What is harm reduction and how is it supposed to work?

The opposition to Charlottetown's Community Outreach Centre and a proposed supervised consumption site has been vocal.

Residents complain about public drug use and discarded needles, and harm reduction programs have come under fire by some city councillors.

The heart of the issue is how to help P.E.I.'s increasingly visible population of drug users and whether drug use is a public health issue at all.

What is harm reduction?

Dr. Heather Morrison, P.E.I.'s chief public health officer,says harm reduction isn't just about drug use or preventing the spread of disease.

"It includes putting your seatbelt on. It includes wearing a helmet when you are going out on a bicycle," she said. "This is to reduce the risk associated with activities you are going to be doing anyway."

When it comes to drug use and addiction, a harm-reduction approach doesn't mean getting people to stop taking drugs. It recognizes that people are going to use drugs and simply aims to limit the risks.

That means things like handing out clean needles to stop the spread of disease, distributing Naloxone to reverse the effects of an overdose, or running a supervised consumption site where people can use drugs and get them tested.

But Morrison said harm reduction is just one piece of the puzzle.

"We talk about really the importance of three things: prevention, treatment and harm reduction. You can't have one on its own, it's really important to have all three. So it's not an either-or," she said.

"We know those individuals who use an overdose prevention site are more likely to get linked into treatment and the evidence would support that in many different peer-reviewed articles."

What is a supervised consumption site?

Supervised consumption sites are places people can bring their drugs to get tested for things like fentanyl, and take drugs in a place where they're supervised by people who know what to do if there's an accidental overdose. Staff vary from site to site but can include nurses, peer support and social workers.

It's also a way to connect people to things like addiction treatment if they want.

"It will save lives. So decrease the number of fatal overdoses, but also it will decrease public substance use," Morrison said. "It's not going to solve everything but it is one important piece."

Opioid-related deaths are at an all-time high. In the first half of 2023, there were 3,970 deaths reported across Canada. On P.E.I., 14 accidental opioid-related overdoses were reported in that same time. Two of those people died.

"What we are seeing is more potent and really dangerous opioids that are often mixed with other drugs as well," Morrison said.

"We have to remember these are all people that we are talking about, that are relatives and are our friends and neighbours."

P.E.I. and Newfoundland and Labrador are the only Canadian provinces that don't have at least one supervised consumption site.

Does harm reduction enable addiction?

Critics of harm reduction and the proposed supervised consumption site, including some Charlottetown city councillors, say they believe harm reduction enables drug use and keeps people dependent on drugs.

"The evidence would not suggest it is enabling," Morrison said. "It increases access to treatment. Those who are using an overdose prevention site are more likely to get into treatment."

PEERS Alliance, formerly known as AIDS PEI, has been tasked with operating the supervised consumption site when it's established. Tessa Rogers is the harm reduction project manager with the non-profit.

"People can't recover if they are dead," Rogers said.

"Why are we promoting folks hitting rock-bottom? Why aren't we supporting them along their journey and connecting them to services when they are ready if they become ready? And allowing people to be in charge of their own life and be in that driver's seat?"

It is a myth that folks who are consuming drugs don't care about their health.- Angele DesRoches, PEERS Alliance

There is a narrative that people need to be punished into recovery, saidAngele DesRoches, the program director with PEERS.

"There's just not a lot of evidence to support that," DesRoches said.

Harm reduction can lead people who use drugs to consider alternative pathways, said DesRoches, and there is no evidence to suggest harm reductionencourages substance use.

"For folks who are pursuing treatment, those services are there. We do see some effort in terms of prevention programming, but what about everybody who is either unable or unwilling to stop consumption?" she said.

"The only thing that harm reduction enables is for folks who are active in substance use to make healthier decisions. And I think it is a myth that folks who are consuming drugs don't care about their health."

What about the rest of the community?

There's evidence from across Canada and all over the world that harm reduction things like needle exchanges and supervised consumption sites cuts down on discarded needles and public overdoses, and saves taxpayer money.

"There are cost savings associated with [a supervised consumption site] in terms of decreased hospitalizations, decreased morbidity and decreased EMS visits," Morrison said.

"If we do some made-in-P.E.I. solutions that are evidence-based, I think we can help prevent some of what we are seeing in other parts of the county."

In 2020, substance use-attributed health-care costs on P.E.I. were more than $76 million, according to the Canadian Substance Use Costs and Harms Scientific Working Group. While the bulk of those numbers are due to alcohol and tobacco, opioids are also included in that calculation.

"There is a wealth of information looking at the positive benefits of overdose prevention, supervised consumption sites, whatever we want to call them," said Nick Boyce, a senior policy analyst with The Canadian Drug Policy Coalition.

"They are demonstrated to reduce disease transmission, demonstrated to increase referrals to other supports and absolutely they reduce overdose deaths.

"We just have to look at the number of overdoses that get responded to on a daily basis that if they didn't, if they had happened off-site, there's a very good chance that person would either end up in hospital or dead."

Tessa Rogers with PEERS Alliance said the community is actively dealing with the adverse effects of drug use because P.E.I. doesn't have a supervised consumption site.

"We are seeing those unfortunate and adverse things happening, like public substance use, overdoses happening in public areas and community areas. We are seeing some escalated behaviours that if at an OPS [overdose prevention site] we might be able to have staff de-escalate this individual," Rogers said.

"With public substance use, a lot of the time people don't have a place to go."

How does harm reduction work in other places?

Peer Six is a supervised consumption site in downtown Sydney, Cape Breton. It opened at the end of June2022, and about 200people have used the site since then.

"What people need to know is this is a health approach. Some people are under the understanding it's about promoting drugs, but it's about promoting health among people who use substances," said Kris Porter, director of The Ally Centre, which runs the site.

"They deserve health too. They deserve a safe place to use. It's all about keeping people alive, really, and they matter. And having an overdose prevention site shows to them that they matter."

Porter believes the site is working. She said drugs tested on site have tested positive for fentanyl several times,at least three overdoses have been reversed, and people are referred to things like treatment through the site almost every day.

"There would be a lot more people using substances in the downtown core, there would be a lot more needle litter and stuff like that. People wouldn't be getting connected to other health services they need," she said.

"I believe people are alive because of it."