Harm Reduction continues to be one of the biggest challenges facing the health and homelessness sector during COVID-19. Reduced access to safe injection sites, social distancing mandates and limited PPE equipment have made providing Harm Reduction support increasingly challenging for front-line workers.

In response to this challenge, the COH partnered with Harm Reduction expert Bernie Pauly to host two Harm Reduction webinars, and a Q&A blog series based on critical questions posed by the audience during these webinars. 

Below is the second in the Q&A series, which focuses on approaches to Harm Reduction during COVID-19. 

Q: Is there a name or term for a policy that supports some Harm Reduction efforts but not all? For instance: our drop in provides safe use supplies, and our community members can be in the space under the influence. However, use on site is not permitted. - Jaclyn S

A: Yes, we call this partial implementation of Harm Reduction. More specifically, “limited Harm Reduction.” This approach creates contradictions and mixed messages. For more information on this topic, see “Turning a Blind Eye” or “Sheltering Risks" paper. Please pm at bpauly@uvic.ca for copies. 

Q: What Harm Reduction approaches can be effective for people experiencing homelessness who use smoked drugs? - Gabriella B

A:  Given the potential of overdose even with smoking, inhalation tents and buddying up are important. Also, safer smoking supplies (pipes etc.) to reduce transmission risk of COVID are helpful.

Q: My workplace (public center, now closed) is considering putting out outdoor hand-washing and portable toilets. Are there any harm reduction issues with outside washroom access re: sanitation or safety? We have an outdoor sharps bin, and security staff that could be nearby. - Sheena J

A: Great question. I would definitely refer this one to my colleagues in the field and happy to connect you! There is the need for ongoing maintenance and support to ensure that the stations are being maintained in a way that prevents COVID; such as foot activation and maintenance of waste water. 

Q: Oximeters may be an important tool in identifying respiratory complications related to COVID pneumonia. To what extent can common opioid response tools be used to also identify when people may need to be transferred to hospital or differentiate between opioid use vs. COVID infection. - Alina M

A:  Such an excellent question. It is often hard to tell the difference between an overdose and symptoms of COVID. Regarding using oximeters: they provide a measure of oxygen saturation, so can be an indicator in general that the person is needing more support. I would suggest if you have access to healthcare provider (e.g. nurse or doctor) have them provide some education/support for using oximeters as part of the assessment and making decisions about when to transfer a person. 

Q: Hi Bernie...wondering if there’s research about whether people are more likely to use “safer sources” vs. street sources if “safer sources” are made available? I know, for example, even though cannabis is now available people are still buying off of the street instead. - Victoria W

A: When people are provided with an appropriate safe supply, illicit use decreases or can be eliminated. However, there is much to learn about effective implementation. Your second question re: cannabis is important and points to the unintended consequences of legalization and the pricing that comes with it. The cost of purchasing retail cannabis is too high for many living on very low incomes and in poverty.  So usually one of the reasons for purchasing outside of the retail market is cost.  Another is related to type of product and what individuals need and prefer. 

This is the second of a Q&A series with Harm Reduction expert Bernie Pauly from the University of Victoria and the Canadian Institute for Substance Use Research. Look for the third blog coming shortly! If you have any additional questions, don’t hesitate to post on the forum of the Homelessness Learning Hub and our experts will get back to you.