Opioids: Harm Minimisation Strategies

General Safety Tips for Opioid Use

Understand Your Substance:

• Prescription Opioids: Follow your doctor's guidelines if prescribed. Research the opioid to understand its effects and proper dosage if used non-medically.
• Heroin: Due to varying purity and potency, start with a small dose to assess strength, especially if you are a new user or returning after a break.

Set and Setting

Know Your Body & Mind (Set): Be aware of your mental and physical state before using. Anxiety, stress, or poor health can exacerbate negative effects.

Know Your Environment (Setting): Use in a safe, controlled environment. Being around trusted people ensures that help is available in emergencies.

Mixing and Masking Effects

Avoid Mixing Substances: Especially depressants like alcohol and benzodiazepines, which can dangerously enhance sedation and respiratory depression.

Stimulants:Substances like cocaine can mask the depressive effects of opioids, leading to a false sense of alertness and a higher risk of overdose.

Measure Your Doses Accurately: Use tools like milligram scales for precise dosing. For heroin, use a very small amount first to test potency.

Carry Naloxone: • Naloxone can reverse an opioid overdose if administered in time. Always have it on hand, especially if using opioids regularly.

Hydrate and Nourish: Stay hydrated and eat nutritious foods to support overall health, as opioids can suppress appetite and lead to dehydration.

Injecting Tamper-Proof Opioid Medications

Did you know that some pills are made so that they turn into a gel-like substance when someone attempts to dissolve them in water, making it impossible to draw into a syringe. This design is intended to reduce the harm associated with injecting opioids, such as the risk of infection, vein damage, and overdose.

Many also now contain naloxone and people need to be mindful of this to avoid withdrawal effects.

Routes of Administration: From Safer to Riskier

Oral Ingestion (Swallowing):

Why Safer: Slower onset and more gradual absorption.

• Prescription Opioids: Follow prescribed dosage, and avoid crushing extended-release tablets.
• Heroin: Rarely ingested due to low bioavailability.

Intranasal (Snorting):

Why Riskier: Faster onset than oral but can damage nasal passages.

• Heroin: Finely chop to reduce harm; alternate nostrils and use saline sprays to mitigate damage.

Smoking:

Moderate Risk: Avoids needle use, but still rapid onset.

• Heroin: Use foil and avoid deep inhalation to reduce lung exposure.

Rectal (Plugging):

Varied Risk: Avoids needle risks, with fast absorption.

• Heroin and Opioids: Use lubrication and ensure cleanliness to prevent infections.

Intravenous (IV) Injection:

Highest risk: direct bloodstream entry, immediate effects, and the highest overdose risk.

• Many opioids now come in tamper-proof forms and do not mix well, which could result in dangerous outcomes if injected. Some also contain naloxone to prevent misuse, so be mindful of this to avoid withdrawal effects.
• Safer Practices: use sterile needles and water, never share needles, and always swab injection sites before use.

Recognising and Responding to Overdose

Recognising Overdose - Symptoms:

• Shallow or stopped breathing
• Unresponsive to external stimulus
• Extremely pale or clammy skin
• Fingernails or lips turning blue or purple
• Limp body
• Vomiting or making gurgling noises
• Slow or stopped heartbeat.

Responding to Overdose

• 1. Call for Emergency Help (000 in Australia): Provide clear information about the situation and what the person has taken.
• 2. Administer Naloxone: If available, administer naloxone according to the provided instructions.
• 3. Perform Rescue Breathing: If the person isn’t breathing and you are trained, perform rescue breathing.
• 4. Place in Recovery Position: Prevent choking by placing the person on their side with their mouth downward to allow drainage of fluid.
• 5. Stay With the Person: Monitor their condition continuously until emergency services arrive.

Safe Management of Withdrawal

For those dependent on opioids, managing withdrawal safely is crucial to prevent severe health complications. Here are steps to manage opioid withdrawal effectively:

Medical supervision

• Seek medical advice: always consult with a healthcare provider before attempting to stop opioid use, especially if you have a history of heavy use or signs of physical dependence. Medical supervision ensures safe detoxification and withdrawal management.

Medication

• Medications such as methadone, buprenorphine, and clonidine may be prescribed to help manage symptoms and reduce severe complications like seizures.

Supportive care

• Nutritional support: maintain a balanced diet to help the body recover. Supplements and hydration can help replenish nutrients lost during withdrawal.
• Hydration: Drink plenty of fluids to avoid dehydration, especially if experiencing vomiting or diarrhea.
• Counseling and Support Groups: Engage in therapy or support groups like Narcotics Anonymous to address the psychological aspects of withdrawal and recovery.

Emergency services

• Immediate medical attention: in cases of severe withdrawal symptoms like seizures, intense hallucinations, or confusion, seek immediate medical attention.

Opioid Replacement Therapy (ORT)

• ORT involves replacing the opioid of dependency with a medically supervised, longer-acting opioid like methadone or buprenorphine. This treatment helps alleviate withdrawal symptoms and reduce cravings, providing a stable path to recovery and enabling a gradual reduction in opioid use under medical supervision.

High-Risk Drug Combinations with Opioids

For Both Heroin and Prescription Opioids:

1. Alcohol
• Risks: Increases sedation, leading to potential unconsciousness and fatal respiratory depression.
• Symptoms: Extreme drowsiness, confusion, slowed or irregular breathing.
2. Benzodiazepines (e.g., Xanax, Valium):
• Risks: Increases the sedative effects, leading to severe respiratory depression and possible death.
• Symptoms: Severe sedation, respiratory arrest, coma.
3. Cocaine and other stimulants
• Risks: Masks the depressive effects of opioids, increasing the risk of overdose as stimulant effects wear off.
• Symptoms: Agitation, false sense of alertness, followed by sudden opioid overdose symptoms.
4. Tramadol
• Risks: Increases seizure risk due to its action on serotonin and norepinephrine levels, especially when combined with other opioids.
• Symptoms: Confusion, seizures, increased risk of serotonin syndrome.
5. Antihistamines (e.g., Diphenhydramine):
• Risks: Increases sedation and respiratory depression.
• Symptoms: Drowsiness, increased overdose risk, difficulty concentrating.
6. Polydrug Use with Other Opioids:
• Risks: Combining different opioids compounds effects and significantly increases overdose risk.
• Symptoms: Profound respiratory depression, pinpoint pupils, unconsciousness.