Not Accepting People’s Drug Use Leads to Potentially-Deadly Consequences

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’t My 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?

Generally, no.

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.

Some 86% of American adults admit using alcohol at least once before, 70% say they’ve drank in the past year, and 55% report alcohol consumption within the past month. Research I’ve dug up indicates that 22.4% of Americans are under 18 and there are 14 million Americans with alcohol use disorder. Assuming there are 328 million Americans, just 5.5% of people meet the diagnostic criteria for alcohol use disorder.

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.

But how?

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.
  • Calling 911.
  • 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.

I Quit Smoking by Vaping — But Now I’m Taking More Nicotine Than Ever Before

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.

Pharmacy Hopping — A Nearly-Unavoidable Reality

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 wait.

And wait.

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.

Why Vaping, Chronic Pain Patient, and Harm Reduction Advocates Need to Join Hands

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-fledged cannabis 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.

Joining Forces Between Chronic Pain Patient and Drug User Advocates — a Worthwhile Endeavor

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?

They can’t.

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.

We Gotta Start Associating Harm Reduction With Tobacco and Vaping More

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.

Anyways.

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.

Let’s Start Using “PWLE” in Place of “People With Lived Experience”

We’re all familiar with “people who use drugs” (PWUD) — a person-first phrasing now-often used in place of once-more-common alternatives like “addicts,” “junkies,” and even “drug users.” I actually prefer “drug user” to PWUD, but that’s not important.

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?

I see two big reasons for doing so:

Here’s the Dealio, Steelio

We call drug users “people who use drugs,” right?

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 Need to Get With the Proverbial Program

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.

This is especially important because, at least in rural, largely-right-leaning areas that lack even a semblance of harm reduction infrastructure — like where I live — most people are learning about harm reduction online. I think this will remain the norm for at least five to 10 years.

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 kinda clunky and, after a few mentions, it needs an abbreviation.

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.

Spongebob Squarepants, “Something Smells,” Season 2, Episode 22a

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…

Something Else…

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.

Why’s Heroin the “Devil’s Drug”? Unpacking This Crock of Horseshit

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.

But, Seriously

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

An Easy Guide to Understanding Why Fentanyl Is So Deadly

Want to finally understand why you hear about fentanyl all the time? Maybe without reading a novel or some complicated journal article written by doctors or college professors? Look no further.

What Is Fentanyl?

Fentanyl is a synthetic opioid available via prescription and the black market that’s about 50 to 100 times stronger than morphine.

Synthetic opioids aren’t inherently bad. Methadone is an example of another synthetic opioid that’s actually used in opioid replacement therapy or medication-assisted treatment (MAT) programs and to treat chronic pain.

Why Are People Dying From Fentanyl?

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.

Both heroin and fake prescription opioid tablets that contain fentanyl are sold on an unregulated market. That means nobody ever knows what’s actually in their heroin, alleged prescription opioids, or other drugs.

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.

How Does Fentanyl Cause Death?

Opioid overdose causes death by making users super-duper sedated — or conked out, in slang terms — and losing the ability to easily breathe due to our airways becoming obstructed.

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.
  • Get naloxone (Narcan) immediately. In Martin, Tennessee, where I am, for example, you can hit up Melesa Lassiter, Northwest Tennessee’s Regional Overdose Prevention Specialist, for free Narcan. Live somewhere else? Visit naloxoneforall.org for state-by-state information about where people can access in-person naloxone and other free resources.
  • 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.

Why We Need “The Big Book of Harm Reduction”

Since I first learned about and became interested in harm reduction — they virtually happened simultaneously some three years ago — I’ve long sought out a manual on building harm reduction (HR) infrastructure: Harm Reduction for Dummies, if you will.

I still haven’t found it.

Grassroots harm reductionists and fledgling HR-related organizations in places without any harm reduction infrastructure have no clue how to grow. We don’t know how to do this stuff. The only people who do are those in areas with better-developed HR infrastructure (e.g., New York, California, Canada, Portugal).

Even then, I feel like expanding harm reduction here in Tennessee — or, hell, the entirety of the (rural) American South — will require substantial deviation from what’s worked in other areas (again, New York, California, or Canada, for example).

Here’s What I’m Trying to Say

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.

How can we go about doing this?

I’m not sure — I’m not even going to act like I’ve got the answers. However, I am willing to proofread and revise any harm reduction-related writing or resources you’ve got — yes, you!

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.

For Drug Users, By Drug Users