Among people who use drugs, harm reduction facilities and their staff, can offer a reprieve from discrimination driven by stigma. Even small gestures like asking how a person is doing can improve the emotional wellbeing of the community members who use the various needle and syringe distribution organizations, supervised consumption sites (SCS), and other harm reduction organizations around the country.
This is particularly important during the ongoing overdose crisis, which the COVID-19 pandemic is also feeding. Compounding the issue is the fact that many harm reduction organizations had to adjust their operations throughout the pandemic, sometimes offering fewer seats in SCS, for instance, or operating with fewer resources.
Sean Bristowe, works with the Canadian Students for Sensible Drug Policy Get Sensible Cannabis Education Project, and previously did outreach work. They said it’s important for harm reduction workers to make time to talk with members of the community and listen to what they have to say. “When you take time to really sit with people and hold space for their stories, it really goes a long way,” they said.
In many cases, people who use drugs experience discrimination from people on the street, and even in the healthcare field. They note that Albertans already have a bit of an aversion to speaking with strangers, and harm reduction in the province regularly faces uphill battles. However, outreach and harm reduction workers have an opportunity to show compassion, they said. This helps form relationships and trust with members of the community, so they’re more likely to make contact again if they’re experiencing a crisis, and it helps them feel more connected.
“In outreach, you witness the general public ignoring them all the time. When people ignore you, day in, day out, that obviously wears on you,” they said.
In many cases, workers with living or lived experience find it easier to build a natural rapport with service users, since they are better able to understand and relate to what community members are experiencing. Rachel Plamondon has been an outreach worker in Vancouver for the past 10 years, and has a wealth of experience working in outreach and at various SCS.
“In outreach, you witness the general public ignoring them all the time. When people ignore you, day in, day out, that obviously wears on you,” Bristowe said.
She said that when a service user comes into a harm reduction facility, and a person with living or lived experience greets and welcomes them, it opens the door to build a relationship. That trust is, most often, formed because the worker takes the time to engage with them.
“When they come in the door and see somebody they already know, their guard is let down a little bit more,” she said.
As such, in many cases, harm reduction organizations are where community members can find a modicum of safety. “We try to have empathy and compassion, which they might not have received prior to coming through our doors,” she said.
The two epidemics have also wreaked havoc on the mental health of the people working at harm reduction organizations. Shay Vanderschaeghe is a program coordinator with the Canadian Drug Policy Coalition‘s Stimulus Program. She often works with harm reduction organizations in smaller communities—in which they are often the only group working in the field.
This is a particularly trying time for people working in harm reduction—as members, with whom the workers may have formed a relationship, of the community face a heightened risk of overdose and ongoing stigma from the world at large. Some people working at harm reduction organizations may also hesitate to share what they are going through. They might fear that their trauma may cause their colleagues, friends, etc., emotional pain as well, considering the growing emotional weight of increasing overdose numbers, and the discrimination and abuse the service users in their community may face.
“We are in a shit storm of mental health issues working in harm reduction,” she said.
To combat this, Vanderschaeghe recommends that harm reduction organizations actively ask what their workers need to work through this difficult time. This might involve adding more staff, as current workers need to take time off to work on their own mental health, for example. “There is no one answer. This is an epic syndemic. No one has ever had to go through this,” she said.
“We are in a shit storm of mental health issues working in harm reduction,” Vanderschaeghe said.
However, it’s not always easy to engage emotionally. Sometimes, harm reduction organizations might even discourage their workers from displaying emotion while interacting with service users. Erica Thomson, Executive Director of the BC and Yukon Association of Drug War Survivors, has seen the organizers and staff of some harm reduction organizations tell workers to not cry or hug service users. Often, but not exclusively, it is people with living or lived experience who are more inclined to display emotion, she noted.
According to Thomson, some of this comes from history. Some harm reduction organizations have staff who are trained social workers. In this field, there’s an old-school view that recommends against outwardly showing emotion when interacting with service users. She has seen this throughout her work. It’s incredibly difficult to not show emotion or even cry when hearing stories from the community, she said.
Harm reduction staff coming from a social work background, or who have been influenced by it, can, in some cases, “have that very old-school [set of ethics],” she said. “Emotions shouldn’t be brought into things. To show emotions would be unprofessional—to cry with a quote-unquote client.’ If you’re not emotional in this crisis, there’s something wrong with you.”
According to Thomson, there can also be stigma against people who use drugs among harm reduction workers in general. Sometimes, staff can lack the empathy of a worker with living or lived experience, she said.
“Emotions shouldn’t be brought into things. To show emotions would be unprofessional—to cry with a quote-unquote client.’ If you’re not emotional in this crisis, there’s something wrong with you.” – Thomson said.
In any case, having empathy and showing emotion and listening to community members can encourage them to return again and seek out help, on top of tending to their emotional wellbeing. “Isn’t the most important piece that people come back?” Thomson said.
Johnson is a writer, editor and journalist whose work has appeared in Filter-Magazine, National Geographic, Undark Magazine, New Scientist and Hakai, among others. He lives in Alberta, Canada.