Harm reduction in substance use and addictive behaviours

Harm reduction strategies aim to reduce the harmful consequences of substance use or addictive behaviours for the individual, those close to them and the communityNational Centre for Education and Training on Addiction (NCETA), 2021. Offer advice on harm reduction to people who use substances, gamble or game. Some people will not choose to stop substance use or addictive behaviours but will consider measures to limit risk. They may be open to revisiting their options for behavioural change later, particularly if information about harm reduction is provided in a nonjudgemental way. The general principles of care in chronic disease management are important, particularly maintaining a therapeutic relationship and a sense of hope.

Interventions for harm reduction that clinicians can offer are outlined in Interventions by clinicians for harm reduction in substance use and addictive behaviours. A printable summary of harm reduction actions that patients can undertake is available. For printable patient information on harm reduction strategies to minimise risk of infection in people who inject or smoke drugs, see Harm reduction advice to reduce risk of infection for people who inject or smoke drugs.

Additional specific harm reduction advice for patients is available for gamma-hydroxybutyrate (GHB).

Figure 1. Interventions by clinicians for harm reduction in substance use and addictive behaviours

Educate patients about ways to reduce harms from use of alcohol or other drugs, gambling or gaming; see the printable patient information sheet How to get help and reduce harms from alcohol and other drugs or gambling - patient information.

Offer thiamine supplementation in managing alcohol use to limit neurological damage.

Review vaccination status—consider the need for vaccination against hepatitis B and human papilloma virus to reduce risks from unprotected sex (and in the case of hepatitis B, other routes of transmission, such as by sharing needles).

Offer access to opioid overdose prevention (naloxone).

Offer advice on sexual health, including contraception, pregnancy testing, and prevention and management of sexually transmitted infections, including HIV pre-exposure prophylaxis (PrEP) and HIV postexposure treatment (PEP).

Offer prenatal, pregnancy and breastfeeding care to limit risk of substance use to a fetus or infant; refer early to services experienced in management of substance use in pregnancy and breastfeeding individuals.

Treat organ damage from substance use (eg smoking-related lung disease, alcohol-related liver disease).

Offer referral for:

dietary management of malnutrition
dental care (see Examination and investigations in assessing substance use or addictive behaviour for a list of dental harms)
physiotherapy and occupational therapy aspects of falls prevention
psychosocial support to manage impact on finances, family and child welfare.

Table 1. How to get help and reduce harms from alcohol and other drugs or gambling - patient information
Printable table
This table lists some ways you can use alcohol or other drugs or gamble more safely. Whether it’s for yourself or someone you’re worried about, you can get free confidential information, support and practical help 24 hours a day 7 days a week anywhere in Australia. This table suggests some of the things you can ask about on the phone lines or websites. For any alcohol or other drug concerns, call the national Alcohol and Drug Information Service on 1800 250 015 or go to https://www.counsellingonline.org.au. For any gambling concerns, call the National Gambling Helpline on 1800 858 858 or go to https://www.gamblinghelponline.org.au.
Finding drugs
Examples of how you could be harmed	Possessing or buying street drugs can cause you legal trouble. People who sell drugs or others buying drugs might assault you.
Some steps to consider or ask about	Find out your legal rights and how to get legal advice (these are not the same in all states or territories). Avoid unfamiliar drug dealers and locations.
Paying for drugs, alcohol or gambling
Examples of how you could be harmed	Costs of drugs, alcohol or gambling could put you in debt or lead you into crime.
Some steps to consider or ask about	Ask for help to manage your money and any debts. Avoid paying for drugs, alcohol or gambling with credit cards. Find out how: gambling venues can help you limit your spending to put a spending limit on your credit or debit card to get yourself barred from going into specific gambling venues.
Getting drugs into your body
Examples of how you could be harmed	If you inject drugs, you are at risk of infections from: bloodborne viruses (eg hepatitis B, hepatitis C, HIV) bacteria causing skin inflammation or infection and other damage (eg to heart valves). Smoking drugs can damage your lungs. Using a pipe can cause mouth burns.
Some steps to consider or ask about to reduce risk from injecting	Find out about your nearest needle and syringe programs. Learn about safer injecting; see the Touchbase toolkit. Inhale or swallow ‘ice’ (crystal meth) instead of injecting it.
Some steps to consider or ask about to reduce harm from smoking drugs	Consider switching from smoking cannabis to using a dry-herb cannabis vaporiser (a medical device from a pharmacy, not any other type of vaping device); do not use cannabis oil in a vaping device. If using a pipe, use a Pyrex one to avoid mouth burns, and clean it regularly. Change the water in a bong (water pipe) after each use to avoid breathing in bacteria. Do not share pipes because this can spread infections.
Not looking after yourself when using drugs, alcohol or gambling
Examples of how you could be harmed	Not eating well could make you lose weight, get infections and damage your general health. Tooth grinding, dry mouth (from some drugs) and not brushing can damage teeth and gums. Sleeping less or irregularly can damage your physical and mental health.
Some steps to consider or ask about	Ask about practical help you might need (eg with housing or food). You can anonymously search the AskIzzy website for local help in a crisis. Aim to set up regular patterns for: eating nonsugary foods drinking enough water mouth care (tooth brushing, flossing, use of lip balm and sugar-free gum) resting and sleep. Ask for medical help with any physical or mental health concerns.
Intoxication (being drunk or high)
Examples of how you could be harmed	Overdose can cause severe harms or death. Your work, home duties or schooling might be affected. You or others around you could become aggressive or violent. You could risk unsafe sex, needle sharing, drunk-driving or drug-driving and crime.
Some steps to consider or ask about	Have someone with you who isn’t drinking or using. Plan in advance how you’ll get home safely. Know how to call an ambulance and give first aid; see the Australian Red Cross First Aid app. Write what drugs you’ve taken on the back of your hand in case you pass out; this could help you get the right emergency care. Keep track of how much alcohol you drink or how much you use of any drug (apps can help). Cut down the number of times you use more than one drug (including alcohol) at a time. Find out which ways of getting drugs into your body will give you a smoother high. Space alcoholic drinks out with water or other nonalcoholic drinks. Space out bongs or cut down the amount of cannabis in each one. If using oral cannabis (edibles) try a small amount and wait 1 to 2 hours before having more. Use cool packs and rest to help with anxiety from stimulant (eg ‘ice’) use. Ask about take-home naloxone (an antidote to opioids like heroin or prescription painkillers) if you or someone you know uses these drugs. Plan your drug or alcohol use to allow time for other life activities and duties. Reduce risk of violence by staying out of overcrowded clubs, raves or other events. Carry condoms and lube. Find out about other contraceptives and ways to reduce risk of infections (eg HIV) and have regular sexual health checks. Leave the car at home if you are going to use drugs or drink while out. Don’t ‘drink-drive’, ‘drug-drive’ or operate machinery while drunk or high.
Having a hangover (crash) after using alcohol or drugs
Examples of how you could be harmed	Your work, home duties or schooling might be affected.
Some steps to consider or ask about	Plan your drug use or drinking to allow time for other life activities and duties. Try to get enough food and sleep.
Going into withdrawal from alcohol or drugs
Examples of how you could be harmed	You could become unwell and have seizures (fits), hallucinations and distress (depending on what you drink or use and how much you have).
Some steps to consider or ask about	If planning withdrawal, organise to do it with medical help to make it safer and more comfortable. Plan (with medical help) for what to do if you have unexpected withdrawal.