Harm Reduction + The Opioid Crisis

By Liz Singh

CW: drugs


Harm Reduction is an approach to public health policy that aims to decrease the risks associated with activities including but not limited to: drug use, sex, and sex work. Risk is a fundamental aspect of life that can be mitigated but not entirely avoided. As such, proponents of harm reduction aim to ensure that the public, and individuals, are as well
informed as possible about the risks associated with certain behaviour, so as to empower people to make informed choices. Bodily autonomy and personal choice are at the core of the harm reduction philosophy.

Harm reduction is an alternative to prohibition–which is a philosophy that addresses risk by forbidding the risky activity. An example of a prohibition policy would be the prohibition of alcohol in the early 1900s. Critics of harm reduction argue that these policies encourage risky behaviour, whereas advocates of harm reduction believe that prohibition does nothing to protect life and can, in fact, increase risk by isolating people who choose to engage in stigmatized behaviour.

Condom distribution programs and needle or pipe exchange programs are examples of harm reduction practises that aim to reduce the spread of sexually transmissible and blood-borne infections (STBBIs) by providing new materials in order to avoid reuse. Supervised consumption sites are another example of a harm reduction initiative. There, the goal is to protect life by ensuring a safe environment during consumption, and to have medical support nearby if necessary.

Research and history show that harm reduction policies have great potential to create lasting change. Examples of this include the popularization of condom use during the 80s to slow the spread of AIDS, and naloxone distribution programs in the 2010s to reduce fatal opioid overdoses.


The phrase “the opioid crisis” or “the opioid epidemic” refers to a dramatic increase in rates of opioid use and dependence, as well as a rise in the number of fatal overdoses in North America, that began in the mid 2010s. A Health Canada report found that nearly 4,000 Canadians died from an apparent opioid overdose in 2017. In Montreal, the number of deaths relating to probable opioid overdoses was 140 for a period of a little over a year (June 2017 through June 2018).

Opioids have been popular as pain medication and as a recreational drug for thousands of years. Some recent shifts have led to the current climate:

Prescriptions: In the 1990s, there was a movement in the medical community towards treating pain conditions–a common ailment in North America–with prescription opioids. Fentanyl–a synthetic opioid 100x as powerful as heroin–is currently the most prescribed.

Black Market Popularity: Some distributors, concerned about inferior product, mix fentanyl or fentanyl analogs into other drugs to increase their potency. This has, in many cases, led to fatal overdoses.

Aggravating Factors

Chronic Pain: Chronic pain is debilitating and widespread. Opioids remain the cheapest and most effective way for patients to reach zero pain.

Limited Medical Treatment Options: Many people looking to control their opioid use pursue Opioid Replacement Therapy, which commonly uses methadone. Methadone programs require strict adherence, which can be a challenge, especially for poor, elderly, or physically disabled people. Many people also experience prohibitive side effects.

Poverty: Private treatment centers are expensive and the wait lists for
public ones can be long. People living in rural communities may not be able to afford to travel to the city where care is available.

Trauma: Many people with substance use disorders are survivors of trauma or have PTSD, such as veterans or sexual assault survivors. Their needs are not limited to their physical health, and reliable mental health care is often even harder to access.

Systemic Racism: The impact of colonialism, and of the residential school system in particular, can be felt in the rates of PTSD and mental illness in the Indigenous community. Indigenous people are at higher risk of overdose and of lethal overdose than non-Indigenous Canadians.

Illegal Status: Under prohibition, most drug use happens in secret. It can be hard to hold irresponsible or dangerous distributors accountable. Black market trade in pharmaceuticals and opioids is an international industry and dilution or contamination does not necessarily happen at a local level.

Stigma: Many people take a moral stance on drug use and can be
unsympathetic to people struggling to control their substance use, or to use safely. Ultimately, stigma and isolation put people who use drugs at
unnecessary risk.

Public Health Responses

Health professionals, community workers and law enforcement are working together across the country to implement solutions and save lives. Some of those responses and proposed responses include :

Naloxone Distribution: Naloxone, also known by the brand name NarCan, is an opioid antagonist that can reverse an overdose. Naloxone is short lasting and meant as a stop gap measure to buy time to call an ambulance. You can get Naloxone for free at a pharmacy by showing your health card.

Drug Testing: Simple testing kits that check for the presence of Fentanyl are available online or through community organizations.

Supervised Injection Sites: Using alone increases the risk of fatal overdose. Supervised Injection Sites are a way for community workers to connect with people injecting drugs, while ensuring a safe environment and emergency response if needed. Canada is home to North America’s first supervised injection site, Insite, which is located in Vancouver. Since its opening in the early 2000s, Insite has provided support to thousands of people in the Vancouver community.

Drug Courts: Drug Courts treat substance dependence as a public health issue and work with people using drugs, and with people they may have harmed through their actions, to reach an equitable and supportive
outcome for all involved. Their goal is to channel people away from the prison system and towards supportive care.

Good Samaritan Laws: In Canada, if you call 911 because of a suspected overdose and the police accompany the ambulance, they will not prosecute people on the scene found in possession of illegal drugs. This is to encourage people to call 911 in the case of a suspected opioid overdose.

Decriminalization and/or Legalization: There is increasing evidence to suggest that the best way to protect life during this overdose crisis would be to legalize or decriminalize the use of drugs. Treating substance dependence as a public health issue, as opposed to trying to legislate people into sobriety, may facilitate drug use, exactly as its opponents suggest, but ultimately it will save lives. On July 30, 2018, the federal government rejected calls from public health officials in Toronto, Montreal and Vancouver to decriminalize drugs beyond marijuana.