Harm Reduction Hacks in Focus: Space Hacks
Hacks for Accident Prevention in Harm Reduction Services & Spaces
There are 11 hacks in this section
Designing Safer Spaces That Stay Safe
Small safety practices prevent big risks
When thinking about physical safety in harm reduction spaces, there are two main considerations: accident prevention and violence prevention. In this section we take a deep dive into accident prevention through the lens of disability awareness, universal precautions, and workplace safety.
Disability Awareness
A disproportionate number of people who suffer from a disordered relationship with substances also suffer from a physical disability. By some estimates, twice as many people who use drugs have a physical disability as the rest of the population.
Universal Precautions and Workplace Safety
Though not all harm reduction organizations or programs are in need of universal precautions or OSHA considerations, most are. It’s important when setting up a harm reduction space to take into consideration the important and real risks of harm reduction work. This includes the potential for entry and exposure to blood-borne pathogens as well as airborne pathogens.
Overview of Disease Transmission and Universal Precautions
Infectious diseases have always been humanity’s companions and are spread in a myriad of ways. Direct contact infectious disease transmission occurs when there is physical contact between an infected person and a susceptible person, such as with a sexually transmitted disease or respiratory illness. Indirect contact transmission occurs when there is no direct human-to-human contact. Indirect contact occurs from a reservoir like a used surface or objects, or from vectors such as mosquitoes or ticks.
Universal Precautions: Handwashing
Proper hand washing is crucial to preventing the spread of infection, and staff and volunteers are encouraged to wash their hands several times a day and are instructed to do so before and after each shift and after handling any used supplies.
Universal Precautions: Gloves
Medical gloves should be worn whenever handling exposed or used supplies, especially those that might be used to prepare or use injection drugs such as syringes, cottons, cookers, tourniquets, and ascorbic acid. Gloves should be changed often, especially between activities or participants.
Universal Precautions: Footwear & Attire
To help prevent needlestick injury and pathogen exposure, harm reduction workers should always wear closed shoes while working. Flat shoes that are comfortable for walking, made of leather or another heavy material, are also recommended but not required.
Universal Precautions: Syringes & Supplies
In general, exposed syringes, that is, unpackaged, unused single syringes, and safer injection supplies such as cottons, cookers, tourniquets, etc. should always be treated with universal precautions. This means that staff and volunteers should never handle them without gloves and/or proper precautions, even if they are capped. Syringes that are still in containers such as boxes or bags are not subject to universal precautions.
Universal Precautions: Environmental Cleanup
Harm reduction providers should, as a matter of course, include environmental cleanup of syringe litter and paraphernalia in and around where they provide services.
Universal Precautions: Surface Safety
These guidelines outline simple, practical steps for surface cleaning that support the health of both participants and staff.
Post-Exposure Prophylaxis Hacks
Though largely unsupported by scientific evidence, the dangers of needle stick injury loom large in the popular imagination. As a result, the emotional response to needle stick injury can be intense even if, statistically, the risks are quite low. For this reason, if no other, it’s essential that harm reduction organizations be prepared for how they might deal with such an eventuality.
Universal Precautions: For Droplet or Airborne Pathogens
During air- or droplet-borne disease outbreaks such as COVID, harm reduction staff or volunteers are required to follow all normal universal precautions and wipe down all surfaces used by more than one person, including pens, clipboards, chairs, desks, cabinet fronts, floors, doors, steering wheels, and so on, at the beginning and end of each shift with a broad spectrum anti-microbial surface cleaner.
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"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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"Between an uncontrolled escalation and passivity, there is a demanding road of responsibility that we must follow. "
Dominique de Villepin -
"We have to be ready and able to reach clients where they are, not where we want them to be”
-
"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 -
"We don’t need to professionalize the people closest to the crisis. We need to recognise them as professionals already.”
Jules Netherland -
"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 -
"There isn’t a way things should be. There’s just what happens, and what we do."
Terry Pratchett -
“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 -
“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.”
-
"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 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 -
“As always, be transparent with participants about what you have, what you don't have, and/or what's for only special populations.”
-
"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. -
"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 -
“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 -
"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 -
"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 -
"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 -
“In general, it is antithetical to harm reduction best practices to call the police except under the most extreme life-or-death circumstances.”
-
"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 -
"Darkness cannot drive out darkness: only light can do that. Hate cannot drive out hate: only love can do that."
Martin Luther King Jr. -
"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 -
“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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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 -
“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 -
“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 -
“Boundaries help me to give all that I can and still come back tomorrow.”
- "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. "
- "Between an uncontrolled escalation and passivity, there is a demanding road of responsibility that we must follow. "
- "We have to be ready and able to reach clients where they are, not where we want them to be”
- "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."
- "We don’t need to professionalize the people closest to the crisis. We need to recognise them as professionals already.”
- "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.”
- "There isn’t a way things should be. There’s just what happens, and what we do."
- “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.”
- “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.”
- "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 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."
- “As always, be transparent with participants about what you have, what you don't have, and/or what's for only special populations.”
- "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."
- "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."
- “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.”
- "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."
- "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."
- "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."
- “In general, it is antithetical to harm reduction best practices to call the police except under the most extreme life-or-death circumstances.”
- "The conflict between the will to deny horrible events and the will to proclaim them aloud is the central dialectic of psychological trauma."
- "Darkness cannot drive out darkness: only light can do that. Hate cannot drive out hate: only love can do that."
- "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."
- “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.”
- 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.”
- “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.”
- “The bottom line is that overdose prevention sites — which exist in more than 100 cities around the world — offer compassion for fellow human beings,”
- “Boundaries help me to give all that I can and still come back tomorrow.”