Taking opportunities to engage with individuals regarding issues concerning overdosing is essential in overdose prevention. This consists of building individual relationships, discussing changes in the individuals’ drug tolerance, and identifying safety concerns such as communicating safety plans when using which allows for the individual to contribute to their own care.
Safer Substance Use
Injection drug use
There are many dangers associated with injecting drug use including
- Frequency of injections (collapse of veins due to overuse)
- Type and potency of drug being injected (potential for overdose)
- Of the blood, (septicemia), untreated can lead to septic shock
- Endocarditis (inflammation of the heart lining, muscle and valves)
- Transmission of HCV and HIV by sharing contaminated needles and other paraphernalia
- Poor nutrition (decrease in appetite)
- Although crack can be injected, crack is most commonly smoked. Some of the dangers associated with smoking crack are:
- Transmission of various infectious diseases such as Hepatitis C, HIV, Tuberculosis (TB) and pneumonia due to sharing of drug paraphernalia.
- Participating in high risk behaviors due to decrease in inhibitions. These behaviors can increase the risk of transmission of sexually transmitted infections.
- For women specifically, there are additional dangers to crack use due to violence, social stigma and increased risk of disease.
Harm Reduction strategies related to substance use
Educating individuals on effective vein care is essential in reducing the risk of abscesses, infections and complications related to overuse of veins. The following are steps to effective vein care:
- Encourage intake of fluids.
- Apply a warm compress before injecting. This will help plump up the vein.
- Always use a tie. Pump up the vein by opening and closing fist
- Inject above the valve of the vein to prevent circulation problems, scar tissue and infection.
- Rotate injection sites. Reduce the risk of a collapsed vein
- Encourage using in a warm safe place to reduce harm associated to inject too quickly and not being careful.
- Start with veins closest to the wrist and work your way up. This way if the bottom part of the vein collapses the remaining part of the vein can be used.
- Inject in the direction of blood flow (towards the heart)
ABSCESSES are a pocket of pus; pus means you have an infection. Pus is in dead tissue, bacteria, and the white blood cells that gather to try and kill the infection. An abscess can start anywhere in the body where bacteria infect damaged tissue. Drug users often get abscess at injection sites. They are more likely to damage tissue and develop an abscess when they “skin pop”, “muscle it” or miss the vein. Both the cut and the drug can damage tissue. An abscess can even develop after the user stops injecting due to the impurities remaining in the body. People with weak immune systems (e.g. people with HIV/AIDS) are more likely to develop an abscess. If an abscess is identified, encourage and assist the person to seek medical attention.
Identifying an abscess:
- Hard, red bump which is tender to touch at site of injection
- Maybe warm to the touch
- Can be painful
- It is also possible for an abscess to appear somewhere other than the injection site
- Soaking an abscess helps draw the abscess to the surface allowing for the pus to drain.
- Soak an abscess in clean hot water for at least 10-15 min 3-4 times a day. Use Epsom salts if available.
- If the abscess is in an area where it cannot be easily submerged, then apply a hot and wet compress (washcloth). Soak compress in Epsom salts, if available.
- If the abscess appears to be getting larger or becoming more painful, seek medical attention as antibiotics may be required.
People who smoke crack may develop oral lesions and sores due to burns from the hot crack pipe or cuts due to broken glass. Sharing pipes may lead to transmission of infections. Plastic mouthpieces are available through the UHRN harm reduction program to allow individuals to protect themselves from exposure to communicable diseases and developing mouth sores.
Elements related to safe drug include encouraging individuals to become vigilant about identifying what they are taking. This practice reduces the risk of potentially ingesting drugs they did not intend to use.
- Three steps for safer drug use:
- Same dealer
- Look, smell, taste the drug
- Do a test shot