Most of us do things every day to mitigate harm to ourselves and each other. We use sunscreen to protect us from harmful UV rays. We wear helmets when we mountain bike (ok, so I do not actually mountain bike, but I hear it is a thing). We try to minimize our sugar intake. We wash our hands and wear masks to prevent the spread of COVID-19. We wear seatbelts when we drive and get a designated driver when we drink.
Harm reduction practices for people who use drugs are just as important as the practices mentioned above. Harm reduction advocates believe that everyone should have access to accurate information so that people can make safer choices.
While heroin use can never really be considered safe, there are measures that can be taken to reduce harm while people continue to use. It is imperative that people are have information about safer use practices, otherwise they may never get better. Dead people do not recover.
Types of heroin
Heroin is an opioid and is derived from the opium poppy. Heroin can come in many different forms, but the most common are white powder, brown base, and tar (which is most common in Texas). Almost all street heroin is “stepped on”, or “cut” with fillers. As the number of cuts increases, the purity decreases. This can make it harder to judge the correct dose and increase the likelihood of a bad reaction, sometimes to the fillers themselves.
Heroin and routes of administration
The most common methods of using heroin are snorting, smoking and injection. Each method comes with its own risks and considerations. Both snorting and smoking may cause breathing problems in people who have asthma. Smoking may cause problems for people with respiratory conditions, whereas snorting can lead to nasal damage.
Of all of the ways to use heroin, injecting has the most risks. There are three ways to inject heroin, intravenous (IV), intramuscular (IM) and directly under the skin (skin popping).
Reducing harm while snorting
Use clean surfaces for chopping and snorting
Alternate which nostril you use to minimize long term damage
Keep snorting tubes clean and do not share them; this can help prevent spread of hepatitis B/C, AIDs, flu and even the coronavirus.
Reducing harm while smoking
Use caution to avoid burning your fingers on the metal of disposable lighters
Do not hold the smoke in; it will not add to the high and may cause irritation to your lungs
If you have asthma, keep your inhaler nearby in case you need it
Reducing harm while injecting
Heat your shot, even if your heroin is dissolvable in cold water; it can help to kill bacteria and viruses
Use sharp, sterile syringes and clean cooking equipment and cottons. Doing so can help prevent abscesses, infections, and endocarditis
Do not reuse cottons; they are a good environment for bacteria to grow in
Use the smallest size needle you can (higher gauge equals a smaller needle)
To avoid contamination, keep your shooting water separate from your cleaning water
Clean your injection site with soap and water, then use an alcohol pad
Rotate your injection sites
Visit Bevel Up to read more about safer injection & injection alternatives
Managing your use
After using heroin regularly, a tolerance will develop, meaning you will have to use more to feel the same effect. After a period of regular use, someone is likely to become dependent. When this occurs, they will experience intense withdrawal when they cease use. Someone who uses occasionally or has a small habit is sometimes called a chippy. The terminology used to describe someone who is addicted is “strung out”.
Managing use while chipping
Avoid using for more than two days in a row
After using for a couple of days, take an equal number of days off
If you are on the edge of needing heroin to function, reach out for help. It is a lot easier to make changes and get support while you are in this phase
Heroin overdose prevention
Overdose is a serious risk for heroin users, regardless of type of heroin used or the route of administration. There is no surefire way to prevent an overdose, but there are steps to lessen the likelihood and safety measures to put in place in case it happens.
Avoid mixing heroin with other drugs, but especially other central nervous system depressants, i.e. benzos, alcohol, etc.
Do a tester shot
Reduce the amount you use after periods of abstinence
Use less when you are in unfamiliar environment
Avoid using alone
Get naloxone (Narcan) and make sure the people around you know where it is and how to use it
Learn rescue breathing
Some final tips for safer use
1. Know what you are buying; consider getting fentanyl test strips
2. Be flexible with your route of administration. There may be times when your preferred method is not safe or practical.
3. Take your time. Being in a rush to get high can lead to big mistakes.
How you can help someone who is using
Most of us have the instinct to try to make people stop doing things that are harmful. While the intention is good, the result is often disappointing. As much as we want to, we cannot make them stop. They may want to stop but are not feeling ready.
One of the best things we can do is to help people implement harm reduction when they are actively using. Sometimes the best we can do is help keep someone alive, so later they can be well. If you need more resources or support to care for someone using, Substance Use Therapy is available for you.
How to get help if you are using
Fortunately, you have options. If you need additional resources/referrals, want to learn more about treatment options or want to begin therapy, Substance Use Therapy is here for you.
You can also call SAMSHA for confidential free help from public health agencies, to find substance use treatment and information. 1.800.662.4357. If you reside in Travis County, you can also call Integral Care at 512.472.4357.
Whatever you are facing, you do not have to face it alone.
Denning, P., & Little, J. (2017). Over the Influence: The Harm Reduction Guide to Controlling Your Drug and Alcohol Use. The Guilford Press.
About the Author:
Kimberly May, LPC-S, LMFT is a therapist at Substance Use Therapy in Austin, TX. Kimberly works with individuals, couples and families whose lives have been affected by substance use. By utilizing a harm reduction framework, Kimberly works effectively with people in any stage of use. In addition to substance use, she works with other issues such as anger, burn-out, anxiety and grief. Contact today to schedule a no-charge, 30 minute, in-person consultation. *Note: telephone and telehealth sessions are currently available.