Board hears about the mission of Harm Reduction at KFL&A Public Health

Naloxone kit image provided by KFL&A Public Health.

Last month, the Kingston, Frontenac, Lennox, and Addington (KFL&A) Board of Public Health (BOH) heard some shocking statistics from Ontario’s Chief Medical Officer’s annual report and answered his call to stand firm with a collective response addressing the burden of harms associated with mood-altering substance use. This month, the Board received a report from those on the front line of the substance use crisis: the Harm Reduction team at KFL&A Public Health.

At their monthly meeting on Wednesday, Jun. 26, 2024, KFL&A Medical Officer of Health (MOH) Dr. Piotr Oglaza reminded the Board of the rise in substance use and abuse and associated harms across communities in Ontario, based on the Chief Medical Officer of Health’s annual report. Moore’s report highlights that substance use-attributable harms cost this province $14.9 billion in 2020.

At that last meeting, the Board passed a motion calling on the government of Ontario to implement province-wide strategies to address substance use harms. “And today we’re building on that momentum. We are sharing some of the work that we are doing locally that aligns with the recommendations included in the chief medical officer Health Report,” Oglaza stated.

To this end, he introduced Rhonda Lovell, RN, BNSc., a KFL&A Public Health Nurse for Substance Use Health & Mental Wellbeing, to present to the Board the work of the KFLA Needle Syringe Program and the Ontario Naloxone Program. Specifically, she discussed the work of the Harm Reduction Staff and the two concepts foundational to their work: the spectrum of substance use and the harm reduction approach.

The spectrum of substance use

“We know that people use substances for a very wide number of reasons,” Lovell explained, harkening back to the Chief Medical Officer’s annual report, including curiosity, social connection, ceremony, to feel good, to perform better on specific tasks, and more. People might consume a substance to enhance task performance, or they might just be curious.

Lovell noted, “Some people who’ve experienced trauma or experienced physical pain or depression, anxiety, or other mental symptoms or conditions might consume substances to relieve some of those intense feelings of distress or pain.” 

Substance use health can be considered on a spectrum. Image from presentation.

If we think about health related to substance use the same way that we think about physical and mental health, it helps provide us with a framework for seeing that “everybody, regardless of their reasons, fits along that same spectrum,” Lovell suggested. “And that helps us to acknowledge that substance use can range from no use to a substance use disorder. Not everybody who uses substances has a substance use disorder (otherwise known as addiction).”

“At various points along the spectrum, depending on time and circumstance,” she noted, “people might experience positive or negative effects from substance use, and their use may change over time; the reason that someone starts to take a substance might not be why they continue to take it. And we need to acknowledge that health and well-being can be supported at any point along the spectrum.”

“It’s a very inclusive way of looking at things,” she stated, “and it also helps to acknowledge Dr. Moore’s call to recognize people’s autonomy to use substances.”

Harm Reduction approach

Lovell explained that harm reduction aims to decrease the risks of an activity without requiring or forcing the person to stop doing the activity. Other forms of harm reduction include bike helmets, seat belts, airbags, oven mitts, and “don’t drink and drive” messages.

More broadly, when it comes to substance use, she explained, “[The harm reduction approach] offers a very non-judgmental approach. It acknowledges the benefits and consequences of substance use. It generally prioritizes the more immediate risks of substance use [and tries to reduce them] with person-centred care, rooted in evidence-informed practices.”

For example, she pointed out that we know distribution of naloxone helps reduce harms related to unregulated substance use, “So it can help reduce the number of deaths that we experience as a community. And we know that the distribution of sterile drug use supplies helps to reduce the transmission of infectious diseases like HIV and hepatitis C,” Lovell stated. 

Focusing on harm reduction when developing programming and policies for service organizations, she said, “also helps to reduce some other harms associated with substance use that the stigma around substance use can cause.”

“So,” Lovell explained, “just by virtue of having these kinds of programs, it can help to reduce some of the stigma and remove some of the barriers people might face to accessing certain programs and services. Making people feel they can do something about the problem and not be judged about their involvement with substance use, to begin with.”

Ontario’s mandated harm reduction programming

Next, Lovell introduced the Ontario-mandated harm reduction programming, including the Ontario Naloxone Program (ONP), which provides take-home naloxone and emergency services naloxone, and the Needle Syringe Program (NSP), which provides Harm reduction supplies and Community sharps disposal.

A timeline of harm reduction programming in the province revealed that the Ontario-mandated needle syringe program began in 1997 after first being established in Toronto in 1989. Needle Syringe Programs provide sterile, single-use equipment to help prevent disease transmission and reduce the potential health risks associated with drug use.

In 2006, Ontario established the Harm Reduction Distribution Program coordinating the distribution of evidence-based harm reduction supplies to Core Harm Reduction Programs throughout Ontario. Funded through the HIV & Hepatitis C Programs of the Ontario Ministry of Health, it is a not-for-profit program of the Kingston Community Health Centres.

In 2008, harm reduction was included in Ontario Public Health’s Standards, which state that Boards of Health in all public health regions “shall ensure access to a variety of sterile needles and syringes and may include other evidence-informed harm reduction strategies in response to local surveillance”; 33 Public Health Units are now providing harm reduction supplies.

In 2016 the Ontario Naloxone Program for Pharmacies was instituted. Then, in 2017-2018, the Ontario Naloxone Program expanded via Public Health Units. In January 2023, the Needle Syringe Program moved in-house to KFL&A PH.

“It’s presented a change in the evolution of our goal as an agency, and since then, we’ve certainly worked hard to implement all the core pieces on that program and integrate it with our naloxone program that’s been ongoing as well,” Lovell said.

KFL&A Public Health’s role is to be responsible for all aspects of local administration of these two programs. “That includes direct distribution of take-home naloxone and safe drug use supplies… We also work with interested eligible organizations to bring them on board so they can access the training and harm reduction supplies,” she explained

Lovell explained that the harm reduction team spends its “very busy” days working on individual and community outreach, training, and consultations and providing harm reduction sharps disposal, core inventory management, staff onboarding, and support. They also do a lot of Ministry reporting and process all orders and deliveries of supplies for the region.

Image from Lovell’s presentation.

Lovell provided a snapshot of their work in 2023 (above), which included 17,956 naloxone doses distributed. Beyond providing safe drug use supplies, the team also responds to calls from individuals who have found discarded drug use supplies. In 2023 the team have safely collected over 600,000 needles.

Lovell also made note that KFL&A Public Health accepts calls from individuals who’ve encountered improperly discarded drug use supplies. If the caller is not able to or feels uncomfortable safely disposing of them, harm reduction team members will attend and do so if possible, or provide simple education on how to safely collect and dispose of the items.

Kingston City Councillor Conny Glenn asked if Lovell could provide advice to anyone who came across needles or other drug paraphernalia in a public setting.

“First of all don’t panic,” said Lovell. “That is always step one and I think that sometimes because there is so much fear and stigma, particularly around overdose related risks, there are often some unrealistic fears over what poses a threat.”

She gave the example of being called to pick up the wrappers from a naloxone kit that were not drug related at all and were just simple paper trash. “So I think that staying calm is a very good first step,” she expressed.

Next, she advised, if you can safely use tongs or other implements to collect the waste and contain it in a jar, simply dispose of it in one of the safe disposal kiosks around the area. And if in doubt, call and provide a detailed location to the collection team.

BOH Chair Wess Jarrod thanked Lovell for her presentation. Next on the agenda was a related presentation about a new campaign called “Support not Stigma” which Kingstonist will cover in a future article.

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