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2.4.4 Emerging and ancillary interventions BOX 24: Resources on harm reduction for stimulant use.
Several additional interventions are important as part of • Guidance for general practitioners working with people who use stimulants:
https://www.rcgp.org.uk/-/media/Files/SMAH/RCGP-Guidance-for-working-
comprehensive harm reduction. Some are briefly provided with-cocaine-and-crack-users-in-primary-care-2004.ashx?la=en
below, including (1) harm reduction for people who use • HIV prevention, treatment, care and support for people who use stimulant
stimulants, (2) drug consumption rooms and (3) drug drugs: https://www.unodc.org/documents/hiv-aids/publications/People_who_
use_drugs/19-04568_HIV_Prevention_Guide_ebook.pdf
checking services. • A community-based site with details about drug compositions and harm
reduction: https://tripsit.me/about/
2.4.4.1 Harm reduction for people who use stimulants:
Cocaine, methamphetamine (tik, ice), methcathinone (cat) rooms across 117 sites. An overview of drug consumption
5
and MDMA (ecstasy) are the most common unregulated rooms is available at: http://www.drugconsumptionroom-
stimulants seen in southern Africa, and methylphenidate is international.org.
the most prescribed stimulant.
2.4.4.3 Drug-checking services: A means to check the quality
Simple harm reduction advice for people who use stimulants and purity of drugs should be available to people who use
is to follow a few steps. drugs. This includes fixed site testing and on-the-spot testing
• Avoid the concurrent use of alcohol and cocaine. Cocaine options, the latter being mostly qualitative tests. For
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use potentially compromises the cardiovascular system example, strips designed to identify fentanyl in drugs may
and is linked to several cardiovascular diseases; this risk help to prevent overdoses. People who use opioids can use
increases with the concurrent use of alcohol. the results of the test kit strip to inform their drug use (i.e. to
• Rest: Sleep deprivation and stimulant use increase the use slowly, to reduce the volume of drug, to use in the
chance of psychosis. People on stimulants often binge for company of others, to have a naloxone rescue kit nearby or
days. People using stimulants should be encouraged to not to use the substance). Test kits can be used on crushed
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lie down in a dark space, with eyes close and relax for at pills or powders. Guidance around the use of fentanyl test
least 3–4 h every 24 h. strips is available at: https://harmreduction.org/issues/
• Hydrate: People using stimulants may be at risk of fentanyl.
dehydration. People should be encouraged to drink
500 mL water per hour, especially if dancing. Key points
• Eat: People using stimulants should be encouraged to eat • Harm reduction requires engaging with patients to
something at least every 24 h, even if not hungry. identify immediate risks and develop means to reduce
• Dental care: Sip water when the mouth is dry and brush these.
teeth twice a day.
• Screening, brief intervention and referral for treatment is
an effective approach to detect and intervene in harmful
Other relevant harm reduction interventions include substance use.
psychosocial support, condoms and lubricants (amphetamine- • Needle-and-syringe services are the cornerstone of HIV
type stimulants can increase sex drive and risky sexual prevention for people who inject drugs and should be
practice) and drug paraphernalia distribution (injecting and/ provided at all contacts with health services.
or smoking kits that include mouth pieces for crack pipes),
services for sexually transmitted infections, income • People who inject drugs should be supported to return
generation and housing support. Substitution therapies for their used injecting equipment and locations for safe
stimulant use disorders are under investigation. disposal of used equipment should be made widely
available.
2.4.4.2 Drug consumption rooms: Drug consumption rooms • Opioid substitution therapy is the most effective treatment
(also known as safe injecting facilities, medically supervised for opioid use disorder. Effectiveness is maximised when
injecting sites or overdose prevention sites) are protected patients are supported and provided with an optimal
places for the hygienic consumption of drugs in a non- dose of medication. Voluntary psychosocial services can
judgemental environment. They allow people to use drugs improve outcomes. Safety risks are greatest early on
under medical supervision or in the presence of trained and during treatment, and patients who are stable should be
equipped peers, enabling an immediate response to considered for take-home dosing. Treatment should be
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overdose and decreasing the transmission of blood-borne long term.
diseases through access to sterile injecting equipment and • Good supply chain and stock management are important
education on safe injection practices. Drug consumption to minimise diversion of opioid agonist medications.
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rooms increase uptake of other health services and are an • Opioid overdoses cause many deaths and are preventable.
entry into care, for example, facilitating access to HIV, viral People likely to witness an opioid overdose should be
hepatitis, TB testing and treatment services and counselling. trained to identify and respond to this, and access to
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In 2018, 11 countries were operating drug consumption naloxone should be maximised.

http://www.sajhivmed.org.za 98 Open Access