What harm reduction means and how it can help someone you love

This page is not medical or legal advice. Do Not Lose Hope is not a clinic or a crisis line.

What is harm reduction?

Harm reduction is a way of caring for people who use drugs or alcohol that starts with one goal: keep them alive and as healthy as possible, right now. It does not wait for the person to quit first.

It meets people where they are, without judgment. It offers practical tools like naloxone, drug testing strips and clean supplies. It treats any step toward safety as a real step, even if it is small. And it keeps a door open to treatment whenever the person is ready.

Your family member may not be ready to stop today. That does not mean you have to wait, or that you have failed. You can still help them stay alive.

Does harm reduction mean saying drug use is okay?

No. This is the most common fear, especially in families of faith.

Harm reduction does not approve of drug use. It accepts a hard fact: a person who dies cannot recover. Keeping someone alive is not giving up on them. It is refusing to give up.

The evidence backs this up. The CDC reports that syringe services programs do not increase drug use or crime. People who use them regularly are more than five times as likely to start treatment as people who never have. Many people come to treatment through someone who kept them safe first.

Many families, across cultures and faiths, believe every life has worth and no one is beyond reach. Harm reduction is one way to live that out. You can hope, and pray if you pray, for full recovery and still keep naloxone in your purse.

What does harm reduction look like?

For drugs

• Naloxone (Narcan) in the home, the car and the backpack.
• Fentanyl test strips to check drugs for fentanyl before use. In California, testing equipment used to check drugs for fentanyl and other contaminants is not illegal drug paraphernalia.
• Never using alone, so someone can respond to an overdose.
• Clean syringes and supplies to prevent HIV and hepatitis C. In California, having syringes for personal use is not a crime.
• Taking extra care after a break. After time away from opioids, a person can overdose more easily on the amount they used before.
• Medication for addiction, like methadone, buprenorphine or naltrexone, which is standard care for opioid use disorder. See Medication for addiction treatment.

For alcohol

• Never driving after drinking. Hand over the keys.
• Not stopping suddenly after heavy daily drinking without a doctor. Alcohol withdrawal can quickly become life threatening.

Why does fentanyl change everything?

Fentanyl is a very strong opioid. The CDC says illegally made fentanyl can be mixed into heroin, cocaine and methamphetamine, and is more and more often pressed into fake pills. Many people do not know their drugs contain it. That is why naloxone matters even if your family member "only" uses pills or cocaine.

Naloxone will not harm someone who is overdosing on something other than opioids. The CDC says to use it any time you think someone is overdosing. With fentanyl, more than one dose may be needed.

What do I do if someone is overdosing?

Signs of an opioid overdose:

• Cannot be woken up, or will not respond
• Slow, shallow or no breathing
• Blue or gray lips or fingernails
• Tiny, pinpoint pupils

Watch the short training video that comes with the naloxone, or the free videos from your county, so you are ready before you need it.

What if they use alone?

Using alone is one of the biggest overdose risks. Ask your loved one to tell someone, or to call the Never Use Alone line at 800-484-3731. The line is open 24/7 and is confidential. The person gives their location and stays on the phone. If they stop responding, the line sends emergency services to that address. Your family member should know that before they call.

How can I talk with them without pushing them away?

These are our suggestions, not medical rules.

1. Lead with love, not lectures. "I love you. I am scared of losing you. I got naloxone, not to judge you, but because I want you here."
2. Ask, then listen. "What do you like about using? What do you not like?" People change when they hear their own reasons.
3. Notice every safer choice. Using with a friend nearby, testing drugs, eating, getting water. Say thank you.
4. Keep the door to treatment open, and do not force it. "Whenever you want to talk about getting help, I will make the calls with you."
5. Set limits that protect you. You can say no to money, no to drugs in your home, and no to being hurt. Limits are not rejection.
6. Do not argue when they are high or drunk. Wait for a calm time.

How do I take care of myself?

Loving someone who uses drugs can break your heart again and again. You need care too.

• Call or text 988 when you are the one struggling. It is for drug and alcohol worries too, including about someone else.
• Join a family support group. See Caring for a family member with mental illness for free family support groups and classes.
• Talk with your pastor about the weight you carry. See When to talk to your pastor and when to see a counselor.

Is getting help risky for immigrants?

For most people, the safety steps on this page carry no immigration question at all. Keeping naloxone and calling 911 for a dying person are about saving a life.

But drug use itself can affect some immigration cases. Under federal law, a person found to be a drug abuser or addict can be denied a green card or, in some cases, deported. If your loved one is not a U.S. citizen, read Can I get help for drug or alcohol use without hurting my immigration case? and talk to a trusted immigration lawyer. See Free legal help in the Bay Area.

Questions people ask

Will having naloxone in the house send the wrong message? Think of it like a fire extinguisher. Having one does not mean you want a fire. It means you want everyone to live if one starts.

Can I use naloxone on a stranger? Yes. Anyone can carry it and give it.

My family member says they do not use opioids. Fentanyl can be hidden in other drugs and fake pills. Keep naloxone anyway.

Where can they get treatment when they are ready? Call your county line. San Mateo County residents: (800) 686-0101. Santa Clara County residents: (800) 704-0900, press 1. Other California counties: find yours on the DHCS county access line list. Anywhere in the U.S., call SAMHSA at 1-800-662-4357. See How to find drug and alcohol treatment for an adult.

Who can help

These are public programs, clinics and free lines. Contact them to confirm hours, languages and openings. Being listed here is not a referral or a promise of service.

• San Mateo County Overdose Prevention: free naloxone from Naloxone Stand Boxes and the vending machine at Maguire Correctional Facility, 300 Bradford St, Redwood City. Email HS_BHRS_OverdosePrevention@smcgov.org. smchealth.org
• Santa Clara County Opioid Overdose Prevention Project: free naloxone by mail for county residents, 408-272-6055. santaclaracounty.gov
• San Mateo County BHRS ACCESS Call Center (for county residents): for substance use and mental health care. (800) 686-0101, 24 hours, TTY 711.
• Santa Clara County Behavioral Health Services Call Center (for county residents): (800) 704-0900, then press 1, 24 hours.
• SAMHSA National Helpline: 1-800-662-4357, free, confidential, 24/7, English and Spanish. samhsa.gov
• Never Use Alone: 800-484-3731, 24/7. neverusealone.com
• Poison Control: 1-800-222-1222, 24/7. calpoison.org
• 988 Suicide & Crisis Lifeline: call or text 988, or chat at 988lifeline.org. Free and confidential, available 24/7/365.

As long as your loved one is alive, there is hope. Keeping them alive is an act of love.