Reducing Harm

Harm reduction refers to a philosophy and set of strategies that work to reduce the health, social and economic harms to individuals, communities and societies that are associated with the use of drugs, alcohol and tobacco.

The values of ‘Harm Reduction’ are grounded in respect for all individuals, focusing on positive change, and recognising that each person has their own needs and strengths. It is recognised that achieving ‘perfect’ health behaviours is not possible, or desirable, for many, if any, people, and so rather than ignoring or condemning the use of substances the aim is to reduce the harm associated with the substance use.

Harm Reduction approaches encompass a broad range of services and practices that apply to both illicit and licit substances. These include, but are not limited to; provision of information on safer drug use, drug-checking services like WEDINOS, needle and syringe provision, overdose awareness education and supply of naloxone, psychosocial support, access to substance misuse services and medical treatments.

Below is a health information video informing the public on the harms associated with using street drugs or drugs/medication bought online.

You don’t always know what you’re getting.


Below is a health information video informing the public on the signs of Opioid overdose; snoring in particular.

Don’t ignore a snore.

For more info on Welsh Government plan click here

  • In 2021, 322 deaths due to drug poisoning were registered in Wales, an increase of 44 per cent from the previous calendar year.
  • Of these, 210 were classified as drug misuse deaths, an increase of 41 per cent from drug deaths registered in 2020.
  • In Wales 45% of men and 34% of women report drinking above the recommended guidelines.
  • Alcohol is the cause of around 1,500 deaths a year, on top of a cost of more than £1 billion of harm to society.
  • Alcohol related deaths are higher in the most deprived areas of Wales.
  • Growing up in families where alcohol or substance misuse is a problem can have negative impacts which persist long into adulthood.
  • 14% of adults have been exposed to alcohol misuse during childhood. Reducing Adverse Childhood Experiences can reduce levels of harmful drinking by 35%.
  • The economic and social costs of alcohol and Class A drug misuse in Wales is estimated to be as much as £2 billion each year.

The following information is intended to provide general harm reduction advice. Although a range of drugs are listed not all substances can be included as this would be far too extensive to include on the website.

  • 2C-x (2C-B, 2C-E etc)
  • 5-MeO-DMT
  • Alcohol
  • Amphetamines
  • Anabolic-Androgenic Steroids
  • Benzodiazepines
  • Buprenorphine
  • Cannabis herbal
  • Cannabis resin
  • Cannabis concentrates
  • Cannabis edibles
  • CBD (cannabidiol)
  • Cocaine
  • Cathinones
  • Crystal Methamphetamine
  • Ecstasy (MDMA)
  • Fentanyl
  • GHB and Related Substances
  • Heroin
  • Ketamine
  • Lean
  • LSD
  • Mephedrone (M-Cat)
  • Methadone
  • Nitrous oxide
  • Nitazenes (2-benzyl benzimidazole opioids)
  • Poppers (Alkyl nitrites)
  • Pregabalin and Gabapentin
  • Psilocybin ‘Magic’ Mushrooms
  • Synthetic Cannabinoids (Spice)
  • Volatile Substances (Solvents)

See the Drugs A-Z for effects and risks of specific substances that are not included in the above list. Always seek advice from support services aimed at helping drug / alcohol users if you feel that you need to talk with someone about your substance use; these agencies are essential to assist and sustain recovery.

Always get help / medical assistance when needed. If someone is suffering bad effects like vomiting, convulsions, unconsciousness – put them in the Recovery Position and call for medical assistance immediately.

  • Although alcohol is legal, it is a depressant drug.
  • Drinking on an empty stomach can cause you to become more drunk more quickly because the alcohol will get into your bloodstream and to your brain faster; so always make sure you eat a meal before you start drinking.
  • Try to pace drinking by having water or a soft drink between alcoholic drinks. This will give your liver a bit more time to process the alcohol and you won’t feel as dehydrated.
  • If you’re out with friends avoid drinking in rounds as it can be easy to lose track of what you’re drinking.
  • Don’t be pressured by others into drinking too much.
  • Don’t be forced into drinking too quickly or get involved in drinking games.
  • Don’t mix your drinks. Mixing drinks can make you more drunk and feel ill than if you just stick to one type of drink.
  • Don’t leave your drink unattended and always make sure you watch your drink being opened / poured, this will avoid someone spiking it.
  • Make sure you know how you’re getting home before you leave the pub / club.
  • When you get home drink some water to help rehydrate your body and dilute the alcohol in your bloodstream; when you go to bed sleep on your side in the Recovery Position to avoid choking if you throw up.
  • If someone is suffering bad effects like vomiting, convulsions, unconsciousness – put them in the Recovery Position and call for medical assistance immediately.

Alcohol information page

  • Amphetamines are stimulants.
  • They will keep you awake for long periods of time before the comedown.
  • Using more than one stimulant drug at a time drug can put your heart under significant stress.
  • Don’t inject – injecting amphetamine can become compulsive and is very risky.
  • If you do inject, always use clean needles and never share any equipment.
  • Safer ways of using are smoking, snorting, swallowing as there is lower risk of overdose, infection and contraction of blood borne viruses.
  • Swallowing it is by far the safest way to use it. Snorting it is more risky and injecting is the riskiest way to use.
  • Stimulant drugs are caustic so if swallowed they can damage the lining of the throat, oesophagus and stomach; if you are going to take them this way then use a capsule or cigarette paper.
  • Amphetamines can cause the body to dehydrate and over heat; if you choose to use make sure you drink water or soft drinks regularly.
  • Don’t forget to eat – amphetamines suppress the appetite so eat before and after using.
  • Amphetamines disrupt sleep patterns so sleep is essential to help your body recover.
  • Try not to use other drugs, such as benzos, to come down; food and sleep are the best way.
  • Make sure you have more days where you don’t use, than days that you do.
  • Use in a safe environment with trusted company and tell someone you are with what you are taking.
  • Amphetamines may interact badly with some anti-depressant medicines such as monoamine oxidase inhibitors (MAOIs).

Amphetamines information page

  • Avoid using cocaine and alcohol together in a session; the effects of taking cocaine and alcohol together are far more dangerous than taking either drug alone. Cocaethylene is formed when alcohol and cocaine meet in the liver. This ‘metabolite’ remains in the body much longer, putting the heart and liver under a prolonged period of stress. The risk of sudden death is 18 times greater when alcohol and cocaine are used together.
  • Avoid using any other drugs in combination with cocaine.
  • Avoid using other drugs to help you deal with the come down. It won’t last and the best way to get through it is with food, sleep and relaxation.
  • Snort it rather than inject it. Injecting can cause serious damage to your body and increases your risk of overdose.
  • Take care of your nose; snorting cocaine repeatedly can cause damage to the delicate nasal tissue. Take a break from cocaine if you develop irritation or bleeding in your nose and give your body a chance to recover. A nasal douche of lukewarm salt water can help reduce the risk of infection inside the nose and also help minimise the damage done by snorting.
  • Don’t share any equipment you use to take cocaine. There is evidence that Hepatitis C can be transmitted through sharing snorting equipment like notes and straws. Never share any injecting equipment including spoons, water and filters.
  • Don’t use bank-notes to snort as there could be blood products on an old bank note. Instead use other pieces of unused paper to make your straw.
  • Take care of yourself physically and mentally; make sure you get enough sleep and eat well daily. The stimulant effects of cocaine can interfere with your sleep patterns, and can suppress your appetite. Eating regular healthy meals, getting enough sleep and good hygiene are all important aspects of staying healthy.
  • Physical health can easily slip if you use cocaine frequently, particularly if you are using every day. If your physical health slips it can lead to more serious problems, affecting work and relationships.
  • Make sure you keep doing things you enjoy without using cocaine.
  • If someone is suffering bad effects like vomiting, convulsions, unconsciousness – put them in the Recovery Position and call for medical assistance immediately.

Cocaine information page

  • You never know what is in the tablet or powder you get so be careful – use a small amount first to see what the effects are and wait a while before taking any more.
  • If using ecstasy and dancing take a break to cool down, ecstasy can cause overheating and dehydration.
  • Get your water balance right – if you are dancing and sweating you should drink up to a pint of non-alcoholic drink every hour to help replace fluid lost through sweating. If you are not dancing & sweating then drink a little less water – you need to remember that drinking too much water in one go can be dangerous.
  • Mixing ecstasy with alcohol will increase the risk of dehydration and can make you take more risks; and mixing ecstasy with any other drugs increases the risks even further and can be very dangerous.
  • If you suffer from any kind of heart condition you should avoid stimulant drugs like ecstasy.
  • If you choose to use ecstasy it is safer to use small amounts on an occasional basis, giving your body time to recover.
  • If someone is suffering bad effects like vomiting, convulsions, unconsciousness – put them in the Recovery Position and call for medical assistance immediately.

Ecstasy information page

  • Overdose, coma and death are real risks with GHB and GBL.
  • GHB, when sold as a solution varies in concentration, so it is very difficult to judge how strong it is, and you can’t rely on what you may have been told. So you can’t be sure how much will give the desired effect and the amount which leads to overdose and coma.
  • Always start with a very small amount; people have ended up coming round in hospital after swigging from the bottle directly.
  • Use small amounts and do not mix with other drugs especially alcohol; GHB & GBL are both depressants so a very little alcohol combined with them can have powerful negative effects.
  • GHB and GBL can have a significant effect on our senses, coordination and thinking which means that you can also be vulnerable to accidents or assaults.
  • Stay with friends to avoid being in a vulnerable position on your own.
  • Do not take drinks from strangers, or leave glasses unattended because someone might spike your drink; GHB and GBL have been linked to drug assisted sexual assault.
  • If someone is suffering bad effects like vomiting, convulsions, unconsciousness – put them in the Recovery Position and call for medical assistance immediately.

GHB information page

  • You can never be sure of the purity of heroin or what it is cut with.
  • Smoking heroin is safer than injecting intravenously; chasing heroin gives the user a hit like injecting as it gets into the bloodstream quickly, and it is far safer.
  • If you do inject, always use clean needles and injecting equipment (spoons, swabs, water etc). You can access these from needle exchanges, drug agencies and pharmacies; this can protect you from blood borne viruses like Hepatitis B & C and HIV.
  • Never share your needles or works with anyone else, no matter how well you know them.
  • If you inject, learn how to inject yourself using the safest technique. Injecting with poor technique is one of the riskiest things you could ever do and can be extremely damaging to your body causing problems such as abscesses, infections, blood clots & deep vein thrombosis (DVT), or hitting an artery. You can contact drug services and needle exchanges for advice on safer injecting.
  • If you are going to inject, use sterile citric acid or ascorbic acid rather than lemon juice or vinegar as these are particularly risky acids and can cause even more damage to veins and other health problems.
  • Mixing heroin with other drugs can increase the risk of overdose, especially drugs like alcohol, benzo’s and methadone.
  • Speedballing (using heroin and crack together) can lead to an extreme decline in your health and lifestyle.
  • Avoid using alone or in unfamiliar or locked places. More overdoses happen in these environments than anywhere else.
  • If you have had a break from using, your tolerance will be significantly lower and you are at a greater risk of overdose.
  • If you suspect someone has overdosed, put them in the Recovery Position and call for emergency help immediately.
  • Know about Naloxone. Naloxone is a short acting opiate antagonist that reverses the effects of heroin and other opiates like morphine – it can save lives.

Heroin information page

  • Ketamine is a dissociative psychedelic used medically as a veterinary and human anaesthetic.
  • Ketamine impairs coordination, so minor accidents like bumping into things are common; it can make you forgetful as well.
  • If you take ketamine when you are out and about you risk losing coordination very suddenly; this could be potentially very dangerous and can make you very vulnerable. And as an anaesthetic, Ketamine means you won’t feel pain so you are at more risk of injuring yourself.
  • Although it is fairly short acting, stick to small doses. You are safer on a small dose than if you take a large amount in one go.
  • Avoid swallowing ketamine – ketamine in the stomach makes cramps worse. Don’t sit in the bath to soothe the pain as there is a risk you may become unconsciousness and drown. Seek medical advice and mention your ketamine use to the doctor.
  • If snorting alternate nostrils, and clean your nostrils after each session to minimise damage.
  • Injecting ketamine brings the additional risk of damage to your veins, skin infections and contracting blood bourne viruses such as Hepatitis or HIV. If you choose to use this way, get safer injecting advice from your nearest needle exchange.
  • There is a risk of bladder problems and kidney damage with regular use. Long-term ketamine use has been shown to damage the bladder and urinary tract, causing ‘ketamine bladder’.
  • If you experience pain in your bladder seek medical help, tell your GP that that you use ketamine. Try to stop or reduce your use if you notice any symptoms.
  • Try to keep your use as low as possible. Give yourself breaks from using if you can to avoid developing tolerance and dependency.
  • If you feel depressed and anxious when stopping ketamine use or reducing the amount you use, get some professional help to do this. Gradual reduction may help. Try to distract yourself with purposeful and enjoyable activities.
  • If you experience ongoing panic and anxiety attacks get support from your nearest drug agency.
  • Don’t use ketamine with alcohol or other depressant drugs as the effects can be unpredictable and may lead to overdose.
  • Make sure you have more days where you don’t use, than days where you use.
  • If you choose to use ketamine use in a safe environment especially if you are an inexperienced user.
  • Tell someone you are with what you are taking and have a person you trust with you in case things go wrong.
  • If someone is suffering bad effects like vomiting, convulsions, unconsciousness – put them in the Recovery Position and call for medical assistance immediately.

Ketamine information page

  • Methadone is prescribed as a substitute to street heroin when users have become dependent. It is used to reduce from opiates and helps to stabilise a users lifestyle.
  • You should take methadone orally at the dosage it has been prescribed – is the safest way to take it.
  • It is recommended that methadone is taken once daily, at the same time each day.
  • If you take methadone with other substances, especially alcohol, heroin and benzos, it increases the risk of overdose.
  • Getting additional support like counselling or CBT to tackle other aspects of your addiction will increase the chances of making changes to your life and improving your recovery capital.
  • Get involved in diversionary activities that are meaningful to you; discovering healthier things to occupy your time – feeling bored will leave you thinking about using; spend time with non-using friends.
  • If you suspect someone has overdosed, put them in the Recovery Position and call for emergency help immediately.
  • Know about Naloxone. Naloxone is a short acting opiate antagonist that reverses the effects of heroin and other opiates like morphine – it can save lives.

Methadone information page

  • Do not spray aerosols directly into your mouth; this is highly dangerous and may freeze your throat or cause your throat to swell up; this can cause breathing to become irregular or stop and can put a strain on your heart.
  • Do not inhale by putting plastic bags over your head as this can cause suffocation. Inhaling through a cloth is less risky.
  • Do not mix with other drugs – particularly alcohol as this can lead to unconsciousness and death.
  • Use only small amounts especially if you are an inexperienced user, and try not to use repeatedly.
  • If you choose to use solvents use in a safe environment i.e. not by a railway, motorway or industrial areas etc.
  • Use when other people are present and have a person you trust with you in case things go wrong.
  • Many of these products are highly flammable and if used at the same time as smoking, or using a naked flame, can harm you or others around you, cause fires or may even explode.
  • Do not drive while under the influence as they can affect coordination and the ability to judge speed and distance.
  • Do not use inhalants when in a negative state of mind; or to cloud negative feelings because they could make those negative feelings worse. Also you are more likely to become aggressive and engage in risky behaviours that may harm yourself and/or others.
  • Death and overdose is a very real risk with solvents and it can happen at any time, no matter how experienced you think you are.
  • If someone is suffering bad effects like vomiting, convulsions, unconsciousness – put them in the Recovery Position and call for medical assistance immediately.

Solvents information page

  • Steroids can be toxic to your liver. If you notice a yellowing of your eyes (jaundice) it can indicate a serious liver problem. Seek medical advice immediately.
  • If injecting steroids ensure that needles are clean and have not been used; get clean needles and safer injecting information from a needle exchange or drug agency.
  • Injectable steroids always are injected into the muscle; there is no anabolic steroid designed for intravenous use.
  • Before using steroids seek advice from a drugs worker. They can give you safer injecting advice and direct you to information about steroids.
  • Taking steroids orally will reduce the risks and problems with injecting. However, taking steroids orally can do more damage to your liver and may be more toxic to your kidneys.
  • It is advised to stop using steroids periodically. Always reduce dosages gradually, don’t stop suddenly.

Steroids information page

If you have a question about drugs or alcohol use that isn’t answered on our website then you can call DAN 24/7 confidentially on 0808 808 2234 at any time and ask an advisor for help.

Given some of the key work undertaken during the pandemic, Welsh Government have reviewed their Plan to consider where it needs to be updated in light of COVID-19 – particularly to meet the new challenges ahead. Having undertaken this review and considered the evidence highlighted by APBs and wider partners, it is suggested that the original priority areas for the next three years remain relevant, and have been reinforced during the pandemic. These priority areas are:

  • Responding to co-occurring mental health problems which are common in substance misuse.
  • Ensuring strong partnership working with housing and homelessness services to further develop the multi-disciplinary approach needed to support those with substance misuse issues who are homeless or at risk of homelessness.
  • Ensuring that all prisons in Wales (and HMP Eastwood Park, women’s prison) have a coordinated, transparent and consistent service for those with substance misuse problems in prison.
  • Providing further support for families and carers of people who misuse substances.
  • Improving access to services and ensuring people get the support and treatment when they need it.
  • Strengthening our multiagency working and care planning to ensure peoples’ needs are met. Substance Misuse Delivery Plan 2019-22 & COVID-19 3
  • Tackling dependence on prescription only medicines (POM) and over the counter medicines (OTC).
  • Ensuring that appropriate and responsive alcohol misuse services are in place following the implementation of the Public Health (Minimum Price for Alcohol) (Wales) Act 2018 on 2 March 2020.

Substance misuse delivery plan: 2019 to 2022

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