Safest Practices for Using Drugs
The most critical harm reduction strategy for persons who use drugs illicitly is to stop injection drug use entirely to eliminate bloodborne infection risk, but if unable to stop, always use new sterile syringes from reliable sources and never reuse or share any injection equipment. 1
Primary Harm Reduction Strategies
Immediate Risk Reduction for Injection Drug Use
- Never reuse or share syringes or any drug-preparation equipment (cookers, filters, water) as this is the primary route of HIV, hepatitis B, and hepatitis C transmission 1
- Use a new, sterile syringe from a reliable source such as a pharmacy or syringe exchange program for every injection 1
- Use sterile water to prepare drugs when possible; if unavailable, use clean water from a reliable source such as fresh tap water 1
- Use a new container (cooker) and new filter (cotton) to prepare drugs for each use 1
- Clean the injection site with a new alcohol swab before injection to reduce skin infection risk 1
- Dispose of syringes safely after using them to prevent needlestick injuries to others 1
Essential Medical Interventions
- Get tested for HIV, hepatitis B, and hepatitis C as early detection allows for life-saving treatment and prevents transmission to others 1
- Get vaccinated against hepatitis A and hepatitis B as these are preventable bloodborne infections with high morbidity in persons who inject drugs 1
- Obtain medical treatment for infectious diseases immediately upon diagnosis, as untreated HIV and hepatitis lead to significant morbidity and mortality 1
Treatment and Recovery Pathways
Substance Abuse Treatment Access
Get counseling and treatment to stop or reduce drug use as substance abuse treatment reduces needle-sharing, exchange of sex for money or drugs, and serves as an entry point to medical care while improving adherence to treatment regimens for infectious diseases 1
The CDC recommends that treatment includes:
- Nonpharmacologic psychosocial approaches such as cognitive and behavioral therapies, which have demonstrated reductions in illicit drug use and high-risk behaviors, particularly for amphetamine-type stimulants 1
- Pharmacologic therapies when appropriate, often combined with behavioral interventions 1
- Adherence interventions to enhance the effects of both psychotherapies and medications while reducing high-risk behaviors associated with infectious disease transmission 1
Overcoming Treatment Barriers
Common barriers include lack of motivation, moderately long waiting periods, poverty, lack of health insurance, and fear of stigmatization 1
Participate in risk-reduction programs even while waiting for formal treatment, as these programs provide immediate harm reduction support 1
Critical Pitfalls to Avoid
- Do not attempt to clean used syringes for reuse as this does not adequately sterilize equipment and still carries significant infection risk 1
- Do not share any injection equipment including water, cookers, cotton filters, or tourniquets, as all can transmit bloodborne pathogens 1
- Do not delay seeking substance abuse treatment due to fear of stigma, as treatment significantly reduces mortality and morbidity 1
- Do not skip infectious disease screening even if asymptomatic, as HIV and hepatitis often have no early symptoms but cause progressive organ damage 1
Additional Mental Health Considerations
Obtain treatment for substance use and mental disorders concurrently, as dual diagnosis is common and untreated mental illness significantly increases non-compliance with harm reduction strategies and medical treatment 1