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Harm Reduction

‘Harm Reduction’ refers to policies, programmes and practices that aim primarily to reduce the adverse health, social and economic consequences of the use of legal and illegal psychoactive drugs without necessarily reducing drug consumption. Harm reduction benefits people who use drugs, their families and the community.[1]
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Introduction to Harm Reduction


Harm Reduction is based upon the principle that the use of drugs, as well as other activities related to drugs, potentially can inflict harm. Often harm flowing from drug use and drug related activities can be reduced or avoided. By information and informed decisions or by taking precautions. This is harm reduction.
Harm Reduction, in so far as it relates to drugs, refers to taking sensible precautions to minimise the associated risks of using drugs. The term is sometimes used in contrast to what might be considered the ultimate in harm reduction, abstinence.
Note: Much of this wiki consists of collected suggestions from members of the forum. These suggestions are in no way exhaustive. Following them does not mean you are not at risk of harm, but if you or someone you know does intend to use drugs, there might be some information of value to you here. Please feel free to edit, improve, but ask to join the "D.F. Lifeguards" group if not already a member to get some idea of our aims.

Basic Safety


  • Never consume an unknown substance.
  • Be aware that what you're buying isn't necessarily what the person selling it to you says it is. This is especially true if they're a stranger but even the best of friends can be given misinformation.
  • Only source drugs from someone you know and trust, unless you already know exactly how to identify what you're seeking.

Researching


  • When given a substance you have never tried, check online resource sites such as erowid, wiki's, and forums for a full range of experience reports, dosage information, safety concerns, routes of administration, and information on what doses might cause "bad trips" for users. Even then, do not assume you know all there is to know about a drug and approach with caution.
  • Know the potential interactions of drugs you consume with any medical conditions you might have and medications you are taking.
  • Understand what you're getting yourself into. Be aware of all side effects, positive and negative.
  • When in doubt, read about (it).
  • Do your due diligence. Know what to expect as much as is possible, and decide, on the basis of good information, if you want to undertake the experiment. There are known unknowns, and it's good to have a road-map of these!
  • Be wary of sales pitches, of general drug hype, rumours including that of those around / close to you.
  • When undertaking the said research, especially online, be selective or at least filter the information : people do sometime lie or bend the truth about doses, effects, combinations, for a number of reasons (from commercial ones , macho "dick sizing" to plain misinformation).

Dosing


  • Start small especially after a period of abstinence as your tolerance level will have dropped[/b].
  • Measure doses accurately, and if the dosage calls for precision, get a proper scale. If using Research Chemicals (RCs) a milligram scale is highly recommended.
  • In some cases, knowing one's own weight might be helpful.
  • Many substances are toxic at not much more than a normal dose.
  • When testing a new substance or new batch of a substance that one has never tried before, start low[/b], to check that there are no adverse effects, and then cautiously increase doses to the desired level.
  • Substances extracted or cultivated from plant material such as poppy tea may vary greatly in potency, even between batches made from the same supply of material. In these cases it is prudent to consume the substance slowly in order to allow time to gauge its potency.
  • Street drugs may be "cut" or otherwise adulterated, and so their potency can also vary. It is a good idea to reagent test substances before consuming, and to start with a minimal amount before slowly increasing to the desired dosage.

Combinations


  • Always search for information on contraindications or other aspects of how drugs react when taken together. There are many combinations that are unsafe and potentially life threatening.
  • Never try a drug combination without having used all of the drugs involved separately on previous occasions.
  • Some over the counter medications contain a desired recreational substance combined with an undesired substance. In many cases the desired dose of one substance would involve consuming a toxic dose of the other substance it is combined with. In these cases an extraction should be performed to remove the undesired substance before consumption.

Synergistic effects


  • Combining two or more substances can lead to additive increases in side effects. Central nervous system depressants such as alcohol, benzodiazepines and opioids in particular are known to be very dangerous in combination as the resulting increase in the level of depression can lead to respiratory arrest.
  • Some substances may be non-toxic or of low toxicity on their own, but more toxic in combination with other substances (e.g. alcohol and cocaine in combination causes cocaethylene to form in the liver which is more cardiotoxic than cocaine alone).[2]
  • Combining central nervous system depressants such as opioids, benzodiazepines and alcohol with stimulants such as cocaine and amphetamines (Sometimes referred to as a speedball) is linked to increased incidents of overdose. The suppression of some of the undesired side effects of the substances concerned may lead the user to believe they can safely consume more than they can tolerate, and the differing duration of effects can lead to a delayed overdose situation when one substance wears off but the other is still active.

Routes of administration


Important:[/b] Different routes of administration result in differing bioavailability of the substance. It is necessary to check the bioavailability of your substance when calculating dosage if switching routes of administration. Failure to do so could lead to overdosing.

Inhalation


  • Inhalation of smoke from burnt plant material is linked to the impairment of blood vessels. It doesn't matter what the active chemicals involved are, the mere burning of plant material results in smoke that is dangerous to inhale.[3]
  • Vaporising may be safer than smoking in that some of the harmful chemicals created in the burning of plant material are not as prominent in the process of vaporisation. The long term health effects of vaping however are not yet fully understood.
  • Hepatitis C has been shown to be transmittable from shared pipes as well as needles. The author sees no reason to assume what is in the pipe is the factor here, except that some substances may increase the likelihood of mouth/gum bleeding. Hepatitis C is contracted blood to blood, so if you have bleeding lips/gums/mouth/etc or suspect you might have, do not share pipes.

Injecting


  • Never share needles, spoons, filters. Also do not share a tourniquet with anyone. They can become contaminated with not only blood but also with bacteria that could lead to infections. Single-use is best & then dispose of along with your needle & syringe. If single-use is not practical, be sure to wipe down with alcohol or wash in warm soapy water after each use. Clean equipment may be available from needle exchanges.
  • Have someone with you in case you overdose.
  • Cigarette filters contain glass fibres which damage veins. Instead use a corner from an alcohol swab, cotton buds or a piece of tampon.
  • Specific lab syringe filters are best to filter your product. Some needle exchanges have filters and they can be legally purchased. A .2 micron syringe filter is recommended far above cotton filters.
  • If at all possible use sterile water. Otherwise flat mineral water or cooled boiled water. The water must always be fresh and clean. If using boiled water, use freshly boiled water not the stuff that has been sitting in the kettle all day.
  • Using a saline solution is ideal when injecting, individually packaged packets are available, such as 3ml containers of saline.
  • If possible try to always use citric acid to dissolve your gear, as vinegar can sometimes be contaminated with Hepatitis. Don't use lemon juice as it contains a fungus which when injected can settle around your eyes and eventually blind you.
  • Elastic tourniquets will stop veins rolling. Stockings or tights make good makeshift tourniquets. Do not leave a tourniquet on for longer than 1 minute and always release it before injecting. If possible try not to use one as they can damage your veins.
  • Use the smallest needle possible to inject. Although make sure the needle is proper to your application. Intramuscular injections require a thicker and longer needle then intravenous injections.
  • Use the smallest amount of water and citric acid possible to dissolve your gear.
  • Dispose of your used injecting equipment carefully. Get a sharps safe box from your syringe-exchange scheme. Keep the box out of the reach of children. A thick plastic soda bottle can substitute if a sharps box is unavailable, such as a Gatorade bottle.

Insufflation


  • Do not use substances by insufflation too frequently, or too much, the benefits of that are numerous besides letting your body to properly heal your nose before damaging it again. Using too frequently is like scratching an open wound. Once in a while abstain completely for more than 3-4 weeks also.
  • After the end of a session use a weak saline solution to clean your nose. Dissolve a level teaspoon of table salt in a glass of warm water, then inhale just a little spray of that water. Not much is needed, don't go crazy with it.
  • Buy some vitamin E capsules, puncture them and drip the vitamin E oil on your little finger or a cotton ear cue. Very gently cover the inside of your nose with the oil. Remember some substances are anaesthetics, so consequently you wont be able to properly gauge pain after use and you might scratch your nose.
  • If possible remove cutting agents and other adulterants before insufflating by "washing" your substance. The exact details will depend upon what the solubility of your substance is in various washing agents, and that of the cutting agents and adulterants. Commonly used washing agents include water, ethanol and acetone.

Oral


  • Onset of action and magnitude of effects may be affected by presence of food in the stomach. It is prudent to make yourself aware of how this might affect your experience.
  • Some substances may induce nausea and vomiting such as mescaline and DXM. Be prepared for such an eventuality, and if possible have someone with you in case of choking.
  • An anti-emetic such as Ondansetron can be helpful in preventing dangerous vomiting while under the influence.
  • Some enzymes involved in the metabolism of drugs in the digestive system may be suppressed by certain substances. For example, grapefruit juice is known to potentiate the effects of some substances by suppressing an enzyme that destroys the substance, and as a result increases the bioavailability of those substances. When in doubt, check any medications and food for interactions with your substance using a drug interaction checker, or better yet, several.
  • Onset of action via oral administration can be slow. It is important not to redose until you are certain the previous dose has peaked, otherwise you risk overdosing.

Plugging


Content to be added.

Sublingual


Content to be added.

Topical and Transdermal


Content to be added.

Set and Setting


  • Be sure to understand the concepts and application of 'set and setting'.
  • Avoid peer pressure. Don't take something or take more of something than you normally would because others are doing so.
  • Make your experience as positive as possible by choosing where, when and with who you use with. This is especially important with psychedelics.
  • Don't drive or operate heavy machinery, or other undertake potentially hazardous tasks while impaired.
  • Do not use substances when pregnant or lactating / breast feeding.
  • Be aware of practical concerns such as not passing out where one is not supposed to and not taking a long lasting psychedelic, dissociative or sedative when you have to be fully functional in the coming hours.
  • Have a trip sitter if possible, especially for first time psychedelic or dissociative use.
  • Use common sense.
  • Be aware of basic domestic hazards, such as forgetting / nodding off while having a frying pan on the stove or having a lit cigarette somewhere.
  • If you anticipate disorientation try to remove obstacles that may present a danger prior to consuming a substance.

Psychological

General precautions


  • Are you suffering from or at increased risk of mental illness? If so, are mood-altering substances a good idea for you?
  • Be wary of using mood-altering substances if you are currently under stress or dealing with real-life problems as this can lead to self medicating behaviours.

Addiction


  • Ask yourself, did the addict you just saw think they were going to become addicted when they tried it "just the one time"? Are you so different?
  • Consider the American Psychiatric Association's (APA) Diagnostic and Statistical Manual, version 5's (DSM-5) criteria for substance use disorders:[4]
    • A drug or drugs are often taken in larger amounts or over a longer period of time than intended.
    • There is a persistent desire or unsuccessful efforts to cut down or control drug use.
    • A great deal of time is spent in activities necessary to obtain the drug or drugs, use the drug or drugs, or recover from its or their effects.
    • Craving, or a strong desire to use a drug or drugs.
    • Recurrent drug use resulting in failure to fulfill major role obligations at work, school or home.
    • Continued drug use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of drugs.
    • Important social, occupational or recreational activities are given up or reduced because of drug use.
    • Recurrent drug use in situations in which it is physically hazardous
    • Continued use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by unsupervised drug use.
    • *Tolerance, as defined by either of the following:
      (a) a need for markedly increased amounts of a drug or drugs to achieve intoxication or desired effect
      (b) markedly diminished effect with continued use of the same amount of a drug
    • *Withdrawal, as manifested by either of the following:
      (a) the characteristic withdrawal syndrome of the drug in question, including psychological withdrawal
      (b) the same (or a closely related) substance are taken to relieve or avoid withdrawal symptoms
    *This criterion is not considered to be met for those individuals taking drugs solely under appropriate medical supervision. Such as chronic pain patients.
    Severity: Mild: 2-3 symptoms, Moderate: 4-5 symptoms. Severe: 6 or more symptoms, over a twelve month period.

Insights for Harm Reduction


Harm Reduction

Useful links

Harm Reduction wiki articles

Harm Reduction groups

Harm Reduction threads

Other Harm Reduction resources

References


  1. ^International harm reduction association. (n.d.). What is harm reduction? Retrieved August 29, 2016, from https://www.hri.global/what-is-harm-reduction
  2. ^Harris, D. S., Everhart, E., Mendelson, J., & Jones, R. T. (2003). The pharmacology of cocaethylene in humans following cocaine and ethanol administration. Drug and Alcohol Dependence, 72(2), 169-182. doi:10.1016/s0376-8716(03)00200-x
  3. ^Wang, X., Derakhshandeh, R., Liu, J., Narayan, S., Nabavizadeh, P., Le, S., … Springer, M. L. (2016). One Minute of Marijuana Secondhand Smoke Exposure Substantially Impairs Vascular Endothelial Function. J Am Heart Assoc, 5(8), e003858. doi:10.1161/jaha.116.003858
  4. ^Gilly PA (2015) How and Why to Diagnose Substance Use Disorders under DSM-5. MOJ Addict Med Ther 1(2): 00009 DOI: 10.15406/mojamt.2015.01.00009

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