1. Harm Reduction: Needle Distribution A presentation for healthcare staff starting a harm reduction program.
January, 2018

2. Acknowledgement

3. Outline of presentation
History of harm reduction
Leadership
Staff
Types of services
Supplies
Room Set-Up
Stats
Your Approach
Resources
SK First Nations sites
Take home naloxone
Groups

4. Harm reduction beginnings
Started in the 1980s in Europe, then adopted worldwide after that
It refers to policies and programs that aim to reduce the harms associated with drug use
Harm reduction is partly defined by a group of principles in which policies and programs are grounded.

5. principles
Pragmatism: substance use is a common feature of the human experience
Humanistic values: The person’s decision to use drugs is accepted as fact. No moralizing
Focus on harms: rather than the use itself
Priority of immediate goals: decrease risk, and perhaps abstinence if the person desires

6. Leadership Endorsement
Chief and Council need to be aware and educated and in favor of harm reduction
It also helps to have Elders and other natural leaders in the community involved in the program to increase community acceptance of it because some think providing needles is enabling people to use drugs. They would use them anyways and providing a needle helps people use safely and connects them to healthcare.

7. Staff
Important to have a few people, one primary person, and at least 1-2 others to cover or to accommodate if client is related to/has history with the staff person
Key staff requirements: can be almost any background education wise; ability to develop relationships is key; must keep information private

8. Type of services
Most on reserve programs have a site in their health centre
There should be an outreach component for those too shy or unable to get to health centre. A regular vehicle is fine. Secure a large sharps container in back of vehicle so you can pick up sharps containers from clients.
Peers can be used

9. Vending machines are options
Existing locations where people congregate are options for places to distribute needles

10. Supplies
The basic supplies needed are: needles, cookers and/or spoons, alcohol swabs, tourniquets, water for injecting, sharps containers, filters. Always have condoms in room too.
Staff need to understand how the supplies are used
Don’t limit the number of supplies given, and it is ok for people to take for others

11. Don’t bother locking up supplies
Don’t bother locking up supplies. If people take when staff are not looking, they may just not want staff to know they are using
Keep the stat sheet hidden if names are on it
Self serve or staff gives, either way

12. Supplies: no sharing of any!!
Needles: 1 cc diabetic needle
cookers and/or spoons: once crushed, water is added and drug is cooked to dissolve pieces
alcohol swabs: to clean the skin
Tourniquets: to make vein more visible. Don’t want to miss.
water for injecting: to cook up the drug
sharps containers: to dispose of needles in (various sizes)
Filters: after cooking, need to filter
Vitamin C: may be needed if drug does not cook into injectable form with water and heat alone

13. Room set-up in health centre
Need a private room and preferably a room that is easy to get to for clients, and one where they don’t have to walk through whole centre
A desk for staff
Use a system for supplies that it easy to wipe down such as a plastic tower with drawers
Lockable Sharps container room for full sharps containers is ideal

14. Room should look less clinical, more comfortable
Good to have drinks, snacks, coffee
You want to encourage people to come in and visit with you.
Biomed picks up sharps containers (Biomed ph is ).

15. Wipe down desk and supply area surface every day with a disinfectant cleaner such as accelerated hydrogen disinfectants.
The yellow drop boxes can be placed around your community. Biomed empties them. FNIHB can purchase for you. Chief, or Health Director, or Health Councillor to Brett Dow You need a cement pad poured first.

16. Don’t leave cardboard boxes all over your room because they are impossible to clean
Encourage clients to use hand sanitizer after they have handled full sharps containers and before they receive supplies
Staff need to wear close toed shoes to prevent injury such as a needle stick. Never wear open sandals or flip flops

17. Stats
Important to keep daily stat sheet (we have a sample you may use)
Don’t have to write down client names
We want numbers in, out, clients seen
Please report to FNIHB every 4 months

18. Protect people’s privacy
Protect people’s privacy. Never tell names of clients obtaining needles to other staff (unless they are involved in their care), or community members. That is a breach of confidentiality.
Lack of trust in the person(s) working in the harm reduction program is the biggest reason people do not come for needles.

19. Needle distribution is more than just needle distribution
It is first and foremost about trusting, non-judgmental, healthy relationships with clients. They need to feel safe and cared for. Be friendly. Help clients with their day to day needs.
It is about promoting all the services the health centre has to offer; vaccines, testing for HIV and other STBBIs, wound care, mental health, addictions, etc.

20. Guiding Principles
Policies/Procedures for your agency to use. You can modify to suit your needs. See print copy.

21. An important resource you should have
“Best Practice Recommendations for Canadian Harm Reduction Programs that provide service to people who use drugs and are at risk for HIV, HCV, and other harms: Part 1 and 2”
It was written by harm reduction programmers and clients throughout Canada and is THE resource to follow.

22. Pamphlets/posters
Most programs order their resources from CATIE. They are excellent, and free.
CATIE’s toll free number is , and their website address is

23. SK First Nation Harm Reduction Sites
19 to date
Ahtahkakoop, All Nations Healing Hospital in FQ, Beardy’s & Okemasis, BRT6, Big River, Cote, Fishing Lake, Keeseekoose, Kinistin, LacLaRonge, Mistawasis, Montreal Lake, Muskeg Lake, Muskoday, One Arrow, PBCN, STC Urban, Sturgeon Lake, Yellow Quill

24. Take home naloxone training
Naloxone is used to reverse an opioid overdose. We can provide you with training for staff and clients. Consider training clients yourselves once you are comfortable.

25. Consider forming a group
Such as like Grateful or Dead in Calgary
See website (Alberta addicts who educate and advocate responsibly)
Gives clients purpose and skills

26. Main messages Leaders need to approve
Relationship between staff and client very important: warm, confidential
Have outreach as part of your service
Do not limit number of supplies given
Make it easy for people to return/dispose of used needles
Involve clients in the program in a meaningful way
Main messages