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Type of submission: Oral
Conference track: Research
Topics: Harm Reduction in North America; Harm Reduction Services and Service Provision
Presenting author: Jalene Anderson-Baron
No biography entered.
Elaine Hyshka, Jalene Anderson-Baron, Kamagaju Karekezi, Lynne Belle-Isle, Bernadette Pauly, Carol Strike, Andrew Hathaway, Richard Elliott, Mark Asbridge, Caitlin Sinclair, Keely McBride, T. Cameron Wild
Background: Organization and funding of harm reduction (HR) services for people who use drugs (PWUD) is largely under provincial/territorial jurisdiction in Canada, and access to these interventions is highly variable across the 13 provinces/territories. We conducted the first national comparative analysis of provincial/territorial-level HR policies to identify factors that may explain uneven service provision.
Methodology: A systematic search identified 101 publicly-available provincial/territorial policy documents published between 2000-2015, which related to the planning of at least one HR intervention (needle/syringe distribution, low threshold methadone/buprenorphine, crack kits, supervised consumption, naloxone, drug checking, street outreach). We used inductive analyses to describe policies including definitions of HR, and deductively evaluated policies using a priori criteria to compare relative strength of HR policy across jurisdictions.
Results: Across Canada, few formal provincial/territorial policies exist to guide organization or funding of HR services, and nearly half the documents identified came from two provinces: British Columbia and Quebec. Six jurisdictions published three or fewer documents each, with the Yukon Territory producing none. Provincial/territorial definitions of HR, including key principles and interventions, shifted over time and varied greatly. There was no nationally consistent definition of HR observed. Most policy documents emphasized prevention of injection-related infectious diseases amongst PWUD, and street outreach and needle/syringe distribution were the most commonly referenced interventions. Less than half of the provinces/territories mentioned overdose in their formal HR policies. Few jurisdictions paid significant attention to the specific needs of priority populations.
Conclusion: Within Canada, provincial/territorial-level HR policy is sparse, and rarely aligned with international best practices. HR definitions are inconsistently applied and policies mainly focus on injection-related programming. Strengthening and expanding policies to encompass a broader range of interventions remains an important task for promoting consistent access to HR services across Canada.