OCTOBER 26-29, 2020

HARM REDUCTION: IF YOU CAN’T QUIT, BE SAFER

 Harm Reduction
(when quitting is not an option)
Amy Faith Ho, MD
@amyfaithho
Director of Clinical Informatics | Integrative Emergency Services
Core Faculty | John Peter Smith Hospital
Dallas-Fort Worth | Texas
Harm Reduction
Reduce harms associated with behaviors
Seatbelts
Helmets
Condoms
Masks
Alternative need not be completely safe – just substantially safer
IVDA
Needle-Exchange Programs
Supervised injection Sites
Self-Injecting
Safe place, buddy system
Rotate injection sites (avoid neck)
Alcohol wipes
Sterile water
Clean cotton filter
Reliable source
Harm Reduction - Heroin
Narcan
Evzio (auto-injector) $4500
Adapt (nasal spray) $150
Over the counter in most states
MAT
X Waiver
Buprenorphine
Suboxone (buprenorphine + naloxone)
Methadone
Hub and Spoke Model
Harm Reduction - Nicotine
Nicotine gum/patches
1 cigarette = 1-2 mg nicotine (inhaled)
1 pack cigarettes = 20 cigarettes
21 mg / 14 mg patches
Low tar cigarettes
Snus
ENDS
Harm Reduction - Alcohol
Housing for homeless alcoholics (Washington)
Serial Inebriate Programs (California)
Librium tapers
Rigid vs. Front load vs. Symptom-triggered
Calculate Alcohol Dependence
5-14 days
5-200 mg, divided
Take-aways
Most of medicine is harm reduction
Counsel without judgement
Use MAT if appropriate
References
Dunford JV, Castillo EM, Chan TC, Vilke GM, Jenson P, Lindsay SP. Impact of the San Diego Serial Inebriate Program on
use of emergency medical resources. Ann Emerg Med. 2006;47(4):328-336. doi:10.1016/j.annemergmed.2005.11.017
Larimer ME, Malone DK, Garner MD, et al. Health Care and Public Service Use and Costs Before and After Provision of
Housing for Chronically Homeless Persons With Severe Alcohol Problems. JAMA. 2009;301(13):1349–1357.
doi:10.1001/jama.2009.414
Lindson N, Chepkin SC, Ye W, Fanshawe TR, Bullen C, Hartmann-Boyce J. Different doses, durations and modes of
delivery of nicotine replacement therapy for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue
4. Art. No.: CD013308. DOI: 10.1002/14651858.CD013308.