Harm reduction happens in the pockets of exquisite care we show our loved ones, without questioning or judging their life choices, or imagining that we know better than they do. It’s extending a belief system of true autonomy and self-determination.

- Shira Hassan, Saving Our Own Lives

HARM REDUCTION IS

  • Liberatory Harm Reduction: As summarized by Shira Hassan, Liberatory Harm Reduction is a philosophy and set of empowerment-based practices that teach us how to accompany each other as we transform the root causes of harm in our lives. We put our values into action using real-life strategies to reduce the negative health, legal, and social consequences that result from criminalized and stigmatized life experiences such as drug use, sex, the sex trade, sex work, surviving intimate partner violence, self-injury, eating disorders, and any other survival strategies deemed morally or socially unacceptable. Liberatory Harm Reductionists support each other and our communities without judgment, stigma, or coercion, and we do not force others to change. We envision a world without racism, capitalism, patriarchy, misogyny, ableism, transphobia, policing, surveillance, and other systems of violence. Liberatory Harm Reduction is true self-determination and total body autonomy.

  • Radical compassion and non-judgment: Liberatory Harm Reduction approaches offer compassionate, non-coercive, supportive, and non-judgmental care, services, and resources to criminalized people and the communities in which they live in order to assist them in reducing potential harms. By meeting people where they are at and not imposing any requirements or expectations on people regarding their substance use and life circumstances, we hold space for people to engage with one another and build relationships nestled within loving, caring, compassionate, and cooperative communities. This means avoiding making assumptions, and instead, asking respectful, non-judgemental, and person-centered questions that intend to address individual needs and empowerment.

  • Collective liberation: Our collective liberation is interdependent and interconnected to the liberation of all others. Collective liberation considers the power structures that hold oppression in place, and emphasizes the collaborative and cooperative role each person has to dismantle and transform systems of oppression. This means investing in and committing to our own and one another’s transformation. Collective liberation consists of naming and owning the contributions we make to systems of oppression, examining how we benefit and profit from those systems, and acting on ways to dismantle them.

    Interdependence: Interdependence refers to the concept that all things are connected and reliant on one other. Interdependence is about the reciprocal and mutually dependent relationships that exist between multiple people, groups, and communities. This means that we rely on or react with one another in such interconnected ways that one cannot change without impacting the other. Interdependence recognizes the power in caring for each other and our interlaced communities.

  • Community care: Community care is a fundamental form of self-care that is designed to uplift entire communities instead of focusing too narrowly on the individual – to support each other within systems that do not inherently support care. For community care to be possible, four core features must be present: mutual support, public space, shared resources, and local democracy. Community care consists of both small- and large-scale actions that we can take to show our support for another person, for groups, and for communities.

    Mutual aid: Collective and community-based practices and efforts to meet people’s needs, independent of state systems and other hierarchical, oppressive arrangements. Mutual aid is grounded in reciprocity and solidarity rather than charity, and builds shared understandings of the systemic failures that make community care for survival necessary. It is a form of political participation that allows us to build relationships and formations that make the conditions we face more survivable and strengthen our ability to take collective action.

  • Bodily autonomy and self-determination: Exercising bodily autonomy and self-determination are foundational, universal rights for all human beings. This means that each person has inherent human rights to be protected from attack, infringement, violation, or interference, and has the freedom to make informed decisions about their own body, health, reproductive care, and wellbeing. Ongoing settler colonialism, structural and systemic discrimination, and regressive health and social policies disproportionately target, restrict, and persecute criminalized, racialized, and stigmatized communities – robbing them of their bodily autonomy, personal agency, self-ownership, and self-determination. We see the universality of bodily autonomy and self-determination as fundamental to the liberation of all criminalized and oppressed communities.

  • Healing justice: A framework that identifies how we can holistically respond to and intervene on generational trauma and violence and bring collective practices that can impact and transform the consequences of oppression on our bodies, hearts, and minds. This framework builds political and philosophical convergences of healing inside of liberation movements and organizations.

    Abolition: A broad-ranging movement to both eradicate the prison-industrial complex (PIC) and its foundations of racial capitalism, settler colonialism, and cis-heteropatriarchy and to create new systems in its place that focus on meeting people’s needs, preventing and transforming harm, and building true community safety and well-being.

HARM REDUCTION AS A PRACTICE AND MOVEMENT

Harm reduction as praxis and as a movement is rooted in love, compassion, community, mutual aid, support, solidarity, and liberation. Long-emerging from deep within grassroots groups of organizers of people who use drugs, sex workers, frontline workers, and activists, communities have been finding ways to save their own lives and those of their fellow community members for decades. The movement is grounded within the situated knowledge and experiences of criminalized communities, organizing collectively to keep each other safe through transformative and creative community-led innovations. Unsanctioned back-alley overdose prevention sites, “bad date” lists and whispers networks, community “cop-watch” programs tracking and exposing law enforcement misconduct and brutality, sharing drug supplies with beloved ones to avoid pain and withdrawal, unauthorized mobile needle distribution programs, and community-led compassion clubs (or “buyers clubs”) providing tested drugs of known potency to eligible members – these are only some examples demonstrating the ingenuity, resourcefulness, and compassion of harm reductionists.

Harm reduction in the context of traditional institutional public health settings routinely under-serve and exclude those most disproportionately impacted by criminalization – Indigenous and racialized communities, people living with dis/abilities, 2SLGBTQ+ communities, and other marginalized people, groups, and communities. For these communities, criminalization, systemic discrimination, trans/queerphobia, ableism, racism, and colonial policies and practices impose significant barriers and challenges to accessing health and other social supports and to receiving the care they rightfully deserve as human beings.

Harm reduction is an essential component of a constellation of care and support that connects people and communities, and facilitates access and connectivity to social care, primary health services, and other resources. A robust continuum of comprehensive harm reduction services that are accessible, inclusive, culturally-relevant are required to ensure that all people, groups, and communities are included and cared for in our constellation of support.

INSTITUTIONAL PUBLIC HEALTH HARM REDUCTION

Harm reduction in the context of institutional public health refers to a set of policies, practices, and interventions aiming to prevent, reduce, and address risks related to substance use and sexual health. Living expertise and well-established scientific evidence definitively shows that harm reduction is an effective, life-saving and pragmatic approach that has saved millions of lives around the world.

Over the past four decades, the activism, persistence, and victories of grassroots community-led harm reduction groups have resulted in an increased uptake of government funded public health harm reduction interventions. Federal, provincial, territorial, and municipal governments have become one of the core mechanisms responsible for funding, establishing, maintaining, monitoring, and evaluating the provision of harm reduction in public health contexts.

These public health harm reduction programs and services aim to provide access to a continuum of health and social services catered to individual needs, desires, and preferences. Traditionally, public health harm reduction approaches work to engage people living with HIV/AIDS, Hepatitis C, and/or other communicable diseases; people who use and exchange drugs; and, sex workers and people engaging in survival sex.

Some examples of harm reduction include providing access to:

  • education and resources about how to reduce potential harms related to sexual health and substance use;

  • sterile injection and inhalation equipment distribution;

  • protective sexual health products (e.g., condoms, dental dams, lubricants, etc.);

  • prevention, testing, and treatment programs for Sexually Transmitted and Blood-Borne Infections (STBBIs), HIV/AIDS, Hepatitis C, and other communicable diseases;

  • supervised consumption and overdose prevention sites;

  • traditional drug substitution programs (e.g., methadone, buprenorphine/naloxone, etc.);

  • comprehensive substance use health care programs embedded in health centres providing prescribed alternatives to the unregulated toxic drug supply (e.g., hydromorphone, morphine, fentanyl products, stimulants, etc.);

  • drug checking/testing services and drug alert systems;

  • detoxification and abstinence-oriented programs.

Public health harm reduction interventions have significant limitations given that they are embedded in governments driven by normativity, utilitarianism, and corporatism. Rather than addressing the root causes of criminalization – failed drug policies, criminalization of poverty, homelessness, lack of housing, etc. – ultimately, governments have institutionalized harm reduction via public health, ultimately perpetuating the medicalization, professionalization, and corporatization of harm reduction.

Criminalized communities often fall into the margins because institutional public health harm reduction focuses too strongly on associations between interventions and outcomes, and does not invest in providing a vast and comprehensive “constellation of community care”. This institutionalization, professionalization, and corporatization has also resulted in the entrenchment and elite capture of harm reduction within the nonprofit industrial complex – forcing non-profit organizations to be reliant on and at the will of government and corporate funders.