Turning a blind eye: Implementation of harm reduction in a transitional programme setting
Abstract
Background: Substance use and homelessness often overlap. Harm reduction is an evidence-based response to reducing harms of use rather than preventing use per se. While harm reduction is a key principle of Housing First, there has been limited research related to the implementation of harm reduction within programmes that aim to end homelessness.Methods: As part of a community-based research study, we conducted 29 qualitative interviews with staff and residents in two transitional programmes. We used interpretive description to analyze the data and generate practice relevant recommendations.Results: Being abstinent was not a criterion for programme eligibility but participants identified “getting and coming clean” as a programme goal. While harm reduction was official policy and safer use supplies were available, there was a zero tolerance policy for substance use onsite and sanctions for use. In the wake of a persistent culture of abstinence and conflicting policies related to substance use and harm reduction, staff turned a blind eye to substance use in an effort to prevent harms.Conclusion: The findings of this study highlight tensions between abstinence and harm reduction policies and the problems associated with the implementation of harm reduction as waiving requirements for sobriety, distribution of clean supplies, and tolerating discrete use in an environment that restricts use as fulfilling harm reduction mandates. Partial or incomplete implementation of harm reduction and a failure to shift norms related to substance use and harm reduction may contribute to harms of overdose, intoxication and stigma as well as tensions between residents.
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Challenges from flexibility and broader social structures may pose a key risk to program fidelity, as practices may differ between agencies and service providers, leading to partial or incomplete implementation of harm reduction.
“These challenges may pose a key risk to program fidelity, as practices may differ between agencies and service providers, leading to partial or incomplete implementation of harm reduction (Pauly et al., 2018).”
From Harm reduction outcomes and practices in Housing First: A mixed-methods systematic review (2021) · cites this paper as Pauly et al., 2018
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Harm reduction outcomes and practices in Housing First: A mixed-methods systematic review
Kerman, N., Polillo, A., Bardwell, G., Gran-Ruaz, S., Savage, C., Felteau, C., & Tsemberis, S. (2021) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2021.109052 · Cited by 42 · see citing works
- Authors
- Pauly, B., Wallace, B., & Barber, K.
- Affiliations
- Centre for Addictions Research of British Columbia, University of Victoria, Victoria, British Columbia, Canada,
- University of Victoria (CA)
- ORCID
- Wallace, Bruce
- Venue
- Drugs Education Prevention and Policy
- Publisher
- Informa UK Limited
- Published
- 2017-06-23
- Volume
- 25
- Issue
- 1
- Pages
- 21-30
- ISSN
- 0968-7637 (ISSN-L)
- 1465-3370
- OpenAlex
- W2718052529
- Cited by
- 36
- References
- 63
- Citations by year
- 2026: 1 · 2025: 6 · 2024: 5 · 2023: 2 · 2022: 3 · 2021: 4 · 2020: 6 · 2019: 5 · 2018: 2 · 2017: 1
- FWCI
- 6.21
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Drugs Education Prevention and Policy (publishedVersion)
- Topics
- Health Sciences › Health Professions › General Health Professions › Homelessness and Social Issues
- Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Keywords
- harm reduction, homelessness, substance use, abstinence, Housing First, implementation, zero tolerance policy, employee attitudes, stigma, drug overdose
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