Harm Reduction Philosophy and Drug Use in Vancouver – Problems, Solutions, and Outcomes
Author(s): Scott Douglas Jacobsen
Publication (Outlet/Website): Harvest House Ministries
Publication Date (yyyy/mm/dd): 2017
Harm reduction philosophy is associated with social justice based in rights and respect for drug users.[i] The focus is, as the title implies, to reduce the harm to drug users. According to the Center for Addiction and Mental Health, it states, “Harm reduction is any program or policy designed to reduce drug-related harm without requiring the cessation of drug use.”[ii]
Its framework emphasizes theory-to-practice with comprehensive strategies. It contrasts with the zero tolerance approach and its big four consequences. Rodney Skager in a publication for the United Nations Office on Drugs and Crime (UNODC) says, “Proponents of the “big four” consequences – exclusion from extracurricular activities, transfer to another school, suspension, and expulsion – believe that harsh consequences…will deter other students…”[iii]
Unfortunately, according to Rodney Skager, zero tolerance approaches worsen the problem. It “lacks credibility” and is backed by “punitive measures” that foster “resentment and oppositional behavior.”[iv] In short, zero tolerance approaches don’t work. Colloquially, zero tolerance is absolutist, or ‘black-and-white’, and harm reduction is more ‘grey’ by implication. This is the divide between zero tolerance and harm reduction approaches.
The harm reduction philosophy has impacts. Why? Its philosophy and theory imply practice. Those that live in British Columbia know about the drug problem in Vancouver. Therefore, the main question narrows in approach and location, “What have been impacts of the harm reduction philosophy in Vancouver?”
Bear in mind, harm reduction philosophy is a non-idealistic view of drug abuse and use. No society will ever be drug-free. That means the philosophy is pragmatic. The focuses are the harms of drugs and the means through which to reduce them. That requires more background because the case study in the harm reduction philosophy applied to Vancouver has nuance.
That means there are numerous facets to the implementation phases of the program. For examples, these can include (non-exhaustively) the Four Pillars, the Insite program, Vancouver Area Network of Drug Users (VANDU), Karmik, Simon Fraser University (SFU) community engagement research into if food programs can be used for harm reduction, and Vancouver Coastal Health (VCH) education on safe drug use, safe sex, Neighbourhood Needle Recovery Program, and the Safer Smoking Pilot Project, and so on.[v],[vi],[vii],[viii] Multiple avenues for solutions.
One sub-tenant of harm reduction philosophy is harm minimization, which means the aim to reduce or prevent harms associated with psychoactive drug use. Those psychoactive drugs can be illicit or licit. A number of programs have been put in place to combat this issue. Take, for instance, the Four Pillars drug strategy of the City of Vancouver.[ix]
It is based on a 1990s model implemented in Europe with four principles or Four Pillars.[x] Those are the following:
harm reduction
prevention
treatment
enforcement[xi]
In major cities such as Frankfurt, Geneva, Sydney, and Zurich, the Four Pillars or principles had the results of reduction in number of drug users, overdose deaths, and infection rates of hepatitis and HIV.[xii] In short, harm reduction as the central philosophical tenet. Prevention, treatment, and enforcement as the practice in the Four Pillar strategy.
All good things with success on important metrics with tallies of the number of people and the drug use consequence severity, in Europe. The assumption based on the association of success with the Four Pillars is the general applicability from Europe to North America. Each done in major cities. Vancouver is one as well. There’s good reason to predict success, or improvement.
Some areas, writings, and discussions might seem familiar residents and visitors of Vancouver. For instance, Vancouver’s Supervised Injection Facility, or Site, (SIF/SIS) gathers media attention.[xiii],[xiv] Insite works, too.[xv] Harm reduction policy has not been comprehensive enough with reports on the inattention to crack as one case, though.[xvi] However, VANDU focuses on heroine and crack. There’s a meshwork of organizations devoted to harm reduction.
Some individualization occurs with publications emphasizing women’s health via women centered harm reduction.[xvii] Depending on the peoples, some First Nation, Inuit, Métis might find harm reduction policies against beliefs, customs, and traditions.[xviii] These issues come into consideration as the program is implemented and expanded via networking.
This takes cultural awareness and sensitivity, specification of the drug type, number of people, and severity of use and abuse. Also, it might require tailoring the principles and program to the community and situation, and conducting outreach to the media to improve public perception of the issues of drug abuse and use in the public sphere. It can be grassroots too. On the ground, the homeless in Vancouver created tent city to advocate for social housing.[xix] What does this mean?
Overall, and without an exhaustive description of the various aspects to the problems of drug use, from the general theoretical ethics and concerns of harm reduction to the particular organizations (grassroots and formal) and publications, harm reduction philosophy has been a net good in terms of outcomes in Vancouver.
Footnotes
[i] Principles of Harm Reduction (n.d.). states:
Harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use. Harm Reduction is also a movement for social justice built on a belief in, and respect for, the rights of people who use drugs.
Harm reduction incorporates a spectrum of strategies from safer use, to managed use to abstinence to meet drug users “where they’re at,” addressing conditions of use along with the use itself. Because harm reduction demands that interventions and policies designed to serve drug users reflect specific individual and community needs, there is no universal definition of or formula for implementing harm reduction.
Harm Reduction Coalition. (n.d.). Principles of Harm Reduction. Retrieved from http://harmreduction.org/about-us/principles-of-harm-reduction/.
[ii] Erickson, P et al. (2002, May). CAMH and Harm Reduction: A Background Paper on its Meaning and Application for Substance Use Issues. Retrieved from http://www.camh.ca/en/hospital/about_camh/influencing_public_policy/public_policy_submissions/harm_reduction/Pages/harmreductionbackground.aspx.
[iii] Skager, R. (2016). Beyond Zero Tolerance: A Reality-Based Approach to Drug Education and School Discipline. Retrieved from https://www.unodc.org/documents/ungass2016/Contributions/Civil/DrugPolicyAlliance/DPA_Beyond_Zero_Tolerance.pdf.
[iv] Ibid.
[v] Vancouver Area Network of Drug Users. (2016). Vancouver Area Network of Drug Users. Retrieved from http://www.vandu.org/.
[vi] Karmik. (2016). Karmik. Retrieved from http://www.karmik.ca/.
[vii] Simon Fraser University: Department of Geography. (n.d.). Food as Harm Reduction (FaHR): The Health Effects of Food for People Who Use Drugs. Retrieved from https://www.sfu.ca/geography/community-engagement/food-harm-reduction.html.
[viii] Vancouver Harm Reduction. (2014). Harm Reduction. Retrieved from http://www.vch.ca/your-health/health-topics/harm-reduction/.
[ix] City of Vancouver. (2016). Four Pillars drug strategy. Retrieved from http://vancouver.ca/people-programs/four-pillars-drug-strategy.aspx.
[x] Ibid.
[xi] Ibid.
[xii] Ibid.
[xiii] Dell, C.A. (2008). Harm Reduction and Abstinence—More Alike Than Different?. Retrieved from
http://www.heretohelp.bc.ca/visions/aboriginal-people-vol5/harm-reduction-and-abstinence.
[xiv] Vancouver Coastal Health. (n.d.). Insite – Supervised Injection Site. Retrieved from http://supervisedinjection.vch.ca/.
[xv] MacQueen, K. (2015, July 20). The Science Is In. Insite Works.. Retrieved from http://www.macleans.ca/news/canada/the-scientists-are-in-insite-works/.
[xvi] Lupick, T. (2014, September 6). Advocates say Vancouver’s harm reduction push has left out crack users. Retrieved from http://www.straight.com/news/722916/advocates-say-vancouvers-harm-reduction-push-has-left-out-crack-users.
[xvii] British Columbia Centre of Excellence for Women’s Health. (2010). Women Centered Harm Reduction. Retrieved from http://bccewh.bc.ca/wp-content/uploads/2012/05/2010_GenderingNatFrameworkWomencentredHarmReduction.pdf.
[xviii] Harm Reduction and Abstinence—More Alike Than Different? (2008) states:
There is likewise confusion when harm reduction measures are considered by Aboriginal peoples. Some First Nation, Inuit and Métis people maintain that harm reduction policies and practices go against their customs, traditions and beliefs. They believe using mind-altering substances causes a person to be “out of balance.” Others, however, consider that there are similarities between a harm reduction philosophy and traditional Aboriginal values. For example, respect is a traditional Aboriginal teaching—and respecting the choices of individuals, families and communities and “where they are at” is a premise of harm reduction.
In fact, the concept of choice underpins a harm reduction philosophy. Harm reduction policies and programs acknowledge that people and their communities are the ‘experts’ on their own experiences. As experts, they are best positioned to decide how to reduce the harm they experience because of substance abuse. Consider, for example, the Quesnel Tillicum Society Native Friendship Centre in northern British Columbia. Based on a need identified within and responded to by the community, the centre provides needles, condoms, swabs and needle exchange containers at no charge to community members.
Harm reduction, at its core, is simply a practice or strategy that reduces the harms individuals face because of their problematic use of substances.
Dell, C.A. (2008). Harm Reduction and Abstinence—More Alike Than Different?. Retrieved from http://www.heretohelp.bc.ca/visions/aboriginal-people-vol5/harm-reduction-and-abstinence. [xix] Dolski, M. (2016, July 12). Vancouver’s homeless create new tent city to advocate for social housing. Retrieved from http://www.theglobeandmail.com/news/british-columbia/homeless-create-new-tent-city-to-protest-vancouvers-social-housing/article30898440/
License
In-Sight Publishing by Scott Douglas Jacobsen is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. Based on a work at www.in-sightjournal.com.
Copyright
© Scott Douglas Jacobsen and In-Sight Publishing 2012-2022. Unauthorized use and/or duplication of this material without express and written permission from this site’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Scott Douglas Jacobsen and In-Sight Publishing with appropriate and specific direction to the original content. All interviewees and authors co-copyright their material and may disseminate for their independent purposes.
In-Sight Publishing 