Harm Reduction Considerations for Adolescents and Young Adults: Winter Exchange Article

Jan 31, 2023 | Julie Karr

Research has shown that while adolescents and young people who use drugs are just as vulnerable to substance use-related harms, they are much less likely to utilize harm reduction services than older age groups.1 Local Health Departments (LHDs) have an opportunity to leverage their existing engagement of young people who may use drugs, their loved ones, and peers, and use these opportunities to educate, support, and provide vetted harm reduction resources.

Adolescents and young people ages 15-24 saw the largest percent increase in fatal overdoses from 2019 to 2020, according to the CDC.2 Rates of new Hepatitis C (HCV) infections among people ages 20-29 more than tripled from 2011-2019; this jump in infections is ‘closely associated’ with injection drug use.3

Overall, adolescents and young people account for more than half of new STIs cases annually.4 Young people who use drugs have higher rates of STIs than their peers. LGBTQ+ adolescents have been found to have a younger debut of substance use and sexual activity than their peers and are more likely to have used injection drugs.5,6,7 With more than 70% of LHDs providing STI testing, this may be a critical setting to provide harm reduction resources and education to young people who may use drugs or whose sexual partners or loved ones may use drugs. That said, how information and resources are shared can be just as important as the information given. NACCHO defines harm reduction as “a set of strategies that reduce the harms associated with substance use.” The National Harm Reduction Coalition notes in their Principles of Harm Reduction that harm reduction should also be “non-judgmental, non-coercive,” recognizing “the realities of poverty, class, racism, social isolation, past trauma, sex-based discrimination, and other social inequalities.”8 These realities exist for young people, as well. Occurrence of four or more Adverse Childhood Experiences (ACEs), such as community violence, incarceration of a caretaker or loved one, and abuse or neglect in the household, are associated with higher rates of substance use among people ages 18-25 years old.9 Trauma-informed care, Recovery Ally, Mental Health First Aid, Brief Intervention, Referral and Treat (SBIRT) are great tools for LHD staff— particularly community-facing staff who regularly interact with those who have experienced traumatic events. Perceived judgement regarding sex, sexuality, and substance use can lead to distrust of health systems among young people.10,11

Public health best practices have acknowledged the shortcomings of abstinence-only sex education in preparing young people to navigate their sexual health, and reduce vulnerability to HIV and other STIs, as well as unplanned pregnancies and stigma. Abstinence-only approaches to substance use ignores the realities that many adolescents will use drugs for a variety of reasons, and that there are a variety of resources and tools that can help them more safely navigate their use and build trust and rapport with healthcare providers who offer evidence-based, non-judgmental care.

In addition to STI clinics, LHDs engage with young people, their families and loved ones in a variety of other settings. Each of these settings provide opportunities to share life-saving and non-judgmental harm reduction information and resources.

  • Immunization
  • Maternal and child health
  • Physicals for teen sports
  • School Health

Naloxone and responding to overdose emergencies

  • Some states require parent or guardian consent to dispense naloxone to people under 18, but the dose administered and signs and symptoms of an opioid overdose are the same for children, adolescents, and adults

Education on Good Samaritan Laws

  • Adolescents and young people may fear calling 911 when a drug-related medical emergency occurs. Providing information about state Good Samaritan Laws—many of which protect the person experiencing the emergency and the person calling for medical help from arrest or prosecution—can help empower a young person to help a friend or loved one in a medical emergency.

Fentanyl Test Strips

  • Fentanyl test strips are non-prescription and can help young people make more informed decisions about the substance they may use. Education on how to use test strips, as well as safety planning around substance use, can be very helpful for young people.
  • As more and more substances are contaminated with fentanyl and other contaminants, encouraging young people to test what they use, go slow, have a buddy, and carry naloxone can be life-saving tips.

Safer use tips and/or supplies

  • Syringe services may be unavailable to people under 18, but if a young person is using injection drugs, it is still helpful to provide them with information around safe injection and not sharing injection equipment to prevent blood-borne infections.
  • Transitioning to smoking from injecting is also a safer alternative that reduces risk of infection and overdose.
  • For those who snort, encourage not sharing straws or using bills.

Online resources with accurate and evidence-based information

  • Sexual minority youth (SMY) are more likely to seek health information from sources other than their health care providers.11 The proliferation of social media can make it more difficult to find vetted, evidence-based information on substance use and harm reduction.
  • harmreductionhelp.cdc.gov has a repository of harm reduction resources on a wide range of topics.

Information on local harm reduction resources

  • If a harm reduction program exists in your community, whether it’s a part of the LHD or not, providing this information can be valuable for someone considering adopting safer use practices

For more information, contact Julie Karr at [email protected].


1. Noyes, E., Yeo, E., Yerton, M., Plakas, I., Keyes, S., Obando, A., Gaeta, J. M., Taveras, E. M., & Chatterjee, A. (2021). Harm Reduction for Adolescents and Young Adults During the COVID-19 Pandemic: A Case Study of Community Care in Reach. Public health reports (Washington, D.C.:1974), 136(3), 301–308. https://doi.org/10.1177/003335...

2. NCHS Data Brief  No. 428  December 2021 U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention National Center for Health Statistics Drug Overdose Deaths in the United States, 1999–2020 Holly Hedegaard, M.D., Arialdi M. Miniño, M.P.H., Merianne Rose Spencer, M.P.H., and Margaret Warner, Ph.D NCHS Data Brief, Number 428, December 2021 (cdc.gov)

3.Mari PC, Gulati R, Fragassi P. Adolescent Hepatitis C: Prevalence, Impact, and Management Challenges. Adolesc Health Med Ther. 2021 May7;12:45-53. doi:10.2147/AHMT.S263864.PMID: 33994820; PMCID: PMC8112853AHMT_A_263864 45..53 (nih.gov)

4.Haider MR, Kingori C, Brown MJ, Battle-Fisher M, Chertok IA. Illicit drug use and sexually transmitted infections among young adults in the US: evidence from a nationally representative survey. Int J STD AIDS. 2020 Nov;31(13):1238-1246. doi: 10.1177/0956462420950603. Epub 2020 Sep 30. PMID: 32996867;PMCID: PMC7951999.

5.Substance Use Disparities by Sexual Identity | The Trevor Project

6.Goldberg SK, Halpern CT. Sexual Initiation Patterns of U.S. Sexual Minority Youth: A Latent Class Analysis. Perspect Sex Reprod Health. 2017 Mar;49(1):55-67. doi: 10.1363/psrh.12020. Epub 2017 Mar 2. PMID: 28253427;PMCID: PMC6668721.

7. HIV Information and Youth | DASH |CDC

8.NHRC-PDF-Principles_Of_Harm_Reduction.pdf (harmreduction.org)

9.Shin, S. H., McDonald, S. E., & nConley, D. (2018). Patterns of adverse childhood experiences and substance use among young adults: A latent class analysis. Addictive behaviors, 78,187–192. https://doi.org/10.1016/j. addbeh.2017.11.020 Patterns of Adverse Childhood Experiences and Substance Use among Young Adults: A Latent Class Analysis - PMC (nih.gov)

10.Rose, I. D., Friedman, D. B., Spencer, S. M., Annang, L., & Lindley, L. L. (2016). Health Information–Seeking Practices of African American Young Men Who Have
Sex With Men: A Qualitative Study. Youth & Society, 48(3), 344–365. https://doi.org/10.1177/0044118X13491769

11. Demant, D., Carroll, J. A., Saliba, B., & Bourne, A. (2021). Information-seeking behaviours in Australian sexual minority men engaged in chemsex. Addictive behaviors reports, 16, 100399. https://doi.org/10.1016/j.abrep.2021.100399

About Julie Karr

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