Using Harm Reduction for Heroin User

Choose Smoking or Snorting Over Injecting

Many heroin users start out smoking heroin, then as they become addicted, switch to injecting heroin. Although smoking, snorting, and injecting are all harmful, there are greater risks associated with injection drug use. These include contracting HIV and hepatitis, which are transmitted through needle sharing, abscesses, vein damage, and severe bacterial infections.

Snorting heroin doesn't have quite as instant an effect as smoking or injecting, but it will still take effect very quickly with much lower risk than injecting it. While all methods of heroin use carry the risk of overdose, it's less likely with smoking because you can stop once you feel high, whereas with injecting, once the drug is in your body, you can't do anything to reduce the effects or the overdose risk (see tip 3).

Always Use a Clean Needle to Inject Heroin

Many of the harmful effects of heroin are related to reusing or sharing needles for injection.

Clean needles are freely available through needle exchange services. If you don't know where your nearest needle exchange is, read how to find a needle exchange, which includes links to listings in several different countries.

In an emergency, you can clean your needles by flushing them out with undiluted bleach, then flushing them with water three times. Remember, blunt needles cause vein damage.

Don't Use Heroin Alone

Although many people are distressed by seeing another person using heroin, having someone nearby can save your life. Heroin carries a high risk of overdose, but if identified quickly, the overdose can be reversed by the administration of a drug called naloxone, which blocks the opiate receptors in the brain.

Signs of overdose include:

• Fewer than 12 breaths a minute
• Loss of consciousness
• Lack of response to pain

Use Infrequently and in Low Doses

Most of the coverage of heroin addiction emphasizes how addictive it is, and research does show that heroin users seem to fare very badly compared to users of other drugs, both in terms of how severely they become addicted and associated problems, such as unemployment and imprisonment. But it does seem that people who are already very troubled are attracted to heroin for self-medication. Some research has identified that low frequency controlled use is possible.

One way to prevent heroin addiction and promote harm reduction is to keep your dose low and infrequent, never increase the dose, and to back off from heroin completely if you find your usual dose is not effective.

Consider Treatment Options

There are many different treatment programs available, and your choices will depend on where you live and whether you can afford to pay. If you are a heavy heroin user, you might consider methadone as a way of getting off heroin and letting your body recover from the damage caused by injections.

Another option to consider if you have difficulty controlling your impulses is naltrexone. This is an oral slow-acting drug that blocks the opiate receptors so you won't get high on heroin. Suboxone, another option, combines buprenorphine and naloxone and works similarly to methadone to minimize withdrawal symptoms.