Drug User Advocacy

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.

Drug User Advocacy From Personal Experience Recovery

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.


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.

Chronic Pain Drug User Advocacy Vaping

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.

Chronic Pain Drug User Advocacy

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.

Drug User Advocacy From Personal Experience

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.

Drug User Advocacy From Personal Experience

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

Drug User Advocacy From Personal Experience Recovery

Current American Medication-Assisted Treatment Conventions Aren’t All Ideal

While medication-assisted treatment (MAT) programs across the country have reduced harm that enrollees otherwise would have experienced without enrolling, some feel that MAT hasn’t been expanded far enough throughout the United States. I can’t help but feel glad it’s legal here in Tennessee, though I also believe our current MAT system is far from ideal — I think we can all agree on that.

Refraining from future drug use would best serve my interests, as I’ve long proven myself to be an often-problematic drug user. Most people can moderate their drug use to avoid addiction and dependency, but I’m not one of those people. While I still use illicit drugs today, I’m in a much better spot now that I’ve reduced my overall intake and largely maintain myself with buprenorphine (Suboxone).

Medication for opioid use disorder (MOUD) prescribers — those are the physicians licensed to prescribe methadone or buprenorphine — are morally incentivized to not tolerate “dirty” urine drug screen results, as knowingly allowing program enrollees to continue illicit opioid use and be maintained using Suboxone could get prescribers in trouble. How would allowing a patient to “get by” with illicit opioid use reflect on a physician if the patient died of an opioid-involved overdose?

Wouldn’t be too cash money, would it?

On the other hand, I wish long-term, addicted/dependent — both in my case — opioid users could be maintained on Suboxone while still using illicit opioids. In my case, since I reduced my other-than-Suboxone opioid use big time, I’ve done myself a solid by seeking out MAT program enrollment. Before getting on Suboxone in September, I found myself in almost-entirely-mental opioid withdrawal every week for anywhere between two and four days.

This cycle got started because I’d have enough money to afford anywhere from three to five days’ worth of using opioids — I could never afford to use throughout the week without interruption — before regressing into a shell of myself until I got paid again. I lived each day during this cycle constantly tracking the time in anticipation for my next high. I wasn’t very psyched about living, either — I felt indifferent about the potential of experiencing overdose. In other words, I never once worried that life was whizzing by too quickly during the three or four years consisting entirely of my oh-so-depressing, constantly-repeating week-long cycle.

After starting Suboxone, I didn’t fiend for heroin — more like a fentanyl-heroin mixture knowing the modern American illicit opioid market — or other opioids as I used to. I also stopped contemplating an “accidental” suicide via opioid overdose. Life was better, in general.

I worry that medication-assisted treatment programs’ firing of patients who test positive for non-prescribed (often-illicit) drugs seems to stand in contradiction to the tenet of keeping patients on — or at least constantly offering them MOUD access — MOUD in favor of returning to the (often-illicit) opioid use they came from, which is typically more dangerous.

Here’s my issue: is it better for MAT programs to (1) allow enrollees to use other opioids and be maintained on Suboxone or methadone or (2) kick enrollees out after testing positive for other opioids an arbitrary one-too-many times?

I think number one is the better option. Here’s why.

What’s the Point of Medication-Assisted Treatment?

I don’t think there’s an objectively-true purpose of medication-assisted treatment. We must ask ourselves what we value most from MAT programs to formulate a worthwhile answer — only then can we hope to define the purpose of MOUD maintenance.

Here’s What I Value From MAT Programs

I think MAT program enrollees’ often-problematic opioid use should decrease as a result of their buprenorphine or methadone use — that’s one performance indicator we can use. Their exposure to risky or detrimental scenarios (i.e., visiting a high-crime area to source illicit drugs) should wane — the second metric we’ve got. And, most importantly, their quality of life should improve — albeit this third metric is considerably harder to quantify. These are the central values I want from medication-assisted treatment.

No, these are not the almighty three “values” I hope to get from MAT. You’re encouraged to pick and choose your own values — don’t just blindly follow mine!

Of course, I recognize MAT as a super-solid alternative to opioid use — and even alcohol use (naltrexone). Whether you have opioid use disorder per the DSM-5 or not, MAT can help you. Even though I didn’t have a physical dependency to opioids before I enrolled in an MAT program — I didn’t experience the same “flu-like,” for lack of a better word, opioid withdrawal symptoms that so many others do; dealing with the mental fallout of ceasing opioid use was the big issue for me, personally — Suboxone maintenance was still a good fit for me.

Again, I think medication-assisted treatment is great for dealing with opioid use disorder and otherwise-problematic opioid use.

What Does the Volunteer State Want From Medication-Assisted Treatment?

The Tennessee Department of Mental Health & Substance Abuse Services’ medication-assisted treatment page states, “The prescribed medication [Suboxone, methadone, or naltrexone] operates to normalize brain chemistry, block the euphoric effects of alcohol and opioids, relieve physiological cravings, and normalize body functions without the negative effects of the abused drug.”

While this definition outlines the physiological effects of suboxone, methadone, and naltrexone, it doesn’t address any higher-level, overall goals for people involved in medication-assisted treatment programs.

Many medication for opioid use disorder prescribers in Tennessee are weighed down by looming regulations. Some are more comfortable than others with regularly accepting “dirty” drug screens — a more-appropriate term might be “positive drug screen” — from patients without firing them. Others fear regulatory backlash if they don’t act in accordance with state guidelines, which encourage prescribers not to retain patients’ enrollment if they submit just four positive drug screens in a two-year period, among other stringent regulations.

What Does Tennessee Want From MAT Program Enrollees?

All MAT programs’ prescribers want to see patients exhibit abstinence from illicit drugs while taking their prescribed dose of buprenorphine, methadone, or naltrexone. Some programs are willing to let regular cannabis use slide, though not anything more than that. Programs also aren’t cool with alcohol use, either.

Due to pressure from the state, however, prescribers often are constrained to appease the state by doing things that aren’t conducive to successful treatment outcomes.

The state’s regulations state that any enrollees who test positive for illicit drugs four times — the text actually reads, “Upon a second/third/fourth positive drug test result within six months of the first/second/third positive drug test result,” which means four positive drug test results for illicit drugs could span a 24-month period at longest — are required to “address the on-going [sic] multi-drug use through increased group and individual counseling, intensive outpatient [sic] and residential clinical treatment.” Imagine getting kicked out of a MAT program because, after pissing dirty four times in two years, you refused to go to residential inpatient clinical treatment.

The aforementioned document is 44 pages long and is packed to the brim with strict guidelines that make it difficult for prescribers to best help MAT program enrollees.

Consider This Scenario

Assume Bob is a regular illicit opioid user who lives in Tennessee. Bob has proven himself to be an often-problematic drug user, having found himself in legal, financial, familial, relational, social, mental, and physical trouble from his opioid use.

Bob solicits a medication-assisted treatment program that prescribes buprenorphine and shortly after enrolls in the MAT program.

Bob’s frequency and intensity of illicit opioid use decreases thanks to his enrollment and regular dosing of Suboxone. However, he still continues to use — just not as often or as much at once. Bob also doesn’t go on binges like he used to.

While Bob will be allowed at least one slip-up, he faces inevitable termination from the program if he continues to submit urine for drug tests that test positive for opioids. Assume that Bob maintains this pattern of use, regularly taking both illicit opioids and the Suboxone he’s prescribed.

Ask yourself — what do you think will happen if Bob is dismissed from the program? Do you think he’ll be better off enrolled in the MAT program and allowed to continue his concurrent consumption of illicit opioids and the Suboxone he’s prescribed or better off dismissed from the MAT program?

Here’s What I Think

Often-problematic drug users continuing their illicit drug use is rarely a good idea. As a long-term, often-problematic illicit opioid user myself, I’ve faced all the problems Bob has and more — I know that continuing to use opioids is a bad idea, at least for me, personally.

The most ideal outcome for Bob is to ultimately cease his illicit opioid use, if not quit the use of all drugs, opioid or not.

Would it be better for Bob, assuming that he wants to continue using illicit opioids, (A) to remain on Suboxone and use other opioids less often or (B) to be dismissed from the MAT program and use illicit opioids on a daily basis?

I think, although not ideal, (A) is the better option.

People in Bob’s shoes could be fired from MAT enrollment if they tell their prescribers that they plan on continuing illicit opioid use. In order to hide evidence of illicit opioid use, they’d have to secure “clean” urine — that which only tests positive for buprenorphine and nothing else — and sneak it in the MAT program’s facility on a regular basis.

Responsibilities of MAT Program Professionals

How responsible is my Suboxone prescriber if he’s okay with me continuing my use of illicit opioids, even though I’d still be on Suboxone and I’d be using less than before beginning Suboxone maintenance?

I don’t think it’d be responsible of him at all. What if I overdosed or another negative outcome occurred?

Is it good enough to have an MAT program enrollee reduce illicit opioid use (i.e., Bob’s scenario above) or would a MAT program physician be settling for less by allowing a patient to do so?

Even the most forward-thinking harm reductionists can see the problems with drawing the proverbial line between these two situations.

The Effects of Buprenorphine on an Opioid-Dependent Patient’s Brain

Before I got on Suboxone, I used illicit opioids as often as I could afford them. I’d be able to spend anywhere from one to four days high in a row upon getting paid. The rest of the week, I’d lay in bed unable to concentrate, nothing short of depressed, and interested in nothing more than the next time I’d be able to get high.

This pattern of use went on for at least two years, if not three or four.

What a way to live, huh?

When I got on Suboxone, I was actually able to finish Youtube videos to the end — not to mention feel joy from watching them. I felt more stable; on Suboxone, I’ve never acted like I would when I was super duper high, and, similarly, I’ve never felt as low as I used to after my binges were over — and that happened consistently… every… single… week.

Suboxone has also deterred me from using illicit opioids on several occasions because I knew I’d end up wasting my money thanks to buprenorphine’s opioid-blocking effects.

Also, although this doesn’t have anything to do with my brain, I’ve been around criminal activity much less than when I was actively using. That makes me feel better and reduces the likelihood of me being sent to jail or otherwise dealing with the criminal justice system.

Where Should We Go From Here?

Personally, I want be able to still use heroin and other illicit opioids on occasion and take Suboxone regularly without facing termination from the MAT program I’m enrolled in.

Going forward, I think patients enrolled in MAT programs should be able to use illicit opioids if they so choose without the risk of being kicked out. It’s safer for me to take Suboxone six days of the week and illicit opioids one day rather than me not use Suboxone at all and only use illicit opioids; I also feel confident that my quality of life is higher this way.

I don’t feel confident in asserting that my idea is the way to go. I certainly think what I proposed above is a good idea, but medical professionals, addiction specialists, mental health practitioners, social services workers, criminal justice system members, long-term illicit opioid users, and others need to spark up a discussion about this before we do anything. None of us know with certainty what’s best — but many of us feel we need change, and change is where we need to start.

Drug User Advocacy Harm Reduction

Where Drug Users’ Unions May Fall Short

People who use drugs, especially their often-problematic counterparts, are given a bad name. Here in the United States, a campaign against drugs and drug users alike has been going strong for some 100 years — if not longer.

Drawing of five wadded fists held in the air. Two fists are red and three are black held together in a show of solidarity for drug user rights.
The Icarus Project NYC

We’ve been painted as — especially non-White and otherwise-disadvantaged people — “dirty junkies” by much of society for quite some time. Not very cash money, is it? This veil of being inherently bad — stigma, in other words — has directly made drug-related problems worse; because of it, we fail to deal with them effectively: criminalizing drug use or policing drug-related activity in general just doesn’t work.

On the other hand, drug users often give themselves a bad name — admittedly, I’ve made people who use drugs look bad countess times over my decade-long, ongoing career as a regular drug user. I still make us look bad today at times, even though I try to use responsibly — a relatively new development in my decade-long drug-using career.

Overall, the net positive done by modern drug user unions is unarguably beneficial to drug users as a whole, both current and future.

That’s What Drug Users’ Unions Are For

Drug user unions (DUU) — or “drug users’ unions,” since they’re both for and by drug users — can make themselves and, by extension, drug users look bad by inappropriately and excessively exposing such problem drug use to the public or by not being well-organized. For example, I looked at one well-known union that was reviewed by multiple people as bad because, at a protest or other public event, members couldn’t tell others what they were lobbying for or why.

I can’t say this without recognizing that DUUs can certainly imprint material, lasting outcomes in the arenas or spaces they’re advocating for fair drug user treatment in — and that’s something they often do.

Overall, the net positive done by modern drug user unions is unarguably beneficial to drug users as a whole, both current and future.

Being Badly Organized Hurts

If you look online for drug user union reviews, you’ll find reports of DUU members as being unable to tell others what, exactly, they were advocating for or why.

Although the idea that drug users should be given equal social footing is reasonable to understand, people are less likely to support drug users’ rights if members at protests or other public showings fail to sufficiently explain their purpose or reasoning.

Outsiders may feel that drug user union members, especially those who struggle to articulate solid reasoning in explaining themselves, simply want drugs to be legalized so they can use without repercussion.

We need to best appeal to opponents of drug users’ rights. How can we do that — by handing them shining examples of drug users living up to the “junkie” stereotype on a silver platter?

The vast majority of all drug consumers don’t often, if ever, exhibit problematic drug use. Very few of us fit the bill of “long-term, often-problematic drug users,” a term I use to describe myself.

Although we harm reductionists know this to be true and use this talking point — that few drug users actually experience serious negative consequences as a result of their drug use — in advocating for our cause, we can’t afford to run the risk of being perceived this way (read: perceived).

To best represent ourselves, I feel like we may benefit from putting our most-prepared, least-likely-to-make-drug-users-look-bad members on the front lines; in other words, every time drug user unions potentially show themselves to the public, they should be careful to avoid revealing anything that could reflect on harm reduction or its practitioners negatively.

Are Drug User Unions Worth Their Salt?

Again, drug user unions positively contribute to our shared cause of promoting equal treatment of people who use drugs, especially their often-problematic counterparts.

So, yes, drug user unions are most definitely worth their weight in salt.

However, we stand to lose footing or hold back our full potential in advancing harm reduction when drug user unions are poorly organized and their operations aren’t well-planned. I feel like we often don’t consider the public relations aspect of drug user advocacy.

While the “model minority” is a load of bullshit, I’m certain that showcasing active drug users in a way that doesn’t make us look bad is a reasonable, practically-minded suggestion.

Drugs cause us to feel different, lose inhibition, and impair our motor skills. When combined with long-unmet needs, which often serve as the basis for addiction, drug use can decay into problematic drug use that reflects poorly on all of us.

Drug User Advocacy Harm Reduction

“People Who Use Drugs”—Slow Your Roll on Person-First Language Like This

In recent years, harm reductionists have pushed to call drug users “people who use drugs” as opposed to “drug abusers,” “substance abusers,” or “drug addicts,” among other labels that hold considerable negative connotations. “People who use drugs,” or PWUD for short, is an example of person-first language, a self-explanatory convention that places people before things — things often viewed as holding people back, such as being physically disabled or having schizophrenia.

I worry that the use of “PWUD” among harm reductionists is excessive and paradoxically detrimental to our shared cause of helping people who use drugs. “People who use drugs” is often associated with political correctness and used in place of other, better-suited phrases like “drug user.”

And, Yes, I Do Have Skin in the Game

I like to call myself a “long-term, often-problematic drug user.” Having used drugs nearly every day for ten years, I’ve been kicked out of college and arrested thrice for my drug use, not to mention guilty of otherwise fitting the bill of the “junkie” or “druggie” stereotype countless times.

I also grew up around a super-problematic drug user of a mother for nine-plus years. She’s been arrested in front of all my middle school classmates for DUI, put me around generally-bad people — just a bunch of bullshit kids shouldn’t have to deal with.

Being Overly Politically Correct Hurts Us

Here in rural Tennessee, people are especially averse to anything that’s been singed by superfluous political correctness. This isn’t geographically specific, though — aversion to political correctness is common among nearly all largely-right-leaning people regardless of location. I should mention that even some left-leaning people aren’t fans of PC, either.

Largely-right-leaning politicians and stakeholders across Tennessee, for example, have supported prevention coalitions, often-exclusionary 12-step programs, and outdated, non-evidence-based rehabs. Yeah, they help some, but they fall short.

How can we best break through to those who are most likely averse to harm reduction? I don’t have the answer, unfortunately. However, one thing I do know is that we should avoid doing anything that can be viewed as overly and unnecessarily politically correct.

What is being overly politically correct, at least as far as drugs or drug users are concerned? I think avoiding “drug abuse,” “substance abuse,” and “addict” — at least when used excessively or as the first option to define what I like to call a “long-term, often-problematic drug user” or their behavior — isn’t overly politically correct; on the other hand, I think exclusively using the identifier “people/person who use/uses drugs” and never using other terms to refer to drug users, for example, could be seen as excessive and unnecessary.

It’s Not About the Number of Words

Choosing “drug user” over “person who uses drugs” isn’t at all about word count. It’s not that I can’t be bothered to type two extra words. This reasoning is nothing short of silly.

It’s about distancing ourselves from things potentially viewed as overly politically correct.

Let’s face it — “person who uses drugs” or, for example, “person experiencing homelessness who uses drugs” are clunky phrases. I’ve noticed that some harm reductionists never refer to drug users as just that — drug users. This leaves their writing and rhetoric prone to being clunky, difficult to read, and lacking good flow.

I prefer “drug user” — remember, I’m both a long-term and active drug user, so I very much have skin in the game — over PWUD, but I understand most harm reductionists want to avoid “drug user.” For those who prefer to use PWUD, please try to use at least a 25-75 blend of “drug user” to PWUD (“at least a 25-75 blend” means a 26-74 blend or better). I think “drug user” is the next-best option after PWUD in terms of identifiers that hold relatively few negative connotations.

For the record, I think — strictly from a literary, grammatical standpoint — that “drug user” is generally superior to “people/person who use/uses drugs.”

Associating Other Social Equity Efforts or Otherwise-Left-Leaning Ideas With Helping Drug Users

Many people who consider themselves harm reductionists view “harm reduction” as equal parts:

  • Helping drug users.
  • Advancing not-necessarily-drug-user-related social equity efforts (e.g., pro-LGBT, pro-sex worker causes).

Back when harm reduction was first applied on a major scale in the mid-1980s — which focused on the reduction of HIV transmission, which happened to be particularly likely among gay men who injected drugs — practitioners were forced to address the intersectionality between gay men, injection drug users, and HIV transmission. Based on its background, it makes sense that many harm reductionists view “harm reduction” as one-half helping drug users and one-half advancing auxiliary social equity efforts.

Also, considering the fact — although I have no hard evidence to support this, you’d be hard-pressed to argue otherwise — that most harm reductionists are largely-left-leaning people, it’s easy to understand why so many harm reduction supporters are also supporters of social justice interests in general.

Here’s my issue with associating (1) helping drug users with (2) social equity efforts or other largely-left-leaning ideas that aren’t directly related to drug use: Doing so detracts from our shared goal of helping people who use drugs.

First off, in rural Tennessee, most residents are averse to things like pro-LGBT or pro-sex worker efforts. Whether we actively promote these agendas in our harm reduction-related programming or simply mix our pro-drug sentiments with pro-LGBT or pro-sex worker ideas on social media for others to see, I think we make it less likely for Tennesseans to hop on board the SS Let’s Help Drug Users. They’ll be less willing to adopt harm reduction-positive ideas and, even if they do adopt such views, they’re less likely to become active, across-the-board supporters.

Second, according to the Harm Reduction Coalition’s (HRC) and the Drug Policy Alliance’s (DPA) definitions of harm reduction, helping drug users comes first. The DPA is equally dedicated to fighting “racialized drug policies,” which helps drug users at large — for example, even though I’m White, since I’m poor, I can’t afford to bail out of jail once arrested or hire a private attorney, both of which makes me more likely to unnecessarily plead guilty to charges and otherwise not defend myself like others who can afford to post bail following arrest or secure private legal representation.

Combating race-driven drug laws is undeniably directly related to helping drug users. Pro-LGBT efforts, for example, aren’t directly related to helping drug users. I recognize that, for example, we may need to adopt different strategies to help transgender people who use drugs, though modifying our approaches to help drug userstransgender drug users are, of course, part of the greater drug-using community — falls short of fully-fledged pro-LGBT efforts. The same holds true for pro-sex worker efforts, as drug use and sex work can very well overlap — and often do; however, advocating for sex workers in non-drug-related capacities should not be considered “harm reduction” because doing so doesn’t directly help drug users like me.

For the record, I’m bisexual and was an online-based sex worker for about four years. I reference pro-LGBT and pro-sex worker efforts here because I have skin in these proverbial games.

If I Wasn’t Already Clear

According to the HRC’s and DPA’s definitions of “harm reduction,” helping drug users is the primary objective of harm reduction. And, of course, this article is discussing harm reduction as it directly relates to drugs — not anything else, such as sex work.

Helping drug users, at least per what two of the world’s leading harm reduction-related organizations think — the Harm Reduction Coalition and the Drug Policy Alliance, if you don’t remember — should be the number-one goal of harm reductionists. If this isn’t your goal, what you’re doing might not be best defined as “harm reduction.”

What do we do as harm reductionists? Things that are directly related to helping people who use drugs. We should avoid doing things that hurt drug users.

In places like rural Tennessee, where I live, people aren’t big on anything that’s pro-LGBT or pro-sex worker in nature. Also, residents of the Volunteer State aren’t already hip to harm reduction; obviously, they don’t support harm reduction-positive ideas, as they’re not even familiar with them.

How can we best appeal to the average Tennessean as harm reductionists? I think associating harm reduction with auxiliary social justice efforts or other largely-left-leaning sentiments can materially slow and geld our goal of helping drug users.

How Social Media Use Potentially Turns Off Newbies

Harm reduction is currently most supported by largely-left-leaning people, at least here in the modern United States. Largely-left-leaning people are almost always responsible for what’s considered by some to be “excessive political correctness.” Again, most Tennesseans aren’t fond of anything even remotely considered excessively or unnecessarily politically correct.

I was introduced to harm reduction online — specifically, on Reddit’s r/Opiates subreddit. In places without harm reduction infrastructure like rural Tennessee, most people who find interest in harm reduction will continue to be introduced to the idea via the World Wide Web.

How will largely-right-leaning or otherwise-not-largely-left-leaning people who haven’t yet been exposed to harm reduction welcome the idea of helping drug users — “harm reduction,” in other words — react upon being initially exposed to harm reduction when referenced in a way that’s seen as excessively politically correct?

Probably not well, at least not as well as if that exposure weren’t influenced by political correctness.

What Am I Getting At?

I worry that some potential supporters of harm reduction-positive ideas, efforts, and programs — even harm reduction resources, such as educational brochures — may be turned off by what they perceive as unnecessary, excessive, inappropriate political correctness.

Using “people who use drugs,” again, isn’t being politically correct, I don’t think; however, outright refusing to use terms like “drug user,” “addict,” or “drug abuse” — even though I think “drug abuse” shouldn’t be used outside of referring to excessive consumption of psychoactive drugs that unarguably constitutes “abuse” — may be considered overtly politically correct.

Associating harm reduction with things that are considered overly politically correct could inhibit adoption of harm reduction-positive ideas.

Does this serve as a well-defined, go-to guide for how not to be viewed as excessively politically correct? Hell no.

I think it’s most appropriate for each of us, as harm reductionists, to exercise discretion in doing things that may earn us an unwanted reputation.

Drug User Advocacy From Personal Experience The Volunteer State

How Current Tennessee Laws Affect Drug Users

Without laws, uncivil action would permeate society. Laws are essential to maintaining order. Few of us would be willing to live somewhere that doesn’t have laws or an active law enforcement presence. 

Worn wooden gavel resting on a wood surface.
Wesley Tingey

Unfortunately, across the United States, existing laws unfairly treat people who use drugs. This is especially true in Tennessee — take syringe laws in Tennessee, for example. Further, law enforcement might not enforce more recent laws that treat people who use drugs more favorably. 

Here are several ways that Tennessee laws and law enforcement officers hurt Tennesseans who use drugs

Some Officers Just Aren’t Up to Speed

Here in Tennessee, we have a law known as T.C.A. § 40-7-124. It was codified — or written into law, in other words — in 2015. For pronunciation’s sake, that’s Tennessee Code Annotated, Title 40, Chapter 7, Section 124. 

The law doesn’t have an official nickname, though you may find it referred to as “Needle Possession Officer Awareness” — for ease of understanding, we’ll refer to it as the Needle Possession Officer Awareness law. 

Put simply, if someone gets apprehended by law enforcement and informs officers that they’re in possession of syringes or sharp objects before they’re searched, they can’t be charged with possession of drug paraphernalia, a violation of T.C.A. § 39-17-425, a Class A misdemeanor punishable by as much as one year in jail and $2,500 in fines.

This is one of the most common criminal charges Tennesseans receive — possession of drug paraphernalia, a violation of T.C.A. § 39-17-425. Law enforcement officers (LEO) are informed of these laws, as well as what constitutes evidence to actually charge people with criminal violations.

LEO are always on the lookout for syringes and sharp objects, as needlestick injuries can potentially lead to the transmission of blood-borne diseases like HIV or HCV (hepatitis C). 

People who inject drugs in Tennessee know all too well that being found in possession of syringes can land them in jail. As such, they’re incentivized to keep quiet about being in possession of syringes. Why, after all, would someone tell on themselves, potentially landing themselves in jail, on probation, or with expensive fines to pay?

This is a problem that LEO routinely face. 

This is the reason why the Needle Possession Officer Awareness law was written into state law by legislators in 2015. Their number one goal was to protect the police officers, deputies, and other LEO who protect civilians from criminals and maintain civility throughout Tennessee. 

Personally, I’ve been arrested for possessing drug paraphernalia, specifically syringes, even though T.C.A. § 40-7-124, the Needle Possession Officer Awareness law, should have protected me. I informed the deputy that pulled me over that I had syringes in my vehicle before I got searched and everything. Despite this, I got sent to jail for a night and had my vehicle impounded. Unable to afford bail or an attorney, I was forced to plead guilty, which resulted in me being put on probation, more commonly known as “11/29.” The probation costs are something like $700. The impound fee was about $250. I also put my loved ones through stress they didn’t deserve as a result.

Are all law enforcement officers here in Tennessee unaware of the Needle Possession Officer Awareness law? Surely not. However, the deputies that arrested me in September — referring to the incident above — weren’t aware. I’ve got a personal friend who works in law enforcement in Southern Middle Tennessee who wasn’t aware. 

I think it’s safe to say that countless other members of law enforcement across the Volunteer State also aren’t aware of this law. 

That doesn’t mean that they’re bad at their jobs, that we should launch a full-scale protest against them, etc. What it does mean is that we should strive to educate deputies, officers, and other members of law enforcement throughout Tennessee about T.C.A.§ 40-7-124. We should educate our friends and family members about this discrepancy, too. The more people who know about this, the more likely Tennessee law enforcement agencies will get on the proverbial ball and educate their employees about the Needle Possession Officer Awareness law and how to enforce it. 

Tennesseans Aren’t Incentivized to Get Medical Help for Drug Overdoses

I’m a long-term drug user and a lifelong resident of Tennessee. Having used regularly for about a decade now, I’ve heard countless stories of people not getting medical attention for others who experience drug overdoses. 

Why didn’t these people help their friends, acquaintances, or fellow community members seek medical help for suspected drug overdoses?

One reason rang true throughout all of these anecdotes: people were afraid of getting in legal trouble. 

Here in Tennessee, T.C.A. § 63-1-156, known by some as “Overdose Prosecution Immunity,” provides some protection to people who seek medical help for a suspected drug overdose, whether it be themselves or someone else. If you want to discuss this law with others, it’s pronounced as Tennessee Code Annotated, Title 63, Chapter 1, Section 156, for the record. Also, for simplicity’s sake, we’ll be referring to this law as the Overdose Prosecution Immunity law from here on out. 

I won’t be explaining the law in full. If you want to check it out yourself, here’s a link

It’s true that the Overdose Prosecution Immunity law does defend Tennesseans from legal trouble if they seek medical assistance for a drug overdose. This can’t be argued. However, the issue with the current iteration of this law is that it’s far too limited in scope. In other words, it doesn’t provide enough protection for Tennesseans who want to do the right thing by seeking help for people who are thought to be experiencing a drug overdose. 

Here’s what this law does: anybody who (A) calls 911, law enforcement, or a poison control center for or (B) assists someone in contacting these entities for or (C) directly provides care to someone who is thought to be experiencing a drug overdose “shall not be arrested, charged, or prosecuted for a drug violation.” They also won’t violate parole, probation, or any restraining orders or orders of protection in doing so. 

To be more specific about the term “drug violations,” Tennesseans are only protected against being charged with the Class A misdemeanors of possession of a controlled substance (T.C.A. § 39-17-418) and possession of drug paraphernalia (T.C.A. § 39-17-425). If people are found with a larger amount of a drug than what constitutes personal use, or simple possession, in other words, they’re not protected by the Overdose Prosecution Immunity Law. 

Here’s the Problem With This Law

Legislators did Tennesseans, in general, and Tennesseans who use drugs a favor by writing this law into state law books. However, they fell short in only allowing this law to protect people who are seeking help for the first time. 

To be fair, I understand why legislators made it this way. As a long-term drug user myself, I very much understand that drug use is risky. I’ve experienced opioid overdose at least three times, each instance of which could have killed me. Fortunately, I was given naloxone (Narcan) two of these times. Even though others might think that I “would have learned my lesson” after just one overdose, let alone three, people who use drugs and struggle with problem drug use or addiction often aren’t dissuaded from further drug use by an overdose. 

I know that I didn’t stop using after overdose. Few other people who use drugs stop immediately after they overdose and never use drugs again. 

I understand that legislators in the Tennessee General Assembly, where our state lawmakers meet, felt that giving people more than one “get out of jail free card” would encourage people who use drugs to keep using if they didn’t enact a strict limit on how many times Tennesseans would be provided legal protection by the Overdose Prosecution Immunity law.

Unfortunately, this just encourages Tennesseans to not seek medical assistance for people who are thought to be experiencing drug overdose. It also encourages them to not provide any help themselves, such as administer naloxone, the life-saving opioid overdose antidote. 

In the eyes of many people who use drugs here in Tennessee, the best thing they can do is get as far away from someone who is thought to be experiencing drug overdose.

Many Tennesseans Struggle to Afford Bail or Hire Attorneys — Here’s Why This Is an Issue

Law enforcement officers are incentivized to arrest people. It generates money for the jurisdictions they work in and may make the agencies they work for look better, thus finding themselves more likely to be awarded grants or otherwise favorable treatment. 

People charged with crimes who don’t plead guilty routinely experience better outcomes than those who do. Economically-challenged people are more likely to experience worse outcomes in court, getting longer jail sentences, more fines levied against them, longer probation time, and other unfavorable outcomes. 

The reason money sets low-income people back is because they can’t afford bail or to hire a private attorney. People who can afford private attorneys frequently experience better legal outcomes than people who are appointed public defenders by courts. People who can afford bail can better prepare themselves for court. 

Many Tennesseans are poor and can’t afford bail or to hire a private attorney. These people end up staying in jail longer after arrest. Their better-off, more wealthy counterparts are able to post bail just hours after being jailed, allowing them to return to their jobs, families, and lives nearly instantaneously. 

Here’s an example of how this comes into play. 

When I was jailed in September for possession of drug paraphernalia — again, even though the Needle Possession Officer Awareness law should have protected me from criminal charges — I felt forced to plead guilty the next day in court because I was on probation at the time and had to check in with my probation officer for a regularly-scheduled monthly meeting, like always. Waiting to be appointed a public defender by the court would have taken at least two weeks, I was told, causing me to not be able to report on time and likely ending badly for me. 

I also wanted to get back to work as soon as possible, as I can’t afford to miss work. As such, I pled guilty as soon as I possibly could, even though I knew I didn’t break the law and that T.C.A. § 40-7-124, the Needle Possession Officer Awareness law, would protect me from prosecution. 

This problem isn’t unique to me. Countless thousands of Tennesseans plead guilty to criminal charges they’ve been given, whether or not they’re actually guilty, to return to their normal lives as quickly as possible. 

Putting Everything Together

These aren’t the only ways that contemporary Tennessee laws and law enforcement officers unfairly influence people who use drugs. However, these three things are major problems that Tennesseans currently face.