Harm reduction exists on a continuum. So, too, does the implementation of harm reduction practices in shelter. You can range from managed alcohol programs within shelter like the Shepherds of Good Hope in Ottawa (sometimes called Radical Harm Reduction) or smaller steps by providing access to shelter after having used alcohol or other drugs without precondition or things like breathalyzers. I am a big fan of shelters like Alpha House in Calgary which is one of the preeminent wet shelters I have ever visited and has integrated harm reduction into all that they do, as well as specialized harm reduction programs within larger shelters, like the Riverfront program at the Calgary Drop-in Centre. Not every shelter is ready to immerse themselves into a managed alcohol program like the Shepherds of Good Hope or fully integrate harm reduction into all that they do like Alpha House, but there are some tips and practices that can be followed to add more harm reduction practice to your shelter. Here are eight:
1. Self Bag Search
If you do bag searches, have the program participant open their bag for staff and provide visual inspection of contents rather than staff opening the bag or touching contents. This is a more dignified approach to bag inspections, while also decreasing inadvertent pricks from sharps if present.
2. Availability of Naloxone With All Staff Trained
To better respond to incidents of opioid overdoses, ensure that all staff within the shelter are trained and have easy access to naloxone. It can be the difference between life and death.
3. Amnesty Totes
When a person cannot safely store their alcohol or other drugs, and/or cannot safely store their needles, pipe or other equipment used, it presents safety risks like increased incidents of binge drinking and greater exposure to needles. By providing a confidential tote at entry for people to store whatever they want to store – which they cannot access while in the shelter – people have a safe place to store their alcohol or other drugs and related equipment.
4. Floor Mats
Mattresses on a bed frame or bunk beds can be hazardous to someone is greatly under the influence. By having some mats on the floor for people that are quite inebriated it is safer for preventing falls, and also easier to help people sleep in the rescue position.
5. Sharps Containers
The more accessible sharps containers are the more likely they are to be used. Outside and at various places inside the building are beneficial.
6. Safe Works
With access to free supplies, people who use can use more safely. Consideration can be made to making everything available from new needles and syringes to cotton pellets, pipes and brass screens to alcohol towelettes, bandages to acidifiers, condoms and lube to dental dams – and more. This is likely subject to the laws of your local jurisdiction and the comfort level of your organization. If you cannot offer these internally, consider developing a pamphlet outlining where and how in the community people can access the supplies they need that would reduce harm.
7. Focus on Housing
Housing is harm reduction. The evidence is clear that many harms are reduced and wellness improved when people have access to safe, appropriate and affordable housing.
8. Involve People Who Use Substances in Reviewing Your Shelter Policies and Procedures
“Nothing about us without us” is a good framing for better supporting people who use substances who stay in shelter. By asking people who use alcohol or other drugs to review your policies and procedures you may learn of ways to adjust your policies or procedures to be more responsive to substance users.