What Is Harm Reduction?
In our lives, we try to reduce the harm that we do to ourselves and others and having an addiction to substances is no different. Harm reduction is a proactive approach to reducing the damage done by alcohol, drugs, and other substances, as well as addressing broader health and social issues, such as HIV/blood borne virus (BBV) transmission. The term “harm reduction” can be used to describe the philosophical beliefs that underlie strategies and programs, or it can be used to describe the strategies and programs on which it is based. Often, harm reduction strategies are used in conjunction with other approaches, which normally involve some type of substance reduction, maintenance, substitutes or abstinence.
Does Harm Reduction Encourage Drug Or Alcohol Use?
A common misconception about harm reduction is that it condones or encourages drug or alcohol use.
Many advocates of harm reduction also support the goal of people working towards abstinence from alcohol, drugs, and addictive behaviors, but recognise that for many people, this process takes time.
In the interim period, while the person is still drinking, using drugs, or engaging in other addictive behaviors, both they and the people around them are vulnerable to harm.
Examples of harm reduction in action include the following.
Drinking and Driving Laws
While it is well known that even small amounts of alcohol can affect people’s ability to drive safely, driving and driving laws allow drivers to have a small amount of alcohol in their bloodstream. The focus is not on eliminating alcohol use from drivers completely but setting a limit over which the greatest risk of causing a serious accident is defined.
Drinking and driving laws do not encourage drinking; they actually discourage it. But they accept the reality that many people will drink to some extent before driving, and that the overall harm to society is lessened by providing a limit so that people can make the decision not to drive once they’ve consumed alcohol.
Needle Exchange Services
Injecting drugs such as heroin, crack, steroids and others is illegal, yet harm reduction advocates for clean needles and associated “works” (umbrella term for the other equipment needed when injecting) to be provided to those who inject free of charge. This is because there is more harm caused to individual drug users, the health care system, and society as a whole if injection drug users pass HIV and hepatitis to each other through sharing needles. The risk to society is also reduced by providing safe ways to dispose of used needles rather than simply chucked out and someone else unintentionally get stabbed by used needles in bins or those found on the floor.
Needle exchange programs do not encourage drug use. In fact, they are usually the first point of contact for drug users to access addiction treatment services. The fact that these services are free means that even those who are homeless or poor can still access safe, clean equipment and safe needle disposal no matter what their circumstances are, removing further barriers for access.
These programs accept the fact that many people will inject drugs whether they have clean needles or not and work on the principle that if users are going to inject then they would prefer that users do not get ill or injured and die as a result of infection or cause illness or injury to others from used injecting equipment.
Needle exchange programs commonly use the same logo to identify exchanges whilst keeping your privacy from others outside of those who do not know about needle exchanges. They can be identified with this symbol:
You can find your nearest exchange on our help and support page.
Safe Injection Facilities/Drug Consumption Rooms
Safe injection sites or “drug consumption rooms” go a step further than needle exchange services by providing a safe place in which people can inject drugs, access clean needles and injection equipment whilst under the supervision of trained medical staff. In addition to the harm reduction goals of needle exchange services, i.e. reducing transmission of HIV, hepatitis, and other infections and damage caused by unclean equipment being used for injecting, safe injection rooms offer a safe space and immediate help if an overdose occurs. Up to the point of publishing this article, not one single person has ever died whilst using DCR’s unlike those who have and will die when they inject alone or with others who would not call for help should an overdose occur.
Safe injection facilities do not encourage drug use, rather they provide a connection between the most vulnerable drug users and treatment services, such as MAT’s, rehabs, detox recovery meetings and others. They save lives that would otherwise be lost to drug use. At present, the UK does not have any DCR’s and leading organisations and others are currently campaigning to allow clinical trials to take place and ultimately to implement them in every town across the UK. Our DCR Project is one example of this.
Sex can be an addictive behavior, and it can lead to unplanned pregnancy, but the main reason that free condoms are sometimes provided as a harm reduction service is to reduce the transmission of STDs, specifically HIV. Drugs impair people’s attitudes towards using protection so reducing pregnancies to parents who would not be able to care for a child due to their own addictions and circumstances is another reason why some services offer condoms too.
Ways To Reduce Your Risks When Injecting
If you use heroin or inject other substances, you’re taking your life into your hands every time you inject. There are many risks and harms associated with injecting and the drug trade that enables it. The only true way to avoid involving yourself in these harms is by avoiding the drug completely.
However, if you do choose to inject substances in spite of the risks, you can protect yourself and others from some of the worst consequences of IV use by following these harm reduction tips for IV users.
Please keep in mind that these harm reduction tips will not guarantee your safety—if you inject, you risk serious, deadly consequences every time you inject.
Choose Smoking or Snorting Over Injecting
Many IV users start out by smoking heroin or their substance of choice, then as they become addicted, switch to injecting instead. Although smoking, snorting, and injecting are all harmful, there are greater risks associated with injection drug use. These include contracting HIV and other blood borne viruses, which are transmitted through needle sharing, abscesses, vein damage, and severe bacterial infections.
Snorting heroin or substances doesn’t have quite as instant an effect as smoking or injecting, but it will still take effect very quickly with much lower risk than injecting. While all methods of heroin or substance use carry the risk of overdose, it’s less likely with smoking because you can stop once you feel “high”, whereas with injecting, once the drug is in your body, you can’t do anything to reduce the effects or the overdose risk until you have actually overdosed. Then lifesaving interventions such as Narcan (Naloxone) must be used quickly to avoid death.
Always Use a Clean Needle to Inject with
Many of the harmful effects of injecting are related to reusing or sharing needles for injecting.
Make it a personal policy to never, ever, under any circumstances, use a needle that someone else has used, and conversely, to never offer a needle you have used to another person.
Clean needles are freely available through needle exchanges. If you don’t know where your nearest needle exchange is, you can find your nearest exchange on our help and support page.
In an emergency, you can clean your needles by flushing them out with undiluted bleach, then flushing them with water three times. However, try to use new, single use needles if possible. And remember, blunt needles cause vein damage.
Don’t Use Alone
Although many people are distressed by seeing another person using drugs, having someone nearby can save your life. Drugs, especially heroin carries a high risk overdose but if identified quickly, the overdose can be reversed by injection or intranasal administration of a drug called naloxone (Narcan), which blocks the opiate receptors in the brain, reversing the effects of the overdose.
If you or someone you are with may have taken an overdose, CALL 999 IMMEDIATELY!
Signs of overdose include:
- Fewer than 12 breaths a minute or not breathing at all
- Loss of consciousness
- Lack of response to pain
- pale white/blue skin colour
- And others
If you suspect someone has overdosed, even if you are not sure, urge on the side of caution and call 999 straight away! The sooner help arrives, the better chance that person has of surviving and recovering.
Use Low Amounts
Most of the coverage of heroin addiction emphasises how addictive it is and research does show that heroin users seem to fare very badly compared to users of other drugs, both in terms of how severely they become addicted and the associated problems that comes with its use, such as unemployment and imprisonment. Try to use the smallest possible amount possible as infrequently as possible.
Try to use the same dealer each time, and try to use it as little as possible to try and keep your tolerance to it as low as possible. If you start to withdraw, try to hold out as long as possible before using again and remember to try smoking or snorting instead of injecting if possible.
Wash Hands, Surfaces And Injecting Sites
It’s important to ensure that any injecting is done as safely as possible. Washing your hands and the injecting site before injecting with antibacterial soap, hot water and injecting swabs/alcohol wipes will reduce the risk of injection from bacteria on your skin or germs and dirt on your hands. wiping down any surfaces that you will be preparing equipment on should also be thoroughly cleaned and disinfected before you open and place any clean, single use, sterile equipment on the surface. Likewise, cleaning up after yourself, cleaning any spillages or marks away to ensure that mess isn’t left for others to find and it also ensures good hygiene for the next time you inject, IF you have to inject.
Consider Other Treatment Options
There are many different treatment programs available, and your choices will depend on where you live, whether you can afford to pay for it yourself or whether funding is possible and your personal preferences. If you are a heavy opioid user, you might consider MAT (medication assisted treatment) as a way of getting off heroin or opioids, letting your body recover from the damage caused by using substances and reducing your overall risk of ill health and possibly death from using.
Although methadone or other medications are addictive, the dosages are precise, taken orally, and unlike heroin, it contains no contaminants.
Another option to consider if you have difficulty controlling your impulses is naltrexone. This is an oral slow-acting drug that blocks the opiate receptors so you won’t get high on heroin. Suboxone, is another option, it combines buprenorphine and naloxone and works similarly to methadone to minimise withdrawal symptoms.
There are various methods to treat substance abuse problems and one of them is through medically assisted treatment. What is this process and does it provide better chances of recovery? We’ll explore this topic.
Addiction is a complex physical and mental condition. There are a multitude of causes and triggers for each individual going through this condition. For some, going to support groups or making minor changes in their environments are enough to curb their substance use and become abstinent. But not everyone achieves successful recovery with the same methods. This is the main reason why rehab centers, community NHS services and others offer various treatment options such as medically assisted treatment or MAT treatment so that there is a suitable treatment option for everyone.
You can find your nearest drug and alcohol service on our help and support page.
What Is Medically Assisted Treatment (MAT)?
As someone considering rehab or community treatment, perhaps you may have wondered, “What is MAT treatment?” To put it simply, medication assisted treatment (MAT) provides government-approved drugs along with behavioral therapy approaches and other behavioural/mental therapies.
MAT Drug Treatment
MAT opioid treatment often utilises medication such as methadone, buprenorphine or naltrexone as partial agonist drugs. These drugs allow people to taper from the full-effect opioids of their addiction and help them lessen their dependency. Health care professionals provide partial agonist drugs on a regular basis until their clients’ withdrawal symptoms are easily managed.
MAT Alcohol Treatment
Alcohol addiction is one of the most common addictions and it is also one of the most dangerous when left untreated. Severe alcohol withdrawal can cause life-threatening symptoms, especially when a person stops drinking abruptly.
In these cases, MAT treatment is highly recommended. The process includes the use of drugs such as disulfiram, acamprosate, or naltrexone. For many people, these drugs are effective. When taken according to instructions, the medications can reduce cravings for alcohol and increase motivation in recovery. These medications are usually used alongside therapies including counselling, group meetings, acupuncture, one-on-one meetings with a Keyworker, meditation and other mindfulness and psychological activities.
If you have a moderate to severe alcohol dependence, it is not recommended to stop drinking completely right away. Rehabs and community based treatment providers combine various therapies with medication-assisted treatment may help you with the process of alcohol detox, treatment, and relapse prevention and will help you create a long lasting recovery from alcohol.
Reducing Your Overall Risks With Alcohol
Drinking alcohol is always full of risk just as using drugs do however you can reduce some of the risk by implementing some simple ideas.
Giving your car keys to your partner, family member or sponsor before you go out, taking a limited amount of money with you when you go out or ask someone to oversee your money if you drink daily and when your daily allowance runs out, you’re done, eating before drinking and staying hydrated with water and drinking at home instead of drinking out to avoid driving home drunk or getting into a bar fight.
Try to keep the strength of the alcohol you consume to the lowest possible strength and the type of alcohol you drink. For example, if you drink super strength cider multiple times a day then try to drink a lower strength cider as well as reducing the quantity you drink. If you are able to only drink 2 cans of low strength cider instead of 4 super strength cans then this can only benefit you and your recovery by reducing the risks associated with alcohol consumption and will mean that if you are going to detox or reduce, then this will only make things a little easier to manage and deal with.
Likewise, reducing your alcohol intake for detox or simply because you want to drink less or stop means that you need to track the amount you’re drinking and measure the amount accurately. If you need to measure out an amount from a bottle or can, measure it in a measuring jug or specific alcohol measuring cup and if possible, dispose of the remaining amount. This may sound silly and be difficult to do but this will prevent you from “topping up” your amount or drinking more than you should by removing the temptation right away from the beginning. Also, only keep the minimal amount of alcohol you need for that day in the house and either go and buy it daily or ask someone else to keep the remaining alcohol you do not need. This further reduces the temptation to drink more, removing further pressure from you and slightly increasing your chances of success in your recovery.
You can find more information about tracking your alcohol intake as well as the physical amount you are consuming by visiting our article to track your intake.
Who Should I Speak To For Help?If you feel that you need help to stop using drugs or drinking then we would suggest that following as a general rule of thumb.
If you are addicted to illegal drugs or alcohol then we suggest that you contact your nearest drug and alcohol service. If you are addicted to prescription medication or over the counter medication then we suggest that you first contact your GP at your doctors surgery.
You can find your nearest drug and alcohol service as well as contact information for your nearest GP (if you are not already registered with one) by visiting our help and support page.
Do’s and don’ts, measurements, strength, type, location and not stopping alcohol quickly ect. Amend pictures. Check separators.