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Harm Reduction
For Opioid Use and Other Substance Use Disorders
What is Harm Reduction?
The principle of harm reduction is to decrease the short and long term adverse consequences of substance abuse, even for those who continue to use drugs, and to make treatment as attractive and accessible as possible. Harm reduction does not demand more than an individual can realistically do at any given time. Realistic, incremental change, rather than radical immediate change, is the hallmark of harm reduction.
In the past, treatment providers have demanded that people be abstinent to enter treatment or obtain abstinence immediately thereafter. Even when this did happen, the same clients were immediately discharged from treatment if they relapsed. As a result, treatment for substance use disorders has been largely unsuccessful until harm reduction came along.
Now, if someone can’t stop using opioids or other drugs before they enter treatment, we bring them into treatment anyway and help them use less. Opioid Use Disorder (OUD) is a chronic, relapsing condition that requires flexibility and tolerance. The reduction of harm, not radical change, is what most clients prefer and need; and any movement towards that goal is treatment success.
In the case of OUD, Medication-Assisted Treatment (MAT) is an essential harm reduction method. In fact, MAT for OUD is the original and most successful form of harm reduction. Opioids are so addicting, the cravings so strong, and the withdrawal so painful that medication is almost always indicated for opioid addiction. Medications are used to engage and retain clients in treatment. Eventually, some clients stop taking the medications and become fully drug free. Others stay on the medications for years. In either case, MAT is used to reduce harm for the individual and those around them.
Myths About Harm Reduction
Even though many of us employ harm reduction strategies in our everyday life (wearing a seat belt while in a car, using sunscreen, obeying the speed limit, wearing a helmet when on a bicycle) the thought of employing harm reduction strategies to people who use substances is still often seen as taboo. Erroneously people think it is enabling, an attempt to legalize substances, or even encourages use.
Harm reduction and abstinence are not opposed; they are not mutually exclusive. Most people who enter SUD treatment want to stop using addictive drugs, but are unable to do so immediately. Harm reduction is also a movement for social justice built on a belief in, and respect for, the rights of people who use drugs.
Harm reduction practices are focused on interventions that will reduce the economic, social and physical consequences of substance use and misuse for the individual and the community. These can include:
- making sure people have safe storage of their alcohol, drugs and related works;
- syringe exchange programs; and
- overdose education and prevention strategies including naloxone distribution, and fentanyl test strips.
Syringe Exchange Program
One proven method to prevent the spread of HIV & Hepatitis C is to offer people experiencing drug dependence and anyone using syringes for medical care harm reduction education and an opportunity to exchange used syringes, as exposure to both HIV and Hepatitis C can occur from sharing unsterilized needles.
Pacific Pride Foundation offers harm reduction education, exchanges new syringes for used ones, and provides materials to help reduce the spread of blood-borne pathogens and to keep people experiencing drug dependence safe. Through a partnership with the Department of Behavioral Wellness, Pacific Pride provides overdose prevention education and distributes Naloxone, a medication designed to rapidly reverse, what are often otherwise fatal, opioid overdoses.
Since the start of the COVID-19 pandemic, Pacific Pride Foundation has adopted a physically distant model of Syringe Exchange. A key component of this new model is a “takeaway kit” assembled by dedicated Syringe Exchange Program Task Force volunteers. Kits include Naloxone, sealed packages of new syringes, safer sex supplies, and safer use supplies.
Syringe Exchange
Santa Barbra: Alameda Park, Corner of Sola & Anacapa
1:30 – 2:30 pm or while supplies last*
Every other Thursday, beginning the first Thursday of the month.
Santa Maria:
123 S College Drive | 2:00 – 3:30 pm or while supplies last*
Every other Wednesday, beginning the second Wednesday of the month.
*Supplies are often depleted during the first hour, so be sure to arrive early.
Drug Testing for Fentanyl
Fentanyl, an opioid that is up to 50 times stronger than heroin, is responsible for a growing number of overdose deaths each year. Typically manufactured as a white powder, it can be mixed into other drugs such as heroin and cocaine without the user knowing, but with extreme consequences. Fentanyl can cause an overdose at first use, and is changing the the landscape of the opioid epidemic.
Fentanyl checking strips, originally designed for urine drug tests, are now being used off label to test for the presence or absence of fentanyl and fentanyl analogs in the illegal drug supply. Drug checking strips allow users to dissolve a small sample of a drug into water, insert a test strip, and look for an indicator line alerting the user to the presence of fentanyl. Fentanyl testing strips are inexpensive, easy to distribute (given adequate infrastructure) and can accurately read whether a substance contains fentanyl or not.
In 2017, the California Department of Public Health began paying for fentanyl checking strips that could be distributed to people who use drugs at syringe exchange programs. A February 2018 John Hopkins University study showed that the testing strips could detect the presence of fentanyl nearly 100 percent of the time. The majority of participants in the study (70%) reported that knowing that their drugs contained fentanyl would lead them to modify their behavior. This could include not using the drugs, using the them more slowly, or using with others who have naloxone. It could also include changing their purchasing behaviors.
Fentanyl test strips are available through Pacific Pride Foundation.
Organizations like DanceSafe have also brought drug checking services to music festivals and dance events and offer fentanyl test strips online.
You can download instructions on how to test drugs for fentanyl here.
Other Harm Reduction Resources
The National Harm Reduction Coalition is a nationwide advocate and ally for people who use drugs. Their website provide information on the principles of harm reduction and offers resources and online trainings at the national and local level regarding harm reduction strategies.
The California Chapter of the Harm Reduction Coalition, located in Oakland, provides harm reduction resources for people who use drugs in California.
The California Harm Reduction Initiative (CHRI), in collaboration with the California Department of Public Health and the Drug Policy Alliance was established by the California Budget Act of 2019, which included $15.2 million to strengthen substance use disorder response by supporting syringe services programs (SSPs). This program represents the single largest government investment in harm reduction in the history of California.
The Drug Policy Alliance is an advocacy organization focused on advancing policies and attitudes that best reduce the harms of both drug use and drug prohibition, and promote the sovereignty of individuals over their minds and bodies.
> Learn more about key harm reduction issues
> A list of state and local organizations that are working for drug policy reform
The California MAT Expansion Project aims to increase access to MAT, reduce unmet treatment need, and reduce opioid overdose deaths through prevention, treatment, and recovery activities.The project also includes media campaigns, engagement of opioid safety coalitions, naloxone distribution, drug take-back efforts, and supportive housing.
Distro “NEXT” is an online and mail-based harm reduction program that supports people who use drugs that do not have access to in-person syringe access services, harm reduction-based education, or drug user health support. NEXT uses technology and the internet to connect with individuals who are geographically isolated from services, or who cannot access them for any other reason.
Introducing Harm Reduction in Collegiate Recovery. Learn more in this news article about how student-led harm reduction is being practiced at UCSB.
Harm Reduction Tips
To reduce the possible harms of opioids:
Do not mix prescription opioids with other drugs. Mixing prescription opioids with other depressants, such as alcohol, benzodiazepines, or street drugs can be dangerous and even fatal .
Use less, start low, and go slow.
Don’t use alone. Have a friend with you who knows what drugs you’ve ingested, who may also respond in case of an emergency. If you must use alone, call a friend and ask them to check up on you .
Carry naloxone. Get a kit and ask your friends and family to get trained in overdose response.