What’s the Harm in Harm Reduction?

Anna Hodgins

Harm reduction policies have a bad reputation. The philosophy behind harm reduction is that policy should focus on diminishing the adverse public health and social consequences of behaviour without necessarily reducing the behaviour. There is peer-reviewed, scientific evidence and international consensus that harm reduction is an effective policy strategy for reducing the negative social and public health consequences associated with substance abuse. Despite this, harm reduction initiatives based upon these strategies come up against regular scrutiny and a lack of support in Canada. We continuously struggle to enact these policies, which bring benefits to individuals and larger communities.

Antonia Maria Costa of the UN explains that, Harm reduction is often made an unnecessary controversial issue as if there was a contradiction between prevention and treatment on one hand and reducing the adverse health and social consequences of drug use on the other. This is a false dichotomy. They are complementary.

Harm reduction-informed drug policies focus on reducing the consequences of use, rather than the use itself. The policies accept that drug use and addiction are inevitable; instead of focusing on the morality and criminality of these behaviours, the policies attempt to minimize the negative social and health consequences of such acts. Harm reduction drug policy models can eliminate the spread of infection through instrument sharing and can improve the social situation of urban neighborhoods by taking substance use off the streets.

The ideas behind harm reduction, such as providing a safe place and clean instruments for people to inject illicit drugs, fail to garner widespread support, either because people are misinformed about the benefits of harm reduction type policies or because of the moral questions the policies raise. However, there is a significant body of evidence that harm reduction policies effectively decrease the harmful social effects of drug use and addiction. So what can we do to eliminate this controversy?

In order to more fully back harm reduction policies, I think it is important to understand the theory behind harm reduction policy separately from the issues to which harm reduction policies are applied. Harm reduction is a theoretical approach to policymaking that could be (and is) applied in response to a variety of issues. The theory of harm reduction policy can be found in drinking laws and birth control. There are still pockets of people opposed to these kinds of laws, but for the most part in Canada, discussion around these policies does not include prohibition of behaviours such as drinking and sexual activity. The public accepts that these behaviours might occur; consequently decision-makers try to implement policies that will reduce some of the potential negative consequences, such as unwanted pregnancy, the spreading of sexually transmitted infections, drinking and driving, or alcohol poisoning.

Interestingly, a Canadian Addiction Survey found that when the policies based on harm reduction models were explained to respondents, they generated more support than when respondents were asked directly about whether they support harm reduction programs. The actual (uninformed) reactions to harm reduction programs demonstrate these findings.

For example, in 2011 a safe crack pipe distribution program was shut down after three years of operation in Calgary, Alberta following an onslaught of negative media attention. Insite, a safe injection site in Vancouver, British Columbia, is Canada’s most widely known example of harm reduction policy in practice. Insite has been around for almost a decade and was granted exemption from the Controlled Drugs and Substances Act in September 2011 by the Supreme Court of Canada, permitting Insite to stay open indefinitely. This permission was not granted without controversy and negative media attention.

With a more basic understanding of harm reduction and greater knowledge of the benefits of these kinds of policies to individuals and public health in general, the stickiness of harm reduction politics might be cleared up.  I encourage the public to seek a better understanding prior to criticizing. Ontario has a number of effective policies that reduce the harms associated with substance abuse, based on harm reduction methods. However, there is not much discussion about the possibility of opening a clinic modeled after Vancouver’s successful safe injection site. When the idea of a safe injection site was proposed to Premier McGuinty this past spring, the Premier jumped around the issue, mindful of the potential public scrutiny and its implications for minority government rule.

So, in light of the solid pro- harm reduction evidence and the apparent lack of public and political support for effective harm reduction strategies, what can we do? I would argue that the next policy step is to explore how to break down the barriers to successfully implementing these policies.

Anna Hodgins is a 2014 MPP candidate at the School of Public Policy and Governance. She holds a BA in Sociology with distinction from McGill University. Previously, she worked at the Calgary Homeless Foundation conducting policy research. Her interests include health and social policy.

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