Harm Reduction

Program

HARM REDUCTION IN TORONTOCHALLENGES & OPPORTUNITIES

HARM REDUCTION PROGRAM

FOR THE SUMMER INSTITUTE ON HEALTH INEQUITIES & URBAN HEALTH June 11, 2008

Describing the true extent of the drug-related harm users regularly face if difficult, is not impossible, if one is not

oneself a user. I would argue, in fact, that because the popular conception of drug

use is so obscured by condemnation that a useful model for harm reduction is

unlikely to come from anyone but a userReal Harm Reduction: Underground Survival Strategies -

Donald Grove

THE ROLE OF ILLICIT DRUG USERS IN HARM REDUCTION

WHAT ARE THE NEEDS OF the people who use illicit drugs?

HIV/Hep C are not the #1 concern of people who use illicit drugs – they’re not even one of their big priorities The main priorities of iDUs are:

1. Availability of drugs2. Quality of drugs3. Money for drugs (Donald Grove, Real Harm Reduction:

Underground Survival Strategies)I would add the 4 big ‘A’s: 1) Avoiding Violence, 2)

Avoiding overdose, 3) Avoiding prison and 4) Avoiding withdrawal (for heroin users) as equally important priorities

Drug user initiated harm reduction

People who use illicit drugs have been informally practicing harm reduction before Harm Reduction was ‘discovered’. Here are some examples of illicit drug user initiated HR:

Exchanging information about drugs and its dealers (How good? Chances of overdose? Count? Fronts? Violent? Sex for drugs or strict cash? Etc…)Using their homes as informal consumption sites or providing a place to stayInfo on how to beat drug tests?Taking care of each others’ children or pets when one is going thru withdrawalTeaching each other how to inject and distributing new needles to each otherPeople on MMT sharing their methadone with friends so that they can deal with their withdrawal illnessHelping each other avoid getting busted (by providing alibis, or providing space to hide)A myriad of strategies are used in prisons, from “lugging” drugs in, making home-made syringes, to coming up with methods to beat piss tests

By need or by design, many Harm Reduction Programs are still geared to reducing HIV & HCV when the users’ experience should form the basis of these programs

THE CHALLENGE!HOW TO OFFER HARM REDUCTION

PROGRAMS RELEVANT TO THE LIVES OF ILLICIT DRUG USERS

AND MEET PUBLIC HEALTH EXPECTATIONS AS WELL AS THE

REQUIREMENTS OF FUNDING AGENCIES?

MEETING THE CHALLENGE…Be Creative! Some examples…When service user asks for a contact to buy dope:

Introduce her/him to another service user that “may” know a non-violent dealer who sells good count

When service user wants to know how to beat urine analysis:Educate her/him about half-life of drugs (handout) and refer her/him to relevant web sites

When service user wants you to shoot her/him upHand her/him a vein map and educate her/him how to inject (if possible, do a demonstration)

Have police on your side: Through Community Advisory Committee, training, and constant negotiations

By responding to the needs of iDUs, a trusting relationship is developed, thru which, HIV/Hepatitis prevention can take place much more effectively. In South Riverdale, the HIV prevalence rate was less than 1% during the 2004 I-Track survey and the HCV prevalence rate was 5% lower than the rest of Toronto

THE WAR ON DRUG USERS

When developing a harm reduction program, workers have to be aware that illicit drug users are living under a state of siegeThe criminalization of certain drugs has made its users criminals by defaultIllicit drug users are vulnerable to infectious diseases, violence, imprisonment, and death.A harm reduction program should be the equivalent of a hospital or a church during wartimes where the more vulnerable warriors are given refugeAn effective Harm Reduction worker has no choice but to work under the gray areas of the law One cannot be an effective harm reduction worker if one is not a harm reduction activist.

summary1. A good HR program cannot ignore the priorities

of people who use drugs. 2. These programs are doomed to fail if they base

their existence on pragmatism alone 3. An effective HR program will integrate equitable

access to public health with human rights 4. Through service user involvement, and the

development of trusting relationship with the community, effective public health education can take place

5. No HR program can work effectively if its staff are not prepared to work within the gray area of the law – without breaking the law of course

COUNTERfit HARM REDUCTION PROGRAM

secrets of successA program where users have an integral part in program design, implementation, and evaluationThe program was staffed by active illicit drug users during its initial 10 years.Active drug users make 1/3rd of the program’s Community Advisory CommitteeAssistants, service users and volunteers inform the program on an ongoing basis

COUNTERfit HARM REDUCTION PROGRAM

secrets of successThe program delivers service through fixed site, mobile delivery, and satellite sitesThe program is accessible 7 days a week, 24 hours a day (even in the days when the program had only one full time worker)Schedules have the convenience of its service users in mind as opposed to the comfort of its staffProgram is always looking for innovative strategies to improve its servicesService users are given as many options as possibleSupportive management

COUNTERfit HARM REDUCTION PROGRAMsecrets of success

The program serves 855 Registered Service Users, 291 Non-RSUs who have given us their names & apx. 350 service users who prefer to be anonymousIn 2007, we had a total of 450 new service usersIn 2007, the program…

Delivered an average of 18,500 new needles/month and collected an average of 15,100 used ones/month for a total of 222,000 new needles distributed and 181,200 used needles collected.Distributed over 15150 stemsMade 8000 referrals – of these

1500 were for shelters, 500 were for housing, 100 were for treatment, 50 were for detox, and the rest were to all kinds of other programs including counselors, doctors, nurses, food services, etc…

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FIXED SITE955 Queen Street East (just east of Carlaw) Open 9:00 to 5:00 Monday to FridayStaffed by COUNTERfit workers,

assistants or volunteersBesides harm reduction materials,

referrals are made to treatment, detox, doctors, counselors, shelters, etc…Coffee and tea is also provided

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MOBILE UNITUnmarked vehicle delivers supply to the homes of users or any other place in our catchment areaOpen for business everyday, including holidaysOn Weekdays between 6:00 p.m. and midnight

On Weekends and holidays between noon and midnight

Staff carries card (similar to our Client Cards)

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Service users or volunteers who are trained with HIV 101 and basic needle exchange

Large number of harm reduction materials delivered to these sites for distribution

Service users who are leery or unable to access COUNTERfit, can access our supplies through the satellite sites

Satellite Sites carry their own signs

SATELLITE SITE

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SATELLITE SITE PLAQUE

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SAFER INJECTION KIT CONTENTS

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Safer Crack Kit Content