Harm reduction within mainstream services: What are the challenges and opportunities to reducing the harms for people who use illicit drugs?

Currently across Atlantic Canada, a number of harm reduction options exist for people who use drugs (defined as the use of any drug in ways other than as medically directed, including different forms of consumption). Many of these services (e.g., needle exchanges) are provided by community-based organizations. A key component of harm reduction involves referring people who use drugs to mainstream health and social services such as emergency shelters and emergency departments. These mainstream services are central to meeting the complex physical, social and mental health needs of drug users, just as they are to all Canadians. However, in some cases these mainstream services cannot meet the needs of people who use drugs because of existing policies (e.g., no syringes allowed in shelters). People who use drugs have also reported sometimes feeling stigmatized by professionals/service workers, and such feelings may stop them from seeking critical help and care. Our proposed community-based research project, developed with community organizations, policy makers, physicians, researchers, and people who use drugs, has three key objectives:1)To understand the types of harm reduction policies and practices (formal and informal ) that currently exist (if at all) within emergency shelters and emergency departments in urban and rural areas across Atlantic Canada; 2) To explore with staff/managers working in these mainstream services the types of harm reduction policies and services that they think would be implemented in these settings (if any), as well as the challenges to providing different services; and 3) To discuss with key stakeholders the challenges, opportunities and strategies for implementing /augmenting harm reduction policies and practices in emergency shelters and emergency departments in both urban and rural areas through a series of pan-Atlantic Canada workshops. Findings from Objectives #1 and #2 will also be presented at the workshops.