Overview This guide was created by Skylark’s Harm Reduction Team in response to the lack of drug education from a harm reduction perspective and the recognition that this knowledge is not often offered to the general public. This guide aims to inform its readers on the importance of harm reduction while providing practical strategies and resources for safer substance use.
40 Orchard View Blvd. #255 Toronto, ON, M4R 1B9 www.skylarkyouth.org
Table of Contents Quick Tips
pg. 3
Methods of Use
pg. 4
Safer Pipe Smoking
pg. 5
Safer Pot Smoking
pg. 6
Safer Snorting
pg. 7
Safer Drinking
pg. 8
Safer Tripping
pg. 9
Safer Injecting
pg.10
Recognizing & Responding to an Overdose
pg.11
Harm Reduction Supplies in Toronto
pg.12
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Quick Tips to Reduce Harm • Pick a comfortable and safe place to use your drugs and use with people you trust. • Always use your own equipment (needles, pipes, bills, straws, alcohol swabs, cookers, sterile water, vitamin C powder, filters, tourniquets and ties). See last page for resources! • Know your drugs and your dealer. Ask questions. If in doubt, use a drug quality testing kit. • Know the risks of using different drugs together (www.drugcocktails.ca). • When trying a new dealer, a new drug batch, or after a break from using, sample the drug—do half of your regular dose. • Know the signs of overdose and avoid taking too much at one time. Buy less so you use less. Buying large amounts of a drug may be cheaper, but you
could end up using more than you want to simply because it’s there. Set a time limit before you start. If you choose, say, to stop drinking at 10:00 p.m.,
watch the time, remind yourself of your time plan, and stick to it. Have some juice ready. Eat a meal before you start, and avoid snacking on salty foods, especially if you’re
drinking. You may drink more out of thirst. Lower your dosage and frequency. In other words, drink, smoke or inject in smaller
amounts—and less often—than you do now. When it comes to alcohol, this could mean choosing light beer or other low-alcohol drinks, or alternating drinks with water or pop. Choose the least harmful method of use. Injecting a drug carries more risk than
smoking, snorting or swallowing it. (If you do inject drugs, avoid the neck area.) When it comes to weed, using a vaporizer or smoking a joint (with a rolled up cardboard filter) is safer than using a bong and some pipes. Plan out some drug-free days. The fewer days in a row you use a drug, the less you will
need to reach the desired effect. If you use the drug every day, try cutting back your use to every other day, and try not using it at all for two to three days. (Make sure you have in mind other ways to spend your time and energy so you don’t end up sitting around and thinking about how you miss getting buzzed. Use at your own speed and don’t feel pressured from others to pick up the pace.
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Methods of Substance Use Snorting
Snorting drugs can damage the inside of the nose and the septum (separation between nostrils). This may increase the risk of contracting Hep C when sharing drugsnorting equipment (like bumpers, keys, bills or straws). If you have to crush your drug before snorting, take time to grind it as fine as possible. Try using a rolling pin, bottle or pill crusher. Finer grinds may reduce the damage inside the nose and can increase the high so you don’t have to snort as much. It can take 5 -10 minutes to feel the drug effect.
Smoking Smoking is safer than injecting but you can hurt your lungs with smoke or burn your mouth if you use homemade pipes. You can also get Hep C if you share your smoking equipment, including pipes and mouthpieces, especially if you have burns or cuts around your mouth. It can take less than 1 minute to feel the drug effect.
Popping
Popping pills, drinking or eating the drug is often safer than other ways of using. It usually takes longer to feel the “buzz” but keeps you safe from many of the risks of snorting, smoking or injecting. It can take 15 –60 minutes to feel the drug effect.
Hooping and Dabbing Hooping is a method of taking drugs by inserting them in your ass or vagina. This can make these areas of your body raw or irritated, which makes it easier for HIV, Hep C, and STIs to enter your body. Drugs can also be dabbed under the tongue or on the gums to be absorbed, which can cause some irritation. It can take 5 –10 minutes to feel the drug effect.
Injecting
When drugs are injected, traces of blood may be left on needles or in syringes and then transferred to other injecting equipment (like cookers, filters, water, swabs and ties). Sharing works means sharing this blood which may have HIV or Hep C in it. Reusing equipment, even if it’s only yours, can lead to other infections, like abscesses or blood infections. It can take less than 1 minute to feel the drug effect.
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Safer Pipe Smoking
Attaching a rubber or plastic mouthpiece at the mouth end of the pipe prevents burns. Mouthpieces can differ in length and width to be the best fit for a stem. A person can also make a mouthpiece using rubber bands, tape or an empty cardboard matchbook. A mouthpiece will help prevent oral lesions and sores due to burns from the crack pipe.
Use screens composed of steel or brass to help prevent heated or melting drug(s) from being inhaled.
Pack 5 screens into your pipe to best ensure safety from the drug(s) being inhaled.
Use push sticks, which help position screens in the pipe.
Hold the flame beside the stem but not directly on it to prevent burns. This produces enough heat to melt the rock but reduces how hot the stem gets. Moving the flame alongside the stem instead of concentrating the flame in one spot will also spread the heat out.
Use lip chap or Vaseline to reduce cracking and burning of lips. This also helps decrease the transmission of diseases like HIV, hepatitis B and C, TB and herpes.
Alcohol swabs and hand wipes should be used to clean one’s hands and equipment before using the equipment. This prevents bacteria and germs in the environment from getting into the body.
Chew gum, to prevent lockjaw and keep the mouth hydrated.
Inhale slowly. This will help prevent burning your lungs.
Exhale immediately. Holding it in doesn’t make the effects stronger—it only hurts the lungs more.
Handle the pipe with care. It will be hot after using it.
Do not share pipes! Sharing pipes may lead to transmission of infections.
Safer smoking equipment is considered unsafe and in need of replacement when:
The pipe and/or the mouthpiece have been used by anyone else.
The pipe is scratched, chipped or cracked.
The mouthpiece is burnt.
The screen shrinks and is loose in the stem.
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Safer Pot Smoking If you are smoking a joint…
Smoke unfiltered joints. Studies have shown that the best THC: tar ratio is achieved by smoking unfiltered joints. A piece of rolled cardboard in the end is fine (and probably desirable), although unbleached, non-printed is best.
Avoid sharing whenever possible, however, If sharing, don’t let the joint touch your lips.
Minimise paper usage in joints. The less burning paper the better.
If you are smoking from a bong…
Regularly clean and replace the water. Unclean bongs and water are breeding grounds for germs and viruses. To clean your bong, rinse with rubbing alcohol and salt.
Avoid using bongs made out of wood, aluminium or plastic (including those made out of drink containers or garden hoses). Toxic fumes can be released when smoking through these types of bongs. It's less harmful to use bongs made out of glass, stainless steel or brass.
Choose a bong which has the mouthpiece at least 20cm away from the water surface. This will ensure water vapour doesn’t enter the lungs. Water vapour (droplets) accumulating in the lungs can cause lung infection. This is called 'pleurisy'.
Use a screen (filter) in the 'cone' or 'down pipe' - this prevents inhalation of small particles and contamination of the water.
Take small, shallow tokes or pulls. About 95% of THC in cannabis smoke is absorbed in the first few seconds so breath holding is quite pointless. All it really achieves is a far greater amount of tar being deposited in the lungs.
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Safer Snorting
Find a clean surface to prepare your drugs as germs and viruses can survive on poorly cleaned surfaces.
Crush the drug until it is as fine as possible (powder). The more finely ground or crushed the drug is, the less likely it will be to cause physical damage such as insufflation-caused abrasions and infections caused by buildup of large drug particles.
To prevent the spread of Hep C, people should use their own straws when snorting or use something that can be disposed of. A pack of Post-it Notes can be a large supply of disposable, rollable coke straws. As people don’t often throw out money, using a bill is not necessarily safe. It may have passed through many hands—and many noses—before coming to the current user.
Rinse your nose with lukewarm water after each “line” by sniffing some water up your nose. This will help disperse the substance deeper into the sinuses where it can be dissolved and flushed from the nasal cavity.
Alternate nostrils – evenly alternating the use of each nostril can help to prevent or prolong the occurrence of injury, infections and permanent damage such as a deviated nasal septum.
Monitor for sinus infections. A sinus infection can quickly spiral out of control, so people who snort any kind of drug should monitor for signs of infection and seek medical assistance should they occur.
Vitamin E oil or lotion can be applied to the inside of the nose to help the healing process.
8
Safer Drinking
Eat something. Food reduces the speed at which your body absorbs alcohol.
Know the strength of your alcohol. Look on the label for the percentage of alcohol.
Set limits on how much you’re going to drink. And, commit to sticking to your plan.
Measure and keep track of your drinks. This will help you avoid drinking more than you want to.
Drink slowly. Alternate drinks with water or other non-alcoholic beverages to avoid drinking too much.
Stay in the company of trusted friends. That way, you won’t have to cope alone if something goes wrong.
If you’re going out, plan a safe way to get home before you get to your destination.
Never accept drinks from strangers or leave your drink unattended.
Stay away from the steering wheel. Stay where you are or make plans to get around by bus, taxi, or ride with someone who hasn’t been drinking.
If someone passes out or overdoses on alcohol...
Roll the person on their side (so they won’t choke if they throw up).
Call out for help—stay with the person who’s in trouble.
Call (or get someone else to call) 911.
Tell paramedics as much as you can.
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Safer Tripping
Think about why you want to get high. It’s best not to use hallucinogens as a way of avoiding or coping with problems.
Find a buddy (who won’t be tripping). Using alone can mean coping by yourself if you get injured or have a bad trip.
Plan your trip. Choose a safe, peaceful place to hang out, knowing that most trips last 8-12 hours. Talk to your friend about things you could do if you have a bad trip.
Be sure you’re in the right frame of mind. Using hallucinogens can be fun, spiritual or educational if you embrace the experience. It can also be scary, especially if you try to control rather than “roll with it.”
Start with a small amount if you’re not sure how strong it is.
Stay away from the steering wheel. Your judgment and coordination may be greatly impaired.
If you’re having a bad trip...
Go to a safe environment (if you’re not already in one) and play calming music.
Surrender to the experience (rather than trying to control it).
Try to meditate or relax.
If someone else is having a bad trip...
Take them to a calm, safe environment.
Reassure them that you’re their friend and that in time the experience will pass.
Help them meditate or relax.
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Safer Injecting
Try and pick a safe place with light, water and where you won’t have to rush.
Wash your hands and clean the work surface with soap and water; clean the vein site with an alcohol swab or soap and water.
Always use a new needle and drug-use equipment!
Filter your drug before you inject– it avoids getting tiny pieces into your body that could mess up your veins and lungs. If crushing it first, grind as fine as possible.
Use a sterile, disposable cooker (spoon) to mix and heat the drug. Avoid re-using and sharing cookers since this can lead to contamination and infection.
Use a clean capped needle for mixing and dissolving. Uncapped needle tips can be damaged if used for mixing.
Use sterile water, if possible. Or boil tap water for five minutes and then let it cool.
Decide which vein you will use to inject. The best sites are on the arm. Veins in the neck or groin are too close to arteries. Using veins close to the head make it easier to overdose and abscesses are more dangerous here. Keep changing the spot where you inject to give your veins a chance to heal between injections.
Plump up the vein with a warm towel. Heat makes veins easier to see and use.
Use a tie that you can undo quickly and easily. Use a non-latex tourniquet or tie two condoms together. Pump up the vein by opening and closing a fist.
Tie a tourniquet (anything that constricts circulation i.e. rubber band) about 6 inches or so above the place where you’ll inject. Untie it before you start to inject to protect your veins from blowing (or bursting).
Always start with a small amount. This can help reduce your risk of overdose.
Always insert the needle at a shallow angle with the bevel up (the sliced angle at the end of the needle) and in the direction of blood flow (towards the heart).
Flagging is important to make sure the needle is in the vein. If you miss the vein you can get an abscess or other infection. When the needle disappears into the skin, pull the plunger back until blood flows into the syringe. If you didn’t get a vein, slowly take it out and loosen the tourniquet before tying again.
Never shoot into an artery! Hitting an artery hurts and bleeds. If you hit an artery, take the needle out right away. Press down hard on the site until it stops bleeding. If it doesn’t stop in 5 minutes, call 911 and go to the hospital.
Dispose of used needles and works by storing them in a container that the needle can’t poke through (hard plastic bottles or sharps containers) and taking them back to your local needle exchange program. 11
Recognizing & Responding to an Overdose Overdose from Uppers:
Shortness of breath, can’t speak or foaming at the mouth.
Nausea, sweating, anxiety.
Pain, pressure, tightness or numbness in chest, arms, or neck.
Racing pulse, seizure (twitching) or rapid breathing and eye movements.
Limp body or passing out.
Overdose from downers:
Slow pulse or no pulse.
Pale skin or face turning blue.
Hardly breathing.
Limp body or passing out.
Call 911 immediately if someone: •
Won’t wake up.
•
Has trouble breathing.
•
Has chest pains.
•
Has a seizure that lasts longer than a few minutes.
Tell the police that someone has overdosed. Try to keep them breathing deeply to get enough oxygen into their heart muscles. In the case of an opioid overdose, use Naloxone if available and follow associated instructions. If you do not have access to Naloxone, tell 911 that it needs to be brought in the ambulance. Lean their body forward (or in the recovery position on their side) so they don’t choke on their own vomit. Apply CPR if you know how. If convulsing, clear a space so the person doesn’t bang into something and hurt themselves. Never try to hold a person down. Do not put them in a cold shower or try to counteract the effect with other substances or home remedies — it won’t help and could make matters worse. Stay with them until help comes (if you can) or at least leave the door open and a note with what they took, to help the paramedics 12
Harm Reduction Distribution Centres The following agencies offer harm reduction supplies through Toronto Public Health. For more information about hours/services, please contact the agency directly.
North West
North East
Eva’s Satellite (Yonge St. & Finch Ave) 25 Canterbury Place T: 416-229-1874
Agincourt Community Services (Sheppard Ave E. & Midland Ave) 4155 Sheppard Ave E., Suite 100 T: 416-321-6912
Fred Victor Caledonia Shelter (Caledonia Rd. & Lawrence Ave E) 1161 Caledonia Rd. T: 416-644-1734
Scarborough Centre (Hub) (Eglinton Ave E. & Brimley Rd.) 2660 Eglinton Ave East T: 416-640-7390
Unison Health and Community Services (Lawrence Ave W, & Allen Rd) 12 Flemington Rd. T: 416-787-1661
Toronto North Support Services (Lawrence Ave. E & Don Valley) 132 Railside Rd. Unit 2 T: 416-499-5659
South West
South East
Breakaway (Queen St. W & Dufferin St.) 21 Strickland Ave T: 416-537-9346
The Works (Yonge St. & Dundas St. E) 277 Victoria St., 1st floor T: 416-392-0520
Toronto Community Health Centre (Queen St. W. & Bathurst St.) 168 Bathurst St. T: 416-535-8501 ext. 124
Inner City Family Health Team (Queen St. E & Church St.) 69 Queen St. E, 4th floor T: 416-368-5666
Parkdale Community Health Centre (Queen St. W. & Dufferin St.) 1229 Queen St. W T: 416-537-2455 ext.271
Maggies (Gerrard St. & Parliament St.) 298A Gerrard St East, 2nd floor T: 416-964-0150
St. Stephens Community House (College St. & Augusta Ave.) 260 Augusta Ave. T: 416-964-8747 ext. 226
Regent Park Community Health Centre (Parliament St. & Dundas St. E) 465 Dundas St. East T: 416-364-2261
YMCA-YSAP Program (Queen St. W. & Spadina Ave) 7 Vanauley St. T: 416-603-6366
Sherbourne Health Centre (Sherbourne St. & Carlton St.) 333 Sherbourne St. T: 416-324-4180 13