Harm Reduction

“Take Care of Others – You Cannot Live Without Them”
– Universal Alaska Native Value ^[15]

COVID-19 & Substance Use

Since the start of the pandemic, substance use and misuse, overdoses and deaths due to substance misuse have increased^[3]. People experiencing financial hardships, disruptions in routine and lack of physical connection may be more vulnerable to substance misuse^[13].• For an emergency: Call 911
• For help finding resources in your area: Call 211 or visit their website.
• In a non-emergent crisis: Call Alaska’s crisis hotline, Careline, at 988.
• Find local in-person or virtual support for behavioral health or substance use management needs: Call SAMHSA’s 24/7 helpline at 800-662-HELP (4357), TTY: 800-487-4889.Click here to find additional resources and learn more about how COVID-19 has impacted substance use with providers, individuals and Alaska’s community as a whole.

What is Harm Reduction?

Harm reduction, in general, is a set of strategies designed to provide community members and individuals access to a life with reduced risk from harm. Meaning that, if people are engaging in activities that could have a risk, they should have access to tools to help them stay safe, rather than potentially being put in further danger. Some of these tools involve policy change, some involve prevention services, others include intervention services and others are based in community involvement.

Harm reduction is a complex topic, and related items to consider include:

How harm reduction saves lives
Substance misuse and harm reduction stigmas
Harm reduction and Alaska law
Alaska harm reduction services and resources

Most people don’t know it, but harm reduction has played an active role in each of our lives, in many different ways. Harm reduction strategies include:

Policy change: requiring drivers to wear a seatbelt when driving a car
Prevention services: offering condoms to the community
Intervention services: offering pre-filtered cigarettes as an option for people who smoke
Community involvement: wearing a mask during a pandemic

Access to a safer way of life is a long-standing practice in public health and community care. In recent years, the term ‘harm reduction’ has been adapted to include the advocacy for the rights of people who use substances (PWUS) to live a life free from additional risks related to substance use. Harm reduction today acknowledges that abstinence from substance use is not always a realistic goal for some people, and involves helping people achieve goals based on their individual needs and circumstances^[¹^].

Substance use often involves social and psychological factors, such as homelessness, unemployment, incarceration, experiences with trauma, adverse childhood experiences (ACEs) and co-existing mental health illnesses. Because of this, harm reduction services need to be designed so that they will best reflect specific individual and community needs^[⁸^]. The very principles of harm reduction recognize the humanity of PWUS, and seeks to help support PWUS with compassion. People who feel supported and are based in a sense of community are more likely to seek help when needed^[¹^]. With this in mind, harm reduction may also look like:

Policy change: advocating for affordable or no-cost HIV/sexually transmitted infection (STI) testing
Prevention services: providing safer smoking, snorting and injection supplies to PWUS
Intervention services: offering housing-first programs, without required sober-status entry
Community involvement: offering educational resources and materials

Harm Reduction Supplies Save Lives

Access to safer substance-use supplies reduces the risk of contracting infectious diseases from substance use^[⁸^].

Learn more about the different harm-reduction supplies, and how they help reduce risk of injury and infection to PWUS and communities at large:

Fentanyl test trips are used to identify the presence of fentanyl, a synthetic opioid that is approximately 50 times stronger than heroin. By detecting fentanyl prior to use, PWUS can make informed decisions to reduce the risk of an overdose^[8].

Sterile water is used to cook a substance and may also be used to clean a syringe. Like filters, sterile water works to prevent the unintended injection of substances or tiny particles into the bloodstream. Using non-sterile water may put PWUS at risk for infection or sores^[8].

Vitamin C contains an acid, which is a safer option to dissolve and prepare unregulated substances, like cocaine and heroin. Using too much Vitamin C, or the wrong type of acid, can cause damage to the vein. This may even cause the vein to collapse, which may lead PWUS to inject into veins that put them in greater danger. Offering pharmaceutical grade Vitamin C may help eliminate the harms associated with too much Vitamin C use, or the use of the wrong or much more harmful type of acid^[¹⁷^].

Filters are used to prevent the unintended injection of particles that might damage or infect veins and organs. Poor filtration of substances prior to use has been linked to heart problems and death^[7].

Tourniquets, or ‘ties,’ are used to wrap around an area, like the upper arm, in order to restrict blood flow and cause the veins to become more obvious and accessible for injection. Using a tourniquet lowers the risk of HIV, Hepatitis C and other infectious diseases, as it allows for a higher chance of a one-time injection rather than repeated attempts of injection.

Syringes, also called needles, are used to inject a substance directly into the bloodstream. The use of sterile syringes is proven to stop the spread of HIV, Hepatitis C and other infectious diseases among persons who inject drugs and their sexual partners^[10]. Sterile syringes also offer PWUS the opportunity to use fresh, sharp needles that will lower the risk of damage to the veins.

Safe syringe and needle disposal is used to prevent injury and infection, like Hepatitis C and HIV. Offering safe syringe and needle disposal products, like sharps containers or needle clippers, reduces this risk of injury and infection to the community^[16].

A safe medicine drug-deactivation bag neutralizes prescription drugs, pills, patches, liquids, creams and films. This renders them inert, unavailable for substance misuse, and safe for the environment. In a simple three-step process, the medication deactivates once placed in the container, adding water, shaking and throwing away^[6].

Naloxone is a medication designed to rapidly reverse opioid overdose. It works to restore normal breathing patterns to a person whose breathing has slowed or stopped as a result of overdosing with prescription opioid medications or unregulated substances, like heroin^[9]. Providing naloxone, and training on its use, to the community helps to save lives by preventing deaths from overdose.

ORDER A FREE HARM REDUCTION KIT

These kits are made available to lower the risk of HIV and HCV by providing safer injection supplies, such as syringes, cookers and filters.

This project was supported by donors to the Healthy Alaska Natives Foundation.

Order a Harm Reduction Kit

Harm Reduction and Stigma

The term ‘stigma’ is used to define acts of discrimination against a group of people or a place^[⁵^].

Stigma with harm reduction services is associated with: a lack of knowledge about what harm reduction is, the need to blame PWUS for individual or community issues, fear associated with substance use, as well as rumors and myths about alcohol, drugs, and PWUS^[²^]. Stigma, judgement, and discrimination only contribute to the physical, mental, social, and legal harms that PWUS are facing. It prevents individuals from:

seeking care, treatment, and recovery services for a mental health condition or substance use disorder
benefitting from treatment and recovery services when admitted
having a sense of value within a community

Stigma occurs on multiple levels, which include intrapersonal, interpersonal and structural stigma.

Intrapersonal stigma is also known as ‘self-stigma.’ Overcoming self-stigma involves looking inward at oneself to identify any possible sources of bias or stigma that you may have against a place or person^[2]. What are some biases that you personally hold towards harm reduction? Do you have internal beliefs or tendencies towards persons who use substances?

Interpersonal stigma is stigma that a person expresses outside themselves towards a person or a place. This can be intentional or unintentional^[2]. One example of interpersonal stigma can be seen today with the language that is used in the field of substance misuse. Do you address PWUS by their humanity or by their substance use? For example: do you refer to them as ‘a person who uses substances’ or as a ‘drug addict’ or ‘alcoholic’?

Structural stigma involves stigma or discrimination that exists within policies, laws and systems. Structural stigma actively prevents stigmatized persons and places from receiving the necessary supports to seek, ask and receive needed help^[2]. One example of this is requiring applicants to a substance-use treatment facility to be sober before admittance to the facility. How can your workplace or education facilities policies, laws and systems better support PWUS?

Exploring each of these on an individual level is a healthy activity that allows each of us to grow personally and professionally, and even to motivate necessary systemic change. Identifying possible sources of stigma on a personal, external and structural level is the first step to helping PWUS to overcome barriers in accessing much-needed supports.

Overcoming stigma may be done through the following key steps:

Acknowledge the humanity of PWUS. Learn how to think of the client, patient, or consumer as a person first, rather than as the substance they use. Start by learning how to use person-first language.

Become aware of internal, external and structural sources of stigma within your bubble. Educate yourself and others about harm reduction. Start by taking advantage of iknowmine’s resources and materials regarding substance misuse.

Treat people with dignity and respect. Include people seeking harm reduction services in program activities and calls to action for policy and law change.

Harm Reduction and Alaska Law

Please refer to the State of Alaska’s website for the most up-to-date information on policies and laws related to the below information:

A person, trained in opioid overdose response, is not liable for civil damages resulting from prescribing, providing, or administering an opioid overdose drug to a person at risk of experiencing an opioid overdose^[14].
A person, trained in opioid overdose response, is not liable for civil damages resulting from prescribing, providing, or administering an opioid overdose drug to a person in a position to administer an opioid overdose response drug to a person at risk of experiencing an opioid overdose^[14].
A person who seeks medical assistance for a person experiencing a drug overdose may not be prosecuted for certain violations^[14].

Opioid overdose response kits may be distributed or administered to a person at risk of experiencing an opioid overdose, or to a person in a position to administer naloxone to a person at risk of experiencing an opioid overdose^[11].
Opioid overdose response kits must include: FDA-approved Narcan nasal spray, CPR barrier patient face shield, nitrile sterile single pair of size large gloves, instructions on recognizing the signs and symptoms of an opioid overdose, protocols for the proper use and administration of Narcan®, or naloxone, nasal spray^[¹¹^].

Alaska law does not specify any language to authorize or prohibit Syringe Services Programs (SSPs)^[12].

Alaska law does not prohibit or regulate the distribution or sale of syringes^[12].

Alaska’s Harm Reduction Service Center

Explore our resource library below for practical resources to promote the health and dignity of people affected by drug use.

Curricula and Lesson Plans

Take advantage of the available culturally responsive curriculum developed by the iknowmine team. Online and offline versions may be available.

the Alcohol, Tobacco, and Other Drugs Lesson plan, or
the Safe in the Village program.

Trainings and Webinars

The iknowmine team offers a free virtual Naloxone Narcan training, found here.
Visit the iknowmine Harm Reduction trainings page to view recorded 2021 training sessions on harm reduction, and to register for upcoming trainings.

Toolkits

The ANTHC Harm Reduction Toolkit, was developed to address substance use related harms in rural Alaska communities.

HIV/STIs

Get tested at a local health care facility. Need help finding one? Search for a local testing center through the CDC’s HIV testing resource site.
Alaskans who are HIV-positive or at high-risk may utilize the Alaska Native Tribal Health Consortium HIV/AIDS Clinical Services program to get connected with case management, counseling, referrals and HIV/STD testing.
The iknowmine store carries a variety of harm reduction supplies, including HIV and STI self-test kits. Click here to review our stock and order today.
The Alaskan AIDs Assistance Association (Four A’s) provides rapid HIV testing that is free and confidential. Find more information, including testing locations, here.

Hepatitis C

Find a testing location for Hepatitis C near you through the CDC’s testing locator.

Learn more about what recovery and treatment services are by visiting our page.

Learn about the different types of recovery and treatment centers available for PWUS here.

Find recovery and/or treatment service space availability with TreatmentConnection
To find recovery and/or treatment center near you, visit FindTreatment.gov

Syringe service programs (SSPs) distribute sterile syringes, safer substance use supplies and education to PWUS^[⁸^]. The SSPs may include just syringe distribution or syringe exchange programs (SEPs) which may require used syringes to be turned in for new syringes to be provided^[⁴^].

Nationwide: Find a syringe distribution or SEP in your area with the NASEN SSP map.
Statewide: The iknowmine store carries a variety of harm reduction supplies, including syringes. Click here to review our stock and order today.
Southcentral: The Alaskan AIDs Assistance Association (Four A’s) provides general safer substance use supplies, including syringe exchange, that is free and confidential. Find more information, including syringe distribution locations, here.
Interior: The Interior AIDs Association provides general safer substance use supplies for intravenous drug use. Find more information here.

General Harm Reduction Supplies

The Anchorage Health Department has a list of locations where harm reduction supplies can regularly be found in Anchorage.
The iknowmine store carries a variety of harm reduction supplies. Click here to review our stock and order today.

Naloxone: Narcan®

Have you administered Narcan® recently? Text ‘rescue’ to 97779 to tell us about your experience.

The State of Alaska’s Project Hope program supplies Narcan® throughout the state.
The iknowmine store carries a variety of harm reduction supplies, including Naloxone Narcan® kits. Click here to review our stock and order today. Verification of Narcan® training completion is required prior to receiving a Naloxone Narcan® kit from iknowmine. Click here to access the training today.

Safe Medicine Disposal

The iknowmine store carries a variety of harm reduction supplies, including Safe Medicine Disposal bags and buckets. Click here to review our stock and order today.

Where Can I Go for More Information?

The Centers for Disease Control and Prevention (CDC) provides information for patients, educators, and providers about harm reduction including how to prevent it, finding testing and treatment sites near you, and support for individuals and their partners who have tested positive for HIV and STIs.

Healthy Native Youth (HNY) provides resources for tribal health educators, teachers and parents. They offer free curricula and lesson plans about STDs and related topics that you can adapt to your community. HNY also offers the Talking is Power text line that provides culturally appropriate tips and resources for caring adults discussing sensitive topics with teens.

^[¹^]Alberta Health Services. (2021). Drug Safe. Harm reduction. Reference: https://www.albertahealthservices.ca/info/Page15432.aspx

^[²^]Alberta Health Services. (2019). Drug Safe. Reducing stigma. Reference: https://www.albertahealthservices.ca/info/Page15432.aspx

^[³^]American Psychological Association. (2021). 03. Substance use during the pandemic. Reference: https://www.apa.org/monitor/2021/03/substance-use-pandemic#:~:text=According%20to%20the%20Centers%20for,the%20onset%20of%20the%20pandemic.

^[⁴^]The Centers for Disease Control and Prevention [CDC]. (2021). NCHHSTP. Syringe service programs. Reference: https://www.cdc.gov/ssp/syringe-services-programs-faq.html

^[⁵^]CDC. (2020). Your Health. Reducing stigma. Reference: https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/reducing-stigma.html

^[⁶^]Deterra. (2021). Home. Deterra destroys unused medication in 3 easy steps. Reference: https://deterrasystem.com/

^[⁷^]Keijzer, L., & Imbert, E. (2011). The Filter of Choice: Filtration Method Preference Among Injecting Drug Users. Harm reduction journal, 8, 20. https://doi.org/10.1186/1477-7517-8-20

^[⁸^]National Harm Reduction Coalition. (2021). The movement. Principles of harm reduction. Reference: https://harmreduction.org/about-us/principles-of-harm-reduction/

^[⁹^]National Institute on Drug Abuse. (2020). Opioids. Opioid overdose reversal with Naloxone. Reference: https://www.drugabuse.gov/drug-topics/opioids/opioid-overdose-reversal-naloxone-narcan-evzio

^[¹⁰^]San Francisco AIDS Foundation. (2021). Ending Stigma. Why provide syringes? Reference: https://www.sfaf.org/resource-library/syringe-access/#:~:text=Providing%20free%20sterile%20injection%20equipment,HCV%20and%20other%20infectious%20diseases.&text=Providing%20free%20sterile%20syringes%20is,drugs%20and%20their%20sexual%20partners.

^[¹¹^]State of Alaska Department of Health and Social Services [DHSS]. (2021a). Get Narcan (Project Hope). About the project HOPE program. Reference: http://dhss.alaska.gov/dph/Director/Pages/opioids/narcan.aspx

^[¹²^]DHSS. (2017). Heroin. Syringe services programs in Alaska. Reference: http://www.epi.alaska.gov/bulletins/docs/b2017_15.pdf

^[¹³^]DHSS. (2021b). Substance-related Considerations. Substance-related considerations during COVID-19. Reference: http://dhss.alaska.gov/osmap/Pages/covid-19_considerations.aspx

^[¹⁴^]The Alaska State Legislature. (2019). Bills & Laws. FullText. Reference: https://www.akleg.gov/basis/Bill/Text/29?Hsid=SB0023B

^[¹⁵^]UAF. (2021). Alaska Native Values for Curriculum. Alaska Native cultures. Reference:http://ankn.uaf.edu/ancr/Values/index.html

^[¹⁶^]United States Food and Drug Administration. (2018). Consumer Products. Safely using sharps (needles and syringes) at home, at work and on travel. Reference: https://www.fda.gov/medical-devices/consumer-products/safely-using-sharps-needles-and-syringes-home-work-and-travel#:~:text=Importance%20of%20Safe%20Sharps%20Disposal,Hepatitis%20C%20(HCV)%2C%20and

^[¹⁷^]Vernacare. (2021). Paraphernalia. Citric acid & vit c satchets. Reference: https://www.harmreduction.co.uk/product/citric-acid-vit-c-sachets/

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