Harm reduction should be at the core of opioid crisis response

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Kate Colizza is a general internal medicine and addiction medicine physician in Alberta. Cheryl Mack is an anesthesiologist, pediatric palliative care physician and clinical ethicist in Alberta. Esther Tailfeathers is an Indigenous community physician in Alberta. Angie Staines is a nurse and founder of the 4B Harm Reduction Society and a member of Moms Stop the Harm. Corey Ranger is a nurse and president of the Harm Reduction Nurses Association. Kinnon Ross is a nurse and member of the 4B Harm Reduction Society. And Brandon Shaw is a member of the 4B Harm Reduction Society.

The term “harm reduction” invokes images of syringe exchanges, supervised consumption sites and naloxone kits. Some might think of life jackets, seatbelts or helmets.

But harm reduction is more than a catalogue of interventions – it is a foundational philosophy of care. At its core, harm reduction is grounded in radical acceptance and the promotion of autonomy, respect and human rights. It “meets people where they’re at” and focuses on supporting them without coercion, judgment or discrimination.

Harm reduction interventions for drug use aim to minimize the risks associated with the drug itself and lessen the trauma and stigmatization caused by drug policies and laws. These interventions are available to people who use drugs whether they want to stop using or not. Harm reduction goes beyond saving lives – it gives life meaning and helps shed stigma to rebuild identity. For many people who use drugs and their families, harm reduction is an expression of love.

Yet harm reduction interventions are increasingly positioned in opposition to sobriety or abstinence. For example, safer supply programs that provide people at high risk of drug poisoning with safe, pharmaceutical opioids have become a popular talking point and political hot potato, despite showing promise in early research. Even well-established interventions, like supervised consumption services, continue to be debated, despite robust scientific and legal support spanning decades. Safe supply, decriminalization and supervised consumption are not addiction treatment modalities – that was never their purpose. They are harm reduction interventions aimed at the poisoned drug supply. Positioning them in opposition to treatment concepts is misleading and creates confusion.

Residential treatment programs (or rehab) are often presented as the “solution” to drug overdose and poisoning deaths, while harm reduction is blamed for “enabling” drug use. Some go as far as to suggest people should be forced into these programs. This is another misleading comparison, as residential treatment programs aim to treat people with addiction, but many people who die of drug poisoning do not meet the criteria for a substance use disorder, necessary to qualify for admission. Many who have died used sporadically or were unintentionally exposed to potent opioids contaminating other drugs; this is one way harm reduction interventions, such as drug checking or supervised consumption, save lives.

Residential treatment has become the cornerstone of the Alberta model. Unfortunately, the expansion of rehab programs has come at the cost of harm reduction services. Most people are surprised to learn that many of these residential treatment programs lack evidence in their programming and do not have medical staff on site. There are also many barriers for people trying to access these programs. In many provinces, these programs lack standardized regulations or reporting requirements. Furthermore, many people do not need residential treatment to reach their goals. A recent study found that the majority of people who achieved abstinence from drugs actually did so without treatment. Not all programs are created equal, and while some can be transformative for certain clients, for others, residential treatment programs fall short.

For many people, the breakthrough they credit for their “recovery” did not come from a particular program or a set of steps; it came when they decided to make a change for themselves. They were given real choices and felt empowered. To heal and make changes, people need to feel cared for and valued. They need to know that they matter and that they will be supported in these challenging processes. This is where the harm reduction philosophy becomes a critical tool, not only for keeping people alive through evidence-based interventions but for caring for people who use drugs with respect, dignity and love. It provides some people who use drugs with hope and a sense of empowerment – an essential foundation to consider future possibilities.

When people who have been struggling with drug use, homelessness, and mental health concerns finally feel safe and cared for, they can explore hobbies and interests, develop meaningful relationships and feel like themselves again. They can make changes in their drug use and engage with their communities if they want to. Harm reduction can help people reconnect with their identity and sense of self-worth. For many, harm reduction not only saves lives, it also makes life worth living. It promotes a sense of security, importance and value that is required for success in any type of treatment program – and in life in general.

Harm reduction is not the opposite of “recovery”; it is, in fact, an essential part of helping people achieve their goals in recovery, however they define that term. Some people may never want to stop using drugs. Harm reduction tells us that all people deserve respect and love, regardless of drug use. The harm reduction philosophy belongs in programming for addiction care and should be at the core of all drug policy if we wish to address addiction and drug poisonings. The current approach, with a strong focus on the residential treatment industry, lacks safe and effective services and leaves a lot of deserving people behind. Holding residential treatment above other approaches sends the message that, in order to matter and have your needs addressed, you have to fit into a treatment model built by others.

In the context of the current drug poisoning emergency, harm reduction means addressing the unregulated drug supply that is claiming lives at a devastating and unprecedented rate. Harm reduction is not a crutch or abandonment – it is a lifeline that recognizes value and worth in all of us.

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