What Harm Reduction Really Means

SPEAKER_01 0:00

The Consumption and Treatment Services or CTS, uh, many people will call this a super advised consumption site, uh, have proven across the country to have saved lives as part of harm reduction. And Talia Storm is the director of the Street Works program in Niagara. Hi, Talia.

SPEAKER_00 0:22

Hi.

SPEAKER_01 0:23

Can we just start uh with what does harm reduction mean? Because I think a lot of people don't understand exactly what that is.

SPEAKER_00 0:33

Yeah, I mean, that's a fair question. And I think people often associate it with the type of work that we do in terms of substance use and harm reduction. But we all practice harm reduction every day, whether that's brushing our teeth, uh, putting on a seatbelt, uh, you know, wearing sunscreen. We just lived through a global pandemic where we had masks and hand sanitizer and social distancing. So harm reduction is really about taking any activity and making it as safe as possible. From our context, of course, that is from a substance use lens. So we are trying to reduce the risk of overdose, the risk of infection. Um, so things like HIV and hepsi, preventing those transmissions, um, reducing abscesses. Um, so it can look very different in many ways. So uh, but in a nutshell, taking an activity and making it as safe as possible.

SPEAKER_01 1:20

Well, I hear people talk about it and they say because you do dispense clean needles, which helps with hep C and HIV and those and those things. And I hear people say, oh, um, they give out handfuls of needles to a single person, and that just means they use more drugs. Is that what is that the ex the experience? Because you do. I mean, you're not just sitting uh at the positive living office on Queenston Street and handing out clean needles. Um talk a minute about um welcoming streets, but is that is that a valid way to look at something? We give them 20 needles and a person 20 needles and that means they're going to use more drugs.

SPEAKER_00 2:07

Uh yeah, that is that is not proven to be the case at all. We need to think about everyone's lived reality. So sometimes people are coming in and they're collecting supplies for themselves and some other people. Um, we see people who use once a week, we see people who use many times a day. It really is dependent on the person. Best practice, um, and the evidence shows that um it is best to give people what they are asking for and what they need. That is always paired with conversation about substance use, about safer substance use. If the person is expressing motivation for treatment, exploring those options, connections to other services, conversations about safe biohazard disposal. Um, but the reality is, you know, some people are trekking across town to uh to come and access supplies. Other folks aren't able to access as frequently, so they might be taking more to last them for a couple weeks. It really is dependent on the person. Um, but it is always paired with conversation about what life looks like for that person and and and also taking the lead on what their goals are. For some folks, they're not ready to explore treatment options yet, and that's okay. I think we can all relate to delaying on calling the doctor or the dentist because we're a little bit nervous about what might come up, or we just don't want to, or we're scared. Um, so you know that that doesn't only happen in those settings, but it also happens for folks who are using substances. Um and if someone isn't ready, that's okay. And we want to keep them as safe and healthy as possible until the time that they uh they choose to to address their substance use, if that ever comes.

SPEAKER_01 3:36

Yeah, and you're located, the office is located on Queenston Street, but you do serve the Niagara region.

SPEAKER_00 3:43

That's right.

SPEAKER_01 3:44

Uh the so I want to talk about uh overdoses and overdose deaths. And you and I haven't discussed this for probably more than a year. Uh during COVID, as you said, there were there were one of the big problems with COVID and harm reduction was that people were encouraged to not be around someone else. And yet, if somebody is um using a substance, it's better to have someone who with them who is not using at that time, in case there is a problem with an overdose issue or some kind of a reaction. There is another person there who maybe could administer naloxone, which reverses the effect of an opioid, uh, call 911. And um so at that time, if I'm if I'm thinking of this correctly, at that time overdose uh trips to the emergency room and overdose deaths were very high. And I I looked today and I was I was so pleased to see that the numbers are well under 100 and they were well over 100. I think, I think in um 2024 during COVID, it was something like 11 deaths per month, and now you're down to I believe five.

SPEAKER_00 5:12

Uh, right now the average in Niagara is still 11 deaths per month. It was as high as 16.

SPEAKER_01 5:17

Okay.

SPEAKER_00 5:18

Um, and I think it's important to remember that deaths are one component of, you know, there's a lot of conversation about the reduction, and it could be because services are more available, people are accessing treatment. Um, the reality is we have also lost a lot of people. And so, you know, there is speculation that is the pool of people using substances smaller, and therefore we're seeing those numbers drop. It's it's it's a very complicated issue when we're looking at data because it can certainly tell a story, but often it's not the full story. Um, and it's tough to speak to those changes. You know, I look at preliminary coroner data for the tail end of 2025, and we saw a big spike again in Niagara. Um, drug trends are constantly changing. So when I started in this field, we were just starting to talk about the one that starts with F and how do you spell it? And it was fentanyl coming on the scene. Um, and today, of course, we still see fentanyl, but we're seeing um we're seeing a lot of other substances too, like metatomidine, for example, causing adverse reactions in folks, and naloxone doesn't work for that. Um, so we are always unfortunately at the mercy of the unregulated street supply, which will always be changing in terms of how strong it is, in terms of how people use their substances, in terms of the impact in the community, and in terms of broader health impact as well. Um, you know, a lot of harm reduction is is in the realm of prevention, which we previously discussed. And we need to think about that in terms of the toll on our EMS services, on hospital services, um, and what that looks like. If we can keep people as healthy as possible, there's a ripple positive impact on the other side for our systems in our community as well.

SPEAKER_01 6:58

Yeah, and the drug, the drugs and the drug supply um ketamine was the uh first sort of horse tranquilizer that um that was showing up. But but uh the when you metadamidine, I have a hard time saying that. But xylene. They're all tongue twisters.

SPEAKER_00 7:16

Xylene metatamine.

Drug Checking And How CTS Works

SPEAKER_01 7:18

But xylene is another one that showed up recently. Uh, I think if people remember back a year or so, um, there were 11 or 12 people who died on in Belleville at almost the same time because of xylene in their in their uh in their supply. Yeah. Which takes us to the consumption site.

SPEAKER_00 7:43

Yes.

SPEAKER_01 7:44

Consumption and treatment site or supervised injection site, as some people know it as. Uh one of the things that you do there is you drug test.

SPEAKER_00 7:54

Yes.

SPEAKER_01 7:55

So you can test for those substances before somebody who comes to the site uses that substance.

SPEAKER_00 8:04

Yes.

SPEAKER_01 8:05

And what what's the reduction in, or I guess how many of those do you catch where there is um someone who comes in and they have xylazine or or anitidine or anything else in the in the uh benzodiazepines, whatever it is.

SPEAKER_00 8:22

Yep. Yep. Yeah. So um we do have drug checking through scatter is the name of the device. Um, and people are able to see a more comprehensive idea of what they're using. And what we have learned through uh access to this program, which has been running for about two years now, give or take, is that 22% of people, once they get the results back, they actually either reduce their substance use or dispose of their substance altogether. The reason why that is such powerful information is because it really shows that when people have access to information about what's going in their body, it empowers them to make different decisions and assess the risk in different ways. Of course, you know, 22% we have seen that change. The other percent it would be people coming in and it was exactly what they expected, right? In terms of the drug test, but it does give us a really good sense of drug trends, at least in the neighborhood, um, and and gives more more power. Information is power, and that's an important thing. I do also want to correct because I do see the update on the site about deaths, and you are right that it uh is now approximately five per month in Niagara between January and March of this year. Um, so that is a decrease from the 11th. Um, so I'm happy to see that.

SPEAKER_01 9:32

Um Yeah, absolutely. Absolutely. When someone comes to the site, so let's say I'm a new person and I'm coming to the site. What's the process? And then going forward, are there a certain number of people who you know are, I don't know, this is a stupid word, registered. And uh, and how many would that be? And then how many people do you think would come into the site if they were able?

SPEAKER_00 10:02

Sure. Um, good questions. So anyone who accesses the site for the first time, they do a bit of an intake with us and we go over expectations of the space, what we can offer them, what our expectations are of their time in the space. Um, and then they can come in and meet with peer support workers, harm reduction workers. We're lucky to have a partnership with Niagara EMS. They're the team responding to overdoses in the site. And people can come in, get their drugs checked if they're interested in doing so, and then proceed to a booth to use. Um, they're given about 30 minutes of time to use, um, and again, under the um under the eye of paramedics who are able to respond in the event of an adverse reaction. There are also so many partners on site, and we're incredibly grateful for that. And I think that's one misconception of the site that it's simply for using substances. But we have access to healthcare workers, housing workers, um, again, that peer support piece, um, cultural uh components for the indigenous community. We run groups, so it's really about a sense of community and offering as much as we can in the space. Um, so we know it's a space people are comfortable and they're more likely to engage in service in spaces where they feel safe and comfortable and judgment free. Uh, so we're really grateful for that. Last year we had just shy of 340 unique people access the space. Um, and of course, there's an ebb and flow to that. We see people move between municipalities right now. The site is uh only available in St. Catharines, so not accessible for our friends in Niagara Falls or Welland or other communities. Um, and there is a significant barrier in that people cannot smoke their substances on site due to provincial legislation. Um, so of course, proper ventilation would be required for that, but we do see a shift towards inhalation use, which is theoretically a harm reduction win, tends to be much safer for both the person using and the broader community. Um, but yeah, there's there's always an ebb and flow. You know, between 2019 and 2025, we had about just shy of 89,000 visits to the site uh and reversed over 1,500 overdoses in the space. Um so we think, you know, about the dignity that's offered in the space that's so very important, giving that second chance. Um, and then again, that that connection to services.

Welcoming Streets And Community Trust

SPEAKER_01 12:11

Yeah, I think that it's uh, you know, even when I went and looked at it, and I I know a certain amount of what um, and I live downtown and I've talked to you before, and I know a certain amount of what happens. I didn't know EMS was on the site, for example. Yeah, and I didn't know about the groups, and I I didn't know about the about the sense of community, and that's a lot about what positive living is about is building a sense of community. And let's just talk briefly um about welcoming streets, sure, which is um an initiative with you and Reach Niagara, which is a mobile health support um organization. I went out with one of the teams one day, and I was I loved it. I loved the, you know, there was one situation where when we first started, uh we stopped at a gentleman and and and the reach worker said, Hey, have you seen Bill? We haven't seen him in four days. Have you seen him? We want to make sure he's okay. And the fellow thought about it and he thought about it, and he said, You know what? I haven't seen him, but somebody I know, um, I don't remember the name, saw him yesterday. And the outreach worker said, That's fantastic. Uh, we were worried. Right. And then, you know, they help businesses understand. And I think that it's um, I thought it was an amazing uh trip that I took out. Is it something that you see is also helping? Now, this would be at the street level.

SPEAKER_00 13:50

Yeah, uh, welcoming streets has been very powerful in our community. It's a pilot project, and we're seeing the um the results of the kind of initial evaluation come through, and it's very strong in terms of what it's meant uh meant for people with lived experience who are helping facilitate the program in terms of the people who are being supported by the program, um, whether it's you know, street and fault community members or the businesses. Welcoming streets really is about fostering that sense of community that you touched on earlier, right? Building compassion, building mutual understanding, bringing back kind of the street code of ethics, if you will, setting those expectations around, you know, cleanliness or where we're using or how we're behaving, um, and lending a hand to businesses so that they can help be part of a solution as well. Um, and again, the preliminary evaluation results have been incredible with that program.

New Rules And Site Closures

SPEAKER_01 14:37

Well, I know it's a pilot program, so let's fingers crossed, let's keep it going. The um the consumption sites came under um okay, I'm just gonna say under attack. Um, I think people have figured out by now that I that I'm a big supporter of consumption sites. In uh January of last year, so about a year ago, when the provincial government came out and and put some pretty strict rules around the sites. Now, I I don't have a problem with rules around the site. I I understand that. Um, but but one of the things that uh is that they mandated was that consumption sites couldn't be so they announced the closure of consumption sites and and also the consumption sites could not be within 200 meters of I don't know if just a school, but I I believe child care center. Yeah, yeah. Um and that resulted in some of the closures. The St. Catharine site was able to stay open because you were not near that, you weren't that close to a school.

SPEAKER_00 15:50

600 meters. I looked it up immediately.

Stigma Across All Income Levels

SPEAKER_01 15:55

And it's not like you're, you know, in a storefront and everybody who walks down Queenston Street is gonna say, oh, look, there's the consumption site. I mean, it's it's uh it's and I think good for the people who go. It's sort of quietly nestled behind a you know, the backside of a building where where I think people would feel more safe going um in and out. Um so I actually want to just backtrack because there was one question I meant I meant to ask. When the the clientele of the site, these are not just people who are homeless, unhoused, living on the street and using drugs.

unknown 16:33

Yeah.

SPEAKER_00 16:34

Yeah, it's uh we do see a mixed bag of folks accessing the site in terms of that socioeconomic background. With the site itself, we do tend to see a larger percentage who are not stably housed, right? And that's where you would see people without access to a site using in parks, using in playgrounds, using on the street, right? It is more visible when people don't have a place to go. Um, in terms of street work services in general, we run a lot of various programs, um, but I will say we see the entire socioeconomic spectrum in those services. So we go into fancy neighborhoods in Fawn Hill and Old Glenridge and support folks who are using substances. We often talk a lot about the hierarchy of substances, um, that some are more glorified in our communities than others. Uh, a good reminder that alcohol is a substance, alcohol is a drug that we treat very differently, as is cannabis now. Um, but we do see people from all walks of life who who are using substances. Um, and some where it's not um, in their definition, problematic in their lives. They're able to, you know, maintain relationships and work. And for others, um, they may be experiencing homelessness or mental health or other components. So we do see the full gamut of folks accessing service, uh, which is a good reminder because I think people tend to default to the more visible substance use and that it only affects people in that situation, which is absolutely not the case.

SPEAKER_01 17:56

Yeah, and of course, uh people who are um there are people who um are experiencing problems with substances who really want to hide. Yes. Right? They really don't want and I, you know, in a higher socioeconomic uh situation that would be normal. They really want to hide.

SPEAKER_00 18:15

Yes.

SPEAKER_01 18:16

So um you can you can help that not them keep their secret, but get the the treatment that they need and maybe the ability to discuss openly what they're going through with family or friends.

SPEAKER_00 18:32

Yes, stigma is alive and well when it comes to substance use. And you know, you you touched on COVID earlier, and that was a stressful time for a lot of folks, and there was the social distancing requirements, and unfortunately, we did see a lot of relapse and death for folks who were maintaining sobriety because the pressures of that time that we were living through were a lot to handle. Um, we hear time and time again from our community base how grateful they are that they can speak openly about their use without being judged, and that is often the first step to broader conversations and access to other supports, right? Um, and you know, our team, including at CTS, will do what we call warm transfers. So they can walk someone down to withdrawal management and get them into detox services. We can walk folks down to other services if that's what they're keen on accessing. Um, but they have that trust built up with our team. There are studies that show that people who access harm reduction programs like ours are actually five times more likely to access treatment at the end of the day because we can help them get there when they're ready. And so I think that's a really important piece of the conversation.