ID: HR19-1226

Presenting author: Bruce Wallace

Presenting author biography:

Bruce Wallace is an Associate Professor at the University of Victoria School of Social Work and a Scientist at the Canadian Institute of Substance Use Research (CISUR). His research and activism center on issues of health inequity, social justice and harm reduction.

Sheltering risks: Harm reduction in homeless shelters

Bruce Wallace, Bernie Pauly

ISSUE: Substance use and homelessness often overlap. Emergency and transitional shelters are often integral to the continuum of responses to homelessness. Implementation of harm reduction within these residential settings face multiple internal and external challenges. The current overdose crisis heightens the challenges of implementing harm reduction, particularly within complex and diverse settings such as homeless shelters.
SETTING: A programme of community-based research (CBR) in a Canadian city featuring qualitative research including; focus groups (N=49) with emergency shelter residents, staff and harm reduction workers, and, in-depth interviews (N=29) with transitional shelter residents and staff.
RESULTS: The findings illustrate the challenges of implementing harm reduction generally and overdose responses specifically when there is a persistent culture of abstinence and conflicting polices related to substance use. Harm reduction was official policy and the sites were defined as low-barrier. However substance use was generally not tolerated on site and yet pervasive with staff resorting to ignoring substance use as a response. In this context, harm reduction is partially implemented and incomplete. Shelters can be a site of risks and trauma for residents and staff due to experiencing, witnessing, and responding to overdoses.
CONCLUSIONS: 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. When harm reduction is limited to the distribution of supplies such as clean equipment and naloxone, important principles of engagement and the development of trust necessary to the provision of services are overlooked with negative implications for service users.