Harm Reduction — Naloxone, Fentanyl Test Strips, Syringe Services
Module 5 of 11 · 45 min
Pragmatic harm-reduction strategies that save lives without requiring abstinence.
Learning objectives
- •Prescribe naloxone appropriately + train patients/families on use
- •Educate on fentanyl test strips + their limitations
- •Refer to syringe services + safe consumption sites where available
- •Counsel on overdose risk after period of abstinence
Naloxone — the critical OD reversal
Pure mu antagonist; reverses opioid respiratory depression in 2-5 min. Forms: IM/IV/SC injection (0.4 mg), nasal spray (Narcan 4 mg/spray), high-dose nasal (Kloxxado 8 mg). Standing order in all 50 states; pharmacist can dispense without script. Co-prescribe naloxone for: any patient on chronic opioids ≥ 50 MME/day, history of OUD, prior overdose, concurrent benzo. Train family/friends on use. Repeat doses if needed (fentanyl OD often needs 2-3+).
Fentanyl test strips
Cheap (\$1-2/strip) immunoassay strips originally for urine. Diluted drug + testing strip = positive/negative for fentanyl above ~100 ng/mL. Used by people who use drugs to check supply for adulteration (fentanyl now contaminates cocaine, MDMA, counterfeit pills). Limitations: doesn't detect all fentanyl analogs, false negatives possible, no quantitation. Distribute through harm-reduction programs. Some states still classify as drug paraphernalia.
Syringe services + safe consumption
Syringe services programs (SSPs): exchange used needles for clean ones + provide naloxone, HIV/HCV testing, wound care, MAT linkage. CDC + WHO endorse. Reduce HIV/HCV transmission ~50% in IV drug users. Safe consumption sites (legal in NYC, parts of Canada/Europe): supervised injection facilities — zero overdose deaths in 30+ years of operation worldwide. Federal law in US still ambiguous. Refer + advocate where available.
Counseling: overdose risk after abstinence
Tolerance drops within days of cessation. Patient released from incarceration, completing residential rehab, or post-detox is at PEAK overdose risk if they relapse — they take their previous dose, but tolerance is gone. Document this risk in MAT discharge planning. Naloxone always at home. Family/SO counseled. This is when overdoses happen.
References
- · CDC Naloxone Guidelines
- · WHO Harm Reduction
- · SAMHSA Overdose Prevention Toolkit