I hesitate to get into this conversation, it has the potential to blow up into a really heated argument, and that is not my intention at all. I just wanted to bring in a harm reduction viewpoint.

I am going to use myself as an example. I am overweight, to a point that it actually does affect my health. I don't look massively overweight, but I am carrying an extra 20 to 30 pounds on a smaller frame, and my back hurts more when I carry this extra weight. I know that I should eat a healthy diet, and exercise more. I know I should avoid junk food, and yet, some days, the junk food is calling and I find it too hard to not answer. The other day someone brought in doughnuts to work. By the end of a crazy busy shift with no real breaks, and many complicated cases, I had eaten my way through 3 of them. 3 doughnuts in one day.... what was I thinking? I know all the stuff I should be doing, and for the most part I try and do it. I have all the intellectual knowledge, and then I have my real life. 

We know that people use drugs and medication for different effects. Telling them we don't agree with what they are doing isn't actually going to change behaviour. On that busy shift at work, if you had come between me and those doughnuts... I would not have been a nice person. I know what I should be doing, but don't tell me what I can be doing.

I know, telling them that they can go ahead won't change behaviour either, and I am not suggesting that at all. I am suggesting we provide information on what the reasons are we would not recommend taking these drugs, and then the information that if a person decides to take those drugs, how to take them as safely as possible. It really is about harm reduction. People have the right to chose how to live their lives, and unless they are harming another individual, I don't know if it is our "right" as health care providers to judge them. 

In this case there is a baby involved, but the mother did approach a HCP for help in being able to take these drugs safely in the context of pumping and breastmilk feeding. While I may not applaud her actions in taking the drugs, I will stand up and cheer that she is responsible enough to ask for information on how to keep her baby safe while she does take them. I am impressed that she braved the health care system which does tend to be a bit "holier than thou" and preachy when it comes to lifestyle choices. I am a bit of an oddity in the health care system, I am not sure I always agree with what western medicine does, and Lord knows, enough baby boys die each year due to complications from circumcision that we really shouldn't believe everything we say.  But I digress. 

It's a hard line to find, not endorsing destructive behaviour, but ensuring harm reduction and health promotion at the same time. I can tell you though, that at the end of that shift, if someone had lectured me about eating those 3 doughnuts, I would have simply made a mental note to avoid that person in the future. But if someone has said, hey, want to come on a digestive walk with me around the hospital, I would have said, "Yes please!". I don't need people to judge me for my actions, I need people to understand that my life is multifaceted and complicated to the nth degree. I am pretty sure that everyone's life is like that. When people approach us for help in unusuall circumstances, that we may or may not agree with on a personal or even professional level, our correct response should be education and harm reduction, vs. judging and preaching. Joy Noel Weiss, who I miss dearly, always used to tell me, "walk softly with a big stick". 

Sonya
who is still learning about walking softly, the big stick thing she had figured out in JK
and who is so very grateful for the information provided by Shaland, who reminded me that it is about harm reduction, because yes, my first response was also to scoff at medicinal reasons for LSD...

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