What is harm reduction?

Harm reduction is a pragmatic set of strategies to help improve overall health

Harm Reduction

Harm reduction works to reduce the the health and social harms associated with drug and/or alcohol misuse. The harm reduction philosophy is built on a set of pragmatic strategies that focuses on positive changes for individuals and the wider communities of Western Bay. The harm reduction approach recognises and values that every individual will have their own strengths and goals to improve their physical and mental health.

 

The principles of harm reduction does not condemn or ignore the use of drugs and alcohol, instead it offers a flexible and dynamic approach to help people achieve their goals. Harm reduction encompasses a range of interventions which include, but not limited too; Needle and Syringe Programme (NSP), blood borne virus screening (BBV), brief interventions, naloxone provision, psychosocial interventions and WEDINOS.

The harm reduction information below is intended to provide general harm reduction advice. The range of drugs listed are some of the most common reported in Western Bay. For more information contact your local service or DAN 24/7 for free confidential in depth advice and support.

Alcohol comes in a wide range of drinks with different alcoholic strengths, colours and tastes. Alcohol is widely used across Wales and is available for everyone over the aged of 18. Alcohol is a substance that sits within the depressant category, this means alcohol slows down activity in the brain which is why sometimes people use alcohol to help them relax.
A unit can be defined as a measurement of pure alcohol (ethanol) in a alcoholic drink, 1 unit= 10 ml of ethanol. Understanding what units are and how many your consuming can help improve your relationship with alcohol. With our alcohol calculator you can see how many units you are consuming. Alcohol by the volume (ABV) is a measurement of how much ethanol is in a certain volume of an alcoholic drink. For example a standard pint of beer in the UK would be 4% ABV, this means from the pint of liquid (568 ml) 4% of it is ethanol.
Examples of units in drinks: 750 ml 13% ABV Bottle of wine has approximately 10 units, 500 ml can of 4% ABV lager, beer or cider has 2 units and 1 litre bottle of vodka or whiskey 40% ABV has 40 units
In 2016 the Chief Medical Officer, published new guidelines on weekly unit consumption. Although there is no safe way of drinking, the guidance states that only 14 units of alcohol per week for men and women should be consumed. This guidance also suggests that you should not consume all 14 units in one sitting, and should spread this over the 7 day week with 2 days free of alcohol.
Example of 14 units of alcohol;

  • 6x pints of standard (4%) beer or cider
  • 6x medium glasses of wine (13% ABV)
  • 9x 275ml alcopops 
  • 14x single measures of standard spirits

The Law: Alcohol is a legal substance to purchase as long as your over the age of 18. To sell alcohol you need to have the appropriate license. In Wales it is illegal to sell alcohol for under 50p  a unit since the implementation of the Minimum Unit Pricing law.
Side Effects: Short term effects can include; blurred vision, slurred speech, lack of coordination, slower reactions, vomiting, dehydration inhibition. Long term effects can include; dependence, heart disease, stroke, liver disease, various cancers, pancreatitis
Alcohol Harm Reduction Advice:

  • Don’t mix alcohol with other drugs, although legal alcohol is a depressant drug and slows the central nervous system down.
  • Eat some food before drinking, a good nutrient dense meal.
  • Try to keep track of how much your drinking in one sitting. Keeping track of this can help you work out when alcohol has left the bloodstream.
  • Try to avoid being in rounds with friends, this makes it difficult to track how much your consuming. If in rounds try to make the round as small as possible.
  • Don’t mix drinks
  • Try to have water or a soft drink in between alcoholic drinks. This will help you hydrate and combat the effects of dehydration that alcohol causes.
  • Always plan journeys home and make sure friends know you are leaving.
  • Look after people who are intoxicated  and stay with them until you know they are safe. If someone starts to vomit or has bad side effects, place them in the recovery position and call for medical assistance NEVER LEAVE THEM ON THEIR OWN.

Heroin is one of number of substances in a group of drugs called ‘opiates’. Heroin usually comes as an off white or brown powder. Heroin and other opiates are sedative drugs that depress the central nervous system and can hinder normal function of the body by slowing everything down. This “slowing down” usually  gives someone a feeling of warmth, relaxation and detachment. Effects can start quickly and can last several hours but this can vary depending on dosage and method of taking the drug.

Medical opioids include: dihydrocodeine (DF 118s), pethidine and methadone, a drug which is often prescribed as a substitute in the treatment of heroin addiction. These have all have similar effects on the central nervous system and can be medically used to treat a variety of conditions.

Side effects: Nausea, Dizziness, Vomiting, Constipation, Slow Breathing, Respiratory Failure, Dependence, Blood Borne Viruses and Infections linked to poor injecting practice (abscess and vein damage)
The Law:

Class A drug under the Misuse of Drugs Act, penalties include 7 years for possession and up to life imprisonment for supply.

Heroin Harm Reduction Advice:

  • Smoking heroin is safer than injecting. Smoking also gets into the bloodstream quickly.
  • Try to gauge the strength of the heroin to reduce the risks of overdose, this is important if you have had a break from heroin. Your tolerance may have dropped and can put you at more risk of overdose.
  • Avoid using other depressant type drugs like; alcohol, gabapentin and benzo’s this can increase your risk of overdose.
  • Avoid using alone in unfamiliar or locked places. More overdoses happen in these environments than anyway else.
  • Always use clean and sterile equipment from your local needle and syringe programme. Never re-use or share equipment, this can increase your risks of contracting blood borne viruses.
  • Ensure you have accurate safe injecting practice information from your local needle and syringe programme.
  • When using heroin make sure someone with you has a naloxone kit and trained in its use. This can reverse the effects of overdose and saves lives.
  • Always call 999 if you or someone you know become unwell from taking heroin

IMPORTANT NOTICE: Illicit or fake benzodiazepines have been identified in Western Bay and contain some very harmful and toxic substances that are causing hospitalisations and deaths in Swansea and Neath Port Talbot. These drugs are often sold as “Street Valium”, “MSJ’s” or “Xanax” and are typically sold in tablet form.

Many people who are taking these drugs are unaware of what is in them, any tablets that have been bought illicitly (without a prescription) should be sent to WEDINOS for testing. Samples circulating Swansea and Neath Port Talbot have contained; Etizolam and Flubromazolam which have lead to a number of hospitalisations in the region.

Benzodiazepines (Benzo’s) are sedatives/depressant drugs that slow down the central nervous system and activity in the brain. Benzo’s can be prescribed by medical professionals and include pharmaceutical drugs, such as; Diazepam and Temazepam to help with the treatment of things such as anxiety and insomnia. More recently there has been a significant increase in the use of illicit and novel benzodiazepines type drugs, referred to as “street benzo’s”. Street benzo’s typically come in tablet form (white and blue more frequently) and are consumed orally. Street benzo’s are often sold lose in clear bags or in blister packs that mimic pharmaceutical grade medication. Generally people think because they are in blister packs like prescribed medication, that these are genuine  product, this not the case.  Street benzo’s are highly unpredictable and  majority of tablets sold do not match the purchase intent of the person buying the drugs.
Benzo’s Side Effects:  increased risk of overdose, nausea, vomiting, withdrawal, dependence,  slurred speech, slower reactions, drowsiness, poor coordination
The Law: Benzodiazepines without a prescription are a Class C drug. For possessions of benzo’s you could have up to 2 years in prison and for supply you could have 14 years in prison along with unlimited fines for both supply and possesion.
Benzo’s Harm Reduction Advice:  

  • Small doses are recommended, a quarter (1/4) or half (1/2) of the substance to gauge the effects. Oral tablets take longer to work and you should wait over an hour before consuming more.
  • DO NOT mix with other drugs, especially opiates and other downers, such as, alcohol. This increases the risk of overdose. Always have access to naloxone if using opiates and benzos.
  • Try not to use benzo’s alone and try to use in a safe space with people you trust.
  • Street Benzo’s are unpredictable and can have various doses in each tablet along with unknown adulterants in them. Be extra cautious and send tablets off for testing before consuming them.
  • Send your tablets to WEDINOS.org
  • Visit your local service for more in depth information or for help regarding benzo use.
  • Call 999 for medical assistance if someone is suffering bad side effects.

MDMA, more commonly referred to as Ecstasy is a stimulant based drug that usually comes in white crystalline powder or tablet form. People often associate MDMA with the powdered form and Ecstasy in the tablet form, although it’s the same drug. MDMA is short Methylene-Dioxy-Meth-Amphetamine and commonly used as recreational drug. Ecstasy is the 2nd most popular drug among young people behind cannabis. Ecstasy can be taken in a number of ways but most commonly it is orally swallowed, and like most oral drugs onset time varies considerably. it is advisable to wait 30 mins to 1 hour and gauge the effects before consuming more.
MDMA Side Effects: increased heart rate, increased body temperature (hyperthermia), vomiting, nausea, dehydration, confusion, panic attacks, anxiety, rapid eye movement, uncontrollable jaw movements
The Law: Ecstasy is a Class A drug
MDMA Harm Reduction Advice:

  • Because ecstasy tablets are so unpredictable you should start by taking a quarter or half of the tablet first and waiting for the onset.
  • Test tablets before taking them, unknown adulterants are common, WEDINOS.org 
  • Take regular breaks from dancing to avoid the dangers of hyperthermia and dehydration.
  • Do not drink too much this can be dangerous, 1 pint of water or soft drink per 1 hour. Too much water can lead to water intoxication (hyponatremia).
  • Wear clothing suitable for the environment, if indoors take layers off to help the body cool down.
  • Anyone with underlying health conditions like; asthma, heart problems, blood pressure problems and epilepsy can have very dangerous reactions.
  • Call 999 for medical assistance if someone is suffering bad side effects.

Ketamine is disassociative analgesic drug of the hallucinogenic category and is most commonly sold as a white powder. Ketamine can come in liquid form but this commonly associated with medical use. As drug it has powerful analgesic properties and can reduce sensations such as pain in the body without impacting the respiratory system like opiates. Illicit use of ketamine (non-medical) is usually consumed in powder form and snorted. As an hallucinogenic drug, ketamine can alter your perception and make you hallucinate.
Ketamine Side Effects: Drowsiness, dizziness, numbness, loss of coordination, confusion, hallucinations, dissociation ‘out-of-the-body’ feelings, bladder problems.
The Law: Ketamine is a Class B drug
Ketamine Harm Reduction Advice:

  • Ketamine impairs coordination, so minor accidents like bumping into things are common; due to ketamine being an anaesthetic people may not feel under the influence that could lead to more harm. Try to use in safe spaces.
  • If snorting ketamine alternate nostrils, ketamine is quite grainy and can damage the soft tissue, clear the nostrils with water after use to clear the substance that may block the nasal passage.
  • If you experience pain in your bladder  or a cramping sensation seek medical attention straight away.
  • Take ketamine in small doses and have regular breaks.
  • Take in safe envrionments with people you trust.
  • Call 999 for medical assistance if someone is suffering bad side effects.

Stimulants are a group as drugs that increase activity in the brain. Drugs such as cocaine, amphetamine, mephedrone (meow meow) would fall into this category, although these are illegal stimulants, we also have legal substances such as caffeine and nicotine that would fall into this category. Two of the most common illegal stimulants on our streets today are cocaine and amphetamine (speed). Cocaine is commonly sold in powder and rock (crack cocaine) form, although in different forms the drug properties remains the same. It is the method of use that changes. Amphetamine typically comes in an off white powder, but can sometimes be sold as a paste like substance that is bombed (orally taken rapped in cigarette paper).
Stimulant Side Effects: increased heart rate, agitation, over active, aggressive, anxious, irritability, paranoia
The Law: Cocaine (crack and powder) is a Class A drug, Aphetamine is a Class B and Mephedrone is a Class B.

Any Class B drug that is prepared for injection will move from a Class B to a Class A.

Stimulant Harm Reduction Advice:

  •  Avoid using stimulants with any other drugs, including alcohol.
  • Avoid using downers to help you deal with the post stimulant crash. It is best to let the brain activity return to normal.
  • If snorting rotate nostrils and take regular breaks from using stimulants. Snort luke-warm water to help clear the nostrils of backed up substances.
  • Don’t share any equipment including snorting straws as you increase the risk of transmitting or contracting a blood borne virus.
  • Do not use money (notes) to use a snorting straw, this can increase the risks of cutting your soft tissue.
  • Stay hydrated and take regular breaks to cool down.
  • Avoid caffeinated energy drinks
  • Make sure you get enough sleep and eat well, stimulants can impact your physical and mental wellbeing.
  • If smoking crack-cocaine make sure you take regular breaks from use.
  • Use lip balm to prevent chapped/cracked lips

IPED’s stands for Image and Performance Enhancing Drugs and includes substances such as; anabolic steroids, human growth hormones, peptides, some fat burners and anti-oestrogenics. Over the past few years IPED use has increased significantly with many people unaware of the potential short and long term side effects from both the substance itself and poor injecting practice.
For a comprehensive video that demonstrates the safest technique for reducing injecting related harms click below.
The Law:  There is no possession offence but it is a Class C and illegal under the Misuse of Drugs Act 1971 to manufacture, supply or possess/import/export steroids with the intent to supply, without a licence to do so. The maximum penalty for these offences is 14 years in prison and/or a heavy fine.
For a comprehensive information on IPED’s click below. The IPED.info website has been developed by Public Health Wales.

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