A Beginners Guide to Harm Reduction
- mobileclinicproject
- 2 days ago
- 13 min read
By Kelly Truong & Poornima Dorairaj
Harm Reduction and Deconstructing Stigmas
The principles of harm reduction, as defined by the National Harm Reduction Coalition, are a set of practical strategies aimed at minimizing the negative health, social, and legal consequences associated with drug use. The ideology behind harm reduction is grounded in social justice and human rights, and focuses on working with people who use substances without judgment, coercion, and discrimination, but rather through the lens of seeing them as whole beings with agency and self-determination to make decisions for their own health and wellness. Harm reduction recognizes the harm and danger of drug use and the reality that both licit and illicit drug use do occur, and it seeks to reduce the negative impacts by providing support for safer consumption and management while meeting people where they are at with clean and reliable resources. The goal of harm reduction is not to “fix” an individual or force abstinence, but to provide safer methods of consumption and education on long-term use that can help reduce further health risks for individuals who use drugs.
There is stigma around substance use disorder, especially considering unhoused individuals experiencing this disorder, since society often chooses to ignore or condemn those who use drugs without providing support and holistic approaches to care. This manifests in unsafe methods of substance use, which ultimately put more individuals at risk of other preventable health problems.
The negative connotation surrounding harm reduction falsely assumes that it encourages substance use among populations. The individuals who hold this prejudiced belief oftentimes do not actually care about the unhoused community; instead, they often demonize and support the criminalization of unhoused folks, and care more about the condemnation of marginalized populations than about their holistic well-being.
Additionally, one’s intersectional identity also affects the level of discrimination and prejudice that individuals may receive for their substance use disorder, as opposed to support and treatment. The identities individuals hold based on their socioeconomic status, race, gender, and more result in disproportionately harsh treatment by law enforcement. To truly understand an individual’s substance use disorder requires acknowledging socioeconomic determinants of health and how systemic oppression can increase one’s likelihood of experiencing this disorder. The reality is that long-term usage of drugs does have a toll on one’s health and well-being, but it is no one else’s authority besides the individual themselves to decide how they would like to live their lives. Harm reduction is more about mitigating the harms and impacts that social determinants can have on health by bridging the gap between marginalized and vulnerable communities and their lack of access to adequate quality health care and resources, while providing a non-judgmental space that sees them as self-determining human beings and understands the socioeconomic conditions that can impact their access.
How To Identify Over-amping and Administer Narcan
An effective preventative method of harm reduction is knowing how to identify over-amping and administering naloxone (Narcan) to reverse an opioid overdose. Over-amping is the build-up toward an opioid overdose and can lead to a heart attack, stroke, seizure, or overheating. The effect can be mitigated through early identification of physical and mental symptoms and prompt intervention.
Physical symptoms of overamping can include:
Nausea and/or vomiting
Falling asleep/passing out (but still breathing)
Chest pain or a tightening of the chest
High body temperature
Cold sweats
Rapid heart rate (typically over 100 beats per minute)
Irregular breathing or shortness of breath
Convulsions
Stroke
Body jerking
Feeling paralyzed while awake
Severe headache, hypertension
Teeth grinding
Insomnia
Tremors
Psychological symptoms of overamping or experiencing mental distress can include:
Extreme anxiety
Panic
Extreme paranoia
Hallucinations
Extreme agitation
Increased aggressiveness
Restlessness or irritability
Hypervigilance
Enhanced sensory awareness
Nearly 80% of opioid overdose deaths happen outside of a medical setting, and intervention is most effective when it is acted on as soon as an overdose has been identified. (AMA, 2025) Naloxone comes in four common forms: nasal spray (NARCAN), auto-injector (EVZIO), nasal spray (Yellow Cap), and intramuscular needle syringe.
Administering a nasal spray (NARCAN):
1. Hold the device with your thumb on the bottom of the plunger and two fingers on the nozzle.
2. Place and hold the tip of the nozzle in either nostril until your fingers touch the bottom of the person experiencing over-amping’s nose.
3. Press the plunger firmly to release the dose into the person’s nose.
Administering an auto-injector (EVZIO):
1. Pull the auto-injector from the outer case (Do not go to Step 2 until ready to use).
2. Firmly pull off the red safety guard. Do not touch the black base (that is where the needle comes out).
3. Place the black end of the auto-injector against the outer thigh, through clothing if needed. Press firmly and hold in place for 5 seconds. (There will be a click and hiss sound when working properly. The needle will not be visible after being used.)
Administering a Yellow Cap nasal spray:
1. Take off the syringe’s yellow caps from both the top and bottom.
2. Pry off the purple cap on the naloxone capsule.
3. Grip the clear plastic wings on the spray nozzle and twist onto the syringe.
4. Screw the naloxone capsule into the barrel of the syringe.
5. Insert the white spray nozzle into the nostril.
6. Shortly push firmly on the end of the naloxone capsule to dispense naloxone into the nose and administer one half of the capsule (1 ml) into each nostril.
Administering an intramuscular needle syringe:
1. Inject 1 cc of naloxone straight into a muscle; this could be the thigh, outer-quadrant of the glute, or the shoulder. You can inject straight through clothing.
After administering naloxone:
*Special Note: Naloxone only blocks receptors that bind to the drugs and cause the overdose. This is temporary, NOT PERMANENT, since the drug is still present in the body; taking more drugs at a later time can cause the overdose to recur; a second dose is necessary for stronger drugs to reverse the overdose. Naloxone wears off between 30 to 90 minutes after administration, so individuals should be under care throughout this period and receive medical care, if possible.
**Naloxone can cause withdrawal symptoms in the immediate minutes following the overdose, with symptoms anywhere from headaches, racing heart rate, nausea, tremors, and more.
1. Call 911 and follow the dispatcher’s instructions.
** Why 911?
To get emergency medical services, 911 must be called
The effects of the drug last longer than the Naloxone is present in your body
To manage withdrawal symptoms and any medical issues, it is important to be evaluated by the emergency medical services or a medical team
Alternatives – We understand that calling 911 may be a cause of discomfort or fear for many individuals; for that reason, here are some safe alternatives to seeking medical care after administering Naloxone to an individual.
Rideshare Services – Uber/Lyft to the closest emergency room for medical care.
Ask a trusted individual, if they have access to a vehicle, to drive you to the nearest hospital urgently to receive immediate care.
Reach out to private emergency services or ambulances in your nearby area for emergency care and medical evaluations without needing to call 911.
2. Administer another dose of naloxone if there is no response in the person after 2-3 minutes.
Moments of recognising over-amping may prompt bystander fear of intervention and of the individual’s reaction to being administered naloxone after over-amping. This may deter people from wanting to interfere with one’s high, especially since coming out of overamping after being administered Naloxone can be understandably disorienting for the individual. Despite this fear, it is encouraged to still intervene and prioritize the health and well-being of the individual undergoing over-amping. The implications of not responding to one’s overamping can lead to irreversible consequences such as a premature death.
Reducing Risks of Infection
What can you do to reduce the risks of infection?
On the individual level, there are quick steps that can be added alongside the injection/ingestion of drugs that not only are more effective for the user but also prioritize decreasing the risks of infections, primarily from bacteria and viruses entering through used needles, cookers, and other equipment. One of the first steps we recommend is seeking out a local center that distributes free harm reduction kits, as these are low-barrier sterile items described in a later section that can help reduce infection rates by minimizing re-use of tools and equipment involved in injection.
If accessing all the necessary tools is not feasible at your location, there are also other precautions that you can take! Ensure that new equipment is used with every injection, from sterile needles and syringes to sterile water and filters for taking up drugs into the bicep. Before working with harm reduction supplies, always wash your hands with soap and water or with alcohol wipes if the former is unavailable. Prepare a sterile surface by wiping down a clean surface and placing clean (preferably new) supplies on the surface nearby before use. Always carry naloxone in case of overdose, and if it’s possible, do not use alone and use in smaller amounts to avoid reaching the threshold of overdose.
Infections from drug use can include life-threatening conditions like endocarditis, a bacterial infection of the heart, which can result from using contaminated equipment or sharing with others. If you must reuse tools, avoid sharing with others to prevent the spread of infection and contracting bloodborne diseases like HIV and Hepatitis B or C, which have lifelong effects.
Aside from the risk of infection, dehydration poses an equal and often overlooked risk to the injection or ingestion of any substance. Dehydration is deadly and can result in symptoms like dizziness, headaches, fatigue, and inability to concentrate. In more severe cases, symptoms include extended periods of no urination, lethargy, weak pulse, seizures, and periods of unconsciousness. Since some drugs affect urinary retention and while others affect overheating and the desire for fluid intake, ensuring that you and those around you are properly hydrated with water can be life-saving. Throughout the day, ensure you are consistently sipping fluids without overconsuming water in short periods or underconsuming water over extended time periods.
How can you tell if you’re dehydrated?
If you experience any of the above symptoms, it is an indicator to seek out a source of water + electrolytes if possible. Another easy way to determine dehydration is by identifying the color and smell of your pee. Any urine that smells strongly or is not a pale, light yellow to clear color is another identifier of dehydration, and while water is the ultimate solution for dehydration, under extreme cases of dehydration, electrolyte-rich fluids are extremely beneficial for the body including drinks like Gatorade, sports drinks, Liquid IV, coconut water, milk, broth-based soups, whatever is most accessible to the individual. Sugary juices and sodas should be avoided as they can worsen dehydration, despite the fact that they are liquids.
Components of Each Kit
To understand the real-world implications of harm reduction, it is equally significant to discuss the components of each kit and their utility to individuals seeking them out. Each kit may vary with more or less items; however, their overall purpose remains the same. Here, below, we have included the items in a standard harm reduction kit with short descriptions, images for reference, and a brief impact of its inclusion in each kit.
SPECIAL NOTE: Before using any substances, please always wash your hands with soap and water, or use alcohol wipes if soap and water are not available. Clean the surface used for drug preparation with alcohol wipes, and if you ever require more, please ask.
Cooker –
Cookers, or the bottle-cap looking item displayed below, are intended as one-time use items for one individual to safely boil/dissolve drugs prior to use or injection.
Goal – Sharing cookers can spread blood-borne viruses like HIV, Hepatitis B, and C, especially if drugs are injected. To avoid the spread of infection, individuals can use their own one-time-use cooker so that the drug injection can be achieved safely.
How to Use – Ensure that each cooker is in a sterile package with a heat-resistant handle; each cooker is meant to be used only once. Heat the drug mixture with a heat source (lighter, candle) until it bubbles to ensure there are no bacteria or other contaminants dangerous to individuals.
Fentanyl test strips –
Fentanyl test strips, as listed in their name, test for fentanyl in drugs so that individuals are aware of the contents of their drug of choice, with particular focus on pills, stimulant drugs (ie. Adderall, Concerta, Ritalin), and other substances.
Goal – With increasing rates of fentanyl overdose, the test strips hope to combat deaths from overdose and help individuals be more aware of the substances they are ingesting.
How to Use – Set aside a small amount of a drug to the side and dilute it with sterile water in a clean container. Place the end of the fentanyl test strip as instructed on the packet in the container and leave it on a nearby surface for two to five minutes before checking the results.
Sterile Water –
A component of the kit that often goes overlooked is the sterile water, which serves as a tool to dissolve and dilute drugs for testing purposes (fentanyl test strips)
Goal – To reduce the risk of infection, sterile water is present in each kit to help with the dissolution of powdered drugs or for the purpose of using fentanyl test strips. Non-sterile water can be a source of bacteria that can be harmful and even fatal.
How to Use – Only when you intend to use the sterile water, twist open the tab on the packet to use it for the dissolution of drugs or other uses. After opening, use immediately and discard as the water is no longer sterile after opening. It is only intended for one use!
Alcohol Wipes/Swabs –
Alcohol wipes are present to help with cleaning injection sites prior to drug injection or for cleansing any skin for safe injection, but avoid irritating any open cuts and wounds.
Goal – To prevent infections and bacteria on the skin from entering the bloodstream
How to Use – The swabs are intentionally multi-purpose, with multiple in each kit. They can be used to clean injection sites, clean fingers, and clean any other equipment, without limits as to how many each individual can request in their kits.
Lubricant –
Lubricants are provided to apply to the tip of syringes, specifically for boofing, to allow for a safer injection into the rectum.
Goal – The rectum is sensitive, and to avoid damaging the mucosa or the lining of the rectum and to reduce any transmissions of infection during sexual activity.
How to Use – For drug use, simply apply the lubricant to the tip of the syringe prior to injection in order to prevent any damage when boofing.
Sterile Saline –
Similar to sterile water, sterile saline is primarily used to dissolve drugs for rectal injection.
Goal – To prevent any infection when injecting the substances into the rectum
How to Use – Simply dissolve the intended drug in sterile saline before injection, as the body more rapidly absorbs saline than water.
Paper Straws –
Paper straws are used primarily for safe snorting of drugs, specifically powdered drugs and inhaling vapour.
Goal – To prevent infections from sharing or reusing straws/dollar bills, like Hepatitis C (in different colors to keep track of which one is your straw)
How to Use – Use the straws to snort drugs up the nose, but when possible, opt for paper straws since plastic straws (even if new) can damage the nasal membranes and cause bleeding in the nose.
Needles & Syringes –
Needles and syringes vary based on every individual’s comfort level and intended place of injection, as well as the drug being injected.
Goal – Our goal in providing everyone with needles and syringes is to encourage no cross-contamination or sharing of needles and syringes. Bent needles are extremely dangerous, and other than infection, carry the risk of permanently damaging the skin and veins, which have more serious implications.
How to Use
Tourniquets –
What are tourniquets? Tourniquets are made of smooth latex and wrap around the upper arm to make veins in the limbs easier to see for safer and less painful injection.
Goal – Tourniquets help hold the veins in place and make them more visible to avoid missing the veins during any injections of the drug
How to Use –
Place the tourniquet on the upper arm near your elbow
Take one side of the tourniquet and pull it underneath the arm
Make a knot and tighten to make veins visible
Loosen the tourniquet after the needle is placed in the vein (before injecting the drug)
**No limits on tourniquets in harm reduction kits if more are requested
Vitamin C –
Goal – Vitamin C is used to produce solutions for injection since the acid can help dissolve solid rock or powdered drugs, but the purpose of it in the kit is to provide pharmacy-grade vitamin C that can be safely used as a safer acidifier than lemon juice or vinegar.
How to Use – Use a small amount of the 100mg sachet of vitamin C (the smaller the amount, the safer) to dissolve the drug and avoid any vein damage from the acidic content.
Mouthpiece –
Goal – to prevent burning lips on the pipe
How to Use – Attach the mouthpiece to the end of the bowl pipe so it is pressed against the mouth, and the pipe doesn’t touch the lips
Filters –
Filters are a method to take up drugs without absorbing solid particles that are undissolved and could inhibit effective injection at the needle or enter the body.
Goal – Reduce the amount of solid particles being injected into the body and minimize damage to the body with the injection of drugs
How to Use – Filters are intended for one-time use and are placed against the needle or syringe prior to the dissolute drug being taken up into the needle/syringe
Bowl Pipes –
Bowl pipes are present to help with smoking crystal methamphetamine and other drugs with heated vapours, with Pyrex glass that is less likely to shatter than regular glass when heated.
Goal – To prevent infections from blood and saliva due to sharing of bowl pipes
How to Use –
Wash your hands
Use a mouthpiece to attach to the bowl pipe
Place the substance of choice in the round part of bowl pipe
Heat the substance with a lighter and use the mouth pipe to ingest the drug
If the bowl pipe is broken or cracked, request a replacement to avoid infections and cuts
Other Items in Kits: lip balm, blank card (clean surface), razor, scoops for drugs, bandages, burn cream, gauze, gloves, wound healing cream, hand sanitizer
Resources and Contacts During Distress
If you are experiencing any distress or issues with drug injection, please do not hesitate to use the resources listed below and reach out to a trusted individual for support and assistance. We want to prioritize your safety and comfort simultaneously, so all contact information is available for your use and at your discretion.
Never Use Alone – Help Service Line Card
Phone Numbers: 800-484-3731 or 877-696-1996
24/7 365-day National Overdose Prevention Call Center
What can they do?
Can call EMS if unresponsive
Are all people with lived experiences (not there to judge/shame/lecture you, there to protect you and provide support if anything goes wrong)
Trained in safety plans, detecting adverse drug events
SSP – Syringe Service Programs
What are they?
Community-based programs that provide safe and sterile injection equipment tools
Access to safe disposal of syringes and needles
Ie. San Francisco SSP → 8 times less issues of improperly disposed syringes
Locate a syringe service program in your county (California) – https://www.cdph.ca.gov/Programs/CID/DOA/pages/oa_prev_sepdirectory.aspx
Naloxone Finder – Can’t access Naloxone? Find it near you:
** Also available at the LA County Library for Los Angeles residents on select dates
Crisis Hotline – No questions asked, no requirements: Call for absolutely anything.
Phone/Text/Chat Online 988 for support