Harm-reduction is not enough to fight addictions, report says

No one should be written off as being “beyond help” when it comes to addictions, says a new research paper by the B.C. Centre on Substance Use, which says authorities should move beyond harm reduction.

Called Strategies to Strengthen Recovery in British Columbia, the paper says it is time for authorities to move beyond a focus on just harm reduction, and embrace a full system of care that includes the possibility of people recovering from addictions.

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“Stopping at harm reduction’s water’s edge is not going to get us where we need to go,” said Marshall Smith, the centre’s senior adviser on recovery initiatives.

“We need to invest research and resources in developing out and enhancing a recovery-orientated system of care and building a system of care that spans from harm reduction right through to abstinence-based programs, systems and services,” said Smith, who said he knows from his own experience as a homeless alcoholic hooked on cocaine and methamphetamine that recovery is possible.

Individuals with addiction are often devalued and written off by society, the paper says.

“This is costly, unethical and wrong. Research has clearly demonstrated that long-term recovery from substance-use disorders and other addictions is not only possible, but is an attainable and sustainable reality for many individuals regardless of the severity and duration of their addiction,” the report says.

Ironically, the study notes that people in recovery and the broader recovery community often face discrimination and social stigma, which many describe “as being reduced to past diagnosis, stereotype or risk score.”

The report is calling for improved addiction-recovery services that would provide equitable access to long-term, quality care regardless of someone’s ability to pay.

It recommends that provincial health policies for dealing with addictions be broadened to include recovery-oriented, abstinence-based interventions and supports.

The move would mark a dramatic shift from a provincial system that has historically focused more on harm-reduction initiatives, such as providing clean needles and take-home naloxone, which counteracts the effects of opioid overdose.

“While countless lives have been saved through these essential programs and supports, the emphasis on public-health and harm-reduction programming has meant that resources and attention aimed at building an effective and co-ordinated addiction-care system have traditionally been lacking,” says the paper authored by Smith and Dr. Evan Wood, the director of the B.C. Centre on Substance Use.

“Research has clearly demonstrated that long-term recovery from substance-use disorders and other addictions is not only possible, but it is an attainable and sustainable reality for many individuals, regardless of the severity and duration of their addiction,” says the paper, the product of more than 18 months of research and consultation with stakeholders, including those who have experienced recovery.

The study says while it is critically important to provide a range of effective acute treatment services such as withdrawal-management programs, it is also necessary to develop and strengthen long-term, recovery-oriented services to support people struggling with and looking to overcome addiction.

“We have for a long time in British Columbia had a fairly singular focus on reducing harm and that needs to continue and I want to be clear that lots of lives have been saved as a result of that,” Smith said, adding that the authors are not suggesting dollars should be diverted from those initiatives.

“[We are advocating] only that recovery and getting well and getting people into an equitable and accessible system of care is needed and needs significant investment,” he said.

According to the report, those recovery-oriented systems of care could include: recovery community centres, recovery high schools, collegiate recovery programs, recovery workplaces and recovery supportive housing, among other services.

“Recovery community centres in particular can serve an important role in a recovery-oriented system of care by serving as a low-barrier, central location in the community where individuals can access peer-led recovery support services, participate in education and training programs, and attend a variety of recovery-oriented mutual support group meetings,” it says.

The authors concluded that recovery residences are “an important component of the continuum of care,” but said they are often undervalued or overlooked within health and social-service systems.

Smith notes, for example, there is not a single municipality in the capital region whose bylaws allow for recovery houses.

“You would think that in the midst of a housing and addictions crisis, municipalities would be looking at what they could do to enable the creation of specialized housing like this,” he said.

The paper makes several policy and regulatory recommendations, including:

• Establishing a template for municipalities for the zoning and licensing of recovery homes and treatment centres.

• Supporting strategies to increase provincial authority to close unlicensed or illegal treatment centres.

• Exploring the development and implementation of a mandatory certificate program for recovery residence operators.

• Supporting the establishment of recovery community centres in suburban areas throughout the province.

• Supporting the establishment of collegiate recovery programs.

• Exploring and possibly piloting B.C.’s first recovery coaching centre.


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