As a nurse, I have seen the full spectrum of challenges our health-care systems face. The overdose crisis is one such challenge – tragically claiming lives while casting a shadow over health care across the country and straining resources.
Since 2016, more than 44,000 Canadians have died from opioid-related overdoses. These numbers are more than statistics – they represent our patients, our communities and our loved ones. My own brother, Brad, died in 2015 as a result of an overdose. I imagine every reader of this article has their own personal connection to this crisis.
People who use substances, their families and the communities around them need us to use every tool at our disposal to provide compassionate care and maintain community safety. Those tools include prevention, treatment, recovery services – and harm reduction.
In the face of this crisis, it is clear to me that nursing is, at its core, harm reduction. We want our patients to live. I hear heartbreaking stories from nurses who have witnessed the immediate consequences of a drug supply that is increasingly dangerous and unpredictable. Nurses face great moral distress when their interventions are limited to the resuscitation of someone from overdose, or when they are discharging patients without the right supports available. Each overdose is a tragic event that strains overstretched resources. Every overdose that is prevented is one less emergency department visit and one less hospitalization. The health-care system is under immense pressure, and nurses are at the forefront of this struggle.
By reducing the frequency and severity of overdose-related incidents, harm reduction allows us to focus on providing comprehensive care and ensuring support is available to people in Canada where and when they need it. This not only improves patient outcomes but also enhances nurses’ working conditions, a key aspect of retention for nurses who often are overwhelmed by difficult working conditions and stressful work environments.
As nurses, we know that we must meet patients where they are, offer skilled care and support without stigma or discrimination. Our role is to care for and protect patients, regardless of their drug use, and harm reduction is an essential component of this role. By building rapport and providing non-judgmental care, we can guide patients towards better health outcomes and connect them with necessary services.
There was a 35 per cent reduction in mortality within 500 metres of a supervised consumption service within three years of opening.
Nursing also is fundamentally grounded in evidence-based practice, and harm reduction is an evidence-based, public health approach that aims to reduce the negative health, social and economic impacts of substance-use related harms, without requiring or promoting abstinence. Harm reduction strategies such as supervised consumption services and overdose prevention sites provide compassionate, non-judgmental spaces for individuals. For example, a study in Vancouver found there was a 35 per cent reduction in mortality within 500 metres of a supervised consumption service within three years of opening.
Supervised consumption services and needle distribution programs also have been proven to reduce the transmission rates of HIV and hepatitis C, and facilitate safer drug use. By providing sterile needles and a safe space for consumption, these sites prevent infections and promote health, easing the strain on hospitals and emergency departments. For every dollar invested in needle distribution programs, an estimated $4 is saved in health care costs, a direct economic benefit that translates into more resources for patient care and health services.
The fact is these sites not only save lives but also connect individuals to essential health and social services, including treatment and recovery. Moreover, they offer acceptance and connection that is an essential component of the nurse-patient relationship. Since I started working in harm reduction in 2017, I’ve seen the direct lifesaving impact of these relationships. People who use drugs face risks that are deeply intertwined with broader social determinants of health such as poverty, homelessness and mental illness. The services they require often are complex but care starts with the ability to build a trusting connection.
In the face of Canada’s overdose crisis, I see harm reduction as a fundamental aspect of nursing practice – it is a necessity, in addition to treatment and prevention. Nurses understand that improving social conditions is key to tackling substance related harms and address the rights of marginalized populations who may be reluctant to engage in traditional health care.
By embracing and embodying a harm reduction approach, we can save lives, support our health-care system and provide compassionate, evidence-based care to those who need it most.
Let’s not use the word “overdose” in relation to incidents where individuals suffer serious and sometimes fatal effects from using opioids. “Overdose” suggests that the person either knowingly or accidentally took an excessive amount of a medication with known potency. In the current epidemic of incidents involving street drugs, the correct term is “poisoning,” since the drugs have typically been adulterated with either very potent synthetic opiates or with a variety of other drugs. The user, being unaware of the actual potency of what is being used or what adulterants have been added, can be seriously affected even when using his or her usual dose.
Why is this important? Calling these incidents “overdoses” is a way of blaming the victims, while calling them “poisonings” opens a number of avenues to reduce harms, such as making tests for opiate potency readily available to users, or making medical-grade opioids accessible as a viable alternative to street drugs.
Henry Olders, MD, FRCPC,
Assistant Professor (retired), Dept of Psychiatry, McGill University