White Coat, Black Art

From zero tolerance to open dialogue: How harm reduction is shifting the conversation on drug use

A recent study in B.C., found that many teens who encountered substance use responded more positively to harm reduction approaches than a blanket don't-do-drugs edict. Harm reduction focuses not on abstinence, but minimizing harm and potential danger.

Harm reduction is 'drug education,' not enabling use, says worker at Skylark charity in Toronto

Nick Jakubiak speaks with peers at Skylark, a Toronto-based charity that helps children and parents struggling with mental health and developmental needs. (Submitted by Nick Jakubiak)
Listen to the full episode26:29

Enid Grant got the kind of phone call many parents dread. Her teenage son was "freaking out" after trying psychedelic mushrooms with friends. 

She was scared for her son's safety, but relieved he reached out to her for help.

"I couldn't prevent that from happening, but I could be there when it happened," said Grant, senior director of children's mental health at Skylark, a Toronto-based charity.

"I could make sure that we talked about it afterwards."

Grant's kids have since grown up to be "wonderful, caring adults." She credits harm reduction strategies — making it easier for them to talk about oft-taboo topics — with getting through the challenging years of their adolescence. 

Enid Grant is the senior director of children's mental health at Skylark Children Youth and Families charity in Toronto. (Submitted by Enid Grant)

Harm reduction focuses not on abstinence, but minimizing harm and potential danger. The number of such initiatives in Canada has grown in recent years, including some high-profile safe injection sites in B.C. to help curb the deadly opioid crisis in that province.

But it hasn't come without pushback.

"We have been, you know, living in a society where abstinence or zero-tolerance policies have been the ones that have, I think, politically felt the most comfortable," said Sally Jenkins, an assistant professor at the University of British Columbia School of Nursing.

"And so we don't have a lot of information for parents about how to do this differently."

Teens respond to harm reduction over abstinence: study

A recent study led by Jenkins interviewing 83 teens in B.C., found that many responded more positively to harm reduction approaches than a don't-do-drugs edict.

Abstinence-based approaches didn't reflect the lived experiences of many youth, who either have already tried drugs, or encountered it among their peers or even their own family circles, she explained.

Emily Jenkins an assistant professor at the University of British Columbia School of Nursing. (Shobhit/Submitted by Emily Jenkins)

In one community they surveyed, she added, many teens told her the zero-tolerance rule was "assumed" without a discussion of any sort.

"Kids just knew it wasn't accepted. End of story," she said.

"They didn't engage in discussions about it. And it was a missed opportunity, and it led to family fragmentation and kids just feeling like they didn't have somebody to go to."

'Harm reduction is just drug education'

Dr. Brian Goldman shared his own story about harm reduction in November, when he revealed on Twitter that he bought a pack of cigarettes for his teenage son, who has fetal alcohol spectrum disorder.

Many tweets in response were supportive, but others questioned his approach.

"I have no right to question [Dr. Goldman] and his wife's choice for their son, nor does anyone else. I hope with all my heart that it restores and maintains their family relationship," wrote Matthew Stanbrook, deputy editor of the Canadian Medical Association Journal.

"But I'm concerned that others may take this example out of context and think that the right approach in general to a youth experimenting with tobacco or other substances is to enable it under supervision."

Nick Jakubiak, a peer harm reduction worker at Skylark, adamantly refutes the notion.

"I don't think harm reduction is ever enabling drug use. Harm reduction is just drug education," he said.

"I believe it's giving people the right tools so that they can make their own informed decisions."

Nick Jakubiak is a peer harm reduction worker at the Skylark Children Youth and Families charity in Toronto. (Submitted by Nick Jakubiak)

He credits his open dialogue with his parents for helping him through his early struggles with drugs. 

"Prior to using [cannabis], I had, like, a whole conversation with my mom. How do you use it safely? [I told her,] this is where I'm going to be. This is who I'm going to be with. And it was really amazing," he said, adding he uses an app to track his cannabis use.

Jenkins says dispelling the stigma around harm reduction could mean the difference between life and death in the long run.

"I work with too many parents who have lost a child to substance use, and that's the point where they kind of shift in perspective around, you know, the role of harm reduction," she said.

"And I don't think we ought to be waiting for that."

Helping parents 'tune in' to harm reduction

In the "Tuning In" workshop at Skylark, parents learn how to steer clear from leading discussions about drugs with worst-case-scenarios typically intended to scare kids straight.

"As a parent, you have to decide: do I want to lead with my fears and what I worry about, or do I want to lead with our relationship and maintain that relationship?" Grant said.

"Because truthfully, if one of your kids is in trouble, do you want them to come to you, or to go to one of their friends who may not be able to help them?"

The workshop also grapples with the difficult notion that parents cannot protect their kids from undue influence at all times — and part of harm reduction is being available if things go wrong.

"As much as they can provide all of the wonderful things that parents can do for their kids, once their kids are adolescents and walk out that door, they're going to be faced with choices," Grant said.

"It's kind of sticking your head in the sand and assuming nothing bad's going to happen [and] not preparing your kids."


Written by Jonathan Ore. Produced by Jeff Goodes.

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