Harm Reduction 

"The true measure of any society can be found in how it treats its most vulnerable members"  https://www.azquotes.com/quote/877037

 

In this essay I argue that the neoliberal policies that underpin harm reduction efforts as it is being practiced in the city of Peterborough and in Canada at large are highly stigmatizing, medicalized and punitive. Under neoliberalism, social problems, including drug addiction, poverty, and homelessness, are often framed as individual failings rather than systemic issues (Balfour 2006). Harm reduction should extend beyond de-criminalization and focus on acceptance and safety of the drug user by providing environments that are mentally, emotionally, and culturally accessible (Canadian Aboriginal AIDS Network, 2019). Further, as demonstrated on Vancouver’s East Side in British Columbia, services that work with people who are historically and systemically oppressed, marginalized, and stigmatized should employ people of lived experience to ensure that the needs of the people rather than the policies of the state are appropriately met (Boyd, 2019).

 

To frame my argument, I walk the querent through the steps from googling, “safe consumption site Peterborough” through the websites to the agency that runs the Consumption and Treatment Site (CTS) program. This process shows the narrative starting at the Public Health level through to the site of the agency who delivers the program serves to allay public fears rather than serve the needs of the drug users that the program is designed to support.

 

I began my research by googling a bar (a safe consumption site for alcohol) before I searched for the safe consumption site for drugs in Peterborough. When googling a local bar, a list comes up readily with descriptions and menus and other happy offerings. However, when I googled the safe consumption site for Peterborough, there was no happy menu.

 

Instead, I was met with a list of 8 options that all led to the Public Health in Peterborough website with the headings: Harm Reduction, Substance Use and Harm Reduction, Opioids, Consumption and Enforcement, Resources, Support and Treatment.  

https://www.google.com/search?q=Harm+Reduction+-+Peterborough+Public+Health+From+%3Chttps%3A%2F%2Fwww.google.com%2Fsearch%3Fq%3Dsafe%2Bconsumption%2Bsite%2Bpeterborough%26rlz%3D1C1CHBF_enCA1007CA1007%26oq%3Dsafe%2Bconsumption%2Bsite%2Bpeterborough%26aqs%3Dchrome..69i57j0i390i650.9578j0j7%26sourceid%3Dchrome%26ie%3DUTF-8%3E&rlz=1C1CHBF_enCA1007CA1007&oq=Harm+Reduction+-+Peterborough+Public+Health++From+%3Chttps%3A%2F%2Fwww.google.com%2Fsearch%3Fq%3Dsafe%2Bconsumption%2Bsite%2Bpeterborough%26rlz%3D1C1CHBF_enCA1007CA1007%26oq%3Dsafe%2Bconsumption%2Bsite%2Bpeterborough%26aqs%3Dchrome..69i57j0i390i650.9578j0j7%26sourceid%3Dchrome%26ie%3DUTF-8%3E&aqs=chrome..69i57.1843j0j7&sourceid=chrome&ie=UTF-8

 

Each of these 8 links takes the querent to a different page on the Peterborough Public Health site with most information addressing the public with a description of what harm reduction is, what is classified as an opiate, how to give Naloxone and how to lodge a complaint about the Consumption and Treatment Site (CTS). The only reference for a service user who may be seeking this service directly from google is in the Harm Reduction link: https://www.peterboroughpublichealth.ca/your-health/drugs-and-harm-reduction/harm-reduction/ 

 

This link led to a short description of harm reduction, how to access harm reduction supplies and gave information on the safer use of drugs before it gave any information about the location of where one might go to use drugs, “safely.” At the very bottom of the page, it reads:

 

Consumption and Treatment Sites. For more information or to submit a complaint, visit the CTS Enforcement webpage. Peterborough's CTS is located at 220 Simcoe Street. It is open 7 days/week, 9:30 a.m. to 8:00 p.m. Learn more and take a virtual tour of the site here.   https://www.fourcast.ca/programs-and-services/opioid-services/consumption-and-treatment-services-site-cts/

 

After clicking “here” the querent is led to the service provider’s website (FourCast) that gives more details to the public on the CTS. From the description, the CTS is a very medicalized environment where a drug user is brought into a room to inject drugs while being monitored by a nurse and then moved into another area for further observation. After a successful injection a service user then has access to treatment options and other services. The next section features a map of CTS followed by a video that can’t be viewed without signing into another application that makes the video inaccessible to a simple click.

 

What does this tell us about how drug use and harm reduction are viewed in Peterborough? The public health website is clearly biased towards the concerned public and perpetuates the stigma around drug users by not addressing them directly and through punitive verbiage. The use of words like harm reduction in combination with the words enforcement and treatment create “silos” or categories “that artificially separate one aspect of human experience from another” (Indigenous Policy Brief, 2019). In this way drug users are publicly framed as problems that need to be policed and/or treated rather than people who just use drugs.

 

To use the bar analogy, if bars are considered safe consumption sites for alcohol, controlled by specific hours and government regulations, safe consumption sites for drug users should provide a similar environment for socializing and drug use, ensuring the supply is not contaminated with dangerous substances. A simple google search did not bring up a list of public spaces that a person who uses drugs can go, rather, it brought up harm reduction which as currently practiced, focuses narrowly on technological and behavioral interventions that perhaps a drug user doesn’t want or need. By comparison, not every person who drinks needs to go to treatment for alcoholism.

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The Policy Brief on Indigenous Harm Reduction sees harm reduction as a way of life and reminds us that Harm Reduction needs to cater to the needs of all marginalized people, BIPOC, women and LGTBQ2S, who are systemically oppressed by neoliberal and colonial practices. In this way we don’t just decriminalize but also decolonize by tailoring addiction services to the most vulnerable and most harmed in our society (2019). In this way, harm reduction allows a person to decide where they are on the spectrum of addiction and make choices about how or even if they need to make changes.

 

So, what could harm reduction as a way of life look like for someone who uses drugs? I propose that along with decriminalization of all drugs, that these drugs or their big pharma counterparts become available and sold in spaces much like a local bar. In a drug bar, an opiate user could get government approved heroine and a stimulant user could get cocaine. There might be a place to go on the nod and perhaps there is a place to dance. Socialization would be promoted. Perhaps there would be hours or a phone number for those who want to seek treatment. Of course, there would be new needle and pipe kits and a medical person on shift. Naloxone would be readily available to anyone who needs it. I suspect that an environment that is welcoming, destigmatized, and decolonized will vastly reduce overdose deaths. However, a drug bar in Canada has yet to materialize even though it has become incredibly clear that a neoliberal punitive approach to drug use has created an epidemic of overdoses and needless deaths due to poisoned drug supply and lack of equitable services (Boyd 2019).

 

To conclude, the Google path to harm reduction in Peterborough fails to adequately address drug users directly, instead emphasizing complaints and concerns. This punitive approach reinforces the mainstream neoliberal ideology that perpetuates stigma while neglecting the dignity and needs of drug users. To create equitable public sites and spaces, we need to challenge stigma, promote harm reduction as a way of life, and provide comprehensive information that fosters understanding rather than fear.