The harm to Aboriginal individuals, families and communities resulting from substance use is immense – reaching across and through families, communities and generations. There are many ways harm from drug use is experienced including the break-down of relationships and families, violence, loss of financial security, disease, and death; these harms are significant. Hepatitis C and HIV infection through injection drug use is happening very rapidly in Canadian Aboriginal communities – most call it a health crisis, some people even called it an epidemic. Our communities need to be able to respond to these issues in meaningful, culturally appropriate and community specific ways. Most Aboriginal people can agree that it is honourable and practical to work towards reducing the harms associated with substance use for both individuals and communities.