Harm Reduction Strategies to Address Crack and Injection Drug Use

Mella Brown and Bo Yih Thomharmreductionconsultants@gmail.com

Types of Drugs

• Focus on: – Opiates– CNS Stimulants– Alcohol

• Women are often poly drug users

Opiates

• Painkillers- percocet, oxycodone, fentanyl, heroin, morphine, demerol, delaudid, etc. - physical and emotional pain

• Central Nervous System(CNS) Depressant– brain and spinal cord work together to process

info from senses and respond

How are opiates used?

• Pills- swallowed, crushed and snorted, or injected

• Heroin - smoked, snorted, or injected

• Methadone – By prescription, daily “drink”

Some effects of opiates

• A happy “glow” 4-8 hours• Comfortable numbness

• Sedation/sleepiness, “on the nod”• Heart rate decreases

• Brain chemistry changes to accommodate the presence of opiates = physical withdrawal

Opiate Withdrawal

• Physical• “junk sick” – up to 4 weeks, up to 3 months for

Methadone• Flu x 1000• Aching, sweating, vomiting, muscle pain, diarrhea

• Kick kits (valium, clonidine, and immodium)• Methadone prescribed for long term users• Ear acupuncture – NADA protocol

Overdose awareness

• CNS is so suppressed, breathing stops• Unconscious, blue lips and fingertips

• Mixing uppers and downers is also dangerous – confuses the body, can’t tell how high you are

• Call 911 – Narcan needs to be administered– be prepared for paramedics and police

Health Promotion StrategiesHealth Promotion Strategies: • Access to new “works” (injection equipment) and information,

24hrs, anonymous (not having to go through a worker) • Sharps containers • Mark own works• Separate snorting material• Develop safety strategies based on what she feels is realistic and a

priority• Discuss vein care, rotating veins, vein cream (vitamin e, preparation

h, polysporin)• Use ½ the amount if tolerance has lowered • Resources that are light on toner

Stimulants

• “Uppers”• CNS Stimulant

• Cocaine, crack• Speed• Crystal Meth

How are stimulants used?

• Swallowing - pills, tablets – speed, “bennys”

• Snorting- cocaine, speed, crystal meth

• Smoking- crack and crystal meth

• Injection- all can be injected

Some effects of stimulants

• Euphoric feelings, 5-15 minutes• Can be more social, confident, energetic,

talkative, hyper (alert), or anxious• Shorter half life = more frequent administration• Cookie feet • Loss of appetite• Dehydration• Increased heart rate

Withdrawal from Stimulants• Primarily psychological – urges to use can still be very strong

• Happy brain chemicals (seratonin, dopamine) are depleted• Big emotions, emotional and physical pain• Hopelessness and self loathing – watch for suicidality

• Extremely tired• Irritable, sensitive to light, noise

• Lasts about 3 days

Overdose awareness• Severe dehydration, overheating, lack of sleep, water and

nutrients

• Seizures, “doing the chicken”– Often in sets of 3– Protect head, never put anything in mouth– Cool down with wet towels in armpits, backs of knees, luke

warm shower with a friend, let her make the water cooler by herself

• Stop using for now

Harm Reduction Strategies

• Strategies re: hydration, food, and sleep• Support to understand withdrawal symptoms as a

part of using (hangover)• Collect resin with a plastic straw instead of a metal

blade• Access to safer crack use kits which address dangers

associated with homemade pipes– HIV and HCV, damage to lungs from metal fatigue, health

problems associated with aluminum foil, aluminum cans, and chemicals from heated plastic

Hepatitis C

• In blood• Destroys liver• Very hardy virus• Transmitted through white blood cells• Many strands

• Interferon (will need support), milk thistle

Toxic pipes – Tin Can

• aluminum• Plastic coating• Ashes• Debris• Sharp edges

• Worst health choice• Most popular where barriers exist because it’s quick

and disposible

Toxic Pipes – Copper Elbow

• Aluminum• Ask• Copper in lungs from collecting resin• Hot – can cause burns

• “An old friend”

Toxic pipes – Asthma inhaler

• Aluminum• Plastic• Ashes• Ingestion of plastic from scraping

Toxic Pipes – Water Bottle

• Plastic• Ashes• Aluminum

Toxic Pipes – Ginseng Bottles

• Metal fatigue• Sharp edges, cuts and burns

Safer Crack Use Kits

• Sturdy Pyrex• Screens reduce damage to lungs• Health promotion messages• Supplies for 1+

A note on cigarrettes

• Knock out the ash• Cover the filter

Alcohol

• CNS depressant

• Ingested by drinking

• Wine, beer, liquor, cooking wine, hand sanitizer, mouthwash

Some effects of alcohol

• Happy at first, but can bring on difficult emotions and depression

• Impaired thinking and memory• Decreased fine motor skills

• Decreased perception (pain, time)

Withdrawal

• Insomnia, sweats and shakes

• Can lead to seizures- non-medical withdrawal management services (detox) may require initial

supervision in hospital

Harm Reduction Strategies

• Mixing alcohol with other CNS depressants (heroin, methadone, percocet) is extremely dangerous. It is also dangerous to mix with benzodiazepines (valium)

• Alcohol is really bad on the liver, a concern for those living with Hepatitis C (HCV)

• Pace drinking, alternate with water, teas, etc.• Safety planning – a place to pass out• Taper instead of “cold turkey” if drinking heavily

Resources

• Harmreductionconsultants@gmail.com

• CATIE – free, excellent harm reduction information in easy to read formats

• Toronto Public Health – Narcan training 416-392-0520

• National Acupuncture Detoxification Association (NADA)