Harm Reduction Is Not Just A Hashtag: Hamilton dialogue report

Developing long-term solutions to the drug poisoning crisis in our community.

Getting to Tomorrow Hamilton

Brought together by witnessing firsthand the consequences of failed drug policies, 47 members of the Hamilton harm reduction community gathered to talk, share, and collaborate on moving forward with a human rights approach to drug policy. From these conversations, it was clear that Hamilton is a city of community collaboration. Participants of the conversations included people with direct and lived experience of drug use, including those that have experienced criminalization and stigma as a result of policy failures, along with front line service providers, health and medical professionals, civic employees, researchers, members of Hamilton Civic Police Service, and more.

Hosted by Keeping Six, The AIDS Network, the Morris J. Wosk Centre for Dialogue, and the Canadian Drug Policy Coalition, these two half-day events revealed tremendous insight, strength and resilience in a community suffering the grief of preventable loss. While health care systems sprang into action to contain the Covid-19 threat, those left to tackle the crisis of drug poisoning felt isolated and forgotten. As the death toll mounted, grassroots networks and agencies were strengthened by their collaboration and commitment to keeping people alive, despite seeing a lack of support from more official channels. That being the case, there was still tremendous hope that this support would be forthcoming. The overarching sentiment at the dialogues indicated that the harm reduction community in Hamilton looks forward to a time when all sectors of the city work together to improve the lives and wellbeing of each and every person, and in particular, people who use drugs and their communities who have borne the brunt of drug policy failures.

What’s Working? “Allowing people to be people is what is working.”

Collaboration: There is a lot going on in Hamilton that the community can be proud of, and in particular it was overwhelmingly clear that the collaboration between organizations was robust and strong. It was frequently mentioned in the discussions that the high level of advocacy, particularly by Keeping Six, for the dignity and rights of People with Lived and Living Experience (PWLLE) of drug use was persistent and effective. It was mentioned more than once that the relationship with a small group of medical professionals, such as doctors and pharmacists, was both excellent and a point of pride in working to advance the well-being of PWLLE in a manner informed by human rights and health-based practices.

Support: It was clear that extensive support for a local homeless encampment and its residents was noticed and appreciated by all in attendance. This hard work has clearly provided the platform for inter- agency collaboration on both material support and systemic advocacy. Of particular note, one dialogue participant said “I appreciate the level of compassion from clients that we encounter in the street. I get lots of calls from councilors asking us why can’t we tear down encampments. I answer: because they are human beings. It is not a police issue it is a societal issue, mental health issue. This is something collectively as a society we need to work together on.”

Success: The imminent opening of a Consumption and Treatment Services (CTS) in Hamilton was mentioned in more than one group as evidence for the level of collaboration and commitment that sectors of the Hamilton have when it comes to advancing a human rights approach to public health and drug policy. Other new and effective services were mentioned, including the work of Keeping Six, The AIDS Network and Grenfell Ministries, in particular two initiatives: The National Overdose Response Service (NORS), and C.O.A.C.H (Community Outreach Action Collaborative Hamilton). There was also discussion about the growing acceptance in Hamilton of harm reduction generally, and harm reduction services specifically. In both instances, this growth was attributed to the advocacy of a number of front line social services agencies, and Keeping Six, in particular.

“Victim Blaming and aggressive attitudes”

While there is much to be proud of, those in attendance were clear that there are significant and dangerous gaps which threaten the health and safety of PWLLE. At length, dialogue participants found common ground in those persistently difficult areas that seem to allude clear-cut solutions. As the above quote infers, victim blaming and aggressive attitudes on the part of many of those tasked with providing support and care to Hamilton’s most vulnerable was described as commonplace, with participants noting this ultimately runs contrary to the principles of harm reduction.

Other commonly mentioned issues were:

“Might be okay, but not here”

In reference to a widely accessible safe supply program, it was made clear that despite the successes of this harm reduction measure both in Hamilton and elsewhere, the availability of safe supply in Hamilton falls grossly short when compared with the need. Further, it was clear from the conversations that there was little hope, given the presence in Hamilton of those in opposition to these life-saving measures, that this service would be significantly expanded. As one participant noted: “safe supply isn’t getting me high, it’s getting me normal.” This is true for many safe supply program participants, though without significant economic and political support from a number of pertinent bodies, the possibility of change can seem bleak. One participant pointed out:

“Hamilton isn’t really ready for the conversation.”
“We need leadership from the top and a plan.”

In each of the five break out groups, a discussion took place emphasizing the need for proactive and humane leadership from the Hamilton City Council. Expressing disappointment at the lack of political representation from the City Council at the Dialogue, it was suggested by dialogue participants that perhaps this was due to recent conflict over community support for a homeless encampment in the city. It was identified that a more collaborative, productive relationship with local elected officials could be very beneficial in advancing a human rights-based approach to drug policy. It must be noted, however, that a number of Dialogue participants expressed significant doubts about the possibility of meaningful collaboration and felt there was little hope at present of this occurring.

Stigma is alive and well

As has been raised in previous dialogues throughout Canada, there are significant and dangerous barriers to accessing public services and facilities, and chief among those barriers is stigma. Citing rudeness, condescension and hostility, service users and allied support workers cited an absence of ongoing, peer-informed anti-stigma training in front line health and social service agencies. Likewise, it was noted that poor leadership, and policies that are inconsistent with the tenants of harm reduction, are creating an atmosphere of stigma that is harmful for the health and wellbeing of clients, and is utterly preventable. One participant noted that even if a social service agency is handing out harm reduction supplies, if the service provider is rude to users, service users will not want to access services in an environment where their dignity and personhood is not upheld.

While the three above segments were the most commonly discussed topics during the event, it should be noted that there existed a plethora of other frustrations and concerns. Speaking up and advocating for change without reprisals from funders and/or the city was discussed in two groups. Other commonly mentioned concerns were:

  • Lack of supportive housing
  • Lack of free, trauma informed counselling for services users
  • Lack of cohesion within front line agencies claiming to practice harm reduction, including no standard of community practice of harm reduction
  • The harm caused when police are called to intervene in a mental health crisis, and
  • The seeming lack of training on the part of first responders on how to best work with PWLLE.
Artwork by: Mike Pritchard

Opportunities for Momentum

Hamilton is a community on the edge of change. While all break out groups spent significant time recounting those ways they felt frustrated or harmed by the current provision of health services, or lack thereof, participants were excited to move beyond the now. Participants expressed a desire to collaborate, plan, and act on those ideas and projects that can and do save lives, while seeking to exert a community dialogue on notions of justice and care for all.

Of particular note:

Coordinate and Collaborate. There was both a stated need and desire for collaboration among grassroots organizations for the purpose of advancing a human rights-based approach to public health and drug policy. It was stated that at present, the collaboration that does exist, as good as it is to see, needs a more formal process to prevent burnout and to be more effective in systems advocacy.

Strategy and political will. The need for a cohesive strategy, and the political will to enact it, was identified in the plenary report back session as necessary for sustained advancement of the community will. It was hoped that with persistent collaboration with City Hall, a path forward, would yield results that save lives and promote inclusion

A ‘seat at the table’. There was wide agreement that if the ideas and experiences of PWLLE were respected and included in decision making circles, we would see a measurable difference in the health and wellbeing of people at the centre of the ‘overdose crisis’. It was discussed further in plenary that without the voices of PWLLE in public health circles, the decisions that emerge risk being ineffective and wasteful.

One additional idea that deserves mentioning, as it was brought up in more than one break out group, is the idea of establishing polling stations in shelters and supportive housing. As has been discussed in other jurisdictions, if polling can be adjusted to accommodate other demographics, such as seniors, then perhaps there is room to better enfranchise PWLLE by making voting accessible to them.

About Regulation Project

The Regulation Project is an international collaboration to advocate and educate for the legal regulation of drugs.