Boston Medical Center (BMC) Grayken Center for Addiction Training and Technical Assistance (TTA)

A Resource for Healthcare and Social Services Professionals


Harm Reduction

*Please note: Federal funding cannot be used directly or through subsequent reimbursement of grantees to purchase pipes used in safer smoking kits or syringes for the purpose of injection use unless purchased under Section 2706 of ARPA. The content below is intended solely to inform and educate medical professionals and addiction care teams and does not necessarily represent the views or positions of our funders. Material from Boston Medical Center's Grayken Center for Addiction Training & Technical Assistance may not be used for medical advice and is not a substitute for the advice or treatment of a qualified medical professional. Practitioners should always consult their state practice laws and exercise their best professional judgment before making clinical decisions of any kind. Anyone using these materials assumes full responsibility for their appropriate use. Boston Medical Center, including Grayken Center for Addiction Training & Technical Assistance, assumes no liability for any decision made or action taken in reliance on this information.
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Harm Reduction Principles

An Overview of Harm Reduction
Harm reduction is an evidence-based approach aimed at reducing risks and negative consequences associated with substance use. This treatment approach supports meeting individuals “where they are” across the spectrum of substance use by incorporating practical, patient-centered interventions that facilitate positive change. Harm reduction strategies include overdose prevention, safer substance use, infectious disease prevention and treatment, sexual health promotion, and wound care. Harm reduction is a key pillar in the U.S. Department of Health and Human Services' Overdose Prevention Strategy supported by SAMHSA.
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Harm Reduction at SAMHSA
The Substance Abuse and Mental Health Services Administration (SAMHSA) is the agency within the U.S. Department of Health and Human Services that leads public health efforts to advance the behavioral health of the nation and recognizes harm reduction as an evidence-based approach that is critical to engaging with people who use drugs. The SAMHSA Harm Reduction Framework comprehensively outlines plans for harm reduction activities, policies, programs, and practices based on their role within the Department of Health and Human Services (HHS).
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National Harm Reduction Coalition
The National Harm Reduction Coalition is a nationwide advocacy and capacity-building organization with the mission to promote the health and dignity of individuals and communities affected by drug use through evidence-based harm reduction strategies.
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National Harm Reduction Technical Assistance Center (NHRTAC)
NHRTAC provides free help to anyone in the country providing (or planning to provide) harm reduction services to their community.
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The Real Deal on Fentanyl
The Real Deal on Fentanyl is a harm reduction website with information about fentanyl, its dangers, and how to reduce harm and the risk of a fatal overdose. The organization has an associated website, Drop the F* Bomb, geared towards parents talking to adolescents about fentanyl.

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Visit webpage: Drop the F* Bomb

Overdose Prevention and Response

Canary is an overdose prevention mobile phone application that monitors a user’s inactivity after activation. In the event that a user stops moving and fails to respond to prompts by Canary, the app issues an alert to others. PLEASE NOTE: This app is available only on the App Store for iPhone.
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How to Respond to an Opioid Overdose | HHS
Access opioid overdose response resources from the U.S. Department of Health and Human Services website outlining best practices for law enforcement, firefighters, and EMS providers to safely administer naloxone for overdose reversal with risk for COVID-19 exposure
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How to use an overdose prevention helpline
This three-minute explainer video, written by Stephen Murray, MPH, NRP, and Matthew Heerema, MS, provides an introduction to overdose prevention helplines and how they work. To connect with the Massachusetts Overdose Prevention Helpline, call 1-800-972-0590 or visit

How to Use Fentanyl Test Strips
Boston Medical Center's Grayken Center for Addiction TTA produced this brochure to illustrate step-by-step how to use fentanyl test strips. If you would like physical copies of this brochure as a patient resource, please email your mailing information, contact information, and number of brochures requested to
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Lifesaving Naloxone | CDC
Visit the Centers for Disease Control and Prevention (CDC) website to learn about naloxone, how it works, how to use it, where to find it, and more.
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Naloxone | SAMHSA
Learn about naloxone, its side effects, the signs of an opioid overdose, and SAMHSA’s efforts to expand the use of naloxone.
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Non-prescription (“Over-the-Counter”) Naloxone Frequently Asked Questions | SAMHSA
The U.S. Food and Drug Administration (FDA) approved the first nonprescription naloxone product, Narcan 4 milligram (mg) naloxone hydrochloride nasal spray. The following questions and answers on SAMHSA's website provide details about purchasing and using Narcan 4mg naloxone hydrochloride nasal spray specifically, health plan coverage, training resources, other formulations of naloxone available, and federal grant funding aimed toward increasing access to naloxone in communities across the country.
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Novel Naloxone Distribution Strategies
Boston Medical Center's Grayken Center for Addiction TTA outlines the potential strategies to increase patient access to nasal naloxone by serving as a guide for administrators, healthcare providers, and non-medical providers attempting to create reimbursable streams for naloxone.
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Opioid Overdose Prevention Information
Free educational materials on opioid overdose prevention from the Massachusetts Department of Public Health.
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Pregnant, Postpartum, and Parenting Persons

Academy of Perinatal Harm Reduction
The Academy of Perinatal Harm Reduction is dedicated to improving the lives of pregnant and parenting people who use substances and offers evidence-based, stigma-free resources, education and support for patients and providers.
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Pregnancy and Substance Use: A Harm Reduction Toolkit
The Harm Reduction Coalition and the Academy of Perinatal Harm Reduction collaborated to create this toolkit for pregnant and parenting people who use drugs, their loved ones, and their service providers, with the goal of promoting the overall health and well-being of pregnant people who use substances and their families.
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Safer Alcohol Use

Incorporating Harm Reduction Into Alcohol Use Disorder Treatment and Recovery
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) Spectrum provides information and citations for evidence-based interventions aimed at reducing heavy alcohol consumption and alcohol-related consequences without complete abstinence including a table established by the World Health Organization (WHO) stratifying risk based on alcohol consumption.
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Reducing Harm, Saving Money: Results from a Managed Alcohol Program
The Canadian Observatory on Homelessness produced a document that describes the benefits of managed alcohol programs (MAPs) to reduce harm from alcohol for people with unstable housing and severe alcohol-related problems based on information collected from their site in Thunder Bay, Ontario.

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Strategies to Reduce Excessive Alcohol Use
The CDC published strategies to help communities create social and physical environments that reduce excessive alcohol use that including strategies recommended by the Community Preventive Services Task Force. The Resources on Community Strategies to Reduce Excessive Alcohol Use includes links to their guide to community preventative services, fact sheet on preventing excessive alcohol use, density measurements, U.S. Preventive Services Task Force (USPSTF) recommendations, and other information for healthcare officials and teams.

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Visit webpage: Resources to Support States and Communities in the Prevention of Excessive Drinking

Safer Cannabis Use

*Get Sensible – Cannabis Harm Reduction Information
Get Sensible — a project funded by Health Canada — created a variety of resources to reduce the risk around cannabis use. Their Sensible Cannabis Booklet series contains educational booklets for youth and adults. Their Get Informed webpage includes resources created by youth-for-youth, such as the How to Read a Cannabis Label information sheet, based on the information outlined in the Sensible Cannabis Booklet series.

Get Informed resources page
How to Read a Cannabis Label info sheet
Sensible Cannabis Booklet series

Harm Reduction and Cannabis Usage
The Erie County Department of Public Health produced this document on reducing harm for individuals with cannabis use to provide information and related resources.
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Harm reduction strategies for cannabis use
This three-minute explainer video, written by Kristin Wason, MSN, NP-C, CARN, and Samantha Blakemore, MPH, introduces the risks associated with frequent cannabis use and strategies to help people using cannabis mitigate some of the associated harms.

Knowing Your Limits with Cannabis
The Canadian Centre on Substance Use and Addiction produced a practical guide for assessing cannabis use that includes tips and tools to help reduce health risks associated with using cannabis.
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Safer Use Cannabis Guide
The Algonquin College in Ontario, Canada produced a variety of resources that including information, tips, and tools on safer cannabis use.

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Safer Injection Practices

*Getting off Right: A Safety Manual for Injection Drug Users
The Harm Reduction Coalition's safety manual for injection drug use compiles a combination of medical information, injection techniques, and practices to reduce harm and promote autonomy for individuals who use illicit substances.
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*Syringe Service Programs Locations | NASEN
NASEN directory of syringe service programs (SSPs) in the United States. Be aware that this directory includes only those SSPs who have authorized NASEN to publish their information solely for NASEN directory purposes. It is not, nor is it intended to be, a comprehensive listing of all SSPs in the United States.
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CDC Guide - How to Clean Your Syringes
The CDC produced a pamphlet that illustrates how to clean your syringes to reduce risk for HIV transmission.

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Visit webpage for English and Spanish Infographic

Safer Drug Use
The Litchfield County Opiate Task Force (LCOTF) produced an education pamphlet with tips to reduce the harms related to injection drug use.

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Visit webpage for Safer Drug Use Infographic

Safer Tablet Injection
The British Columbia Center for Disease Control (BCCDC) on Substance Use produced a resource for anyone who is injecting tablet medications (pills) and would like to do so more safely.
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Syringe Services Programs: Summary of State Laws
The Legislative Analysis and Public Policy Association (LAPPA) produced a summary of the information with respect to syringe service programs (SSPs) for each state, including citations to applicable statutes and/or regulations, whether the state allows SSPs by statute, whether there are any municipal or county ordinances or regulations in place within the state, program components, miscellaneous provisions, and information on any pending legislation. This project was supported by Grant No. G2199ONDCP03A awarded by the Office of National Drug Control Policy.
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Safer Nicotine & Vaping

E-cigarette, or Vaping, Products Visual Dictionary
HHS produced a guide that highlights the different e-cigarette, or vaping, product generations and substances used in these devices as an educational tool for healthcare officials and providers.
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How a Cigarette is Engineered
The FDA Center for Tobacco Products (CTP) designed an information sheet that provides information on how a cigarette is engineered and describes the risks associated with use.
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The 101 on E-cigarettes Infographic
The American Heart Association produced an infographic describing different e-cigarettes and vaping, including information for parents to provide to teenagers about nicotine use.
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What is Tobacco Harm Reduction?
The Australian Tobacco Harm Reduction Association provides basic information regarding the principles of tobacco harm reduction for the purposes of understanding how to decrease risks associated with use.
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Safer Sex/ChemSex & Sexual Health

*ChemSex 101: Everything you wanted to know (but didn’t know to ask)
This toolkit is designed to give harm reduction organizations and syringe services programs an overview of chemsex, including the communities impacted and the range of use; a description of the different substances being used, including their effects, what to expect when using, and how to stay safe; a summary of education to provide participants, the importance of peers, harm reduction strategies, and the role technology plays in chemsex. Includes appendices that have a menu of kits that harm reduction programs can put together for participants, a glossary of common terms used in chemsex, and a guide to chemsex party planning.
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*ChemSex First Aid Guide
This booklet covers some general First Aid practices for some specific chemsex-related emergencies. It includes some information on how to make judgment calls, and when not to; when to call an ambulance, as well as some tips to help avoid some of the most common emergencies that can happen in chemsex environments. This document was written and prepared by David Stuart and Ignacio Labayen De Inza. Sept 2018.
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*Male Sexwork Handbook: A Basic Guide to Working Safe, Sane, and Smart in the Sex Industry
This handbook, created by HOOK in partnership with the Harm Reduction Coalition, helps those that work with male sexworkers in social services and professionally by stating the concerns and negotiations that face male sexworkers. This information is intended to allow them to better communicate, comprehend, and be sensitive to male sexworker situations and decisions. For those who work in the industry, this handbook serves to communicate the kind of street-sense knowledge that helps you work with both eyes open in hopes that your sessions and experiences enable you to meet your immediate and long-term goals, whether that be a life in the sex industry or recovery from some strokes of bad luck.
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*Sexual and Reproductive Health
The NEXT Distro page on Sexual and Reproductive Health includes links to resources and information on termination to promote reproductive health and autonomy in people who use substances.
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Safer Sex Guide
This guide, created by CATIE (Canadian AIDS Treatment Information Exchange), gives tips on how to prevent sexually transmitted infections (STIs) and explains how to make sex safer.
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Safer Smoking Practices

*Safer Crack Smoking
This resource, created by CATIE (Canadian AIDS Treatment Information Exchange), provides information about how to smoke crack and helps to identify when a person is overamping and needs to rest, and when a person needs emergency medical services.
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*Safer Crystal Meth Smoking
This resource, created by CATIE (Canadian AIDS Treatment Information Exchange), provides information about how to about how to smoke crystal meth and helps to identify when a person is overamping and needs to rest, and when a person needs emergency medical services.
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Safer Sniffing Practices

*Safer Snorting | CATIE
An informational booklet created by CATIE (Canadian AIDS Treatment Information Exchange) provides information about how to prevent harm when snorting substances and how to care for your nasal passages.
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*Safer Snorting | Harm Reduction Action Center
The Harm Reduction Action Center created a one-page flyer that lists and explains the items needed to sniff more safely.
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*Safer Snorting | QTHC
The Queer & Trans Health Collective (QTHC) is a grassroots health organization run by and for queer and trans community members.
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Wound Care

What You Need To Know About Wounds (wallet card) | CATIE
This pocket-sized resource, created by CATIE (Canadian AIDS Treatment Information Exchange), contains basic harm reduction information for people who use drugs about identifying when to get medical care and tips for how to take care of wounds.
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Wound & Abscess Care for People Who Use Drugs
This resource, created by NEXT Distro, discusses how to prevent and care for injection-related injuries. It contains information on injection-related complications that need medical attention and how to prevent wounds and care for abscesses.
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Litchfield County Opiate Task Force: Xylazine Wound Care Handout for Patients
The Litchfield County Opiate Task Force produced a resource about how to care for xylazine related wounds and can be found on their harm reduction website that includes additional information and infographics on xylazine and safer use strategies.

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Overdose Prevention in the Presence of Xylazine
Boston Medical Center's Grayken Center for Addiction TTA and the University of Pittsburgh have created informational handouts for patients on overdose prevention in the presence of Xylazine. There are MA-specific and National pocket-size versions in English, with Spanish coming soon!

English Pocket Guide (MA)
English Pocket Guide (National)

Xylazine Wound Care Handout for Patients
Boston Medical Center's Grayken Center for Addiction TTA and the University of Pittsburgh have created xylazine wound informational handouts for patients. There are pocket-size versions in English and Spanish and a larger version for visual display.

English (pocket-size)
Large size (English)
Spanish (pocket-size)

Grayken Center for Addiction TTA is a program of Boston Medical Center (BMC), a 514-bed academic medical center located in Boston's historic South End and the largest safety-net hospital in New England.

Funding for Grayken Center for Addiction TTA is provided by:

Massachusetts Department of Public Health Bureau of Substance Abuse Services (BSAS)
GE Foundation
Opioid Response Network

The content on this site and the content presented by Grayken Center for Addiction TTA is intended solely to inform and educate healthcare and social service professionals, and shall not be used for medical advice and is not a substitute for the advice or treatment of a qualified medical professional. The hospital, the program, and the contributors are not acting as health care providers or professional consultants on behalf of any specific patient and disclaim establishing a provider-patient relationship with any specific patient.

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