Ethical harm reduction practice

Health professionals should tailor the information and support to each person. 

In Aotearoa New Zealand, health services are obligated under the Code of Health and Disability Services Consumers’ Rights to, among other things: 

• Fully inform people about all options available to them. 
• Provide services in a manner that minimises the potential harm to, and optimises the quality of life of, that person. 

This means that health services should provide access to harm reduction information and support, or let a person know where they can get that information from. 

These suggestions can help you make sure you are practicing ethically: 

1. Consider your decision making processes, as they should be ethically based
   Professional codes of conduct, such as Tikanga Matatika (Dapaanz Code of Ethics), can be a guide for ethical practice in harm reduction. Tikanga Matatika is a code of ethics for dapaanz (Addiction Practitioners Association Aotearoa New Zealand) members and has been found to align well with harm reduction principles by a 2023 kaimahi (workers) review; it offers a decision-making process to navigate ethical dilemmas against the three pou of maanaki (care), pono (integrity), and pūkenga ahurea (skilfulness). 
   
2. Work as a team
   Working with a team including managers and supervisors helps to ensure that your practice is ethical and aligned with harm reduction values.
   Working as a team can help to identify knowledge or competency gaps. Regular refresher trainings may be needed (e.g. for topics such as safer injecting practices), particularly in organisations that don’t specialise in harm reduction as this can help staff feel confident talking about and practicing harm reduction. 
3. Explore how your service supports peers and other staff who have experience using substances
   Peers that work in harm reduction services may use substances themselves and have the strong ability to connect with others who use substances. An organisation can support this workforce by ensuring that their hiring, management, and support processes accommodate the hiring of peers. Clear expectations of how and when personal experiences may be shared, and what the relationship is between personal experiences and a person’s work role need to be identified. The Te Pou website has more information about the peer workforce.  
4. Check the language that you use 
   Some terms that are commonly used in alcohol and other drug services may not be as relevant for people accessing harm reduction services, due to terminology implications. For example, “recovery” is commonly used as for and by people who have experienced an addiction but are now committed to abstinence. This may not be a relevant term or goal for people who pursue harm reduction; phrases like ‘positive change’ may be more appropriate. 
5. Reflect on your practice 
   Critically exploring and reflecting on your practice helps strengthen the support you provide. This could be done when your team, colleagues, managers, and supervisors explore the way they work, identify what is working well and what could be improved.  
   Here are some questions that can prompt discussion: 
   
   • How might you describe all of the options and approaches that a person has access to? 
   • How might you explain what harm reduction approaches are to people who are interested in your service? 
   • Who decides what might be changed, within the person you’re supporting’s life, and when it happens? 
   • What do you base your perceptions of risk on? How does this align with both evidence of risk as well as the personal experiences of the person you’re supporting? 
   • How do you develop trust with the people you support? 
   • How could you tell if you have the right staffing for the community you are aiming to support? 
   • What could be the potential ethical tensions when peers are from the same community as the people they support, and how can they be minimised? How might this change if the community is small or if there are blurred boundaries outside of a service when using or obtaining substances? 
   • How might you identify and address a situation where a staff member’s own substance use or previous experiences are negatively affecting their ability to provide non-judgmental information and support for the people using your service? What might you need to do if you noticed your own substance use was interfering with your ability to do your job? 
   • How might you identify and address potential concerns about dual relationships? 
   • How do you ascertain whether the information you’re sharing is accurate and useful for the people you’re sharing it with? 
   • How do you ascertain whether your own self-disclosure is for the benefit of the person you’re supporting or for your own benefit? 
   • How do you outline confidentiality and when you might need to share information with other people? 
   • How might you deal with a situation when you have serious concerns for the wellbeing of a person or the people around them? 
   • How might you raise important topics such as wound care in an appropriate manner, while still maintaining focus on the person you’re supporting and what they want to work on? 
   • How might you deal with a situation where the person’s whānau wants them to be abstinent from all substances, but they do not want to be? 
   • What power imbalances may be present in the way you or your service practices? How might you address these?