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Dumfries and Galloway Alcohol and Drug Partnership (ADP)

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HARM REDUCTION

Drug Harm Reduction Information

Don’t Take Drugs Alone

Taking drugs on your own is not a wise idea.

Most fatal overdoses take place when people are taking drugs on their own, behind closed doors. Taking drugs alone increases the chances of a fatal overdose, because there is no one else there to call for help. This is why it’s really important to have a trusted person there who can call emergency services for help if it’s needed.
Having someone you can trust with you in the room is really important when using opioids. It means there is someone there who can call for an ambulance. However, they might also be able to give you naloxone, which can be used in emergencies to help reverse the effects of opioids.

Don’t Mix Drugs

Taking a mixture of different drugs in a single session can be very dangerous

People will often take one drug, and then take another to ‘top up’ or come down. Sometimes they will replace the drug they are taking with another drug. However, this drug mixing can create unexpected, unwanted and unpredictable effects on both your physical and mental health. Taking opioids like heroin and methadone and depressants like benzodiazepines and alcohol in combination is very risky. Please don’t take drugs that aren’t prescribed to you, or that have been bought online. You won’t know what they contain or the harm that they can cause you. Drug use carries a risk of overdose in its own right. When drugs are combined, this risk is very much increased.

Don’t Try New Substances

Everyone should be very cautious about the sources they buy drugs from, and the drugs they take.

Please don’t be tempted to try new substances. Don’t take pills or powders unless you know what they are, as you don’t know what affect they will have. ‘Street benzos’ are a benzodiazepine-type tablet which may be known as blues, vallies, benzos, scoobies and diazepam. Much of the diazepam sold at street level contains other benzodiazepines such as etizolam. Taking “street benzos” daily can have serious consequences to your physical and mental wellbeing and frequent use can lead to anxiety, depression and sleep problems. Etizolam is unpredictable, and is a leading cause for hospitalisation and deaths in the UK.

Signs of an Overdose

If you believe someone is having an overdose, or if you feel unwell after taking any drug, dial 999 immediately.

If you can correctly identify the physical signs and symptoms of an overdose, there is a chance you will be able to save a life. It is important to remember that the time gap between using drugs and slipping into an overdose can be several hours.
Some of these symptoms include:
  • Pinpoint pupils (this indicates whether opioids are involved).
  • Breathing problems (e.g. slow/shallow or infrequent breaths, snoring/rasping sounds or not breathing at all).
  • Pale skin colour. Lips, tip of nose, fingertips or nails with a bluish tinge.
  • No response to noise (shouting) or touch (shoulder shake).
  • Loss of consciousness
What you can do:
  • Be vigilant and think of your own safety first. Watch out for needles that might be around the casualty. Never attempt to re-cap a needle
  • Check the casualty for a response – shake their shoulders and shout loudly ‘open your eyes’ or ‘wake up’.
  • If there is no response, shout for help from anyone that is around.
  • Turn the casualty on their back and open their airway by gently placing two fingers under their chin and tilting their head back.
  • Place your ear above the casualty’s mouth and LISTEN for breathing, FEEL for breath on your cheek. Also LOOK at their chest to see if it rises and falls. Do this for 10 seconds.
If the person is breathing, place them in the recovery position. Dial 999 and calmly ask for an ambulance. Give the location and status of the casualty, i.e. the address and that the casualty is unconscious and breathing. Stay with the person until the ambulance arrives. If the person is not breathing, dial 999 and calmly ask for an ambulance. Give the location and status of the casualty – i.e. the address and that the casualty is unconscious and NOT breathing. Begin CPR. If you don’t know CPR, the emergency call handler can talk you through this process.
Click the link below to learn:
  • How to respond when someone is unconscious & unresponsive
  • How to respond to suspected opioid overdose
  • How to put someone into the recovery position
  • How to perform CPR
  • How to inject Prenoxad Injection (injectable naloxone)
Prenoxad Injection

Safe Injecting

There are key actions that can reduce some dangers when injecting drugs.

Not sharing drugs or equipment with another person is very important. Sharing drugs/equipment can put you at risk of infection through blood-to-blood contact. Sharing drugs/equipment puts you at a higher risk of HIV and other infections found in the blood like hepatitis C. Sharing of needles and syringes can create a high risk of passing infection on to others. It’s important to remember that the equipment such as spoons, water, filters which are used when preparing drugs for injection can have traces of blood on them.
Top tips are:
  • Wipe down any drug packaging, wraps or baggies with alcohol wipes as soon as possible after buying
  • If preparing drugs, always prepare a clean surface, cleaned down with anti-bacterial spray or alcohol wipes. If it’s not possible, use something like clean kitchen roll and dispose of it afterwards
  • Do not share any paraphernalia, including needles, water, spoons of equipment for injecting straws or equipment for snorting, pipes for smoking or dabbing in shared bags.
  • New equipment greatly reduces the risk of ALL infections
  • Clean your hands and the injecting site
  • Alternate your injecting site (rotate sites)
  • Use sterile water
  • Maintain skin health
  • Dispose of equipment safely

It is important to dispose of used needles carefully. The best place is a proper sharps bin, which you can get from your local needle exchange and some chemists. For more information on needle exchange in Dumfries and Galloway contact:

NHS Specialist Drug and Alcohol Service
Lochfield Road Primary Care Centre,
12 Lochfield Road, Dumfries. DG2 9BH
t. 01387 244555

We Are With You
79 Buccleuch Street, Dumfries. DG1 2AB
t. 0800 035 0793

Naloxone

Naloxone is the name of a medication which can temporarily reverse the effects of an opioid overdose.

The most commonly known opioids are heroin, methadone, buprenorphine, codeine, morphine, fentanyl and tramadol. Opioids affect the part of your brain that instructs your lungs how to breathe. During an overdose, this signal is reduced and then eventually switched off. If used within a short period of time, naloxone can be a life saver by allowing you to breathe again. Using naloxone allows time for someone to seek emergency help. Naloxone kits can be supplied to drug users at risk of an opioid overdose and can be given to their family and friends to be used by them when someone has had an overdose. If you have a naloxone kit, check it contains two needles by holding it up to a bright light. You should see two dark rectangular patches. Don’t open the kit to check it – the kit must remain sealed until use.
Click here for more information

Remember: naloxone kits save lives.

Organisations Issuing Naloxone Kits in D&G:

NHS Specialist Drug and Alcohol Service
Lochfield Road Primary Care Centre,
12 Lochfield Road, Dumfries. DG2 9BH
t. 01387 244555

We Are With You
79 Buccleuch Street, Dumfries. DG1 2AB
t. 0800 035 0793

SFAD Take Home Naloxone Service

Tolerance

Tolerance is your body’s ability to process a certain amount of a drug. Low tolerance means that your body can only process a small amount of a drug (i.e. it takes less drugs to feel the effects).

Tolerance develops over time, so the amount of a drug a long-time user needs to feel the drug’s effects can be more than a newer user. Tolerance also wavers depending on several factors including, weight, size, illness, stress, compromised immune system, and age.

Most importantly, tolerance can decrease rapidly when someone has taken a break from using a drug whether intentionally  – for example, while in drug treatment or detoxification – or unintentionally – for example, while in police custody or the hospital. 

Taking the same quantities of a drug that you believe you are used to, after a period of abstinence increases your risk of a fatal overdose.

Prevention Tips:

  • Use less when you are feeling unwell or you haven’t used—even a few days of abstinence or decreased use can lower your tolerance.
  • If you are using after a period of abstinence, be careful and go slow
  • Do a tester dose, or go slow
  • Use different method, i.e. snort instead of inject

Blood Borne Viruses

Blood Borne Viruses (BBVs) (e.g. hepatitis C, HIV) can be passed from person to person in a variety of ways, such as sharing injecting equipment or blood/bodily fluid contact with a person who has a BBV.

If you are worried you have a BBV we recommend you get tested. This can be organised by either contacting We Are With You or by contacting the NHS Specialist Drug and Alcohol Service.

HIV, Hepatitis C and STI testing along with sexual health advice is available at all Sexual Health Clinics in Dumfries and Galloway and is free of charge.

Count 14

It’s recommended that you don’t drink more than 14 units of alcohol a week, spread out over at least 3 days, to keep the risks from alcohol low. This is the same for both men and women.

 

14 units is the equivalent of:

 

  • 6 pints of beer
  • a bottle and a half of wine
  • half a bottle of spirits

It is best to spread this evenly across the week rather than drinking all at once. Having several alcohol-free days each week is a good way to cut down.

Tips for cutting down

  • Have food before and during drinking
  • Drink plenty of water in between alcohol drinks
  • Watch out for bigger measures poured at home
  • Check the strength of your drink - brands can vary dramatically
  • Choose a low or alcohol-free option instead
  • Set a budget for a night out and stick to it
  • Have several alcohol-free days each week

What is a unit?

A unit is 10ml of pure alcohol.

You can work out how many units are in any drink. Multiply the volume (in ml) by the % abv (strength) then divide by 1000.

For example, a 750ml bottle of wine which is 13% abv would be:

750 x 13 = 9,750/1000 = 9.75 units

Or use this handy drinks calculator: https://www.count14.scot/#unit-calculator

Alcohol Poisoning

Alcohol poisoning can happen when you drink alcohol quicker than your body can process it. It can make you seriously ill and you may need to go to hospital for treatment.

  • Confusion
  • Slurring words or being unable to speak
  • Being unable to coordinate movement, for example being unable to stand, walk or pick things up
  • Being sick
  • Urinating or defecating yourself
  • Pale or blue tinged skin. On black or brown skin this may be easier to see inside the lips, on the gums and under the fingernails.
  • Slow or irregular breathing
  • Having a seizure or fit
  • Loss of consciousness

If you believe someone has alcohol poisoning all 999 immediately.

 

Things you can do to help someone who has drank to much alcohol

Do:

  • Stay with them because there is a risk they could choke on their own sick or stop breathing
  • Sit them up if they’re awake, or put them in the recovery position if they’ve passed out and check they’re breathing properly
  • Give them water to sip if they’re able to swallow it
  • Keep them warm with a jacket or blanket

Don’t

  • Do not let them drink more alcohol
  • Do not give them coffee or drinks containing caffeine because this can dehydrate people with alcohol poisoning
  • Do not put them in a cold shower or bath because there’s a risk they could get too cold, fall or lose consciousness in the water

Recognising Alcohol Withdrawal

Heavy drinkers who suddenly decrease or stop drinking altogether may experience withdrawal symptoms. They are potentially dangerous and should be treated as a serious warning sign that you are drinking too much.

Withdrawal symptoms are part of a condition called ‘alcohol withdrawal syndrome’, which is a reaction caused when someone who has become dependent on alcohol stops drinking it.

The more you drink on a regular basis, the more you’re likely to be affected by withdrawal symptoms. To keep health risks from alcohol to a low level, the UK Chief Medical Officers (CMOs) advise it is safest not to drink more than 14 units a week on a regular basis.

If you are concerned you might be dependent on alcohol, you should seek medical advice to help you cut down and stop your drinking safely.

Symptoms of Alcohol Withdrawal

Withdrawal symptoms can be physical and psychological, and range in severity from mild to severe.

Typical symptoms of alcohol withdrawal can include:

  • Hand tremors (the shakes)
  • Sweating
  • A pulse rate above 100 beats per minute
  • Nausea
  • Vomiting
  • Headaches
  • Loss of appetite
  • Depression
  • Anxiety
  • Irritability
  • Restlessness
  • Insomnia (difficulty sleeping)

Milder symptoms usually start within eight to 24 hours from the last alcoholic drink.

Severe symptoms can additionally include hallucinations (seeing, hearing, or feeling things that aren’t real), as well as seizures or delirium tremens (‘DTs’).

Delirium tremens is a severe indication of alcohol withdrawal. Symptoms include:

 

  • Severe disorientation
  • Increased heart rate, blood pressure and breathing problems
  • Uncontrollable restless behaviour

Severe withdrawal effects can be life threatening.

Approximately one in 10 people with alcohol withdrawal syndrome are affected by seizures. If left untreated, up to one in three of these patients go on to experience delirium tremens.

If you (or someone you’re looking after) experience repeated vomiting, severe shaking or hallucinations, seek medical attention.

Seeking Help

If you think you are dependent on alcohol or are looking for support to reduce and stop your drinking, it is important to seek help. 

 

NHS Specialist Drug and Alcohol Service
Lochfield Road Primary Care Centre,
12 Lochfield Road, Dumfries. DG2 9BH
t. 01387 244555

We Are With You
79 Buccleuch Street, Dumfries. DG1 2AB
t. 0800 035 0793

Alcohol and Drug Support South West Scotland
79 Buccleuch St, Dumfries DG1 2AB
t. 01387 259999

225 King St, Castle Douglas DG7 1DT
t. 01556 503550

32 Charlotte St, Stranraer DG9 7EF
t. 01556 503550

Alcohol, Drugs and Pregnancy

When you’re pregnant, taking drugs and/or drinking alcohol can seriously affect you and your baby’s health. Sometimes this can be lifelong.

How drugs can harm your baby

Taking drugs (including tobacco and alcohol) when you’re pregnant, even in small quantities, can put your baby’s health at serious risk. It increases the risk they’ll be stillborn or will die in the first few weeks and months of life.

These are difficult things to imagine happening but are real risks if you take drugs.

Your baby’s also more likely to:

  • Be born early
  • Be underweight
  • Have feeding and breathing problems
  • get infections
  • Have problems with their development and growth

Prescribed Medicines

You should also speak to your GP, midwife or a drug support service if you’re regularly taking prescribed medicines. Stopping your medication suddenly could be harmful for you and your baby.

Neonatal Abstinence Syndrome (NAS)

Some prescribed or illegal drugs that can cause physical dependency can pass through the placenta and be absorbed by your baby.

Following delivery your baby may show signs of physical withdrawal known as Neonatal Abstinence Syndrome.

Some of these babies may need specialist care after birth and medical treatment to help them withdraw.

If you have any questions about NAS you should speak to your midwife.

How alcohol can harm your baby

There’s no known safe limit of drinking during pregnancy.

Some people will tell you that having the odd drink when you’re pregnant is okay.

The safest option is to stop drinking when you’re trying to get pregnant or as soon as you know you’re pregnant.

Your baby’s developing all the way through your pregnancy. Alcohol can be harmful at any stage.

Drinking alcohol:

  • Damages your baby's developing cells which can affect how their brain and organs develop and how they look
  • Makes it more likely you'll have a miscarriage, or your baby will be born early or underweight
  • Can cause foetal alcohol spectrum disorder

Foetal Alcohol Spectrum Disorder (FASD)

If you drink while pregnant your baby could develop fetal alcohol spectrum disorder (FASD). This is a term used to describe a range of alcohol-related birth defects.

About 3 in every 100 children and young people in the UK have FASD, but it’s preventable by avoiding alcohol when pregnant or planning a pregnancy.

FASD may not always be detected at birth but can cause problems later in life, including:

  • Problems with hyperactivity, impulsivity, and attention
  • Learning and behavioural difficulties
  • Experiencing difficulty in social interaction, personal care, making sense of the world, and staying safe
  • Sensory difficulties such as being sensitive to, and distressed by, certain patterns of light, sound, or touch
  • Vulnerability to victimisation and bullying