Kanna Hayashi | Harm Reduction in an Unprecedented Overdose Crisis

The pandemic has exacerbated an already existing overdose crisis—one we are over five years into as of now. In 2021, Dr. Hayashi explained, we were losing an average of six people a day to drug toxicity. The severity of this number was not understated. But how do we tackle this crisis? Dr. Hayashi suggests we need a combination of treatment and recovery support as well as harm reduction policies, and that focusing on only one is not enough. 

Following this, Dr. Hayashi explained what harm reduction is, adding that her aim was to make her presentation and findings accessible to as wide an audience as possible. In her words, harm reduction is any policies, programs and/or practices that aim to reduce the harms associated with the use of psychoactive drugs in people unable or unwilling to stop. She stresses that the most important part of this definition is that it serves those who are continuing drug users for any reason without expecting or guiding them to stop their use. Instead, the focus is solely on reducing the harm associated with their use and protecting their health.

Dr. Hayashi then pivoted to sharing some of the harm reduction policies and programs currently being offered in Vancouver. She shares that she considers B.C. a leader in harm reduction practices, due to its history and present of strong community activism, especially in Vancouver’s Downtown Eastside. Some examples of these programs include needle exchange programs, supervised injection sites, drug checking programs, naloxone distribution, overdose prevention sites, and expansion of opioid agonist therapy. These programs have contributed to several positive changes, such as increased attendance to supervised injection and overdose prevention sites, increased treatment participation, and decreases in needle sharing and public drug injections. 

But why, Dr. Hayashi asks us, is the overdose crisis worse now? The answer, quite simply, is COVID-19. She explains that with the pandemic closing borders, unregulated street drugs became more toxic due to changes in how and where drugs were trafficked. As well, pandemic closures resulted in lack of access to services and disrupted peer networks. The result of this was that drug users’ needs were unmet, and overdoses skyrocketed. 

As the final portion of her lecture, Dr. Hayashi discussed her recommendations for future harm reduction strategies, specifically framing them to address the places COVID-19 exacerbated already existing gaps in support. Her largest finding is that opioid agonist therapy (OAT) is not serving the purpose it needs to. In brief, OAT is a harm reduction program where primary care physicians prescribe opioids. It is considered the current gold standard in opioid addiction treatment. But COVID-19 made it harder to talk to primary care physicians, resulting in a lack of access to opioids. This impacted 19 per cent of people in Vancouver who were on OAT in 2020. As well, 23 per cent of Vancouver drug users studied were already avoiding health care due to prior mistreatment by health care practitioners. Adding to that, now that we are in year five of the overdose crisis, Dr. Hayashi believes that people’s tolerance for opioids has changed and that the drugs provided through OAT may not be strong enough. 

Therefore, Dr. Hayashi suggests a novel harm reduction approach: prescribed safer supply. Approved by the B.C. government in July 2021, this is Canada’s first permanent safer drug supply initiative and will provide pharmaceutical alternatives to street drugs for the purpose of preventing overdoses. The VIDUS project will evaluate how this approach does in this regard as the program is rolled out. Dr. Hayashi also stressed the importance of community-led safer supply—again highlighting the value of meeting the needs of drug users who are distrustful of medical clinics. 

Finally, Dr. Hayashi ended her lecture by emphasizing the impact of broader issues in contributing to the overdose crisis, such as misogyny, racism, poverty, childhood trauma and the housing crisis, and stating that these are the things we also need to tackle if we wish to engage in truly comprehensive harm reduction work.