Ontario Public Health Standards
identify the minimum expectations for public health programs and services to be delivered by Ontario Public Health Units
Harm reduction philosophy
strategies that aim to reduce harms, without requiring people to stop - meeting people where they’re at
well-researched and evidence based
More characteristics of harm reduction
commitment to evidence
respecting rights of people who use drugs
commitment to social justice and collaborating with people who use drugs
avoidance of stigma
Who does harm reduction benefit?
people who use drugs
families
communities
Acts related to drug use that were motivated by colonialism and racism (2)
Indian Act 1884 amendment, regulated sale of alcohol to Indigenous peoples
Opium Act, 1908 was used as a legal tool to discriminate against Chinese immigrants
Other example of how harm reduction can be applied in public health (many)
sunscreen
seat belts
speed limits
birth control
cigarette filters
Clients that access harm reduction services often experience….. (many)
poverty
homelessness or housing insecurity
food insecurity
racism, homophobia, transphobia
domestic/sexual violence
interactions with the criminal justice system
STIGMA
Biggest barrier to harm reduction
stigma!
Examples of harm reduction activities as they relate to substance use (many)
policies in organizations
e.g. hospital, prisons, policing
information on safer drug use
peer education
overdose prevention and response
needle & equipment distribution programs
safe injection sites/safe consumption sites
opioid agonist therapy (methadone & buprenorphine)
drug checking
legal services
legislative and policy change
individuals with this mindset and values**
2 aspects to harm reduction nursing
1) hand-off nursing
2) hands-on nursing
Hands off nursing
non-judgmental attitude
understanding contextual factors
advocating for client well-being and with clients (shelter beds)
holistic case management
health education & training
Hands on nursing
nursing assessment, diagnosis, planning
acute care (ex. overdose response)
wound care & foot care
drug checking
SBBI/STI testing and treatment
mental health and social supports
Bad language to use
addict
junkie
abuse
dirty/clean
Good language to use
people who use drugs
people with lived/ living experience of substance use
Main problem with an unregulated drug supply
don’t know what’s in it!
random drugs with random side effects
T or F: Opioid and drug overdose deaths are decreasing in Canada
TRUE
people who are most likely to die have died
drug trafficking orgs have changed recipes
but closure of consumption and treatment services (CTS) hasn’t been reflected in data yet
T or F: Most people use substances without developing a Substance Use Disorder (DSM-V)
TRUE
Substance Use Disorder (DSM-V) - criteria (many)
hazardous use
interpersonal problems
neglected major roles
withdrawal
tolerance
larger/longer use
repeat attempts to quit/control use
much time spend using
related physical/psychological problems
activities given up to use
craving
T or F: Harm reduction is one tool to address the drug toxicity crisis
TRUE
Drug toxicity crisis - best way to address the crisis is to ______ and address _______, which are almost always _______
work upstream
root causes
polices choices**
Consumption & Treatment Services description
facilities that allow people to LEGALLY CONSUME drugs (typically IV)
using new equipment in a more controlled environment
under the supervision of trained medical and non-medical staff
Evidence-based benefits of CTS (many)
incredible record at preventing overdose deaths*****
less injection drug use morbidity (infections)
reduction in HIV and HCV transmission
less public and risky drug use
increase in access to treatment services
no significant disruptions in public order or safety
Challenges to CTS
long lines
hours of operation
peer-assisted and staff-assisted injections
smoking permissibility
Potential consequences to closing CTS sites
increased ED visits
increased adverse health impacts
increased overdoses and deaths
increased visibility of discarded substance use paraphernalia
disproportionately higher rates of substance-related deaths for Indigenous and Black communities and individuals with lower income
