Foreword
Amid ongoing public health crises spanning addiction,
mental health, and the effects of social inequities, healthcare
providers—particularly nurses—play a critical role
in addressing these challenges. This special issue of the Canadian
Journal of Emergency Nursing (CJEN) is dedicated to the exploration
and advancement of harm reduction strategies within
emergency and acute care nursing. As board members of the
Harm Reduction Nurses Association (HRNA), we are proud
to present research and commentary that address the evolving
landscape of harm reduction, focusing on supervised consumption
sites (SCSs) and the complexities of caring for individuals
with substance use disorders (SUDs).
The articles included in this issue highlight the systemic barriers
healthcare providers face. These barriers include stigma, safety
concerns, and emotional exhaustion when caring for individuals
with SUDs or mental health and addiction (MHA) disorders.
These challenges are amplified in rural and resource-scarce
areas where social-structural stigmas and inadequate funding
hinder equitable care. Hodgson, Lavigne, and Bardwell’s editorial
emphasizes the unique obstacles rural nurses in British
Columbia face when implementing harm reduction strategies
amidst policy debates and media-driven misconceptions about
workplace safety.
Ilievska, Pittman, and Ralph provide a descriptive study exploring
emergency department (ED) registered nurses’ perceptions
in Southwestern Ontario regarding SUDs and SCSs. In the context
of Canada’s escalating opioid crisis, their findings reveal that
while ED nurses exhibit empathy toward individuals with SUDs,
their knowledge and comfort with SCSs remain limited. This
study is innovative in reporting ED nurses’ combined views on
SUDs and SCSs, as well as identifying specific services that EDs
and SCSs should provide from the nurses’ perspectives.
Tang et al. conducted research in Saskatchewan examining
healthcare providers’ perspectives on frequent MHA-related ED
visits. The study identifies key challenges, including social determinants
of health (e.g., housing crises, financial struggles), structural
barriers (e.g., inadequate training, stigma, and resource
shortages), and their impacts on patient care. Healthcare providers
emphasize the need for increased funding, early education
on mental health, and improved MHA-specific training to
enhance community support and reduce ED recidivism. Despite
the challenges, providers highlight the rewards of their work and
stress the importance of collaboration between governments,
communities, and healthcare professionals.
Furlong reviews barriers to implementing harm reduction strategies
for SUDs in acute care hospital settings. Key challenges
include stigma, safety concerns, lack of education, and burnout
among healthcare professionals, particularly nurses. Furlong’s
review underscores the importance of comprehensive nurse
training, standardized care protocols, and trauma-informed
practices to improve patient outcomes and staff well-being. The
review concludes by advocating for organizational changes,
expanded research, and education to reduce stigma, enhance
safety, and support harm reduction in inpatient environments.
The common thread of these works is emphasis on advocacy
for the integration of universal harm reduction policies within
healthcare settings, emphasizing culturally safe, trauma-informed,
and anti-oppressive approaches. Strategic implementation
of peer support workers, scaling up detox facilities,
and incorporating safe consumption spaces in hospitals are
pivotal steps to ensuring both staff safety and patient dignity.
Educational programs, especially for nurses, are critical to dispelling
stigma and fostering greater understanding of SUDs and
MHA disorders. The findings demonstrate that addressing the
root causes of stigma and prioritizing equitable care can better
meet the needs of vulnerable populations.
A critical theme emerging from these studies is the connection
between social determinants of health and healthcare outcomes.
Structural issues such as the lack of affordable housing, financial
instability, and limited access to community-based services
drive individuals to seek care in emergency settings, often as a
last resort. Nurses and other healthcare providers bear witness
to these systemic failures and are uniquely positioned to advocate
for policy reforms that address these upstream factors.
Initiatives like early childhood education on mental health and
substance use, as well as employment support programs, hold
potential for disrupting cycles of inequity and improving longterm
outcomes.
The intersection of healthcare delivery with reconciliation
efforts cannot be overlooked. Collaborating with Indigenous
communities offers healthcare providers an opportunity to
learn from Indigenous knowledge systems and uphold the Calls
to Action of the Truth and Reconciliation Commission. This
includes respecting self-determination and incorporating culturally
appropriate care practices that honor the diverse experiences
and needs of Indigenous patients.
This issue of CJEN marks an important step forward in understanding
harm reduction within emergency care. The research
and commentary provide critical insights into ED nurses’ perceptions,
the effectiveness of harm reduction strategies, and
their broader implications for practice and policy. Hodgson,
Lavigne, and Bardwell underscore the severe social-structural
stigma experienced by people who use drugs (PWUD) in rural
areas, which is intensified by media coverage and political narratives.
They emphasize the urgent need for collective action from
the nursing profession to uphold ethical responsibilities and
guarantee PWUD safe access to hospital care.
ISSN: 2293-3921 (print) | ISSN: 2563-2655 (online) | https://doi.org/10.29173/cjen506
Print publisher: Pappin Communications http://pappin.com | Online publisher: University of Alberta www.library.ualberta.ca/publishing/open-journals
Canadian Journal of Emergency Nursing · Vol. 48, No. 1, Spring 2025 9
Ilievska’s study further identifies stigma, implementation concerns,
and a lack of collaboration between EDs and harm reduction
services as significant barriers. The findings underscore the
need for fostering partnerships and advocating for policies that
enhance care for individuals with SUDs.
The highlight in this issue is the urgency to address Canada’s
escalating crisis of drug-related harms. Harm reduction strategies,
including supervised consumption sites, needle distribution
programs, opioid agonist therapy (OAT), safer supply
initiatives, and targeted public health education, play a vital
role in minimizing the negative effects of substance use while
respecting individuals’ dignity and autonomy. However, a comprehensive
harm reduction approach must integrate these strategies
into a cohesive system that addresses broader structural
inequities.
We extend our deepest gratitude to the authors, reviewers, and
editorial team for their dedication and invaluable contributions
to this vital work. Their collective efforts embody the importance
of research, innovation and compassion that defines harm
reduction nursing. As you engage with the works presented, we
encourage reflection on their implications for your practice and
consideration of how you might contribute to advancing harm
reduction strategies in your professional context. By working
together, we can continue to drive progress, enhance patient
care, and support the implementation of effective harm reduction
interventions.
Sincerely,
The Board of the Harm Reduction Nurses Association