There is considerable progress to be made on improving health care for people who use drugs. Stigma around substance use continues to be widespread and many health professionals are not well equipped to provide care within the context of people’s lives, choices, and circumstances; however, reducing the risks of drug use through harm reduction in a judgment-free environment is an essential health service. Hospitals have a significant opportunity to increase access to harm reduction and improve health outcomes for people who use drugs.
Harm reduction refers to the evidence-based policies, programs and practices that aim to minimize the negative impacts of drug use, and focuses on working with people without judgment or requiring that they stop using drugs in order to receive support. – Adapted from Harm Reduction International
A hospital-based response
While Canada is relatively progressive on implementing harm reduction, access to these essential services remains a critical gap in many communities and is not yet common in hospital settings. Harm reduction often includes health services such as access to safer drug use supplies, safer supply prescribing, and supervised consumption services, but it is much broader than service delivery; meaningful and effective harm reduction requires a philosophy of judgment-free, culturally sensitive and trauma-informed care.
Casey House is a sub-acute specialty hospital with a proud history of practicing harm reduction by delivering holistic health care in a welcoming environment, free from stigma. In partnership with Toronto Public Health, our harm reduction services have included providing 24/7 low-barrier access to safer injection and inhalation supplies since 2014, and access to safer crystal meth supplies since 2018. Distributing safer drug use supplies aims to reduce infectious disease transmission and other harms associated with substance use, alongside naloxone kits to reverse overdoses. Since 2020 this service has become more essential with the convergence of the overdose crisis, housing crisis, and the COVID-19 pandemic.
Pivoting in a pandemic
In the spring of 2020, when the COVID-19 pandemic forced many harm reduction and outpatient hospital services to close, Casey House continued to provide 24/7 barrier-free access to safer drug use supplies at our front door. This enabled our hospital to not only maintain access to this key service, but also identify and respond to evolving community needs:
Increased Demand: In the six months prior to the pandemic, Casey House distributed an average of more than 4,000 harm reduction kits per month. In the first six months of the pandemic, that average more than doubled to over 9,000 kits each month.
Peer Support: With more people accessing safer drug use supplies at the front door, Casey House expanded services to include support from peers with lived experience of drug use. Through meaningful conversations, peers connect with individuals picking up supplies and provide additional support and guidance based on each person’s need.
Around the world, a wealth of harm reduction research and knowledge has been generated over several decades. Building on that foundation, Casey House collects quantitative and qualitative data to gain a stronger understanding of our hospital’s role, the services we provide, and how we can better meet the health needs of our community.
Time and place are key to increasing access to safer drug use supplies
While many community health centres, public health units, and organizations that serve people who use drugs distribute harm reduction kits, Casey House’s location and safe 24-hour access are key reasons people visit our hospital for supplies. Most pick-ups are after 5 p.m. and on weekends, when many local services are not open. Our physical location is especially important: the majority of individuals travel by foot, are not accessing supplies at other locations, and are often picking up kits for more than themselves, extending our reach.
Harm reduction services can improve engagement with health care
Many people accessing safer drug use supplies at Casey House are not connected to health care or other harm reduction services. As well, many ask for information on additional supports, such as shelters, crisis support, clothing, first aid, naloxone, and food. In our experience, training staff and providing safer drug use supplies in a judgment-free environment yields several benefits: it communicates openness, encourages people to speak with health care providers about their drug use, and increases the willingness of both clinicians and the people they care for to discuss drug-related harms. Providing a compassionate space for conversation helps build stronger, more honest relationships which have the potential to deepen engagement and trust with health care overall.
Our experience thus far points to the promise and potential for hospitals to improve health care for people who use drugs by embracing a harm reduction approach – particularly given the increasingly toxic supply of unregulated drugs and the growing risk of overdose. At Casey House, additional research is underway to dig deeper into the impacts of introducing harm reduction initiatives in clinical care settings. As we continue to enhance our role to meet community needs, we are working towards expanding our hospital services so we can continue to improve health care for people who use drugs.
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Miroslav Miskovic, Soo Chan Carusone, Adrian Guta, Bill O’Leary, Karen de Prinse, and Carol Strike. Distribution of harm reduction kits in a specialty HIV hospital. American Journal of Public Health. 2018 October. 108:1363-1365. Abstract available at https://ajph.aphapublications.org/doi/10.2105/AJPH.2018.304600