The Case for Harm-Reduction

Edited by: Diane Lee and Thuwaraka Mohanakumar

Strategies for addressing homelessness have taken many forms over the years, with the most recent trends shifting towards harm reduction. But what is harm reduction and is it better than abstinence-only programs? 

These strategies target individuals who experience both homelessness and addiction, which only represent about one-quarter of the total unhoused population in Canada (Government of Canada, 2022, p. 4). 21-27.6% report addiction as the leading cause of housing loss and substance use increases along with time spent experiencing homelessness (Government of Canada, 2022, p. 4). Although addiction should be addressed when combating homelessness, it is a small portion of the much bigger picture. 

Traditionally, abstinence-only programs have been used. This means providing services, such as housing and shelter, to unhoused people only if they refrain from using drugs and alcohol. More recently, however, harm-reduction strategies have been used which meet the individual where they are in terms of their substance use and finds ways to make it safer. For example, syringe-swap programs have been created to reduce the risk of HIV for people who inject drugs. 

Harm-reduction efforts are often criticized because they are perceived as enabling drug-use. This perspective reflects a paternalistic attitude which assumes that individuals are incapable of making their own decisions. Often, substance use disorders are a coping response to traumatic experiences. Taking away one's autonomy can perpetuate this experience of trauma and leave them ill-equipped to cope. Abstinence-only programs can also be traumatizing because they enforce the message that housing is earned, and not a basic human right. 

Harm-reduction strategies can reduce the negative consequences associated with substance use, such as social, physical, emotional, and spiritual concerns (British Columbia Centre for Disease Control, 2023, para. 1). It reduces deaths due to overdose and infectious disease such as HIV and hepatitis (British Columbia Centre for Disease Control, 2023, para. 2). The use of harm reduction reduces the stigma associated with substance use among those who experience homelessness and can encourage individuals to access treatment (British Columbia Centre for Disease Control, 2023, para. 2). 

References 

Government of Canada. (2022, April 21). Report on addiction, substance abuse and homelessness. Government of Canada. https://www.infrastructure.gc.ca/homelessness-sans-abri/reports-rapports/addiction-toxicomanie-eng.html. 

British Columbia Centre for Disease Control. (2023, December 1). Understanding harm reduction: Substance use. HealthLink BC. https://www.healthlinkbc.ca/healthlinkbc-files/understanding-harm-reduction-substance-use.