Harm Reduction Education for Injection Drug Users
The most effective education for a patient who injects fentanyl and methamphetamine should focus on using clean supplies for all aspects of injection, accessing syringe service programs, and having naloxone readily available to prevent overdose death. 1
Primary Harm Reduction Strategies
Infection Prevention
- Never reuse or share syringes, needles, water, or any drug preparation equipment 1
- Use only sterile syringes from reliable sources like pharmacies or syringe exchange programs 1
- Use sterile water to prepare drugs when possible; otherwise, use clean water from a reliable source like fresh tap water 1
- Use a new container (cooker) and a new filter (cotton) for each injection 1
- Clean the injection site with a new alcohol swab before injection 1
- Safely dispose of syringes after one use in a proper sharps container 1
Overdose Prevention
- Always have naloxone readily available and never use alone 2
- Consider using a test dose with each new supply, even when buying from the same source 3
- Be aware that fentanyl is increasingly found in stimulants, particularly in powder forms of methamphetamine (12.5%) and cocaine (14.8%) 4
- Know that crystalline forms of methamphetamine are less likely to contain fentanyl than powder forms 4
Accessing Support Services
Syringe Service Programs
- Syringe service programs provide free sterile equipment and other resources 1
- These programs can connect you to additional health and social services 1
- They often provide HIV and hepatitis testing, vaccination, and other preventive services 1
Testing and Medical Care
- Get tested regularly for HIV, hepatitis B, and hepatitis C 1
- Consider getting vaccinated against hepatitis A and hepatitis B 1
- Seek medical care if you develop symptoms of infection 1
Important Cautions
Drug Supply Risks
- Be aware that methamphetamine is increasingly contaminated with fentanyl, which dramatically increases overdose risk 5, 6
- Fentanyl test strips may not detect all fentanyl analogs or high-potency synthetic opioids 3
- Xylazine (an animal tranquilizer) is increasingly found in the drug supply and can reduce your ability to detect fentanyl 4
Common Pitfalls to Avoid
- Don't assume cleaning equipment with bleach is as effective as using new equipment - while cleaning may reduce risk, it's not as reliable as using new, sterile equipment 2
- Don't focus only on needle/syringe sharing - sharing water, cookers, and filters can also transmit HIV and hepatitis 1, 2
- Don't inject alone - having someone present who can administer naloxone is critical for preventing fatal overdose 2
- Don't assume all drugs from the same source have consistent potency - drug composition can vary significantly, even from the same dealer 3, 7
By following these harm reduction practices, you can significantly reduce your risk of acquiring bloodborne infections like HIV and hepatitis, as well as decrease your risk of fatal overdose while continuing to use drugs.