addiction and
  Mental Health

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HARM REDUCTION BARRIERS
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Individual Barriers

• Fear of prosecution
• May not live close to harm reduction facilities
• Age
• Inaccurate understanding of risks
• Written harm reduction information inaccessible
  for literacy-level reasons
• Fear of lack of confidentiality

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Social Barriers

• Stigma attached to addiction and harm reduction
  services
• Cultural beliefs

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Legal Barriers

• Contravening Criminal Code paraphernelia laws
• Law enforcement crackdowns
• Arrests of NSP (needle and syringe program)
  clients and volunteers reduce NSP attendence
• Parole, probation or bail conditions

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Political Barriers

• Insufficient Funding
• Reports censored by senior government officials
• Ideology trumping evidence

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Canada Needs Harm Reduction!

• 80 of CMA Members support harm reduction
• Evidence shows harm reduction has positive
  effects on poor health outcomes associated with
  drug use
• Lowers risk of disease transmission
• Provides education about drug addiction