I was happy to take part in Indigenizing Harm Reduction, a webinar presented by the UBC Learning Circle. Len Pierre, Andrea Medley, Janine Stevenson and Andrea Derban shared their experiences and thoughts on how best to connect with First Nations communities to introduce and support harm reduction principles. Len is of Coast Salish descent; Andrea (Medley), Haida. Both Len and Andrea work with the First Nations Health Authority (FNHA) on public health and in particular, harm reduction. Janine Stevenson and Andrea Derban bring nursing backgrounds to their work with the FNHA.
Overdose and Harm Reduction
Janine started with an overview of the public health emergency declared in April 2016. She said that while the appearance of fentanyl in BC plays a significant part in this overdose crisis, overdoses from other drugs occur too, and it’s not just fentanyl that puts people at risk. In other words, harm reduction strategies and solutions need to be long term, not temporary.
All health authorities are seeing an increase in overdoses. The establishment of overdose prevention sites is good; not one fatal overdose has occurred at newly established sites or long term sites like supervised injection sites Dr. Peter Centre or Insite. (Supervised injection sites have federal exemptions from Health Canada to operate. Overdose prevention sites do not have formal exemptions, but given the current situation, the BC government supports them.) As of April 2017, there are twenty overdose prevention sites in BC, listed by health authority: Fraser (6), Interior (3), Northern (1), Vancouver Coastal (5), and Vancouver Island (5). Sadly, most overdoses occur in private homes, where people are beyond the reach of prevention sites.
How Society Views Addiction
“We are more than our behaviours.” This is such a simple and true statement. Nevertheless, it’s not often applied to people who use drugs, Andrea Medley pointed out. She talked about drug use through different perspectives. There is no universal definition of addiction in medical terms; language itself doesn’t shape it well. Should it be called substance us? Problematic substance use?
The law enforcement view is that drug use of any kind is criminal, yet drugs (and alcohol) have been legal and illegal in different times and places, and use continues. The social frame for drug use is problematic as well. The idea that drug use and addiction are based on personal choice and fault doesn’t allow for a wider view of society’s role in shaping drug or alcohol use. It doesn’t see drug use as a response to pain and trauma. It doesn’t see addiction as a health issue, and on a larger scale, social justice issue, yet addiction can be these things. For Indigenous individuals and communities that have, and still bear, the impact of colonization and generations of alienation and abuse through the Indian hospital system, residential schools, and systemic racism, trauma is real and ongoing. For some, that can lead to drug use and resulting challenges.
Harm Reduction for the Whole Person
Len said quietly, “We work with humble hearts… We can’t just talk about harm reduction. We need to decolonize. People need to share feelings and thoughts on addiction.” He and Andrea introduced how they work with intersecting approaches that include principles of compassion, harm reduction, and cultural tradition. Harm reduction is acknowledging pain as well as healing, a journey of discovery and not perfection.
Len and Andrea use an Indigenous model of harm reduction based on four approaches and animal symbols. The wolf symbolizes building relationships for healing. The bear is a symbol of strength and protection; intergenerational connection and strength is embedded in culture and tradition. Knowledge and wisdom are offered by the eagle, urging awareness we must meet people exactly where they are in their journey. The raven symbolizes an acceptance of self.
Len and Andrea acknowledged that there is no one set of symbols for all Indigenous people, and adjustments may be needed when working in different regions. Symbols are important; so is language. Referring to people who use drugs as addicts or junkies can be shaming; see the person who uses drugs. Harm reduction isn’t a perfect line from using to abstinence; abstinence is not the goal for many. Safer use may be the goal, and that is just fine.
Aboriginal people are disproportionately represented in populations with HIV and HCV. They are also overrepresented in populations who use drugs. Using harm reduction principles connected to traditional ways and teaching aims to support people in changing their relationships to drug use without shaming them, working from a foundation of strength and connection.
Read More
Indigenizing Harm Reduction: scroll to the bottom of this page for video and presentation slides.
Drug Use and Overdose Response: resources for people providing overdose care.
Toward the Heart: harm reduction information and resources from the provincial harm reduction team.
Questions? Feedback? Get in touch!
Janet Madsen, Capacity Building and Knowledge Translation Coordinator, [email protected]