torontoharmreduction-blog

[torontoharmreduction-blog]

Introduction

Introduction:

My name is Katerina, and I find it extremely important that I help contribute to raise awareness surrounding the idea of Harm reduction, and the good that it brings to our city, Toronto. “I personally believe that it is one of the most strategic and thought out approach to reach out to people who have crossed a path where they need therapy for their addictions. My blog will touch upon the pros and progresses of harm reduction throughout many different lenses. To begin with, harm reduction will be portrayed how it has become extremely beneficial towards our youth. This will be shown throughout the newly founded organization called the Shout Clinic. Secondly,  I will be touching upon the SIFS (Supervised Injection Facilities) we are now seeing pop-up around Toronto, and share what we can do to help further implement their development. Thirdly, there will be a blog on the effects of pipe sharing, and how there are many tactical strategic ways to bring awareness to them through the use of safe needle kits. Fourthly, speaking about the Shambhala Music Festival, and discussing the harm reduction and look at the success and how beneficial the harm reduction facility pop-ups were. Fifthly, I will discuss the importance of the public eye, and how NIMBY viewers can have a huge impact when implementing further HR programs throughout their communities. Sixthly, I will discuss sex workers and show the comparison before and after female sex workers turned out to be once they had access to harm reduction facilities. And lastly, I will touch upon the slow growing involvement the government is beginning to have when discussing the legal rights and legalization harm reduction. Overall, the main purpose of this blog is to raise awareness surrounding harm reduction, and highlight the benefits and pros we have received right here in Toronto from these such facilities. Raising awareness and reaching out to the public eye, helping them better understand the true reasoning as to why harm reduction, and when it comes to drug consumption, is for the better of our city and our people.

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The Legal System

“Harm reduction approaches to drug use have been lauded for having lives, being cost-effective, elevating pragmatism over prohibitionist ideology, being flexible in tailoring responses to the problem, and for their counter-hegemonic potential to empower people who use drugs” (Klein, 2015). An article that I had come across examines Canada’s legal system and their engagement with harm reduction. Furthering into the topic, the article discusses recent cases that incorporate harm reduction’s focus on empirical evidence in policy making into Canadian constitutional rights jurisprudence (Klein, 2015). “Although it has at times formed an important part of federal and provincial criminal and health policy in Canada, the law’s relationship with harm reduction has been ambivalent while harm reduction increasingly finds support in international human” (Klein, 2015). It was said that domestic courts have only engaged very little with harm reduction relatively. 
 Do I think this could this possible be a turning point? Apparently, recent judges, policymakers, and scholars have begun to explicitly and implicitly reflect and support aspects of harm reduction in legal approaches (Klein, 2015). Slowly but surely, I am finding more and more evidence how the government is becoming more and more lenient and approachable when discussing possible harm reduction facilities for drug consumption. “The practice and philosophy of harm reduction, however, find their roots in both public health policy and grassroots community activism”  (Klein, 2015).  Again, bringing it back to my original purpose of my blog, harm reduction in my personal opinion is the answer we have been looking for when it comes to finding answers about our users, and we need to attract the public eye to help spread awareness.

Klein, Alana. “Criminal Law and the Counter-Hegemonic Potential of Harm Reduction.” Dalhousie Law Journal, vol. 38, no. 2, 2015, pp. 447–471.

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How to drugs: Use in moderation. When in doubt, go without.

(via lsd-something-something)

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Sex workers

When it comes to sex workers, there is much room for harm reduction to do its good deed. “There are many times of sex work ranging from the well paid escorts to street based sex workers” (Neal, 2014). The sad truth about the work is that there are many concerning and dangerous illnesses that are transmitted through it. “When investigating sex workers and drug users’ access to health services, researchers have found that stigma is one of the key barriers experienced by this extremely vulnerable population” (Neal, 2014). A study was done to conduct and assess impact of harm reduction programs on HIV and Syphilis infection and related risk behaviours among female sex workers (Zhang, 2014). What was done? Two cross sectional surveys were conducted amongst a group of female sex workers, before and after they had access to harm reduction facilities.  Harm reduction is shown to be a very effective and proven to work when taking a look at the results of this study.

“Although odds of unprotected sex with primary sex partners did not significantly change over time, odds of unprotected sex with clients declined significantly and remarkably” (Zhang, 2014). The group had come to a conclusion where harm reduction strategies may be an effective means of reducing unprotected sex with clients among FSWs. Although this study hadn't shown all the results pointing towards great success from harm reduction, it did in some cases, which only proves that we are on the right path providing people with supervised consumption.

Neal, Norma, et al. “Street based sex workers needs assessment .” Home — Street Health, Feb. 2014, www.streethealth.ca/.

Zhang, Li . “HIV, Syphilis, and Behavioral Risk Factors among Female Sex Workers before and after Implementation of Harm Reduction Programs in a High Drug-Using Area.” PLOS ONE: accelerating the publication of peer-Reviewed science, 8 Jan. 2014, journals.plos.org/plosone/.

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NIMBY- What does the public think?:

The only way we are going to be able to raise awareness towards harm reduction when it comes to the use of drugs in our city of Toronto, is if we catch and persuade the public eye. I had found a very interesting journal article in which looked further into community perceptions of supervised consumption facilities, in other words, for illicit drug use. When it comes to planning facilities like such, local communities tend to express their strong reactions towards the ordeal. “‘Not in my backyard’ (NIMBY) type reactions are frequently encountered and public opinion polling is limited in its ability to provide detailed insights into the reasons why people support or oppose these facilities in Toronto and Ottawa” (Gillian, 2017). This team of analysts had explored perceptions of the residents and local business owners to the idea of supervised consumption facilities, and examined their perceptions of the cons this would bring to their community.

After a numerous amount of data collection and interviews with a variety of people who formed the communities, they were able to see the public’s point of view a lot more clear. “These participants saw these facilities as potentially risk-reducing, but recognized that the facilities could also create risks for their communities” (Gillian, 2017). High levels of concern were expressed regarding from the idea of a possible risk of public nuisance associated with supervised consumption. What we can take from this study is that the public truly does recognize the fact that harm reduction facilities for drug involvement do show a great potential in success, but there needs to be some sort of security and dependency for the public to feel comfortable to help pursue them.

Gillian, Kolla, and Carol Strike. “Risk creating and risk reducing: Community perceptions of supervised consumption facilities for illicit drug use.” Health, Risk & Society , 19 Feb. 2017, pp. 91–111.

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Shambhala Music Festival:

I chose this photo to represent the large-scale electronic dance music events (EDMEs) that have developed a high risk profile for the attendees and promotors. Taking an even closer look, this photo is an actual picture taken from the Shambhala Music Festival which is ‘a multi-day event in a rural setting with recognized history of providing harm reduction services alongside medical care” (Munn, 2016). The objective of the study conducted by Matthew Munn along with multiple colleagues was to describe the medical response at the event, where there were on-site HR interventions and dedicated medical care delivered to the public. “There were 1,393 patient encounters and the patient presentation rate was 20,8 per one thousand” (Munn, 2016). None of these patients required intubation and there had fortunately been no fatalities.

The Harm reduction services provided throughout the festival had included multiple outreach teams, educational materials being handed out, a pill checking facility, a dedicated women’s space, and a ‘Sanctuary’ area that provided non-medical peer support. More than 10,000 encounters were recorded by mobile and booth-based preventive and educational services, and 2,786 pills were checked on-site with a seven percent discard rate (Munn, 2016). To conclude, this team had been able to portray not one but two complementary public health strategies to minimize risk at an EDME festival. “Incorporation of HR practices when planning on-site medical care has the potential to inform patient management, reduce presentation rates and acuity, and decrease utilization and cost for local, community based health services.” (Munn, 2016)

Munn, Matthew Brendan. “Observed Benefits to On-Site Medical Services during an Annual 5-Day Electronic Dance Music Event with Harm Reduction Services.” Prehospital and Disaster Medicine , vol. 31, no. 2, Apr. 2016.

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Pipe Sharing:

This entry is going to be discussing the widespread pipe sharing amongst the crystal methamphetamine smokers here in Toronto. The arising question of the hour is, will safer smoking kits have a potential role to play? A quick background about crystal methamphetamine smoking, is that it is also intertwined with many severe health problems including transmission of hepatitis. A journal entry formed by Charlotte Hunter along with a group of colleagues of the Bio-med central, did a study touching upon this very subject. “Five focus groups were conducted with crystal methamphetamine smokers recruited by community health agencies and youth shelters in Toronto, Canada” (Hunter, 2012). The participants were questioned about their motivations when it comes to their crystal methamphetamine usage, which included their process of smoking, their health problems they've experienced, behaviour issues, and what they would like to see within the harm reduction kit supplied to them.

The results in this study were quite intriguing. A majority of the participants shared how they believe pipe sharing when smoking is part of the culture to smoking, it would be hard to change. “Heated pipes were unlikely to cause direct injuries, but participants mentioned having dry, cracked lops, which may be a vector for disease transmission. Many reported having sex with multiple partners and being less likely to use condoms while on the drug” (Hunter, 2012).  Coming to a conclusion, although they had accepted the fact they probably will not be able to stop the sharing of pipes, safer smoking kits could still be a strong impact towards this issue. “Within the context of a broader health promotion and prevention program, pilot testing of safer smoking kits to initiate discussion and education on the risks associated with sharing pipes and unprotected sex for some communities is worth pursuing. This would be an excellent way to raise awareness and spread the word to users who may not know what exactly they are getting themselves into. Anything helps.

Hunter, Charlotte . “Reducing widespread pipe sharing and risky sex among crystal methamphetamine smokers in Toronto.” BMC, Research in progress, 16 Feb. 2012, www.biomedcentral.com/.

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SIFs (Supervised Injection Facilities):

Toronto has a very severe, growing, uphill battle when it comes to injection drug use. A strategic way to incorporate harm reduction into this deadly addiction, was the plan of safe injection houses. “In response to epidemics of HIV infection and overdose in Vancouver in the mid- 1990s, a range of actors advocated for the creation of supervised injection facilities (SIFs), and after several unsanctioned SIFs operated briefly and closed, Canada’s first sanctioned SIF opened in 2003” (Kerr, 2017).  More than a decade later, we are now seeing more and more of these facilities popping up around our city of Toronto. This includes one that has opened up right in the downtown core, just minutes away from Ryerson University. Ever since Canada’s first ever opening SIF, a growing acceptance of SIFS and increasing concern about overdose have since prompted a rapid escalation in efforts to establish SIFs in cities across Canada (Kerr, 2017).  

The recommended best practice policy for needle users, is to facilitate use of a sterile needle and syringe per injection, which will reduce transmission of a human immunodeficiency virus along with pathogens. Many needle and syringe programs (NSPs) distribute sterile needles; that is, needles that are free from microorganisms, including pathogens, and come in commercially sealed packages that have never been opened” (Strike, 2013). The severity and push towards the use of sterile needles needs to be implemented and helped out as soon as possible.  “There is a pressing need to create a more enabling environment for SIFs through amendment of federal legislation” (Kerr, 2017). Being able to reduce the risk o transmission from contaminated needles  is the start to the end of such deadly diseases spreading throughout.

Kerr, Thomas, et al. “Supervised injection facilities in Canada: past, present, and future.” Harm Reduction Journal, vol. 14, no. 1, 2017.

Strike, Hopkins, et al. “Best Practice Recommendations .” CATIE - Canada's source for HIV and hepatitis C information, 2013.

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Shout Clinic 

I found it extremely essential to blog a photo that is representing our youth population who are currently choosing to inflict themselves with drug use. An amazing youth services clinic we have right here in our city of Toronto is called Shout Clinic. Shout Clinic has become a fully functioning clinic targeting towards our marginalized and homeless transitional youth who are between the ages of 16-25 years old. Each and every day they thrive for the success to “promote access to health care for street involved youth” (Shout, 2017). Shout Clinic was able to join services alongside the commonly known West Central Community Health Centres of Toronto, which was very reassuring towards the service as they are fully protected long-term.

“The main purpose of Shout clinic is to increase the accessibility of health care to an under-served and marginalized youth population.”  Everyone deserves a chance and right to have access to direct comprehensive social and health care no matter where you are at in life. Having a reputation serving diversity, client rights and social justice, integrity, respect and non-judgemental, Shout Clinic continues to improve and better people within our younger generation’s lives each and every day.  

“SHOUT Clinic - History of Youth Services.” Queen West Central Toronto Community Health Centre, ctchc.org/.

Barnaby, Lorraine, et al. Drugs, homelessness & health: Homeless youth speak out about harm reduction: The Shout Clinic harm reduction report, 2010. Toronto, Ont: Wellesley Institute, 2010.