Reducing Harm with Injection Drug Use

By CareerSmart Learning Contributor, May 25, 2017, as published by Healthcare Hot Spot


The basic principle of harm reduction for people who inject drugs (PWIDs) is not injection drug use cessation, but rather making injection drug use safer.  There is no way to make injection drug use completely safe, so the goal is to make it safer

The stereotype of PWID has been a person injecting heroin and living on the streets, but the current reality is that PWID could be anyone.  With the influx of opiate addiction throughout this country, PWID live in small towns and big cities alike (Goodnough, 2015).  Injection drug use has several avenues of potential harm: abscesses, HIV/AIDS, Hepatitis C, and overdose, just to name a few.  While harm reduction strategies for injection drug use aren’t necessarily taught in medical or nursing schools, the information is still invaluable in helping a population that is often stigmatized and at risk for many health issues.

  1. Abscesses:  There are several possible causes of abscesses, but in the PWID population the common cause is a contaminated foreign body (e.g. dirt, pathogens in dirty water or on the skin) entering the body at the injection site.  Educate PWID so they understand the importance of and have access to clean injection paraphernalia, such as sterile water, new cotton balls, and clean syringes and needles. PWID may use water from a gutter or a nearby stream or ravine when they are homeless or in need of an immediate fix.  Both water sources are not suitable for injection and carry risk for infection.  Cotton balls are used as a filter, so the drugs are passed through a small cotton ball before filling the syringe.  Many PWID have stated that they reuse cotton balls to make sure they get all the drugs out of them.  Cotton balls should not be reused because it is essentially acting as a sieve and retaining all of the particulates the drugs are mixed with.  Optimally, PWID should clean the injection site prior to injecting to ensure that bacteria on the skin are not then pushed into the body.  While this sounds like common sense, it requires education of this population.  Lastly, dull needles are an additional risk.  In one interview, a nurse from Scott County, IN discovered that PWID were reusing needles up to 300 times, until the needle finally broke off in their arm (Goodnough, 2015).  Some PWID reuse needles because they don’t have anymore, but some reuse needles because they have not received education to the contrary.
  2. HIV/AIDS and Hepatitis C:  Preventing HIV/AIDS and Hepatitis C among PWID seems simple, but is actually quite difficult.  The risk for HIV/AIDS and Hepatitis C is in sharing needles, syringes, and other injection paraphernalia, such as the instrument the drugs are cooked in and tourniquets.  While the majority of states allow pharmacies to sell syringes without a prescription, some pharmacies still will not sell syringes without a prescription.  Buying syringes is also an added cost for a population that experiences high rates of homelessness (CDC, 2017).  Many cities across the country have syringe service programs (SSPs), sometimes called needle and syringe exchange programs, offering PWID a safe and confidential way to get syringes and other paraphernalia for free or at a low cost.  One study found that PWID under the age of 30 are more likely to share syringes and needles, therefore at a higher risk for HIV than older users (CDC, 2017).  In addition, the CDC estimates for every time needles and syringes are shared, the user has a 1 in 160 chance of sharing equipment with an HIV-positive person (CDC, 2017).  Informing PWID about the local SSPs or places for safe needle disposal help to decrease the user and community’s risk for HIV/AIDS and Hepatitis C.
  3. Overdose:  PWID are at an increased risk for overdose once released from incarceration because they have either started the withdrawal and detox process or completed it.  PWID should take a “tester dose” to lower their risk for overdose after being released from jail, as opposed to resuming the dose of drugs they were accustomed to prior to incarceration.  Tester doses are also helpful to PWID when they start using a new batch of drug because the potency could vary. 

Harm reduction for PWID is focused on both education and access to clean injection supplies.  Access to clean injection supplies alone does not equate to the best harm reduction outcomes because PWID still need to be educated that all injection paraphernalia should not be shared, not simply needles and syringes.  Educating PWID about safer injection techniques and resources in the area could help them engage in safer injection practices and lower their risk for the many health issues associated with injection drug use.


Goodnough, A.  (2015).  Rural Indiana Struggles to Contend with H.I.V. Outbreak.  The New York Times.  Retrieved from https://www.nytimes.com/2015/05/06/us/rural-indiana-struggles-to-contend-with-hiv-outbreak.html?_r=0

CDC.  (2017).  HIV and Injection Drug Use.  Retrieved from https://www.cdc.gov/hiv/risk/idu.html

May 25, 2017

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