Heroin Harm Reduction Guide - Advice & Tips for Users

Why harm reduction?

Many people find harm reduction ridiculous; after all, instead of promoting safer use shouldn’t we concentrate on helping people stop completely? Is it ever right to support heroin use?

But actually, harm reduction does help a person stop completely by keeping them alive and healthy until the day they're ready to quit:

1. Dead addicts can't quit - so we need to keep people alive and well until they're ready for treatment.
2. Seriously compromised physical, mental and cognitive health reduces a person's abstinence chances - so we need to help addicts stay as healthy as possible until they're ready for change.
3. Addicts already in regular contact with health workers learn about treatment options and have facilitated treatment access.

Basically then, if you support abstinence as the optimal goal, you should support harm reduction as a great vehicle for helping addicts get there.

So if you (or someone you care about) use heroin, delve into the following harm reduction ideas and consider making a few simple changes to safeguard health and well-being.

Read on to learn...

• why it makes sense exactly
• 50+ Harm Reduction Tips

The Philosophy Behind Heroin Harm Reduction

Consider some of the arguments behind harm reduction:¹

• It’s less judgmental. Society (and some treatment providers) may view people as ‘good’ when they abstain or use responsibly and ‘bad’ when they don’t or when they don’t want to quit at this moment. Under a harm reduction philosophy, people aren’t judged on their drug use. Each person is treated with the same dignity and respect – no matter what their situation or history. Each person is considered deserving of health and happiness, whether they choose to use heroin or not.
• It recognizes that sometimes improving a person’s quality of life is more important than insisting that person accept a goal of total abstinence (and not supplying services to people who don’t accept this goal).
• It empowers people to believe in the possibility of self-directed change.
• It meets people where they are now. This way every opioid user can benefit from harm reduction and better health right now – not just when they achieve some optimal state of motivation and readiness for abstinence.
• It recognizes that sometimes a bit of education can help opioid users minimize their risks of health consequences and fatal overdose.
• It recognizes that society as a whole benefits when drug users get healthier and more in-control.
• It recognizes that most change occurs as an incremental process – not a sudden lurch. By supporting a person as he makes small improvements we help him move steadily toward a chosen goal.
• Harm reduction programs tend to be evidence-based and science-driven.
• Small financial harm reduction investments cause major societal cost savings.

Heroin Harm Reduction Tips

Snorting

• Alternate nostrils. This reduces the odds of infection and tissue damage.
• Don’t share straws. Minute flecks of blood on a straw can transmit hepatitis B or C.
• Don’t use rolled-up money to snort with. Paper money is teeming with germs and you increase your risk of infections.
  
• Take some time before snorting to chop up very finely. If you need to snort black tar heroin, you’re best off dissolving this in water completely and then sniffing this water.
• Make sure you’re snorting on a clean surface (a plastic card from your wallet can work). This reduces the odds of sinus infections as well as cold and flu.

Smoking/Snorting

• Don’t hold it in your lungs. This won’t increase absorption but it will increase lung irritation and damage.
• If you have asthma, make sure you have your inhaler on hand. Inhaled heroin can lead to serious asthma attacks.

Injecting: Protecting Your Veins

• Try to work on a clean surface. If you’re not sure about your work area, putting down a sheet of newspaper can help a lot.
• If you mainline, use the smallest needle that you can find. Sharp needles reduce vein damage and every time you reuse a needle the point gets progressively duller.
• Don’t inject into muscle or skin-pop unless your heroin dissolves easily in water without needing to add an acid. Doing otherwise increases your chances of abscesses (black tar heroin may differ).
• Never inject against the flow of blood in your veins. Inject toward your heart.
• Never inject into an artery (this increases your risk of gangrene and other problems). If you can feel a pulse, it’s an artery.
• Inject slowly – don’t slam it in. The faster you inject the greater your risks of vein tearing. Take the needle out as soon as you are done to reduce bruising.
• Don’t flush the needle (pulling blood in to re-inject). This doesn’t get you any more heroin but it does increase vein damage by making the hole bigger, increasing bleeding and clotting and damaging vein linings.
• If you need to use an acid to dissolve your heroin, try to avoid using lemon juice or vinegar; opt for powdered vitamin C or powdered citric acid instead. Injecting lemon juice or vinegar can cause fungal infections. Use as little acid as is needed to completely dissolve your drugs.
• Don’t inject tablets. Tablets contain additives and these don’t dissolve completely. Injecting solids into veins increases the chances of vein damage/collapse.
• Rotate your injection spots. If you find you can no longer inject in lower-risk areas (like the elbow area) you should consider moving away from injecting rather than moving down to higher-risk areas. The risks of serious health complications and lasting pain and disability go up substantially once you move on to riskier injection sites, like the legs, groin, feet, etc.

Injecting: Reducing Bacterial Risk

• Wash your hands with soap and hot water before you start preparing your works.
• Heating your shot, even when not needed, may help to reduce bacterial infections. If your water isn’t sterile, heating it to a boil before mixing with dope can reduce bacterial risks.
• Don’t lick the needle!
• The tip of the needle picks up bacteria from your skin every time you insert through it. If you need to insert several times because you’re having a hard time finding a vein you may want to change your needle.
• Choose your water carefully. Consider the following water supplies, listed in order from safest - to - most dangerous: 1. unopened sterile water pack, 2. boiled water, 3. cold tap water, 4. bottled water (bacteria in bottled water pose no health risk when ingested into the stomach, but may cause infection when injected), 5. distilled water (though distilled water contains no minerals, it is not generally intended for human consumption and can be bacteria-rich), 6. hot tap water (hot tap water may not be hot enough to kill bacteria – this can make hot water riskier than cold), 7. toilet water, 8. puddle water, 9. shared sterile water pack, 10. shared cup of water.²
• Cleaning the injection site before injections can help to reduce bacterial infections. Wash with soap and water and then wipe with alcohol.
• Don’t save your cottons for the residue that accumulates. Used cottons are great bacterial incubators.
• Get a tetanus vaccine and stay up to date.
• If you get a skin infection or abscess, try not to pick at it, squeeze it or cut it open. This can spread infection and worsen the problem. A doctor might prescribe antibiotic treatment or perform a small procedure to open and treat the wound.
• As a much safer alternative to conventional injecting, you can prepare your works (use a syringe without a needle!) as normal but then insert the syringe into your rectum and gently squirt in the contents.

Injecting: Avoiding Infectious Disease

• Not only shouldn’t you share a needle, you also need to use your own water, cotton, tie, cooker or spoon. Sharing any of these increases your risk of infectious diseases.
• If you inject, you can greatly reduce your risks by using a new sterile needle each time you inject, as well as new cotton each time, a clean cooker and fresh sterile water. Keeping things clean and sterile reduces your odds of skin infections and abscesses, internal infections like endocarditis and transmittable infections like HIV and hepatitis C. If possible use sterile medical grade disposable cookers and syringes as well as sterile water.   
• If you absolutely need to reuse a syringe, learn how to safely clean with water – bleach – and water again.
• A drop of blood that’s too small to see can contain enough hepatitis or HIV to get you infected. Not only shouldn’t you share any injecting supplies, you also need to make sure that your heroin never comes into contact with another person’s needle, mixing water, cooker or filter.³
• Get a hepatitis B vaccine.
• Be flexible with your intake – if you can’t get a clean needle, you’re much better off snorting or smoking than using a friend’s.

General Health Preservation

• Work past constipation by having a bowel movement before you get high (using will make constipation worse). Also, eat a high fiber diet and stay hydrated.
• Have condoms on hand (to prevent STDs from unplanned sexual activity).
• Don’t rely on pain as a sole indicator for when dental or medical care is needed. Since heroin is such a potent pain reliever, serious problems can go unnoticed; If something looks like it needs medical attention – even if it doesn’t hurt - it probably does.
• If you get a sudden high fever and feel very unwell you may have septicaemia (blood poisoning). This is a potentially lethal condition so treat this as a medical emergency.
• A large skin infection, where the skin becomes tight, hot, red and painful over a large area is possibly cellulitis. This is also a medical emergency requiring immediate attention.
• Go see a doctor if any skin near an injection site becomes black or discolored, or starts weeping fluid.

Avoiding Addiction

• If you’re using but not yet dependent, avoid using more than 2 days in a row and take a break if you start feeling like you need drugs.

Avoiding Overdose

• Don’t use alone or behind locked doors.
• Try a small tester shot first.
• If you can, buy from someone you know and trust and ask them about potency before using.
• If using alone, try snorting instead of mainlining.
• If you’ve taken a break – even a short one - your tolerance can drop substantially and a hit that you could have handled easily before can become dangerous. After a break, use with caution, use less, and consider safer forms of administration, like smoking or sniffing.
• Feeling very run-down can increase heroin’s effects. Use less if feeling ill, very tired or dehydrated or if your liver isn’t working well.⁴
• Have naloxone on hand and know how to use it.
• Don’t mix heroin with benzodiazepines, alcohol, cocaine or other drugs. Mixing substances increases overdose risks. Some OTC and prescription drug can stay in your system for a day or longer, so you have to be careful even when combining heroin with medications you took the day before.⁵
  
• Learn CPR and rescue breathing to save a life.

Starting Methadone or Suboxone Treatment

• Getting involved with a methadone or Suboxone treatment program can help you stabilize, take breaks and improve your overall functioning.

Preventing Community Harm

• Dispose of injection equipment in a Sharps container to protect others from accidental sticks and infectious disease transmission.
• Get tested for HIV and hepatitis C.

Consider Treatment - Even if Not Abstinence-Ready

Harm reduction helps you safeguard your health while using, but nothing improves health as much as reducing or stopping altogether.

If you want to stop, then treatment’s a no-brainer. Suboxone or methadone can get you stabilized and rebuilding your life in a matter of weeks.

But even if you’re not sure you want to stop completely, treatment is still worth considering. Research shows that people getting heroin treatment...⁶

• Are less likely to overdose.
• Use less (or sometimes stop completely) – and longer periods in treatment generally equate to progressively reduced use.
• Get physically and emotionally healthier (a by-product of reduced use and increased contact with medical professionals).
• Commit fewer crimes.
• Are better able to hold onto a job and maintain satisfying intimate and social relationships.