Community health clinics discuss approaches to reduce harms from drug addictions
Transitions Clinic Network (TCN) is a network of community health clinics that serve returning community members. TCN clinics are led by Community Health Workers (CHWs) with lived experience of incarceration who support people with their health care and reentry. TCN hosts a monthly Frequently Asked Questions (FAQ) column. This column is a space where we answer questions about health care and empower individuals to prepare for healthy reentry. This month we are writing about harm reduction. This is not a topic that is generally discussed in prisons, so we are writing to educate on how to reduce the harms of drug use, including overdose deaths, within your community.
What is harm reduction?
Harm reduction is a public health approach to reduce the harms of various behaviors, including drug use. Harm reduction is a non-judgmental approach that offers practical strategies to reduce the potential negative outcomes of using drugs, including death and disease. Harm reduction aims to meet people who use drugs “where they’re at” and support them with strategies and tools to make the safest possible choices, whether one’s goal is using safer, reducing use, or not using at all.
Why is harm reduction important in prison?
Prison is a community and harm reduction is an important effort to protect our community and prepare individuals for reintegrating into society. In the prison context, harm reduction is crucial because it recognizes the individuals within the prison system may engage in behaviors, such as drug use, regardless of the strict rules and possible consequences. Even though harm reduction efforts are limited in prison, it is important to promote awareness of ways to reduce the spread of infectious diseases like HIV and Hepatitis C and reduce the risk of opioid overdose through safer use practices.
How can you practice harm reduction in prison?
Because drug use is strictly prohibited in the prison system, many harm reduction strategies that are widely available in the community are not available to people who are incarcerated. This may make it difficult to decrease the harms but it is still good to be aware of the basic harm reduction strategies and the things that you can do to support the health and wellbeing of people who are using drugs. Note: we acknowledge that there are very real consequences to both using drugs and disclosing use to other individuals inside so please utilize this harm reduction strategies/tools at your discretion. These are some common safer drug use principles:
- Sterile supplies: If at all possible, do not share syringes or other drug use supplies. Because of the lack of access to clean supplies and syringes, injection drug use is the #1 driver of Hepatitis C infection in prison.
- Medications for opioid use disorder (MOUD): All prisons have an ISUDT team that can prescribe MOUD (commonly known as Suboxone, Buprenorphine, or “Bupe”) to individuals who are struggling with opioid use disorder. While we understand there are politics or stigmas that may keep people from using MOUD, it is a proven harm reduction method that decreases cravings, opioid use, risk of infectious diseases, and fatal overdose.
- Reducing stigma: One important thing about harm reduction is addressing and reducing stigma (shame) around drug use. People use drugs for many different reasons. In addition to the very real fear of consequences of using drugs in prison, people encounter a lot of judgment of their drug use. Stigma and fear of judgment can lead people to engage in riskier behaviors and keeps people from asking for help. We can reduce stigma by doing simple things such as avoiding harmful words like ‘junkie’ or ‘druggie’ and by letting people know that you are willing to listen and offer non-judgmental support.
- Overdose awareness and prevention: People who use opioids are at risk of dying from an overdose. There is even more risk now as we see more fentanyl, a very strong synthetic (man-made) opioid, in the community. There are things you can know and do to prevent or respond to an opioid overdose and keep your community members alive! More details below.
What is an opioid overdose and who is at risk?
Opioid overdose occurs when someone takes too many opioids, leading to life-threatening effects, mostly caused by respiratory failure (people stop breathing). Those at high risk include people taking pain medications, recreational drug users, and those with opioid use disorder. Another thing to consider is if someone takes a break from using opioids or stop taking their MOUD (Suboxone or Methadone), it can also increase risk for overdose if they use again. Understanding how to prevent, identify, and respond quickly to an overdose can save lives!
How can you prevent an overdose?
- Don’t use alone: Always make sure that someone else is around and is aware that you may be using substances so they can respond if you overdose.
- ‘Test’ your drugs: Start by using a small amount to see how it affects you before taking a large amount. We are seeing a lot of fentanyl in the community so it is important to go very slow if possible.
- Don’t mix drugs: Drugs taken together can interact in ways that increase their overall effect and increase chance of overdose. Taking alcohol or ‘benzos’ with an opioid is especially risky.
- Understand the risks! If you just stopped using MOUD or have not used for a long period of time, you are at increased risk.
How can you respond to an overdose (even without naloxone)?
Immediate action and seeking professional help are critical when responding to an overdose. Naloxone is a medication that can reverse an opioid overdose – while incarcerated people cannot carry naloxone, staff at the prison have it so you may need to be prepared to call on them to assist. Here’s what you can do right away:
- Recognize the signs of a potential opioid overdose: Unresponsive, bluish/grayish lips or fingertips, no or slow breathing (less than 1 breath every 5 seconds), choking or gurgling sounds.
- Try to wake them up by saying their name or rubbing their chest hard (sternum rub).
- Call for help! You can say the person is ‘not breathing’, you DO NOT need to mention drug use. Staff should have access to naloxone.
- Do rescue breathing by placing the person on their back, plugging their nose with one hand, and giving 2 even regular-sized breaths. Give one breath every 5-seconds until they start breathing on their own.
- Once they are breathing, you can put the person on their side they don’t choke on vomit in their mouth.
- Stay with the person to make sure they don’t stop breathing again.
- Practice self-care: Witnessing an overdose is very scary, particularly in prison. Take some time to take care of yourself, whatever that may look like for you.
How can you practice harm reduction in the community after release?
The same principles above apply for safer drug use in the community. Getting out of prison can be a very risky time for people since your use habits may change, you may have decreased drug tolerance, or be tempted to use alone. So please know your risk for overdose and proceed with caution if choosing to use substances. Many people find MOUD helpful in continuing to reduce cravings and opioid use in this period of transition, so if you are on MOUD or interested in trying it, find a doctor near you who can offer it. In the community, you may have access to some additional harm reduction resources like naloxone, access to sterile syringes and supplies, and community organizations that can support your goals for using safer or treating substance use disorder. When you are released, you will be given naloxone and at least 30-days of your medications (including Suboxone) to take home.
By embracing harm reduction, we acknowledge that the journey towards healthier and safer lives is different for each person and can be challenging. We recognize that punitive measures and moral judgement do little to address the root causes of risky behaviors. Instead, harm reduction encourages a more holistic and humane approach to empower people, connect them with essential resources, help them work toward their goals, and ultimately save lives.
Do you have tips for reducing harm in prison? We’d love to hear from you and share your ideas! Or if you have other healthcare-related questions about reentry, feel free to write us at: Transitions Clinic Network, 2403 Keith Street, San Francisco, CA 94124. Or call our Reentry Health Hotline at (510) 606-6400 to speak with a CHW and to see if there’s a TCN program in your community of return. We accept calls from CDCR Monday to Friday, 9am-5pm.