Introduction
Harm reduction is any strategy that minimizes the adverse health and communal consequences of using drugs without requiring the user to stop the usage. Such people have the right to access health providers like any other person. There are principles that abide harm reduction with intentions to protection of human rights and the advancement of public health. This paper presents harm reduction strategies for Karen, Jody, and Nila based on their unique needs, the considerations of realistic help and feasibility, and substance intake patterns.
Recommended Strategies to Reduce Harm in Three Client Cases
Reducing Harm in Karen’s Case
Karen’s needs revolve around preventing opioid pills’ adverse health effects and stopping her from progressing from occasional to regular use (Levengood et al., 2021). Firstly, in Karen’s case, self-care-focused safer use education is an easy-to-implement option to prevent drug-induced accidents linked to using transportation and fulfilling job responsibilities. Drowsiness is a common side effect of opioid pills, so Karen should be instructed to refrain from driving a car or using any tools/devices that can cause injuries after taking pills (Medline Plus, 2018). Secondly, promoting the avoidance of excessive use is recommended to prevent problematic dependency. Karen should be recommended to keep her current dose unchanged for as long as possible and refrain from taking pills on other occasions aside from parties.
Thirdly, Karen’s dose size is not reported, but her drug intake endeavors take place during parties where other judgment-affecting substances and factors, including peer pressure, might be present. Thus, as the third strategy, overdose risks should be managed preemptively by providing Karen with a naloxone kit and instructing her on taking naloxone and recognizing overdose symptoms. Naloxone reverses overdose events in prescription opioid users and is available in nasal spray and injection solution forms (Centers for Disease Control and Prevention, 2021). To select one option, Karen should talk to friends and learn if they can administer intravenous/intramuscular injections.
Fourthly, considering Karen’s alcohol intake history and the readiness to engage in experimentation with substances, she might want to restart this habit for some reason and should be aware of its implications. Thus, substance interaction education is recommended to warn Karen against taking opioids and alcohol simultaneously, thus avoiding liver damage, respiratory arrest, and other effects (LaRowe et al., 2020). Fifthly, Karen has started taking pills recently, so she might be unaware of the effects that breaking, dissolving, or crushing pills has on drug delivery and overdose risks (Medline Plus, 2018). Instructing her to carefully examine each pill for integrity is necessary to make overdose events highly unlikely.
Reducing Harm in Jody’s Case
Jody has been using opioids for two years, starting with prescription drugs for post-injury limb pain management and gradually progressing to intravenous illicit opioid administration. The first strategy reflects his HIV prevention needs and occasional drug use with another person whose HIV status is unknown. It involves providing Jody with complete information on supervised injection sites (SIS) and needle-syringe programs in his geographic area, enabling him to get new needles if necessary (CSCS Ottawa, 2014). If users share equipment that comes into contact with blood, HIV contracting may occur.
The second recommendation involves providing a naloxone kit and designing a medical alert bracelet for Jody. A nasal kit might be preferable; Jody typically injects drugs alone and might need a non-user’s assistance in case of overdose, and non-users might have no intravenous injection skills (Medline Plus, 2018; Strike et al., 2015). Jody should be encouraged to always carry naloxone and wear a bracelet that provides brief and simple instructions on what to do if Jody passes out and how to apply his nasal spray.
The third measure is education on safer injection sites as part of preventing injection-related complications (IRCs) and further health deterioration affecting Jody’s injured hand (Strike et al., 2015). Reliance on peculiar injection sites, such as “the neck, groin, or hands,” increases IRC risks (Strike et al., 2015, p. 64). As a regular injection drug user, Jody should be warned against resorting to these injection sites, especially the injured hand.
Fourthly, Jody may get contaminated/impure illicit drugs, which raises IRC/overdose risks, so drug substitution therapy (DST) should be used (Strike et al., 2015). Jody should get prescription opioids to deal with limb pain management without injections. Fifthly, it is recommended to provide Jody with a supply of elastic and clean tourniquets through a local equipment distribution program (Strike et al., 2015). Jody typically injects alone, so the use of overly tight things, such as belts, might result in vein/limb damage if he fails to remove the belt.
Reducing Harm in Nila’s Case
Nila, an 18-year-old crack user, has complex needs as she ran away from her family more than two years ago. She experiences housing instability, which might add to her vulnerability to using illegal methods of earning money. Firstly, providing mouth care education is a realistic and necessary initiative; Nila smokes crack on a daily basis, which increases her oral health risks (NC Harm Reduction Coalition, n.d.). To prevent poorly healing sores and blisters, she should be educated on balancing her water intake and using accessible ointments, for instance, medicated lip balms. Secondly, providing Nila with a kit for safer inhalation, including glass stems, screens, chopsticks, and mouthpieces, is recommended to reduce the risks of sharing smoking supplies with her acquaintances (Beirness et al., 2008; Strike et al., 2015). Since she reports readiness to consume crack with any new people, equipment-sharing risks are prominent.
Thirdly, offering education to warn Nila against mixing crack cocaine with other substances is recommended. Facing trauma and being receptive to roommates’ drug experiments, she might potentially engage in mixing crack with alcohol or other drugs, thus developing aggression issues and other devastating mental health effects (Czermainski et al., 2020). Fourthly, it is recommended to link Nila to a condom distribution program in her area to reduce her risk of contracting STDs. As a stimulant, crack cocaine can promote increases in libido shortly after administration, creating the risks of engaging in unprotected sex with co-users for Nila (Wouldes & Lester, 2019). Fifthly, encouraging Nila to avoid increasing her crack use and taking large amounts is recommended. Increased inhalation means the vapor will be in excess, leading to brain damage or lung problems. On top of crack’s health effects, Nila’s excessive consumption might exacerbate her already existing financial insecurity as a coach-surfer, encouraging her to engage in crime or sex work to meet her drug use needs.
Conclusion
In conclusion, harm reduction strategies are used to help reduce the health effects of drug users who are not ready to quit. Excessive drug usage causes throat, lung, and liver cancer. Some harm-reducing strategies include using naloxone to reduce excessive opioids, avoiding overdosing, and using prescribed pills. For users who inject drugs, each person must have his/her syringe and know how to avoid damaging the veins.
References
Beirness, D. J., Jesseman, R., Notarandrea, R., & Perron, M. (2008). Harm reduction: What’s in a name? Canadian Centre on Substance Abuse.
Czermainski, F. R., Lopes, F. M., Ornell, F., Pinto Guimarães, L. S., Von Diemen, L., Kessler, F., & Martins de Almeida, R. M. (2020). Concurrent use of alcohol and crack cocaine is associated with high levels of anger and liability to aggression. Substance Use & Misuse, 55(10), 1660-1666.
LaRowe, L. R., Powers, J. M., Garey, L., Rogers, A. H., Zvolensky, M. J., & Ditre, J. W. (2020). Pain-related anxiety, sex, and co-use of alcohol and prescription opioids among adults with chronic low back pain.Drug and Alcohol Dependence, 214, 1-9.
Levengood, T. W., Yoon, G. H., Davoust, M. J., Ogden, S. N., Marshall, B. D., Cahill, S. R., & Bazzi, A. R. (2021). Supervised injection facilities as harm reduction: A systematic review.American Journal of Preventive Medicine, 61(5), 738-749.
NC Harm Reduction Coalition. (n.d.). Safer crack use.
Strike, C., Watson, T.M., Gohil, H., Miskovic, M., Robinson, S., Arkell, C., Challacombe, L., Amlani, A., Buxton, J., Demel, G., Gutiérrez, N., Heywood, D., Hopkins, S., Lampkin, H., Leonard, L., Lockie, L., Millson, P., Nielsen, D., Petersen, D., Young, S., & Zurba, N. (2015). The best practice recommendations for Canadian harm reduction programs that provide service to people who use drugs and are at risk for HIV, HCV, and other harms: Part 2. Working Group on Best Practice for Harm Reduction Programs in Canada. Web.
Wouldes, T. A., & Lester, B. M. (2019). Stimulants: How big is the problem and what are the effects of prenatal exposure?Seminars in Fetal and Neonatal Medicine, 24(2), 155-160.
CSCS Ottawa. (2014). The limits of compassion [Video]. YouTube.
Medline Plus. (2018). Safe opioid use. Web.
Centers for Disease Control and Prevention. (2022). Lifesaving naloxone.