Understanding Harm Reduction
September is Recovery Month and interviewing Michelle Bilan about Harm Reduction was definitely a highlight of the month for me. Michelle, a member of the Saskatchewan Union of Nurses is an RN, BN, MN, ACRN and has worked in Saskatchewan as a public health nurse and educator in the community for 30 years. She has been a district public health nurse, maternal/infant nurse, nursing instructor, nursing consultant, and communicable disease/sexual health nurse. Michelle holds an American certification in HIV/AIDS care and has worked with people living with or at risk for HIV for over 10 years.
Michelle is very adamant that she sees herself as an “advocate” and not an expert on Harm Reduction. What is very apparent after speaking with her, is that she is an articulate and passionate defender of approaches that meet people exactly where they are at. Helping people to reach a greater understanding of Harm Reduction will help reduce shame, lessen stigma and allow more people to reach out for help. That would be a pretty big win, wouldn’t it?
We need more people to understand Harm Reduction so that the stigma is lessened and more people can get help.
Our interview took place via Facebook Live on September 10th and it was both educational and inspirational. There’s a lot of misunderstanding about what Harm Reduction is – and so I’m grateful to be able to share the information that Michelle shared with me during our interview – here in this blog post. But please – check out the Video as well – Michelle’s knowledge and passion is persuasive. I myself became a proponent for Harm Reduction only after I educated myself about it – so if this blog post can help more people increase their understanding of Harm Reduction then more people are likely to find recovery. Importantly, Harm Reduction aligns with many of our own Intentions & Guiding Principles – in particular the one that stresses that we need to be supported to find and followed individualized pathways and patchworks.
Trying to Define Harm Reduction…Is Hard
It would be easier to educate people if there was one single agreed upon definition of Harm Reduction. However – like the term “recovery” – there is no single agreed upon definition. The best approach to reaching a stronger understanding of Harm Reduction is to view it as more of a philosophy, perspective, world view if you will.
As its name suggests, the goal of Harm Reduction is to minimize harm – to reduce the adverse consequences of an action or behavior (example, opioid use). Those harms can be health, social or economic related and include costs to the individual, their families, their community and to society at large.
According to Michelle, most definitions of HR incorporate the following principles:
- Pragmatism (practical, feasible, cost effective, realistic)
- Evidence based
- Human rights
- Basic human dignity and minimizing stigma
- Self-determination (right to choose goals, speed, acceptability)
Risk-taking is a part of everyday life and most of us are already familiar with various types of Harm Reduction – things we do that are part of everyday life. For example:
- Putting on seatbelts when we drive
- Wearing a helmet when riding a bike
- Using life jackets when boating
- Affixing the “Patch” to quit smoking
- Using condoms during sex
Fortunately, there are also various effective Harm Reduction methods related to substance use – such as methadone/substitution programs, naloxone, safe injection sites, needle exchanges, and legalized marijuana.
The stigma associated with substance use disorders has resulted in gross misunderstandings about these particular Harm Reduction strategies. The myths include ideas that Harm Reduction:
- Enables drug use
- Encourages non-users to engage in drug use
- Increases disorder and threatens public safety
In reality, evidence shows otherwise. Practicing Harm Reduction reduces the risks of substance use including the spread of infections like hepatitis and HIV and accessing Harm Reduction services can also be very beneficial for individuals just in terms of learning what other options there are for them to improve their health.
People who hold anti-Harm-Reduction sentiments are not against Harm Reduction per se. No one would deny a child a bike helmet or car seat. It’s the lack of a clear understanding of Harm Reduction, coupled with judgments against Harm Reduction approached for activities that are less socially acceptable, that works against us advancing Harm Reduction as the evidence-informed modality that it is. People have little acceptance for activities that they usually don’t engage in themselves. Thus, the sentiments against Harm Reduction are often sentiments against activities that are more damaging to certain populations – indeed populations of individuals who are particularly vulnerable due to:
- Social class
- Social isolation
- Past traumas
Meeting the Client Where He or She Is At
An understanding of Harm Reduction includes the deep knowing that clients need to be met – exactly where they are at. Caregivers employ various frameworks and understandings about how change happens and recognize that everyone comes to them at different stages (pre-contemplation, contemplation, preparation, action, maintenance). Increasingly, service providers are being encouraged to adopt more holistic, culturally appropriate frameworks (using the Medicine Wheel with Indigenous clients, for example).
It’s important that relationships between caregivers and clients using Harm Reduction methods are non-judgmental, client-centered and based on trust and respect. Setting practical goals is important – and encouraging baby steps works best. Caregivers need to consider their client’s level of readiness and view the relationship as collaborative. Client and caregiver can have different goals for behavior but they share the same goal to reduce harm.
The Rewards of Harm Reduction
Michelle shared that one of the most rewarding experiences of her nursing career as a Harm Reduction advocate was having a former client that she never would have expected to hear from – reach out to her and ask for help. Overall – the relationships that she has made with her clients – some going on ten years – are the true rewards of her work.
Furthermore, according to Michelle, using the Harm Reduction model and trying to reach mutual goals is less frustrating, more rewarding. Rewarding…and meaningful.
We are grateful to all of the nurses and other front-line workers who work so hard to support all individuals who benefit from their help. For more about how nurses are making a difference addressing the addiction crisis – one of the most significant health and social challenges that we face today visit: makingthedifference.ca