Harm reduction Thunder Bay Ontario


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harm reduction perspectives, needle exchange, myths and misconceptions discussed

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Harm reduction Thunder Bay Ontario

  1. 1. Dispelling the Myths: The WhiteTape of Harm ReductionGreg Riehl December 5th, 2012Thunder Bay District Health Unit
  2. 2. • Define harm reduction• Identify the goals of harm reduction• Explore harm reduction among key populations• Identify myths and misconceptions• Values, choice, culture and harm reduction.• Discuss your role with harm reductionObjectives
  3. 3. • Practical non-judgemental services that seek to minimize drug related harm to the individual in society• Originated in Amsterdam and UK in the 1980s by drug users themselves in response to rising HIV rates• Needle exchange, Methadone maintenance• Abstinence is one of many strategies and services that can be provided.Harm Reduction
  4. 4. International Harm Reduction Association (2002):“Policies and programs which attempt primarily toreduce the adverse health, social and economicconsequences of mood altering substances toindividual drug users, their families and communities,without requiring decrease in drug use”.Harm Reduction (As cited in Ministry of Health, 2005)
  5. 5. A neutral, non judgmental, lowthreshold approach, gearedtowards individual attributes andcontext as well as social factors ofbehavior and potential risk forharmKeane, 2003; Hathaway, 2002; Erikson, 2001Harm Reduction
  6. 6. The GOAL of harm reductionis to help users makeinformed decisions andempower themselves toreduce the potential harmfrom drug use.
  7. 7. Principles of Harm Reduction• Humanistic Values• Focus on Harms• Priority of Immediate Goals• Pragmatism• Balancing costs and benefits to individuals and society Ministry of Health, 2005 Beirness, Jesseman, Notarandrea & Perron, 2008
  8. 8. More About Harm Reduction• Reduces sharing of needles• Saves lives by reducing drug-related health risks.• Improves quality of life• Reduces the spread of HIV• Reduces OD deaths• Opportunity for education and referrals Health Canada, 2001
  9. 9. Medical Model is to treateveryone the sameTrue or False
  10. 10. Special Populations • Concurrent Disorders (mental health and addictions) • Remanded Populations • Youth • Women
  11. 11. Insite
  12. 12. Who’s not afraid of needles?
  13. 13. Safer consumption sites
  14. 14. National Anti-Drug Strategy•Government of Canada Launches New Anti-drugCampaign: New Ads Latest in Effort to Help ParentsKeep their Children Drug-free•This was October 2007 Knowledge does not equal behaviour changehttp://www.hc-sc.gc.ca/ahc-asc/media/nr-cp/_2010/2010_196-eng.phphttp://www.nationalantidrugstrategy.gc.ca/sp-dis/2007_10_04_1.html
  15. 15. • There is a disconnect with what is being said and what is being practiced• Compare federal, provincial, regional, local practices.• Who decides what we do? Unfortunately not our clients.Cultural Disconnect
  16. 16. “We have major concerns with some of the initiatives,falling under the banner of Harm Reduction, that donot include abstinence as a goal. Rather than reduce,they only prolong the misery caused by addiction.Whereas, properly funded, prevention andabstinence-based treatment programs actually reducethe number of people addicted and the relatedharms.” C.D.(Chuck) Doucette President Drug Prevention Network of CanadaDrug Prevention Network of CanadaPrevention Education Treatment
  17. 17. Nature of Harm Reduction• Harm reduction is not a black & white subject• Harm reduction is not something you either know or don’t know• Harm reduction involves thinking and feeling, study and practice, knowledge and intuition
  18. 18. Harm Reduction Does Not…• Provide rules of ethical or moral behavior for every circumstance• Offer guidance about which values should take priority or how they can be balanced in practice
  19. 19. When Do Values Collide?• When one’s personal, professional or institutional values conflict• When an individual’s values conflict with the values of another individual
  20. 20. MYTHS• HR enables drug use and encourages drug use among non- drug users• HR drains resources from treatment services• HR increases disorder and threatens public safety and health BC Community Guide, 2005
  21. 21. Saskatchewan Registered Nurses’ Association:“Focus is on the assumption that harmsassociated with certain behaviours can bereduced without the elimination of thebehaviour”Harm Reductionists accept abstinence asa goal along a continuum… SRNA Position Statement, 2008
  22. 22. Nurses have a responsibility to provide non-judgmental care to individuals and families affectedby substance use, regardless of setting, social class,income, age, gender or ethnicity, and they caninfluence the development of organizational andgovernmental harm reduction policies related to druguse.CNA CANACJoint Position Statement
  23. 23. 4 Pillars TreatmentPrevention • Improve physical, emotional, and• Prevent or delay onset. psychological healthHarm Reduction Enforcement• Reduce harms for • Strengthen community individuals, families, and safety by responding to communities. crimes and community disorder issues.
  24. 24. Harm Reduction StrategiesRelated to Drug Use• Needle exchange• Supervised injection sites• Methadone• Street outreach programs• Safe crack pipe programs Beirness, Jesseman, Notarandrea, & Perron, 2008
  25. 25. • Methadone Reduces • Illicit opiate use • Overdose deaths • Frequency of injecting • Needle sharing • HIV/HCV/HBV transmission • Criminal activity, recidivism T Kerr, R Jürgens. Methadone Maintenance Therapy in Prisons: Reviewing the Evidence. Montreal: Canadian HIV/AIDS Legal Network, 2004.Substitution Therapy
  26. 26. • Assess patients fully and ask about their use, how they support their use, &if they are withdrawing• It isn’t your life, so avoid judgment• Manage withdrawal properly –withdrawal is a MEDICAL EMERGENCY• Set realistic boundaries• Understand the impact of trauma, pain and anxiety• Ask patients to tell you if they use• Don’t punish patients for using• Keep the door open• Be clear about what patients can expect from you & what you expect from them“They may have made some bad choices but your job is tolook after their needs” Remember Maslow????Substance Use and Care
  27. 27. Maslow’s Hierarchy of Needs Where is your client at right now? Social Determinants of HealthMaslows hierarchy of needs and subpersonality work, Kenneth Sørensenhttp://two.not2.org/psychosynthesis/articles/maslow.htm
  28. 28. • Aboriginal injection drug users are the fastest growing group of new HIV cases in Canada.• An estimated 6,380 Aboriginal people were living with HIV (including AIDS) in Canada at the end of 2011 (8.9% of all prevalent HIV infections) which represents an increase of 17.3% from the 2008 estimate of 5,440.• The estimated prevalence rate among Aboriginal people in Canada in 2011 was 544.0 per 100,000 population.Epi in First Nations
  29. 29. Risk Factors for HIV in First Nations • Injection Drug Use • Unsafe sex • Many sexual partners • Sexual and physical abuse • Incarceration • Alcohol Abuse • Lack of knowledge • Low self esteem • Residential school syndrome • Loss of culture and spirituality All Nations Hope, 2002 Joining the Circle, CAAN
  30. 30. •Culturally appropriate services •There is a lack of harm reduction services to First Nations (rural and on-reserve) Wardman & Quartz, 2006 & Dell & Lyons, 2007)“Programs and services for First Nations, Métis and Inuit people must‘first and foremost, show respect and honour for all Aboriginal beliefs,practices and customs’ and reflect the ‘pride and dignity thatAboriginal heritage demands” Culture and Harm Reduction
  31. 31. • Not all harm reduction measures are applicable to all people, groups, or communities.• Many Aboriginal communities adhere to models of abstinence and prohibition and do not allow for moderate substance use.• Stigma and discrimination• Absence of services Dell & Lyons, 2007
  32. 32. Community and Public Health• What is your role in providing care, treatment, and support for those who use illicit drugs and are at risk for contracting .• Nurses have a duty to provide safe, competent, ethical care.• Protect dignity and choice• Enact social justice CNA, 2007
  33. 33. Population Health Approach• Consider underlying conditions that put people at risk of using, abusing, and misusing drugs (ie. marginalization, poor support networks, lack of access to health services, poor coping skills).• Consider determinants of health:  Income and social status  Social support networks  Education  Employment  Coping skills  Culture  Physical environments  Health services Health Canada, 2001
  34. 34. What CanYOU Do?• HIV and HCV are PREVENTABLE• Consider harm reduction within framework ofproviding medical care • goal is to minimize harm with a patient-first approach • maximize intervention options • Knowledge ≠ behaviour
  35. 35. Summary• As health care practitioners, we must provide culturally competent care to our clients and citizens of our communities.• Western culture tends to blame the victim.• Harm reduction can improve the quality of people’s lives.• Some people are faced with several risk factors that put them at risk for harm.• We need to implement cultural elements when working with our clients and with our partners.
  36. 36. “Ultimately we know deeply that the other side of every fear is a freedom.” Marilyn Ferguson
  37. 37. Greg Riehlgreg.riehl@siast.sk.cagregriehl@sasktel.net1.306.775.7383• Thank you for your participation.Questions? Comments?
  38. 38. References• All Nations Hope AIDS Network. (2002). Harm reduction in Saskatchewan: A resource guide. Regina, SK: Author.• Beirness, D.J., Jesseman, R., Notarandrea, R., & Perron, M. (2008). Harm reduction: What’s in a name? Ottawa, ON: Canadian Centre of Substance Abuse.• British Columbia Centre for Disease Control. (2003). The needs of someone living with HIV. Vancouver: Author.• Canadian Aboriginal AIDS Network. (2007). Walk with me pathways to health: Harm reduction service delivery model. Ottawa: Author.• Canadian Aboriginal AIDS Network. Joining the Circle: An Aboriginal harm reduction model. Retrieved July 10 th, 2008 from http://www.healingourspirit.org/pdfs/publications/joincircle.pdf• Canadian AIDS Treatment Information Exchange. (2007). Study looks at underlying causes of HIV, hepatitis C and substance use in Aboriginal youth. Retrieved July 8, 2008 from http://www.catie.ca/catienews.nsf/news/F78C7BC9B71F09388525733100608E31?OpenDocument• Canadian Nurses’ Association. (2007). Promoting equity through harm reduction in nursing practice. Ottawa: Author• Dell, C. A., & Lyons, T. (2007). Harm reduction policies and programs for persons of Aboriginal descent. Ottawa, ON: Canadian Centre on Substance Abuse.• Health Canada. (2001). Reducing the harm associated with injection drug use in Canada. Ottawa: Author.• Health Canada. (2001). Harm reduction and injection drug use: An international comparative study of contextual factors influencing the development and implementation of relevant policies and programs. Ottawa: Author.• International Harm Reduction Association. (2002).• Ministry of Health. (2005). Harm reduction: A British Columbia community guide. British Columbia: Author.• McLeod, A. (2004). As the wheel turns: The HIV/AIDS medicine wheel. The Positive Side, 6(4), 14-16.• Saskatchewan Registered Nurses’ Association. (2008). SRNA position statement: Promoting equity through harm reduction in nursing practice. Regina: Author.• Wardman, D. & Quantz, D. (2006). Harm reduction services for British Columbia’s First Nation population: A qualitative inquiry into opportunities and barriers for injection drug users. Harm Reduction Journal, 3(30), 1- 6.