Harm Reduction Spotlight: Brandon Kober
Spectra Plasmonics had the opportunity to sit down with Brandon Kober, a former harm reduction nurse, to learn more about harm reduction and its future in Canada. With his experience on the frontlines at safe injection sites in Hamilton and Toronto, Brandon now lends his insights and perspectives on harm reduction approaches to students, industry, and non-profit organizations.
This is the first post in a series of conversations with Harm Reduction leaders for Spectra’s blog.
What is harm reduction? Why is it important?
Specific to drug use, harm reduction, at its core, is a radical sense of empathy for people exactly where they currently are in life, considering all the social, economic, and political determinants of health and putting them into context for that individual. It is trying your very best in that moment to reduce harm, driven by an understanding that: people will use drugs, there’s nothing inherently wrong with drug use, and it is our societal attitudes toward people who use drugs that often causes the most harm.
What is drug checking? Why do you believe it is valuable?
I can speak to my own experience working frontlines at injection sites. People come into a site with drugs in hand from an unregulated source, and we have no clear idea what is in that substance. There is no guarantee that the person is getting what they paid for and, when consumed, this can often lead to adverse outcomes including overdose, but also other psychoactive and physiological effects they were not anticipating or desiring.
We have long seen the impacts of the unregulated drug supply - it kills people, perpetuates further and more complicated substance use disorders, and can worsen other mental health issues. And so, drug checking is an essential tool to give us a sense of what is actually out there on the street and really empower people who use drugs. It is really beneficial for that person to have informed consent and choice about what they’re buying and using. It also shifts power away from larger dealers upstream who have say over what is in the drug supply and are not necessarily incentivized to do a great job. It thus serves as a form of consumer protection and power for people who use drugs.
An additional benefit is to the frontline peer workers, harm reduction workers, and nurses who are also empowered to have data-informed harm reduction conversations with their clients that can lead to less use of unknown and dangerous substances, less harm, and less overdose.
At a broader, systemic level, I see considerable value for admin - for health system leaders and planners, and public health agencies - to coordinate all of this data and information about what the supply actually looks like and tailor their response appropriately. I envision a future in which we can get a live view of all the drug checking data coming in from various organizations and outreach teams across a city, such as Toronto or Vancouver, and produce a heat map of areas which have seen an uptick of some really nasty new substance that has been leading to overdoses or other adverse effects. We could then tailor responses like having EMS or outreach teams be more present in that area, ready to respond.
There are a variety of different ways that drug checking adds value, and really, it is a complement to safe supply. A big goal of the harm reduction community is for safe supply, which is a key tool in our toolkit. The issue, though, is that safe supply is very difficult to roll out perfectly. There is no real path forward that does not include the street supply persisting and changing, so drug checking is one way to help regulate this unregulated supply. Having both safe supply and drug checking is a more pragmatic toolkit.
What does Canada do well in the harm reduction space? Where can we look to improve?
There is a bit more of an appetite in dense urban areas like Toronto and Vancouver to be innovative in tackling these problems. This may be for a number of reasons, such as the acuity and visual presence of the crisis in big cities, but it also takes political will, courage, and resources to consider what approaches have failed us and shift how we do things to be more harm-reducing. So that’s a good starting point. However, there are tons of areas for improvement. There are plenty of cities and communities reeling from this crisis and unfortunately have very little political will to embrace harm reduction approaches. Think NIMBYs. Further investing in safe supply and drug checking technology are also key, as well as broader decriminalization of illicit substances, something that cities like Vancouver and Toronto have officially requested from the federal government. This is a great start, but it would be terrific to see drugs decriminalized across the country.
Another major barrier to progress on this front is incrementalism. Despite those local areas like Vancouver and Toronto having a lot of political will to take risks, at a broader scale, we seem to approach things painfully incrementally in Canada. We love to trial things - a lot of pilot projects. But at what point do you say, “okay, this was successful, let's roll it out widely”? Or, to step back and critically evaluate whether the incremental approach was representative of the impacts a more comprehensive approach may have.
What makes you optimistic about the future of harm reduction?
The culture is shifting around drug use in general. An encouraging sign is how quickly cannabis went from being faux pas to legal. Obviously, there was decades of activism, but Canada actually took it upon itself to look to other jurisdictions and learn about that it's not as harmful as we have been led to believe, and that you actually cause more harm by criminalizing it. Legalizing cannabis was imperfectly done, but I don’t think we have seen any great harm to society. If anything, we have seen benefits, including less people being criminalized for drug use. You can see that beginning with other drugs like psychedelics. We are having conversations about legalizing those, and there are some jurisdictions that have already done it. And then, there’s progress being made in Canada and elsewhere with safe injection sites and decriminalization. Things are slow, but it’s happening.
And again, there is progress with drug checking like Spectra. Having people in the tech industry approaching this very complex problem and thinking ‘how can we help? What can we do to offer something that would actually benefit people?’ Particularly for those who are not usually afforded this kind of attention - who are discounted, even left for dead.
All those things are encouraging, but definitely, there is still a long, long way to go.
This interview reflects personal views and in no way that of an institution or organization.
Spectra Plasmonics is a Kingston-based technology company whose mission is to empower anyone to make better informed, human health related decisions by developing chemical sensing products that are high performing and simple to use.