Kayla DeMong considers it a sign of success if her clients keep showing up.
DeMong is the executive director of Prairie Harm Reduction. The organization provides supports to people who use drugs, including Saskatchewan’s only supervised consumption site in Saskatoon’s Pleasant Hill neighbourhood.
As a rule, the group doesn’t require abstinence in order to access its services, which sets them apart from some other addiction services.
“When we force people or manipulate them to seek abstinence as a part of engaging in support services, we’re just creating a cycle for them of disappointment and a lot of difficulty ahead,” said DeMong.
Advocates say that harm reduction aims to meet people where they’re at. That can mean supporting someone to continue using drugs in a supervised way amid rising overdose-related deaths.
Some support programs, like housing and employment services, require clients to completely give up drug use before accessing them.
Not only can that create barriers to getting care and assistance, DeMong says, it also perpetuates the idea that someone lacks value because they use drugs.
“In the long run, it [abstinence] limits their ability to engage in services and create community and build relationships with positive support,” she said.
Kayla DeMong is the executive director of Prairie Harm Reduction in Saskatoon’s Pleasant Hill neighbourhood.. (Submitted by Kayla DeMong)
Prairie Harm Reduction’s supervised injection site provides spaces for people to use different kinds of drugs in a safer setting, and a community centre that offers access to other support services.
Harm reduction common in medicine
There are few areas in health care that require absolute abstinence or compliance to receive care.
“Harm reduction is something we do in medicine all the time, because if we only are going to treat good patients, we don’t treat anybody,” said Eugenia Oviedo-Joekes, a University of British Columbia scientist and Canada Research Chair in person-centred addiction care.
She says that when it comes to other chronic illnesses, such as diabetes or heart disease, patients aren’t turned away if they refuse to give up sugar or visit the gym.
“It seems that in addiction, suddenly we have this high bar for people: If you don’t stop using drugs, I’m not going to treat you,” said Oviedo-Joekes.
White Coat Black Art26:31Prairie Harm Reduction
Focusing solely on a person’s drug addiction can also ignore conditions that may be exacerbating drug use, like past and present trauma, housing and financial insecurity, and physical and mental health issues.
Not requiring abstinence in order to access services “means that people can walk in somewhere and, right away, someone’s there to talk to them,” said Zoë Dodd, community scholar at the MAP Centre for Urban Health Solutions at Unity Health in Toronto.
“[Harm reduction] makes space for building relationships with people and actually getting to know them, which is, I think, the biggest part of harm reduction,” Dodd said.
Zoë Dodd, a community scholar with the MAP Centre for Urban Health Solutions in Toronto, says that harm reduction programs provide people who use drugs ‘dignity.’ (Submitted by Zoë Dodd)
Approach can lead to stability: DeMong
At Prairie Harm Reduction, DeMong says they’ve seen successes from that approach.
Derek Clayton Charles is a daily visitor to Prairie Harm Reduction’s supervised injection site where he uses a variety of drugs, including hydromorphone. Before he started visiting the centre, he says he was overdosing sometimes twice a week.
But since coming to Prairie Harm Reduction, he says he hasn’t overdosed once. He’s also been able to get assistance with housing, treatment for hepatitis C and help with filing his income tax.
Now, he hands out naloxone kits to other drug users and shares the story of his brother’s overdose death to bring attention to the risks associated with drugs like heroin and fentanyl.
“A lot of times I go through the streets of Saskatoon and I find anywhere from one to 15 people overdosing,” he told White Coat, Black Art host Dr. Brian Goldman.
Small-scale possession of illicit drugs will be decriminalized in B.C. starting next year
Federal Minister of Mental Health and Addictions Carolyn Bennett and her provincial counterpart, Sheila Malcolmson, announced that adults in British Columbia will be allowed to possess small amounts of some illicit drugs starting next year — a move that marks a dramatic shift in Canada’s drug policy.
Prairie Harm Reduction also offers an employment program for people who use their services. The workers provide peer support, and are paid at the same rate as staff.
It’s a way to provide stability that can help the centre’s clients better address their own health needs.
“Maybe that doesn’t mean that the drug use stops completely, but we see a lot of people who haven’t been housed in years and years and years obtain employment with us and be able to find stable housing,” said DeMong.
‘We need options,’ says researcher
Saskatchewan leads the country in HIV infection rates — an issue that Prairie Harm Reduction aims to address by providing clean supplies to those who use its supervised injection site.
And like many other provinces, Saskatchewan also faces a staggering number of overdose deaths — a record 421 in 2022 — in the midst of what advocates call a drug toxicity crisis. A paramedic is always on site at the centre.
Despite that, DeMong says that the provincial government has repeatedly rejected funding for the supervised consumption site.
“The wall that’s been put up around the safe consumption site and that funding is really rooted in discrimination and this belief that people who use substances don’t deserve help while they’re using — and that people only deserve help when they want to enter into recovery and live a life of abstinence,” she told Goldman.
Eugenia Oviedo-Joekes is a professor in the UBC School of Population and Public Health and Canada Research Chair in person-centred addiction care. (Submitted by Eugenia Oviedo-Joekes)
In a statement provided to CBC Radio, the government of Saskatchewan said it has budgeted $3.8 million for harm reduction programs across the province. The province’s minister of mental health and addictions, Everett Hindley, defended the decision last year saying that the province has limited resources, and noted it funds some of Prairie Harm Reduction’s other programs.
Dodd says that while knowledge of harm-reduction approaches is growing, governments would sooner fund abstinence-based programs — and that there is a misconception that harm reduction gets more funding than it does.
“The abstinence-based approach has been shoved down people’s throats for so long. People believe that that works. People believe that rehab works,” she said. “Lots of people have tried these things and they don’t work for them.”
Oviedo-Joekes echoes concerns about an abstinence-only model. “We need options,” she said.
“All we can do is to support the choices that people are going to make so they can do it in the safest way possible — and instead of dragging them away, we provide spaces for conversation.”
The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.
It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.
Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”
Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.
Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.
A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.
On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.
Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”
But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”
“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.
Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.
Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.
Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.
“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.
“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”
This report by The Canadian Press was first published Sept. 13, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
