Harm Reduction Strategies to Address Crack and Injection Drug Use

1. Harm Reduction Strategies to Address Crack and Injection Drug Use Mella Brown and Bo Yih Thom harmreductionconsultants@gmail.com

2. Types of Drugs • Focus on: • Opiates • CNS Stimulants • Alcohol • Women are often poly drug users

3. 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

4. How are opiates used? • Pills - swallowed, crushed and snorted, or injected • Heroin - smoked, snorted, or injected • Methadone • By prescription, daily “drink”

5. 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

6. 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

7. 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

8. Health Promotion Strategies Health 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

9. Stimulants • “Uppers” • CNS Stimulant • Cocaine, crack • Speed • Crystal Meth

10. How are stimulants used? • Swallowing - pills, tablets – speed, “bennys” • Snorting - cocaine, speed, crystal meth • Smoking - crack and crystal meth • Injection - all can be injected

11. 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

12. 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

13. 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

14. 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

15. Hepatitis C • In blood • Destroys liver • Very hardy virus • Transmitted through white blood cells • Many strands • Interferon (will need support), milk thistle

16. 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

17. Toxic Pipes – Copper Elbow • Aluminum • Ask • Copper in lungs from collecting resin • Hot – can cause burns • “An old friend”

18. Toxic pipes – Asthma inhaler • Aluminum • Plastic • Ashes • Ingestion of plastic from scraping

19. Toxic Pipes – Water Bottle • Plastic • Ashes • Aluminum

20. Toxic Pipes – Ginseng Bottles • Metal fatigue • Sharp edges, cuts and burns

21. Safer Crack Use Kits • Sturdy Pyrex • Screens reduce damage to lungs • Health promotion messages • Supplies for 1+

22. A note on cigarrettes • Knock out the ash • Cover the filter

23. Alcohol • CNS depressant • Ingested by drinking • Wine, beer, liquor, cooking wine, hand sanitizer, mouthwash

24. 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)

25. Withdrawal • Insomnia, sweats and shakes • Can lead to seizures - non-medical withdrawal management services (detox) may require initial supervision in hospital

26. 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

27. 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)