As of now, the phrase “harm reduction” is generally associated with illicit drugs — particularly “hard” drugs like opioids (e.g., heroin) or “radical,” “hardcore” things like injecting drugs.
Although not watering down our cause and staying true to long-term, often-problematic drug users like me is something virtually all harm reductionists share, with this idea, we’re shooting ourselves in the foot.
Why haven’t we begun associating harm reduction with vaping or chronic pain patient advocacy on a widespread scale yet? Some of us have, but the vast majority of us haven’t. These two associations, in particular, will launch the societal acceptance of “harm reduction” into the god damn exosphere. In other words, regularly associating our cause with chronic pain patient advocacy and vaping will improve our advocacy efforts big-fuckin’-time. And, also, the tenets we share as harm reductionists will help improve chronic pain patient advocacy and vaping — this isn’t a one-sided affair.
But First, a Definition — What Is Harm Reduction?
There’s no widely-accepted definition of “harm reduction” (HR), though I define it as things that reduce harm done to or experienced by drug-involved people (e.g., active users, dealers, people in recovery, family members of addicts). Generally, it consists of doing things to help active drug users like me.
How Do We Benefit From Associating Ourselves With Patient Advocacy and Vaping?
Let’s face it — HR is generally associated with “hard” drugs and radical ideas. Although most, if not all, of the tenets we support as harm reductionists are based in academic research, evidence, and the oh-so-beautiful scientific process, our movement is still fringe because of the harsh stigma associated with our nature of work — largely-illicit drugs!
Although many Americans are on board with the idea of rolling back drug possession laws and even full-fledgedcannabis legalization, most of us aren’t comfortable with the idea of non-cannabis drug policy reform — especially not with “hard” drugs — let alone doing things that actively help current drug users keep using drugs in ways that we perceive as problematic (i.e., running syringe exchanges, supervising consumption to respond to overdose).
Don’t get it twisted — I still agree with these things. However, we can’t deny that most Americans don’t agree.
We harm reductionists benefit from associating our cause — as well as drug policy reform and drug user advocacy — with vaping and chronic pain patient advocacy by:
Expanding our scope.
Being viewed as reasonable.
I’m sure there are some other ways converging our interests benefits us, but these are the primary two that come to mind.
How Do We Help Vaping and Chronic Pain Patient Advocacy?
Again, this relationship isn’t parasitic in nature — we both benefit from this ordeal. Rather than acting as the blood-sucking leaches every mammal just loves, I like to think of us as altruistic cleaner shrimps that rid acquatic creatures of parasites.
Although not entirely, harm reduction is largely concerned with practical actions that have real-world benefits as opposed to vague ideas that are often pushed solely by voice or writing and take many decades to pay off. While vaping is very much a practical, real-world thing that has near-immediate utility, chronic pain patient advocacy is often the opposite. Or so it seems.
Vaping, in general, is viewed as most people as something that reduces harm from already-legal tobacco products. Tobacco-associated stigma is low compared to other drugs. Harm reduction is viewed as more of a “drug thing” than vaping. In 2019 — and still today, though it’s overshadowed by the ongoing COVID-19 pandemic — vaping took a reputation hit by being associated with illicit counterfeit cannabis concentrate cartridges. HR benefits vaping by better acknowledging that regulated vaping is a very real alternative to such harmful illicit options, as many people currently just view vaping as an alternative to something that’s already legal (tobacco).
Where Do We Go From Here?
I’ll be the first to tell you — I don’t know, exactly. We certainly need to start talking about it as individuals. So, in other words, that means you can reach out to members of the social media-based communities that you aren’t already on board with (vaping and/or harm reduction and/or chronic pain patient advocacy) and spreading this idea with them.
Although I almost always say that most people’s activity on social media falls short of being “advocacy,” I genuinely do believe that uniting these three communities by personally reaching out to people on social media is an effective way to advocate for these causes — not just harm reduction.
If you go to any chronic pain community on social media, Internet forums, or elsewhere, you’ll quickly find patients — who’re often under-treated, giving them good reason to be upset — who blame the drug-seeking habits of many thousands of opportunistic black market entrepreneurs and irreverent recreational drug users for causing modern American pain management to be where it stands now.
Even though I’ve never been doctor-shopping, or purposely visiting physicians and other prescribers with the intention of being prescribed one or more pre-desired drugs, we “addicts” — at least that’s what we’re often called by angry chronic pain patients and their advocates — I am sometimes still blamed for contributing to the opioid epidemic. And, even if I’m not directly blamed for doing such, I often feel like I’m being blamed for that thanks to the quite-often-angry attitudes and firey rhetoric of these deservedly-mad chronic pain sufferers.
What’s With the Finger-Pointing?
I won’t break them down, but there are several reasons as to why at least some members of web-based chronic pain patient advocacy groups actively place blame on us. It makes them feel better. They might feel like, since they’ve got an inherently-evil, dirty, negligent character in “dirty junkies” or “drug addicts” — I use quotations because they’re jam-packed with a lot of stigma and I try to avoid using them where appropriate (and avoiding their use is so very often appropriate — they have a better chance of getting justice in the form of pain management treatment that truly dumbs their symptoms down to a universally-manageable level… or, at least that’s how it seems like many of them think.
I think most chronic pain patients and other non-patient advocates know that blaming selfish, ruthless, objectively-bad “dopeheads” won’t get them anywhere. But maybe not.
Why Don’t Advocacy Effort Leaders Make Way for Change?
No cause or community wants to become known as salty, bitter, or toxic. At least not any advocacy group, that’s for sure.
While, of course, changing the collective behavior of an entire community member by member is difficult — and only possible to a certain degree, as some members won’t be willing to play ball — I still think it’s worthwhile to weed out this addict-blaming behavior from the crowd.
Now, as Drug User Advocates, Let’s Think About the Flip Side
I haven’t seen much conversion among the drug user advocacy, drug policy reform, harm reduction, and otherwise-helping-drug-involved-people crowd — I’ll call this “drug stuff,” for lack of a better wording — and the chronic pain patient cohort.
Where would these groups overlap, anyway?
Chronic pain patient advocates — and, surely, there’s a better name for this group than “chronic pain patient advocates”; this phrasing, although accurate, is fairly clunky — generally want to roll back the relatively-recently-implemented guidelines that have extensively limited opioid prescribing.
We, too, as “drug stuff” advocates, want access to a safe drug supply. Both of these — expanding opioid prescribing and opening up access to pharmaceutical-quality, reliably-dosed, otherwise-illicit drugs — involve expanding opioid access in a medical capacity. Although our goals are different, we ultimately want roughly the same outcome, give or take a few shades of variance.
Something Else We Both Want
It’s safe to say that most members of both groups want greater individual liberties. Although this is something virtually everybody supports, I think our — we (a) “drug stuff” supporters and (b) chronic pain patient advocates — desires are far different from most people’s ideas of “civil liberties.”
Lower property taxes is one of the most common requests from people who request expanded civil liberties. Here are some other common demands:
Taking away the often-viewed-as-unfair amount of power that law enforcement has to search and seize assets — police didn’t have this ability whenever the Founding Fathers formed the United States.
Blocking government agencies from conducting surveillance on innocent citizens.
Abolishing the cash bail system, thereby restoring low-income people’s rights to fairly develop a legal defense strategy. In modern practice, low-income defendants often plead guilty to crimes even if they know they’re not guilty because they’re so scared to fight the system.
Giving felons, parolees, and incarcerated people back their ability to vote and possess guns.
Severely limiting the ability of law enforcement agencies to use physical, corporal, sometimes-deadly.
We differ from most in that we’re not vying for less government involvement in general. Rather, at least in this category, we want better access to safe, legal, regulated, standardized drugs — particularly opioids.
And Another Thing
I think both of our sides can agree that we don’t like urine drug screens. Although medical providers — and especially specialized pain management physicians — can’t force patients to submit urine samples, in practice, they do, in fact, effectively force patients to put up with drug screens.
Refusing drug screens, as we all know, regularly results in getting fired from a pain management program.
Illicit drug users like me don’t like drug screens. Although, yes, I recognize utility in drug screens because they can prevent heavy machinery operators from potentially harmful situations. Here’s the big issue, though — cannabinoids, for example, can stay in our systems for well over a week, if not a month; how can an employer reliably infer that an employee is under the influence of psychoactive drugs at the time of screening if they test positive for long-lingering cannabinoids or drugs with long half-lives like buprenorphine or methadone?
As we all know, although we can’t really have drug screens forced upon us unless we’re on probation or parole or incarcerated. However, just as in the doctor’s office example above, oftentimes, entities that ask for drug screens are typically able to weasel people into taking them. It’s not just doctors’ offices.
People who work for state and federal departments of transportation are usually required to remain abstinent from drug use at all times, even in their personal lives. Just like the heavy machinery operator can be fired for “dropping dirty,” as we often call it, even if they aren’t actually high at the time of testing, other transportation industry workers are subject to similar treatment.
Such policies allow employers to extensively control employees’ lives — oftentimes, it’s not like people can just up and leave one day from their jobs; as such, people who are disproportionately affected by such invasive policies often feel trapped… it’s just not very cash money.
Not cash money at all.
Here’s one caveat: physicians may be able to prevent serious adverse drug reactions and even death by administering drug screens. For example, if a pain management doctor’s patient tests positive for a benzodiazepine, he may warn the patient to cease benzodiazepine use, require them to promptly report for random drug tests at any time, or even outright fire the patient, thus potentially cutting them off from the misused opioid analgesics that could end up taking their lives.
The same caveat holds true for protecting workers from the threat of heavy machinery mishaps. I’m sure there are several other caveats, too.
How Can We Overlap Our Two Causes?
Unfortunately, I don’t know, exactly, how we can get the show on the road.
If you regularly use social media or a web-based message board and are a “drug stuff” advocate, consider engaging with chronic pain patient advocacy circles to potentially turn them on to the idea that we could get more done by joining forces. Now, I will say this: In general, using social media to change other people’s minds is silly. This is not, at all, “advocacy.”
It might feel like advocacy, but it sure as hell ain’t. With that being said, I’m not otherwise aware of how to turn these people (pain patient advocates) on to the potential of merging at least some of our advocacy efforts.
Time to Wrap It Up
I usually don’t like writing about things unless I have concrete, do-able recommendations, strategies, or tweaks to share. This is one of those times where I’m shit outta ideas — but, since this’ll need to be a collaborative effort throughout the “drug stuff” and the chronic pain patient advocacy communities, anyway, you should share your ideas with me, directly, or either of these communities at large.
The phrase “harm reduction” is most often associated with drugs and, to a much lesser extent, sex work — specifically, street prostitution and escorting as opposed to web-based, non-contact sex work — here in North America.
So much of our struggle as harm reductionists comes from trying to get our fellow laypeople rolling with SS Harm Reduction. Really, most of us who want to help drug users are interested in drug policy reform, drug user advocacy, and harm reduction, but most of us tend to lump it all under the umbrella of “harm reduction.”
Like damn. Those three are wayyy too fuckin’ long to say together just to identify ourselves.
I live in a rural, largely-right-leaning area that has virtually no HR infrastructure. You can imagine how few people are on board with harm reduction in bum-fucked-Egypt — in this case, BFE is Northwest Tennessee; my fellow injection drug users aren’t used to being able to source syringes in an above-ground manner. We’re used to the social services-criminal justice alliance not treating us right — why would we trust anything that seems too good to be true?
When it comes to my efforts in “drug stuff” — the aforementioned trio of things that help drug users — I feel like I’m responsible for making sure HR itself (i.e., mentioned by name) and HR-positive ideas thought of by people who don’t label their actions “harm reduction.”
We Gotta Normalize HR
People in the largely-right-leaning areas that dominate the United States by land mass are averse to ideas that seem overly left-leaning or excessively politically correct.
The modern American political landscape is more divisive than ever — check out this minute-long video that uses imagery to show just how discordant (yes, fancy word, I have big brain) we are in these times.
Social media also contributes to divisiveness among Americans. I don’t know what characteristics of social media lend themselves to this gross argumentativeness, though I know it’s true.
Also, I think largely-right-leaning people are all but averse to “radical,” high-level harm reduction applications like supervised consumption sites or safe supply; however, they are, in my opinion, likely to see the merit in switching to vaping largely-harmless nicotine solutions from smoking tobacco, which exposes smokers to dozens, if not hundreds of carcinogens. Hell, I’d think that many Americans wouldn’t even be down with syringe exchanges.
With such barriers in mind, it’s absolutely essential that we actively start involving tobacco and vaping in general harm reduction messaging. And, I’d go as far to say that harm reductionists, as individuals, should strive to associate entry-level harm reduction applications — or low-hanging fruit on the proverbial harm reduction tree, in other words — like switching to vaping from smoking or making sure to pace alcohol consumption and drink water in between every alcoholic drink, for example, with the phrase “harm reduction.”
In other words, if it’s appropriate for you to mention these entry-level ideas alongside “harm reduction,” do it! If more of us adopt this habit, we’ll undoubtedly improve the spread of harm reduction.
Not-So-Guilty by Association
Although tobacco so reliably causes cancer and other often-fatal health problems, since the drug is legal and has long been socially accepted by Americans from Fairbanks to Miami, it’s viewed many times more favorably than just about all illicit drugs.
The most widely-recognized application of harm reduction here in the United States is — and this is whether people actually think of it as “harm reduction” or not — switching from dip, chew, or another form of tobacco in favor of vaping.
Already, I can see how some people might not want to mar together the two worlds of (a) “hard” drugs that are viewed as inherently bad or high-level, “radical” ideas like supervised consumption sites and (b) basic, common-sense strategies that the American public is generally already on board with. Admittedly, it does seem disingenuous to associate non-radical, non-“hard”-drug-related ideas with what we’ve come to accept as “harm reduction.”
However, isn’t our cause as harm reductionists to help as many drug users as we possibly can to the greatest extent achievable? I think it is. Wanting to actively avoid easily-achievable, entry-level applications of harm reduction in favor of their way-more-advanced counterparts isn’t based upon solid reasoning — there’s nothing wrong with working smarter, not harder.
Well, at Least a Little Guilty
Vaping doesn’t have a smooth, buttery-soft image, unfortunately. Throughout 2019, people across the country developed often-serious pulmonary injuries, dozens of which died. News reports incorrectly linked the injuries to regular-ol’ vaping — the vaping smokers and dippers use to get clean of tobacco, that is — to the lung injuries. In actuality, the bulk of the injuries, if not all of them, were caused by counterfeit cannabis concentrate cartridges.
With legalization and regulation, states’ cannabis industries have become just like any other consumer goods market. Rather than, for example, cannabis concentrates being made in unregulated, illegal, often-unsafe makeshift labs and packaged in whatever’s convenient, these legal state markets offer branded products to customers.
You likely know that legal cannabis markets’ wares are often super duper pooper scooper mooper super fuckin’ expensive. Many people have eschewed the legal, well-regulated state cannabis markets in favor for the black market cannabis they’ve grown up with. With these two factors comes a perfect storm for tons of counterfeiting — and that’s exactly what caused the 2019-2020 vaping lung illness outbreak (that’s not my name for it; I ripped the name from Wikipedia), or so we think.
Admittedly, I’m not a vaping expert — I’m pulling this info essentially straight from Wikipedia. Centers for Disease Control and Prevention believes that patients who presented symptoms of vaping-associated pulmonary injuries were often exposed to cannabis concentrate cartridges that used abnormally-high proportios of vitamin E acetate, a thickening agent that’s regularly used in cannabis concentrate cartridges.
Usually, such cartridges wouldn’t contain more than 20% vitamin E acetate. Many illicit cannabis concentrate cartridge sellers were using vitamin E acetate to the point that cartridges were made up of at least 50% vitamin E acetate.
Vitamin E acetate is used because, to the untrained eye, it closely resembles THC oil, the most common cannabis concentrate.
Most Americans, so it seems, aren’t aware of the fact that counterfeit cannabis products were widely associated with observed vaping-related pulmonary injuries.
Ultimately, the vaping lobby ended up taking a net loss in terms of reputation. Still, it’d be beneficial to us to associate our cause with entry-level HR applications like this.
Associating Harm Reduction With Protective Measures Against COVID-19
Of course, global pandemics don’t come around too often. Like all of us, I hope the threat of catching COVID-19 goes away super soon.
However, while the pandemic is still very much in full swing, we should seize the opportunity to associate “harm reduction” with any and all entry-level, common-sense applications (e.g., wearing face masks or respirators, offering free novel coronavirus test facilities) that virtually everybody will recognize as effective.
And, just so we don’t get confused, potentially-controversial measures like forced stay-at-home orders shouldn’t, in my opinion, be linked to “harm reduction” — it seems like right-leaning people are responsible for much of the stay-at-home order protests; since we already desperately need to involve right-leaning people (especially those in rural areas) as harm reductionists, distancing ourselves from supporting such stay-at-home orders might be a good idea.
In Other Words, Let’s Make Harm Reduction Not Necessarily Drug-Related
If we could collectively brand “harm reduction” as a collection of common-sense, practical strategies for reducing all sorts of harms — not just drug-related harms — we’d be so, so much better off.
And, to be clear, I’ve already seen people associating the phrase “harm reduction” with the measures mentioned herein. But these harm reductionists are the exception, not the rule.
Lastly, since the vaping/smoking thing isn’t exactly in most harm reductionists’ wheelhouse, a lot of us — me included — might have to educate ourselves before we start making these associations publicly.
I want to hear what you have to say on this issue. And, no, this isn’t some generic call-to-action I close all my articles with; I really, really do value the community’s insight on this issue.
In the world of harm reduction, we support things like drug-involved organizations hiring active and former drug users — oftentimes, particularly-problematic drug users — and involving them in decision-making responsibilities; employing current and former sex workers in sex worker-centered outreach efforts; putting LGBT people to work in LGBT-related capacities; and so on.
All of these people have what’s called “lived experience.” But why, exactly, is preference often given to people with lived experience?
But… get ready for a total shower thought… why don’t we refer to people with lived experience as just that — “people with lived experience,” or PWLE for short?
Why We Needa Get Wit Da God Damn Program, My Fellow Bruhs
First off, it seems like much harm reduction-related communication takes place online. Social media often’ isn’t conducive to typing things out in full. Although we don’t go into full-on “text lingo” a la an out-of-touch 65-year-old — wat u gng 2 b dng l8r? — on social media, we certainly do use initialisms like PWUD to refer to the long, drawn-out, fucking-clunky phrase that is “people who use drugs.”
What other concise — hell, even halfway-concise? — wordings do we have to refer to people with lived experience, particularly Alphabet Gang members, sex workers, people who’re temporarily without a reliable, regular living space (or, to be more specific, without both a bed and a private bathroom, two things that are often used to determine whether someone is “homeless” or not), formerly-incarcerated people, drug users, etc.?
I’m aware of PWLE, but the phrase is criminally underused. Just to clarify, while my idea for PWLE was entirely original, I am not the first person to use this compact initialism to refer to people with lived experience. A quick google search uncovered a 2013 blog post that brought up the idea — though the author was very much against using the compact alternative to “people with lived experience” or any of its many hella-longer alternatives.
For example, I found this one description on a harm reduction-related job opening posted online and it’s nothing short of long and drawn-out — it’s a clunky-fuck, that’s for sure:
“People with lived or ongoing experience with drug use, incarceration, homelessness, and/or sex work; people of color, women, and members of the LGBTQIA+ communities; and people living with HIV/AIDS and/or hepatitis C are …”
This leads me to define benefit — watch out, Spanish master Daniel Garrett here! — numero uno: We’ll be better able to convey our ideas online.
Although it seems silly that a single initialism — PWLE isn’t an acronym because you say the letters one-by-one, which is an initialism; NASA, on the other hand, is an acronym — could help us communicate better, but it really could.
Who knows, maybe it might open up people to write or otherwise communicate about PWLE and PWLE-related issues — plain and simple, I bet the grossly-expanded, wholly-unnecessary phrasing used above discourages people (especially people who write, even if it’s just to compose a personal social media comment) from discussing PWLE.
I know it’d deter me from doing so.
Time for Benefit Number Two
We need to claim the initialism “PWLE” before another community or discipline takes it for themselves and popularizes it.
I often wonder why harm reductionists don’t refer to harm reduction as “HR.” In the past few months, I’ve been doing just that — placing “(HR)” behind one of my first uses of “harm reduction” to save myself time and, hopefully, at least, make my message easier to interpret.
Yeah, yeah, we all know the lousy-ass business function of human resources has taken the two-letter abbreviation of “HR” for themselves, but if we can’t beat out the world of human resources for the right to widely take “HR” for ourselves, what the fuck are we doing, anyway?
So, while I’m on the subject, I think we should start using “HR” as an abbreviation for “harm reduction” — the phrase is SUPER FUCKING CLUNKY AND I HATE IT!
I don’t hate it, necessarily, though I’d much rather use a single word — or any other phrase that’s got fewer than four syllables, for that matter — to refer to what we harm reductionists recognize as “harm reduction.”
And What’s Behind Door Number Three?
All considered, PWLE will likely get more attention — or, I guess a better way to put it is “more advocates who’re down for their cause” — just by adopting the abbreviation.
And — quick disclaimer — who knows if adopting the no-frills alternative of PWLE would have any material benefit for people with lived experience? I’m sure a big chunk of us harm reductionists would argue that adopting PWLE on a community-wide basis wouldn’t be worth the effort.
What do we lose if we do make the change and our efforts don’t bear fruit? I don’t see us losing anything. How hard could it be to make the swap, after all? Should be easy like a Sunday morning…
I’ve looked at a few job postings from large harm reduction-related organizations here in the United States and almost always find disclaimers that encourage Alphabet Gang members, sex workers, and drug users to apply, as members of these groups are given preferential treatment.
Alphabet Gang, if you haven’t already figured it out, means “LGBT.” Before you get your panties in a wad, I’ll have you know I’m in the in-group for all three of these classes — not just the Alphabet Gang, so, therefore, my ideas are unequivocally better than members of the out-group. Hmph! Bow down, out-group plebeians!
But, seriously — I worry that, in some (if not many) cases, out-group members may run into trouble applying for sex work/drug use/LGBT-related positions. What if inferior in-group candidates are awarded positions over better, more-qualified applicants simply because they’re queer, cam models, or active drug users?
This idea isn’t relevant to the “Let’s adopt the abbreviation ‘PWLE’ in place of ‘people with lived experience'” thing, though I’d feel irresponsible if I left it out.
I admit — haven’t got anything revolutionary here. Really, in this piece, I’m thinking out loud more than anything.
Growing up, I remember viewing heroin as among the worst of the worst drugs. I didn’t know why — I wasn’t familiar with any of the ins and outs or the specifics of heroin. Also not apparent to me was the similarity between the widely-illicit heroin (diacetylmorphine, a.k.a. diamorphine) and pharmaceutical opioid painkillers (e.g., oxycodone, morphine).
People, in general — at least where I’m from, southern Middle Tennessee, and where I live now, Northwest Tennessee — accept the consumption of diverted prescription opioid painkillers as “better” (whatever that means) than heroin.
Yeah, I know, modern American street heroin is significantly more dangerous thanks to the all-pervasive fentanyl and the inherently-uncertain nature of goods on the black market — but, in terms of the drugs themselves, they might as well be the same damn thing!
Anecdotal reports across the Interwebs, in my experience, at least, generally say that heroin feels significantly different from prescription painkillers.
I should note that heroin is a prescribed, pharmaceutically-available drug in some countries. Keep in mind I’m talking about the home of the free and the land of the brave, the single world superpower, the best country in the world — hell naw, I don’t like getting free healthcare and I fuckin’ LOVE going to jail for drug use that doesn’t bother a n y — f u c k i n’ — b o d y — which is, of course, the currently-more-divided-than-ever United States of America.
Anyways, Enough of the Bullshitting
Here’s what I came here to say: It’s silly that heroin is viewed as leagues “worse” — in terms of social standing or stigma, that is — than prescription opioids. And, again, heroin is hella dangerous… like, Hot Fire OXYCODONE 30 mg 30mg Roxy blue Roxycodone Roxicodon blues HOT FIRE FREE SHIPPING LEGIT PHARMACY NO BS blueberries. Tell me that ain’t fuckin’ fire.
Yeah, I Know Everybody Already Knew This
Daniel brings no revelations today. Not even close. Just a pile of horse shit on this clear-skied springtime day.
You welcome. Big pile of dookie coming right up. Oh wait. You just read it.
Heroin’s got this D O U B L E — W H A M M Y effect, where we get the shit end of the stick for:
It’s unregulated, you never know what you’re getting.
People who use heroin need more help than people who use pharmaceutical opioids. Due to the greater social toll that heroin brings to the table, they aren’t able to get that help.
I don’t know what, exactly, we can do to fix this.
And not just mounting a call-to-action here because I’m planet Earth’s greediest self-promoter — I really want to hear y’all’s proposals for fixing this issue.
I’d like to hear real-world, practical solutions that could be implemented somewhere with virtually no existing harm reduction (HR) infrastructure — like the rural, largely-right-leaning areas that make up most of the United States such as Tennessee, North Dakota, Wyoming, or Missouri — in no longer than, let’s say, a year. If you think a more “high-level,” likely-viewed-as-“radical” HR approach is warranted, go ahead and hit me with that idea, too, even though it wouldn’t be able to work somewhere like Northwest Tennessee on a relatively short-term basis.
Aight den. Peace out. Girl Scouts. Boy I’m fuckin’ smooth — “peace out, Girl Scouts”… that’s an original saying I came up with ALL BY MYSELF! Gimme cool points.
+100 | Daniel Garrett Cool Account +100 | Labor
See, I knew my accounting degree would pay off one day! ………….. ok I’m done with this POS article peace out bye. Dueces #cool #coolerthanu #buzzoffdweeb
Opioid use is popular right now in the United States. Heroin is used by many in place of prescription opioids. Most heroin found in the modern American opioid supply actually contains a mixture and fentanyl and heroin. Fake prescription opioid tablets marketed as real ones are used similarly.
Even if people are prepared to use fentanyl, it’s so potent that measuring out accurate doses is difficult. Also, because heroin, fake opioid pills, and other illicit drugs aren’t made in safe, regulated, pharmaceutical-quality environments, one customer could get sold product that has several times as much fentanyl as another. Concentrations of active ingredients like fentanyl are called “hot spots” among people who use drugs (PWUD) like me.
Oftentimes, fatal opioid overdoses result from a combination of drugs, not just opioids. Also, all opioids can cause death — not just fentanyl.
PWUD Don’t Know How to Stay Safe
I’m a long-term opioid user. My history includes over three years of heroin use — intravenous heroin use, that is — and three overdoses. Today, I do things like give out free, clean syringes and naloxone (the opioid overdose antidote) and educate people how to use drugs safely.
Why do I do this? Because dead people don’t recover.
Up until just three years ago, I wasn’t aware of how to stay safe while using drugs. All I knew was that drugs are bad and that I shouldn’t be using them in the first place.
There are many, many issues that plague modern American opioid users. The solutions below aren’t a cure-all in any way. If you know somebody who uses opioids — including yourself — these things can help keep you safe:
Enroll in a medication-assisted treatment (MAT) program immediately. In the United States, buprenorphine and methadone are prescribed as an alternative to other opioids. One way to find these programs is through this free tool.
Use around at least one other person who knows you’re using, knows how to use naloxone, and isn’t also using at the same time as you.
Get fentanyl test strips. The ones I’m familiar with are the green-label “Rapid Resposne 1 Strip.” Find them from harm reduction organizations like FentAware (though only 6 at a time) for free, or from health product supply stores online. DanceSafe has got some, too.
Always assume any drugs you use contain fentanyl.
It’s always safer to not use drugs than to use drugs. Even if you follow the precautions above, it’s still possible to overdose. I don’t condone drug use. If you haven’t already started using drugs, please don’t use.
We need to collectively build “The Manual of Harm Reduction.” It’ll help mobilize grassroots harm reductionists like me and the many drug-related organizations that are held together with twigs and bubble gum — and that, unfortunately, happens to be a lot of them.
One thing I think we need to do for sure is start talking about “The Manual of Harm Reduction” among fellow harm reductionists.
What Might “The Manual of Harm Reduction” Look Like?
Most likely, we’d have a collection of essays and articles as opposed to a textbook-type thing. In order to decide what issues and pieces of work are most important, we’d get together and decide what’d make a final, more-condensed version.
It also might behoove us to categorize “The Manual’s” content by location, if not come up with an entirely separate manual for places like the American South.
But Most Importantly…
You need to start talking about the idea for “The Manual of Harm Reduction,” or whatever the hell you wanna call it. It doesn’t matter what we call it — and it also doesn’t matter who gets credited for this idea.
In other words, don’t float this as Daniel Garrett’s idea — rather, consider it the entire (North) American harm reduction community’s idea.
However, the majority of Americans, especially Republicans and other right-leaning people, definitely do consider some or all of these things “radical,” even though two-thirds of Americans don’t support the criminalization of now-illicit drug possession and only one-tenth believe the War on Drugs is a success.
Areas that are more left-leaning than Tennessee have been more open to things like harm reduction-positive ideas, practices, and policies. These ideas have traditionally been a left-leaning thing — that’s the simplest way I can put it.
Politicians, Stakeholders, and Other Decision-Makers Have Pushed for Ineffective Approaches
ROPS, as they’re known — pronounced “ropes” — hold public naloxone trainings and give out naloxone in Tennessee. The naloxone and the trainings are free, though ROPS systemically fail to reach active opioid users and others who are most at risk of opioid overdose.
I talked to one ROPS here in West Tennessee who told me they weren’t willing to distribute naloxone unless the recipients got trained to use it first — directly under their supervision, too. It’s easy to imagine how the long-mistreated, long-term, often-problematic drug users who the state claims to help aren’t too keen on visiting these trainings or accepting naloxone from ROPS.
Again, this isn’t to say ROPS are bad — our ROPS here in Region 6N, Melesa Lassiter, is great; she’s also laced me up several times over the past year or two, putting me on to tons of things I wouldn’t have otherwise learned. It’s just that, due to the distrust of resources that government agencies claim are for the most disadvantaged people, my fellow long-term, often-problematic drug users aren’t very open to the knowledge and naloxone ROPS provide.
Another note — naloxone doesn’t always cause withdrawal. I’ve had naloxone administered thrice — all in 2019 within a three-or-four-month period — and never experienced withdrawal as a result. A big reason for this, I think, is because my significant other, the person who administered the naloxone on all three occasions, never used a full dose of naloxone to bring me back. I know many people think you can’t reverse an opioid overdose without welcoming precipitated opioid withdrawal, but this isn’t true.
Third — We’ve Fallen Short, Ourselves
We harm reductionists haven’t done a good enough job of framing harm reduction-positive ideas in a way that most largely-right-leaning people will agree with — me included.
As I fleshed out in “How Outwardly Left-Leaning Harm Reductionists Hurt Our Cause,” people in the American South — rural Middle and West Tennessee, in my case — aren’t fond of things that seem politically correct or those that are associated with left-leaning values or ideas. Since many modern American harm reductionists are largely-left-leaning people, they tend to conflate our shared cause of helping active drug users like me with other things like non-drug-user-specific social equity efforts (e.g., pro-LGBT efforts).
I get it — some people want to bring about social change and level the playing field for traditionally-disadvantaged groups. This cause is worthy of merit — and I’m not just saying that because I’m bisexual and stand to benefit from pro-LGBT social equity efforts or because I was a sex worker for about four years and similarly stand to benefit from pro-sex worker social equity efforts. Oh, plus, I’ve always been low-income, so it’d help me triply if this playing field were leveled out. Just so you know I’ve got skin in the game — that’s all.
Regardless of what you, independently, value, we can’t escape the fact that most residents of Tennessee are averse to left-leaning or politically-correct things. If you want to expand harm reduction from states like Washington, California, and New York out to the completely-fucking-bare Volunteer State, you must be sensitive to the beliefs and attitudes of Tennesseans.
And, like I’ve mentioned, this isn’t just true for Tennesseans — it’s true for North Carolinians, Georgians, Kentuckians, and any other Southeastern state’s residents. Well, it also holds true for the largely-right-leaning states of North and South Dakota, Montana, and Wyoming, for example.
What’s the Solution for Tennessee and the Rest of the South?
I’ll be the first to tell you — I don’t know. While I know what Tennesseans don’t like, I’m not well-versed in Christian literature, values, or culture, which seem to be supported by the overwhelming majority of the Volunteer State’s residents.
People who understand these values and, by extension, how to frame harm reduction-positive messaging are vital to our efforts. Here in Tennessee, specifically, we don’t have any networks of harm reductionists or others who are interested in harm reduction-like things. I’ve looked through countless resources online with magnifying glasses and fine-toothed combs and have uncovered very few contacts.
For example, I went to the HepConnect Grantee Meeting in Raleigh, North Carolina, in March 2020 and met several Tennesseans who are active in harm reduction — not just interested in it — and have been for longer than me. I know there are several dozen others out there, too, if not more, but I just don’t know how to get a hold of them.
So, admittedly, it’s not like we Tennesseans have our shit together when it comes to harm reduction. We just — of course, I can’t speak for everybody in saying this, but every Tennessean harm reductionist who I’ve talked to largely agrees with these general sentiments — feel that we’ll need to modify the “harm reduction” that has worked for states like New York and California or countries like Canada and Portugal in order to effectively roll out harm reduction infrastructure in the Volunteer State.
However, I do know that we grassroots harm reductionists — many of whom, like me, are people who actively use drugs or are former long-term, often-problematic drug users — need to hop to action before the state does.
Right now, if you’re an active drug user, you can’t work as a Regional Overdose Prevention Specialist. From what a ROPS has told me, you’ve got to have something like a couple years’ clean time from regular drug use in order to hold the position. That person said regular drug users wouldn’t be able to work for the state in any capacity, unfortunately.
We’ve seen countless manifestations of seemingly-drug-user-oriented organizations that don’t hire active drug users or involve them in decision-making processes and, as a direct result, fail to do things that best help active drug users, especially “long-term, often-problematic drug users,” as I call them.
There will come a time when harm reduction goes mainstream. If we haven’t positioned ourselves well enough by then, I worry that the best interests of us active drug users won’t be kept in mind.
According to the state’s Allison Wilhelm, as of April 21, 2020, there are seven current SSP sites — two in Memphis, two in Nashville, and three in East Tennessee (Chattanooga, Johnson City, and Knoxville).
A Betor Way is also in Memphis, though at 1571 Sycamore View Road. It operates every Friday from 6:00 to 9:00 p.m.
Although it’s not an SSP, the Shelby County Health Department operates a Needle Disposal Program. Visit 814 Jefferson Ave.’s Central Laboratory, found in Room 258, between 8:00 a.m. and 4:30 p.m. to get a sharps container and to turn in used syringes. Note that, unlike every other SSP listed here, Shelby County Health Department charges a “minimal fee” for its syringe disposal services.
Nashville is only home to one SSP, Street Works, which ran for years on an underground, illegal basis before earning an official title as one of the Volunteer State’s few Syringe Services Programs. In Madison, on 907 Gallatin Pike, Street Works operates from Monday to Friday from 9:00 a.m. to 5:00 p.m.
You can also call (615) 779-4840 for more information.
Note: I claimed there were two SSPs in Nashville. According to the Tennessee Department of Health, both of which are operated by Street Works. One is located in Nashville at 101 Old Trail Court, the other at 907 Gallatin Pike in Madison. I don’t know the difference between these two locations — call Street Works at the aforementioned phone number to learn more.
East Tennessee is home to three SSPs, two of which are run by Cempa Community Care, the other by Choice Health Network.
Chattanooga’s SSP is run by Cempa and can be found at 1042 East 3rd St. It operates from 8:00 a.m. to 5:00 p.m. on Monday, Tuesday, and Thursday; an additional hour in the evenings on Tuesdays; and closes early on Fridays at 12:30 p.m.
Operated by Choice Health Network, Knoxville’s SSP is found at 701 N. Cherry St. and operates for two hours on Monday and Thursday, from 1:00 p.m. to 3:00 p.m.
Since publication, someone from Choice Health Network told me these times and this address are wrong. They asked me to include their phone number — (865) 208-7356.
As of now, unfortunately, there aren’t any syringe services programs in rural Tennessee. This leaves most of Tennessee’s injection drug users shit outta luck.
I recommend visiting pharmacies — try independent ones — for syringes, though you may get turned down. If this doesn’t work, try out diabetes or medical supply websites or the free mail-based supply distributor NEXT Distro.
The most recent fentanyl warning on r/Opiates is three months old. Looking back on other “fentanyl warnings,” they’re few and far between — there seems to be no more than two per month over the last year. Jynxies Natural Habitat is a Blogspot-based website dedicated to sharing the owner’s own stamp reports and relaying submissions from readers, though it’s been defunct for a half-decade. Reddit’s r/Glassine, too, was dedicated to stamp reports prior to its closure over two years ago. Free-standing sites like the now-defunct Opiophile, Drugs-Forum, and Bluelight have also been home to similar reports — though the latter two sites aren’t defunct, they’re not as active in subjective drug experience reporting as we’d like them to be.
While I’m not privy to all online subjective drug experience reporting platforms, something I am sure of is that we’d all benefit from having access to readily-accessible, active drug experience reporting websites.
The Need for Drug Reporting Sites Comes From the “Black” Part ofthe Black Market
All across the United States — hell, even across your county — the quality of illicit, unregulated drugs varies. As drug users, we never know what we’re getting.
We all know, as active American drug users, that fentanyl can very well be in any sack of dope you get. The concern with fentanyl is that there’s a relatively small threshold between an active dose and a potentially-fatal one. Another problem is that, due to the unregulated nature of the illicit drug market, manufacturers don’t use pharmaceutical-quality manufacturing processes — in other words, this results in “hot spots,”or areas of varied strength across batches of illegal drugs.
Keep in mind that we don’t need drug reporting websites or other platforms solely because of fentanyl. Rather, we need drug reporting sites because of the nature of the black market — without the often-pesky regulatory bodies that oversee commerce, the market lacks even a shred of accountability.
Dark Net-Based Illicit Drug Markets, in a Way, Act as Drug Reporting Sites
In the “real world,” of course, we don’t have to do any drug reporting. However you may get drugs, you’re not required to leave any reviews or reports of batches you come across.
On “the onions” — the phrase colloquially refers to dark net markets that can be visited via the Tor Browser, the logo of which is an onion — you’re incentivized to leave reviews.
With most modern platforms, the more, the better, and the more accurate reviews bring you more value in the eyes of vendors. Vendors like doing business with people who’re both motivated and thorough in leaving reviews, as better reviews stand the chance of boosting business.
If you didn’t already know, the path to success on any dark net market is to pull in great reviews on a consistent basis who are also well-reviewed themselves. On an above-ground peer-to-peer sales platform like eBay, for example, we can take accusations of theft to police and — who knows? — maybe even to court. We can leave reviews on other platforms, too, even if we have’t done business on them.
With dark net markets, you’re not taking any complaints to police or industry regulators — unless you like going to jail, not passing go, nor collecting $200 (yes, that’s a Monopoly joke). You might not be able to leave reviews on other platforms because the vendor might not be active on them. Also, with all dark net markets, you have to buy something from vendors in order to have the opportunity to review them. You can post on forums, naming-and-shaming vendors that’ve done you wrong, but that’s about it in the line of recourse.
The Importance of Drug Checking
If you don’t know what you’re consuming, you can’t truly be safe. Also, if you don’t know how pure your drugs are, you face similar safety issues. Drug checking helps people make better decisions.
By extension, online drug experience reporting accomplishes similar results — it improves drug users’ decision-making, boosts involvement and interest in harm reduction, aids public health surveillance, and helps build well-rounded, effective public health responses.
Drug checking, defined by DanceSafe as “a harm reduction service that helps drug users avoid ingesting unknown and potentially more dangerous adulterants found in street drugs,” varies from drug experience reports in several ways:
Drug checking objectively, empirically determines what samples contain and (though not very often) in what proportions; experience reports don’t.
Experience reports are often entirely subjective in nature. Sometimes, reporters do use rapid fentanyl test strips or reagent tests, for example.
The primary focus of drug experience reports is on people’s personal experiences with drugs, not their guesses as to what to what they’ve consumed contains.
Lastly, drug experience reports are typically shared in real-time, whereas there’s often a several-day delay in the empirical chemical analyses reported by outlets like DrugsData.org.
Are There Any Widely-Used, Go-To Platforms for Finding and Leaving Drug Reports?
DanceSafe, for example, is one of the largest drug-checking entities in the world. The non-profit organization also creates and distributes educational material; at festivals and other events, the entity offers water, earplugs, condoms, peer counseling services, and event patrol oversight (i.e., making sure dance floors are clear of potential hazards). DanceSafe doesn’t publish its results, unfortunately, but the group said “we are hoping to when [Fourier-transform infrared spectroscopy] has been more widely introduced” in a Facebook message dated Monday, April 20th.
The Erowid Center runs DrugsData.org, which happens to be “the best option for test results right now,” according to DanceSafe. DrugsData.org’s list of samples of often-illicit drugs that have been tested via gas chromatography–mass spectrometry, or GC-MS for short.
While this organization is good at what it does, tests can be downright expensive, ranging anywhere from $40 for whole, pressed ecstasy tablets; research chemical samples, any non-pressed ecstasy, and blotter costs $100. Testing herbal supplements and pharmaceutical tablets, powders, and capsules costs $150.
To get an idea of how active the site is, it’s got two entries from April 17th, 15 from April 8th, 23 from March 22nd, two from March 20th, six from March 13th, 38 from March 9th, and four from March 6th. I believe this resource is the best publicly-available aggregation of empirically-tested drug samples on the Internet right now.
Just one glance at DrugsData.org and it’s easy to see that the Erowid Center project isn’t the type of resource to host drug users’ personal, anecdotal experiences — again, keep in mind DrugsData.org is for drug checking, not subjective drug experience reports. While Erowid, also an Erowid Center property, hosts these subjective drug experience reports, they don’t feature images or location.
At least in my experience, people tend not to turn to Erowid for location- or batch-specific drug experience reports — “stamp reports,” in other words. It seems like many drug users in my area, especially those that are the most disadvantaged or at the highest risk of experiencing drug-related problems, aren’t aware of web-based drug resources. Of course, they aren’t too keen on sifting through lengthy personal accounts of drug use.
Don’t get it twisted — Erowid is a solid resource. We just don’t have any active online platforms for sharing short-form, readily-digestible drug experience reports. Also, of those that do exist, none of them — to my knowledge, and please correct me if I’m wrong — condone location sharing. And I think location-sharing is very important in sharing drug experience reports and empirical drug-checking results.
The Importance of Location in Online Drug Experience Reporting
On Reddit’s r/Opiates subreddit, for example, community members aren’t allowed to share their location. Moderators are incentivized to discourage such sharing and actively censor such posts out of self-preservation. Reddit doesn’t want to help people find illicit drugs. By avoiding location, r/Opiates stands a much better chance of avoiding a swift banhammer strike.
Remember how expensive getting a DrugsData.org test is? The layperson can’t readily afford these tests.
Also, these tests aren’t performed instantly. In the real world, how often are drug users like me willing to wait after copping drugs?
Oh so often, we use drugs within minutes or hours of buying them. Many of us can’t afford to wait to use — well, it’s more appropriate for me to say that we’re not willing to wait to use, whether we’re just impatient or we want to send withdrawal symptoms packing.
Lastly, chemical analyses might not always match up with subjective drug experience reports. Although these breakdowns identify what substances drugs contain, we can’t always predict how people will react to them.
In other words, DrugsData.org-style analyses just aren’t practical. They’re important, yeah — don’t get me wrong. They’re just not readily available or practical for the vast majority of active drug users like me.
Virtually Anybody Can Get Involved
In order for an online drug experience reporting website to have utility, it needs to be readily-accessible. In other words, for it to be worth half a shit, it needs to be easy to access.
When PeopleGet Active in Harm Reduction, They’re More Likely to Support Harm Reduction
Like I already mentioned, around here, people are usually blown away by how “cool” fentanyl test strips are. Some people have been impressed by the small, already-balled-up, perfectly-sized cottons I distribute.
Platforms that allow people to share subjective drug experience reports will similarly get people, particularly active drug users, interested in harm reduction — even if they don’t know what “harm reduction” is.
Drug-Checking Websites Aren’t a Bad Thing
Don’t think that drug-checking result sites like DrugsData.org are a bad thing — they’re great!
What I am saying is that we don’t have a sufficient means of readily sharing subjective drug experience reports with others. And, while DrugsData.org is drug-related, subjective drug experience report-sharing is an entirely different thing.
What Does Sufficient Drug Experience Reporting Look Like?
I’ll be the first to tell you — I don’t know. I don’t know what the ideal drug experience reporting hub or framework would look like. I don’t know what problems might arise in creating or operating one.
I’d imagine that creating such a platform is risky because of its tie to illicit drugs. What if you get accused of helping people buy or sell illicit drugs? What if someone sources drugs from someone they met through your website and experiences a fatal overdose — don’t you think you could potentially be implicated?
Also, again, drug-checking reports from DrugsData.org and company are beneficial to our cause as harm reductionists. We don’t need to get rid of any existing sites to bring about a better world of subjective drug experience reporting.