Harm Reduction

Stigma involves negative attitudes or discrimination based on a person’s situation. Some examples of stigma include country of origin, race, culture, drug use, mental health, poverty, sex work and a history of incarceration. Individuals who use substances often experience high levels of stigma impacting their ability to access health care and social services. The following are implications of stigma for clients and service providers:

Willingness to access services

• Discourages access to prevention, testing, case management, and health care services.
• Feelings of shame and worthlessness also prevent people accessing treatment.
• Discourages disclosure of drug use to health/social service providers.

Risk and behaviors

• Less likely to access harm reduction services that will keep them safer.
• Impacts access to educational or other resources.
• Increases risk for overdose if people use alone due to hiding their drug use from their loved ones.

Self-worth

• Less likely to make changes to reduce their harmful behaviors, and making other positive changes such as reducing use, finding housing or accessing medical care.

Relationships and trust

• Assumptions are made by health and social service providers: e.g., they won’t show for appointments; follow through with referrals; abide by rules of agency, etc.
• These reinforce stigma, lower expectations, and present barriers to recovery and reintegration.

Funding

• Stigma affects political will to provide adequate funding and programs for people that use drugs, especially individuals who use drugs via injection.

The above content has been adapted from the Ontario Harm Reduction Distribution Program (OHRDP).

Using supportive language

Language is powerful. It reflects our values and beliefs, and impacts our thoughts and actions. Language used in society to describe people who use drugs is often negative and degrading. Terms like abuser, junkie, addict, and drug user perpetuate stigma and discrimination. The language used to describe people who use substances or those who struggle with addiction can have a lasting impact on self-esteem and can influence how they are treated. As a result, people who use drugs often become marginalized and alienated from the supports and services they need out of shame or to protect themselves from poor treatment.

Stigmatizing language does not help people with substance use issues to improve their lives. By describing a person as a “junkie” or “user”, it highlights one part their identity, and disregards all other parts that matter to them, their families and their communities. Individuals are more than their substance use, they are people first. 

Supportive terms

People with lived experience - first-hand accounts and impressions of living as a member of a minority or oppressed group. In the context of harm reduction, people with lived experience refers to those who have used substances in the past and share those experiences for many purposes.

People with living experience - first-hand accounts and impressions of currently living as a member of a minority or oppressed group. In the context of harm reduction, people with living experience refers to those who actively use substances, but also share those experiences as they happen.

Peer workers – a term used when a person with lived or living experience is employed by a harm reduction program to help provide services to those who actively use substances.

It is important to note that while we should not attach negative labels to other people, individuals should be able to self identify as they wish.

The above content has been adapted from the Toronto Public Health Website and the Government of Canada, “Changing how we talk about substance use”. 

[1] Kelly, J.F., & Westerhoff, C.M., (2009). Does it matter how we refer to individuals with substance-related conditions? A randomized study of two commonly used terms. International Journal of Drug Policy, in press

There is a broad range of substance use from abstinence to dependence. An individual’s substance use may change throughout their life, for a variety of reasons. The following graphic describes the continuum of substance use.

About the continuum of use:

• People do not automatically move along the continuum.
  • Some people may only use substances socially for their entire lives
  • Some people can move around the continuum over time
• People can be at different points of the continuum for different substances.
• Where a person is on the continuum, does not necessarily impact their ability to manage and minimize risks. For example:
  • Someone that is “heavily addicted” may still use new equipment every time
  • Someone who has used cocaine for a long time may overdose
  • Someone who uses substances socially may overdose or spend too much
• For people struggling with dependency, it is often normal to not use substances for a while, then use substances again (sometimes referred to as “relapse”). This is like many other forms of addiction.
• The reason(s) people start to use substances are not always the reason(s) they continue to use substances.

The above content has been adapted from the Toronto Public Health website, Stigma: Why Words Matter and Substance Use Spectrum. 

• Doing Nothing Not An Option
• We Are In This Together
• Stop The Stigma
• We Are A Caring Community 

The Waterloo Region Integrated Drugs Strategy (WRIDS) is a community collaborative working group aiming to prevent, reduce and eliminate problematic substance use. The vision of the WRIDS is to make Waterloo Region safer and healthier. The WRIDS presents an opportunity to address problematic substance use across multiple sectors, amongst various populations and locales throughout Waterloo Region. The approach to addressing problematic drug use is based on the four pillars of Prevention, Harm Reduction, Recovery and Rehabilitation, and Enforcement and Justice.

Work on the Waterloo Region Integrated Drugs Strategy began in 2008 through a 26-member Task Force in consultation with more than 300 citizens and service providers. In 2011, the Strategy was released. It draws on a framework that incorporates five approaches across 99 recommendations. These recommendations spanning public education, health care, and government policy, are intended to have positive health, social and financial outcomes. Click here to view the Waterloo Region Integrated Drugs Strategy document. Since that time, work on the strategy has evolved with priorities emerging in relation to the local context of substance use and its harms on the population.

There are approximately 130 individuals from over 40 organizations, agencies and the community who are involved in the work of the WRIDS. The WRIDS is guided by a multi-sectoral steering committee and four coordinating committees which align with each of the four pillars. Check the WRIDS website for more information.

Naloxone is a medication that temporarily reverses the effects of an opioid overdose. Opioids are a type of drug that slows down breathing. Examples include but are not limited to heroin, fentanyl, hydromorphone, morphine, methadone, codeine and oxycodone.

In Canada, Naloxone is available in two different forms, injectable (intramuscular) and nasal spray (intranasal). A Naloxone dose usually takes 2-5 minutes to work from the time of administration; however, the results are a temporary measure. It is imperative to always call 911 in an overdose situation, as the effects of the overdose may return once the naloxone has worn off.

Check this video on Naloxone Facts and infographics with information about naloxone developed by the University of Waterloo School of Pharmacy and Region of Waterloo Public Health.

An overdose is a medical emergency, 911 should always be called.

Below are possible signs of an overdose:

• Person can’t be woken up
• Breathing is slow, or has stopped
• Snoring or gurgling noises
• Fingernails and lips turn blue or purple
• Pupils are tiny or eyes are rolled back
• Body is limp

When is a person at risk of an overdose?

• When using alone
• Reduced tolerance
• Mixing with another depressant, such as alcohol or a benzodiazepine (Xanax)
• Switching to a different opioid
• Buying from a new source
• New user
• When you have been sick, tired, run down or dehydrated
• Mixing opioids with prescription medications
• No one is immune from overdose, whether using as prescribed or illicitly

How to respond to an opioid overdose with Naloxone

1. Shout their name and shake their shoulders.
2. Call 9-1-1 if they are unresponsive.
3. Give naloxone with 1 spray into nostril or inject 1 vial or ampoule into arm or leg.
4. Perform rescue breathing and/or chest compressions.
5. Stay with them - If there is no improvement after 2-3 minutes, repeat steps 3 and 4.

Click here for an overview on how to administer Naloxone.

The Good Samaritan Drug Overdose Act provides immunity from simple possession charges for those who call 911 in an overdose situation. It is important to remind those at risk of overdose or family/friends that this law will offer legal protection. For more information, check the Good Samaritan Drug Overdose Act on the Public Health Agency of Canada website. 

Kitchener

Waterloo

Cambridge

In 2017, The Ministry of Health launched the Ontario Naloxone Program (ONP) and designated public health units in Ontario as naloxone distribution leads for eligible community organizations to increase the distribution of naloxone to those most at risk of opioid overdose.

The responsibilities of the local public health unit include the following:

• Ordering naloxone
• Distributing Naloxone to eligible community partners 
• Coordinating and supervising naloxone inventory
• Training community organization staff on naloxone administration/eligibility criteria
• Supporting policy development and supporting naloxone availability

The Region of Waterloo Public Health and Paramedic Services currently has partnerships with community organizations, local hospitals, police services, fire departments and ambulance services across the region.

For more information about becoming an ONP, email the harm reduction team at: harmreduction@regionofwaterloo.ca 

Waterloo Region Overdose Monitoring
The system is updated monthly and reports on overdose-related 9-1-1 calls to Paramedic Services. Check the data on the Overdose Data for Waterloo Region page.  

Community Overdose Alerts
Alerts are issued through the Overdose Monitoring Alert and Response System (OMARS) and are shared through the Waterloo Region Integrated Drug Strategy (WRIDS) website to alert the public when:

• It is suspected a local drug supply is tainted
• There are suspected counterfeit pharmaceuticals in the local illicit market
• Other qualitative data indicates

For the most current alerts, check the Overdose Alerts page.

To receive overdose alerts, subscribe on the WRIDS website.

Overdose Bulletins 
The bulletins are published on a quarterly basis by Region of Waterloo Public Health staff. These bulletins highlight data from Paramedic Services, Overdose Monitoring, Alert, and Response System (OMARS) and Ontario Naloxone Program. Check Overdose Data for Waterloo Region for the most up to date overdose bulletins.

For more information about reports and data sources email the harm reduction team at: harmreduction@regionofwaterloo.ca 

The Region of Waterloo Public Health and Paramedic Services provides overdose prevention training upon request for businesses, hospitals, schools and various community organizations. The purpose of overdose prevention training is to provide information about overdose prevention.

For more information about overdose prevention training, email the harm reduction team at:

The Needle Syringe Program (NSP) distributes new harm reduction supplies (safer injection, safer inhalation, safer sex, disposal containers and wound care supplies); supports disposal of used injection equipment; and provides education related to blood borne infections, skin and vein problems, and overdose prevention. Needle syringe programs have existed in Ontario since 1989 and have operated in Waterloo Region since 1989.

These programs help to:

• Reduce the spread of HIV and Hepatitis C
• Reduce the number of used needles discarded in public places
• Educate about safer sex and sexual health and increase condom use
• Increase referrals to treatment programs, health and social services 

A variety of harm reduction supplies are available at our Needle Syringe Programs (NSP) and Public Health Clinics across the region. Check in with a program partner before visiting to make sure they carry the needed supply as some programs may not carry all the supplies listed below.

• Naloxone kits (nasal and injectable)
• Safe injection supplies (syringes, stericups, etc.)
• Safe inhalation supplies (bowl pipes, mouthpieces, etc.)
• Wound care supplies (gauze, saline, etc.)
• Safe sex supplies (condoms, lubricant, etc.)

Kitchener

Waterloo

Cambridge

The Region of Waterloo Public Health and Paramedic Services supports Needle Syringe Programs (NSP) across the region to offer non-judgemental and confidential access to harm reduction supplies and services.

To find harm reduction supplies in another Ontario community, check the Ontario Harm Reduction Distribution Program (OHRDP) interactive map.