Working in harm reduction is difficult. Looking out for the safety of people who use drugs (PWUD) and those who oppose harm reduction values is emotionally draining. Oftentimes my client care will seem to have failed. Read on for 4 valuable lessons that I learned while working in the role that helped me get through the tough parts of the job.

1. Stigma toward people who use drugs is very prevalent amongst healthcare workers

This is one of the main frustrations that I battled with regularly. Many health care professionals still carry stigmatizing beliefs or attitudes toward people who use drugs, especially those who have concurrent disorders. For example, there are nurses who will roll their eyes when they see the same patient presenting to the emergency department the third time that week. The patient may be labeled as “difficult” or “uncooperative”. The patient does not get properly assessed and treated and therefore relapses when they return home. Hospitals in themselves are major barriers to PWUD and often lead to trauma related to folks’ hospital stay.

When we learn about revolving door syndrome in school, the onus is always on community resources/programs to prevent relapse. But how can the community carry out supports that medical professionals did not target fully in the first place, with their limited resources? The wait lists for ACT teams (and similar) can be months to years. ACT teams have limited capacity to take in new clients, as they generally maintain 60 to 100 clients at a time, unless they are a flexible ACT team that can take up to 200 clients. All in all, community providers should not be responsible for the result of stigma in hospitals causing negative outcomes. In the end we’re the ones who have to pick up the pieces.

2. Advocacy is for more than achieving the best outcomes for your clients

Advocacy is not just important for helping folks access better care but to further develop the therapeutic relationship. Although nurses are generally viewed as caring and compassionate, this is not always the case with people who have had negative experiences with health care professionals. As a nurse, you’re still part of a system that alienates PWUD. Gaining trust with those who have been misled is difficult. The best way you can show a client that you genuinely care for their well-being is by forming an alliance with them and advocating in their best interest. In other words, don’t just tell them you care–show them.

3. The journey of recovery is rarely ever linear, but that’s ok

Recovery is not linear, unlike in medical conditions. There’s no right or wrong when it comes to mental health and addictions, as long as a condition does not cause a person distress or deterioration. Things that seem simple to you, like taking a pill every morning, can be an impossible challenge to someone else. Developing the habit of taking daily morning medications would be a huge progress to recovery even if it would be meaningless to you. On a similar vein, end goals are always different. Being “cured” or “healed” or “recovered” means something different to everyone. Also, recovery is often 2 steps forward, 1 step back. This does not necessarily always mean that the current supports are ineffective, since there are always external factors that thwart the original plan.

4. Ignorance about the principles of harm reduction leads to demoralizing criticism

Ignorance about harm reduction practices leads to a lot of judgment and assumptions. I’ve avoided talking about my job to a lot of people, including my parents, because I knew they wouldn’t understand. Or worse, they’d think I’m “enabling” people by not forcing them to go to rehab. Substance use and addiction is a social issue grounded in racist, classist, and legal roots. What I try to remember is that harm reduction is based on empirical research and evidence. I also try to think in a harm reduction lens when responding to those who criticize this line of work. Just like how I say that abstinence is not for everyone, harm reduction is also not for everyone. Working in harm reduction may be difficult, but the core principles of this approach makes it worth it.