Editor’s Choice Canadian harm reduction policies: A comparative content analysis of provincial and territorial documents, 2000–2015 T. Cameron Wild a, *, Bernie Pauly b , Lynne Belle-Isle c , Walter Cavalieri d , Richard Elliott e , Carol Strike f , Kenneth Tupper g , Andrew Hathaway h , Colleen Dell i , Donald MacPherson j , Caitlin Sinclair a , Kamagaju Karekezi a , Benjamin Tan a , Elaine Hyshka a,k a School of Public Health, University of Alberta, Canada b School of Nursing and Centre for Addictions Research of BC, University of Victoria, Canada c Canadian AIDS Society and Centre for Addictions Research of BC, University of Victoria, Canada d Canadian Harm Reduction Network, Canada e Canadian HIV/AIDS Legal Network, Canada f University of Toronto, Canada g School of Population and Public Health, University of British Columbia, Canada h University of Guelph, Canada i University of Saskatchewan, Canada j Canadian Drug Policy Coalition, Canada k Inner City Health and Wellness Program, Royal Alexandra Hospital, Edmonton, Canada A R T I C L E I N F O Article history: Received 20 October 2016 Received in revised form 8 February 2017 Accepted 22 March 2017 Available online xxx Keywords: Harm reduction Policy Content analysis A B S T R A C T Background: Access to harm reduction interventions among substance users across Canada is highly variable, and largely within the policy jurisdiction of the provinces and territories. This study systematically described variation in policy frameworks guiding harm reduction services among Canadian provinces and territories as part of the first national multimethod case study of harm reduction policy. Methods: Systematic and purposive searches identified publicly-accessible policy texts guiding planning and organization of one or more of seven targeted harm reduction services: needle distribution, naloxone, supervised injection/consumption, low-threshold opioid substitution (or maintenance) treatment, buprenorphine/naloxone (suboxone), drug checking, and safer inhalation kits. A corpus of 101 documents written or commissioned by provincial/territorial governments or their regional health authorities from 2000 to 2015 were identified and verified for relevance by a National Reference Committee. Texts were content analyzed using an a priori governance framework assessing managerial roles and functions, structures, interventions endorsed, client characteristics, and environmental variables. Results: Nationally, few (12%) of the documents were written to expressly guide harm reduction services or resources as their primary named purpose; most documents included harm reduction as a component of broader addiction and/or mental health strategies (43%) or blood-borne pathogen strategies (43%). Most documents (72%) identified roles and responsibilities of health service providers, but fewer declared how services would be funded (56%), specified a policy timeline (38%), referenced supporting legislation (26%), or received endorsement from elected members of government (16%). Nonspecific references to ‘harm reduction’ appeared an average of 12.8 times per document—far more frequently than references to specific harm reduction interventions (needle distribution = 4.6 times/document; supervised injection service = 1.4 times/document). Low-threshold opioid substitution, safer inhalation kits, drug checking, and buprenorphine/naloxone were virtually unmentioned. Two cases (Quebec and BC) produced about half of all policy documents, while 6 cases – covering parts of Atlantic and Northern Canada – each produced three or fewer. Conclusion: Canada exhibited wide regional variation in policies guiding the planning and organization of Canadian harm reduction services, with some areas of the country producing few or no policies. Despite a wealth of effectiveness and health economic research demonstrating the value of specific harm reduction * Corresponding author at: School of Public Health, University of Alberta, Edmonton, AB T6G 2T4, Canada. E-mail address: cam.wild@ualberta.ca (T. C. Wild). http://dx.doi.org/10.1016/j.drugpo.2017.03.014 0955-3959/© 2017 Elsevier B.V. All rights reserved. International Journal of Drug Policy 45 (2017) 9–17 Contents lists available at ScienceDirect International Journal of Drug Policy journal homepage: www.elsevier.com/locate/drugpo