A Little Safer Goes a Long Way

In our work, we are reminded daily of the importance of harm reduction and we see the changes it brings to people’s lives. Harm reduction is an evidence-based approach that seeks to reduce the harms associated with addiction and substance use, without requiring people to stop using those substances. 

Our program does this by giving people prescribed alcohol, which can make their lives safer and give them a chance to focus on what’s important to them. This approach requires that the person using controlled substances be given the ability to decide how they will minimize harms. Harm reduction workers refrain from judgment and do not place their own expectations on the people with whom they are working. 

Harm Reduction provides an option for people to engage with peers, medical, and social services in a non-judgemental way that will meet them where they are. The approach has been proven to be effective in building positive change in people’s lives. 

If you’ve been following our work and found yourself wondering how MAP looks for someone in the program, we’ve created a narrative to help  people understand  the benefits of harm reduction, by  inviting  them to imagine something of what it is like to participate  in the MAP. 

The story below doesn’t belong to one person, but rather, it is a patchwork of real life experiences that participants have shared with us so far. 

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Meet Ruth, this is her story.

Ruth is a 32 year old woman from Labrador who moved to St. John’s to go to trade school. She has been drinking since she was 12 years old, when a close family member died. Her drinking both continued and increased as other friends, family, and community members either passed away or left home. Having lost so many of her closest personal and cultural supports, she struggled to process her  grief.  She wanted to get out of her immediate environment and start a new life as an adult. She wanted a fresh start. 

When she moved to St. John’s Ruth felt isolated and out of her element. She was  drinking even more than usual. It helped her cope, fit in with others, and mentally escape. Her drinking started to interfere with trade school, so she began weaning herself down, and even tried to quit “cold turkey” a couple of times. She would frequently wake up in an ambulance, in the hospital, or in public with a crowd of people around her after having a withdrawal seizure. 

At this point, Ruth stopped going to class and paying her rent. She needed all of the money from her student loans to pay for enough alcohol to keep her from getting sick. She did not want to end up in hospital anymore. Ruth felt ashamed in  hospital, and felt that they couldn’t help her. There were no family doctors available in town to take her as a patient either. Ruth started managing her own withdrawal with alcohol, but this came at a price. 

Ruth soon found herself staying in a shelter, where she was kicked out for having alcohol in her locker. All of her belongings were stolen on the street that night, which meant she didn’t have any IDs or personal documents that she would need to get back on her feet. She started staying on couches, relying on people who would have her – people who also drink and do other drugs. As long as she brought beer, she could stay. When she needed beer for herself though, she began trading sexual services to get what she needed. Her other options were either being violently ill without alcohol, or going to the community centre down the street to find some free hand sanitizer to drink in a pinch. This would also make her very sick.

Ruth was in an inescapable cycle of alcohol, violence, and poverty. After 5 visits to the local Recovery Centre (also known as “detox”), innumerable ambulance rides to the emergency room, and a few stints in lockup for public intoxication and alcohol theft, Ruth had no ability to maintain any income or housing. 

Another sex worker on the street recognized Ruth’s shakes, tremors, and psychosis as dangerous withdrawal symptoms. She saw that Ruth was desperate for her alcohol supply and that it was taking up her entire day, every day. She told Ruth about MAP, a program she used for about six months to help her get to inpatient treatment out of the province. She spoke to Ruth about what it could be like if her alcohol doses were a prescription, dropped off to her at a safe spot every day. She would no longer need to worry about where she would get her next drink, and could focus instead on finding housing, feeling well, and stabilizing her life. 

MAP at the St. John’s Women’s Centre

Ruth goes into the St. John’s Women’s Centre to ask about MAP and is immediately connected to an outreach worker who listens to her without judgment.  Then she gets connected  to the Harm Reduction Nurses and a prescriber, who assess her for the harms her alcohol use is causing. The following week, she is prescribed a safe amount of alcohol for her, 10 drinks a day, spread out over 2 drop-offs so that she isn’t in a position to drink it all at once. 

With her prescription set, Ruth gets to know the outreach workers at MAP and the regular faces at the Women’s Centre – people who she can trust and rely on. The nurses also connect her to treatment for her previously undiagnosed Hepatitis C, and the team at MAP works with her to get her IDs and her income support application. They work together to find safe, affordable housing that works for Ruth, and she is finally able to leave the shelter she’s been staying in since being with MAP. She goes to Harm Reduction Peer Support every other Thursday, sharing and listening to other women who have been where she has been, at every stage of recovery. 

Now that she is housed, has reliable income, and her alcohol use is more stable than ever, Ruth decides she wants to cut down how much she is drinking per day. She thinks it’s finally time for treatment, and has picked out an inpatient program in Nova Scotia that offers Indigenous-specific treatment on the land for people who are dependent on substances that have also experienced trauma. Between MAP and healthcare providers, her care team works together to get her there. Her prescription is slowly reduced at her own pace until she is only drinking one beer a day when needed for withdrawal and anxiety. 

She goes into treatment for 3 months, and instead of returning to St. John’s decides it’s time to reunite with her family in her home community. She’s nervous about what this will bring up, but has never felt more prepared to cope. She feels like a more resilient person now, in control of her situation and her own wellness. She moves in with an aunt who is sober too, and they support each other. Ruth reaches out occasionally to women in her peer support group, and to her case manager to let them know that things are tough but that she’s doing well. She feels like she has support to fall back on whenever she needs it. 

Ruth worked hard to reach these goals and made brave choices to build the change in her life that she wanted to see. The successes here are hers to define, and the credit belongs solely to Ruth herself.  The managed alcohol team was glad to stand beside her as she moved in the direction of her goals.

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The benefits of MAP and other harm reduction options for people are individual and diverse. Some people are able to realize dramatic life goals and make changes like Ruth did. For some people, their life is just a little bit safer and more stable every day. 

The team at the St. John’s Status of Women Council recognizes that both ends of this continuum are just as important, and deserve the same amount of celebration and recognition. 

Substance use and its harms are complex. It’s critical that treatment options in this province continue to match that complexity. This means continuing to have care that’s non-punitive, prioritizes dignity, and lets people determine their own path. And that’s exactly what harm reduction is all about. 

Becky Fleming

Harm Reduction Coordinator, SJSWC