Harm Reduction

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In the interest of harm reduction, I’m going to describe precautions that addicts, still in active addiction, can take to reduce the risk of overdose death. This information can be accessed at: http://harmreduction.org/wp-content/uploads/2011/12/getting-off-right.pdf

1. Don’t use alone. Use a buddy system, to have someone who can call 911 in case you stop breathing. Do the same for another addict. Obviously you shouldn’t inject at the same time. Stagger your injection times.
Many states now have Good Samaritan laws that protect the overdose victim and the person calling 911 for help, so that police don’t give criminal charges to people who do the right thing by calling for help for an overdose.
Take a class on how to give CPR so that you can revive a friend or acquaintance with an overdose while you wait on EMS to arrive.

2. Get a naloxone kit. I’ve blogged about how one patient saved his sister with a naloxone kit. These are easy to use and very effective. You can read more about these kits at the Project Lazarus website: http://projectlazarus.org/

3. Use new equipment. Many pharmacies sell needles and syringes without asking questions. Your addict friends probably can tell you which pharmacies are the most understanding.
Don’t use a needle and syringe more than once. Repeated use dulls the needle’s point and causes more damage to the vein and surrounding tissue. Don’t try to re-sharpen on a matchbook – frequently this can cause burrs on the needle point which can cause even more tissue damage.

4. Don’t share any equipment. Many people who wouldn’t think of sharing a needle still share cottons, cookers, or spoons, but hepatitis C and HIV can be transmitted by sharing any of this other equipment. If you have to share or re-use equipment, wash needle and syringe with cold water several times, then do the same again with bleach. Finally, wash out the bleach with cold water. This reduces the risk of transmitting HIV and Hepatitis C, but isn’t foolproof.

5. Use a tester shot. Since heroin varies widely in its potency, use small amount of the drug to assess its potency. You can always use more, but once it’s been injected you can’t use less. The New England overdose deaths described by SAMHSA may have been avoided if the addicts had used smaller tester shots instead of shooting up the usual amount.

6. Use clean cotton to filter the drug. Use cotton from a Q-tip or cotton ball; cigarette filters are not as safe because they contain glass particles.

7. Wash your hands thoroughly before preparing your shot, and clean the injection site with an alcohol wipe if possible. Don’t use lemon juice to help dissolve heroin, as it carries a contaminant that can cause a serous fungal infection.

8. Opioid overdoses are much more likely to occur in an addict who hasn’t used or has used less than usual for a few days, weeks, or longer. Overdose risks are much higher in people just getting out of jail and just getting out of a detox. Patients who have recently stopped using Suboxone or Subutex may be more likely to overdose if they resume their usual amount of IV opioids.

9. Don’t mix drugs. Many opioid overdoses occur with combinations of opioids and alcohol or benzodiazepines, though overdose can certainly occur with opioids alone.

10. Don’t inject an overdosed person with salt water, ice water, or a stimulant such as cocaine or crystal methamphetamine – these don’t work and may cause harm. Don’t put the person in an ice bath and don’t leave them alone. Call for help, and give mouth-to-mouth resuscitation if you can.

To people who believe I’m giving addicts permission to use, I’d like to remind them that addicts don’t care if someone gives them permission or not. If an addict wants to use, what other people think matters little. But giving people information about how to inject more safely may help keep the addict alive until she wants to get help.

The Harm Reduction Coalition has excellent information on its website: http://harmreduction.org

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2 responses to this post.

  1. Posted by Benjamin Keith Phelps on December 21, 2014 at 8:37 pm

    Bravo! Dr Burson. People who believe this type of information gives anybody permission to use in these types of articles are already living in a fantasy world, so there’s not much point in trying to persuade them of its value & need. Your information is always good & may save someone’s life out there that otherwise would’ve died & never had the chance to get clean in the future. I know that in my own life, had I passed before finding a way to get clean, it would’ve devastated my parents a hundred times worse. They really NEEDED to see that I was trying to get well & that I did eventually succeed at it, in order to have a little peace of mind over all that happened during my active addiction. I know every parent would like to have that opportunity – to see their child get better rather than die, & I wish to God I could give each parent of an addict that in this world, but unfortunately, there’s nothing anybody can do to make it happen for someone else. HOWEVER, providing addicts & loved ones with PROPER INFORMATION goes a L-O-N-G W-A-Y in helping bring up the numbers of those who live through an accidental overdose versus those that don’t. And even better, that same information also helps some not even go through an OD that otherwise would have. That’s why it’s SO important that we have advocates like Dr. Burson out here doing the work that they do! I commend Dr Burson every chance I get b/c as a MAT patient myself, I know how important it is that someone who REALLY cares takes on this work. Speaking of clean needles, in my area (DC), pharmacies will NOT sell needles unless you can show a prescription for insulin or a previous prescription on file at their store. I think that’s the MOST ASININE law they could possibly come up with! By doing that, they’re practically GUARANTEEING that junkies will have to share needles when they’re desperate. That’s SO uncalled for. What it achieves is that by the time addict A & addict B finally get clean & wanna stop using permanently, now they likely have a terminal illness to contend with, meaning YET ANOTHER lifetime medication regimen, or almost immediate death in a usually quick manner. Why would we EVER subject someone to this fate, merely b/c they made the poor judgment call years ago to try a drug we don’t think they should’ve tried? B/c after that first time trying it, they lost control over further use, & so until they successfully arrested that use – whether by methadone, NA/AA, Suboxone, naltrexone, etc – they couldn’t help their inability to stop. And from personal experience, once I used a needle to mainline heroin, I couldn’t seem to pull myself away from that ritual for a long time, no matter how hard I tried. I am outraged, amazed, shocked, heartbroken, & many other things over this policy they’re enforcing around the District, which in my mind is nothing more than a prescription for HIV or Hep C, if not a few other things, as well. Am I the ONLY one who has a problem with this?

    Reply

  2. Posted by Solarc on January 29, 2015 at 9:08 pm

    The Harm Reduction Coaliton also published

    How to get off right
    http://harmreduction.org/wp-content/uploads/2011/12/getting-off-right.pdf

    Reply

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