Prevent Infection, Overdose, and Death

Harm Reduction

Harm reduction includes principles, policies, and practices that aim to reduce the harms associated with certain risky behaviors. Using harm-reduction strategies keeps us safe. For example, driving a car or riding a bike can be risky. However, if we wear our seat belt or helmet (two harm-reduction strategies), we are less likely to sustain severe injuries if we get in an accident. 

 

Harm reduction strategies are also applicable to substance use and related social conditions. Grounded in public health, social justice and human rights, harm reduction strategies aim to promote positive behavior change by meeting people where they are at—without judgement, coercion or discrimination. Harm reduction strategies are utilized by many people, including those with substance use disorders, members of their support network and even healthcare providers. 

 

In the context of substance use, some commonly used harm reduction strategies include the provision of sterile needles or “Needle Exchange Programs,” needle collection boxes and naloxone distribution programs. Harm reduction strategies support the safety of all individuals by encouraging incremental changes to risky behavior. 

The Syringe Exchange Program

Skagit County Public Health’s Mobile Syringe Exchange program aims to reduce health risks among adult IV drug users and the community at large. The program offers one-for-one needle exchange, safe disposal containers, no-cost Narcan® kits, education, referrals to treatment and more. Providing individuals with sterile needles helps prevent the transmission of blood-borne diseases, such as HIV and Hepatitis C. This program also helps reduce the number of contaminated needles in our community and the public waste system (i.e., in order to obtain a sterile needle, an individual must return a contaminated needle). An additional focus of the Mobile Syringe Exchange program is intervention and referral to behavioral health services, including treatment for substance use disorders. In 2019, 89 individuals were referred to treatment.

The Mobile Syringe Exchange program saves lives. It is estimated that 362 overdoses were reversed with naloxone obtained from the Syringe Exchange between February 2016 and April 2020.

The mobile van can be found in multiple locations throughout Skagit County:

Mount Vernon
Tuesday: 9AM-12PMCoastal Farm & Ranch Parking Lot, 2021 Market Street
Thursday: 3PM-5PMSenior Center, 1401 Cleveland Street
Sedro Woolley
Tuesday: 1PM-4PMUnited General Hospital, 2000 Hospital Drive
Thursday: 9AM-11AMSenior Center, 715 Pacific Avenue
Burlington
Thursday: 12PM-2PMTierra Nueva, 701 E. Fairhaven Avenue
Concrete
1st and 3rd Monday: 2PM-4PMSenior Center, 45821 Railroad Avenue
Anacortes
3rd Monday: 10AM-12PMSalvation Army, 3001 P Avenue
Marblemount
1st Monday: Call Randall for time and site360-826-2661

For Current Drug Users

Here are ways to reduce risk of infection, overdose and death:  

  1. Prevent the risk of contracting communicable diseases by using clean needles. The Mobile Needle Exchange Program offers a 1:1 needle exchange along with other lifesaving resources.  
  2. Prevent overdose –

HOW TO AVOID OVERDOSE

DO NOT USE ALONE

KNOW WHAT IS IN YOUR DRUGS

When possible, test your drugs before using. The Mobile Syringe Exchange has free fentanyl test strips.

START WITH A SMALL AMOUNT

Fentanyl is approximately 50-100 times stronger than other opioids.

WATCH AND WAIT BEFORE THE NEXT PERSON USES

HAVE NALOXONE READY

AN OVERDOSE IS A MEDICAL EMERGENCY-CALL 911 IMMEDIATELY

  1. If you witness an overdose, call 911 immediately. YOU COULD SAVE A LIFE. The Good Samaritan Law protects  you and the overdosing person from drug consumption or drug possession charges.

If you are unable to call 911 or unable to stay until medical help arrives, make sure to:

  • Administer naloxone, if available. 
  • Provide rescue breathing
  • Leave the person where they can be found, with doors unlocked and/or open. If 911 is called, tell the dispatcher exactly where the overdosing person is. Give them as much information as possible (e.g. second floor or in the bathroom). 
  • Put the person experiencing an overdose in the Recovery Position. This will help keep their airway clear and prevent them from choking.

For more information and other harm reduction tips:

Warning: Dangerous Drug Interactions

Are you using prescription or illicit opioids? Many drugs have the potential to interact negatively with opioid medications.

 

EXAMPLE: Benzodiazepines, a class of psychoactive drugs including Xanax and Valium, are often prescribed for anxiety and insomnia. When benzodiazepines are combined with opioids, the risk of experiencing an overdose drastically increases. This is because both types of medications suppress bodily functioning. When mixed, these medications may lead to slowed or stopped breathing, decreased heart rate, and risk of death. Alcohol acts in a similar way. Therefore, it is recommended to restrict alcohol use while taking opioids. 

 

The Mayo Clinic provides additional examples of medications that may negatively interact with opioids:

Anti-seizure medications, such as carbamazepine (Carbatrol®, Tegretol®, others), topiramate (Topamax®, Qudexy XR®, others) and lamotrigine (Lamictal®)
Certain antibiotics, including clarithromycin
Certain antidepressants
Certain antifungals, including itraconazole (Onmel®, Sporanox®, Tolsura®), voriconazole (Vfend®) and ketoconazole
Certain antiretroviral drugs used for HIV infection, including atazanavir (Reyataz®), indinavir (Crixivan®) and ritonavir (Norvir®)
Drugs for sleeping problems, such as zolpidem (Ambien®, Edluar®, others), eszopiclone (Lunesta®) and zaleplon (Sonata®)
Drugs used to treat psychiatric disorders, such as haloperidol (Haldol®), clozapine (Clozaril®, Versacloz®), aripiprazole (Abilify®) and quetiapine (Seroquel®)
Medications used to treat certain types of nerve pain, such as gabapentin (Neurontin®, Gralise®) and pregabalin (Lyrica®)
Muscle relaxers, such as cyclobenzaprine (Amrix®) and baclofen

Both prescription and over-the-counter medications have been shown to produce adverse health effects when mixed with opioids. Know your medications, and the potential for life-threatening drug interactions. Talk with your doctor or pharmacist about your medications and be honest when they ask about your current drug/medication use.

Overdose: Know the Signs and How to Help

Too much of an opioid—which varies based on the individual, length of time used and what the drug is made of, overwhelms brain receptors, and depresses the central nervous system. If an overdose is not reversed in time, a person’s body will shut down and breathing will stop. It can be difficult to tell if a person is just very high or experiencing an overdose. If you are having a hard time telling the difference, it is best to treat the situation like an overdose—it could save someone’s life. 

 

Minutes count in an opioid overdose. Follow these steps:

  1. Check for signs and symptoms of an opioid overdose
Unconscious and/or UnresponsiveBlue/purple (light skin) or gray/ashy (dark skin) skin tone, nails, and lips
Slow and shallow, erratic, or no breathCold and clammy
Pinpoint pupilsLimp body
Slow, erratic or absent pulse (heartbeat)Vomiting
Awake but unable to talkChoking sounds or snore-like gurgling noises
  1. Call 911. Tell the dispatcher where you are and the symptoms of the person who has overdosed (e.g., not breathing or unconscious). 

If you are trying to help in an overdose, WA State’s 911 Good Samaritan law protects you and the overdose victim from drug consumption or possession charges. Don’t be afraid to call 911 for help! 

 

If you are unable to stay until medical help arrives, place the person on their side in a rescue position and where first responders can find them.

What to do during an overdose
  1. Give naloxone and rescue breathing

If you have naloxone, give one dose. Naloxone can take 2-3 minutes to work, so start giving rescue breaths.

To perform rescue breathing:

  • Make sure nothing is in the person’s mouth blocking their airway.
  • Place one hand on the chin and tilt the head back. With the other hand, pinch the nose closed. 
  • Administer a full breath and look for the chest to rise.
  • Continue administering 1 breath every 5 seconds. 
  • If the person does not respond within 3-5 minutes, give a second dose of naloxone and continue rescue breathing until medical help arrives.
  1. If the person wakes up, stay with them. Encourage them to get follow-up medical care.

When naloxone wears off (roughly 30-90 minutes), a person may stop breathing again. Encourage the person to be taken to a clinic or emergency room where health care staff can monitor their breathing, manage any withdrawal symptoms, and treat any other medical conditions.

Carry Naloxone

Naloxone, also sold under the brand names Narcan® and Evizio®, is a lifesaving medication that can reverse an opioid overdose. Naloxone is not addictive, nor can it cause harm if administered in a situation that turns out to not be an opioid overdose. Anyone who either uses prescription or illicit opioids, or knows someone who does, should carry naloxone.

It is important to note that naloxone:

  • Only works on opioids; it has no effect on someone who has not taken opioids
  • Cannot be used to get high and is not addictive
  • Has a long safety history; adverse side effects are rare
  • Can be easily and safely administered by laypersons

Naloxone can be administered nasally or intramuscularly. There are currently four types of naloxone available; click each one to learn more. 

naloxone-injection-vial

INJECTABLE

Naloxone Autoinjector

AUTO-INJECTOR

Naloxone Intranasal Spray

INTRANASAL

Naloxone Nasal Spray

NASAL SPRAY

Where to Find Naloxone

In Washington State, naloxone can be dispensed at pharmacies with or without a prescription. Naloxone can also be provided by community-based organizations. No-cost naloxone can be obtained from the Mobile Syringe Exchange, didgwálič Wellness Center, and Skagit County Public Health.

Naloxone Providers:

 

ProviderAddressPhone
Family Pharmacy (Skidmore Pharmacy)1213 24th St., S-400, Anacortes360-293-2124 / 360-293-0419
Rite Aid #52341517 Commercial Ave., Anacortes360-293-2119 / 360-299-8568
Safeway Pharmacy #0593911 11th St., Anacortes360-293-5393 / 360-299-9135
Walgreens #07131909 17th St., Anacortes360-299-2816 / 360-299-8565
Costco Pharmacy #6621725 S Burlington Blvd., Burlington360-747-5702 / 360-757-5709
Haggen Pharmacy #3436757 Haggen Rd., Burlington 360-814-1516 / 360-814-1595
Walgreens #11300623 S. Burlington Blvd., Burlington360-707-2741 / 360-707-5928
Sea Mar Community Health Center Pharmacy7438 S. D Ave., Ste. C, Concrete360-853-8109 / 360-853-8350
La Conner Drug #1146708 E Morris St., La Conner360-466-3124 / 360-466-4775
Hilltop Pharmacy LLC1223 E Division St., Mount Vernon360-428-1710 / 360-428-7847
Sea Mar Community Health Center Pharmacy1400 N Laventure Rd., Mount Vernon 360-428-4075 / 360-542-8797
Haggen Pharmacy #34502601 E. Division St., Mount Vernon360-848-6930 / 360-848-6948
Rite Aid #5245412 E. College Way, Mount Vernon360-424-7958 / 360-424-0255
Safeway Pharmacy #1472315 E. College Way, Mount Vernon360-424-0467 / 360-424-0427
Wal Mart Pharmacy 10-25962301 Freeway Dr., Mount Vernon360-428-3911 / 360-428-3688
Rite Aid #5248851 Moore St., Sedro-Woolley360-856-2153 / 360-856-0714
Schaffner Pharmacy1990 Hospital Dr., Ste. 120, Sedro-Woolley360-853-2003 / 360-854-2765
Walgreens #10994320 Harrison St., Sedro-Woolley360-855-0735 / 360-855-0912

The Good Samaritan Law

The Good Samaritan Law

If you witness what you think is an overdose, do not wait to call 911. The Good Samaritan Law protects you.

In WA State, anyone trying to help in a medical emergency is generally protected from civil liability by RCW 4.24.300. WA State’s 911 Good Samaritan Overdose Law (RCW 69.50.315) gives additional, specific protections against drug possession charges:

  • If you seek medical assistance in a drug-related overdose, you cannot be prosecuted for drug possession. 
  • The overdose victim is also protected from drug possession charges.
  • Anyone in WA State who might have or witness an opioid overdose is allowed to carry and administer naloxone. (RCW 69.41.095

*The Good Samaritan Law does not protect those from outstanding warrants, probation or parole violations, drug manufacturing or delivery, controlled substances homicide, or crimes other than drug possession. 

For further information and frequently asked questions, check out:

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