Why We Need Harm Reduction
Community Contribution by S.S.
Everyone agrees that change is needed when it comes to houselessness and addiction in the Cowichan Valley. Subsidized and supportive housing has been neglected for decades, opioids over-prescribed, extended families scattered in search of work, wealth hidden offshore rather than paid in taxes, and organized crime profits off the most vulnerable individuals. There are many other factors contributing to increasing homelessness, much of it stemming from over forty years of neoliberal policies.
We know what didn’t happen; no one decided they’d prefer living on the streets to working a job. No one chose to become addicted. No one chose to be assaulted. No one chose to be constantly vigilant until stress and exposure broke down their health.
Many people on the streets are living with untreated trauma. A meta-analysis of studies found around a third to be living with PTSD (“A Systematic Review and Meta-Analysis of the Prevalence of Post-Traumatic Stress Disorder among Homeless People”, Psychiatric Quarterly, May 2020, abstract: https://link.springer.com/article/10.1007/s11126-020-09746-1 ). This is one of the reasons people self-medicate.
Many people on the streets suffer from a brain injury. An extensive study from 2019 shows around 50% of the unhoused and precariously housed had a traumatic brain injury, and 25% had a moderate to severe injury. By comparison, 22% of the population has had a TBI and only 3% have had a moderate to severe brain injury. (“Traumatic brain injury in homeless and marginally housed individuals: a systematic review and meta-analysis”, The Lancet Public Health, Dec 2019, https://doi.org/10.1016/S2468-2667(19)30188-4 ).
Some people living on the streets had a mental illness before becoming homeless, and some developed one as a result of the unending stress of unmet needs, as many of us would. Some have a combination of these issues.
This situation is not about people who made bad choices needing to be punished. No one needs to suffer more in order to be convinced to choose the ‘straight and narrow’. Some survivors say they were once living on the streets with an addiction and they changed, so others should too. However, their brain is not everyone’s brain. I have yet to meet anyone who claims to have walked the path of recovery entirely on their own - moving from survival mode to a rebuilt life without support.
So, here we are. People with nowhere to go are living in public view. Some parents want to prevent their children from witnessing this. Some businesses are affected. Fixing this will take many millions of dollars and years of preparation and construction.
This current situation took over forty years to develop so it won’t be solved quickly. We can start by preventing trauma in children so we don’t see them sleeping in doorways in a few years. We can try to keep people safer than they’d otherwise be. We can keep people alive until we can give them a place to sleep behind a locked door. We can try to keep those who are addicted from dying in isolation. Why? Because they’re our children and our community members, and they deserve to live.
Trying to keep individuals and our community healthy is called harm reduction. It’s the result of research, not socialist city councils as some have claimed. The ideas may sound surprising at first – giving out drugs! - but the concepts are tested and adjusted as needed. Harm reduction values the practicality of accepting people as they are and helping them stay alive until they can access further help.
The harm reduction entry in Wikipedia states “Harm reduction is used to decrease negative consequences of recreational drug use and sexual activity without requiring abstinence, recognizing that those unable or unwilling to stop can still make positive change to protect themselves and others” (https://en.wikipedia.org/w/index.php?fulltext=1&ns0=1&search=Harm+reduction%29&title=Special%3ASearch) and contains many examples of harm reduction in action, all with citations. I hope you’ll look over the many forms it takes and the ways it’s used around the world. It’s not scary but it is change, which is what we are all fighting for, right?