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Harm Reduction for Veterans With Substance Use Disorder
Substance Use
Are you concerned about yourself or about a Veteran in a substance use-related crisis?
If you see someone showing symptoms of overdose or who is in immediate danger, dial 911.
If you're worried that you or a loved one is at risk of overdosing, it's important that you talk to a specialist right away. The following resources offer free, confidential support, 24 hours a day, 365 days a year.
Using a helmet in sports or when riding a bike or motorcycle. Buckling a seatbelt. Using sunscreen lotions. These are just a few examples of harm reduction measures that people take in everyday life.
As it relates to substance use, harm reduction is not an alternative to abstinence or treatment (just as using a seatbelt is not an alternative to careful driving). Rather, it is part of a continuum of options that helps reduce the risk of death and other negative health consequences stemming from substance use. Harm reduction measures provided by VA include:
The medication naloxone to reverse opioid overdose.
Sterile needles and injection equipment to prevent infection.
Test strips to identify drugs containing fentanyl or xylazine.
As with helmets or seatbelts, harm reduction for substance use does not suggest VA is encouraging dangerous behavior—merely that VA is acknowledging and trying to mitigate the risk. For example, syringe services programs are associated with a 50% reduction in the transmission of HIV and hepatitis C among people who inject drugs, and research shows that regular users of these programs are five times more likely to enter treatment for substance use disorder. Naloxone availability reduces overdose deaths, which took nearly 107,000 lives in the U.S. in 2021.
Harm reduction keeps Veterans alive while continuing to promote healthier behavior. Only living people can recover.
Preventing opioid overdose deaths with naloxone
Unhealthy use of opioids—such as using them without medical supervision or for longer, in higher doses, or greater frequency than prescribed—comes with a significant risk of overdose. It is important for Veterans and their family members and caregivers to know what to do in an emergency. Learn about the signs of overdose and about the medication naloxone below. Knowing how to use this medication could save a life.
Veterans using nonprescribed stimulants should also talk to their health care provider about having naloxone on hand. It is important to have naloxone because nonprescribed stimulants are often mixed with opioids like fentanyl, which can be deadly even in small doses.
Naloxone is a medication designed to rapidly reverse an opioid overdose. When used after an overdose, naloxone can block the effects of the opioids and help prevent death. Naloxone’s effects are temporary, so it is critical to seek medical assistance immediately after it is administered. Naloxone has little effect on someone who does not have opioids in their system. Always administer naloxone whenever an opioid overdose or poisoning is suspected. (“Poisoning” is when opioids such as fentanyl are added to a person’s drug without the person’s knowledge or consent.)
If you or someone you care about uses opioids or nonprescribed stimulants, you should have naloxone on hand:
If you are a Veteran who uses opioids, ask your VA provider about prescribing you naloxone, which is provided free.
If you are a Veteran who uses nonprescribed stimulants, please ask your VA provider about prescribing you naloxone.
If you are not enrolled in Veterans Health Administration (VHA) care, or if you are a family member or friend of a Veteran who is interested in getting naloxone, talk to a local pharmacist, health department or community group. Naloxone is available without a prescription, though there may be a fee in some states.
Since naloxone is used in emergency situations, the person who is experiencing the overdose or poisoning will need someone else to give them the medication.
Look for the following signs and symptoms to identify a potential overdose or poisoning:
Loss of consciousness or limp body.
Slowed breathing or choking.
Small, “pinpoint” pupils.
Pale, blue or cold skin.
Slowed heart rate.
If you see someone exhibiting any of these symptoms, dial 911 immediately.
Naloxone should be given to anyone who may be showing signs of an opioid overdose or poisoning. It can be administered as a nasal spray or as an injectable medication, depending on the type prescribed. Talk to your provider about the options:
Nasal spray—This needle-free device, approved by the Food and Drug Administration, allows for the quickest and easiest delivery in an emergency. The person with naloxone should make sure the person overdosing is lying on their back and then spray naloxone into one nostril.
Auto-injectable—This prefilled auto-injection device is easy for anyone to use. The person administering naloxone should turn on the device to hear the instructions and inject naloxone into the overdosing person’s thigh muscle.
If someone you know is experiencing any symptoms of an opioid overdose or poisoning—listed in the “Signs and symptoms of an opioid overdose or poisoning” section above—you should:
Dial 911 immediately.
Administer naloxone (if it is available).
Try to keep the person awake and breathing.
Turn the person on their side to prevent choking.
Opioid Overdose Education and Naloxone Distribution Program
VA’s Opioid Overdose Education and Naloxone Distribution (OEND) program teaches Veterans how to prevent, recognize and respond to an opioid overdose or poisoning. Learn more about the OEND program by talking to your VHA provider today.
Preventing infections with syringe services programs
Sharing needles and syringes means using them after someone else used them to inject drugs or medicine or for tattoos or piercings. Because of use of shared needles, people who inject drugs are 20 times more likely than the general U.S. population to be infected with HIV. They are also more likely to acquire other serious infections, such as acute hepatitis C (a viral infection leading to inflammation of the liver). Syringe services programs help reduce the spread of these infections.
Community-based SSPs provide access to sterile needles and syringes to people who inject drugs. They also safely dispose of used syringes and may offer:
Naloxone to prevent death from overdoses.
HIV and viral hepatitis testing and referral to care.
HIV prevention services.
Vaccination against hepatitis A and B.
Treatment that can cure hepatitis C infection
Access to substance use disorder treatment and supportive services.
The presence of the drugs fentanyl or xylazine in a drug you are taking without medical supervision can be extremely dangerous, even lethal. The presence of either one increases your risk of death by overdose. Fentanyl is about 50 to 100 times more potent than morphine, and a lethal dose of it can be very small. Xylazine, in addition to increasing overdose risk, can cause severe skin wounds that spread and worsen quickly.
Unfortunately, people who take drugs without medical supervision usually are unaware when it has been mixed with fentanyl or xylazine. You cannot detect the presence of fentanyl or xylazine by sight, smell, taste or touch, and knowing the source your drug came from—even if you have used it in the past—does not mean it is safe. That is why test strips can be critical for reducing your risk.
Fentanyl test strips provide quick results and are used to identify the presence of fentanyl in many types of drugs taken without medical supervision, whether in pill, powder, or injectable form. Detection lowers your risk of unintentional exposure and overdose. Follow the instructions provided with the strips. Xylazine test strips work in a similar fashion.
No test is 100% accurate. A negative result does not guarantee that the substance does not contain fentanyl or xylazine, so you should still follow other protective measures. Do not use the substance if you get a positive result. The healthiest choice is not to use the substance and seek treatment immediately.
Never take drugs alone. Take a small amount of the drug first and wait several minutes between doses.
Carry naloxone, which can rapidly reverse an opioid overdose or poisoning. The medication will not reverse the effects of xylazine, but it will help if opioids are present in your drug.
Seek medical care for skin wounds, which can worsen quickly if xylazine was present.
