Safer Consumption Tips:
Smoking: Using a pipe, stem or bong. Make sure everyone has their own pipe or mouthpiece. If you are smoking crack, use a filter.
Snorting: Crush powder as fine as possible and make sure everyone has their own straw. Alternate nostrils between hits.
Swallowing: Pills, crushed in thin paper, or a drink. Mix your own drink so you know how strong it is. It can take up to an hour to kick in, so wait a while before consuming more.
Booty Bumping: Use a turkey baster or syringe without a needle. Avoid sharing equipment and get vaccinated for hepatitis A.
Injecting: Use your own sterile syringes and gear. If you need to reuse syringes, wash with cold water, bleach and then water again.
Benefits of Injecting Drugs
- Very efficient way to use — drugs are absorbed directly into the bloodstream.
- This can lead to a more intense and longer high compared to other methods.
- Can be more economically efficient — people may need to buy less compared to other methods, which can save money.
Risks of Injecting Drugs
- Criminalization of injection paraphernalia causes unnecessary exposure to risk for people who inject drugs.
- Shared equipment can lead to HIV or hepatitis C transmission.
- Higher rates of overdose and overdose-related death for people injecting drugs compared to snorting or smoking.
- Skin and soft tissue infections like abscess and other bacterial infections can be fatal.
Safer Injection Tips:
#1. Prepare Yourself:
- Find a safe, clean, well-lit area
- Clean hands or fingertips with soap and water or an alcohol pad
- Wipe injection area with alcohol pad in one direction
#2. Prepare Solution:
- Using your own clean cooker or spoon, mix drugs with sterile water, heat (add Vitamin C if necessary)
- Add a filter (piece of cotton ball or pellet — avoid cigarette filters) using clean fingertips
- Insert tip of syringe into filter and pull up solution
#3. Find a Vein:
- Body heat can help veins be more accessible — find a warm place or bundle up!
- Use a tourniquet a few inches above the injection site to help the vein plump up (avoid using shoestrings or leather belts)
- Insert the needle bevel up into the vein
#4. Register Your Shot:
- Before injecting, pull back slightly on the syringe to check for dark red blood (this means you hit a vein)
- If the blood is bright red, frothy and pushes back the plunger, you hit an artery, take the syringe out immediately and seek medical advice or attention!
- After registering, release tourniquet before injecting.
#5. Do a Test Shot:
- Inject a little bit of drug solution to “taste” and test strength and effect before injecting more from that syringe
- This can help prevent overdose
#6. Inject and Tidy Up:
- Once you finish injecting, dispose of used syringe(s) in a sharps container.
There are many reasons why people cannot adopt all these steps. If you can use as many of these as possible regularly, it will dramatically harm and risk. Even using just one reduces harm — celebrate small steps and any positive change!
Skin and Soft Tissue Infections (SSTI)
What are SSTI’s?
- Skin and soft tissue infections (or SSTIs) are bacterial infections such as abscesses, cotton fever, and endocarditis.
- For people who inject drugs, they can be caused by improperly cleaned skin, a missed shot, non-sterile injection equipment, or contaminated drugs.
- It’s critical to provide both the equipment and safer injection education to promote the safest possible injection every time.
Signs of an SSTI
- Bad odor or smell
- Affected area getting bigger
- Redness around edges
- Thick pus
- Pain or loss of feeling
When someone presents with a wound that is causing them pain or distress, our first recommendation is always that they see a medical professional for diagnosis and treatment. Even if you are 99.9% sure something is wrong, only a medical professional can give a diagnosis.
How to Manage SSTIs
- Symptoms might not always appear at the injection site.
- If you miss a shot, apply ice or frozen items (frozen bagged food, snow, cold drink) on the same day and elevate. If swelling occurs the next day, apply heat regularly using a cloth soaked in hot water, or use a hand warmer.
- Avoid injection at or below the affected area.
- Do not squeeze or poke an abscess. This can introduce more bacteria to the wound.
- If things don’t improve after 3 days, or if you are experiencing chills, fever, extreme fatigue or pain in the abscess, seek medical attention. This may be a blood infection, which could be deadly.
How to Avoid SSTIs
- Clean skin prior to injection, including injection site and fingertips.
- Use sterile equipment including syringes, cookers, and cottons.
- Use safe injection techniques (see front) to avoid missed shots and vein injury.
- Cover injection site with a band aid to prevent bacteria from entering.
- Ask and Listen: Your participants are the experts! They can tell you what they know, what they need, what’s working and what isn’t.
- Research: There are plenty of harm reduction resources out there to support you. Start with these key resources:
- Provide Options: Cater to a range of ways that people take their drugs by offering a variety of safer use and safer sex supplies and resources.
- Celebrate Small Steps: Affirm any positive change!
Harm Reduction 101
What is Harm Reduction?
- Incorporating a spectrum of strategies including safer techniques, managed use, and abstinence to promote the dignity and wellbeing of people who use drugs
- A framework for understanding structural inequalities like poverty, racism, homophobia, classism, etc.
- Meeting people “where they are,” but not leaving them there
We Use People First Language:
- A person is a person first, and a behavior is something that can change — terms like “drug addict” or “user” imply someone is “something” instead of someone
- Stigma is a barrier to care and we want people to feel comfortable when accessing services
- People are more than their drug use and harm reduction focuses on the whole person
Health & Dignity:
Establishes quality of individual and community life and wellbeing as the criteria for successful interventions and policies.
Participant Centered Services:
Calls for nonjudgmental, non-coercive provision of services and resources to people who use drugs and the communities in which they live in order to assist them in reducing attendant harm.
Ensures participants and communities impacted have a real voice in the creation of programs and policies designed to serve them.
Affirms participants as the primary agents of change, and seeks to empower participants to share information and support each other in strategies which meet their actual conditions of harm.
Recognizes that the realities of various social inequalities affect both people’s vulnerability to and capacity for effectively dealing with potential harm.
Pragmatism & Realism:
Does not attempt to minimize or ignore the real and tragic harm and danger associated with drug use or other risk behaviors.
Harm Reduction Interventions
- Risk Reduction: Tools and services to reduce potential harm
- (h)arm (r)eduction: The approach and fundamentals to reduce potential harm
- (H)arm (R)eduction: A philosophical and political movement focused on shifting power and resources to people most vulnerable to structural violence
Understanding Risk, Set and Setting
Nothing and no one exists in a vacuum. Understanding risk, set, and setting can give clinicians, harm reductionists, outreach workers, and other service providers more tools to support risk and harm reduction for participants.
The risk itself (e.g. related to drug use or sex work) that you’re discussing.
- What issue is being presented?
- What other possible sources of harm might be connected to the main issue?
- What drug is being used? What is the risk of overdose?
The “mindset” that someone brings to the situation, including thoughts, mood and expectations.
- How are they feeling? Confident? Angry? Anxious?
- Are they physically in pain or hurt? Do they need to get well?
- Can they engage with you fully? Are their basic needs being met?
The physical and social environment of where the person is, and their perception of how that can promote/reduce risk.
- What is the physical environment where the potential harm is occuring? In a home? At work? On the street?
- Who is around them? Police, bystanders, other participants? How does the person present to these people? How will they react?