September 16, 2021
Understanding opioid harm reduction
Not all people who use alcohol or other drugs want to stop or reduce their use.
And, some people who do want to stop, may not be ready to take that step yet.
Because we know all drug use carries a risk of harm, we want to try and reduce some of that risk1 and this can be achieved through harm reduction.
Harm reduction covers specific policies, programs and practices that can reduce the harms associated with substance use – whether that’s harms related to physical or mental health, individuals, families or the broader community.2, 3
Harm reduction can be applied to any substance, by any person, in any environment.4
Here we discuss harm reduction in relation to opioid use.
Opioid use on the rise
We’re seeing a concerning rise in opioid use in Australia.5
Opioids include certain types of painkillers, such as codeine or oxycodone, as well as illegal drugs like heroin.
All opioids can cause dependence and can result in accidental overdose, hospitalisation or death.6
Vital organs such as the lungs, brain and heart can also be damaged by opioids.7
Every day in Australia, there are approximately 150 hospitalisations and 14 emergency department presentations involving opioids.
And three people die from drug-induced deaths involving opioids each day.5
For people experiencing opioid addiction (dependence), there are specific harm reduction approaches that can help reduce some of these risks.
Harm reduction at home
If you – or someone you know – uses opioids, try taking the following harm reduction measures:
- encourage family and friends to learn how to use take home naloxone – a medicine that can reverse the effects of an opioid overdose (more information on naloxone is provided below)
- avoid mixing drugs (polydrug use) – mixing opioids with depressant drugs such as alcohol or benzodiazepines can greatly increase the risk of overdose
- don’t use opioids alone and always tell someone what you’ve taken
- if using illicit opioids such as heroin, test with a small amount to reduce overdose risk
- do not drive or operate machinery after use
- always use clean needles and never share injecting equipment
- safely dispose of used injecting equipment.
If you know someone who has had a bad reaction after taking opioids, never leave the person to ‘sleep it off’. Snoring or gurgling could mean someone is having trouble breathing and may be experiencing an overdose.8 Call 000 immediately.
Harm reduction in the community
There are many harm reduction programs and services for people who use opioids (and other drugs).
Needle and syringe programs (NSPs) provide sterile needles and syringes to people who inject drugs to stop the spread of blood borne viruses such as HIV/AIDs and hepatitis B and C.
They also provide other paraphernalia (such as tourniquets) for free, or at a low cost. Australia has one of the lowest rates of HIV transmission via injecting drug use because of the availability of NSPs.9
Needle and syringe programs can be found across metropolitan and regional Australia.
NSPs provide a range of services, including:
- information and education
- safe disposal containers
- sterile injecting equipment
- referrals to treatment services.9
Pharmacotherapy is the use of prescribed medication to help treat alcohol or drug dependence.
Pharmacotherapies for opioid dependence include buprenorphine and methadone. Buprenorphine is now available as a long-acting formulation that can be taken weekly or monthly.
People living with a dependence on heroin or prescribed opioids often struggle to stop or reduce their use because of unpleasant withdrawal symptoms or cravings.10
Methadone and buprenorphine can prevent withdrawal and cravings for opioids10, reducing the risks associated with continued use such as overdose, infection, poor health and even death.
These medications can also help people who want to come off opioids completely.
Naloxone is a medication that rapidly reverses an opioid overdose.
If a person's breathing has slowed or stopped because of an opioid overdose, naloxone can quickly restore regular breathing. It is available as an injection or nasal spray.11
Naloxone can be administered by anybody and can be prescribed by a doctor in all states and territories.
You can also get it from any community or hospital-based pharmacy, however there are different conditions in different states – it’s free in NSW, SA and WA under the take home naloxone program8 and available for a small fee everywhere else.
Naloxone is also freely available at needle and syringe programs across VIC, NSW, SA, TAS and WA.
Supervised injecting facilities (SIFs) are a hygienic place where people can inject drugs.
These are supervised by health workers, so if someone overdoses a staff member can respond straight away.
SIFs can:
- reduce overdose deaths and harm
- reduce ambulance attendances and emergency department presentations
- reduce the number of discarded needle and syringes in public places
- reduce the risk of blood borne viruses such as HIV and hepatitis C
- provide referrals to treatment and support
- provide access to other health and social services for people who inject drugs.12-18
Key harm reduction services in Australia
In Australia we have harm reduction services in every state and territory.
If someone you care about is experiencing social or physical harm from drug use, these services can provide support and advice:
- ACT Canberra Alliance for Harm Minimisation and Advocacy (CAHMA)
- NSW NSW Users and AIDS Association (NUAA)
- NT Northern Territory AIDS and Hepatitis Council (NTAHC)
- QLD Queensland Injectors Voice for Advocacy and Action (QuIVAA)
- QLD QuIHN Needle and Syringe Program and Harm Reduction (QuIHN)
- SA Hepatitis South Australia Clean Needle Peer Projects (CNP)
- TAS Tasmanian Users Health and Support League
- VIC Harm Reduction Victoria (HRVic)
- WA WA-Peer Based Harm Reduction Western Australia (formerly WASUA)
Remember, taking care of yourself is just as important as helping others.
If you are affected by someone’s alcohol or drug use, you can contact the following 24-hour helplines for information and support.
Family Drug Help (VIC, SA and TAS): 1300 660 068
Family Drug Support (NSW, QLD, NT and ACT): 1300 368 186
- Harm Reduction Australia. What is harm reduction? n.d. [19.07.2021].
- Australian Government Department of Health. What is harm minimisation? 2004 [20.07.2021].
- Hawk M, Coulter RWS, Egan JE, Fisk S, Reuel Friedman M, Tula M, et al. Harm reduction principles for healthcare settings. Harm Reduction Journal [Internet]. 2017 [15.09.2021]; 14(1):[70 p.].
- Hopwood M, Treloar C. Chapter 75 - International Policies to Reduce Illicit Drug-Related Harm and Illicit Drug Use. San Diego: Academic Press; 2013 [15.09.2021]. Available from:
- Australian Institute of Health and Welfare. Opioid harm in Australia and comparisons between Australia and Canada. Canberra AIHW; 2018.
- Australian Institute of Health and Welfare. Australia’s health 2018. Canberra Australian Institute of Health and Welfare; 2018.
- National Institute on Drug Abuse. Heroin Drug Facts 2021 [04.08.2021].
- Australian Government Department of Health. About opioid overdose and adverse reactions 2019 [cited 2021 August 24].
- Government of Western Australia Department of Health. Needle and Syringe Programs n.d. [21.07.2021].
- Turning Point. Parmacotherapy 2021 [21,07.2021].
- Australian Government Department of Health. About the take home naloxone pilot 2021 [21.07.2021].
- Kerr T, Tyndall MW, Lai C, Montaner JSG, Wood E. Drug-related overdoses within a medically supervised safer injection facility. International Journal of Drug Policy. 2006;17(5):436-41.
- Markwick N, Ti L, Callon C, Feng C, Wood E, Kerr T. Willingness to engage in peer-delivered HIV voluntary counselling and testing among people who inject drugs in a Canadian setting. Journal of Epidemiology and Community Health. 2014;68(7):675.
- Wood E, Tyndall MW, Stoltz J-A, Small W, Zhang R, O’Connell J, et al. Safer injecting education for HIV prevention within a medically supervised safer injecting facility. International Journal of Drug Policy. 2005;16(4):281-4.
- Kimber JO, Mattick RP, Kaldor J, Van Beek I, Gilmour S, Rance JA. Drug and Alcohol Review. 2008;27(6):602-12.
- Tyndall MW, Kerr T, Zhang R, King E, Montaner JG, Wood E. Drug and Alcohol Dependence. 2006;83(3):193-8.
- Wood E, Tyndall MW, Zhang R, Montaner JSG, Kerr T. Rate of detoxification service use and its impact among a cohort of supervised injecting facility users. Addiction. 2007;102(6):916-9.
- Belackova V, Silins E, Salmon AM, Jauncey M, Day CA. “Beyond Safer Injecting”—Health and Social Needs and Acceptance of Support among Clients of a Supervised Injecting Facility. International Journal of Environmental Research and Public Health,. 2019;16(11).
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