Navigating Conservative Drug Policy in Ontario's Safe Consumption Sites: A Critical Investigation of Harm Reduction Policy and Practice

Abstract

As harm reduction is increasingly integrated into social and health services and programs, it is essential to recognize the tension between healthcare provided by mainstream institutions and the values of harm reduction. Based on ten interviews with frontline staff who work at safe consumption sites in Ontario, Canada, I explore the challenges of providing harm reduction services under the 2018 Progressive Conservative Government’s Consumption Treatment Service (CTS) reform. My study interrogates the sociopolitical assumptions about drugs and drug use within the CTS policy and examines practices of micro-policy implementation by frontline staff. I characterize` harm reduction as an ontological expression rooted in the lived experience of drug use that places value on relationships and depathologizing drug use. I ask how frontline staff respond to the CTS policy if it changes their understanding and practice of harm reduction and how the policy is accommodated, refused, and disrupted? To answer these guiding questions, I turn my attention to investigating Policy Navigation Practices (PNP) which I define as the creative discretion staff use to balance policy implementation in their encounters with guests. I apply critical medical anthropology theory and methodology to analyze public health policy and services for people who use drugs. This research illuminates the gulf between the lived experience of drug use and the Ontario provincial government’s response to the overdose crisis. I prioritize how networks of care emerge in relation to and are embedded into, sociopolitical contexts that force these practices of care into existence. I situate Safe Consumption Sites (SCS) under the CTS policy as a microcosm of two conflicting worldviews about substance use, ideas of health, and forms of care. The findings advance our understanding of policy implementation practices in SCS and harm reduction as a form of care.