Different pills of various color and shapes loose on a surface.

A Harm Reduction Guide for Safer Substance Use

Around the country, police report near-fatal overdoses from touching minute quantities of fentanyl, a synthetic opioid. The only problem? That’s actually medically impossible (BuzzFeed News). As fictitious as the idea that dealers dose trick-or-treating kids every Halloween (Newsweek), fake cop overdoses push a narrative that only the police protect us from instant drug-related death. If just touching Fentanyl can kill you, there’s no point in promoting safe drug use. There’s also no reason not to intensify a counterproductive, brutal “War” on drug users and dealers. 


• Share evidence-based harm reduction information with people you know.

Carry Narcan with you and learn how to recognize and intervene in an overdose.

• Support the National Harm Reduction Coalition, Drug Policy Alliance, or a drug users’ union.  

Why should I know about drug safety? 

Even if you never use mind-altering substances, you likely know somebody who does. One in five people in the U.S. have used illegal drugs, to say nothing of those who won’t self-report (Very Well Mind), and 85% have consumed alcohol (NIH). Knowing about safe substance use means we can look out for the safety of people around us. And knowing the evidence helps us make informed opinions on an important issue. 

What kinds of drugs are there? 

Stimulants like caffeine, nicotine, and cocaine increase your heart rate and energy. Depressants like alcohol and benzodiazepines decrease your heart rate, as do opioids like OxyContin and heroin. Acid and psilocybin mushrooms are hallucinogens, and marijuana is in its own class (VeryWellMind). 

But aren’t illegal drugs different from things like caffeine or alcohol? 

In terms of risk, no. Alcohol is the most harmful mind-altering substance available, though it’s treated very differently than heroin or methamphetamine. It’s addictive, creates severe long-term effects, and can easily cause a lethal overdose — though getting dangerously drunk is often encouraged. A peer-reviewed study found that “the legal status of a drug has little to do with its harms” (ACSH). 

Aren’t drugs like crack cocaine and heroin worse? 

Crack cocaine and powder cocaine are two delivery mechanisms for the same substance, one that’s quite similar to Ritalin (Slate). Fentanyl and heroin work on the same parts of the brain as medical OxyContin and morphine (Drug Policy Alliance). Crack and heroin are stigmatized because of their association with low-income users, especially people of color.

It’s harder to safely use illegal drugs than those that are medically prescribed, which is why you hear more stories of people overdosing on crack than Ritalin. First, illegal drugs are produced in secret, so they can include adulterants and other dangerous substances. Fentanyl is a cheaper additive that can easily create a lethal dose when not measured properly. Also, people are more likely to do illegal drugs in private, meaning there’s less chance of help in the event of an overdose. 

What are overdoses and addictions? 

An overdose is a toxic amount of drugs overwhelming your body. As a depressant, alcohol can hasten an overdose from other depressants like opioids. Mixing stimulants and depressants also increase the risk of an overdose if one wears off before the other (NHRC). 

Addiction is the compulsive use of a drug despite unwanted consequences. If you can’t get through the day without coffee, you’re addicted to caffeine. This addiction isn’t socially harmful since caffeine is readily available (The Guardian). Because it’s a pattern of behavior, it isn’t correct to say that someone’s addicted after a single use (NIH). The idea that addicts suffer from weak willpower or must “hit rock bottom” before kicking an addiction are both harmful myths (PBS). 

How can people use drugs more safely? 

Test your drug supply using reagents and test strips to know exactly what you’re consuming (Dancesafe). To prevent infections, don’t share pipes or needles, or use needles more than once (NHRC). Stay hydrated, especially on stimulants like cocaine or MDMA, and avoid using substances—including alcohol!—alone (Drug Policy AllianceCBC). Don’t take psychedelic drugs if you aren’t in a good headspace or aren’t in an environment in which you feel safe, and try to have a non-intoxicated friend serve as a “trip sitter” (Vice). Finally, watch out for signs that your substance use is becoming a problematic addiction (Healthline). 

How can we keep other people in our communities safe? 

We should all know the signs of an opioid overdose, carry Narcan, and be prepared to use it. Many municipalities, states, nonprofits, and health insurance providers offer it for free (GoodRx). And we have to recognize that shaming people who use drugs is worse than counterproductive. It doesn’t erase addictions but takes lives by forcing people to use drugs in less safe ways. We also need to support harm reduction efforts like injection sites that allow for safe drug use and drug users’ unions that fight for the rights of substance users while opposing the criminalization and incarceration of drug users (ACLU). 


• Knowing about the safe drug use of mind-altering substances is important, even if you don’t use drugs yourself. 

• The criminalization and stigma around certain substances are based on racism and classism, not medical risk. 

• Stigmatization of drug use is deadly since it promotes unsafe use and prevents people from accessing help.

1920 1280 Andrew Lee

Andrew Lee

Andrew Lee is a writer and organizer plotting a better world in Philadelphia. His work has previously appeared in Notes From Below, Perspectives on Anarchist Theory, Plan A Magazine, ROAR Magazine, and Teen Vogue.

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