Handing out clean needles and overdose-countering drugs to substance users are key elements of harm reduction, but CK Public Health officials admit it is very difficult to track the exact impact they are having.
They do believe it is saving lives one day at a time.
“This is a public health challenge,” Dr. Shanker Nesathurai, Chatham-Kent’s medical officer of health, said of tracking harm reduction. “On one level, giving them (substance users) clean supplies keeps them alive for another day. Ultimately, we would prefer people to not use substances, but if they do, I’d want them to be doing so in as safe a manner as possible.”
Nesathurai said cessation would be the ultimate goal, but it might not be achievable.
“Abstinence is a very contentious construct. In a clinical sense, abstinence can be a goal. It’s better to not smoke, better to not drink, better to not engage in sex,” he said. “But how realistic is it as a treatment? From a public health perspective, we’ve decided it’s not the best approach.”
Enter harm reduction, and supporting people by reducing the harm in indulging in certain activities.
For example, harm reduction is applied by CK Public Health for smokers. Treatments include nicotine gum, inhalers and patches.
Nesathurai said someone may not escape the nicotine addiction as a result, but it helps get them away from the act of smoking.
“We all know cigarette smoking can harm you; can cause lung cancer. It’s not just the nicotine and the tar, as there are probably 60 or 70 other compounds that are present,” he said. “We’d sooner have people stop smoking and use nicotine gum than to keep smoking and be exposed to all those other toxic compounds.”
Nesathurai said he recognizes there are people who object to harm reduction programs.
“One (objection) is we give out harm-reduction products and somehow the public health service is endorsing the underlying conduct and that we’re somehow enabling people to use,” he said. “I don’t think giving out condoms really changes if people are going to have illicit or high-risk sex. It’s the same with other tools. People with substance issues have related medical problems. Our effort is to help keep them alive.”
Quinn Talbot, a health educator at CK Public Health, agreed.
“It’s about safer, managed use,” Talbot said. “Public Health offers and supports the co-ordination of programs that lower the harmful risks of substance use.”
Harm reduction is not a fix. Talbot said it is about using policies and practices to make dangerous or risky activities safer.
“Wearing a helmet when biking and wearing a seatbelt. Wearing sunscreen. Using nicotine patches,” are forms of harm reduction, Talbot said. So too is using sterile needles.
Nesathurai said he understands the concern from members of the public that substance use can lead to litter in public places.
“No one wants their children to encounter needles in public spaces,” he said, adding, “People who get needles and pipes from us, they also get disposal boxes. We try to minimize that risk. We have to provide assistance, but recognize it’s not entirely risk free.”
He said harm reduction costs money, but added that “our culture provides services in areas that people engage in all sorts of unhealthy activities.” He used the examples of surgery and treatments for people who develop heart disease for being obese, and for smokers who contract lung cancer.
Members of the board of health commended public health officials on their efforts in harm reduction, but asked if there is any way to better track success.
“I would say we are making an impact. What is the level of impact? I think it’s there, but it would be hard to quantify,” Nesathurai said. “About two people every month are dying from substance-use-related deaths (in Chatham-Kent). I would offer that harm reduction reduces the risk (of death from substance use). They don’t take it to zero, but they reduce the risk.
“I’m proud CK Public Health participates in harm reduction,” he added.
