When working with young people who are using alcohol and/or other drugs, practitioners should consider the following questions (Flemen, 2008):

• Is the young person currently injecting drugs?
• Is the young person planning to commence injecting drug use or continue injecting drug use?
• Is the young person in a position to consider substitution or abstinence? (Function is an important consideration here).
• Is the young person willing to consider other modes of administration?
• Does the young person have a good understanding of the risks associated with injecting drug use?
• Is the young person aware of the risks of sharing equipment?
• Does the young person know how to prevent and treat wounds?
• How safe is the young person’s injecting technique?
• Does the young person have the capacity or the resources to implement possible harm reduction strategies?
• Does this strategy or intervention provide a genuine prospect of harm reduction for this young person?
• If the strategy or intervention were withheld, would greater harm take place?

Obviously, the most effective way to reduce injecting-related harm is to cease injecting drug use.  This will not be a realistic first option for many young people; especially those who are street based injecting drug users or members of a substance using peer group. 

If the drug of choice is an opiate, the next step on the harm reduction continuum would be to consider substitute pharmacotherapy to reduce the risks inherent in the use of street drugs.  Commencing a pharmacotherapy program will require preparation and some level of stability as it required regular medical monitoring. If this is not conducive to the young person’s stage of change, it is time to consider other routes of administration.  Is snorting, smoking or shafting (rectal administration) something the young person could commit to?

Advice on alternative routes can be found in the attached pdf, which also includes methods that apply to non-opiate drugs.

A young person who is unwilling or unable to consider any of these options should be provided with harm reduction strategies relating to the reduction of risk of Blood Borne Virus infection and the improvement of health and wellbeing resulting from improved injecting technique and wound management (Flemen, 2008). Virtually all injecting drug users can benefit from going over safer injecting techniques on a regular basis, regardless of where they are on the stage of change cycle.  Even experienced users make errors which can expose them to vein damage and infection.

Whilst the alternatives to injecting may be desirable from a health perspective, the immediacy of the ‘rush’ that many users experience from direct injecting acts as a powerful reward, and it is a practice that is very difficult to simply shift away from. Again, function is an important consideration.  If injecting drug use is the young person’s only coping strategy – what are the risks involved in taking this away?  Is cessation really a viable alternative when there are limited or no supports in place for this young person and crisis is a daily occurrence?  These are very important questions to consider when talking with a young person about their options and undertaking a cost-benefit analysis in relation to harm reduction options. The beauty of using harm reduction strategies is that it opens the door to further treatment whilst maintaining the immediate safety of the young person as the focus.

Assessing sources of risk for people who inject drugs
A young person injecting drugs may be exposed to multiple risk factors.  Practitioners working across all practice contexts need to undertake comprehensive and holistic assessment of these risk factors, as some risk factors will be directly related to injecting whilst others are related to other factors.