Extreme Cold: Harm Reduction Tips for People Who Use Drugs

Extreme Cold:

PUBLISHED ON 1/31/25

Harm Reduction Tips for People Who Use Drugs

Extreme weather poses risks to everyone’s well being but presents unique challenges for people who use drugs. For example, hotter days can pose the risk of dehydration or stroke while colder days make intravenous drug use very difficult and seasonal respiratory illness can greatly affect people who smoke their drugs. As the temperature drops, we’d like to share harm reduction tips for safer use during the winter months.

Visit nextdistro.org/resources for our “Extreme Heat: Tips and Harm Prevention” guide.

Potential Risks Hypothermia: Being in cold weather for a long time can cause hypothermia. People who are unhoused and use drugs out in the elements are especially at risk when nodding off.

Hypothermia causes slowed breathing and slowed heart rate which is very risky when you are using a substance that has similar side effects. If an overdose happens while that person is also experiencing hypothermia, that individual is at a higher risk of fatality.

Intravenous use: When it’s cold, the body will naturally constrict blood vessels close to the skin to preserve heat. Warming up the injection site and encouraging veins to pop out are important steps when preparing to shoot up. This, and needing to take clothing off to get to the injection site, puts intravenous users at a disadvantage when they need to use outside in cold weather. Trying to shoot into veins that are constricted causes repeat injection attempts and increases the likelihood of infections, abscesses, and missed shots.

Proper temperature regulation: People who use stimulants will experience a higher body temperature while high. This may make it tempting to take off some layers to comfortably regulate body temperature. Excessive sweating in cold weather can increase your risk of getting sick if you’re outside for a long period of time.

Lack of running water: Public fountains are usually turned off during the winter and frozen pipes can affect public restrooms. This can lead to a lack of access to running water, which is so important for hydration and proper clean up before and after intravenous use.

Seasonal respiratory illness: During the winter, cases of respiratory illnesses increase. This is a challenge for people who smoke their drugs as smoking can prolong or worsen any respiratory illness.

Frostbite: Frostbite occurs when the skin and underlying tissues freeze due to extreme cold. The longer the individual remains in freezing temperatures, the worse the effects of frostbite can become. Prolonged frostbite can lead to permanent skin and tissue damage, gangrene, and in severe cases, amputation.

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Harm Reduction Tips Use maintenance: Consider temporarily switching your route of administration from shooting up to sniffing. Even if this is done once a day, it can lessen the strain on your veins. Consider tapering down how much you use when going into extreme cold or hot weather. If you have a respiratory illness, consider decreasing how often you smoke.

Plan your use accordingly: Can you use in a public bathroom instead of using outside? If this is a possible option, try having your syringe loaded before entering the bathroom to give yourself as much time as possible. Remember that your veins will take longer to pop out when you’re cold. Try running the injection site under hot water to help them pop up. If you do have the option to use in the restroom, either keep the door unlocked or unlock it immediately after you push your plunger just in case of an overdose.

Don’t isolate: Using with people you trust who have naloxone is ideal but not always an option. If you need to use alone, do not isolate yourself completely. Immediately after using any type of depressant that might cause nodding off or sleepiness (benzos, opiates, tranq, alcohol, ketamine), seek any type of warmth or shelter that might be available. Passing out alone in cold weather is dangerous.

Layers: Avoid removing layers until you are inside or somewhere warmer. Keep yourself as warm as possible whenever you are using in the cold.

Hand Warmers: Hand warmers are a good tool to help with getting veins to pop up if you are shooting in cold weather. They also help keep your extremities warm which can lessen the chances of frostbite.

Cover extremities: Keep your hands and feet covered up as much as possible to lessen the chance of frostbite.

Mask: Wearing a mask can keep your face warm and decrease the chance of contracting a respiratory illness.

Hydration: Try your best to stay hydrated, hot beverages can help you warm up.

Test your drugs: Testing your drugs anytime you plan on using can decrease the chances of an overdose. For more information on testing your drugs and which testers are recommended for which drug or drug combos, visit nextdistro.org/resources for “At Home Rapid Drug Testing”.

Any extreme weather will impact or exacerbate any pre-existing medical conditions. The best way to keep yourself safe is to plan ahead for extreme weather and keep updated on weather forecasts. Connecting with various support networks like close friends, harm reduction organizations, or outreach support groups can really help you get resources needed to make it through extreme weather.

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