Harm reduction in British Columbia

Conceptually, harm reduction is an approach that reduces the harmful effects of behavior. It involves a range of nonjudgmental approaches and strategies aimed at providing and enhancing the knowledge, skills, resources, and supports for individuals, their families, and communities to make informed decisions to be safer and healthier.[1]

Harm reduction for illegal and legal psychoactive substances is an integral component of the overall substance misuse prevention, treatment, and care continuum. The range of services available to prevent harms from substance use in British Columbia include creating awareness of the risk of driving under the influence of alcohol, peer support programs, outreach and education to encourage safer behavior, substitution therapies such as metha­done, needle distribution programs, and a supervised injection facility. A summary of the results of scientific evaluation of Insite may be found at http://uhri.cfenet.ubc.ca/images/Documents/insight_into_insite.pdf. Participation in a full range of harm reduction programs has been associated with a decreased risk of HIV and hepatitis C virus (HCV) infection.[2]

Those providing harm reduction supplies and services must respect human rights and the dignity of their clients by adhering to basic ethical principles. The populations who are served by harm reduction activities are diverse but often include vulnerable individuals who face considerable drug-related stigma. In many communities across the province, harm reduction services also become an integral access point for marginalized populations to access the health system to engage in care.

Overarching provincial policies on harm reduction best practices and supply distribution are guided by the BC Harm Reduction Strategies and Services (HRSS) committee. It is composed of representatives from the five BC regional health authorities, BC Centre for Disease Control, BC Ministry of Healthy Living and Sport, and First Nations and Inuit Health. HRSS policy states that each health authority and its community partners must work together to provide a full range of harm reduction services within their respective jurisdictions, including access to supplies and referrals to health care, mental health, addictions, and other relevant community services. It also states that harm reduction supplies should be available to whoever needs them, regardless of the person’s age, drug-using status, drug of choice, or residence. HRSS policy also requires health authorities, agencies, and community partners to formulate a community plan for safe harm reduction supply disposal. The plan may address community education, the provision of sharps containers in supervised settings, and the pickup of discarded supplies from streets, parks, and alleys.

Current items funded by the BC Ministry of Health and subsidized by Provincial Health Services Authority include needles and syringes, sterile water, alcohol swabs, male and female condoms, and lubricants. In the fiscal year 2007/08, 5.3 million needles and syringes were distributed in BC.

Since the 1990s, crack cocaine has become more prevalent in BC. People who smoke crack may develop oral lesions and burns from hot or broken crack pipes, and HCV has been detected on crack paraphernalia. People who share crack pipes may therefore be at increased risk of exposure to HCV and other communicable disease.[3,4] Push sticks are used to pack and position the filter or screen (often Brillo) inside the crack pipe. Once the crack has been smoked the push stick is used to recover the crack that has hardened on the inside pipe wall. It was reported that people were using the plunger of syringes as push sticks, discarding the needle and rest of the syringe. Therefore plastic mouth pieces and wooden push sticks were made available through the BC harm reduction supplies in 2008. A 2008 analysis of supply distribution and qualitative interviews with supply distributors identified a lack of standardized policy and practice.[5,6] To address these issues the HRSS committee has created a BC best practice document available at www.bccdc.org/download.php?item=3791 and a training workshop was held for 80 front-line distribution staff and peers in January 2009.

Community harm reduction services provide referrals, advocacy, education, and supplies distribution. These programs do not encourage people to use drugs, but make it as easy as possible for them to get help. They increase the engagement of vulnerable and marginalized populations into the health and social service system to reduce transmission of HIV, HCV, and other communicable diseases such as sexually transmitted infections, and support other concurrent mental health conditions and ad­dictions such as alcohol dependency.

References

1. BC Centre for Disease Control. Harm Reduction Strategies and Services Policy and Guidelines.www.bccdc.org/download.php?item=3829 (acces­sed 31 March 2009).
2. Van Den BC, Smit C, Van Brussel G, et al. Full participation in harm reduction programmes is associated with decreased risk for human immuno­deficiency virus and hepatitis C virus: Evidence from the Amsterdam Cohort Studies among drug users. Addiction 2007;102:1454-1462.
3. Fischer B, Powis J, Firestone CM, et al. Hepatitis C virus transmission among oral crack users: Viral detection on crack paraphernalia. Eur J Gastroenterol Hepatol 2008;20:29-32.
4. Tortu S, McMahon JM, Pouget ER, et al. Sharing of noninjection drug-use implements as a risk factor for hepatitis C. Substance Use & Misuse 2004;39:211-224.
5. Harvard SS, Hill WD, Buxton JA. British Columbia Harm Reduction Product Distribution. Can J Public Health 2008;99:446-450.
6. Buxton JA, Preston EC, Harvard S, et al. BC Harm Reduction Strategies and Services Committee. More than just needles: An evidence-informed ap­proach to enhancing harm reduction supply distribution in British Columbia. Harm Reduction Journal 2008;5:37. www.harmreductionjournal.com/content/5/1/37 (ac­cessed 2 April 2009).

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Dr Buxton and Mr Panessa are co-chairs of the BC Harm Reduction Strategies and Services Committee. Dr Buxton is physician epidemiologist and harm reduction lead, BC Centre for Disease Control. Mr Panessa is manager of Harm Reduction and Blood Borne Pathogens at the BC Ministry of Healthy Living and Sport.