Table 1 Harm reduction supplies and education by substance and route of use and rationale
From: Meeting people where they are: implementing hospital-based substance use harm reduction
Substance and route of use (when applicable) | Supply or education | Harm reduction rationale |
|---|---|---|
Alcohol | “Rethinking Drinking” brochure from the National Institute on Alcohol Abuse and Alcoholism on safer drinking a. We also provide tips to reduce the harms of alcohol use including: -Decrease drinking days and drinks per day -Eat before drinking -Alternate water with alcohol or dilute alcohol -Create a drinking tracker card -Make a safer drinking plan (e.g., carry condoms and lock car keys) -Naltrexone and other medication education | These interventions may improve individual health measures, such as cirrhosis progression and alcohol withdrawal severity. They may also reduce risky physical and social behaviors, psychiatric hospitalizations, and symptoms of depression and anxiety, and improve self-efficacy, social functioning, and workplace productivityb. |
Sobering center flyer | Informs patients of a location with medical staff where they can stay while intoxicated. | |
Medically supervised withdrawal management facility flyer | Informs patients about a medically managed alcohol withdrawal facility where they can also link to residential treatment. | |
Food assistance resources | Access to a nutritious diet is important as reduced dietary intake and changes in nutrient absorption due to alcohol use may mediate long term health impacts. | |
Stimulants | Safer stimulant use education | We counsel patients to prepare for a decreased awareness of the need to eat, sleep, and drink, increased libido, and a higher likelihood of sleeplessness and psychosis. Tips include drinking water, eating, resting, carrying condoms, and using in a safe space with a trusted individual. Many patients do not realize stimulants carry overdose potential. We discuss overdose risk and safer use strategies, as outlined in this table depending on the route of use. |
Tobacco | Toothpicks and gum | Oral fixation to reduce cravings and reduce frequency of use. |
Education | We discuss the health benefits of stopping tobacco use, as well as resources for financial aid for nicotine replacement therapy through 1-800-No-Butts. | |
Opioids | Safer opioid use education | We review overdose risk and safer use strategies, as outlined in this table depending on route of use. |
Smoking opioids and stimulants | Pyrex pipe | Reduce need to share equipment or use broken equipment. Reduce risk of cuts and burns, and subsequent infection transmission by providing a pipe that does not overheat and a barrier to directly touching the glass. Educate that smoking increases the risk of cardiovascular and respiratory harms. Educate that smoking carries reduced overdose and infection risk compared to injectingc. |
Rubber pipe mouthpiece | ||
Steel wool | Cleans cocaine pipe residue to avoid re-inhaling prior substance. | |
Smoking fentanyl | Clean foil | Reduces need to reuse materials and can help encourage people to switch from injecting to smoking, which reduces risk of infection and overdosec. |
Pyrex pipe and rubber mouthpiece | See "smoking opioids and stimulants" section for pyrex pipe and rubber mouthpiece information. | |
Education | We review overdose prevention, infection risk reduction, and other safer use strategies. | |
Inhaling opioids or stimulants | Clean straws | Reduce the need to reuse and share materials, thus reducing infection risk. |
Education | Counsel patients to adequately crush substances to reduce injury to nasal mucosa. We share that smoking carries lower overdose risk and infection risk than injectingc. | |
Injecting opioids or stimulants | Sharps container | Reduces presence of used needles in community by providing a disposal method. |
Needles | Reduce risk of viral and bacterial infections by reducing sharing and reuse. | |
Cooker | Reduces risk of infections. | |
Tourniquet | Reduces need for multiple injections by making veins more accessible. | |
Cotton pellets | Filter out large particles from drug solution and reduce reuse of pellets. | |
Alcohol wipes | Clean skin to reduce infections. | |
Vitamin C | Used to change cocaine from free base to water soluble, acid salt form for injecting cocaine. Patients may otherwise use citrus fruits like lemons, which carry infection risk. | |
Education | Injecting is associated with highest risk of infections and overdosec. Thus, we educate about: -Cleaning skin -Rotating injection sites -Reducing punctures by using a tourniquet and heat to find veins and injecting with bevel up to reduce infections and preserve veins -Injecting in safer anatomic sites (e.g., avoiding groin and neck vessels) | |
All kits may include | Fentanyl test strips and education | Fentanyl test strips reduce unintentional ingestion of fentanyl and overdose riskd. We discuss that fentanyl strips cannot detect all fentanyl analogs and should be used in addition to other precautions (e.g., carrying naloxone, using test doses, not using alone). We also discuss that fentanyl test strips are not recommended for amphetamine testing due to high false-positive rates. Fentanyl test strips can be used for pressed pills, heroin, and cocaine. |
Condoms | Riskier sex is more common while using substances. Condoms can prevent sexually transmitted infections. | |
Never use alone flyer and education | Never use alone is a confidential and anonymous overdose prevention line (1–800-484–3731). The operator asks for a first name, location, and the phone number the person is calling from. The operator stays on the line while a person uses and calls 911 if the person stops responding. Using alone increases overdose risk. | |
Naloxone | Opens discussion that opioid overdose and death are possible outcomes of substance use. Reverses opioid overdose. | |
Overdose prevention education | Allows discussion of overdose risk and includes tips such as not using alone, using a test dose, using through a safer route (e.g., inhaling rather than injecting), and carrying naloxone. | |
Local resources | Includes overview of local SSPs and other services to encourage and enable patients to connect to outpatient resources. | |
Additional resources | Information about rectal substance use and wound care as well as widely available resources from the National Harm Reduction Coalitionc and NEXT Distro.e |