Harm Reduction Hacks in Focus: Space Hacks
Big H, Big R Harm Reduction: Practicing Harm Reduction with Others
There are 4 hacks in this section
It’s not just what we give—it’s how we show up
Big H, Big R harm reduction is about connection, respect, and meeting people with humanity
Harm reduction leader after harm reduction leader spoke to the fact that de-escalation begins with self. It starts with how we as individuals approach the work both internally and how we treat others. They pointed out that as leaders in the space, we set the vibe and if we aren’t chill the service site won’t be either.
It is important that we are honest about the fact that many of us who are attracted to doing harm reduction work come from very similar backgrounds to the folks that we’re serving. This means that, like our participants, we are very likely to be highly traumatized and suffering from extreme stress. This trauma and stress mean that we, like our participants, are reactive because we are often in activated amygdala states, which means that our emotions and stress hormone levels are heightened, rendering us both more emotional and less able to react rationally to adversity or conflict.
Given that, it is critical that those of us doing the work take the time to focus on ourselves as well as the spaces and services we build. Leaders talked about three primary areas to focus on with regard to personal de-escalation prevention:
What is Big H, Big R Harm Reduction?
Harm reduction is often thought of as merely the provision of risk reduction supplies and health education, but those practical strategies are sometimes called little ‘h’ little ‘r’ harm reduction because, according to almost every harm reduction expert spoken to, those intervention methodologies are only the lubricant for the real spirit of harm reduction that helps people change and creates spaces where escalation is less likely to occur.
Hacks for Practicing Big H, Big R Harm Reduction
That spirit of harm reduction, it is believed by many, is also essential to providing the kinds of services that result in people being twice as likely to enter treatment for SUD if they’ve accessed harm reduction than if they haven’t.
The 4-C’s Hack
The 4-C’s of harm reduction outreach were originally the 3–Cs, and were developed by Christian Crump, then of John the XXIII syringe access in Salinas, California, and later modified to include the 4th by Catherine Swanson and Roxanne Butterfield.
Edie Springer’s Worker Stances for Clients Who Use Drugs & Harm Reduction Worker: Best Practices
Harm reduction immediately resonated for Edie, who was herself a former drug user and methadone patient. Faced with the devastation of HIV’s impact on drug-using communities, Edie fully embraced harm reduction and trained hundreds of harm reduction workers who have carried her legacy with them. She developed these worker stances in 1996 and they have been shared among many of us in the harm reduction community for generations.
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"We have to be ready and able to reach clients where they are, not where we want them to be”
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“In general, it is antithetical to harm reduction best practices to call the police except under the most extreme life-or-death circumstances.”
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“Caring for myself is not self-indulgence, it is self-preservation, and that is an act of political warfare.”
Audre Lorde -
“One doesn’t have to operate with great malice to do great harm. The absence of empathy and understanding are sufficient.”
Charles M. Blow -
"If you question harm reduction works, I can’t help but wonder if you have ever actually seen what happens in these spaces. We promote health safety and dignity, and it works. It is simple, beautiful and changes peoples lives."
Haven Wheelock -
"What should young people do with their lives today? Many things, obviously. But the most daring thing is to create stable communities in which the terrible disease of loneliness can be cured."
Kurt Vonnegut Jr. -
"We live in a world in which we need to share responsibility. It's easy to say "It's not my child, not my community, not my world, not my problem." Then there are those who see the need and respond. I consider those people my heroes."
Fred Rogers -
“Many of the harm reduction leaders interviewed talked about the importance of not having too many policies and involving your participants in the development of policies—especially those that impact them directly.”
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“The bottom line is that overdose prevention sites — which exist in more than 100 cities around the world — offer compassion for fellow human beings,”
Mayor Jim Kenney -
“Identify five things that you can see, four things that you can touch, three things that you can hear, two things that you can smell and one thing that you can taste.”
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"Letting go gives us freedom, and freedom is the only condition for happiness. If, in our heart, we still cling to anything - anger, anxiety, or possessions - we cannot be free."
Thich Nhat Hanh -
“As always, be transparent with participants about what you have, what you don't have, and/or what's for only special populations.”
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"Anything that’s human is mentionable, and anything that is mentionable can be more manageable. When we can talk about our feelings, they become less overwhelming, less upsetting, and less scary. The people we trust with that important talk can help us know that we are not alone."
Fred Rogers -
"Opponent’s of syringe service programs and harm reduction in general typically remark that it “sends the wrong message.” The message they are referring to is, “We love you and want you to be safe.”
Christopher Abert -
“Boundaries help me to give all that I can and still come back tomorrow.”
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"Not all traumas are the result of what happened to you; some are the result of what didn’t happen for you"
Gabor Maté -
"One of the problems that arises with the term “people who use drugs” is that it is intentionally pluralistic in its embrace of ALL people who use drugs—from recreationally to deeply problematically. This makes using it to talk about the things that especially impact people who are using drugs problematically very difficult. "
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"Darkness cannot drive out darkness: only light can do that. Hate cannot drive out hate: only love can do that."
Martin Luther King Jr. -
"There isn’t a way things should be. There’s just what happens, and what we do."
Terry Pratchett -
We need to play that game where we require politicians to finish every sentence denouncing supervised injection facilities with the phrase, “and that is why I think injecting alone in a McDonald’s bathroom is better.”
Jonathan Giftos -
"Anything that’s human is mentionable, and anything that is mentionable can be more manageable. When we can talk about our feelings, they become less overwhelming, less upsetting, and less scary. The people we trust with that important talk can help us know that we are not alone."
Fred Rogers -
"The conflict between the will to deny horrible events and the will to proclaim them aloud is the central dialectic of psychological trauma."
Judith Lewis Herman -
“People who cause harm are often also survivors of harm. If we want to address the roots of violence, we have to honour both truths.”
Danielle Sered -
“When another person makes you suffer, it is because he suffers deeply within himself, and his suffering is spilling over. He does not need punishment; he needs help. That's the message he is sending.”
Thich Nhat Hanh -
"We don’t need to professionalize the people closest to the crisis. We need to recognise them as professionals already.”
Jules Netherland -
"Between an uncontrolled escalation and passivity, there is a demanding road of responsibility that we must follow. "
Dominique de Villepin -
"I describe my experiences as a nurse volunteer at the overdose prevention site as “being in the right place at the right time doing the right thing.” And that’s exactly where I want to be as a nurse: working outside the system to make a real difference in people’s lives, showing up in the community when it matters most and challenging rules that directly contribute to the overdose crisis, and exposing government inaction by being part of the solution on the ground. For me, this is what nursing is all about."
Marilou Gagnon -
"One of the most important things we can do as advocates is to define & make concrete the vague terms used by politicians. What does it mean to “take a public health approach”? What you mean when you say “treatment”? Politicians rarely know. Our job is to make it plain for them."
Jonathan Giftos
- "We have to be ready and able to reach clients where they are, not where we want them to be”
- “In general, it is antithetical to harm reduction best practices to call the police except under the most extreme life-or-death circumstances.”
- “Caring for myself is not self-indulgence, it is self-preservation, and that is an act of political warfare.”
- “One doesn’t have to operate with great malice to do great harm. The absence of empathy and understanding are sufficient.”
- "If you question harm reduction works, I can’t help but wonder if you have ever actually seen what happens in these spaces. We promote health safety and dignity, and it works. It is simple, beautiful and changes peoples lives."
- "What should young people do with their lives today? Many things, obviously. But the most daring thing is to create stable communities in which the terrible disease of loneliness can be cured."
- "We live in a world in which we need to share responsibility. It's easy to say "It's not my child, not my community, not my world, not my problem." Then there are those who see the need and respond. I consider those people my heroes."
- “Many of the harm reduction leaders interviewed talked about the importance of not having too many policies and involving your participants in the development of policies—especially those that impact them directly.”
- “The bottom line is that overdose prevention sites — which exist in more than 100 cities around the world — offer compassion for fellow human beings,”
- “Identify five things that you can see, four things that you can touch, three things that you can hear, two things that you can smell and one thing that you can taste.”
- "Letting go gives us freedom, and freedom is the only condition for happiness. If, in our heart, we still cling to anything - anger, anxiety, or possessions - we cannot be free."
- “As always, be transparent with participants about what you have, what you don't have, and/or what's for only special populations.”
- "Anything that’s human is mentionable, and anything that is mentionable can be more manageable. When we can talk about our feelings, they become less overwhelming, less upsetting, and less scary. The people we trust with that important talk can help us know that we are not alone."
- "Opponent’s of syringe service programs and harm reduction in general typically remark that it “sends the wrong message.” The message they are referring to is, “We love you and want you to be safe.”
- “Boundaries help me to give all that I can and still come back tomorrow.”
- "Not all traumas are the result of what happened to you; some are the result of what didn’t happen for you"
- "One of the problems that arises with the term “people who use drugs” is that it is intentionally pluralistic in its embrace of ALL people who use drugs—from recreationally to deeply problematically. This makes using it to talk about the things that especially impact people who are using drugs problematically very difficult. "
- "Darkness cannot drive out darkness: only light can do that. Hate cannot drive out hate: only love can do that."
- "There isn’t a way things should be. There’s just what happens, and what we do."
- We need to play that game where we require politicians to finish every sentence denouncing supervised injection facilities with the phrase, “and that is why I think injecting alone in a McDonald’s bathroom is better.”
- "Anything that’s human is mentionable, and anything that is mentionable can be more manageable. When we can talk about our feelings, they become less overwhelming, less upsetting, and less scary. The people we trust with that important talk can help us know that we are not alone."
- "The conflict between the will to deny horrible events and the will to proclaim them aloud is the central dialectic of psychological trauma."
- “People who cause harm are often also survivors of harm. If we want to address the roots of violence, we have to honour both truths.”
- “When another person makes you suffer, it is because he suffers deeply within himself, and his suffering is spilling over. He does not need punishment; he needs help. That's the message he is sending.”
- "We don’t need to professionalize the people closest to the crisis. We need to recognise them as professionals already.”
- "Between an uncontrolled escalation and passivity, there is a demanding road of responsibility that we must follow. "
- "I describe my experiences as a nurse volunteer at the overdose prevention site as “being in the right place at the right time doing the right thing.” And that’s exactly where I want to be as a nurse: working outside the system to make a real difference in people’s lives, showing up in the community when it matters most and challenging rules that directly contribute to the overdose crisis, and exposing government inaction by being part of the solution on the ground. For me, this is what nursing is all about."
- "One of the most important things we can do as advocates is to define & make concrete the vague terms used by politicians. What does it mean to “take a public health approach”? What you mean when you say “treatment”? Politicians rarely know. Our job is to make it plain for them."