Harm Reduction – Challenging Stigma and Giving a Voice

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BoyleStreet_Learning_head2

“Harm Reduction is a comprehensive, just and science-based approach to substance use…”

By: Marliss Taylor, Program Manager of  StreetWorks. 

Harm Reduction may be one of the most misunderstood terms in our current society. Some see it as condoning substance use or other “undesirable” behaviors. Some see it as a threat to a community. Some see it as only an activity that an individual or organizations do. Some see it as what you do when all else has failed.

In fact, Harm Reduction philosophy, strategy and activity does quite the opposite. It opens the door and welcomes people to become as safe and healthy as possible.

It is beyond a set of activities and programs but speaks to the approach, mindset, and attitude that strives to respect the Human Rights of individuals, consider people’s strengths, recognizes and addresses any barriers, and treats all people with respect and compassion.

Streetworks defines Harm Reduction as:

Harm Reduction is a comprehensive, just and science-based approach to substance use. The principles can also apply to activities such as sex work. It represents policies, strategies, and services, which aim to assist people who use legal and illegal psychoactive drugs to live safer and healthier lives.

All substances have both positive and negative effects, and substance use may affect one’s health and legal vulnerability. It is clear that most people who use substances do not experience problems, but in some circumstances, substance use can become dependent and/or chaotic. Harm Reduction recognizes that people use drugs for many reasons. Reduction of substance use and/or abstinence is not required in order to receive respect, compassion or services.

Harm Reduction enhances the ability of people who use substances to have increased control over their lives and their health, and allows them to take protective and proactive measures for themselves, their families and their communities.  

A manufactured war 

There are two main branches of Harm Reduction – Policy and practice.

The policy side challenges us to look critically at legal measures, national policies and social attitudes. In order to understand the drug war, we need to look at what happened in 1971. While the United States was in the midst of the unpopular Vietnam war.

In 2016, John Ehrlichman (senior counsel and Assistant to President Richard Nixon) was quoted as saying:

The Nixon White House had two enemies: the antiwar left and [the] blacks…We knew we couldn’t make it illegal to be against the war or being black, but by getting the public to associate the hippies with marijuana and blacks with heroin, and then criminalizing both heavily, we could disrupt those communities. We could arrest their leaders, raid their homes…” 

“Did we know we were lying about the drugs? Of course, we did” (Dan Baum, Harper’s, April 2016)

Judicial discrimination 

There is no doubt that there is an unequal application of drug laws which systematically biases against people of colour and the poor. In the United States, for many years, people caught with crack were given a prison sentence that was 100 times more harsh that those that were caught with cocaine. This is a stunning difference in sentencing given that the only difference between cocaine and crack is the addition of baking soda.

Typically, cocaine was seen as the drug of the middle and upper classes – Hollywood’s drug – whereas the ‘street’ used crack. The law has since been modified but currently, the crack to cocaine prison sentence still remains at a 17:1 ratio.

Closer to home, we see that babies are routinely drug tested if their mother “appears” to have used substances, despite the fact that substance use spans all cultures, genders, and socioeconomic groups.

Mothers from more upscale parts of town are not routinely suspected of using substances and no testing occurs. A study in Sweden demonstrated that hospital staff were only correct 7% of the time when they were asked about which patients they thought had used drugs during their pregnancy.

War on Drugs misguided 

The drug war is 46 years old this year. Many people have grown up believing that this war is the only response to substances that is possible. However, most people would agree that the drug war isn’t working. The current world view is that illicit substance use is a problem and needs to be stopped.

In fact, substance use has been part of the normal human experience for millennia. Very often, people use the criminal law to define what is problematic or not. My glass of wine is a joy; there are wine-tasting clubs, stores on every corner, and wineries to visit. Most people could not imagine the same circumstance for heroin. Yet, alcohol was deemed the most harmful drug in the world in 2010 by The Scientific Committee on Drugs, led by Dr. David Nutt in the UK.

Close to home

In almost every case, the element that makes a substance unsafe is the fact that it is illegal, and is controlled by a black market that is focused on making the greatest amount of money in the shortest amount of time.

In Edmonton, the world changed at Boyle Street when oxycontin was arbitrarily removed from circulation on April 1, 2012. Within 2 weeks, heroin and fentanyl came screaming into town and the legacy can be seen in the unprecedented number of funerals for our community members.

The greatest risk currently is that the opioids available on the street are from unknown sources, and because it is illegal, there can be no regulations to make the substances safer. The only official response is “don’t do it”, which has not proven effective to date.

From both a policy and practice perspective, there are currently a number of Harm Reduction issues/activities that are relevant locally. These include supervised injection services, needle exchange, overdose prevention programming, managed alcohol programs, vaping, legalized cannabis and others. They are rooted in the desire to keep people safer and healthier.

There is some resistance from the broader community to continue or start these types of programs. The question for every one of these issues/activities should not be – should we do it? The question is actually – is it ethical not to do it?

Marliss Taylor is the Program Manager of the StreetWorks and has over 20 years of experience working in harm reduction.

Additional Resources: 

There are some very good videos that discuss perspectives on substance use and the drug war:

Johann Hari – Everything You Think You Know About Addiction is Wrong

Ethan Nadelmann – What Has the War on Drugs Done to the World? 

Dr. Carl Hart – Let’s Quit Abusing Drug Users

New “Brain on Drug Policy”

 

#KnowYourFwords

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FWORDSBANNER

Do you #KnowYourFwords?????

Boyle Street Community Services Water Wings program offers Flagger, First Aid and Food Safety tickets for the general public.

Food Safety, Flagger, and First Aid tickets are a “difference maker” to employers and can set your resume apart from other potential hires during the selection process.

Course registration includes group and individual registration options and all courses are administered in a brand new training space in North East Edmonton.

Successes that can be measured…

In January, a client named Boyd came to Water Wings after struggling to find long-term employment. Through these ticketing programs, Boyd was able to acquire his Pro-Serve and Food Safety ticket and is now enjoying sustainable, long-term employment as a Banquet Server.

Ticket cost and information:

Flagger: $40
Clients will attend half-day course (2 hours) training.

Food Safety: $70
Clients will attend 1 full day course training with half day test preparation.

First Aid: $126
Clients attend a 2-day course that runs from 9 a.m. to 5 p.m. each day.

Registration:

Registration for these tickets can be done over the phone or in-person.

For more information contact Water Wings:

Website: Boylestreet.org/waterwings
Email: WaterWings@boylestreet.org
Phone: 780-424-4106 Ext: 236
In person:
North East Location: 14021 – Victoria Trail NW
Downtown: 10112 – 105 Ave

The Forgotten Feast – Indigenous and Global Health Research Group and The Flaman Foundation

Find your calling at Boyle Street Community Services.
Find your calling at Boyle Street Community Services.

Due to a generous donation from the Frank J. Flaman Foundation, on Friday, February 3, 2017 Boyle Street Community Services held the Forgotten Feast. This is an annual event for the community organization that provides a warm and hearty meal for Edmonton’s most vulnerable populations. Though Boyle Street Community Services is typically not able to host a meal service in the evening, in the early winter each year the agency holds a Forgotten Feast in partnership with the local business community. The name of the event originated from the decrease in donations the agency receives following the end of the holiday season. It is a time of year that is generally the coldest and when the fewest resources are available. The event has significant meaning to the clients, staff, and volunteers at Boyle Street Community Services. The Forgotten Feast provides an opportunity for not only a wholesome meal but also for the community to gather together in support and companionship.

This year, support from the Frank J. Flaman Foundation purchased all of the food for the feast, which included roast beef and many healthy vegetables. The event was facilitated by Boyle Street Community Services and the Indigenous and Global Health Research Group at the University of Alberta, who worked as volunteers during the event to aid in preparing and serving the nutritious and delicious meal. Dr. Sangita Sharma leads the group and is the Endowed Chair of Indigenous Health and a Centennial Professor in the Department of Medicine. She and the members of her team were glad to be able to participate and are very grateful for Flaman’s kind gift. The highlight of the dinner was the roast beef. As Sharma’s work has shown, beef is a very nutrient dense food that contains large amounts of vitamin B12, zinc, and iron and is a very cost-effective and culturally appropriate way of addressing nutritional inadequacies. As we know, many of the clients served by Boyle Street Community Services have limited access to healthy food sources and rely on inadequate nutrition options throughout most of the year. The beef provided at this meal, along with other nutrient-dense foods, was very well received.

Sharma and her team are thrilled to be partnering with Boyle Street Community Services to improve the health and wellness of vulnerable peoples in the community. She has recently received funding from the Royal Alexandra Hospital Foundation to work with Boyle Street and several other community organizations to identify what barriers exist for vulnerable peoples when accessing services and to examine opportunities to improve experiences and availability of services. The goal is to inform current programs and policies to directly meet the needs and priorities of the community. The dinner on Friday evening marked the beginning of this work, and Sharma and Boyle Street Community Services are very grateful to the Flaman Foundation for sponsoring the Forgotten Feast in 2017.

Executive Director Julian Daly Guest Editorial (Edmonton Journal)

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BoyleStreet Blog Header

I spoke out this week about Edmonton’s Homeless Count results to urge caution to the community in interpreting the numbers.

The results were initially presented as if the number of homeless identified in the count were an absolute, rather than a snapshot or trend — a figure that provides a glimpse but not the full picture — as is now being said.

Nothing would make me happier than to see a 24 per cent reduction in Edmonton’s homelessness but the figure simply does not reflect the reality of what we see and is evidenced on the front lines every day. Because of Boyle Street Community Services‘ day-to-day work and our involvement in the count, we are aware of areas of significant under-reporting, which calls the methodology of counting and the way we report results into question.

Our Street Outreach team, a team which is out in the river valley and parks every day, has worked with over 800 individuals sleeping outside this year alone, compared to the 30 people identified by the count. We saw a 43 per cent increase in camping in the river valley this year. The numbers of clients who use Boyle Street as a mailing address because they don’t have a fixed address and are likely homeless has gone up from 1,600 last year to 2,200 this year.
We know of many instances in which people are homeless but would not report themselves as such, individuals who knew the count was happening and avoided agencies on that day, or those who simply refused to answer personal questions asked by strangers. And who can blame them for that?

Our point is this: we know that there was significant under-reporting of people who are homeless, meaning the number of 1,752 is not an accurate total. The number is actually higher. How much higher? We don’t know. We don’t have accurate enough data to know.

We hope that the next time we count the homeless population in Edmonton that we can have a more robust, regular and comprehensive methodology and approach, giving us a more accurate picture.

A serious concern is that if these numbers are seen by policy-makers and the community at large as factual, they may be used as rationale for a decrease in resources and energy in the fight against homelessness. The broader community — a community which has been massively supportive of the efforts to end homelessness — might have breathed a sigh of relief and eased their focus and efforts. Those who are challenged by homelessness cannot afford this.

Our organization raising questions about the homeless figure has, in some quarters, been sadly and unfairly characterized as being anecdote-driven as well as not recognizing all the good work done by government and social agencies to end homelessness. Our concerns are driven primarily by hard evidence collected over a long period of time by our workers.

Yes, there was anecdotal evidence as well and we make no apology for that. Anecdotes are people’s observed evidence. Their truth. Their story. And consequently, shouldn’t be so easily dismissed.

Since stories about the most recent homeless count results came out, many Edmontonians have shared their anecdotes with us too. They are telling us that what we said is what they see.

I’ve also been at pains to highlight that thousands of people are currently housed in our city as a result of the amazing work and investment from government and agencies. Indeed, my colleagues at Boyle Street have been leaders in this work and I am proud that they’ve housed so many people over the years. Great work being done to end homelessness and rising homelessness aren’t mutually exclusive realities. The one doesn’t point to the failure of the other.

We all want to see an end to homelessness and the fight to end homelessness needs to continue. I just hope that the homeless count figures don’t lull us into a false sense of security that the battle is won or nearly won because it isn’t. Far from it.

#JustCall211 Campaign

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#JustCall211 Online Campaign 

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Just Call 211 and Press “3” when you see someone in physical or mental distress. By doing so you will dispatch the 24/7 Crisis Diversion Team getting that individual the help that they need immediately.

The 24/7 Crisis Diversion Team is an integrated community response team that aims to help those in distress on the street in non-emergency situations. They work directly with the community member and ensure that each interaction with an individual in distress ends with a “warm handoff” by connecting the individual with the support that they need for the immediate crisis.

The 24/7 Crisis Diversion Team provide crisis intervention services when someone is:

  • Experiencing a medical or mental health (non-emergency) crisis
  • There is a potential safety concern for the individual involved
  • Possibly intoxicated, or otherwise impaired

Boyle Street Community Services is a partner in the 24/7 Crisis Diversion Team along with:

  • Hope Mission
  • Canadian Mental Health Association
  • Emergency Medical Services
  • Edmonton Police Service
  • REACH Edmonton