Nurses Lead Harm Reduction Efforts Amid Toxic Drug Crisis in B.C.

Nurses on Vancouver Island are increasingly integrating harm reduction strategies into healthcare as the toxic drug crisis intensifies. On December 2, 2023, fourth-year nursing students from Vancouver Island University hosted a harm reduction education panel in collaboration with the VIU Harm Reduction Alliance. The event aimed to raise awareness of the crisis, challenge existing stigma, and create a safer community.

Nursing professor Sarah Lovegrove emphasized the growing relevance of harm reduction within the nursing field. “Even just six years ago when I was practising in the ER, very few nurses practised harm reduction or understood what it meant,” she stated. “Now we’re seeing a new wave of nurses who understand it and are practising from that perspective.” This new cohort of nurses, including students graduating in the spring, will bring valuable knowledge about harm reduction practices to hospitals across the region.

In addition to the panel discussions, third-year nursing students provided training on naloxone, a medication that can reverse the effects of an opioid overdose. This training is a crucial component of harm reduction strategies that aim to save lives in the face of increasing overdose incidents.

Panel speakers included prominent figures in the harm reduction movement. Corey Ranger, president of the Harm Reduction Nurses Association, and Dr. Jessica Wilder, co-founder of Doctors for Safer Drug Policy, shared insights into the evolving landscape of drug use and its implications for public health. Edward Joe, an Indigenous harm reduction educator with the First Nations Health Authority, highlighted culturally sensitive approaches to harm reduction.

Dr. Wilder noted that harm reduction extends beyond illicit substances and can be applied to various risk-laden activities, such as the use of sunscreen to mitigate UV exposure or wearing seatbelts in vehicles. “As a doctor, I am not a judge; it isn’t my place to decide whether or not my patients engage in behaviours that may be harmful,” she explained. “My job is to help them stay healthy, and my patient is the one who defines what healthy means to them.”

The local street drug supply has become increasingly perilous, shifting from heroin to potent synthetics like fentanyl and its analogues, including para-fluorofentanyl, which can induce an overdose with as little as two milligrams. While para-fluorofentanyl can be detected using drug testing strips, another dangerous opioid called nitazenes, found in the street supply, remains undetectable. Dr. Wilder pointed out that benzodiazepines, commonly prescribed for anxiety, are also frequently mixed into the opioid supply, contributing to heightened risks.

“We’ve had instances in our community where over 80 percent of the opioid supply contained benzodiazepines,” she noted. The effects of sudden discontinuation can lead to severe withdrawal symptoms, including tremors and seizures, and can even be fatal.

Dr. Wilder shared data from a patient in Nanaimo who diligently tested his drugs over a month. The results revealed alarming variations in the composition of his opioids. During the first week, his drugs contained 30 percent fentanyl and 23 percent para-fluorofentanyl, along with other substances. In subsequent weeks, the presence of fentanyl diminished, replaced by varying levels of para-fluorofentanyl.

When discussing the challenges of addiction, Dr. Wilder highlighted the physiological barriers that prevent many individuals from simply stopping drug use. “Our current system does not have the capacity to support people who want treatment when they want it,” she explained. “This results in my patients dying while waiting for the resources and supports they need to enter recovery.”

Edward Joe elaborated on the First Nations Health Authority’s initiatives in harm reduction, which include funding community care cabinets stocked with naloxone and offering traditional foods and cultural activities to marginalized populations. He emphasized the importance of connection in combating addiction, stating, “The opposite of addiction is connection.”

Joe noted that in some communities, harm reduction involves bringing cultural practices directly to individuals experiencing homelessness, fostering a sense of community and support.

Corey Ranger addressed the prevalent misconceptions surrounding harm reduction policies, stating that misinformation often breeds fear and opposition. He recounted the story of a former patient who faced multiple overdoses but ultimately found recovery and reintegration into his family life after receiving appropriate support. “Since 2016, there have been 18,000 deaths in British Columbia due to the unregulated drug supply,” Ranger said. “These deaths are preventable and driven not by individual failure, but by political and policy choices that have allowed a highly toxic, unpredictable, illegal supply to flourish.”

As the crisis grows, it is clear that the integration of harm reduction into nursing education and practice is essential. The commitment of nursing students and professionals to adapt and respond to this public health emergency signals a hopeful shift towards better health outcomes for vulnerable populations in British Columbia.