“They're causing more harm than good”: a qualitative study exploring racism in harm reduction through the experiences of racialized people who use drugs

Abstract

Background Increased opioid-related morbidity and mortality in racialized communities has highlighted the intersectional nature of the drug policy crisis. Given the racist evolution of the war on drugs and the harm reduction (HR) movement, the aim of this study is to explore racism within harm reduction services through the perspectives of our participants. Methods We conducted a qualitative descriptive study to explore the perspectives of racialized service users and providers on racism in the HR movement in the Greater Toronto and Hamilton Area (GTHA). Four racialized service users and four racialized service providers participated in semi-structured interviews that were audio-recorded, transcribed, and analysed thematically. Results Five themes related to racism in HR were generated: (1) whiteness of harm reduction as a barrier to accessing services, (2) diversifying HR workers as a step towards overcoming distrust, (3) drop-in spaces specific to Black, Indigenous, and people of colour are facilitators to accessing harm reduction, (4) lack of representation in HR-related promotional and educational campaigns, and (5) HR as a frontier for policing. Conclusions Our findings suggest that structural and institutional racism are prevalent in HR services within the GTHA, in the form of colour-blind policies and practices that fail to address the intersectional nature of the drug policy crisis. There is a need for local HR organizations to critically reflect and act on their practices and policies, working with communities to become more equitable, inclusive, and accessible spaces for all people who use drugs.

Unmet needs and harm reduction preferences of syringe services program participants: differences by co-use of illicit opioids and methamphetamine

“…A second limitation is the lack of racial and ethnic diversity in our sample, therefore limiting this study’s ability to capture potentially unique characteristics of non-white PWID. Although non-white PWID are highly represented in total opioid overdose deaths, feelings of shame, mistrust for predominantly white institutions, and an increased fear of policing continue to drive disparities in SSP access [ 17 ]. Finally, we did not assess whether participants who reported use of both methamphetamine and illicit opioids also used the two simultaneously.…”

Unmet needs and harm reduction preferences of syringe services program participants: Differences by co-use of street opioids and methamphetamine

“…A second limitation is the lack of racial/ethnic diversity in our sample, therefore limiting this study's ability to capture potentially unique characteristics of non-white PWID. Although non-white PWID are highly represented in total opioid overdose deaths, feelings of shame, mistrust for predominantly white institutions, and an increased fear of policing continue to drive disparities in SSP access (Godkhindi et al, 2022). Finally, we did not assess whether participants who reported use of both methamphetamine and street opioids also used the two simultaneously.…”

Multidisciplinary argument for the decriminalization of drugs

“…"Meet the client where they're at" is a basic tenet of introductory psychology (Pomerantz, 2023), social work (DuBois and Miley, 2019), and counseling education (Gerig, 2018). Requiring abstinence in order to engage in substance use treatment ignores this key interdisciplinary value and tells the client where they "need to be" in order to receive treatment.…”

“…As the opioid epidemic increasingly impacted White communities, compassion was integrated into the conversation about people who use drugs, and the media increasingly differentiated how people in urban and suburban communities who used drugs were portrayed (Hansen & Netherland, 2016). This created a shift in the acceptance of harm‐reduction practices, along with diminished engagement among racialized communities who perceive it as a White‐dominant space (Godkhindi et al., 2022).…”