Harm Reduction

Harm Reduction
This episode of Cracking Addiction tackles harm reduction interventions in people who inject drugs. Harm reduction is any intervention which minimises harms to patients, others and society.

Harm reduction can be broken down into:
1. Opioid substitution therapy
2. Take away regimen for opioid substitution therapy
3. Overdose advice and naloxone
4. Management of comorbidities

Methadone treatment is proven to reduce the following: opioid use, deaths due to overdose, suicide and trauma, risk of BBV transmission and criminal activity.

General overdose advice includes:
• Beware hypno-sedatives in combination of opioid medications
• Risk of overdose is greatest in the first two weeks of treatment of opioid substitution therapy especially if one starts on too high an initial dose of Methadone or the dose is up-titrated too rapidly
• Signs of overdose (sedation, drowsiness, snoring -which can be a sign of airway obstruction, decreased respiratory rate, cyanosis, pinpoint pupils)
• Never let someone sleep it off
• Always call 000
• Advice / training re CPR
• Administer naloxone in event of opioid overdose (which will be discussed in a later episode of Cracking Addiction and a later blog post)

Other aspects of harm reduction include easy access to opioid substitution therapy reduces opioid / needle use; needle exchanges provide free sterile injecting equipment with safe used needle disposal which reduces risk of BBVs; hepatitis B vaccination reduces risk of hepatitis B transmission and the treatment for hepatitis C reduces risk of cirrhosis and cancer.

People who inject drugs have higher rates of comorbid mental health illnesses, increased risks of developing STIs and increased rates of smoking. It is important to adequately screen for and treat mental health illnesses and diseases and STIs. It is also important to broach smoking cessation to our patients as these brief interventions can prove effective in aiding patients in ceasing smoking.

Author: Dr Thileepan Naren
MBBS FACRRM FRACGP
Thileepan is an Addiction Medicine Advanced Trainee and experienced general practitioner with a demonstrated history of working with disadvantaged and marginalized groups.