Harm reduction persists: Returning to collective care
For more than a decade, communities across Canada have been experiencing tremendous harms associated with the growing toxicity of the unregulated drug supply. Responses to this crisis remain fragmented, and too often they are shaped more by politics than by evidence or need. In recent years, the already limited landscape of harm reduction services has contracted further as governments across Canada have cut funding and reduced support.
However, harm reduction did not begin as government-funded policies or programs. It began as collective care.
Roots of harm reduction
Harm reduction in Canada originated in approaches built by people who use drugs to keep each other safe. This movement has evolved, adapted and expanded in response to harms faced by people who use drugs, with or without formal government support.
For instance, in the late 1980s, in response to rising rates of HIV, people who use drugs and their communities organized needle exchange programs. These were not sanctioned initiatives — they were community responses born out of urgency and necessity. Government support followed: by 1994 there were 30 publicly funded needle exchange programs operating in British Columbia, Alberta, Ontario and Quebec.
A wide range of harm reduction programs had a similar start: supervised consumption sites, naloxone distribution programs, safer supply initiatives and drug checking programs all owe their origins to unsanctioned community care, often led by people who use drugs.
Public health authorities eventually supported many of these approaches, helping to scale them up in parts of the country. However, in doing so, they often became framed as health services for individuals, rather than as expressions of community autonomy, care and resistance to the harms of systems such as prohibition and criminalization.
This distinction is important. Public health helped scale critical access, which saved lives. But when the broader political and social foundations of harm reduction are left unacknowledged, the movement’s core — grounded in rights, dignity, agency and leadership by people with lived and living experience — can be diluted or sidelined.
Rollbacks during a public health crisis
As the toxic drug crisis has continued, harm reduction services in some regions are facing significant challenges. Restrictions, funding cuts and service closures have reduced access to life-saving services across the country.
These rollbacks reflect a set of decisions about what kinds of responses are acceptable, whose suffering is tolerated and whose lives are worth protecting.
In many cases, harm reduction has become a political target. Misinformation continues to shape public understanding, while the visible outcomes of the housing crisis and substance use are used to justify scaling back services rather than expanding meaningful supports. Harm reduction services are increasingly blamed for the very systemic conditions the movement seeks to address.
This narrative obscures what is actually driving harm: a toxic, unregulated drug supply; increasing rates of poverty; ongoing criminalization; and a lack of safe, deeply affordable housing. These are structural conditions and policy choices, not consequences of harm reduction.
When harm reduction is scapegoated, attention is diverted away from the root causes of harm. The result is a familiar and deeply concerning pattern: services are reduced, risk increases and the burden of coping and responding to compounding harms falls most heavily on communities already facing marginalization.
We have seen this before: in times of crisis, when support is withdrawn or withheld, responsibility shifts to communities, and harms deepen for those already most affected.
History shows us that when these systems withdraw, communities do not stop responding. They adapt. They organize. They find ways to keep each other alive, even under increasingly constrained conditions.
Within these moments, new approaches emerge, which not only respond to immediate risks but also challenge the broader systems that produce those risks.
Radical resistance: How harm reduction presses on
Harm reduction is a pragmatic and adaptive response to changing harms faced by people who use drugs. It has continued to advance, with or without formal government support, because of the people who have built and sustained it.
People who use drugs, peer networks and community organizations have consistently stepped in to address needs, often with limited resources and little recognition. These community-driven approaches address gaps left by formal systems and have the potential to build new systems of care.
Peer-led overdose prevention sites, outreach work and mutual aid networks remain essential, particularly when service access is limited. Even in the face of backlash and uncertainty, communities continue to push for access, dignity and care.
As harm reduction services across the country are dismantled or reshaped under political pressure, these community-driven approaches are not just important, they are indispensable.
Harm reduction, as both a movement and a practice, plays a critical role here. It is not only about reducing immediate harm, although that remains urgent. It is also about advocating for systemic change and insisting on responses that reflect the realities people are living through.
This raises an important question: How will supporters of harm reduction show up in this moment?
Collaboration has always been central to harm reduction’s progress. Following the leadership of people who use drugs, healthcare providers, researchers, lawyers, journalists, public servants and policymakers have all contributed to advancing harm reduction approaches in Canada.
This moment calls for renewed commitment and for new coalitions.
It will require courage and trust across sectors. Institutions will need to trust in the expertise and leadership of people with lived and living experience and to act on that trust in meaningful ways. At the same time, harm reductionists will need to continue pushing to find ways to embed harm reduction principles and practices within systems that have not always been designed to support them.
We are at a pivotal moment.
Harm reduction began as people keeping each other alive when no one else would. Those roots run deep and that foundation has not changed.
This moment calls us to return to those roots with greater clarity about what is at stake, and a renewed commitment to collective care.
Harm reduction has never depended on permission.
We keep each other safe.
Kaela Pelland is CATIE’s knowledge broker, harm reduction knowledge mobilization. With more than 15 years of experience in community-based health and social services, she has worked in a variety of roles supporting people who use drugs and people living with and at risk of HIV and hepatitis C. As a person who uses drugs, she is passionate about centring the voices, experiences and leadership of those most impacted by the toxic drug crisis.