A nurse practitioner’s experience with harm reduction

Cammie Lewis has been a nurse for more than 20 years and a nurse practitioner for the past 10 years. During the last five years, she has been working at the Kelowna Opioid Agonist Treatment (OAT) Clinic, and her work took on a more harm reduction focus.

“It’s a good fit for me and there’s a huge need right now due to the unregulated drug supply crisis we are in,” she says.

However, it took Cammie a while to come around to the idea of harm reduction.

“Like a lot of people, I was initially skeptical," Cammie admits. "I was afraid it was an excuse for not doing more upstream work, like poverty reduction, affordable living and food security. Now, I understand the need for, and the importance of, harm reduction as a part of the whole continuum of care to meet people where they are at.”

The term ‘upstream’ relates to proactively promoting and addressing root causes that prevent adverse health issues from arising. Harm reduction is often considered ‘downstream’ where treatment is reactively implemented for illnesses that have already taken hold and reached a crisis point.

“I can now see harm reduction as prevention and health promotion," says Cammie. "Harm reduction says to people, ‘I see where you’re at and I think you’re important. You deserve to be treated with respect.’ Stigma is reduced, and this creates inclusion of really vulnerable people who are now willing to come forward for help; people we would have previously missed.”

In turn, health policy can be influenced.

“For me, the purpose of incorporating harm reduction into my work is to move people forward on that continuum of health," she says. "That’s always my goal and purpose, connecting with people where they are in the moment, but not to leave them there, and instead, to gently encourage steps forward to greater wellness.”

Cammie has also learned to respect that people move in their own time and for their own reasons. Sometimes the pace feels slow; but change can also happen quickly.

“My favourite part of the job is watching beauty emerge from chaos," says Cammie. "I get to see people going from homeless to having homes, or getting their kids back or eventually going to university. I get to see amazing recoveries over time. When you meet people at the ground level, they truly engage; without that engagement, you can’t move forward at all. We’re engaging with people that don’t often access other areas of health care. They have a chance for increased wellness, however they define it.”

Cammie gives a shout out to her colleagues. “I’m super lucky to work in a multidisciplinary team where everyone works together in a trauma-informed environment. And I mean everyone, from the security guard at the entrance to our medical office assistants who hand out most of our harm reduction supplies; our pharmacists, nurses, social workers and doctors – everyone understands the value of harm reduction.”

If you’d like to share how you’re incorporating harm reduction in your work at Interior Health, please contact Alison Houweling.

• Harm Reduction Physician Series: Dr. Megan Hill
• Addiction medicine: working smarter, not harder