Jane, 52, is a long-term sex worker and often-problematic drug user. She preferred cocaine for some two decades, drifting in and out of jail, rehab, and places to stay along the way. Now, she uses heroin to treat her chronic pain. I believe the unfortunately-illicit opioid satisfies her nearly-lifelong craving for stimulants, although she still uses meth from time to time to scratch that proverbial itch.
Jane, a tried-and-true oldhead, distributes more safe drug use supplies throughout Northwest Tennessee and Jackson-Madison County than likely anybody. Well, I’m sure her numbers are behind Northwest Tennessee’s sole Regional Overdose Prevention Specialist — who only distributes naloxone, might I add — but she’s up there.
How did Jane, a “community guide,” become a leading figure in drug-related public health here in rural West Tennessee, yet still not be employed, commended, or even recognized for her contributions?
The answer lies in the intersection of Tennessee’s painfully-slow response to the opioid epidemic and its unusually-harsh criminal justice-social services alliance. Oh, and the fact that rural communities in the Volunteer State still don’t have a single syringe exchange. Y’know, problems with community buy-in and stuff like that.
Introducing the Community Guide
Other harm reductionists and public health officials have long aligned with well-connected sex work/drug-involved people like Jane to further distribute safe drug supplies and, thus, reduce transmission of blood-borne diseases like hepatitis C and HIV, encourage drug-involved people to improve their lives, and all that good stuff.
Yet, I haven’t seen anybody define the role that Jane plays here in Northwest Tennessee. Or anywhere else. I think “community guide” is a fitting term because, although Jane might not have the glowing reputation of a mayor or city council member, she’s super-integrated in Northwest Tennessee’s sex work/drug-related underworld.
Tennessee, as well as every other government or government-related entity in the realm of public health, needs to begin using — hell, not “using,” but employing — people like Jane as community guides to start reaching the most deprived members of society, those that the criminal justice-social services alliance has done nothing but harm.
I live in Northwest Tennessee, also known as Region 6N by the state (at least as far as Regional Overdose Prevention Specialist jurisdiction is concerned), a nine-county region home to about 254,000 people. 2014 — that’s when I moved here. It’s also when I picked up opioids as my drug of choice. I’ve been using illicit opioids, both heroin and diverted prescription opioids, regularly since then.
Although now I’m “in recovery,” I’m still in touch with people who use opioids around here. I give out syringes, naloxone, fentanyl test strips, and the like. I educate people about safe drug use practices. I inform law enforcement and members of the public about relevant issues and the gospel of harm reduction.
I read countless articles and social media posts about how the novel coronavirus pandemic would disrupt the drug trade. Nothing, really, changed around here. Until now.
A week-and-a-half ago, I came across a report of some strong heroin. People I know claim this stout stuff acts like normal heroin, but another (often strong) wave kicks in anywhere from a few minutes to over an hour later — even if they inject it intravenously.
I came across this same stuff again just five days after my first encounter with it. People around me say they’ve had this stuff before, maybe even as far back as a few months or years ago. But it’s in supply now. If you’re buying opioids, whether it be heroin, diverted prescription opioids, or counterfeit opioid painkiller tablets, there’s a chance you come across this stuff.
I know it’s in Jackson, too, which isn’t technically in Northwest Tennessee — it’s central West Tennessee.
I was told by a regional medical/public health official there were nine fatal overdoses in Northwest TN in the past month. I was also told by a fellow opioid user that there were three fatal overdoses on Mother’s Day weekend alone. I don’t know if these three are included in the nine since the second report came from an unofficial, anecdotal source.
Unfortunately, I don’t know what’s in this heroin. It could also be in counterfeit pain pills around here, if not elsewhere, but I don’t know. I haven’t heard reports of this stuff in Knoxville, Nashville, or North Carolina from sources in these areas.
I think a novel psychoactive substance (NPS) is being cut into heroin because of supply chain issues thanks to the novel coronavirus pandemic. But we don’t know what that NPS is yet. It could be a fentanyl analogue. It could be something like U-47700. But I don’t know. It’s definitely an opioid, that’s for sure.
My purpose in writing this is to sound the alarm and tell people who use drugs, specifically opioids, to be careful. But how, exactly, can you be careful while using this drug — whatever the hell it is?
Advice for Using Opioids During This Time
These tips are gathered from real-world experience with harm reduction in mind. The following tips aren’t necessarily true for all opioids — again, they’re written with this batch of whatever-the-fuck-it-is in mind.
Take It Super Duper Slow
Like I said, this stuff takes anywhere from a few minutes to over an hour to fully kick in. You should always use test doses (called test shots if you’re injecting), but especially with what’s going around right now. Although it’s tempting to use a larger dose at first or even a few minutes after doing a test shot, refrain yourself from dosing again for at least an hour, if not longer.
I know this is difficult. Plus, it’s not practical to assume everyone will take this precaution. A test dose might not be enough to bring someone out of hellish opioid withdrawal. Also, being careful isn’t always synonymous with having fun — I understand the rush this stuff brings is nothing short of sensational.
Cook It First
You can’t do this unless you inject — well, you can, but most snorters don’t want to dissolve their drugs in water; plus, most people aren’t willing to boof, or rectally administer, opioids, even though it’s the next-best route of administration after injecting with roughly 60% bioavailability — but “cooking” your dope refers to heating it up wth a lighter just to the point of boiling (some prefer to heat it to a boil, some don’t) once you dissolve the drugs into water.
Rumor has it that cooking this stuff makes it potentially safer by helping the other active drug(s) kick in faster. If possible, even if you only snort or boof, cook your opioids before using them (I wouldn’t cook pills, but, then again, I wouldn’t recommend injecting or otherwise using pharmaceuticals other than directed, which is usually orally). Here’s how to do just that:
Dissolve some of your drugs (this is possible with other water-soluble drugs, not just opioids) in water. I recommend using less than one milliliter of water, as well as using metal “cookers” as shown below. A metal spoon will work just fine, too.
Mix the drugs until they dissolve. Sometimes, like with black tar heroin, they might not dissolve without heat. Here in Northwest Tennessee, though, powdered heroin that readily dissolves in water is the norm.
Hold a lighter under the cooker just until it boils. The boiling point is reached as soon as you begin seeing bubbles form. You should see black scum forming at the top of the solution. These are likely impurities, if not one or more of the novel psychoactive substances (or one or more of their byproducts), that you don’t want to be consuming anyway. Keep in mind you want to avoid boiling because opioids could be destroyed. Nobody wants that. At least not me.
Use cotton or a wheel filter (good luck finding those; they are available online, just kinda pricey) to draw the solution into a hypodermic syringe or an oral syringe — hell, a turkey baster, if you can’t get either of those. You can get oral syringes from pharmacies without prescriptions. Go ask any pharmacy (I’ve had success at Walmart) for an oral syringe, they’ll usually give one to you for free. You can buy hypodermic syringes online from medical/diabetes supply shops without syringes — I’d recommend pharmacies, but most here aren’t willing to sell needles without prescriptions.
Most people don’t store injection drug solutions for long, as they usually cook just enough for one dose. If you do decide to store an opioid solution, I recommend keeping it in a refrigerator.
Know How to Spot It
Check out these pictures an anonymous source took of this batch. These were taken just a few days ago, around Wednesday, June 10th.
Remember how I said the color of the uncooked solution is often darker? Here’s what that solution looks like before being heated. Note the color of the solution is darker than after it’s been heated.
Although the cooked solution is visible in the first picture above, here’s what the cooked, filtered solution looks like. There doesn’t seem to be much difference in the filtered and unfiltered solution after it’s cooked.
But what does the dope itself look like?
Here’s what the stuff looks like outside of plastic.
This stuff is said to taste just like any other batch of heroin and wasn’t sweet like fentanyl-cut batches sometimes are. Keep in mind that you can’t reasonably identify drugs just by their appearance, though it is important to know what this stuff could look like and how it might behave.
If you come across any opioids that share some or all of these chracteristics, contact me and/or other drug-involved persons, ranging from dealers, fellow users, family members, prevention coalitions, law enforcement agencies (reporting the presence of drug trends to law enforcement ain’t snitchin’), syringe services programs, medication-assisted treatment program administrators and physicians, addiction treatment providers. Don’t do anything that might incriminate you, but there are plenty of ways to go about sharing drug reports without getting yourself or others in trouble.
If you live in Northwest Tennessee and need naloxone (Narcan), contact Region 6N Regional Overdose Prevention Specialist (ROPS) Melesa Lassiter at (731) 819-7603 or email@example.com. You can also contact Martin Housing Authority if you’re around Martin at (731) 587-3186 or the Weakley County Prevention Coalition at (731) 514-7951 or firstname.lastname@example.org.
If you live elsewhere in Tennessee, use this to find your region’s ROPS, along with their phone numbers and emails.
Mitragyna speciosa is the fancy taxonomical name for kratom, a deciduous evergreen* tree native to Southeast Asia that’s in the Rubiaceae family alongside coffee and tea. Unlike these two oh-so-common commodities, kratom doesn’t contain any caffeine. Rather, kratom contains about two dozen alkaloids that are collectively responsible for its pain-relieving, uplifting, and opioid-dependency-satisfying effects.
“Kratom” refers to both the Mitragyna speciosa tree and its leaves, the part of the plant that’s actually consumed. Don’t worry, though — in the United States, kratom trees don’t grow wildly, so “kratom” always refers to the leaves here.
*If kratom were grown in much of the U.S., its leaves would fall off in the winter; it’s native to tropical Southeast Asia, where the temperature never gets low enough for Mitragyna speciosa to go dormant (lose their leaves), making it a “deciduous evergreen” tree.
The Origin of Kratom
Although Mitragyna speciosa grows across tropical SE Asia, it’s only legal in Indonesia. While some kratom might come from illegal sources, it’s safe to say 99% of kratom available to American consumers is from Indonesia.
Indonesia is the fourth-most populated country on the planet with some 270 million residents but has just one-fifth the land mass. The country takes the form of an archipelago, or a bunch of islands; the second-largest of its 17,000 islands, Borneo, happens to be one of the most sparsely-populated spots in the Republic of Indonesia. Indonesia owns about three-quarters of Borneo — its share is split into five provinces: Central, East, North, South, and West Kalimantan.
West Kalimantan is where most kratom comes from. I don’t know how much, but I feel comfortable saying at least 95% of all kratom on the current market comes from Indonesia’s part of Borneo.
The city of Pontianak, (in the province of) West Kalimantan, (in the country of) Indonesia is the largest kratom hub in the country — and, by extension, the world.
Some kratom is grown in the U.S., but almost entirely for personal consumption. I feel confident the U.S. will ramp up its production of kratom in the future, but I don’t know how long that’ll take.
Traditional SE Asian Kratom Use and How Modern American Consumption Differs
Traditionally, laborers of SE Asia have chewed fresh kratom leaves — in much lower doses than what modern American kratom consumers take — to power through the workday and alleviate aches and pains. They’ve been doing this for at least a few hundred years, if not way longer (I’d think it’d be thousands of years, but I’m not sure if the already-super-lacking body of kratom research supports this). Brewing tea — technically, it’s a tisane, not a tea — has also been common throughout SE Asia.
In the United States, we practically only consume kratom in dried, powdered form. Kratom leaves are milled like flour. Most often, we either swallow the powdered kratom, often done with a liquid, or make tea out of it, though tea-making is much less common. Modern American kratom consumers’ doses vary wildly, though most range between 3 and 12 grams.
The first noticeable wave of kratom came into the States after American soldiers returned home from the Vietnam War. This didn’t cause a permanent surge in kratom demand, though. The modern wave of popularity began within just the last 20 years. No doubt, the ongoing “opioid epidemic” — I don’t like that name, and you probably don’t, either — influenced the botanical’s popularity. The rise of e-commerce played a big role in boosting kratom’s accessibility, as did globalization.
Usually, you’ll find kratom in loose, powdered form. It also comes in capsules for ease of dosing, though capping them yourself is much cheaper. The only way to get fresh kratom leaves is to grow them yourself, have a friend or acquaintance who grows them, or live in SE Asia.
The Unfortunate State of Chronic Pain Treatment
I won’t elaborate on how tough opioid prescriptions are to come by for chronic pain here in modern America, but, just as you guys know, it’s fuckin’ tough. Even if you can get one — good luck finding prescribers willing to give you as much as you need — a constant worry of getting cut off lingers in the back of chronic pain patients’ minds.
The very real potential of having your legal opioid painkiller supply cut off out of nowhere is a big issue on its own. That risk comes in the form of opioid dependency. Wouldn’t you want a magic bullet to make opioid withdrawal syndrome go away once it rears its ugly head? It’s bound to happen in every CPP’s doctor-visiting career.
Kratom does just that. Yup, no bullshit, it satisfies our brains’ opioid receptors enough to stop withdrawal dead in its tracks. And it’s not that kratom has some limitless recreational potential or something — that couldn’t be further from the truth. There’s debate on whether kratom is an opioid or not, but, come on, it sure as hell acts like one!
But not when it comes to euphoria.
It acts like an opioid in terms of analgesia, say countless thousands of anecdotes online, but not when it comes to causing dependencies of its own.
We haven’t even got to the legality aspect yet. Mitragyna speciosa, at least in its raw form, is legal in almost every jurisdiction across the U.S.
And did I mention how cheap it is? Fair market value (FMV) of a kilogram of kratom is currently between $80 and $130; with doses ranging from 3 to 12 grams, a fair-market-value dose’ll run you ~$0.25 to ~$1.50. When I took kratom regularly, I dosed anywhere from 3 to 6 times daily.
Kratom holds its ground as a stand-alone pain reliever. Pharmaceutical companies hold several patents on alkaloids that are in kratom; patents don’t always indicate worthwhile or commercially-viable ideas, but early research indicates these alkaloids are worth their salt in healthcare contexts.
Mass Mis-Marketing in the Modern Mitragyna Market
We know almost all kratom comes from Borneo. Then why are there so many “strains” that come from other islands? I’ll tell ya why — ‘cuz it’s a marketing ploy.
Don’t pay much attention to “strain” names. Just find what works for you. I already wrote about this issue in full here, if you want to learn about mass mis-marketing in the modern Mitragyna market.
Problems With Kratom’s Mainstream Marketing
One thing that hurts kratom’s stock is how it’s marketed like the rash of legal highs that exploded in head shops, gas stations, and even “legal high” specialty stores in the early 2010s across the United States. It’s often sold in eye-grabbing packaging and, while I can’t be mad at store owners trying to put roofs over their heads, I most definitely am upset with the way kratom is sold at gas stations, head shops, etc.
I wrote about why buying kratom at stores like this is a bad idea here, if you’re interested.
Where to Find Kratom
Local in-person, non-ecommerce kratom markets are not very competitive. Where I live, a town of 10,000 and a county of 30,000 in the South, kratom never costs ≤ $0.50 and usually doesn’t go for ≤ $0.75. Shopping online is how you get kratom for the FMV of ~$80 to ~$130 — don’t expect to find kratom for this cheap at a gas station!
I don’t want to promote any vendors. Seemingly EVERY kratom resource online either’s hosted on a vendor’s page or has affiliate links to one or more vendors’ websites. Who am I if I fall guilty to the same lack of objectivity? I’m trying to teach you to fish here rather than just give you the fish, too, as that old-as-dirt proverb goes; here’s the steps I would follow:
Look for American Kratom Association Good Manufacturing Processes (AKA GMP) certified kratom-selling outfits in the United States — this is, of course, assuming you’re in the U S of A like me. You can find a list on the AKA’s website. Only the largest kratom businesses can afford getting this seal of approval. Buying from nobody but AKA GMP-certified vendors would leave countless more-than-suitable, way-cheaper alternatives.
AKA GMP This stamp of approval is the safest way to find a legit source of kratom, but I’ve never done it myself. I’ve always received kratom from non-certified sources. Here’s the thing — every single bit of kratom that any AKA GMP-certified company imports comes from non-AKA GMP-certified entities. Buying directly from Indonesia is ideal for getting the most value (lowest price); it’s also likely to be fresher coming straight from the source.
I got into kratom because of my problematic non-medical opioid use. What I mean is, even though I wasn’t opioid-dependent, kratom improved my ability to abstain from the use of “real” opioids, in turn boosting my quality of life. I’m not a chronic pain patient (though I am a CPP advocate) and want to be clear about how I got involved with kratom. This is relevant because I was always used to buying unregulated drugs (yes, kratom is a drug). CPPs are used to buying regulated goods and services; veering away from AKA GMP-regulated kratom sources could ultimately delegitimize our shared interest of giving CPPs more tools to handle chronic pain.
If I had to leave you with three ways to find good kratom sellers online, it’d be these:
The more legitimate the social media presence, the better.
The longer they’ve been around, the better.
The more (legitimate) reviews, the better.
How to Use Kratom
You can toss-n-wash — that’s short for “toss and wash” — powdered kratom with a liquid fairly easily. Put the kratom in your mouth and take a few swigs of chocolate milk (my favorite), orange juice, or, hell, just water. Trust me, though, this shit tastes rank.
You can also mix kratom into a drink, like a chocolate milk, for example. That’s what I always did.
Of course, you’ve got the capsule option. I don’t think capsules are good for dosing upwards of three or four grams; for me, personally, it always felt like the capsules rose to the top of my stomach — I could feel them inside of me for, I dunno, 30 minutes or so after dosing. And I didn’t like that feeling. But you might not have the same experience — that’s the big thing here, you won’t know which mode of administration is best until you try them out for yourself.
And then there’s tea — or tisane, is the right name, so I understand. Boil kratom powder or crushed leaf — I think crushed leaf is better for tea, personally — for a few minutes or even 30, 45 minutes. Add some lemon juice to extract some more alkaloids into the final product. I don’t know how it works, but it do.
Don’t worry about the specifics of how you toss-n-wash or make tea out of kratom. Just experiment and find out what works best for you. Don’t buy into any bullshit guides online — all of them come from places of personal experience. What works for Billy Joe might not work for Bobbi Sue.
To Tell, or Not to Tell… Your Doctor?
No… just, no. Let’s think — what’s the upside? Your doctor is cool with it and points out potential drug interactions.
What about the potential downside? Your doctor tells you kratom was responsible for X deaths in a recent year and that it’s bad. He identifies drug interactions that aren’t there and uses this excuse to cut back on your other meds or even not prescribe them at all.
Although there’s a blatant lack of empirical, academic-type research about kratom, there’s tons of anecdotal reports from fellow kratom users that can easily be found online. This includes other kratom consumers’ experiences with telling their doctors or other healthcare professionals about their kratom use. Just don’t do it — it’s sad I have to say that, but keeping your trap shut about kratom use is a very real concern in the modern American healthcare space.
Right off the bat, let’s get shit straight. Not everybody in harm reduction (HR) is unwelcoming. Not everybody in HR has shut out me or my opinions. Not everybody in HR has been uninclusive. Many people in HR have been good to me — or, at the very least, fair. I hope to be involved in HR until we’ve achieved the fair treatment of drug users across the United States. This is the only thing I’ve ever had a passion for.
When I say “harm reduction isn’t inclusive,” I mean this: Because some of my opinions haven’t fit the mold of the average American (or Canadian) harm reductionist, they have been written off by some or even most of the HR community. Not only that, I fear my reputation has been irreversably damaged by well-known community members — particularly one community member — speaking out against me. I worry this may also happen to others who wish to get involved in HR, especially those in rural, largely-right-leaning America. These areas, which make up the bulk of the United States, currently aren’t well-represented within HR.
Let me be clear:
The primary goal of this article is to ignite the discussion that the HR community might not be as inclusive as it wants to be.
Ultimately, I want to de-homogenize HR. In other words, I hope more diverse viewpoints will enter the fray, particularly those of people from rural, largely-right-leaning America; this will result in the tenets of harm reduction being adopted (1) more widely and (2) more extensively (in other words, people will adopt more of our views as opposed to just one of our views) by people in rural, largely-right-leaning America.
I’m choosing not to call anybody or any organization out by name — I don’t want to play into “call-out culture.” If I did, I’d be guilty of the same convention I’ve fallen victim to. Even if I were okay with calling others out and causing harm within my own community, that’s not my goal here. I also don’t want to identify those who have treated me well out of fear they, too, might face pushback from the community or its members.
Most of this article doesn’t chronicle my subjective experiences in harm reduction. Rather, the first several sections investigate the nature of HR, commonly-shared characteristics among harm reductionists, problems newcomers to all communities face, issues with entering communities online (specifically on social media), and human nature in general.
Again, I don’t want to push us apart. I want to bring us closer together. In order to become more inclusive and improve the adoption of HR across the country, we must examine ourselves and HR at large.
Understanding the Nature of Harm Reduction and Commonly-Shared Characteristics Among Harm Reductionists
The American mainstream has long written off drug users. Of course, alcohol, coffee, and tobacco are okay, but anybody who uses anything else is nothing short of a dirty, degenerate dopehead!
Of course, I don’t believe this, but the American mainstream long has — and, in large part, still does.
Harm reduction, although there isn’t a single widely-accepted definition, has included people who’ve long been cordoned-off from society — particularly people who use drugs (PWUD). PWUD who are interested in HR or who’re active in the field often fit the bill of “long-term, often-problematic drug user,” just as I do.
I became interested in HR after learning about it on Reddit’s r/Opiates subreddit some three or three-and-a-half years ago. I often visited r/Opiates and other drug-related subreddits because I felt as if I couldn’t talk about drugs IRL (in real life); further, there wasn’t enough solid information about drugs IRL, nor was there enough of it.
I love that HR welcomes people who’ve long been considered worthless or who’ve otherwise been unwelcomed by the rest of society.
However, when opinions that even kind of resemble those of the mainstream — those that people have faught against for decades, literally decades, before I became interested in HR — are floated in HR, they’re sometimes (if not often) met with disagreement, if not hostility.
The divisiveness of the modern American political landscape doesn’t help, nor does the fact that many (if not most) discussions about HR take place on social media. I don’t know how social media lends itself to divisiveness, but it unarguably does. Further, the fact we’re still living in the times of “cancel/call-out culture,” which arose around 2014, doesn’t help. If you’re not familiar with call-out culture, people get career prestige points by calling out others who don’t share similar opinions — so, even if someone doesn’t like the idea of dogging someone online (or IRL), they’re incentivized to do so; even further, further, it’s not just the missed opportunity of career prestige that’s at stake — not calling someone out can implicate a community figurehead (or even an average community member) as being complicit in fostering “uninclusive” or “microaggression-friendly” or otherwise-bad environments.
Many — I’d go as far to say most — harm reductionists have faced substantial drug-related harms in their own lives. Who else would be pushed to openly supporting “radical” things like syringe exchanges or supervised consumption sites? Again, I don’t consider these things radical, but it’s safe to say most people do.
Harm reductionists are sensitive to people, organizations, government agencies, and groups that could take away what they’ve worked so hard to secure. Wouldn’t you exercise caution, yourself? Or distance yourself from people who claim to be down with the cause but seem to have ulterior motives?
The Very Real Disadvantage of Being a Newcomer
This goes without saying, but newcomers to any community are discouraged from sharing unpopular opinions or sticking up for anybody — especially those who’ve been “canceled.” This is especially true online.
Newcomers to communities are likely to be scrutinized before being embraced. This makes newcomers less likely to share their opinions on hot-button topics or that are otherwise potentially-controversial than established community members.
Even then, established members are unlikely to speak out on topics for which they hold views that differ from the average community member. For example, in HR, a field that has little funding or employment opportunities, people who lead or work for funded organizations are unlikely to challenge popular opinions or otherwise “break the mold” out of fear they’ll lose funding, have their pay docked, be put on administrative leave, or outright fired. This can result in reduced community participation. Socially-astute individuals will “play the game” — they’ll unquestionably embrace widely-held opinions, avoid rearing hard-hitting questions, or even tolerating important conversations that seek to change long-held group norms.
We all “play the game.” In our lines of work, whether HR-related or not, we put our heads down and do what’s best for self-preservation. Well, at least anybody with half a brain would “play the game” (whatever that means). My dad has told me that dozens of times — “Just play the game, son, you’ll get farther in life. I’ve done it. You need to do it, Dan, just get with the damn program!”
Note: My dad is awesome and I love him very much. Rhetoric like this comes from nothing but the best place; he wants to see me succeed, and we all need people in our corners who’ll tell us shit that might be hard to listen to — shit that damn near nobody else is willing to tell us.
Newcomers Are Especially Disadvantaged in Online Discussions and Largely-Web-Based Communities
Like I said earlier, newcomers to any community are likely to go through an informal probationary period where established community members judge whether they’re worthy of inclusion. This isn’t an HR-specific thing — it’s a humanity-wide thing.
Online, we can actually quantify how well community members are supported in the form of post engagements, favorites, likes, reactions, shares, retweets, replies, followers, friends, and so on. Even if nailing down precise community support figures is difficult, it’s easy to gauge where community members stand on the proverbial totem pole.
Assume a newcomer shares an unpopular opinion in good faith on Twitter, Facebook, or in an email-based Google Groups community. The opinion has been developed over many months or years and was shaped by the newcomer’s real-life experience. The newcomer tries to be friendly, respectful, and level-headed in how they approach the issue. Do you think the newcomer’s idea will be taken seriously or given merit? How about if a well-trusted, long-established community member shared the same idea? Which one would get more community support for the same idea?
Almost certainly, the community figurehead — they don’t have to be a true figurehead for this example to work; just a well-trusted member of the in-group — will find more support for the same idea.
Newcomers are likely to get discouraged from sharing their off-kilter ideas after just a few unsuccessful tries — hell, maybe even after just one try!
If community support is the goal — of course, social inclusion is a basic human want, so doesn’t everyone operate with community support in mind? — community members are incentivized to discuss safe topics rather than veering off the well-trodden path.
“Just play the game,” right?
Isn’t that something we all do? Especially when we first get a job or start hanging out with a new group of friends — don’t we all do things to promote or, at the very least, protect our perceived value?
Don’t get it twisted — “playing the game” isn’t bad. It shouldn’t be frowned upon. Doing tried-and-true things in the interest of self-preservation is as old as humanity itself. If I knew what’s good for me, I’d play the game myself. That’s actually how I got into writing: I wanted to do something from home and travel to work, wear uniforms or adhere to dress codes, punch time cards, or put up with potentially-asshole bosses — I could make much more if I just played the game.
The “Rock-Star Effect”
Again, many people who’re active in HR have long been mistreated. They haven’t been included elsewhere. Wouldn’t you be protective of the one place you call home? I would, that’s for damn sure.
Some people in harm reduction have amassed relatively large, loyal followings over the years. I don’t think any of these people got into HR because they saw an opportunity to become a “rock star” — rather, they got involved because they’ve personally been adversely affected by drugs and wanted to spur change.
HR is one of the few spaces former/current drug users and sex workers can be accepted in — at least be accepted for who they truly are. These “rock stars” are largely responsible for gatekeeping, or deciding who can become bona fide members of the HR community and who can’t.
Calling people out for their mistakes — hell, even their unpopular opinions, even if they were expressed in good faith — is a form of fodder for HR rock stars. Do all harm reductionists with substantial followings or in-group clout “cancel” fellow community members? No. However, “cancel culture” has piqued the interest of countless pop culture fans over the past few years. Emotionally-dense social media posts involving “cancellations” disproportionately elicit likes, shares, responses, and other interactions from interested community members.
Of course, no “rock star” would turn down a chance of openly, harshly criticizing someone. After all, it drives social media engagement like wildfire. Further, as mentioned earlier, community figureheads can be held responsible by other community members if they have a chance to “cancel” — or call them out, in other words — someone and choose not to.
Are most HR “rock stars” aware of their “rock star” status? I don’t think so. However, we can’t deny the influence of social media engagements over our actions. We all do things on social media with the intention of eliciting attention from others in the form of sweet, sweet post engagement. Even though I like to think I’m better than that, I’m no different.
Reliving Trauma When Facing Viewpoints That Our Oppressors Have Used to Keep Us Down
Trauma, contrary to popular opinion, isn’t tucked away in the mind; rather, we physically relive trauma when triggered. Once a spouse is undeservingly yelled at or beaten, they relive the horror of seemingly-inescapable domestic abuse every time someone yells at them. I’m not a psychologist, so I can’t explain the mechanisms behind this phenomenon, but it’s true — trauma is stored in the body, for lack of better words.
HR community members aren’t used to seeing opinions that break the mold. When they are, they’re especially averse to idly letting them pass by without openly criticizing those views — and oftentimes their creators in ad hominem fashion. Even though damn near all of us know that personal attacks aren’t logical or cash money, we’re still prone to insulting people, rather than reasonably deconstructing their ideas, particularly when sensitive topics are at play.
If I say drug users should take more responsibility for their actions, it’s easy to understand why harm reductionists might take offense. This sounds like something a police officer would say to someone arrested for drug possession while transporting them to the local jail, or a loved one — y’know, one of those who thinks doing anything for someone in active addiction constitutes “enabling” behavior? — might offer up to a drug-addicted family member.
I better understood such outlash once I learned that trauma was stored in the body — and our emotions can easily overtake reason, which is even more likely when such a super-sensitive topic is at hand.
Why Are Most Harm Reductionists Left-Leaning and Seemingly Not Familiar WithRural, Largely-Right-Leaning America?
Admittedly, I don’t have any research to back any of this shit up — I think all of my assertions and postulations are well within reason, though — but most harm reductionists aren’t just left-leaning, they’re largely-left-leaning. They’re used to hearing accusations of being “radical,” whether or not they actually are. This long-term mmmmmm-blockin’-out-the-haters (Brandon Bowen’s Vine, remember this one?) is conducive to not accepting differing viewpoints now or in the future, especially when surrounded by fellow harm reductionists.
But, seriously, these people are used to fighting opposing viewpoints. That’s how they got here to harm reduction. They’re still used to fighting opposing viewpoints. Can you see how this would breed intolerance, despite how inclusive people in this space strive to be?
Many, if not most, people in HR are from areas that are left-leaning and already have HR-type resources in place. Whether or not these resources were in place when they started isn’t relevant, in my opinion, because you can’t draw parallels between ass-backwards rural Tennessee and, I dunno, fuckin’ Massachusetts 20 years ago.
Here’s My Point
It’s been difficult for me to share my opinions within HR. Just to put a timeline on things, although I’ve been giving out supplies and educating people about drugs for much longer, I started writing about HR-related issues as Daniel Garrett (that’s my government, in case you’re wondering) around November 14, 2019. I did so to let others know that I’m out here putting in work. How else would people know I’m here? The grapevine ain’t that long.
When I try to stick up for Poor Whites or say that shit really is that different here in the rural South… it’s difficult. Because some of my opinions — like we often-problematic drug users should, in fact, try to be more responsible for our actions — I’ve been widely unwelcomed to the space of harm reduction.
I thought this space was inclusive — but I gets no clout tokens for growing up bisexual in rural Tennessee, being involved in sex work for some four years, having used drugs in an often-problematic fashion for a decade, nun-a-that. And that hurts. It’s so tempting to give up this HR shit. To give up being the only motherfucker in Northwest Tennessee giving out syringes and shit, which I’m doing on an unpaid and unfortunately-illegal basis. Don’t forget I’m on two probations. I often hear people say they’re willing to go to jail for this shit — have fun with that! I went to jail for the first two times in 2019 and I’m too much of a pussy for that shit. It’s in my best interest to never illegally distribute another syringe, but I know I’ll be doing this for a while — no matter how difficult it is for me to spread my unconventional opinions in this space.
And hopefully, one day, I’ll be able to help some other youngblood find his footing in this very space. Maybe even for sharing unpopular, somehow-controversial opinions.
Here marks the end of the article. If you’d like to learn more about my subjective experience, keep reading.
My Experience With the Harm Reduction Community
I’ve been giving out safe drug use supplies for about two years now. Much of the syringes, naloxone, fentanyl test strips, etc. I’ve given out have come from a mail-based supply distributor based in New England. I don’t want to name them here because the outfit isn’t supposed to mail supplies outside of the state they’re located in.
In the past few months, two individuals — one in Washington, one in Indiana — have sent me a collective 3,000-or-so syringes, not to mention single-use bacteriostatic water containers, tourniquets, cookers, cottons, fentanyl test strips, antibiotic ointment, and even condoms (I’ve never really given out condoms, as they’re already widely available here; I’m primarily interested in giving out supplies that aren’t often available active drug users in rural West Tennessee).
I haven’t paid a dime for these supplies.
I’ve had long, rousing, stimulating chats with dozens of harm reductionists online and over the phone. I only came across these people on social media — I’d “cold messaged” them on social media or via email and, luckily for me, they were willing to entertain my requests for help. I still keep in contact with some of these folks today.
Through Facebook, I reached out to a lady in East Tennessee, some six hours away from me, who I heard was involved in HR. Over the past 15 months or so, she’s taken me to two HR-related conferences and given me other opportunities that I wouldn’t have had otherwise. In a field that’s full of organizations “held together with twigs and bubble gum,” as a more-experienced counterpart told me in late 2019, I’ve found several diamonds in the rough who’ve done a whole lot for me.
Don’t mischaracterize my words and say I hate all harm reductionists and they’re all pieces of shit — that’s not at all the truth. Like all humans, most people have good intentions.
However, due to several factors already mentioned — not all of which are HR-specific, as you might recall — as well as the fact that most American (and Canadian) harm reductionists are largely-left-leaning people, I think the modern HR community isn’t as inclusive as its membership thinks it is.
Here’s an Anecdote
Back when I first got active in HR circles on social media, I challenged someone who said something I didn’t agree with.
The other person was a panelist at a rural-oriented, HR-related speaking engagement at November 2019’s International Drug Policy Reform Conference in St. Louis, Missouri, which was put on by the Drug Policy Alliance. They shared some solid advice at the event and I looked up to them. On Twitter, they quoted an article in which a licensed social worker and state public health official stated that “[Naloxone] is not meant to be the solution to a person’s overdose.”
The state official was more or less saying that, while naloxone should be readily-accessible and is a useful tool in reversing opioid overdose, it shouldn’t be the cure-all for dealing with opioid addiction or otherwise-problematic opioid use.
I agree with this statement. Although I’ve been revived from opioid overdoses thrice with naloxone and even though I give the life-saving drug out to fellow drug users and laypeople throughout West Tennessee, I think we should invest more in programs that intervene early on in children’s, teens’, and young adults’ lives; schools should expand sports programs to include more than basketball, football, and baseball (which seem to be the Holy Trinity here in the South); and so on. Will this solve drug addiction or otherwise-problematic drug use? Of course not. However, I think such measures will reduce problematic drug use. These solutions resonate with me, particularly, because I wasn’t involved with any social programs in school outside of basketball for one year (I wasn’t good enough to make the team again), I wasn’t engaged in many healthy activities, I didn’t have a mom for the latter half of my childhood (the full list is rather lengthy; I’ll stop here for the reader’s sake). I picked up drugs because they satisfied otherwise-unmet needs in my life. I actually ended up attempting suicide at 16, almost certainly due to a many-layered combination of intersecting issues in my life at the time.
Note: The article doesn’t specify what is meant to be the solution to opioid overdose, but I assume medication-assisted treatment and improved early-life social involvementare both fine alternatives — though they aren’t alternatives for reversing opioid overdose (that’s naloxone’s job), exactly, we’d rather not have people experiencing overdose in the first place. I do agree that naloxone should be the first-line reactive (rather than proactive) treatment for opioid overdose.
I piped up — this was on Twitter and I had, like, literally zero followers at the time; I just made my account a few minutes prior — and argued the state official’s ideas were worthy of merit. I was shamed for not understanding (illicit) opioid use here in the United States and also advised not to speak to women if I wasn’t spoken to first. The Twitter user got several favorites, retweets, and co-signs from fellow harm reductionists and other people who’re interested or active in public health, medicine, pharmacy, and related fields.
Of course, I got zero.
Some More Anecdotes
I won’t explain these as extensively as the story above — it’s just not necessary. Just know that sharing off-color opinions within this community has proven difficult for me.
Even though I’m openly bisexual, I’ve been called a “cis White male” by people who know I’m bisexual at least a dozen times, likely more. And this isn’t in general — this is only within the HR community. If these people weren’t aware of my sexuality beforehand, once I made it clear, they still denied that I could take the title of “queer.”
Sometimes, when I share opinions that unarguably fit that of the average harm reductionist, I’m shot down just because people recognize that others have said bad things about me. This holds true when others share my writing or interact with me.
I’ve been told several times that people won’t associate with me openly because of the bad reputation I’ve picked up for myself. So, they feel like shooting down my viewpoints are necessary to avoid being viewed as guilty by association.
In my time as a harm reductionist, I’ve never heard anybody talk about Poor Whites — actually, yeah, I heard one talk of Poor Whites at a conference/convening back in March. Outside of that, it’s only been about racial justice.
I don’t like dwelling on this shit. I don’t wanna think about it anymore. There are dozens, if not hundreds of times where others in HR have wrongly slighted me or not given me the chance. I haven’t yet mentioned that time that one popular harm reductionist called out my writing and got hundreds of comments and hundreds of likes on her posts for “canceling” me. I still face the fallout of that today. Just for having a different fucking opinion.
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I grew up with a super-problematic drug user of a mother. For her, someone who couldn’t ever use drugs responsibly, being in “recovery” meant not using drugs.
For most of us, however, using drugs without going completely overboard is possible. And, even though I’ve also proven myself to be a long-term, often-problematic drug user, I consider myself to be “in recovery” even though I still use drugs.
Due to mounting drug-related legal issues, I turned to medication-assisted treatment — a.k.a. Suboxone — in September 2019. My reason for seeking an alternative to illicit opioids was strictly legal in nature — I was tired of the legal consequences associated with drugs and drug paraphernalia like syringes.
Although I only used illicit opioids once in my first two months of medication-assisted treatment (MAT), I eventually returned to using heroin and diverted prescription pain pills more often. Since January or so, I’ve been reducing my illicit opioid use and the resulting problems that often follow my drug use; I’ve also improved my life in various other ways, such as cleaning my house and brushing my teeth more often.
But, still, most of modern America wouldn’t consider me as being “in recovery.”
What’s the deal? Why can’t we consider this ongoing transition I’m going through as being “in recovery”? And, even if I don’t end up quitting drugs in the long run, we should still consider this change I’m currently going through as being just that — recovery.
Changing What Recovery Means
My purpose here is to ultimately attract more long-term, often-problematic drug users and their less-problematic counterparts into bettering their lives, specifically by decreasing their drug use and any resulting drug-related problems.
I think we can go about doing this in several ways. Here are some ideas I’ve got.
Note: Even if you don’t think some or all of these ideas hold water, I hope you agree that we should, in fact, want to actively change the definition of being “in recovery” from drug addiction or otherwise-problematic drug use.
Addiction Treatment Outfits Shouldn’t Require Patients to Have Substance Use Disorder
Though I’m just an MAT program enrollee, not a provider, I understand that Suboxone programs and methadone clinics across the Volunteer State can only treat people who have opioid use disorder or are dependent on opioids. This might not be true — the state’s opioid treatment program (OTP) and office-based opioid treatment facilities (OBOT) guidelines can be found but are difficult to read through; also, since I’m not a provider, I don’t have any real-world experience with state or federal regulatory agencies and their enforcement of such guidelines. However, generally speaking, MAT programs don’t accept people unless they meet the diagnostic criteria for opioid use disorder — and, yes, they treat people with alcohol use disorder, though, since I’ve got no experience with alcohol addiction treatment, I don’t want to speak on the issue.
What if Suboxone and methadone clinics accepted patients who didn’t have substance use disorder? And, more importantly, what if they still allowed patients to test positive for other drugs without potentially being fired?
Then, I wouldn’t have to worry about refrigerating “clean” urine in anticipation of drug screens. Programs wouldn’t have to waste as much money drug testing me, either, if abstaining from drugs that you’re not prescribed wasn’t a requirement — I should note that most, if not all, programs around here allow patients to test positive for THC and its metabolites, so we are able to smoke weed as an alternative to other drugs (or just smoke weed for the hell of it, for that matter).
Addiction Treatment Facilities Should Also Offer Less-Intensive Outpatient Services
Here in rural Middle and West Tennessee, the only addiction treatment outfits we’ve got are full-fledged rehabs, methadone clinics, and Suboxone programs — and I’m sure we’ve got halfway houses and sober living facilities. There might be a few facilities lingering around that don’t fit any of these five labels. Oh, and you can’t forget Narcotics Anonymous (NA), Alcoholics Anonymous (AA), and other 12-step-based programs.
All of these outfits inherently support complete abstinence from drugs — yeah, Suboxone (buprenorphine) and methadone are both very much “drugs,” but usually aren’t “abused” with the intention of getting high — and don’t have much lenience for being “in-between,” like I am right now.
Also, I think addiction treatment providers — which can include plain-Jane mental health practices, as counseling proves helpful to many former often-problematic drug users — should offer less-intensive services that provide an added sense of structure in patients’ or clients’ lives. An example of this could be life planning.
And, yes, I recognize that this section doesn’t include many concrete, well-defined examples of “less-intensive outpatient services.” I usually don’t like writing about things unless I offer concrete, well-defined recommendations for fixing the problems I point out. However, simply sparking the conversation about redefining recovery is my primary goal here — and that’s something you can help me with.
I’m Asking You for Help
Even if you’re not involved with any addiction treatment outfits or drug user-oriented organizations, I encourage you to take to social media and ask people who are in recovery, involved in addiction treatment circles, or otherwise interested in or active with any drug-related entities to reconsider what “recovery” means. You don’t have to share this article with them — it’d be great if you did, but it’s most certainly not necessary.
Oftentimes, as drug users, we’re close to people who don’t support our drug use. When you’re a long-term, often-problematic drug user, as I call it, who in their right mind would support your continuing drug use? Many people confuse “support” with “enabling,” unfortunately, encouraging family members, friends, and acquaintances of addicts to not even associate with their loved ones as long as they’re using drugs — and those who do associate with them keep a distance.
As an often-problematic drug user myself, it’s especially difficult to tell others I use drugs. If old friends or peers ask if I still use drugs, answering “yes” often elicits negative responses. “Maybe you’ll quit using one of these days,” an old friend of mine recently said. People are generally unwilling to learn about naloxone, let alone accept a naloxone kit (syringe, vial of naloxone, and instructions) from me; as a heroin user, I can’t expect to comfortably tell others something like, “I’m about to use, would you stick around for 10 or 15 minutes?”
These problems, of which there are countless examples — many more than the two above — arise from two areas:
General stigma around drugs, particularly illicit drugs.
The misconception that bailing someone out of jail, allowing someone to live with you while battling addiction, or agreeing to supervise their drug use to promptly respond to overdose are all nothing more than “enabling.”
First, I’ll share my experience with this issue, followed by things we can do to improve these problems.
It Comes From a Good Place, But the Road to Hell Can Very Well Be Paved With Good Intentions
I’ve been with my significant other for over five years. My drug use was a problem long before we got together, though, in the infancy of our relationship, I was able to keep my drug use “together.” Fortunately for me, she’s never used drugs — at least not like I have, in the fashion of a long-term, often-problematic drug user.
Understandably, she hasn’t always responded favorably to my drug use. I’ve long concealed my use from her. Just like you wouldn’t want to tell a loved one you’ve been injecting heroin, even if it’s not negatively affecting your life and you’re able to use in moderation, because you don’t want them to worry — it’s that kind of deal, more or less.
Since I started giving out naloxone, syringes, and other safe drug use supplies to fellow drug users across Northwest Tennessee roughly two years ago, I’ve always had naloxone around. Since early on, I’ve tried to educate my S.O. about the potentially-life-saving drug. Up until recently, it’s been difficult, though — just as I’d rather not tell her my plans for getting high due to potential backlash, she was similarly bitchy when I tried to teach her about naloxone and responding to opioid overdose.
Last year, within a three- or four-month period, I had three opioid overdoses — well, two full-fledged ODs and one close call — from which I was revived with naloxone by my S.O.
The first time, she recalls struggling to draw up naloxone into a syringe. Imagine having the antidote in your hands but not being able to use it — my heart’s pumping just thinking about it. It’s scarier than any horror movie I’ve seen.
That struggle ultimately arose from my aversion to bringing drug-related things up to her, which, of course, came from her long-held anti-drug stance — which, although diminished, is still alive today — and her rock-solid belief that helping me navigate the waters of addiction wholly constituted “enabling” behavior.
Although she’s now willing to supervise my opioid use, I’ve long been incentivized to use drugs away from home (without supervision) — I almost always have to drive an hour away to cop, so why not use before I drive back home? I mean, wouldn’t you want to get a judgment-free shot off?
Using in such situations might have been fun, though doing so unarguably put me even further in harm’s way.
Here’s Yet Another Sticky Situation I’ve Found Myself in
In 2019, I was arrested for syringe possession despite the fact a 2015 Tennessee state law (T.C.A. § 40-7-124) should have protected me.
You can read more about this story here, but it goes like this: I was speeding and got pulled over. Knowing I was in possession of used syringes, I refused the deputy’s request to search. As always, they brought a drug-sniffing dog — poor pupper, unknowingly being used as an instrument in the long-running, entirely-oppressive War on Drugs — to unfairly construct probable cause by detecting the scent of drugs that weren’t there. The deputies obviously weren’t aware of the 2015 law that protects people from getting charged with Possession of Drug Paraphernalia, a Class A misdemeanor, if they inform police they’re in possession of syringes or sharp objects that could be construed as drug paraphernalia before a search is executed. Unable to post bail or afford private legal representation, I was essentially forced to plead guilty to the charge.
At the time, my girlfriend thought that, no matter the circumstances, bonding me out would have exemplified enabling behavior. While we both conclude that, at least in many situations, bonding a long-term, often-problematic drug user like me out of jail could very well be considered “enabling,” she now recognizes that she could have helped me avoid major life issues by simply calling a bail bondsman to help me post bail — and that isn’t enabling.
To further fuel the fire of intimately-intersecting issues that plagued my life at the time, I was on probation. Like many probationers, I was required to report in person every month. It just so happened that, at the time of arrest, I was six days away from my next report date. The probation office I was assigned to had a policy where you could postpone your report date by a week if you couldn’t make it, extending my “grace period,” if you will, to 13 days.
If you didn’t already know, you can be “violated,” or sent to jail, for not reporting.
A court liaison — I think the woman I talked to was a probation officer (P.O.) or another court official, as there weren’t any official “court liaisons” there — told me it’d likely be at least two weeks before I could be appointed a public defender and attend another court date.
So, here were the potential outcomes:
Plead guilty and show up to probation on time, being violated for catching a charge (although violation is ultimately up to the P.O. or judge, since I was already on probation for Possession of Drug Paraphernalia in the first place, I felt confident I’d be violated).
Wait for a public defender, not be able to report on time, be violated, and end up not beating the case, thereby being considered for violation twice.
Wait for a public defender, not be able to report on time, be violated, but ultimately beat the case.
Plead guilty and show up to probation on time, narrowly avoiding violation purely by luck.
Plead guilty and not report to probation — running from the law, in other words.
At the time, I was nothing short of nervous. I went to jail for the first time ever in March and ended up being put on probation in August.
Just a month-and-a-half later, I found myself in jail again.
Just a month-and-a-half prior, I “lucked up,” in my mind, by only getting probation for Possession of Drug Paraphernalia — initially, though the charges were entirely unfounded, I was also charged with D.U.I. and Violation of Implied Consent.
Just a month-and-a-half prior, I’d lost what little hope in the criminal justice system I had.
I was scared. I wanted to die — that wasn’t a new feeling, by any means, but it was based in reason more than ever before thanks to the potential of violating probation, not passing “Go,” not collecting $200, and going directly to jail.
I genuinely felt like I might spend more time in jail, something I despised after spending just 24 cumulative hours behind bars. I thought my life was in shambles and my drug use was spiraling out of control — it wasn’t actually as bad as I thought, but as a newly-minted thought-to-be-unfunctional addict, I had no confidence in myself.
It seemed like all those warnings my dad and other family members gave me — “You don’t wanna turn out like your mom, do you?” — had gone to waste. My run-ins with the grossly-unfair criminal justice-social services alliance I had turned into the good-for-nothing junkie my mom was for the bulk of her life, that her dad (my grandfather) was for much of his life, and that so many other community members grew up to exemplify the behaviors of.
Just two days after release, I overdosed — that was the third of three overdoses I experienced in 2019, and, while it wasn’t a true, full-on, passed-out-and-blue-in-the-face overdose, I was certainly close to it.
After this, I felt especially compelled to do anything that’d make me look better in the eyes of my P.O.; that’s why I got on Suboxone, actually, which I’m still on today.
And, even with a letter from the medication-assisted treatment program’s director that said I was making good progress, even with the list of signatures I’d racked up from attending NA meetings, even with me knowing I’d taken initiative, I was still scared of being violated.
Fortunately, I didn’t get violated, though the probation officer didn’t seem to care about steps I’d taken to better myself.
“The only reason I didn’t violate you is because I didn’t have time to get around to it.”
Let’s Make Things Clear — It Wasn’tMy Significant Other’s Fault
If you’ve picked up the vibe that I’m not taking responsibility for my actions, I understand — so far, admittedly, I understand I come across that way.
Whether or not my ol’ lady was comfortable with my drug use, I am still ultimately responsible for taking syringes with me on my drug run and for absent-mindedly speeding in the first place. I’m ultimately responsible for getting arrested and having my vehicle impounded. I also can’t blame my significant other for not seeking help from a bail bondsman — I’d been arrested for Possession of Drug Paraphernalia a few months prior (and once before we got together), so I totally understand why she didn’t want to help me bond out. She and my dad told me they wouldn’t be willing to help me bond out if I got arrested after my first arrest of 2019, after which, fortunately, my dad helped me post bail.
Also, since long before I began using drugs nearly 10 years ago, I knew that legal troubles were damn near guaranteed for anybody who regularly used, sold, or were otherwise around drugs. Having grown up with a super-problematic drug user of a mother, I knew that drug use — at least for addiction-prone people like us — just about always resulted in jails, institutions, or death.
I read the terms and conditions before I signed up for this shit.
And, although I’d long skirted serious legal problems, I knew shit would eventually catch up with me.
Are the Eventualities of “Jails, Institutions, and Death” a Guarantee for People in Systems That Treat Drug Users Fairly?
I understand that the majority of people who use drugs do so without facing substantial problems. Maybe parents smell weed on their teens’ clothes and ground them for a month or you drink too much alcohol and end up puking, but that’s about it for most people.
And, yes, there might be more or less people who face “substantial problems” as a result of alcohol use but don’t have “alcohol use disorder,” but, either way, the prevalence of problem drug use is still low.
Although I know that people, in general, aren’t likely to consistently run into problems as a result of their drug use, certain countries’ populations are less prone to problems stemming from drug use if they’ve got more-forgiving drug policies or less drug-related stigma.
For example, if I lived in a country with more lenient drug policies — regardless of stigma toward drug use — I likely wouldn’t have been arrested and ultimately found guilty of Possession of Drug Paraphernalia three times if drug policies were more lax. And, also, if I lived somewhere with less stigma toward drug use — independent of drug policy leniency — I think I wouldn’t have faced as many drug-related problems. Stigma and drug policy bring forth different problems, though they overlap on many issues.
Even if there were a society with entirely-friendly drug policies and no stigma towards drug use, some drug users would inevitably face major consequences from using drugs.
So, to answer my question, “jails, institutions, and death” — a phrase that seemingly all long-term, often-problematic drug users are familiar with — are less of a guarantee in places that have less stigma toward drugs and friendlier drug policies. Still, of course, even in a perfect world, some problems would still result from drug use.
How Can We Better Accept People’s Drug Use?
Once most Americans are willing to accept other people’s drug use, most people reading this will be dead — at least I think we’re that far away.
However, it’s clear that you’re interested in supporting someone in active addiction, and that’s what matters. Just one person — hopefully you — can have a big impact on an active addict’s life.
Know How to Respond to an Overdose and Be Available to Supervise Others’ Drug Use
In my case, as an active illicit opioid user, I can protect myself from overdose by doing a few things:
Always use around someone else who knows how to use naloxone and spot signs of opioid overdose.
Make sure that person has access to naloxone. Point it out to them before using — do this every time you use.
Do “test shots” (doses) with every new batch you use.
Not mixing drugs — if you’re drinking alcohol, only drink alcohol.
You can be that supervisor for a friend, family member, or even someone you don’t know very well. There are plenty of good naloxone administration and opioid overdose response guides out there — look on google for on— so I won’t be explaining how, exactly, you’d learn.
However, in general, opioid overdose response looks like this:
If breathing slows or the user goes unconscious, make sure their airway isn’t obstructed.
Giving the person naloxone.
(Possibly) performing rescue breathing.
Give Addicts Autonomy in Making Decisions
When it comes to recovering from drug addiction, we often know what’s best for ourselves. Why do many rehabs, drug courts, and probation or parole programs not take advice from current and former often-problematic drug users?
Don’t they do that in quite literally every other field — take advice from experts?
We really are experts in dictating the course of our addiction recovery ventures. Still, expect us to fail several times before getting it right.
Don’t View “Recovery” as Complete Abstinence
One of the most dangerous ways family members and friends treat addiction is by considering “recovery” to be full-out abstinence from all drugs.
If someone shows good faith in wanting to reduce drug use or fulfill unmet needs to improve their lives overall, support them!
Since I’ve been able to tell my S.O. when I use drugs, I’ve reduced my consumption, enrolled in a medication-assisted treatment program (“Suboxone clinic”), and experienced greater quality of life. I know this is just an anecdote, and not everybody will follow my same recovery path, but trust me when I say that supporting someone in active addiction is the best thing you can do. I agree it’d be ideal if I didn’t use drugs, but that isn’t a practical.
Sure as hell not anytime soon, at least.
Recovery should be about improving one’s quality of life — let your addict do what they think is best (within reason, of course). Simultaneously, try to be that voice of reason, but fall short of dictating their recovery decisions.
The story of how I got hooked on cigarettes is funny. Well, not “ha ha” funny, but strange — that’s for sure.
It was February 2017. I was three months short of earning a bachelor’s degree — a Bachelor’s of Science in Business Administration (BSBA) in Accounting — and was gearing up to apply for jobs. Big boy jobs, that is.
I remember sitting on my back porch’s concrete steps when my dad told me I should quit smoking weed in preparation for entering the workforce. “Every employer worth a shit’s gonna drug test, Dan,” sounds like something Dad would’ve actually said during that phone call.
And — it was that simple — I quit smoking weed.
Well, here’s the simple part: I started smoking cigarettes in place of weed. And, hey, it wasn’t just simple — it was fucking stupid!
That’s the story of how I got hooked on cigarettes. I had first smoked when I was, I dunno, 16 or so, but I only smoked every few weeks — hell, every few months, even, up until I was 19-ish. This was when opioids became my primary drug of choice. Almost every time I used opioids from 2014 onward, I smoked cigarettes.
Keep in mind that I couldn’t afford opioids every day, so I ended up taking pain pills and, later on, heroin anywhere from two to six days a week.
Of course, after February 2017, I was smoking damn near every day. Some days, I didn’t have the urge to smoke, though most days I did.
Although I still smoke cigarettes today, I’ve reduced my use substantially with the help of the almighty Juul.
Yeah, I know Juul is a very high-school-esque device to use as opposed to a better, higher-quality nicotine vaporizer — or a “vape,” in simpler terms — but it was cheap to buy and easy to set up.
Here’s the Bad Part
Before Juul, like I already said, I had days where I wouldn’t smoke. Now, I’m vaping every single day. And, before, I usually wouldn’t smoke more than one or two cigarettes a day unless I was using opioids. Now, I’m using darn near a full Juul Pod a day — if not more than a Pod a day.
If you didn’t know, a Juul Pod supposedly equates to a pack of cigarettes. I’m not buying it — I’ve heard from other people online, though just in the form of anecdotes, that a Juul Pod is closer to 12 cigarettes.
Either way, I’m consuming more nicotine and inhaling nicotine-charged vapor or smoke more frequently than ever before. Admittedly, yeah, I’ve largely taken myself out of harm’s way, or so I think I have, but I’m spending more money on tobacco products than ever before (I do consider Juul a tobacco product, if I wasn’t clear).
What Can I Do From Here?
Recently, I bought a Novo 2 something-or-other, a higher-quality nicotine vaping device than Juul. With tax, it was about $40 — that’s not an objectively-large amount of dough, but it was a big hit for me, personally.
The local vape shop didn’t have any vape juice sample packs, so I was essentially forced to blow $20 on a big fuckin’ bottle of e-liquid — and I didn’t even like it. Fortunately, the store allowed me to trade in that e-liquid for another flavor. I didn’t like it, either.
I don’t wanna gamble with $20 bottles of vape juice. I’d rather stick to Virginia Tobacco Juul Pods for the time being. It’s way more expensive than using the Novo — or any other vaping device, really, for that matter — but at least I know what I’m getting.
Whether I stick with the more-expensive Juul or actually find an e-liquid I like, I’m still better off vaping than returning to near-daily tobacco use. And this still holds true even though I continue to smoke cigarettes anywhere from two to five days each month.
It just sucks that the most-available means of quitting tobacco ultimately ended up increasing my nicotine consumption. And, yes, I know it’s my fault that I didn’t Juul responsibly. It’s just easy to “go overboard,” as you could call it, having a Juul within arm’s reach.
I’m trying to Juul less and, also, I’m trying to find an e-liquid that’s similar to Juul’s Virginia Tobacco in flavor. Once I find that e-liquid, I’ll undoubtedly start saving money and, in my opinion, I’ll also have better success in decreasing my nicotine consumption.
Did I Ever Get the Job?
To clarify, I didn’t quit smoking weed to pass a single employer’s drug test. Rather, I quit in anticipation of any pre-employment drug tests that might come my way.
And, hell naw, to this day, I still haven’t used that god damn degree. I immediately enrolled in a Master’s of Business Administration program after graduating and dropped out halfway through because I felt like I wasn’t learning anything and because business — at least studying business — just wasn’t for me.
I’m still a self-employed writer, which I first became in mid-2015. Funny how things work out.
Alright. So, I’m prescribed Suboxone® and a stimulant. Won’t say which one, but you could guess its name and probably be right.
Tuesday, I checked in for my weekly visit at the MAT program I’m going to — fortunately, they let me talk to the counselor (not that I’m interested in counseling in the slightest right now… it’s a requirement) and the doctor over the phone. I did have to drop off my urine, though. Love pissing in cups. Fucking love it.
So, they sent my Suboxone RX to the pharmacy — keep in mind both the clinic and the pharmacy are over an hour away from home — and I stroll over to the pharmacy. They say it’ll be 30 minutes.
I go back to the pharmacy, they say THEY DON’T HAVE ANY GOD DAMN SUBOXONE®!
Okay, whatever. They say they’d get some Thursday.
Guess what? It’s Thursday! AND THEY SAY THEY WON’T HAVE ANY GOD DAMN SUBOXONE® UNTIL SATURDAY!
Okay, whatever. I’m used to the bullshit at this point.
This pharmacy is the only one I know — mind you, I’ve tried nine different pharmacies in the area at this point — that will take discount cards. And, no, I don’t have insurance.
Luckily for me, I don’t take as much Suboxone® as I’m prescribed. Luckily for me, I lie to my doctor and say I take more than I actually do. Just so I can avoid bullshit like this — if I hadn’t been saving up meds, I’d be in brutal withdrawal right now. Fun. Oh so fun.
So, now I’m going to a different pharmacy that’s an hour away — it’s in the same area the first preferred pharmacy is, for the record — to get my Suboxone filled without a discount card.
But wait — they don’t have the stimulant in stock until tomorrow.
Aren’t We Supposed to Avoid Pharmacy Hopping?
Yeah. Pharmacy hopping is what gets us in trouble. It’s what gets us on the radar. It’s what gives us “druggies” a bad name.
But that’s what I’m forced to do today — pharmacy hopping. Oh, the joys of being a dopehead. But, this is what I signed up for.
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.