Battered not only by the ongoing overdose crisis but also with challenges caused by the COVID-19 pandemic, harm reduction workers across Canada are struggling with burnout, experts say.
“We are going to lose a generation of harm reduction workers to burnout because of the unrelenting nature of this crisis,” Gillian Kolla, postdoctoral fellow at the Canadian Institute for Substance Use Research at the University of Victoria, told Global News.
“People who care deeply about working with people who use drugs, who have worked in this field for a very long time, are finding they can’t do this work because it’s just too emotionally fraught,” she said.
A 2022 report from the Canadian Centre on Substance Use and Addiction found the drug toxicity crisis and the COVID-19 pandemic are largely to blame for the higher levels of burnout those in the harm reduction field are facing.
“I love my job and simultaneously wish it didn’t have to exist. I couldn’t imagine doing nothing about the overdose crisis. It is an honour to be paid for something I am so passionate about, but also hard to be engaged in what seems like such an endless battle with governments to value the lives of people like me,” a harm reduction worker in the report noted.
A study released last year specifically focusing on Toronto also found profound impacts on harm reduction workers.
“It’s important to recognize that some emotions that we have as humans in response to seeing other humans suffer, and the loss and grief that comes about it, that’s a normal reaction,” said Kolla.
“The scale of the crisis is the problem.”
COVID-19 and the overdose crisis in Canada
Over the past several years, the overdose crisis has continued to worsen in Canada as toxic drug supply has increasingly made its way through the nation. The COVID-19 pandemic made it harder for people who use drugs to access safe supplies and worsened feelings of isolation, stress and anxiety.
According to the Canadian Centre on Substance Use and Addiction report, fentanyl appeared in 55 per cent of toxicity deaths in 2019, 80 per cent in 2020 and 87 per cent in 2021.
“It’s important to recognize that the overdose crisis is being caused by fentanyl having permeated the unregulated drug supply,” according to Kolla.
And, although harm reduction workers were already experiencing burnout before COVID-19, the pandemic has only “exacerbated” the problem, she said.
“It’s not just the isolation from the COVID pandemic, but it’s the isolation from the COVID pandemic that came after years of neglecting this issue. It’s the huge amounts of economic deprivation that is often existing within communities of people who are most affected by overdose. It’s the systemic racism towards Black and Indigenous people that is exacerbating the history of colonialism in Canada,” said Kolla.
Between Jan. 2016 and March 2022, there were a total of 30,843 apparent opioid toxicity deaths in Canada, according to a September 2022 report into the opioid overdose epidemic from special advisors working with the Public Health Agency of Canada.
During the first two years of the pandemic, the country saw a 91 per cent increase in these types of deaths, compared to the two years prior, federal data shows.
A total of 90 per cent of all accidental apparent opioid toxicity deaths occurred in British Colombia, Alberta or Ontario – though elevated rates have also been observed in other areas, including Yukon.
“I’m aware that my own personal stress leaves me with less to give or to offer at work. I have to be very measured with my energy and conserve it where I can. I can’t extend myself as much as I did pre-COVID,” a harm reduction worker said in the report by the Canadian Centre on Substance Use and Addiction.
In Ontario alone between Feb. and Dec. of 2020, there was a 79 per cent increase in monthly opioid-related deaths, according to the province’s public health agency.
“COVID could have been an opportunity for our society to finally appreciate harm reduction because for a long time, harm reduction has been kind of icky to people,” Daniel Bear, professor at Humber College’s faculty of Social and Community Services, told Global News.
“And the government response in drugs policy is wholly inadequate. Full stop. People don’t need to be dying. The fact that people are dying is a sign of the failure of our system,” he said.
How to reduce the stigma?
Reducing the stigma some have when it comes to drugs is also important to help the overdose crisis in Canada and reduce the stress on harm reduction workers, according to Kolla.
“We haven’t had as fulsome of a response as we would expect because of the stigmas around drug use,” she said.
“It’s also very important to recognize that as much as we’ve come up with the war on drugs mentality, the just say no to drugs mentality – these types of messages have actually been inherently very, very harmful.”
For many, according to Bear, this stigma comes from prohibition models.
“It’s not like the stigma against people who use drugs went away,” he said.
Kolla added that harm reduction workers also need specialized mental health supports, while Bear pointed to decriminalization as a key part of the solution.
“We need decriminalization to allow people to enjoy the same protections, concerns and care from their government no matter what they do or what they consume. Safe supply is what we expect in a society, whether that’s beer or chicken breasts or heroin,” he said.
“You may not like harm reduction but it’s going to save someone’s life.”