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Harm Reduction

FAQs & Information

Frequently Asked Questions

What is Harm Reduction

Harm Reduction is a set of practical strategies and ideas aimed at decreasing negative consequences associated with drug use. Harm Reduction is also a movement for social justice built on a belief in, and respect for, the rights of people who use drugs.

 

What is Naloxone/Narcan?

Narcan is a potentially life saving medication designed to help reverse the effects of an opioid overdose in minutes Available as an intranasal spray or as an intramuscular injection.

 

What are the signs of an overdose?

Symptoms may or may not include & are not limited to: Vomiting/gurgling noises, nausea, drowsiness, extreme weakness, confusion, unconscious/unresponsive, unable to speak, slowed breathing, slowed heart rate, erratic pulse, small pupils, chest pains, pale/clammy skin, low body temp, lips & fingernails turning blue, limp body, vision issues, dulled reflexes, & seizures.

What to do if you witness an overdose (Intranasal Spray)?

Step 1: Check response. Tap their shoulder & if you do not gain a response, pinch their ear lobe or fingertip. Try to gain their attention. Shout their name, shout “Wake up!”, ask them questions (“What is your name?” “Do you know where we are?” etc). If you still do not gain a response, call 911 & continue the next steps.

Step 2: Roll the individual on their back & lift their chin. This will clear their airway & allow easier breathing.

Step 3: Open your Narcan packaging & remove 1 of the 2 nasal sprays. Insert the nasal spray into their nostril until your fingers touch the edges of their nostril. Push the plunger & release the full dose.

Step 4: Roll the person onto their side & wait 2-3 minutes for the Narcan to take effect. You may now also rub their sternum, provide CPR and/or mouth to mouth. Keep in mind that the individual may wake up startled & frightened. They may be agitated & violent.

Step 5: If they do not wake up within 2-3 minutes of the initial Narcan dose, repeat steps 2-4. This time, administer the 2nd nasal spray into the other nostril. Wait another 3-4 minutes for the Narcan to take effect. You may continue CPR throughout steps 4 & 5. Hopefully, by this time extra help will have arrived. If not, a third dose of Narcan may be necessary, if available.

How is Inrtanasal Narcan administered?

What to do if you witness an overdose (Intramuscular Injection)?

Step 1: Check response. Tap their shoulder & if you do not gain a response, pinch their ear lobe or fingertip. Try to gain their attention. Shout their name, shout “Wake up!”, ask them questions (“What is your name?” “Do you know where we are?” etc). If you still do not gain a response, call 911 & continue the next steps.

Step 2: If you have an alcohol pad, clean the injection site (arm, thigh, OR butt) UNLESS you are administering on the tongue.

Step 3: Remove the caps from the naloxone & the needle. Turn the naloxone upside down and insert the needle. Draw back on the syringe to extract the naloxone until full/1 ml.

Step 4: Inject the full 1 ml dose into the arm, thigh, or butt (or tongue if using an intravenous needle). You may administer through clothing.

Step 5: Roll the person onto their side & wait 2-3 minutes for the Narcan to take effect. You may now also provide CPR. Keep in mind that the individual may wake up startled & frightened. They may be agitated & violent. Intramuscular injections are often painful as well.

Step 6: If they do not wake up within 2-3 minutes of the initial naloxone dose, repeat steps 2-5. Wait another 3-4 minutes for the naloxone to take effect. You may continue CPR throughout steps 5 & 6.

Hopefully, by this time extra help will have arrived. If not, a third dose of naloxone may be necessary, if available.

How is Intramuscular Narcan administered?

What is it?

  • Depressant
  • Liquid, Drink

What are the Effects?

  • Can produce feelings of relaxation, lowered inhibitions, and increased sociability. Dizziness, nausea, slurred speech, slow reflexes, sleepiness, impaired judgment, dehydration, and hangovers.
  • Alcohol affects people differently, and can affect the same person differently at different times. Effects can vary depending on body weight, metabolism, tolerance from prior use, food in the stomach, and other physical factors.
  • Alcohol hangovers happen differently for different people, but usually occur after consuming too much alcohol and/or being at altitude and/or being dehydrated. Hangovers typically involve nausea, headaches, and a feeling of mental stuffiness or irritability.
  • ‘Overdoses’ on alcohol are called alcohol poisoning. Alcohol poisoning can cause loss of motor control, vomiting, seizures, blackouts, loss of consciousness, and death under certain circumstances. “Sleeping it off” can be very dangerous if someone has alcohol poisoning.

Harm Reduction Tips

  • Always check interactions individually.
    • Avoid combining alcohol with other depressants like benzos, opioids, or GHB. Combos can quickly become fatal due to their combined effects on heart rate, blood pressure, and respiration.
    • Alcohol also has quite a few interactions with non-depressant drugs, like ketamine (this mixture frequently produces severe spins and blackouts), SSRIs (which may make a person much more sensitive to alcohol), cocaine (cocaine and alcohol metabolize to create the toxic byproduct cocaethylene), and many more. 
  • Try to always have water or electrolytes with you when you drink. Dehydration significantly worsens hangover symptoms and can be dangerous.

What is it?

  • Stimulant
  • Relaxant
    Solid/Smoked
  • Solid/Ingested
  • Liquid/Drank
  • Other names: Maryjane, weed, pot

What are the Effects?

  • Sensory enhancement/sensitivity are common.
  • Cannabis may increase appetite.
  • Cannabis tends to cause an increase in heart rate, red eyes, and dry mouth.
  • Not everyone finds cannabis to be relaxing. Some people are particularly prone to anxiety/paranoia.

Harm Reduction Tips

  • Always check interactions individually.
    • Combining weed with psychedelics (including dissociatives like ketamine and nitrous) can drastically intensify the experience.
  • Can irritate the lungs, throat, and mouth. Using vapes or edibles instead of combustion (smoking) reduces irritation.
  • High-temp dabbing increases the risk of throat/lung irritation (or even damage) because the oil is so hot. Try to low-temp your dabs whenever possible.
  • Edibles can take several hours to fully kick in. Always wait at least two hours before eating more.
  • Cannabis edibles are metabolized differently than smoked cannabis. Smoking weed introduces both delta-9-THC and 11-hydroxy-THC into the body, but the oral route of metabolizing THC produces much more 11-hydroxy-THC than smoking does.
    • 11-hydroxy-THC is more potent and longer-lasting than delta-9-THC, and tends to produce a more pronounced racing heart. This is why edibles can be so much more intense and unpredictable than smoking weed.

Myths & Facts

Contrary to popular belief, it is possible to experience withdrawal after using cannabis daily for a long time. Withdrawal typically manifests as insomnia, appetite changes, anxiety, or irritability. Cannabis withdrawal is never life-threatening and is rarely anything more than a nuisance for a few days or weeks.

What is it?

  • Stimulant
  • Solid/Snorted/ Ingested
  • Liquid/Injected
  • Other names: Crack (Inhalant/Smoked)

What are the Effects?

  • Users generally report feelings of confidence, alertness, talkativeness, and euphoria.
    • Use of cocaine or any other stimulant can lead to insomnia and sleep deprivation. Staying awake for two or more days dramatically increases anyone’s risk of entering into a psychotic state.
  • The effects come on within minutes and peak after about 15-30 minutes, with a total duration of about 30-60 minutes.
  • When injected, the effects are substantially more intense than snorting and come on in seconds.
  • When smoked in the form of crack (baking soda & cocaine), the effects come on in seconds and are much stronger than snorting, but wear off within minutes. This can lead to compulsive redosing. 
  • Cocaine hydrochloride (powder cocaine) can’t be smoked effectively, which is why it has to be converted into crack to produce this more substantial rush.
  • The risk of cardiovascular injury with cocaine is significantly higher than other stimulants. High or frequent doses of cocaine can damage the heart and blood vessels, causing strokes, aneurysms, and heart attacks.
  • Cocaine is very short-acting, and the after-effects (the “comedown”) can be quite unpleasant. This is worsened by higher or more frequent doses, or more potent routes of administration like smoking and injecting. The comedown often leads to compulsive redosing.
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Harm Reduction Tips

  • Always check interactions individually.
    • Cocaine causes a sudden increase in heart rate, blood pressure, and body temperature. Combining cocaine with exertion and/or other stimulants may cause overheating, arrhythmia (uneven heartbeat), and hypertension.
  • Repeated snorting can damage nasal cavities and sinuses. To reduce risks, use saline spray before, during, and after any snorting session.
  • Sharing snorting devices can spread Hepatitis C and other diseases. Rolled up Post-It notes and personal straws can be used as disposable snorting devices.

What is it?

  • Depressant
  • Opioid
  • Liquid/Injected
  • Solid/Snorted/ Ingested/Smoked
  • Other names: Tar

What are the Effects?

  • Heroin has powerful pain-relieving properties. 
  • It’s typical for people to feel deeply content and relaxed, sometimes to the point of “nodding” in and out of consciousness. Not everyone experiences euphoria from heroin.
  • The “nod” state is very similar to the dreamlike experience of being on the verge of sleep. Many people express surprise at how psychedelic nodding can be. Overdoses are often compared to falling into a deep sleep.
  • Side effects can include nausea, vomiting, drowsiness, slurred speech, constipation, and itchiness.
  • When injected or smoked, the effects are felt within a few seconds; when snorted, within 5-15 minutes.
  • The effects of heroin typically last 3-5 hours, with variation depending on how you ingest it.
  • Most heroin is now cut with, or completely replaced by, fentanyl. Even when it’s not, different batches of heroin can vary greatly in strength, making it one of the easiest drugs to overdose on.
  • For many people, heroin produces a warm feeling that’s compared to being in love. This adds further risk of compulsive use for people who are experiencing emotional distress or other mental/physical health challenges.
  • Using frequently can lead to very uncomfortable withdrawal symptoms that make it much more difficult to remember your initial boundaries around use. Withdrawal can also make it very difficult to stop using due to getting “sick.”

Harm Reduction Tips

  • Always check interactions individually.
    • Mixing heroin with other depressants like alcohol or benzodiazepines (such as Xanax) greatly increases the risk of overdose and death. 
  • To prevent overdosing, many users will inject a small amount first (“tester shot”). This safety measure has become less effective because fentanyl and other potent synthetic opioids are rarely mixed evenly in any given bag of heroin. One part of a baggie may contain no fentanyl at all, while another part of the same baggie may contain a fatal dose.
  • Opioid overdoses become fatal because a person’s breathing and heart rate slow so much that they stop altogether.
  • Naloxone (“Narcan”) is an overdose reversal drug that can be administered as a nasal spray or injected into a muscle, depending on the form. You can find it using the Naloxone Finder on the Harm Reduction Coalition’s website.
  • If someone is breathing fewer than seven times per minute (or not at all), administer naloxone if you have it and call 911 for help. Start CPR if their heart stops. Lack of oxygen from slowed or stopped breathing can cause blue or gray tinting to someone’s lips, nose, fingers, and toes.

What is it?

  • Stimulant
  • Liquid/Injected
  • Solid/Snorted/ Smoked
  • Other names: Meth, Ice, Crystal, Glass, Tina

What are the Effects?

  • Meth causes increases in blood pressure, heart rate, and body temperature. Other effects may include dehydration, overheating, tooth grinding and jaw clenching, and sometimes itching. 
  • Cognitively, meth produces feelings of confidence, sociability or talkativeness, a strong desire to be moving and doing things, feelings of competence, and a decreased need for sleep.
  • Can increase alertness and focus in ways that are very similar to amphetamine. Can produce a speedy euphoria, especially when smoked or injected. This comes with an intense initial “rushing” effect.
  • Many users also report increased libido/sexual arousal.
  • Coming down from meth can make you feel lethargic, anxious, and depressed, which can lead to compulsive redosing.
  • Some people enter into patterns of multi-day binge use in an attempt to obtain meth’s euphoric rush. The risk of binging is drastically increased with shorter-acting and more intense routes of administration like smoking, injecting, or hot railing.
  • Long-term, regular, high-dose meth use can cause damage to dopamine neurons, resulting in Parkinson’s-like symptoms such as twitching, stuttering, and muscle spasms.
  • Meth is very long lasting, which can make it difficult or impossible to sleep. Sleep deprivation can have serious negative impacts on physical and mental health. Psychosis and paranoid delusions are a common consequence of anyone being awake for three or more days or chronically sleep deprived, regardless of whether they’re on drugs.
  • Injecting methamphetamine reaches the brain almost immediately, increasing the risk of overdose (“overamping”). Overamping can cause dangerous spikes in heart rate and blood pressure, sometimes leading to cardiac arrest, overheating, or arrhythmia

Harm Reduction Tips

People who suffer from depression and lack of energy, or who have very demanding high-stress lives, may be more vulnerable to developing a problematic relationship with meth

Myths & Facts

Many of the stereotypical meth-related consequences like “meth mouth” are actually a product of dry mouth and poor oral hygiene, although smoking meth can cause enamel decay.

What is it?

  • Stimulant
  • Solid/Smoked Dipped/Snorted

What are the Effects?

  • Produces focus enhancement, feelings of relaxation, appetite suppression, stimulation, and mild euphoria.
  • Increases heart rate and blood pressure.
  • The effects can usually be felt immediately and can last up to 30 minutes depending on the dose and form used.
  • Can feel dizzy or nauseous.
  • Tobacco is highly carcinogenic, although nicotine itself is not. Regular smokers have a much greater risk of developing lung cancer and other forms of cancer.
  • Smoking tobacco increases the risk of heart disease, circulatory problems, bronchitis, chronic cough, and emphysema.
  • Depression, irritability, restlessness, and anxiety are some of the withdrawal symptoms experienced by those who stop using nicotine after a period of regular use. Nicotine withdrawal is not dangerous, but it can be very physically and mentally uncomfortable
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Harm Reduction Tips

  • Try to smoke outdoors. Smoking indoors increases the health risks associated with smoking and can impact the health of non-smokers (and pets) who share your space.
  • A number of overdoses, some fatal, have occurred in children following the ingestion of vape liquid. Always store far from the reach of children.
  • If you choose to switch to vaping, be aware that you may decrease carcinogen consumption but dramatically increase nicotine consumption. Try to use low-nicotine vape juice and be conscious of how frequently you’re hitting your vape

Myths & Facts

  • Although available evidence indicates that vaping is significantly less risky than smoking, much is still unknown about the potential health impacts.
  • Although vaping has helped many people quit using tobacco, the consumption of nicotine in any form still carries the risk that one might develop compulsive use and/or physical dependence.