Toronto Harm Reduction Task Force Holly Kramer, Project Coordinator

The THRTF is an association of professionals, agencies and community members working together to reduce the harms to communities and individuals associated with drug distribution and use.

The wisdom of the community will always exceed the knowledge of the expert. -John McKnight

Harm Reduction = …decreasing the adverse health, social and economic consequences of drug use without requiring abstinence from drug use. [Riley et al]

In other words…. … a harm reduction approach does not view or promote abstinence as a goal, either in the short or the long term.

The only goal of harm reduction is to reduce or mitigate harms to: Individuals (users) Families Communities Society

Harm Reduction offers… A social justice response, rather than a criminal justice response, to drug use.

Harm Reduction… a philosophy, a way of thinking, a premise, an approach, a perspective… NOT a sticker, a buzzword, or a conundrum

Harm Reduction, AKA… Risk management or or Mitigating danger or or Damage control or or Injury/death or prevention Life support or Health promotion or Safety endorsement or REALITY CHECK

Harm Reduction is…a way of thinking… a way of doing business meets people where theyre at in holistic way respects individuals reasons for using acknowledges clients as people deserving of dignity and respect is non-judgmental; does not punish use/relapse sees use as a symptom, not the problem seeks practical ways to reduce harm without necessarily eliminating use.

CRACK PIPE KITS example of h.r. tool Glass stem Non-toxic (as opposed to pop tins); smooth rim (as opposed to broken bottles) Screens Non-toxic (as opposed to brillo) Gum, lip balm To produce saliva/treat cuts/burns: reduces risk of disease transmission TOOL FOR OUTREACH WORKERS To engage/build trust with hard to reach users

Annex Program (Seaton House) example of h.r. program Offers shelter and supports to long term alcohol users; Provides controlled access to consumable alcohol (i.e. as opposed to Listerine etc.) Residents alcohol use decreases; Other social determinants of health met: e.g. improved nutrition, health care needs, hygiene, socialization etc. AGAIN: Alcohol consumption actually decreases!

Harm Reduction is a continuum… all the way from chaotic use to abstinence Recognizes that abstinence may not be achievable by everyone Understands that using/not using cycle is normal Meets people where theyre at by: Encouraging safer use Offering alternatives A harm reduction approach provides for peoples needs regardless of use

Harm Reduction distinguishes between use and behaviour… EG: Designated drivers are harm reduction in action… We dont say, dont drink; we say dont drink and drive.

Harm reduction: Understands that drug use is universal Recognizes that some people have always used drugs – usually for a REASON Accepts that some people will always use drugs Contends that No one should be denied service or access to service merely because they are using a drug, licit or illicit.

Drug use: SIGN SYMPTOM MANIFESTATION COPING MECHANISM BALM UNMET NEEDS DESPAIR PAIN ILL HEALTH TRAUMA

Spot the incongruities! Social Determinants of Health Care in childhood/adolescence Education (opportunities) Employment/job security Food security Appropriate housing/stability Social inclusion Access to health/dental care Freedom from discrimination persecution/violence/stigma Some common experiences among users ABANDONED, ABUSED, HOMELESS, HUNGRY, ISOLATED, NEGLECTED, POOR, SICK, SCARED, SCARRED, UNLOVED, UNWANTED, UNEMPLOYED, UNDEREDUCATED

Providing service from a harm reduction philosophy: Recognize the value and necessity of self determination and of individual support plans.

and….. some people manage well with little support, but sometimes have setbacks and need a higher level of support, for a while… people need to be able to move back and forth from one level of care; fluidity is realistic; clients should be supported to maintain as much independence as they are able; a spectrum of service is necessary… BASED ON CLIENT NEED

Some websites of interest: