In recent years, health care has embraced the concept of “evidence based” practice. We incorporate this daily in our diverse work settings. We invoke it when we mentor students. We know, for example, that rigorous control of blood sugar levels in people with diabetes reduces their risk of organ damage – and so we aim for established target levels. We know that aggressively treating cardiac risk factors reduces heart attacks – and we do our best to help our patients reduce those risks. We know that adopting a harm reduction approach to problematic substance use saves lives. But do we implement harm reduction practices for our patients struggling with addictions? Truthfully, more often than not, many care practitioners do not.
Harm reduction is a continuum of pragmatic strategies to reduce harms related to substance use. For example, many Canadians consume alcohol to some degree. Nation-wide harm reduction campaigns have highlighted the risks of drinking and driving. As a result, many Canadians planning to consume more than a couple of drinks plan ahead to have a designated driver, call a cab, or use transit in urban areas. This is harm reduction. So is taking away an intoxicated person’s car keys.
Other examples include providing people who use substances with clean supplies to reduce the risks of infectious disease such as HIV or Hepatitis C which can be transmitted by sharing equipment such as needles and pipes. Prescribed opiates such as methadone and Suboxone can help stabilize the lives of people struggling with addictions to drugs such as prescription painkillers. The epidemiological evidence supporting these strategies is robust, yet many health care providers continue to ignore it.
Moreover, not only do some of us ignore solid evidence – some of us even apply punitive actions against people with addictions. Patients with escalating prescription painkiller demands may be fired by physicians who are concerned about legal issues. Canadian nursing professor Bernadette Pauly and colleagues conducted research published in 2007 showing that when health care setting norms characterize those suspected of misusing drugs as drug seeking, lacking in personal responsibility or undeserving of care, that therapeutic relationships are hindered – there’s a big surprise! These researchers found evidence that some providers may avoid these patients, delay providing care, provide care minimally or roughly, or provide patients with less information.
In September 2011, the Supreme Court of Canada ruled against the federal government’s attempts to close Vancouver’s highly successful supervised injection facility, known as Insite. Although Stephen Harper would escalate the profoundly futile “war on drugs” infamously declared by Richard Nixon over forty years ago, this decision represents an important step in the right direction towards creating comprehensive, evidence based approaches to substance use in Canada. With a few notable exceptions, health care practitioners have not been leading the fight for evidence-based health services for people who use drugs. This is both unprofessional and unethical. It is time for health care providers to put aside stereotypes and judgments, to educate ourselves about the evidence on harm reduction, and to start insisting upon harm reduction models as the standard of care.