1. Drug Use:
Stigma, Stereotypes and
Harm Reduction
Updated: July 2015

2. Goals and Objectives
• Gain a better understanding of the negative
effects of stigma on people that use drugs.
• Reflect on the how stigma and stereotypes are
generated.
• Examine ways in which access to and provision
of services can be affected.
• Consider ways to reduce stigma and improve
the well being of people that use drugs.
• Briefly look at the philosophy and practice of
harm reduction.

3. 3
Group Guidelines
Purpose:
•To build a safe, respectful, and supportive learning environment for the workshop.
•Some of you have chosen to be here, while some of you have been mandated to be
here by your work.
•We value diversity and learn from comparing and contrasting experiences.
•Some participants may have a personal connection to the issues we will be
discussing and we should acknowledge this.
•Everyone participates in their own way.
•Risk taking and self-disclosure is encouraged and supported.
•Everyone has the right to pass.
•All voices are heard.
•Use “I” statements.
•Everyone uses their own strengths and resources.
•One person speaks at a time.
•Confidentiality is maintained but not guaranteed. (context of coworkers and people
you know outside of work)
•Learning is a process. Open yourself to the possibilities.
•Step Up, Step Back

4. 4
What do you notice about these pictures?

5. Stereotypes, Stigma & Discrimination
• Stereotype
– Over-simplified generalization about a group –
generating judgement / prejudice
• Stigma
– A statement about a person / group based on
overgeneralization – often disapproving
• Discrimination
– Denial of social participation / human rights

6. Anonymous Survey
• Consider the following statements…
• There are no right or wrong answers.
• We are not collecting your responses and
you do not need to put your name on the
handout.
From HRC (http://harmreduction.org) Adapted from Using Harm Reduction to
Address Sexual Risk with Drug Users and Their Partners, HIV Education
and Training Programs, NYSDOH AIDS Institute, by Joanna Berton
Martinez, August 2009. Some of the statements on this exercise were
borrowed from Project Implicit and their Implicit Association Tests,
https://implicit.harvard.edu/implicit/

8. Consider the following statements. Either in your head, or
on paper, mark the box that most accurately reflects your
response to the statements below.
Strongly Agree Agree Disagree Strongly Disagree
• Although I don't necessarily agree with them, sometimes I have prejudiced feelings
(like gut reactions or spontaneous thoughts) toward drug users that I don't feel I can
prevent.
• I understand the experience of being stigmatized as a drug user.
• Sometimes I am uncomfortable around people who are very different from me.
• It is not appropriate for me to talk about my drug and alcohol use with clients.
• I trust drug users just as much as I trust non-drug users.
• If a woman is pregnant, she has a responsibility to stop taking drugs.
• Drug users have a difficult time practicing safe sex consistently.
• Drug users have meaningful participation in developing policies and programs at my
organization.
• I know how to avoid language that stigmatizes drug users.
• Although it is hard to admit, I sometimes judge people who cannot stop using drugs.

9. People Who Do “Drugs”
• Drug use is a powerful source of stigma and
discrimination.
• The stigma attached to drug use may be
reinforced by the fact that it is an illegal and
covert activity, and that there is no legal
protection available to people who use drugs.
• There are also stereotypes of drug users, such -
“junkies” and “bad” when in fact many drug users
are employed, bring up families, are financially
stable, are good neighbours and good friends.
• Alcohol as a drug?

12. “Hierarchy” of use and stigma…
• Which drugs and which drug users are:
– Most stigmatized?
– Least stigmatized?
– Why?

13. Judgments can be based on…
• Class of people
• Race of People
• Legality
• How they are taken (smoked; injected; snorted…)
• Frequency of use
• Impact on personal health
• Impact on social circles
• Personal experience
• Media – i.e. Bath Salts

14. People Who Use Crack Cocaine
• People of all income levels use crack for a
variety of personal and systemic reasons.
• Ongoing myths and misconceptions that
characterize crack users as chaotic and
dangerous, coupled with the realities of a
powerful addiction that can be difficult to control,
have contributed to the intense stigmatization
and marginalization of people who use crack.

15. People Who Use Crack Cocaine
Homeless adults who use crack face discrimination and
poor treatment from service providers.
• 50% of homeless adults who use crack said they had been judged
unfairly or treated with disrespect by a health care provider in the
past year.
• The most common reasons people felt they were discriminated
against were because of their use of alcohol or drugs or because
the health care provider thought they were drug-seeking.
• 24% of homeless adults who use crack reported having had at
least one negative experience with hospital security, including
being told to go away, verbally assaulted, physically removed or
beaten up.

16. People Who Use Injection Drugs
• Prejudice and discrimination against IDUs
makes those not yet infected with HIV and
HCV more vulnerable, facilitating the
transmission of HIV and HCV infection.
• People who have acquired HIV through
injecting drug use face a double stigma:
– They are marginalized and discriminated
against on the basis of their drug use, as well
as their HIV status.

17. Ontario Crack Use Data
- OHRDP Wave I

18. Ontario Needle Exchange Data
- OHRDP Wave I

19. Ontario ITRACK Data (2014)
Frequency of injecting in previous month:
Once in a while (not weekly) 22%
Once or twice a week 17%
Three or more times a week 17%
Every day 31%
For those injecting daily, # of times per day:
1 time 9%
2-5 times 59%
6-10 times 19%
10 or more time 13%

20. Forms of Stigma
The next few slides are adapted form
The Harm Reduction Coalition (harmreduction.org)
Group Exercise

21. Stigma from Individuals/Society
• Labeling and avoidance
− People lock up their valuables when a drug
user comes over.
− The person on the street is called a “crack
head”.
− People assume “junkies” don’t care about
their health.
− Families / friends disown people or cut them
off…

22. Toronto Drug Strategy Survey
• “My brother doesn’t want to talk to me because I’ve used
[drugs].”
• “I’m outcast from the family because I’m an alcoholic.”
• “Your mom, your dad, your brother, your sister… they
say you’re a worthless piece of crap, and they want
nothing to do with you.”
• “My family, that’s where I get it all from. I’m a whore, I’m
a thief, I run the streets, I’m a crackhead, I’m dirty, I’m no
good."

23. Institutional Stigma
• Employers & co-workers believe people who use
drugs won’t be reliable / are untrustworthy.
• Landlords believe people who use will be a
problem
• Healthcare providers:
• Believe drug users aren’t reliable for treatment (re-
infection; won’t comply with medications)
• Emergency departments believe people are “just drug
seeking”
• Stigma  Discrimination

24. • “They won’t even give you a pain killer because they
take one look in your eyes and say, “Oh, you’re a
druggie.”
• “When you have alcohol and drug problems, it’s hard to
get housing…unless you can get it by doing paper work
only – if they don’t see you.”
• “I’ve been thrown out of the hospital. I’ve been thrown
out in a hospital gown by security guards.”
• “When I walk outside, the police jack me up because I’m
a drug user. It’s not right.”

25. Self Stigma (internalized)
• Asking for help means admitting to themselves
and others that they are one of those ‘hopeless
addicts’ and acquiring that label and all that goes
with it.
• It’s my fault, I’m diseased, bad, what’s the point
of doing XYZ (housing, medical care, drug tx,
etc.)?

26. Stigma by Association
• HCV+ = drug user
• Go to HCV support group = drug user
• Access needle exchange = drug user
• Working with drug users = stigma
• Drug user in the family = stigma

27. • “Sometimes being black, you can’t be
chillin’ with people on the street. ‘Cause on
my street, if I’m seen chillin’ with certain
white people the cops would just pull me
aside and see if I’m selling crack or
something.”
• “I’m Native and they assume I have an
alcohol problem. They figure I’m a
drunken Indian, which is pretty awful.”

28. Key Elements of Drug Related Stigma
• Blame and make moral judgments
• Criminalize
• Pathologize
• Patronize
• Fear and Isolation

29. Key Elements of Drug Related Stigma
• Blame and moral judgment
• “just say no”; your own fault for getting HIV / HCV;
weak-willed; you don’t care
• Criminalize
• drugs = bad  get tough  punish
• Incarcerating drug users for non-violent crimes vs.
resources for supportive services
• Pathologize
• something is wrong with drug users; they can not help
themselves…

30. Key Elements of Drug Related Stigma
• Patronize
• Drug users often told what they should do, or what
they need, as opposed to seeking input and involving
them.
• Fear and Isolation
• Drug users are “scary”;
• Fear-based public education campaigns;
• People afraid to talk about drug use; HIV; Hep C
• People become isolated, hide their behaviour, or are
not honest with families, friends or professionals,
such as doctors or counsellors

31. “Once a junkie, always a junkie.”
Stigma
Stereotypes/
Labels
Expectations/
Roles
Limited
Opportunities
Internalized &
Reinforced
JulianBuchanan,SocialInclusionUnit,GlyndwrUniversity,
Wrexham,LL112AW
Cycle of Drug-Related Stigma

32. “Once they put it in your head so many
times, you hear it over and over. It’s like a
recording in your head that won’t stop.
Like, “I’m a crackhead, I sell my body.”
Once you keep hearing this recording over
and over, this is what you start to believe.
You start to believe this is what you are,
and you’re worthless.”

33. Implications for Clients and Providers
• Willingness to access services
• Risk and behaviors
• Self-worth
• Relationships and trust

34. Willingness to Access Services
• Discourages access to prevention,
testing, case management, health
care services.
• Feelings of shame and
worthlessness also prevent people
accessing treatment because they
feel they are ‘not worth bothering
with’.

35. Risk and Behaviors
• Less likely to access prevention services; don’t
disclose drug use to health/social service
providers; discourages disclosure of HIV/HCV
status.
• Increases risk for overdose if people use alone.
• For people who can “pass”, the potential stigma
means they may have even less access to
services than people who are so stigmatized
already that they “don’t have anything to lose”.

36. Self-Worth
• Less likely to make changes around
reducing harmful behaviors, making
other positive changes such as
reducing use, finding housing or
accessing medical care.

37. Relationships and Trust
• Assumptions are made by health and
social service providers:
– e.g., they won’t show for appointments; be
adherent with treatment; follow through with
referrals; abide by rules of agency
• These reinforce stigma, lower
expectations, and present barriers to
recovery and reintegration:
– e.g., don’t call them back; hard to find a job

38. Funding
• Stigma effects political will to provide
adequate funding and programs for
people that use drugs, especially
IDUs:
–They’re getting HIV/HCV even with
education; Shouldn’t they know better?;
If they don’t care/why do we?

39. Drug Related Stigma
http://harmreduction.org/issues/drugs-drug-user

40. Things we could do…
• Move from models of “treating” and fixing people
to listening to people, and creating space for
inclusion
• Put a human face on the issue of substance use
• Train and educate professionals about
substance use
• Educate the public about substance use
• Change our language
• Use art to reduce stigma
• Build on existing efforts
www.toronto.ca/health/drugstrategy/reportsandfactsheet.htm

41. VIDEO
“Count the Costs Series: Promoting Sigma
and Discrimination”
- Hungarian Civil Liberties Union
http://drogriporter.hu/en/stigma

42. VIDEO

43. Thinking about your own use.
• Take a few minutes by yourself to answer
the following questions.
• Then discuss your responses with
someone else.
• Remember to respect each other’s privacy
and only share what you feel comfortable
with.
Adapted from “Under the Influence”, Canadian AIDS
Society, 1997

45. Working by yourself,
answer these questions:
• Do you drink /use substances? If so, where, how much,
how often, for what reasons? If not, why not?
• What did you learn about substance use when you were
growing up?
• What are your attitudes now about substances?
• What do you experience when you see a man under the
influence of a substance? A woman? Is there a
difference?
• How do you distinguish between social drinking, the use
of alcohol in moderation and heavy drinking? Do others
have a different way of measuring?

46. • With a partner discuss your responses to part A.
Respect each other’s privacy and share only
what you feel comfortable with. Here are some
questions to guide the discussion:
– What have you learned about yourself regarding your
attitudes, values and beliefs about substance use and
sex?
– How did you feel responding to these questions?
– How do you think your client might feel when you ask
questions about their substance use and sexuality?
– Have you identified any biases? If yes, what can you
do about them?
– What are you most uncomfortable with?
– Are you aware of what you do not want to share and
why?

47. Drug use is influenced by
many factors

48. Continuum of use
• No Use - the person does not use particular substances.
• Experimental Use - the person tries a substance and may or may
not use it again.
• Social or Occasional Use - the person uses the substance in an
amount or frequency that is not harmful (e.g., drinks on a social
occasion; ceremonial use).
• Medication (prescribed) - the person uses a medication as directed,
under medical supervision. Risks are minimized.
• Problematic Use - the person experiences negative consequences
from using a substance (e.g., health, family, school, work, financial,
legal problems).
• Dependence - the person is psychologically and/or physically
dependent on a substance and continues using, despite experiencing
serious problems. Withdrawal symptoms may exhibit if use stops.

49. • People do not automatically move along the continuum.
• Some people may stay social users for their entire lives.
• Some people can move around the continuum over time.
• People can be at different points of the continuum for different
substances.
• Where a person is on the continuum, does not necessarily impact
her/his ability to manage and minimize risks. For example:
• Someone that is “heavily addicted” may still use new equipment every time.
• A long time cocaine user may overdose.
• A social user may overdoes or spend too much.
• For people struggling with dependency, not using for a while, then using
again (sometimes referred to as “relapse”) is the norm.
• The reason(s) people start to use are not always the reason(s) they
continue to use.
Notes about the Continuum of Use

50. Another Perspective

51. 51
Stages of Change
MAINTENANCE
ACTION
PRE-
CONTEMPLATION
CONTEMPLATION
PREPARATION

52. Drug, Set and Setting
Three interrelated factors affecting substance use:
• The substance being consumed (Drug)
• The person taking the substance (Set)
• The context in which it is taken (Setting)

53. Drug
What substance(s)?
• The specific pharmacology of the substance(s)
– Effects on physiology and neurochemistry.
– Half-life: How long does it take the body to eliminate it?
• How much is taken
– Potency.
– For some drugs you can take tiny amounts, others require a lot.
• How it is taken (route of administration) affects:
– How quickly the feeling “comes on”.
– How intense it feels.
– How long it lasts.
• Quality of illicit substances
– It may be hard to know what you’re getting; the ingredients can include
anything. What are they cut with?
– A dealer may say a substance is one thing but sell something else.
– It may look like the stuff from last time but it might be stronger or
weaker, or have different ingredients.

54. Set
Who is taking the substance?
• Size and body weight.
• Physical, mental, psychological state.
• How tired they are.
• Their mood before they use.
• Their reason(s) for using.
• Genetics.
– How does their body metabolize drugs?
• Experiences with this or other substances.
– Tolerance; Habituation; Sensitization
• Expectation, or anticipation, of how the substance will
feel or effect them.
• Did they eat recently if swallowing a drug?
• Are they using other substances at the same time?

55. Setting
What context is it being taken in?
• Where are they?
– Alone; with friends; with strangers?
– Indoors or outdoors?
– Quiet setting or lots of people and noise?
• What time of day?
• What type of music is playing?
• Rules and regulations.
– Community and social attitudes towards certain
substances or ways or taking them.
– The legal status of different substances.

56. Drug : Set : Setting
DRUG
SET SETTING
Upper/Downer/Hallucinogen/
Strength/Purity/Cost
Physical
location/ Who
else is there/
Socio and
cultural norms
Psychological
state/ Physical
size and health/
Reason(s) for
using/ Financial
situation
Experience
& Risks

57. Routes of Administration
• Different methods of administration affect the intensity and
duration of the high, and pose different advantages and risks.
• Smoking / Inhaling
• Injecting
• Intra-venous
• Intra-muscular
• Subcutaneous
• Insufflation (snorting) / Hooping (suppository)
• Sublingual (under the tongue)
• Transdermal (through the skin)
• Swallowing / Ingesting
• Placebo effect / Contact high

58. Smoking / Inhaling
Concerns:
- Burns to lips and mouth
(with certain substances
e.g., crack).
- Damage to lungs and
airways.
- Quick ‘come-on’ can
increase the ‘rush’ and
potentially makes using
more addictive.
Advantages:
- Easier to titrate dose.
- Effects felt rapidly.

59. Injecting Concerns:
- Infection through re-using or
sharing equipment.
- Abscesses.
- Easier to overdose.
- Finding a safe space.
Advantages:
- More “bang for buck”.
- (More intense high.)

60. Snorting / Hooping Concerns:
- Sharing straws, bills and
bumpers can transmit all
types of germs from the
common cold and flu to
Hepatitis C.
- Damage to
nasal/anal/vaginal
membranes.
Advantages:
- Quicker and easier to
administer.

61. Swallowing Concerns:
- Harder to measure dose.
- Drugs are absorbed more
slowly through the gut
therefore the positive and
negative effects of the drugs
tend to be less extreme;
however, they tend to last
longer.
Advantages:
- The risk of getting HIV or
the Hepatitis C virus (HCV)
is greatly reduced (almost
no risk) from swallowing a
drug.

62. How can we address drug use?
• Some communities have developed strategies to
address issues relating to substance use.
• These typically have “4 pillars”:
• Prevention
• Harm Reduction
• Treatment
• Law Enforcement
• All four are needed to effectively respond to
substance use issues.
• Funding heavily weighted to Law Enforcement
– 70-90% of budgets

63. •Needle exchange
•Detox
•Drug Treatment
•Mental Health
•Social Workers
•Medical Care
•Housing
•Food
•Employment
•Police
•Courts
•Prisons
Which approach is likely going to be more helpful?

64. Resources and Priorities

65. Currently (since 2006)
• Impact of localized/municipal policies
– e.g., uneven distribution of safer crack kits; problems
establishing methadone clinics
• Federal (Canadian) Anti-Drug Strategy
– Changes to policies and legislation
• e.g., cancellation of safer tattooing project in prisons
– Changes to sentencing for drug related crimes
– Research, political and scientific debates
– Example of current prevention (not4me.ca)
– CSSDP mirror site: not4me.org

66. Harm Reduction?
Media and Public Perception

67. Harm Reduction as we know it...
What is Harm Reduction?
Our own personal Harm Reduction....

68. 68
Harm Reduction as we know it…
• Sun Screen
• Condoms
• Seat belts
• Bicycle Helmets
• Designated driver
• Blood alcohol levels
• Nicotine patches/gum
• Needle Exchange

69. Harm Reduction?
• Limited understanding and
misconceptions
• For example: Needle exchange
– Not just needles
– Many other services and connections
• Programs; policies; practices
• Programs and supplies are tools for
engagement
• It’s a philosophy...

70. What Harm Reduction is NOT
• About abstinence
• A stepping stone to abstinence
• Anti-abstinence
• Value based about drug use
• The best response for everyone
• Does not say that drugs are good

71. What Harm Reduction IS
• About social inclusion
• About
• Practices
• Programs
• Policies
….All aimed at reducing harms associated with drug use
• About legal AND illegal drugs
• Founded on public health and social justice
• Founded on knowledge that many drug related
problems are the result of failed policy & laws
• Founded on principles of respect
• Requires us to think systemically
(Canadian Harm Reduction Network)

72. Harm Reduction Initiatives
• Street Outreach
• Education, providing achievable options
• Supplying condoms
• Moderate/Controlled using strategies
• Needle Exchange and Safer Inhalation Programs
• Tolerance zones (e.g., Supervised Injection Sites)
• Methadone Maintenance Programs
• Prescription of heroin and other drugs (e.g., NAOMI)
• User groups, peer support
• Law-enforcement cooperation

73. Harm Reduction Practice Tips
• Be non-judgmental and self-aware.
• Be patient with yourself and the client.
• Be realistic in your expectations.
• Listen well – actively and empathetically.
• Remember you are witnessing their important events
and struggles. You will be affected.
• Regular participation in the harm reduction process can
reduce “magical thinking” or dissociative behaviours
associated with substance use.
• Create an opportunity for the client to think of
themselves as part of a community.

74. Harm Reduction Practice Tips
• Interventions that imply pathology or require the wearing of labels
are not useful.
• Keep asking what’s working and why? What doesn’t and why not?
Who is being reached? Who is not?
• Experience tells us that a higher level of participation by the client
(over time) often means more sustained change.
• Be objective, reflective, a mirror. Resist evaluating or projecting.
• Ask yourself: What do you want to achieve? What do you want to
prevent?
• Ask the client: What do you want to achieve? What do you want to
prevent?
• Empowerment adds to peoples’ skills and abilities.

75. Key Points
• Focus on risks, not the substances.
• Focus on ways to reduce the risks, which
may/may not include stopping the
substance use.
• Focuses on “any positive change”.
• Support client’s right to choose their
goal(s) to reduce risks.
• Treat your client the way you would want
to be treated.

76. Harm Reduction
PWUD’s
Professionals

77. Professionals
• Harm reduction kits
• Supports /
Counselling
• Health care
• Referrals
• Non-Judgment
• Money
• Access to drugs
• Safety
• Drug quality
• Preventing sickness
• Preventing overdose
Individual
People who use

78. • Public Health (HIV /
Hepatitis C, STI’s)
• Reducing risks in
community (safety,
crime)
• Spaces to connect with
other people who use
• Employment
opportunities
• Meaningful
engagement /
participation
• A sense of belonging
Community
People who useProfessionals

79. • Advocating for ODSP / OW
• Support with housing rights
• Support with access to
services (i.e. healthcare)
• Advocating within the legal
system
• Advocating when
discriminated against
• Having a voice to create
change in systems that
are discriminatory
• Being actively political
• People who use drugs
educating those who
provide services so that
we can challenge
systems that cause harm
Political / Systemic
People who useProfessionals

80. Harm Reduction Strategies
Emphasize practical, short-term improvements,
whether or not they can be shown to reduce drug
use:
• Injecting daily but getting connected to a doctor for the
first time.
• Still smoking crack daily but now using own pipe and
not sharing.
• Showing up to 2 appointments out of 4, versus never
coming in before.
• Learning to eat soft foods when high.

81. “Risk Reduction”
Self-directed strategies that can help people
avoid:
•overdoses
•bad highs
•negative health effects (e.g., dehydration)
•missed commitments
Adapted from: “Greenspan, N.R., et al. “It’s not rocket science, what I do”: Self-directed
harm reduction strategies among drug using ethno-racially diverse gay and bisexual men.
International Journal of Drug Policy (2010), doi:10.1016/j.drugpo.2010.09.004”

82. 5 Risk Reduction Tips
1. Rationing
2. Rules for selecting and mixing
3. Controlling quality
4. Following guidelines during use
5. Maintaining a healthy lifestyle

83. Rationing
• Limiting or regulating the quantity and/or
frequency of use in a particular setting, or
over a given time period.
– “I limit myself to two pills a night.”
– “I don’t party every weekend.”
– “I need time to recover before work on
Monday.”

84. Rules for selecting and mixing
• Which drugs you will use.
– Certain characteristics maybe reasons to choose or avoid
specific drugs:
• “It doesn’t leave me hung-over.”; “I can afford it.”
• “I won’t do that because it’s illegal.”; “I don’t like speedy drugs.”
• How you will take them.
– Method of consumption can be a deterrent:
• “I would never stick anything up my nose.”
• Which drugs you can use at the same time.
– Physical harms are often reason to avoid specific drugs or
combinations:
• “If I mix these two I could pass out.”
• “This drug won’t mix well with my prescription.”

85. Controlling quality
• To ensure, as best you can, the quality of drugs
used.
– Obtaining drugs from a “reliable source”
• Get to know your dealer
– Using drugs that have been (safely) used by others
• Ask around: “Peer Reviews”
– Trial & error and inspection
• Get to know how drugs look, taste, smell
• Become familiar with how they feel in the body and how
long the effects last

86. Following guidelines during use
• Drinking water when partying
– Especially in hot environments or when physically
exerting yourself
• Using with people you trust and have
experience
– They can help if you have a problem
• Not sharing drug use equipment
– To avoid HIV and Hep C but even common cough
and cold viruses
• Watch out for your drinks
– To prevent deliberate or accidental contamination

87. Maintaining a healthy lifestyle
• Eating, resting, sleeping
• Drinking water
– Not sharing water bottles
• Taking vitamins and other supplements

88. Safer Inhalation Kit
•Alcohol swabs
•Pyrex-glass pipe
•Rubber mouth
piece
•Heat resistant
metal screens
•Chopstick
• Helps prepare
screens
•(Lip Balm)

89. VIDEO: Step-by-step demonstration of safer crack smoking:
http://www.hepcinfo.ca/en/resources/safer-crack-smoking-demo

90. Safer Injection Kit
•Alcohol swabs
•Cookers
•Sterile water
•Cotton filters
•Needles/syringes
•Tourniquet
•Safer injecting
tips
•(Vitamin C)

91. 91
VIDEO: Step-by-step demonstration of safer injection:
http://hepcinfo.ca/en/resources/safer-injection-demo

92. Cannabis Risk Reduction
• Know your source.
• Be careful about mould and bacteria.
• Eating poses lowest health risks, though harder
to titrate (manage) dose.
• Use with people you trust.
• Be mindful of smoking public spaces.
• Avoid getting high and driving.
• Smoking increases risks of pulmonary disease.
– Try a vaporizer instead of smoking.

93. Cannabis Risk Reduction
• Vaporizers offer and alternative to smoking.
• Cannabis is heated to the point THC vaporizes but the
plant material is not burned.
Cannabis before (left) and
after (right) vaporization.
This vaporizer relies on convection
rather than conduction.

94. Vaporizer vs. Smoking
• Vaporizer after 2 months use (left)
• Pipe after 2 weeks use (right)

95. Medicinal Cannabis in Canada
• MMAR
• MMPR
• LP’s
• Compassion Clubs
• Herb/bud; concentrates; edibles

96. Alcohol Harm Reduction
• Managed Alcohol Programs:
• Wet / Damp / Dry
• Shelter Based Alcohol Harm Reduction Programs:
• Hamilton, Ottawa, Toronto, Thunder Bay
• Ottawa Study:
– Shelter-based Managed Alcohol Administration to Chronically
Homeless People Addicted to Alcohol
Canadian Medical Association Journal (CMAJ), 174(1): 45-49, 2006
– Significantly decreased Emergency Department visits and police
encounters
• Listen to a conversation about a program in Thunder Bay, Ontario:
http://www.cbc.ca/video/watch/AudioMobile/Superior Morning/ID=23093

97. VIDEO: Shelter-based Managed
Alcohol Program (Ottawa)

98. How Does My Language Reflect My Values?
• “Drunks”, “Alcoholics” →
– “Alcohol users”, “Individuals with Problematic Alcohol Use”
• “Drug Addicts”, “Junkies”, “Crack Heads” →
– “People Who Use Drugs”, “Individuals Struggling with
Drug Addiction”, “Active Substance Users”, “A Person
Living with an Addiction”
• “Drug Abuse”, “Substance Abuse”→
– “Drug Use”, “Problematic Substance Use”
• “Clean Needles”, “Dirty Needles”
– “New”, “Used”
• “Hooker”, “Prostitute” →
– “Sex Trade Worker”

99. 99

100. Reaching Out
Harm Reduction Programs
are often the first or only
contact “drug users” have
with health or social
service providers.

101. Outreach workers:
•Listen to you
•Provide moral support
•Are someone to talk to
•Are treated like a friend
Outreach Workers
“Someone to listen to me”

102. • The recurring theme of the personal
relationship with outreach workers
– Outreach workers treat you like a person
– Outreach workers are trusted
– Outreach workers are comfortable and friendly
What makes
outreach programs unique?

103. “I am very open with xxx because he makes me feel
comfortable, isn’t judgemental.”
“ Family things and issues. You get a relationship
going and it is easy to talk to them about anything.”
“With life problems – relationships, trouble with
family, relapsing, staying clean, being stressed out,
nightmares.”
Trust with Outreach Workers

104. “I have changed my view from looking at myself
as someone who doesn’t have anything to
contribute or isn’t worth anything . I see myself
as someone who can put back into the
community and can contribute to the
community. I can look for jobs, I can find a job
and contribute; even with my drug use I can
still do things. It has given me back my life.”
Improved self-worth

105. 105
Bill
Bill is a 52 year old gay man who has had HIV
for 18 years. He has had numerous depressions
over those years and has chronic low energy
and fatigue. 8 months ago his roommate
suggested he “smoke a bowl” of crystal meth
to help pick him up. He tried it and got his
apartment cleaned for the first time in months.
Now he is partying regularly with other poz-
guys and having lots of sex for the first time in
years. Bill is now looking to reduce his use but
is having trouble doing that.

106. Contact Us
Nick Boyce, Provincial Director
nboyce@ohsutp.ca
CC Sapp, Acting Director
ccsapp@ohsutp.ca
490 Sherbourne St., 2nd
Floor
Toronto, ON M4X 1K9
1-866-591-0347 (toll free)
416-703-7348 (t)
www.ohsutp.ca