Harm reduction in name, but not substance: a comparative analysis of current Canadian provincial and territorial policy frameworks
Abstract Background In Canada, funding, administration, and delivery of health services—including those targeting people who use drugs—are primarily the responsibility of the provinces and territories. Access to harm reduction services varies across jurisdictions, possibly reflecting differences in...
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| Format: | Article |
| Language: | English |
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BMC
2017-07-01
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| Series: | Harm Reduction Journal |
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| Online Access: | http://link.springer.com/article/10.1186/s12954-017-0177-7 |
| _version_ | 1818064540160491520 |
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| author | Elaine Hyshka Jalene Anderson-Baron Kamagaju Karekezi Lynne Belle-Isle Richard Elliott Bernie Pauly Carol Strike Mark Asbridge Colleen Dell Keely McBride Andrew Hathaway T. Cameron Wild |
| author_facet | Elaine Hyshka Jalene Anderson-Baron Kamagaju Karekezi Lynne Belle-Isle Richard Elliott Bernie Pauly Carol Strike Mark Asbridge Colleen Dell Keely McBride Andrew Hathaway T. Cameron Wild |
| author_sort | Elaine Hyshka |
| collection | DOAJ |
| description | Abstract Background In Canada, funding, administration, and delivery of health services—including those targeting people who use drugs—are primarily the responsibility of the provinces and territories. Access to harm reduction services varies across jurisdictions, possibly reflecting differences in provincial and territorial policy commitments. We examined the quality of current provincial and territorial harm reduction policies in Canada, relative to how well official documents reflect internationally recognized principles and attributes of a harm reduction approach. Methods We employed an iterative search and screening process to generate a corpus of 54 provincial and territorial harm reduction policy documents that were current to the end of 2015. Documents were content-analyzed using a deductive coding framework comprised of 17 indicators that assessed the quality of policies relative to how well they described key population and program aspects of a harm reduction approach. Results Only two jurisdictions had current provincial-level, stand-alone harm reduction policies; all other documents were focused on either substance use, addiction and/or mental health, or sexually transmitted and/or blood-borne infections. Policies rarely named specific harm reduction interventions and more frequently referred to generic harm reduction programs or services. Only one document met all 17 indicators. Very few documents acknowledged that stigma and discrimination are issues faced by people who use drugs, that not all substance use is problematic, or that people who use drugs are legitimate participants in policymaking. A minority of documents recognized that abstaining from substance use is not required to receive services. Just over a quarter addressed the risk of drug overdose, and even fewer acknowledged the need to apply harm reduction approaches to an array of drugs and modes of use. Conclusions Current provincial and territorial policies offer few robust characterizations of harm reduction or go beyond rhetorical or generic support for the approach. By endorsing harm reduction in name, but not in substance, provincial and territorial policies may communicate to diverse stakeholders a general lack of support for key aspects of the approach, potentially challenging efforts to expand harm reduction services. |
| first_indexed | 2024-12-10T14:37:37Z |
| format | Article |
| id | doaj.art-04ab2062d57d47c7bbc1156cd92d3c16 |
| institution | Directory Open Access Journal |
| issn | 1477-7517 |
| language | English |
| last_indexed | 2024-12-10T14:37:37Z |
| publishDate | 2017-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Harm Reduction Journal |
| spelling | doaj.art-04ab2062d57d47c7bbc1156cd92d3c162022-12-22T01:44:46ZengBMCHarm Reduction Journal1477-75172017-07-0114111410.1186/s12954-017-0177-7Harm reduction in name, but not substance: a comparative analysis of current Canadian provincial and territorial policy frameworksElaine Hyshka0Jalene Anderson-Baron1Kamagaju Karekezi2Lynne Belle-Isle3Richard Elliott4Bernie Pauly5Carol Strike6Mark Asbridge7Colleen Dell8Keely McBride9Andrew Hathaway10T. Cameron Wild11School of Public Health, University of AlbertaSchool of Public Health, University of AlbertaSchool of Public Health, University of AlbertaCanadian AIDS SocietyCanadian HIV/AIDS Legal NetworkSchool of Nursing and Centre for Addictions Research of BC, University of VictoriaDalla Lana School of Public Health, University of TorontoDepartment of Community Health and Epidemiology, Centre for Clinical Research, Dalhousie UniversityDepartment of Sociology, University of SaskatchewanAddiction and Mental Health Branch, Health Service Delivery Division, Alberta Health ServicesDepartment of Sociology, University of GuelphSchool of Public Health, University of AlbertaAbstract Background In Canada, funding, administration, and delivery of health services—including those targeting people who use drugs—are primarily the responsibility of the provinces and territories. Access to harm reduction services varies across jurisdictions, possibly reflecting differences in provincial and territorial policy commitments. We examined the quality of current provincial and territorial harm reduction policies in Canada, relative to how well official documents reflect internationally recognized principles and attributes of a harm reduction approach. Methods We employed an iterative search and screening process to generate a corpus of 54 provincial and territorial harm reduction policy documents that were current to the end of 2015. Documents were content-analyzed using a deductive coding framework comprised of 17 indicators that assessed the quality of policies relative to how well they described key population and program aspects of a harm reduction approach. Results Only two jurisdictions had current provincial-level, stand-alone harm reduction policies; all other documents were focused on either substance use, addiction and/or mental health, or sexually transmitted and/or blood-borne infections. Policies rarely named specific harm reduction interventions and more frequently referred to generic harm reduction programs or services. Only one document met all 17 indicators. Very few documents acknowledged that stigma and discrimination are issues faced by people who use drugs, that not all substance use is problematic, or that people who use drugs are legitimate participants in policymaking. A minority of documents recognized that abstaining from substance use is not required to receive services. Just over a quarter addressed the risk of drug overdose, and even fewer acknowledged the need to apply harm reduction approaches to an array of drugs and modes of use. Conclusions Current provincial and territorial policies offer few robust characterizations of harm reduction or go beyond rhetorical or generic support for the approach. By endorsing harm reduction in name, but not in substance, provincial and territorial policies may communicate to diverse stakeholders a general lack of support for key aspects of the approach, potentially challenging efforts to expand harm reduction services.http://link.springer.com/article/10.1186/s12954-017-0177-7Harm reductionPolicyContent analysisCanada |
| spellingShingle | Elaine Hyshka Jalene Anderson-Baron Kamagaju Karekezi Lynne Belle-Isle Richard Elliott Bernie Pauly Carol Strike Mark Asbridge Colleen Dell Keely McBride Andrew Hathaway T. Cameron Wild Harm reduction in name, but not substance: a comparative analysis of current Canadian provincial and territorial policy frameworks Harm Reduction Journal Harm reduction Policy Content analysis Canada |
| title | Harm reduction in name, but not substance: a comparative analysis of current Canadian provincial and territorial policy frameworks |
| title_full | Harm reduction in name, but not substance: a comparative analysis of current Canadian provincial and territorial policy frameworks |
| title_fullStr | Harm reduction in name, but not substance: a comparative analysis of current Canadian provincial and territorial policy frameworks |
| title_full_unstemmed | Harm reduction in name, but not substance: a comparative analysis of current Canadian provincial and territorial policy frameworks |
| title_short | Harm reduction in name, but not substance: a comparative analysis of current Canadian provincial and territorial policy frameworks |
| title_sort | harm reduction in name but not substance a comparative analysis of current canadian provincial and territorial policy frameworks |
| topic | Harm reduction Policy Content analysis Canada |
| url | http://link.springer.com/article/10.1186/s12954-017-0177-7 |
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