The province of British Columbia takes a harm reduction approach to substance use. However, there are many layers of complexity within our conversations around substance use. It’s essential that people who use substances are treated with the deep respect that they deserve. This section will cover some of the principles and methodologies around the evidence-based harm reduction approach we use today.

Harm reduction within peer support work looks like meeting people where they’re at, promoting safety and providing support that’s free from judgment. We are not here to support or condemn an individual’s use of substances.

A very simple way to look at harm reduction is to think of it in terms of reducing the potential harm of injury or death from things that are preventable.

Most of us practice this basic principle every day. For example, when we choose to use seatbelts in a car, we’re reducing the harm that can come from a car accident. When we wear sunscreen, we’re reducing our potential harm from the effects of the sun. When we wear a helmet on a bike ride, we’re reducing the potential for brain injury or death in the case of an accident. We accept that some degree of risk exists in our day-to-day activities and attempt to reduce the potential for harm.

The International Harm Reduction Association (2002) describes harm reduction as:

Policies and programs which attempt primarily to reduce the adverse health, social and economic consequences of mood-altering substances to individual drug users, their families and communities, without requiring decrease in drug use.

Harm reduction is, in essence, the act of reducing the risks of any behaviour to create better outcomes for individuals and communities alike. In a substance use context, harm reduction can be practices like drug testing kits, supervised injection sites or carrying a naloxone kit.

Healthlink BC’s Understanding Harm Reduction: Substance Use (2020) expands on this idea:

Harm reduction is a public health approach that aims to reduce harms related to substance use. Harm reduction includes many options and approaches. It may include abstinence, or not using substances at all. Stopping all substance use isn’t required before receiving care. It meets people wherever they are in their substance use journey. Evidence shows that harm reduction does not increase or encourage substance use.

Harm reduction strategies and services can lessen the consequences associated with substance use. The consequences include social, physical, emotional and/or spiritual concerns. It may include access to safer sex and safer substance use supplies and/or take home naloxone. It also involves outreach and support programs and referrals to health and support services. Harm reduction helps ensure services are non-judgmental and available to all.

Harm reduction treats people with respect. It helps people connect with others and develop healthy relationships. It involves working directly with people and their communities. The service helps individuals; families and friends learn harm reduction skills. People can learn about the resources and supports in their communities.

Harm Reduction Approaches

Between January 1 and June 30, 2020, 728 people died in B.C. from drug overdoses. B.C. has been in a state of public health emergency for nearly five years now, and overdose numbers continue to rise.

Dying from overdose is preventable. Harm reduction aims to meet people where they’re at, promoting safety and support that’s free from judgement.

The foundation of harm reduction is that there’s never been a drug-free society. Strategies that reduce the potential harm that can come from drug use ask that we suspend any judgement around drug use and work instead to reduce its impacts.

Harm reduction can involve many different approaches and supports. These supports can include needle distribution, safe disposal, supervised consumption services (SCS) and overdose prevention sites (OPS), medication-assisted treatment, safer supply and overdose treatments like naloxone.

There’s no one approach. What works for some may not work for others. The list above includes just some of the ways harm reduction is manifested in services. In fact, it’s important to note that harm reduction is not a set of services but rather an underlying philosophy of care that belongs in every care setting.

Talking about this important topic, and sharing stories can reduce stigma and save lives; we know the stigma of substance use can kill. Check with your campus supervisor to learn your campus’s approach to harm reduction. Ask for clarification regarding what your involvement in harm reduction is as a peer support worker.

The Principles of Harm Reduction

(Adapted from Harm Reduction: A British Columbia Community Guide)

Realistic Approach

Harm reduction takes a realistic view of substance use. As we’ve mentioned, harm reduction accepts the fact that the non-medical use of mood altering or psychoactive substances happens almost worldwide. Harm reduction therefore acknowledges that, although there are risks, substance use also gives the person who uses benefits that have to be taken into account. Harm reduction also recognizes that drug use is complex and includes a range of behaviours from chronic dependence to abstinence. There are also different degrees of harm to individuals and communities.

Human Rights

Personal choice, self-management and taking responsibility are key components of harm reduction. It respects the rights and basic dignity of people who use substances and accepts their decision, without judgement. There’s no move to either support or condemn substance use – ‘it is what it is’. Harm reduction supports informed decision making when it comes to active drug use and recognizes an individual’s right to freedom of choice and self-determination – a core value we continue to explore in this work.

Focus on Harms

As the name suggests, harm reduction places emphasis on the harms of substance use over how much the person uses or the fact of their substance use. Priority is given to decreasing any negative consequences of substance use – both to the person who uses and others – rather than attempting to decrease the substance use itself. While harm reduction encourages safer practices and patterns of substance use, it also doesn’t exclude a longer term goal of abstinence. In this way, harm reduction complements the abstinence model of addiction treatment.

Maximize Intervening Options

Harm reduction acknowledges that people who use substances can benefit from a variety of approaches and treatments; there’s no “right way” to do it, no single treatment or one type of prevention option that works across the board. People are kept safe and alive when there is easy, early access to a range of interventions and the ability to choose. Another key in the co-creation of effective harm reduction strategies is involvement of both individuals and communities impacted by substance use.

Priority of Immediate Goals

Harm reduction starts with where a person is at in their substance use, with a focus on their most immediate concerns or needs as the starting point. Harm reduction then establishes achievable goals or steps that, taken one at a time and gradually built on, can lead to a fuller, healthier life for people who use substances.

Involvement of People who use Drugs

Harm reduction places people who use substances at the centre of treatment and all related approaches. It recognizes both their freedom and their ability to make their own choices. They’re acknowledged as the best source of information about their own drug use, and the focus is on empowering them to work with service providers to determine what may work best in terms of interventions to reduce harm.