What are the safest ways to use drugs?

Safest Ways to Use Drugs: Harm Reduction Strategies

The safest approach to drug use is complete abstinence, but for those who continue to use drugs, comprehensive harm reduction strategies can significantly reduce morbidity and mortality. 1

Primary Prevention

For individuals who have never used drugs:

• Behavioral counseling interventions may help prevent initiation of drug use, though evidence for specific interventions remains insufficient 1
• Early education about risks and consequences of drug use is important, particularly for adolescents 1

Harm Reduction for Individuals Who Use Drugs

General Safety Practices

• Get counseling and treatment to stop or reduce drug use 1
• Never use drugs alone - having someone present who can respond to emergencies is critical 2
• Get tested regularly for HIV, hepatitis B, and hepatitis C 1
• Get vaccinated against hepatitis A and hepatitis B 1
• Seek medical treatment for infectious diseases 1
• Obtain treatment for substance use and mental disorders 1

For Injection Drug Users

• Stop injection drug use completely to eliminate risk for bloodborne infections 1
• If continuing to inject:
  • Never reuse or share syringes or drug preparation equipment 1
  • Use a new, sterile syringe from reliable sources (pharmacies, syringe exchange programs) 1, 2
  • Use sterile water to prepare drugs; if unavailable, use clean water from reliable sources 1, 2
  • Use a new container (cooker) and new filter (cotton) for each injection 1, 2
  • Clean the injection site with a new alcohol swab before injection 1, 2
  • Dispose of syringes safely after use 1, 2
  • Participate in syringe service programs that provide sterile equipment and connect to other health services 2

Overdose Prevention

• Always have naloxone readily available when using opioids 2
• Understand that substance abuse treatment (including medication-assisted therapy like methadone or buprenorphine) reduces overdose risk 1

Treatment Approaches

Substance abuse treatment is highly effective at reducing drug-related harms and includes:

• Pharmacologic therapies (medication-assisted treatment) 1
• Nonpharmacologic psychosocial approaches 1
• Often, a combination of both approaches is most effective 1
• Cognitive and behavioral therapies have demonstrated reductions in illicit drug use and high-risk behaviors 1

Common Pitfalls to Avoid

• Don't assume cleaning equipment with bleach is as effective as using new equipment 2
• Don't focus only on needle/syringe sharing - sharing water, cookers, and filters also transmits disease 2
• Don't underestimate barriers to treatment access including:
  • Lack of motivation to enter treatment
  • Long waiting periods
  • Poverty
  • Lack of health insurance
  • Fear of stigmatization 1

Special Considerations for Sexual Health

For individuals who use drugs and engage in sexual activity:

• Engage in safer sexual practices to prevent STDs and HIV 1
• Consider limiting number of sexual partners 1
• Use condoms correctly and consistently 1

The evidence strongly supports that substance abuse treatment serves as an entry point to medical care and improves adherence to medical treatment regimens for infectious diseases 1. This comprehensive approach to harm reduction addresses both the direct risks of drug use and the associated behaviors that increase morbidity and mortality.