“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”