Overdose Crisis and Harm Reduction
People from all walks of life use substances. Of all social classes. Consumption has always been part of our communities. From ancient times, the Arabs used opium for fun or for medical1 reasons. At the turn of the century, codeine was available over the counter, often in cough syrups. Cocaine was widely used by psychiatrists, including Sigmund Freud, a well-known psychoanalyst. In some South American cultures, the coca leaf has been traditionally used for millennia, particularly in Peru. Westerners have been drinking alcohol for a long time, out of habit, for pleasure, and sometimes to get through a hard time. Our government has even created a crown corporation that distributes this substance. Recently, this corporation has been offering reward points that can be redeemed by loyal users.
In 2018, the federal government legalized cannabis to protect public health and safety by allowing adults to purchase legal cannabis. This legislative change is expected to open the dialogue on cannabis, reduce stigma, and greatly improve funding for health and social services related to addiction and substance use. Legalization is also intended to make up for nearly fifty years of prohibition, tarnished by outdated and damaging moral and religious principles.
People receive various treatment based on the substance they use. This way, a person who chooses to drink alcohol will be able to do so openly, for their own motives, without being subject to judgment. However, someone who chooses to use a so-called “illegal” substance (regardless of the reasons that led to its illegal classification) will unequivocally face numerous prejudices and taboos. The overdose crisis, which has resulted in over 14,000 deaths in the country since 2016, continues to kill nearly 10 people a day. Yet, the government still refuses to declare a public health emergency. Remember the SARS crisis in 2003. Remember the speed of action of our governments to raise awareness and implement support and prevention resources. SARS had killed 800 people worldwide2. The overdose crisis is “currently the leading cause of death among 30-39-year-olds in the country3.” Life expectancy for males between the ages of 25 and 45 has been stagnating for three years in Canada, a phenomenon unobserved since 1921.
The various political parties are reluctant to take a stand for the protection of people who use substances. Drug criminalization, a recent (1960s), yet well established, phenomenon in our social perceptions, binds the hands of our decision makers to take concrete and effective measures to end the harm created by drug contamination through lack of access to quality addiction services, and through the prosecution and stigmatization of people who use substances.
This article focuses on the harm reduction approach related to addiction and substance use. But harm reduction for what? Health care providers will begin by saying that drug-related harms must be reduced, including the risk of contracting STBBIs (sexually transmitted and blood-borne infections), raising awareness on the risks associated with mixing substances, and informing people about safer ways to use drugs.
Instead, we would like you to reflect on the harms caused by the social context upon people who use substances. Among people who use drugs are alcohol drinkers, who do not suffer the same harms from their use. Negatively perceived, labelled, denied jobs, or forced to use an unpredictable substance in an unsafe environment. Our prejudices impact on the lives of people who use. The impact of the double standard imposed on those who use prescribed opioids vs. those who are denied prescription refills and end up buying from the black market.
The current social context is rigid towards people who choose to use. Criminalizing drug use has failed to meet all the original objectives. Every year, new substances appear on the market, whose exact composition remains unknown. We find ourselves in a context where drugs are contaminated, and where people use substances in unsafe contexts. How is it that a system survives, even though we not only know the consequences, also the possible solutions?
Harm reduction is about working to ensure that people can experience the benefits and reduce the potential harms of substance use, whether legal or illegal. It also means working to reduce the harms of use, both societal and individual. Harm reduction is about giving a voice to those who are affected by drug policies, that is, the people who use. Harm reduction means acting according to humanistic and egalitarian principles, based on scientific facts, rather than moral and religious principles.
1 Wojciechowski, J. (2005). Medical practices and drug use: lineaments of field construction. Psychotropic drugs, theft. 11 (3), 179-207. doi:10.3917/psyt.113.0179.
3 Simon Coutu, RAD, Crise des surdoses au Canada, 23-09-2019..