HARM REDUCTION Flashcards
1
Q
Define
Harm Reduction
A
- an approach or strategy aimed at reducing the risks and harmful effects associated with substance use and addictive behaviours for the individual, community, and society as a whole
2
Q
Discuss:
Harm reduction in the context of substance use
A
- a pragmatic, realistic, humane and successful approach to addressing substance use
- recognizes that abstinance may be neither a realistic or desirable goal for some users
- use of substances is accepted as a fact and the main focus is placed on reducing harm while substance use continues
3
Q
Discuss
Stigma
In Context of Drug Users
A
- fear and misunderstanding often lead to prejudice against people who use
- people who experience stigma are less likely to seek treatment, harm reduction, and health care services
- public and social stigma perpetuates self stigma
4
Q
Common Drivers of Stigma
Three ‘beliefs’
A
- belief that substance use is a reflection of poor willpower or moral failure
- belief that people who use substances are dangerous and reckless
- belief that substance use is not a real illness and people ‘could choose to stop’
5
Q
Examples of Stigma
A
- negative media portrayals
- social avoidance and exclusion
- discrimination in health care, housing, criminal justice systems
- failure to accomodate employees who use
6
Q
Outcomes and Impacts of Stigma
A
- delayed or decreased use of health and social services
- poorer quality of services received
- concealment of substance use
- loss of work and limited access to leadership opportunities
- increased risk of homelessness
- health-harming coping strategies and behaviours
- increased risk of poorer physical health, quality of life, and psychological outcomes
- poorer outcomes for substance use treatment
7
Q
Eight Principles of Harm Reduction
A
- accepts for better or worse that drug use is part of our world and chooses to work to minimize its harmful effects
- establishes quality of individual and community life and wellbeing as the criteria for successful interventions and policies
- ensures people who use drugs have a real voice in creation of programs and policies designed to serve them
- recognizes that realities of poverty, classism, racism, social isolation, past-trauma, sex-based discrimination, and other social inequities affect peoples vulnerability to and capacity for dealing with drug-related harms
- understands drug use is a complex phenomenon that encompasses a continuum of behaviours that range from severe use to total abstinance - acknowledges that some ways of using are safer than others
- calls for non-judgemental, non-coercive provision of services and resources to people who use drugs and the communities in which they live in order to assist them in reducing attendant harm
- affirms people who use drugs as the primary agents of reducing harms and seeks to empower people who use drugs to share info and support each other
- does not attempt to minimize or ignore the real harm and danger that can be associated with drug use
8
Q
Explain:
why does harm reduction work
A
- value people and their expertise so that they feel empowered to determine and voice their own hierarchy of needs, and the next steps are clear between provider and participants
- rooted in evidence-based practices that have shown decreases in health and social harms
- keep individuals engaged in care at any stage in their drug use
9
Q
Examples of harm reduction in health care
A
- prioritizing access to peer supports for people presenting with substance-use related concerns
- prescribing adequate, realistic doses of preferred medications for people who are staying in hospital, without judgement
- providing access to safe consumption rooms on site
- distributing harm reduction supplies within a hospital
- non-punitive approach to drug use on hospital grounds
- using respectful non-stigmatizing language with patients and in their charts
10
Q
Discuss:
the experience of seeking treatment for acute pain as a person recovering from opiod use disorder
A
- Methadone can provide more stable life but people are still plagued with stigma, especially when needing treatment for acute pain - ex. treating a broken arm
- prescribing opioid pain medication is standard, but when addicts bring up methadone, providers stigmatize patients and send them home feeling rejected
- methadone users with acute injury get bounced around healthcare system trying to find pain relief that no prescriber will give due to labelling them as ‘drug seekers’
- turn back to illicit drugs to stop pain - become ashamed and fearful for losing progress; may cause relapse
11
Q
Discuss
the experience of seeking treatment for acute pain as a person recovering from opiod use disorder from a HR lens
A
Providers ask questions rather than involving stereotypes and judgements
* ask: how long have you been taking methadone? –provider concludes that pain needs to be treated aggressively
* ask: when did you last use opioids? – determine that patient may need to take higher dose of methadone while in acute pain
* ask: how do you feel about treating your pain with another opioid? – understand that increased methadone likely wont suffice; leave choice to patient
* ask: how is this plan working for you? - understand untreated pain can cause people to turn to old coping mechanisms
12
Q
Discuss
What is / what drives addiction?
and what helps people overcome?
A
- addictions begin with pain and end with pain - begins with attempts to cope
- pain that causes people to use typically relates back to trauma; person attempts to get away from distress
- people can only be with their own pain if they experience compassion for someone else
- addicted people need a compassionate presence which will permit them to experience their pain without having to run away from it
- difficult in society focused on instant relief and quick satisfaction
12
Q
Drivers of the Opioid Crisis in North America
A
- Highly potent synthetic opioid fentanyl and it’s analogues in illegal drug supplies
- Overprescribing of opioids also significantly increased first wave of opioid related overdoses in the late 90s-early 2000s
- Ongoing criminalization of drugs leads to fear of police and arrest that encourages people to consume drugs in less safe ways (rushed) and spaces (alone), and discourages from calling 911 for overdoses
- Poverty, homelessness, and other SDH, and political resistance to harm reduction programs
13
Q
List:
strategies to combat the opioid overdose crisis
A
- population level naloxone distribution
- expansion of I-OAT
- emergence of OPS
- piloting drug-checking services
14
Q
Discuss
Population-level scale-up of naloxone distribution
A
- access has life saving potential in general and during overdose crisis
- previously, cost and designation as a prescription medication had prevented widespread distribution
- as of 2016, every province and territory established widespread and free distribution programs of naloxone at community health centres, pharmacies, and healthcare institutions
- factors needed to improve access include:
1. large scale programs with sufficient funding
2. a supportive political climate
3. sufficient human resources - early evaluation showed variable availability across canada, with only an estimated 1/4 of pharmacies having kits available
- suggests more scale-up needs to be done
15
Q
Discuss
Expansion of I-OAT
A
- IOAT = opioid agonist treatment
- involves prescription of pharmaceutical grade opioids to people with treatment-refractory opioid use disorder
- RCTs have shown I-OAT to be safe and effective for people who inject drugs and for whom other forms of treatment were not effective
- outcomes: reduction in opioid use, cocaine use, and criminal activity; and overall improvements in well-being
- access has been improving in Canada following change to fed. government and efforts by the provincial BC government
- still resistance on the federal level and provincial levels across the country outside of BC
16
Q
Discuss
The emergence of OPS
A
- lower budget and quicker implemented than safe consumption sites
- Service users at OPS can inject drugs, and at some locations smoke or snort drugs, under the supervision of trained volunteers and/or staff, usually including at least one health professional (e.g., nurse or nurse practitioner, physician) per shift
- used in increasing numbers by target population and with no reported fatal overdoses on site
- late 2017 - federal law granted policy allowing provinces experiencing opioid-related public health emergencies to apply for an exemption for temporary OPS
- political barriers faced in ON where PC government increased political pushback and stalls in continued operation of existing OPS sites
- PC gov rebranded programs as Consumption and Treatment Services and has imposed restrictions on where CTS can be located, how often approvals need to be renewed, and additional application requirements
17
Q
Discuss:
Piloting Drug-Checking Services
A
- Offer opportunities for clients to anonymously analyze content of drugs they intend to use and receive additional information about drug-related risks and safe use strategies
- To date, there are operational and forthcoming drug checking service locations in British Columbia and Ontario, mostly situated at programs providing SCS or OPS, and at select music festival and party settings
- Preliminary evidence from nightlife settings has shown that drug checking may influence and lead to modifications in drug consumption risk behaviours
- Barriers: high costs of purchasing the more sophisticated technologies and the legal exemptions required to carry out drug checking research
18
Q
Pandemic and Opioid Tends:
Overdose Mortality Overview
RNAO
A
- Physical distancing measures introduced during the COVID-19 pandemic have resulted in reduced service levels for pharmacies, outpatient clinics, and harm reduction sites that provide care to people who use drugs.
- These measures increased risks of drug-related overdose and death
- ⅓ of opioid related deaths were among people employed during the pandemic in the construction industry → similar to pre-pandemic trends
- Most deaths occurred among people aged 25-44 → increased from pre-pandemic trends
- Most deaths occurred among men → increased from pre-pandemic trends
- Most deaths occurred when no one was present to intervene → similar to pre-pandemic trends
19
Q
Pandemic and Opioid Trends
Drugs most involved in overdose
A
Illicit drugs:
* fentanyl - involvement of other opioids (methadone, hydromorphone, oxycodone, morphine) did not increase during this time
* benzodiazepines -> increased use from pre-pandemic levels & three fold increase in use of etizolam (not approved for use in CA)
* stimulants -> increased use from pre-pandemic trends; primarily driven by cocaine and methamphetamines
20
Q
Pandemic Opioid Trends
Prescription opioid most overdosed on:
A
Methadone
21
Q
Pandemic Opioid Trends:
Communities and Populations Most Affected
A
- Homeless populations - OD increased >100% during pandemic
- Rates of opioid-related death rose significantly in half of Ontario’s public health units during the pandemic.
- The highest rates of opioid-related death during the pandemic occurred in Sudbury and Districts, Porcupine, and Algoma public health units.
22
Q
London InterCommunity Health Centre: Safer Opioid Supply Program
Health and Social Impacts
A
- reductions in overdose risk and improvements in health and social wellbeing
- reductions in fentanyl and other street acquired drug use
- many reported reduction in intravenous drug use
- reduction in overdose and overdose risk
- increased access to health and social services
- reduction in ED visits and hospitalizations
- increased feelings of safety
- reductions in contact with the police
- improved relationships with family members and friends
- reduction in criminal activities
23
Q
London InterCommunity Health Centre: Safer Opioid Supply Program
Reasons for wanting to join
A
- avoid overdose
- improve health and stability
- improve safety and reduce involvement in sex work and street hustles
24
Q
London InterCommunity Health Centre: Safer Opioid Supply Program
Challenges Faced by Clients
A
- high demand for SOS program
- lack of info about program administration and eligibility criteria
- lack of pharmaceutical medication options available -ex. heroin
- negative experiences in healthcare system
- challenges stemming from inability of one SOS program to meet community needs - issues related to pharmacy pickups, gender-based coersion and violence, and sharing/selling of medications
25
Q
London InterCommunity Health Centre: Safer Opioid Supply Program
Program Level Recommendations
A
- increase number of prescribers
- provide clear information about waitlist and triage criteria
- continue to expand wraparound services
- offer supervised consumption services
- emphasize harm reduction strategies through education campaigns
- provide accompaniment for pharmacy pickup
- advocate for program expansion and increased pharmaceutical options
26
Q
London InterCommunity Health Centre: Safer Opioid Supply Program
Systems Level Recommendations
A
- expand coverage for high-dose injectable opioid formulations on the Ontario formulary
- expand access to diacetylmorphine (heroin)
- address stigma and discrimination within the healthcare system
- provide continuity of care and improve pain and withdrawal management for hospitalized SOS clients
