Table 4 Examples of formal harm reduction definitions found within provincial and territorial policy documents

British Columbia (8/10 documents formally define harm reduction)

“Harm reduction refers to policies, programs, and practices that seek to reduce the adverse health, social and economic consequences of the use of legal and illegal psychoactive substances. Harm reduction is pragmatic and focuses on keeping people safe and minimizing death, disease and injury associated with higher risk behaviour, while recognizing that the behaviour may continue despite the risks. It seeks to lessen the harms associated with substance use while recognizing that many individuals may not be ready or in a position to cease use. Harm reduction does not require, nor does it exclude, abstinence from drug use as an ultimate goal. Harm reduction is an essential part of a comprehensive public health response to problematic substance use that complements prevention, treatment and enforcement. A harm reduction philosophy should inform strategies directed at the whole population, as well as specific programs aimed at sub-populations of vulnerable people. Harm reduction acknowledges the ethical imperative of helping to keep people as safe and healthy as possible, while upholding human rights, respecting individual autonomy and supporting informed decision making in the context of active substance use.”—BC Harm Reduction Strategies and Services Policy and Guidelines 2014, p. 2

Alberta (3/4 documents formally define harm reduction)

“Harm reduction recognizes there will always be a portion of the population who will engage in higher risk behaviours, such as the use of unprescribed injection drugs and/or have unprotected sex with more than one sex partner. Harm reduction focuses on reducing or minimizing the harms associated with higher-risk behaviours. Harm reduction helps protect individuals from the most harmful health consequences of addiction behaviours for themselves, their families / partners and their communities, while facilitating referrals to treatment and rehabilitation services.”—Alberta Sexually Transmitted Infections and Blood Borne Pathogens Strategy and Action Plan, p. 19

Saskatchewan (1/3 documents formally define harm reduction)

“Harm reduction: (1) is an approach or strategy that aims to reduce the negative consequences of drug use, rather than to eliminate drug use; (2) can involve programs or policies that are designed to reduce drug-related harm without requiring abstinence or cessation of drug use; (3) promotes incremental improvements in the behaviours of injection drug users that are practical, achievable and ultimately lead to benefits for both users and communities.”—Building Partnerships for Health: A Strategic Planning Framework for Injection Drug Use in Saskatoon, p. 105

Manitoba (1/3 documents formally define harm reduction)

“Harm reduction strategies engage people who are at risk of contracting HIV or hepatitis C, focusing on where they are in their lives. It is a pragmatic approach that recognizes the limitations of abstinence-based approaches for populations with well-entrenched high-risk behaviour patterns. Harm reduction approaches focus on decreasing the negative consequences of high-risk behaviours to individuals, communities and society. Rather than necessarily attempting to have people cease engaging in behaviours that are associated with the spread of HIV (such as sharing injection drug equipment and unprotected sexual contact), it seeks to reduce the potential harm of such activities. These strategies may result in some people abstaining from risk behaviours; however, abstinence is not the primary objective of harm reduction. The focus is on assisting people to change their risk behaviours through education, peer support and opportunity building. Harm reduction strategies can include confidential condom provision; needle distribution and exchange; safe disposal sites for used injection equipment; safe injection sites; a policing focus on drug dealers; and pharmacy, health centre, nursing station and community involvement in needle exchange and sales. They can also include media campaigns focusing on the continuing prevalence and risk of HIV, sexually transmitted disease and hepatitis C infection, prevention and harm reduction activities and the benefits of early testing and treatment in reducing transmission to others and improving quality of life for persons with HIV/AIDS. Harm reduction approaches must recognize and be sensitive to Aboriginal cultural diversity, the traumatic effects of attempted assimilation and the unique aspects of post-colonial cultural revitalization.”—As Long as the Waters Flow: An Aboriginal Strategy on HIV/AIDS. A Component of Manitoba’s Provincial AIDS Strategy, p. 24

Ontario (1/7 documents formally define harm reduction)

“… any program or policy designed to help reduce substance-related harm without requiring the cessation of substance use”—Ontario Public Health Standards, p. 32

Quebec (2/11 documents formally define harm reduction)

“It is impossible to eliminate the use of illegal drugs or the problematic use of alcohol as much as it is to think we can eliminate heart disease or cancer. It is possible, however, to limit or reduce the health and well-being problems as well as the harms that result from the inappropriate use of psychoactive substances. This means that in addition to health promotion and prevention measures, services must be offered to people who use drugs that, without aiming for abstinence or non-use, aim to reduce the harms associated with inappropriate use.” [translation]—Pour une Approche Pragmatique de Prévention en Toxicomanie: Orientations, Axes d’intervention, Actions, p. 25

Nova Scotia (2/4 documents formally define harm reduction)

“Policies, programs, and practices that aim to reduce the negative health, social, and economic consequences (e.g., HIV, hepatitis B and C, overdoses) that may ensue from the use of legal and illegal psychoactive drugs without necessarily reducing or stopping drug use. Its cornerstones are public health, human rights, and social justice. It benefits people who use drugs, families, and communities. It ensures that people who use psychoactive substances are treated with respect and without stigma and that substance-related problems and issues are addressed systemically.”—Review of Nova Scotia’s Strategy on HIV/AIDS: Looking Back & Moving Forward, p. 59

Nunavut (1/2 documents formally define harm reduction)

Using illicit drug use as an example, characteristics or principles of harm reduction are as follows: 1) pragmatism; 2) focus on harms; 3) balancing costs and benefits; 4) priority of immediate goals. Under these four principles there is extensive information included for each. In general, pragmatism, respect and dignity for the person using drugs, focusing on harms, and setting incremental and realistic immediate goals are key aspects of harm reduction that are emphasized. Importantly it is noted that “containment and amelioration of drug related harms may be a more pragmatic or feasible option than efforts to eliminate drug use entirely.” The authors also note this model supports a hierarchy of goals, and abstinence as a possible goal within this hierarchy “Most harm-reduction programs have a hierarchy of goals, with the immediate focus on proactively engaging. Achieving the most immediate and realistic goals is usually viewed as first steps toward risk-free use, or, if appropriate, abstinence for individuals, target groups, and communities to address their most pressing needs.”—Nunavut Addiction and Mental Health Strategy, p. 59