Your Life and Health Matter: Build a Safety Plan for Overdose Prevention

Purpose:

This document is for harm reduction providers working with people who use drugs, and anyone that uses drugs. It can be used to assess risks, and provide strategies to reduce the risk of overdose, overamping, and other bad reactions that may occur when using drugs by building an overdose prevention safety plan.

Know the Facts:

The street drug supply is unpredictable and inconsistent. This means that the type and amount of drugs people can get is not regular or steady. They are often "cut" with other drugs or materials that can have unwanted effects. You can't tell how pure your drugs are from looking at them, and purity levels are always changing.

Fentanyl and Xylazine and Medetomidine are in the drug supply:

  • Fentanyl is 50-100 times stronger than heroin. It is the main component of drugs sold as heroin and is also sometimes mixed with other drugs such as cocaine, and crystal meth. It is important to test stimulants to see if they have fentanyl on board. Learn about Fentanyl: Fentanyl: The 411. The pill supply also contains fentanyl.
  • Xylazine is an animal tranquilizer, that is not approved for human use. It is nearly always combined with fentanyl. It is done so to extend the effect of the fentanyl. This combination is called "tranq". Xylazine use can also cause severe skin wounds. Learn about Xylazine: Xylazine Test Strip Counseling. Medetomidine is also a tranquilizer which is more potent than xylazine, but we know less about it. Both of them cause long lasting sedation which naloxone does not reverse even though the person is breathing again.

Take Notice:

  • Pay attention to changes in your drugs such as a color, taste, and the way it cooks up/dissolves.
  • Be extra careful if you change your dealer or have other changes in your source of drugs.

Check Your Drugs:

Test your supply by using test strips.

  • Access free drug testing supplies
  • Find where you can check your drugs at specified Drug User Health Hubs. New York's Drug Checking Service offers people who use drugs timely and detailed information on the contents of their drugs. Knowing what is in your product can help you to make more informed decisions.

What is Tolerance and Why it Matters:

Tolerance is the body's ability to process a certain amount of a drug. As you develop tolerance to some drugs (ie. opioids), you will usually need more of it to feel the desired effect. When your tolerance is lower, just a small amount of a drug can increase your risk of overdose. Your tolerance decreases if you:

  • Stop or take a break from using a drug
  • Reduce the amount of drugs you use, even if only for a short time.
    • If you've been sick, lost weight, or have been feeling under the weather or weak — this can affect your tolerance.
    • People who have recently been released from jail, prison, or detention or have been discharged from a hospital or a drug treatment program are at increased risk of overdose because they may not have had access to drugs or medications for opioid use disorder in these settings.
    • Medications for Opioid Use Disorder (MOUD) such as methadone, buprenorphine/Suboxone® can help manage cravings, and withdrawal. Buprenorphine or methadone make it less likely to overdose.

Start Low and Go Slow

Do a small test dose to check how strong your drug is. Go slow. Use less and pace yourself.

  • Try not to mix drugs. Mixing drugs and alcohol increases the risk of overdose. Taking opioids in combination with alcohol and/or other depressant medications like benzodiazepines or tranquilizers can be deadly.
  • If you are using more than one drug, then use less of each drug and wait to see how you feel before using another drug.

Try to Find a Buddy:

  • Try to use with a trusted person who is alert and can respond in the event of overdose or let a trusted person know to check on you. Ask them to text, call or check-in on you 3-5 minutes after you use drugs to make sure you are ok.
  • If you are going to use, alone call the "Never Use Alone" hotline (1-800-484-3731). The Never Use Alone hotline is toll-free and nationwide. Volunteers are available 24 hours a day, seven days a week, to stay on the phone with you and make sure you stay responsive. In the case of an overdose, they will alert medical services. Your information is never shared with anyone other than medical services.
  • Stagger your use if you are in a group, be sure that someone is alert and can respond in the event of overdose.
  • Always carry naloxone. Be familiar with signs of an overdose and be prepared to respond with naloxone.

Carry Naloxone (Narcan):

  • Naloxone will reverse an opioid overdose. Have it out and ready to use if needed.
  • Naloxone can be administered as a nasal spray or via injection.
  • Naloxone will make someone breath again but if they are sedated from benzos or xylazine they won't fully wake up no matter how much naloxone you give. If they are breathing, it has worked!
  • If you are out of naloxone, get a new kit. Go to your local syringe exchange program or find a drug store near you at: www.health.ny.gov/overdose.

Try to Find a Safe Space

  • Find a place where you feel safe and can take your time to prepare your drugs.
  • Choose a place that has clean water and is well lit.
  • Use in a space where you can be reached if you need help.
  • Avoid leaning against or locking the door.

Protect against infections

Safer Consumption:

  • Smoking: Using a pipe, stem or bong, uncoated aluminum foil can be used to smoke from or to create a Do it Yourself (DIY) stem. Try to make sure everyone has their own pipe or mouthpiece.
  • Snorting: Crush powder as fine as possible and make sure everyone has their own straw. Alternate nostrils between hits.
  • Booty Bumping: Use a turkey baster or syringe without a needle. Avoid sharing equipment.
  • Injecting: Use your own sterile syringes and gear. If you need to reuse syringes, wash with cold water, bleach and then water again.

Safer Equipment for Stimulant Use:

  • Syringe service programs (SSPs) provide safer drug use equipment and other harm reduction services to people who use drugs, including kits for safer smoking, sniffing and injecting.
  • Safer smoking kits often include glass stems, rubber mouthpieces, brass screens, lip balm and disinfectant wipes.

      o Using your own glass stem reduces the risk of getting or passing hepatitis C.

      o Using rubber mouthpieces and keeping your lips hydrated with lip balm helps you avoid burns and cuts.

      o Using brass screens lowers the risk of lung issues by reducing the amount of debris that is inhaled.

      o Safer sniffing kits often include disposable straws, plastic cards, plastic razors and plastic scooping spoons.

      o Using your own disposable straws and scooping spoons reduces the risk of getting or passing hepatitis C.

  • Injecting crack: Base is added to cocaine to make it smokeable. (In rock form, it's known as crack.) To revert crack into its powder state, you need to add ascorbic acid (vitamin C) or citric acid. (These are the only acids that can safely break down the rock for injection. Other acidic substances like vinegar or lemon juice can cause severe infections).
  • If you use too much vitamin C or citric acid, the shot will burn, and you may damage your veins.
  • If you use too little, the drug will not completely dissolve and you won't get your full shot.
  • Add small amounts of vitamin C or citric acid little by little until the rock dissolves.

Stimulant Overamp:

Overamping happens when the effects of a stimulant become overwhelming, distressing, and/or dangerous. The experience of overamping can be physical, psychological, or a mixture of the two.

Factors that can increase the likelihood of overamping can include:

  • Using larger amounts of stimulants or mixing different drugs.
  • Compromised health (especially cardiovascular/heart-related issues).
  • Sleep deprivation.
  • Inadequate food and/or water.
  • Using in a new or uncomfortable environment, or with new people you're not comfortable with.
  • Using too much or too high of a dose.
  • Route of administration used. If you notice that you feel more uncomfortable when you inject versus smoking, changing the way you use can make a difference. Also, to avoid the complications that can come with the higher frequency of injecting stimulants, consider alternative routes of administration. Using other routes even occasionally can be protective! No matter which route you choose, try not to share any equipment.

Take Care:

  • Stay hydrated! Drink plenty of water or other fluids.
  • Eat regularly.
  • Get enough sleep and rest when you feel worn down.