What are Best Practices for Harm Reduction in Canada?

Harm reduction programs need access to the most up-to-date evidence, resources, and well-trained staff if they are to ensure delivery of high-quality services. However, many programs in communities across Canada are often very busy, have limited resources, and struggle to meet demand. Although service providers might desire to know about the newest scientific evidence, realistically how many have the time to search this out and determine the quality and transferability of the evidence to their programs?

We came together as a group of service providers, service users, and researchers from across Canada to make evidence readily available and applicable to the everyday operation of programs that provide service to people who use drugs and are at risk for HIV, hepatitis C (HCV), hepatitis B (HBV), and other harms. In July 2013, we launched the first installment of a comprehensive harm reduction best practices document with a national scope.

This new resource provides a quick overview of best practices and program policies to reduce harms. For example, we know from studies in Canada and internationally that when people who inject drugs have problems accessing clean needles, they are more likely to reuse needles, including those previously used by someone else, which puts them at risk of HIV, HCV, and numerous other harms, such as abscesses and vein problems. Therefore, we recommend that programs distribute needles in the quantities requested by client without limits. To reduce the availability of used equipment, we recommend that programs provide multiple, convenient locations for disposal.

If a new needle and syringe is recommended for each injection, is the same true for safer crack cocaine smoking equipment? After considering the limited availability of scientific evidence about disease transmission and product safety information, our group recommends that crack cocaine smoking equipment be considered unsafe and in need of replacement when: the pipe and/or mouthpiece has been used by someone else; the pipe is scratched, chipped or cracked; the mouthpiece is burnt; and/or the screen has shrunk and become loose in the stem.

Overdose is the most common cause of death among heroin and other opioid users. Significant improvements in overdose prevention are possible if we offer good education and training programs for clients, including how to respond to an overdose. Training should include recognising signs of overdose, knowing when to call 911, how to respond when witnessing someone else overdose, and how to use naloxone, a drug that can reverse the effects of an opioid overdose. We also recommend assessment of the feasibility and acceptability of naloxone distribution programs. 

Many more recommendations are contained in the document and we invite readers to check it out and tell us what you think. Our team is midway through development of a second installment, set to release in late 2014, of new best practice recommendations. That installment will focus on recommendations related to program models, testing for HIV, HCV, and HBV, vaccinations, skin and vein care, referrals and counselling, relationships with police, and more. So stay tuned!

*Please note that the material presented here does not necessarily imply endorsement or agreement by individuals at the Centre for Addictions Research of BC

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Authors: Dr. Carol Strike (left) and Dr. Tara Marie Watson (right), Dalla Lana School of Public Health, University of Toronto

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