Harm Reduction Guide

What is Harm Reduction?

In simple terms, harm reduction is about employing strategies to reduce the risks and dangers that accompany drug use. Advocates of harm reduction strategies take the perspective that people are going to choose to do drugs. However, instead of admonishing drug users for their choices, advocates of harm reduction offer interventions in the form of healthier, safer choices, methods for reducing or eliminating drug use, and resources for treatment.

Harm reduction strategies apply to all drug use, including alcohol. These strategies can save lives and lead people to resources that can help them quit.

Examples of Harm Reduction Strategies

Harm reduction strategies will vary from drug-to-drug, although there will be some cross-over. It’s helpful to point out that not all harm reduction strategies are community-based. Many elements of harm reduction are rooted in empowering people to make better personal choices, including reducing or moderating their drug and alcohol use and avoiding high-risk situations.

Here’s a breakdown of harm reduction by major drug class:

Heroin/Opioids

Heroin and other opioid drugs can be consumed in many different ways. These drugs can be smoked, snorted, ingested, or injected intravenously (IV). IV use is considered the most dangerous method because it involves the use of syringes and direct contact with bodily fluids which increases the likelihood of disease transmission. It is also easy to overdose on opioids, which is a major factor in implementing harm reduction strategies.

Here are some harm reduction programs for heroin and opioid drug users:

• Needle/Syringe Exchange Programs: These programs offer IV drug users to properly dispose of used needles and receive clean needles. Facilities that offer needle exchange also offer exposure to programs and tools for quitting, including information on rehabilitation services, mental health services, and relapse education.
• Medication-Assisted Therapy: This would include the use of FDA-approved medications for treating opioid use disorder (OUD). The most well-known OUD medication is methadone, which has been used to help people recover from OUD for decades. Methadone is only administered at specific clinics. Methadone treatment is seen as a safer alternative to IV drug use. Suboxone and Sublocade are some newer medications used in MAT. Suboxone can be prescribed by a doctor and does not need to be administered by specialty clinics because it is much more difficult to misuse. Sublocade is a once a month injection that is administered by a medical professional and lasts for 30 days.
• Safe Injection Sites: A safe injection site is a place where heroin IV users can inject under supervision. The intention is that trained staff can intervene in the event of an overdose, administering the powerful anti-opioid drug Naloxone. These sites will provide clean supplies and an environment that can reduce the transmission of disease. There will also be resources and information for those who are interested in quitting. These sites are common in Europe and exhibit a different approach than American drug policies, however, some advocates are working to provide these sites for Americans.

Personal harm reduction strategies for opioids would include:

• Getting educated on the dangers of opioid use disorder.
• Training and access to Naloxone can help prevent overdose
• Using clean equipment, and never sharing needles/syringes
• Never combining drugs (especially depressants like alcohol and benzodiazepines)
• Not driving after using

Alcohol

Alcohol is a common factor in many avoidable deaths. From cancer to car crashes, alcohol use can lead to many dangerous outcomes. There are programs and solutions for harm reduction related to alcohol use:

FDA-approved medications for Alcohol Use Disorder (AUD): There are medications that have been approved by the FDA which can help reduce the harm associated with alcohol use.

• Acamprosate: This medication can reduce the cravings for alcohol, helping those seeking to reduce or eliminate their alcohol consumption
• Disulfiram: This medication produces painful withdrawal symptoms if someone uses alcohol. The fear of painful symptoms can be a motivator for people trying to quit.
• Naltrexone: This medication (which can also be used to treat opioid use disorder) has been shown to reduce cravings by inhibiting the effects of alcohol on the brain. Essentially, this drug blocks the pleasure-producing effects of alcohol.

HAMS (Harm Reduction and Moderation Support): HAMS is a non-profit group dedicated to helping people reduce, moderate, or quit drinking. HAMS offers support groups, community education, and a dedicated program designed to help people moderate or quit using alcohol.

Managed Alcohol Programs (MAPs): Canada is leading the way with this inventive harm reduction strategy. MAPs work by administering alcohol in a controlling tapering schedule, helping people detoxify safely. These programs are often offered in homeless shelters or in conjunction with community addiction treatment programs.

Designated Driver Programs and Options: The concept of having a “designated driver” is not new. A designated driver is someone who will offer safe transportation for people who have been drinking. There are several designated driver-related options. Not all programs are available in all cities. A web search for designated driver programs in your city will yield more specific programs. Here are some examples of some designated driver options:

Uber and Lyft: The options can be ideal because they can be less expensive than other options and there are drivers nearly everywhere, especially in larger cities or places where drinking will take place (such as concerts, festivals, and sporting events). The major drawback to these services is if you drove your car to your drinking destination, you’ll have to find a way to get it home.

There’s an App for that: Major mobile app developers for Google and Apple offer designated driver apps. These apps differ from rideshare services in that they often include the option of someone driving you home in your car. Search for “designated drivers” in your app store for options. Note that some options like “DDNY” (Buffalo) and “SafeRideNOW App” (Atlanta) are specific to certain cities or metropolitan areas.
Many sports teams, stadiums, concert venues, and bars will have affiliations with or information about designated driver programs in your area. Don’t be afraid to ask your bartender or the guest services desk at any venue for information on designated driver programs.

Personal harm reduction strategies for alcohol include:

• Arranging transportation in advance to avoid drunk driving.
• Be aware of your surroundings and have an “out” plan if you find yourself in an uncomfortable or unsafe situation.
• Give your car keys to a designated driver – someone you can trust who will get you home safely.
• Employ the “buddy system” when going out. Having people you trust nearby who can look out for your safety can be very helpful
• Only bring enough money for a couple of drinks and a ride home if needed. Stick to a budget when purchasing alcohol.
• Don’t drink alcohol or specific drinks you’re unfamiliar with without having a plan in place. Some cocktails can have especially high alcohol content or may be made with alcohol that metabolizes differently than what you’re accustomed to. Be cautious and consistent.

Stimulants Including Meth and Cocaine

Stimulants can be harmful in many ways with some factors being the method of use and the amount of time between taking the drugs.

• Needle/Syringe Exchange Programs: As with heroin, IV drug use carries significant risk and should be avoided. Using sterile equipment obtained from a Needle/Syringe Exchange Program can substantially reduce the risk of contracting/spreading disease.

Personal harm reduction strategies for stimulants would include:

• Incorporate periods of abstinence between the use of stimulants. Prolonged periods without sleep can contribute to psychosis, hallucinations, and extreme mood changes.
• Avoid using other drugs with stimulants.
• Come down from stimulants as naturally as possible.
• Using sterile equipment and not sharing equipment

Cannabis (Marijuana)

The view on cannabis is changing rapidly in America, with many states adopting more progressive policies on recreational and medicinal use.

The primary approaches to harm reduction involving cannabis revolve around personal choices:

• Incorporate periods of abstinence
• Never use cannabis and drive
• Avoid mixing drugs
• Ingesting cannabis is seen as a safer alternative to smoking or vaping, although there is an increased risk of taking more than intended since it takes longer to produce effects when ingesting orally
• Use clean equipment where possible, and avoid sharing equipment
• Use highly concentrated and more potent cannabis products with caution

MDMA (Ecstasy)

MDMA, aka ecstasy, is a common “club drug” that is used at parties, festivals, concerts, and raves. Ecstasy often comes in pill form and is notorious for being inconsistent and unstable in dosing and effects. Makers of ecstasy often “cut” in different drugs to enhance the effects or to save money. These cutting agents can often be other, powerful drugs in their own right and may produce unexpected effects. There are ecstasy testing products available online and sometimes at music festivals or organized parties where ecstasy use is likely. These products can test for purity and could reveal if the ecstasy pill is adulterated in some way.

Personal harm reduction strategies for ecstasy include:

• Avoid taking ecstasy with other drugs
• Stay hydrated but avoid overconsumption of water
• Have people you trust that you can turn to if you begin to experience negative or unexpected side effects

General Harm Reduction Strategies

There can be a significant crossover between drug-specific harm reduction techniques. The strategies listed below are universal harm reduction tools that can be used.

• Abstaining from drugs and alcohol as often as possible
• Utilize existing mental health and addiction treatment resources
• Educate yourself about the dangerous side effects of drug use
• Practice safe sex. Condoms are an easy and fairly effective way to prevent unwanted pregnancy and sexually transmitted diseases. Additionally, sex with someone who is intoxicated can more easily be argued to have been nonconsensual
• Never combine drugs
• Taking drugs you’re not used to in a safe place with people you trust
• Not buying drugs from people you don’t know or can’t trust
• Don’t take pills if you don’t know exactly what they are
• Use caution when drinking if you didn’t see how the drink was made/poured. It can be easy for people to “spike” beverages with drugs including notorious date rape drugs like GHB.
• Date rape drug testing kits can be purchased online.
• Maintain your overall health. Drink more water, eat healthier food

Harm Reduction Works

Despite the mounting, although still debatable, evidence that indicates harm reduction strategies are safe, effective, and useful in our communities, stigma remains. Many of the criticisms against harm reduction strategies are rooted in a fundamental difference in philosophy to addiction treatment and recovery. Additionally, the perception that drug use is purely a moral issue, rather than a physical and psychological issue also promotes misunderstanding about harm reduction.

In 2018, there were over 67,000 drug overdose-related deaths in the United States. Overdose deaths are preventable, and harm reduction can play a major role in reversing this trend. If we can escape the issue of morality in drug use, the benefits become very clear. Once we acknowledge that people are going to engage in drug use, we can meet them where they are, and offer safer solutions including the number one harm reduction tool available – ABSTINENCE.

Here we’ll look at the common misconceptions about harm reduction

It leads to drug use: Wrong. Harm reduction acknowledges that people are already doing drugs, and seeks to meet them where they are. Harm reduction encourages safe practices and does not exactly promote drug use, but rather aims to make current users safer and healthier. The CDC has reported that providing harm reduction tools in the form of needle/syringe exchange leads to people receiving addiction treatment who otherwise may not have received care. Clinics and other places that offer harm reduction support are often a place that drug users are first exposed to treatment options and alternatives to dangerous drug use.

On the other side, drug users may be lulled into a false sense of security while having access to harm reduction resources, so their drug use may be prolonged. Studies have shown that, overall, harm reduction practices lead to increased rates of recovery, even if some people continue using drugs.

It is dangerous: Wrong. Harm reduction at its very core is about increasing safety – not just for the drug user but sometimes for the community as well. Encouraging abstinence, addiction treatment, disease treatment, and safe disposal of tainted drug materials help keep the public safe. A good example is the Toronto, Canada supervised injection sites and the benefits they provide alongside the negligible impact they have had on crime and the community.

It is costly: Wrong. By encouraging healthy behaviors, including abstinence and addiction treatment, harm reduction strategies can save money in the community. Reducing HIV transmission is a major cost-saving measure in and of itself. According to the CDC, the cost of treating a single HIV infection is over $370,000 over the life of the patient. The economic burden of unmitigated disease spread, overdose deaths, and unsafe sex is substantial. Promoting safety is far less costly than treating danger.

It doesn’t work: Debatable. The CDC reports that users of needle/syringe exchange services are 5 times as likely to receive addiction treatment. That being said, those who are more open-minded to treatment may be more likely to use these services in the first place, which would influence the interpretation of this data. The National Institute on Drug Abuse noted that harm reduction strategies could have prevented a devastating HIV outbreak in Scott County in Indiana. Wearing condoms is a harm reduction strategy that is extremely effective at preventing the spread of disease.

Harm reduction can provide benefits to drug users and the larger community, and as long as people choose to do drugs, helping them quit, moderate, or use safely remains an important societal goal. In the end, drug use is never safe and the safest possible way to interact with drugs is to avoid them entirely and remain abstinent.