We’ve all heard heard dozens of fellow users spout countless inaccuracies, misleading statements, and flat-out incorrect assertions about drugs, drug use, and drug laws as if they were all fact.
There’s no way this article could even hope to cover a half of a percent’s worth of the myths, half-truths, and facts we’ve heard as drug users since 2010 — that’s when I first began using illicit drugs — and address them to help readers better understand them.
Without further ado, let’s get started.
Myth #1 — You Should Disinfect With Alcohol Swabs Before AND After Injection
A few weeks ago, I asked a fellow local intravenous heroin user whether she used alcohol swabs prior to injecting. She told me she used alcohol swabs both before and after injecting. This is actually worse for your health as opposed to just using an alcohol swab immediately prior to injection, no matter the type of injection used: IV (intravenous, or directly into the vein), IM (intramuscular, or directly into the muscle), or SC (subcutaneous, or under the skin).
Injections make small holes in the skin through which bacteria and other potentially-dangerous microorganisms can enter. Following an injection, blood rises to the surface and closes the hole made by the syringe. The faster this happens, the less likely foreign objects are to make it inside the human body.
Using an alcohol swab after injection prevents blood from clotting. This is why it’s not a good idea to use alcohol swabs after injection.
Fact #1 — All Adults in Tennessee Can Purchase Syringes Legally
Many injection drug users in Tennessee struggle to get their hands on clean syringes. They usually are forced to hit the black market to source clean syringes, but, unfortunately, due to the underground nature of the black market, market participants can’t be sure that their sharps are fresh.
Although pharmacists in Tennessee are legally required to ask everyone without a prescription for syringes what they plan on using syringes for prior to completing the sale, it is possible for all adults with valid identification to purchase syringes from pharmacies. However, at least in my experience, pharmacists in rural Tennessee routinely turn customers down.
It’s possible to purchase larger-diameter syringes without a pharmacy’s help — think of veterinarians, vet supply stores, or pet stores. However, these syringes are absolutely not intended for the injection of illicit drugs.
Again, in actuality, injection drug users have one hell of a time trying to purchase syringes from pharmacies. Those who have tried to get syringes from pharmacies, especially in rural areas, often feel discouraged from trying other pharmacies in hopes of getting a “yes.”
I understand the rationale behind not wanting to feel responsible for helping an injection drug user shoot up, but people who inject drugs will get high whether or not they have access to clean, fresh syringes or not. As such, this idea doesn’t make much sense — shouldn’t pharmacists want to help underserved, at-risk persons from reusing sharps or sharing them with other users? Also, even if you purchase syringes off the black market, the only choice for most rural Tennessean injection drug users, there’s no guarantee they’re clean.
Anyway. To wrap this “fact” up, know that it’s legal to purchase syringes from pharmacies here in Tennessee without prescriptions but, in the same breath, understand you’re highly likely to get turned down.
Myth #2 — If You Have a Reliable Illicit Source for Diverted Prescription Medication, You’ll Never Come Across Fakes
Assume you occasionally consume prescription opioids (Norco, OxyContin). It doesn’t matter how often you take them. What does matter, in this scenario, is the source of the opioids.
According to federal government statistics, beginning in 2015, the rate of opioid prescribing in the United States dropped for the first time in some two full decades. This caused major supply chain issues on the American illicit opioid market.
People who were then able to regularly, reliably source prescription opioids from trusted sources had to do things like:
- Start paying more for the same pharmaceuticals they were once getting.
- Go longer between their chances to source opioids since many people got completely cut off from opioids by their physicians.
- As time progressed past 2015, the likelihood of purchasing counterfeit opioid tablets off the American illicit opioid market drastically increased.
These counterfeit tablets can either be made in a clandestine lab or in a fully-fledged pharmaceutical manufacturing operation would operate. The former is made possible by people selling small-time pill presses via the mail. They are usually sent part by part to avoid detection.
Their counterpart, the big labs mentioned above, are typically operated by Mexican drug cartels. Due to the widespread availability of pill presses, there are hundreds, if not thousands, of clandestine, one-room pill-pressing operations across the United States — but do we really know how active they are? Of course not — I’m just pointing out that pill pressing doesn’t just happen in big-time, Mexican-drug-cartel form.
Both are able to purchase pre-made mixes of inactive ingredients online. In most cases, these counterfeit opioid tablet manufacturers choose fentanyl as an active ingredient. Fentanyl has a lower threshold between the point at which consumers feel its effects — both analgesic and recreational — and the point at which opioid overdose symptoms manifest.
Another factor that makes counterfeit opioid tablets so deadly are “hotspots.” Hotspots are simply clumps of active ingredients. Fentanyl is much more potent than other opioids — extremely so. Because the volume of only a grain or two of salt can cause death in a human adult, it’s easy to understand why fentanyl “hotspots” are such an issue with counterfeit opioid tablets.
Dude, There’s No Way My Pills Could Be Fake
I’ve heard this rationale from countless drug users I’ve been around. I understand the thinking, especially from people who happen to have better connections to the diverted prescription opioid market, though it’s not a valid idea.
As you know, just one run-in with fentanyl-laced counterfeit opioid tablets can cause a potentially-fatal overdose.
Over the past few years, the quality of counterfeit pharmaceuticals — things like fake Xanax and pain pills, namely, not counterfeit blood pressure pills from India or anything, just to be clear — has improved drastically. It’s no longer possible to routinely tell fakes from their real counterparts just by identifying their characteristics.
How do we spread this message to people who use diverted prescription opioids — that they should view everything they come across as potentially counterfeit? I’m not sure. It’s often difficult to make the case to diverted prescription opioid consumers that their pills could be fake and contain the-super-easy-to-overdose-on drug fentanyl.
I think our best hope is to continually spread this message — that your pills could be fake and contain drugs with higher overdose potential like fentanyl even if you purchase them from trusted sources — to people who use drugs.
Fact #2 — Non-Opioids Can and Do Contain Fentanyl
We’ve all seen reports of non-opioid drugs like cocaine, methamphetamine, and even cannabis containing fentanyl. Although opioids are more likely to contain fentanyl than their non-opioid counterparts, other drugs can and do contain fentanyl — this isn’t just an over-sensationalized narrative pushed by news outlets.
There are a few reasons why batches of drugs on the American illicit opioid market contain fentanyl — and if you’d like to read more about why fentanyl is so deeply ingrained in the modern American illicit opioid market, check out this previous article of mine. They include the following:
- Because fentanyl is much more potent than heroin, distributors don’t have to transport as much volume or weight when they adulterate their heroin with fentanyl. The more fentanyl in an opioid mixture, the easier distribution is.
- Fentanyl furthers people’s addictions and dependencies. Once the illicit opioid consumers in an area become dependent on fentanyl in addition to heroin — or another opioid like oxycodone, for example — the less satisfied they’ll be by batches of opioids that are fentanyl-free.
- Fentanyl-heavy batches effectively provide free marketing to dealers. Dealers have been known to push exceptionally strong or unevenly-mixed batches of illicit opioids that also contain fentanyl, causing more overdoses than usual — and potentially more deaths. Full diclosure — dealers are people, too, and they often don’t want to see their customers die. However, it’s undeniable that dealers stand to benefit by selling batches of “heroin” — really, almost all American “heroin” is a fentanyl-heroin mixture — that are more likely to cause overdose.
- Fentanyl-positive “heroin” hits different. Even though opioid users know how dangerous fentanyl is — at least they should know for the sake of their well-being, and all — many report that they’d rather use heroin-fentanyl mixtures than just heroin, or whatever opioid-fentanyl mixture is at hand.
- The last major reason is that fentanyl is much easier to manufacture than opioids like heroin. Heroin requires farmhands to cultivate broad, wide-open fields of Papaver somniferum, better known as the opium poppy. Fentanyl is manufactured with chemical precursors, meaning there’s no need for massive farming operations. Further, well over 90% of the world’s illicitly-manufactured fentanyl (IMF) actually comes directly from professional-yet-illegal manufacturers in China. These manufacturers use the Internet to sell high-quality, nearly-pure fentanyl and countless fentanyl analogues at low prices.
As you can reason, there are plenty of reasons to add fentanyl to other opioids. But why would anybody include fentanyl in non-opioid drugs?
There’s no question that high-level distributors have made mistakes during the adulteration process that resulted in the cross-contamination of other, non-opioid drugs like meth with fentanyl.
For example, assume a high-level distributor just got done adulterating their heroin with fentanyl. The distributor used a few blank credit cards/gift cards to mix the two opioids together. Rather than cleaning the cards off before attempting to adulterate their cocaine, for example, the distributor inadvertently contaminates their cocaine supply with fentanyl.
A personal anecdote from a Northwest Tennessee man — I’ve referred to him as Jonah before in one other article — is that, after he was court-ordered to go to rehab twice in two or three months, he ended up testing positive for opioids both times. Jonah never uses opioids and doesn’t like them.
The one thing that stayed consistent between the two drug screens is his meth consumption.
Further, other meth consumers in Jonah’s local area have also reported that they’ve tested positive for opioids following their consumption of local meth, despite the fact they didn’t otherwise consume opioids.
Since fentanyl was — and still is — regularly found in the local illicit meth supply to which Jonah has access, I think it’s reasonable to assume that people higher up the supply chain intentionally cut meth with fentanyl. It’s not very feasible for high-level distributors to continually make the same cross-contamination mistake over, and over, and over, and over again.
Here’s Jonah’s hypothesis as to why his community’s local meth supply contains fentanyl: after a few days of binging on meth, almost certainly bringing no sleep and — in many other methamphetamine consumers’ cases, too — an insufficient nutrient load into the mix, it’s not hard to reason that these people’s bodies would feel sore, worn out, or otherwise bad. Jonah feels as if the distributors who are responsible for adulterating methamphetamine with fentanyl provides the distributors with a competitive advantage because consumers’ aches, soreness, and lethargy would be better dealt with than by consuming methamphetamine without fentanyl included.
Could Jonah be wrong about this idea? Yes. I think it’s a valid idea, however, and I haven’t seen it floated anywhere else.
What’s important to know is that all drugs, not just opioids, are liable to contain fentanyl. The problem with this is twofold: (1) users don’t know they’re consuming fentanyl and (2) since there’s such a low threshold between the amount of fentanyl needed to cause physiological or psychological effects and overdose, it’s easy for people to potentially die from unknowingly consuming fentanyl.
Myth #3 — You Can “Narcan” Yourself
Before Anything Else, Let’s First Understand Naloxone
First off, “Narcan” isn’t technically a verb — it’s a proper noun officially stylized as NARCAN® Nasal Spray — though you’ll inevitably hear it used as such somewhere. Narcan is a pre-loaded, single-use nasal spray that’s available over the counter in pharmacies across the United States. Drugs are available over the counter when they have little to no contraindications, or negative reactions to other medicines or people who have certain health conditions.
Naloxone, the sole active ingredient in Narcan and Evzio — similarly styled EVZIO®, an auto-injector that talks users through the entire process — has no contraindications outside of people who are allergic to naloxone.
Many people who overdose on opioids are opioid-dependent, meaning their bodies need to maintain minimum levels of opioids or else they’ll face opioid withdrawal syndrome, which shares many of the same symptoms of the flu. Although this isn’t a true contraindication — which means, according to Google, “suggest or indicate that (a particular technique or drug) should not be used in the case in question.” — opioid-dependent people experience precipitated opioid withdrawal for an hour or two following administration.
Depending on what opioid an opioid-dependent person is reliant on, the peak of opioid withdrawal syndrome takes roughly 72 hours to be reached. Precipitated withdrawal, on the other hand, causes the full slate of peak opioid withdrawal syndrome symptoms to rear their oh-so-ugly heads in opioid-dependent people.
This is a small price to pay in exchange for having your life saved, though — an hour or two of pain to have another shot at this beautiful experience we call “life.”
Naloxone acts as a powerful public health tool. Whether you think reviving someone who knowingly uses opioids and understands they can die from doing so is a good idea or not, since naloxone is cheap and has no true contraindications, naloxone is an effective tool for preventing death.
And, although off-topic, you may come across people who aren’t supportive of responding to opioid overdoses with naloxone. No matter their reasoning, I think the vast majority of all reasonable-minded humans agree that nobody should die while suffering. Many regular drug users — especially those suffer from drug addiction — use drugs to fill the gaps created by long-unmet needs not being fulfilled. I genuinely believe that every stint of problematic drug use comes to an end, however long it might take; this thinking lends itself to the idea that every addict will has a real, tangible shot at recovery.
Most people will get behind the idea of making sure people in active addiction don’t die in pain. This approach may be useful in educating laypeople about naloxone or persuading them to get on board the naloxone train.
Naloxone has been used extensively to reverse overdoses throughout the United States, especially recently.
According to the U.S. Centers for Disease Control and Prevention, more than 26,400 opioid overdoses were resolved from 1996 to 2014 through the administration of naloxone in the United States alone. Many opioid overdoses, as well as their reversals thanks to naloxone, go untracked, though.
For example, I had at least two opioid overdoses — I say “at least two” because I was given naloxone a third time when I was potentially just a few minutes away from experiencing overdose; I’m not sure if I can definitively count that as an “overdose” — in 2019. Both times, fortunately, I was revived with naloxone. Would I have died or experienced permanent brain damage without naloxone’s help? There’s no way to know.
I enrolled in a medication-assisted treatment (MAT) program after that third potential overdose, though not at all because of the overdose — rather, I was facing legal consequences as the direct result of my ongoing illicit drug use. My life is better now that I’m on buprenorphine (Suboxone, Subutex). It is impossible to get help for drug addiction, after all, if you’re dead.
When Should Naloxone Be Administered?
Knowing when to administer naloxone is the same thing as knowing how to recognize an opioid overdose.
Bluish lips, fingertips, and toes are one of the most widely-reported symptoms of opioid overdoses, according to friends, family members, peers, first responders, physicians, nurses, and other medical professionals who’ve seen people experience opioid overdose.
While opioid users sometimes nod out, if an overdose is, in fact, present, they’ll be unconscious or very close to completely losing consciousness. Just like when people are unconscious for any other reason, people experiencing opioid overdose won’t be able to respond to any stimuli, even an air horn, a bright flashlight shined into their eyes from inches away, or a loud, blood-curdling scream.
The skin will turn a different color, though what color it turns depends on the person’s regular skin tone. Lighter-colored people, such as most White and Asian people, skin may begin turning hues of blue and purple. For darker-complected people, like most Middle Easterners and Black people, skin tones may start to become any one of a range of gray colors. Keep in mind that these aren’t scientific facts — just concerns we should play with.
If you’re unsure of what to look for or think you might not be good at recognizing these color changes, always first look to the lips for help. They’re the easiest to read, generally. Also, fingertips and toes may be of help, too.
Assume you’re not sure of what to do. You see someone exhibiting one or more of these opioid overdose symptoms, but you also see that their current cohort of symptoms could very well be caused by another drug’s pattern of overdose symptoms.
Here’s what we’re going to do. I’ll explain how to administer naloxone, as well as what signs you should look for to know when it’s an appropriate time to “Narcan” somebody.
Once you’ve identified an opioid overdose, you should immediately call 911. If you have to move away from the person who’s overdosed to call first responders, you should place them in the recovery position, seen here.
This prevents them from breathing in a foreign object. Opioids, especially in excessive doses, are known to cause puking; the recovery position neutralizes the risk of asphyxiation by vomit — opioids, since they’re also known to cause unconsciousness, can make it difficult for people to clear vomit from their airways.
Now, it’s time to administer Narcan. Don’t worry about getting their body in a certain position; simply spray one spray in each nostril. Make sure the nozzle is firmly inserted inside each nostril before spraying.
If you’re using injectable naloxone, draw the naloxone solution into the syringe and inject it into the thigh or upper arm. To bridge the gap from now until paramedics alive, perform rescue breathing. There are several other best practices to follow in responding to opioid overdose, though I won’t list them here — I’m just trying to give you an idea of what administering naloxone is like, if you didn’t already know.
That’s how the naloxone administration thing works. But can you revive yourself with naloxone?
But Can You Revive Yourself With Naloxone?
Let’s Cover a Real-World Example, After Reading Which You’ll Determine the Answer Yourself
Opioid overdoses can happen anywhere from a few seconds to a few hours after opioids are taken; the fastest overdoses usually happen with intravenous administration, since no absorption barriers have to be passed.
Oral consumption, on the other hand, is sure to take the longest in terms of causing an opioid consumer to experience opioid withdrawal syndrome. One time — and it’s not like I’m proud to admit this; not at all — I experienced an overdose in 2014 that involved oral administration.
It was early June 2014. I won’t get into why, but I was angry at the time — very angry. I had almost never, ever used drugs in direct response to my emotions. I first took oxycodone — relative to my opioid tolerance at the time, I just took a standard dose; nothing special. Then, maybe 45 minutes later, I took alprazolam, and, relative to my benzodiazepine tolerance at the time, it wasn’t a large dose, either.
I had actually combined alprazolam (Xanax) with oxycodone before several times, not to mention in larger doses than I did on this super-humid evening. About an hour after I took the Xanax, I decided I wanted to walk back to my room, as I wasn’t having any fun with the people I was hanging out with.
Keep in mind that pretty much all students at this school had left a week or two prior, as the spring semester had just come to close.
On my way back to my room, I passed out. The only thing I remember is leaving the room. The room was no more than ~40 steps away from where I’d passed out, including a small flight of stairs.
Here’s what ended up happening: I stayed that way, collapsed in a lump on the carpeted hallway floor. All by myself. With nobody to help me. Not a soul.
Everybody else had left campus just a week or two prior. I ended up coming to about three to four hours after I’d passed out. I was extremely disoriented, dehydrated, and confused. I felt more confused than I ever had in my entire life for about 15 minutes. I puked, and I puked, and I puked. And then I puked some more.
I’m very lucky to be alive.
Could I Have Administered Naloxone Myself and Prevented That Overdose?
Again, I don’t remember anything about falling out. Even if I knew what naloxone was and I had it with me, how would I have recognized the “point of no return”?
Therein stands the central issue with the prospect of naloxone self-administration in response to opioid overdose — you don’t know when you need to hit yourself with the life-saving drug.
I very well suspect that some opioid users could successfully prevent an impending overdose via naloxone self-administration. However, if you miss the mark just one time, game over!
Also, keep in mind that opioid users often can’t afford to ruin their high, which is exactly what naloxone does. Or, they might just not want to blow their high.
Put simply — and if you want to read more about my take on naloxone self-administration, check out my article on it — you can’t rely on yourself to administer naloxone in the event of overdose.
One last thing about naloxone — after I’ve been given naloxone, I’ve never experienced precipitated opioid withdrawal syndrome. This is because I just happened to be given enough naloxone to resume consciousness, though not enough to forcefully remove the opioids that were occupying my noodle’s opioid receptors from those receptors — that’s what causes precipitated withdrawal, if you didn’t know. I also still felt high after all three of my run-ins with naloxone.
Fact #3 — Kratom Is an Opioid
Many advocates of kratom, including the American Kratom Association, argue that kratom is not an opioid despite the fact it causes effects oh-so-remarkably similar to opioids, mitigates opioid withdrawal syndrome, and acts on the brain’s opioid receptors as its mechanism of action.
I wholeheartedly disagree — I think kratom is, in fact, an opioid.
What Is Kratom?
Kratom (Mitragyna speciosa) is a deciduous evergreen tree — the tree would lose its leaves if grown in a non-tropical area, though, since it’s found in tropical areas, kratom trees don’t ever shed their leaves for the winter, making it both deciduous and evergreen — that is native to Southeast Asia. People have used kratom for at least hundreds of years, usually by laborers to power through workdays thanks to its stimulating and analgesic effects.
Kratom contains a couple dozen alkaloids, or psychoactive compounds, that are responsible for its effects. People typically use kratom by swallowing ground, powdered kratom leaves, making tea, or chewing fresh leaves raw a la chewing tobacco.
Although the pro-kratom advocacy organization American Kratom Association considers kratom not to be an opioid, I disagree. There’s no single, widely-accepted definition of “opioid,” which makes arguing whether kratom is an opioid or not difficult — without agreeing on a definition, you can’t reasonably discuss whether kratom is, in fact, an opioid or not.
How Do Opioids Work?
Again, in order to make this case, I first need to define “opioid.” It’s reasonable to say, no matter which definition you’re using, that an opioid is something that acts on the brain’s opioid receptors and has morphine-like effects.
Why does morphine — and, of course, other opioids — relieve pain, cause analgesia, and potentially lead people to addiction or dependence?
We’ve got a few different kinds of opioid receptors. One of them is the mu-opioid receptor.
A 1996 study found that, by comparing humans to mice that lack the mu-opioid receptor, the mu-opioid receptor is responsible for both the “therapeutic and the adverse activities” of morphine. Mice without the mu-receptor gene are more sensitive to painful stimuli, don’t pull as much reward from drugs of abuse, and lack the same dependence, reward, and analgesia from morphine that mice with the mu-receptor gene.
Here’s Why Kratom Is, in Fact, an Opioid
Two of the most prevalent and powerful alkaloids in kratom are mitragynine and 7-hydroxymitragynine (7-OH). Primarily, the effects of these alkaloids come from partial agonism of the mu (µ) opioid receptor.
Mitragynine acts as a partial agonist at hMOR (EC50 = 339 ± 178 nM) and a weak antagonist at hKOR and hDOR. 7-OH acts as a partial agonist at hMOR (EC50 = 34.5 ± 4.5 nM) and as a competitive antagonist at hDOR and hKOR.
Some kratom fans may argue that, since kratom is only a partial agonist, it can’t be considered a true opioid. LSD and THC, for example, are both partial agonists of the 5-HT2A and CB1 receptors, respectively. LSD is still considered a classic psychedelic based on its effects; THC is defined as a cannabinoid for the same reason.
Myth #4 — Kratom Is a Deadly Drug
The other ideas I’ve addressed so far are likely more familiar to you than this one. While this might not be a widely-held misconception, I’ve come across a handful of people who think kratom is a deadly, dangerous drug.
The only people I’ve heard say this in real life were all involved with a medication-assisted treatment program in Jackson, Tennessee — two of them were physicians and the other was the program’s director and a registered nurse. I’ve seen people online say the same things, too.
These two physicians and the director-cum-registered-nurse told me kratom causes worse opioid withdrawal symptoms than buprenorphine (Suboxone). That could be the single most ignorant thing I’ve ever heard. I’ve taken kratom for three-plus years. Never did I have serious withdrawal symptoms.
Now, since I’ve been on Suboxone, I can’t even begin to feel the effects of kratom, even in high doses. Also, before enrolling in the MAT program, I never had a material physical dependency to opioids. Now, I do.
Comparing Kratom to Other Opioids
Opioids are notorious for causing respiratory depression, the most common direct cause of death stemming from opioid overdose.
Kratom has less potential for causing respiratory depression than classical opioids. It’s also less likely to be abused like other opioids, as it just doesn’t have the same recreational potential.
Kratom, Alphabet Soup’s Best Friend
The Centers for Disease Control and Prevention (CDC) have published research that fingers kratom as a direct cause of death in about 100 people after examining some 27,000 accidental drug overdoses across a 17-month stretch in the United States.
The U.S. Food and Drug Administration, as well as other federal government agencies, have used similar research as a tool to campaign against kratom. Ostensibly, officials hope to have the drug viewed as a deadly, dangerous drug by the American public.
I feel that the three aforementioned medical professionals — although they’re obviously incentivized to slam alternatives to opioids other than buprenorphine, considering they work for a medication-assisted treatment program, and all — may have been led astray by FDA and CDC reports.
Also, these reports have spurred news agencies around the country to write about kratom as a potentially-harmful or definitely-deadly drug, further pushing people to view kratom negatively.
Here’s the Verdict
Yes, kratom is a drug. Like all drugs, kratom can prove harmful. However, kratom doesn’t pose much of a threat because:
- Kratom has little recreational potential.
- It’s less likely to cause respiratory depression — or vomiting, for that matter.
- Kratom is much, much safer than classical opioids, especially those sold on the black market, not to mention readily available and cheap.
Kratom, which is often used to curb anxiety, depression, chronic pain, and other health problems, can be used irresponsibly, especially by people who are self-medicating to deal with anxiety or depression.
Also, because the kratom market is largely unregulated, there’s no way to reliably enforce manufacturers to prevent kratom from being contaminated with pathogens, heavy metals, other active ingredients, bulking agents, or any other adulterants. Kratom needs to be regulated — at least if we want the kratom industry to be safer, that is.
Tying Everything Together
I hope I’ve been able to shed some light on commonly-held myths, misconceptions, and half-truths that are common among people who use or are otherwise involved with drugs.
Please do reach out to me if you think I got anything wrong.