Mental Health and Addictions health promoter believes understanding the harm reduction toolbox will help combat the opioid crisis

Laura Chapman, health promoter and Cape Breton resident, works for Mental Health and Addictions in Nova Scotia Health’s Eastern Zone.
Laura Chapman, health promoter and Cape Breton resident, works for Mental Health and Addictions in Nova Scotia Health’s Eastern Zone.
Laura Chapman, health promoter and Cape Breton resident, works for Mental Health and Addictions in Nova Scotia Health’s Eastern Zone.  
In her role, Chapman tries – along with colleagues, community partners and nonprofits – to make the environment in which Nova Scotians live a place where it becomes easier to lead healthy, flourishing lives.  
Chapman is a staunch advocate of harm reduction when it comes to addressing drug use. 
Harm reduction is an evidence-based practice which acknowledges that people have the right to engage in drug use and other risky behaviors. But, instead of trying to simply stop these risky behaviours, harm reduction practitioners recognize that it’s more effective to focus on reducing harms associated with the behaviour. 
By shifting the focus to the harms, this enables people to change behaviours, but in a way that gives them individual freedom and protects their right to engage in behaviour that may put them at risk.  
Focusing on harm reduction also reduces judgment and subsequent stigma that people often face from others. Chapman uses a commonplace behavior to explain this concept and the idea of harm reduction. 
“Every time people drive a vehicle, they are taking a risk,” said Chapman. “For people who choose to drive despite the fact that they might get killed or injured, they are given the option to wear a seatbelt - which are installed in every vehicle by the way. 
“Wearing seatbelts is a requirement in most jurisdictions because we know that people won’t stop driving, but wearing a seatbelt reduces harms if the driver gets into an accident. This enables safer use while engaging in a behavior that has risks – in this case, driving.”
Chapman describes another common practice of harm reduction – providing sterile needles when using injection drugs.  
“Providing sterile drug using equipment, such as needles, to people who inject drugs drastically reduces the risk of acquiring blood-borne infections like hepatitis and HIV for both the person who is injecting as well as the entire community,” said Chapman.  “Risk to others is also reduced when you provide sterile injecting equipment in abundance which allows people who use
drugs (PWUD) from needing to share with others.”  
Harm reduction is just one aspect of what’s called a ‘public health model’ for addressing drug use.  
In direct contrast to a prohibitionist model – which advocates for the criminalization, imprisonment and punishment of PWUD– a public health model advocates for the allowable, but strictly regulated supply of drugs either through decriminalization or legalization. 
Historically, many societies have been applying a prohibitionist model to drug use whereby some drugs were made illegal and those who used illegal drugs were punished by law – often referred to as the ‘War on Drugs.’  
This model has been proven ineffective in combating drug use and has led to a high cost of social and health harms, including an oversaturated prison population, many who have been sent there because of a substance use disorder.  
In our current situation, all drugs except for alcohol, tobacco and cannabis are deemed illegal, and therefore public perception of their use is seen differently.  
When people use illegal drugs, they are often viewed as “bad” and “immoral.” This perception keeps jurisdictions from applying harm reductionist measures– an outcome of the arbitrary criminalization of drug use.  
For example, though heavy drinking may be frowned upon by some, it is still a very legal and very commonplace activity that many people engage in openly and without fear– often in the bars and homes of Nova Scotia.  
On the other hand, if someone is using heroin or another opioid, they would have to keep their use secret and often use the drug in hiding for fear of punishment or social stigma.  
Though opioids and alcohol can both be overused drugs, people who use either are treated differently in society simply because one is legal and the other is not. 
In an effort to truly apply a public health model to drug use, perceptions of drug use must first change. Often this change comes from decriminalizing or legalizing drugs.  
Chapman notes that the tide is shifting, as some jurisdictions are now applying a public health model. For example, two years ago Canada made the sale and use of recreational cannabis legal for adults which public health advocates believe will tamper the potential negative effects, given cannabis (the product, manufacture, distribution and point of sale) is now heavily regulated. 
In addition to this, Canada has been tackling the opioid epidemic, with overdose deaths reported across the country.  The recent coronavirus pandemic has exacerbated the epidemic, with record overdoses, mainly due to disrupted supply chains and a street supply that is often contaminated with fentanyl and carfentanyl, which often leads to unintentional overdose. Given this, it has become clear that opioid drug use in Canada is not going away.  
“The best way we can tackle this epidemic is by applying a public health model and principles of harm reduction,” said Chapman. “There is a lot we have done already, but there is more that we could be doing.”
In Nova Scotia, the province has already implemented several evidence-based harm reduction measures either through Nova Scotia Health or its community partners. These include:
However, given the continued increase in opioid use and deaths, there is a growing call to keep expanding harm reduction approaches and offer a robust continuum of services to reduce the negative outcomes experienced by those who use drugs or live with opioid use disorder.  For example, the approaches that other jurisdictions are taking include decriminalization and safe supply. These will be discussed in our second article in the harm reduction series. 
This article is the first of two articles in a series on harm reduction and is part of Nova Scotia Health’s outreach for Addictions Awareness Week. #AAW2020
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