Category Archives: From Personal Experience

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.

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

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.

Understanding Syringe Access in Rural Middle and West Tennessee

West Tennessee, a 21-county area home to roughly 1.56 million people over 10,650 squre miles, is home to two Syringe Services Programs (SSP). In comparison, Middle Tennessee is home to 41 counties, 2.68 million people, 17,009 square miles, and a lone SSP; East Tennessee, home to the most SSPs of any single Grand Division (3), holds 13,558 square miles with 2.4 million people.*

Outside of these two SSPs, which happen to be in the far southwestern extreme of West Tennessee, there’s essentially nothing good for drug users in terms of treatment programs, syringe access, or softer drug policies. I live about 125 miles from Memphis and 145 miles from Nashville — both are roughly two-and-a-half hour drives. No matter where you are in Northwest Tennessee, you’re at least, give or take a few minutes, an hour-and-a-half’s drive from your starting location to Memphis or Nashville.

It’s like this — if you aren’t already in Nashville or Memphis, you’re probably not participating in any of Tennessee’s recognized Syringe Services Programs. Even people inside those cities sometimes find it difficult to visit the physical locations where services are provided to participants; in other words, both Nashville and Memphis are all but havens for syringe access.

Here’s One Resource We Do Have — But It Sure Ain’t Syringe Access

The Tennessee Department of Health established the role of Regional Overdose Prevention Specialist in Oct. 2017. Currently, there are 21 Regional Overdose Prevention Specialists (ROPS) across 13 districts. ROPS are hold town hall-style naloxone trainings and distribute the lifesaving drug for free. According to the Volunteer State, ROPS primarily target three audiences:

  • First responders.
  • Entities that provide community-based resources, addiction recovery services, or treatment.
  • People who’re most likely to experience overdose, including their friends and family members.
Multi-color map of Tennessee broken down into counties. Each color represents one of 13 areas that the Tennessee Department of Health's Regional Overdose Prevention Specialists (ROPS) are assigned to.
Districts assigned to the state’s 21 ROPS. I’m in Region 6N.

From what I understand, a significant portion of attendees tend to attend ROPS training events to satisfy continuing education requirements. None of the 35 to 75 people I’ve given syringes, naloxone, and other harm reduction supplies to in my time as a practicing harm reductionist — virtually all of whom were long-term, often-problematic drug users; in other words, the most generally-disadvantaged drug users — have been familiar with Regional Overdose Prevention Specialists.

I’ve talked to some ROPS, all of whom admitted that they largely failed to reach regular often-illicit opioid users who are at high risk of overdose, as well as people who they’re close with. Yes, they inevitably reach some people at risk of experiencing opioid overdose, but not nearly enough.

Do Pharmacies Play a Role in Syringe Access?

In rural Middle and West Tennessee, if not elsewhere in the Volunteer State, injection drug users like me primarily get their syringes in black-market fashion. Pharmacies are given legal discretion to sell syringes without prescriptions, even if they feel that the sharps they sell will be used for injecting illicit drugs.

However, in actuality, very few pharmacists sell syringes without prescriptions. The relatively few active injection drug users who’ve tried buying syringes from pharmacies aren’t likely to keep asking pharmacists to sell them syringes; rather, it often feels like pharmacists are sworn enemies of people who use drugs.

I’ve heard that pharmacists in bigger cities are more willing to dispense syringes without prescriptions, though I don’t know this from experience.

Either way, it’s safe to say that pharmacies don’t play a role in expanding syringe access. Thanks to most local pharmacists’ unwillingness to provide injection drug users access to clean syringes, they actually do a good job of keeping disease transmission, likelihood to continue injecting drugs, and likelihood to not seek out drug treatment high.

But Seriously — What Resources for Drug Users Are Here?

We’ve got outdated, non-evidence-based drug rehabs, often-exclusionary 12-step programs, probation and parole, and drug courts, as well as medication-assisted treatment programs — though there’s just 19 physicians prescribing buprenorphine for opioid use disorder and two methadone clinics in Northwest Tennessee, a nine-county area that’s home to 254,000 people.

Outside of that, we’ve got absolutely nothing for drug users like me.

More About Sharps on the Black Market

As I’ve already mentioned, most sharps that local injection drug users source are from the black market. What does the “black market” for syringes consist of, exactly? The more popular sources of sharps are:

  • Fellow drug users, typically taking the form of injection drug users.
  • Illicit drug dealers.
  • Most importantly, family members who have prescriptions for syringes.

Drug Users Benefit From Performing Services for Fellow Drug Users

Due to drug laws, participants in illicit drug markets often face scarcity. Since a local market’s illicit drug vendors can’t openly offer their services, few end-users in any given area are familiar with all the dealers worth their salt there — buyers have a seller-finding problem.

Sometimes, end-users rely on fellow end-users to act as middlemen. End-users aren’t likely to give up their connections for two reasons: (1) dealers may not be comfortable with taking on new clients and (2) leveraging a relatively valuable connection by prospective middlemen. The nature of the black market makes opportunities scarce — that’s what ultimately makes these connections with dealers not always easy to come by and, therefore, valuable.

Family members seem more trustworthy than other sources of syringes. However, due to the nature of the black market, you can’t ever be sure family-sourced sharps have never been used. Still, I’d feel safer trusting a family source than a fellow user or dealer.

One time, I drove a well-connected fellow drug user to source drugs. She wouldn’t have been able to get there otherwise. Even though I regularly give her harm reduction supplies (e.g., syringes, naloxone, tourniquets) and she knew she would have still secured my transportation, whether she’s got a clean syringe to spare or not.

I understand she was incentivized and may have felt pressured to procure a syringe for me. What if I were less likely to turn to her as a middleman in the future as a result of her not giving me a clean syringe?

I’d asked her for a syringe upon getting the drugs, to which she obliged. Just before injecting, I found the barrel to contain a little bit of what looked like water.

Syringes never have liquid in them unless they’ve been used. At least never in my experience as a regular injection drug user.

Fortunately, because I’ve secured syringes and company from a free, mail-based harm reduction supply distributor for a year-and-a-half or two years now, I’ve never needed to hit the black market for sharps. I can only imagine how much more risk I could’ve faced without my long-time, super-safe supply source.

Dealers Aren’t Likely to Offer Syringes to Buyers

Now, I don’t know what things are like where you are, but dealers offering syringes, naloxone, and other drug-using supplies isn’t a thing here.

While I’ve provided two low-level dealers with syringes, naloxone, and company, they didn’t start a market trend where competitors felt forced to offer these same supplies.

If syringe access was better here, I feel like dealers here would more likely stock syringes for sale or as complements to the illicit drugs they sell.

It should go without saying, but dealers would be more likely to stock harm reduction supplies if we had better harm reduction infrastructure here.

The best shot we, as advocates of drug users, have at implementing this infrastructure is to become active in doing things that effectively promote harm reduction-positive ideas in a grassroots, self-motivated, lone-wolf manner.

Understanding Syringe Laws in Tennessee

Tennessee Code Annotated § 40-7-124 grants immunity to people who inform police they’re in possession of syringes or sharp objects that could be considered drug paraphernalia (a violation of T.C.A. § 39-17-425) from getting charged with or prosecuted for Possession of Drug Paraphernalia for those syringes or sharp objects.

Despite the fact this law came into being in 2015, it’s alarming that many law enforcement officers aren’t aware of the law. I’m sure many agencies across the Volunteer State do a great job of educating their members.

However, if law enforcement agencies here were on top of things, I wouldn’t have been arrested for Possession of Drug Paraphernalia for syringes despite the protection afforded to me by T.C.A. § 40-7-124, which I’ve seen nicknamed as the “Needle Possession Officer Awareness” law. What’s worse is that the syringes, albeit used, didn’t test positive for drug residue. I also didn’t admit to using them for illicit drugs. From what I understand, the syringes shouldn’t have been construed as drug paraphernalia based on T.C.A. § 39-17-425.

I’m not an attorney, but I’m intimately familiar with these two laws pretty well — I’d hope anybody else who’s been charged with and prosecuted for Possession of Drug Paraphernalia three times would be, too.

Lastly, I know many officers aren’t familiar with differentiating low-gauge, intramuscular-use syringes from their high-gauge counterparts that are common among injection drug users.

The former, usually ranging from 21 to 25 gauge, is included in naloxone kits.

Again, even though syringes themselves not used for illegal drugs aren’t illegal, people found in possession of naloxone kits containing IM-use syringes are liable to face unfair treatment from law enforcement, including ultimately getting charged with Possession of Drug Paraphernalia even though such a charge would be unfounded.

A local resident who I’ve given naloxone kits told me he’d been pulled over with at least one naloxone kit in his vehicle’s glovebox.

He told me the police asked to search his vehicle. In doing so, they found the naloxone kit and scrutinized him for the (albeit clean, unused) syringe it contained.

While it’s certainly possible to fight unfounded criminal charges in court, many residents of the Volunteer State, especially people living in rural areas and who are particularly-disadvantaged drug users, are unable to post bail or afford private legal representation.

They often prematurely, unnecessarily plead guilty to charges they’ve been accused of, even if defendants are confident they don’t deserve some or all of them.

I’ve been in that same situation. At the time of arrest, I was already on probation and arraigned 6 days out from my next scheduled report date. In court, I was told it’d take at least two weeks to be appointed a public defender and get back in court. Unable to post bail or hire a private attorney, I was forced to plead guilty — if I waited in jail, I could still end up getting charged, resulting in two potential violations since I wouldn’t have showed up on time; if I pled guilty, I could get violated because I caught a criminal charge, the cardinal sin of any probationary agreements.

What Can We Do for Syringe Access in Tennessee?

Tough question.

You can source clean syringes, naloxone, and other harm reduction supplies, then distribute them to illicit drug dealers and injection drug users.

You can try to inform in-state pharmacists of the benefits of selling syringes without prescriptions to suspected or potential injection drug users.

You can tell others about the state of syringe access in Tennessee and encourage them to support safe syringe disposal sites, syringe services programs, and the like.

I’m sure there are other ways you can advocate for improved syringe access in the Volunteer State, but I’m drawing blank. Whether you get engaged in syringe access advocacy or not, at least you’re now better informed about syringe access in rural Tennessee.

*Note that, since no official Tennessee Department of Health information regarding the number or location of Syringe Services Programs, there’s no way to be entirely sure of how many SSPs are up and running right now.

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.

I’m Burnt Out from Practicing Harm Reduction

Verywell / Cindy Chung

I’ve been giving out clean syringes, naloxone kits, and educating drug users and laypeople both here in Northwest Tennessee and online for about three years. Only once have I been paid for doing these things, which came in the form of writing three articles about laws that affect drug users here in Tennessee. I’ve also been a lone wolf in my efforts, not out of choice, but because there aren’t really any groups or even individuals providing these services locally.

While I don’t go out of my way to distribute supplies or educate others on a daily basis — I have to work, you know — I’d love to do this on a daily basis, given I could get enough money to sustain myself from doing so.

Last week, after three years of feeling strong passion for practicing harm reduction, I felt disinterested in pursuing these efforts any longer.

I don’t think this is permanent. I also don’t think this period of disinterest will last very long. However, my growing discontent with practicing harm reduction is undeniable. It seems to have hit a peak this past weekend.

Shit Gets Old

Last weekend, I distributed syringes, naloxone, and other supplies to a few people, all of whom were in the same location. They were hanging out at a certain someone’s house. None of them had regular access to free, clean syringes or other supplies, from what I learned from them.

Still — and without getting into any specifics — I felt disrespected by my fellow drug users. Even though I was, quite literally, risking my freedom to give them these supplies at no cost, it felt as if they felt entitled to what I gave them.

Nobody needs to treat me like a king for distributing harm reduction supplies or educating others, but I’d at least like mutual respect.

A Culmination of Things

I doubt this was the only factor that played into my current disinterest for practicing harm reduction.

Another thing is that I struggle to get help from others who are interested in harm reduction. These other people have lives, too, so I can’t expect them to hold helping me above all things else.

It just stinks not to have people around me who are just as interested in harm reduction as I was.

With this being said, I can’t blame anybody for not helping me as much as I’d like. I am notorious for not maintaining good relationships with others.

For example, I notice that I am only able to source illicit drugs from a small handful of people, even though I’ve sourced them from about a dozen different people since I came here to West Tennessee. Whose fault is that? While I could blame just a few broken relationships on other people, I feel like pointing my finger isn’t very responsible of me.

As such, I have to blame it on myself, of course, as blaming others would be nothing short of silly!

This translates over to practicing harm reduction. Although I try to do things that promote good relations between me and anybody I come across who’s even remotely interested in practicing harm reduction, I’m sure that I’ve inadvertently done things that has turned others away.

For example, several people who I’ve tried to meet have thought I’m a police officer in disguise or a confidential informant. Both of these are false. Still, even though I didn’t try, obviously, to be viewed as such, something — or some things — I’ve done have led others to think so.

In Closing

Other factors like not being able to get paid for this work are major influences into my current attitude towards harm reduction, of course, though they don’t really merit any explanation. Of course, in somewhere like Northwest Tennessee, where widely-held views aren’t kind towards drug users and there are zero forward-thinking programs to help problem drug users, there aren’t going to be any open positions for working as a paid harm reductionist.

This isn’t the end of harm reduction for me. In all likelihood, I’ll probably start warming back up to practicing harm reduction in just a few days. If not, this period of discontent likely won’t last for longer than a month or two.

I know I don’t have a big following — well, ANY following — online, but I wanted to hash my feelings out in writing and publish them just to have a publicly-available placeholder to explain why I wasn’t active as a harm reductionist for a short while.

Again, I need to note that it isn’t anybody else’s fault for my current disinterest toward practicing harm reduction.

Also, I’m sure it’s natural for anybody who helps other people to experience these feelings — I believe some refer to this as caregiver burnout.

Common Opioid Potentiators and How They Affect Opioids

Although I don’t currently use opioidsI’m on Suboxone, which is very much an opioid, though not a “fun” opioid, that’s for sure — I sure am familiar with potentiating them.

What Is an Opioid Potentiator?

To potentiate something is to make it better. Certain drugs synergize well with other drugs.

For example, some opioid users claim that benzodiazepines — which are a very dangerous combination (I’ve overdosed on the combination once before) — feel good with opioids. In other words, they synergize well with one another.

Opioid potentiators, for this article’s purpose, are over-the-counter drugs that give you more bang for your buck. Although there are many opioid potentiators, I’ll be writing about three of my favorites.

Cimetidine (Tagamet)

Cimetidine, also sold under the brand name Tagamet, is marketed as a stomach acid reliever. The drug is a solid opioid potentiator because it inhibits certain liver enzymes that are responsible for breaking down opioids and eliminating them from your body.

Inhibition, if you didn’t know, of such liver enzymes is good in terms of improving your opioid high or your opioid’s analgesic effects — the weaker concentrations of such liver enzymes are, the longer opioids stay in your body, meaning you get high for longer.

In my opioid using career, I’ve found that most opioids last about four hours. Believe it or not, our good friend cimetidine can boost up your duration of opioid high by up to two hours, prolonging your high — well, at least this is how it always worked when I consumed opioids alongside the trusty Tagamet.

If you want a longer duration with slower onset of effects, take cimetidine well before your opioids of choice — in my experience, anywhere between 30 and 60 minutes before dosing is sufficient to take full advantage of Tagamet as an opioid potentiator.

To retain your normal onset time but still prolong effects, take cimetidine at the same time you dose your opioids of choice.

Typical doses of cimetidine for this purpose — liver enzyme inhibition, that is — are 600 milligrams, or three 200-milligram tablets. Cimetidine is very affordable and is available practically everywhere.

I’d like to note that I’ve read real-deal academic research regarding a link between the development of gynecomastia in roughly one-fifth of men who took the stomach acid reliever regularly for even just a few months at a time.

Classic Chewable Antacids

Cimetidine is just as much of an antacid as classic chewable tablets bearing the active ingredient of calcium carbonate.

Tums, which is what I’ll be calling antacid chewable tablets with calcium carbonate from hereon out, also potentiate opioids, though not at all in the same way as cimetidine. Rather, calcium carbonate causes the stomach’s acid to get a higher pH level, making it more basic, which is an ideal condition for the human stomach to absorb all opioids taken orally.

Keep in mind that you can substitute baking soda — that’s right — for Tums. Although baking soda doesn’t contain calcium carbonate — which never, ever happens — sodium bicarbonate, which is the chemical name of baking soda, if you didn’t know, is still very much capable of raising your stomach’s pH level and thus boosting the proportion of opioids that actually gets absorbed by your body instead of caught up in the blood membrane barrier, which effectively renders a certain percentage of every drug lost.

Diphenhydramine, a.k.a. Benadryl or Dormin

Benadryl is a common first-generation — we currently have as late as third-generation antihistamine drugs available — antihistamine that is also used as a sleep aid.

When it comes to potentiating your opioids, diphenhydramine boosts the high — at least it does according to most people’s point of view — by either adding to the sedation or sleepiness you feel, also known as the “nod,” as well as itchiness that is super-duper common among opioids.

Some people enjoy this itch.

I think those fuckers are crazy. When I used opioids as my primary drug of choice for about 5.5 years — the streak just ended three months ago, though the buprenorphine I take now is still an opioid — I scratched my face, particularly my nose, far too much when I was high. Two days after I would consume opioids, my nose and surrounding areas would start peeling off small amounts of dead skin from my scratching rampages.

When it comes to timing Benadryl for opioid potentiation, I recommend taking 25 mg — many other potentiators take more than just one tablet’s worth of diphenhydramine, though this works more than well enough for me. If you’re looking more for the nod, try taking at least 50 mg, though don’t exceed this dosage unless you’ve already done this once before.

Fatty Foods

We all love — well, at least most of us love it — fatty foods. Unfortunately, they take a serious toll on people’s health.

With that being said, our bodies actually require at least a certain amount of fat to stay in good shape.

Personally, I subsist on a diet well into the extra-fatass sector of the standard American diet, or the western pattern diet, as it’s known — just about the most unhealthy nationwide eating habits of any country on the planet.

To be honest, I don’t know the science behind why increasing fat content in your stomach just before you take opioids by mouth actually improves the bioavailability of the drugs you’ve chosen to have fun with beyond their normal levels.

DXM, a.k.a. Dextromethorphan or Coricidin Cough and Cold

This medication is available all across the United States in an over-the-counter fashion. The drug is pharmacologically known as belonging to the drug class of morphinan. Drugs that are part of the morphinan family have three psychoactive properties that other particular drugs almost always don’t all possess at the same time — these three properties are dissociating, sedating, and stimulating, all of which dextromethorphan can possess.

I never took DXM much for opioid potentiation. This was because, once I found out that dextromethorphan, a relatively harmless over-the-counter medication — not to mention a cheap medication, at that —really was a legitimate, reliable means of keeping your opioid tolerance from growing, I was taking medicine that could have caused serotonin syndrome if I took DXM with that medicine. I was taking an SSRI, a common type of antidepressant that doesn’t mix well with DXM due to this serotonin-related health problem.

Taking DXM, again, is something that I don’t have much experience with. However, I understand that most people who utilize the common cough suppressant for opioid potentiation purposes report that consuming the drug— just an aside; I remember in high school when people sometimes hung out with one another after school, all of them sharing a good experience on high-dose dextromethorphan — anywhere from 30 to 60 minutes prior to consuming your opioids.

I never did it, but even I know that you might put yourself at harm by taking too much DXM with opioids. High doses of DXM are potentially harmful on their own, let alone with interference from heavy painkillers.

Naltrexone Might Help

Naltrexone is what’s known as an opioid antagonist, a drug that has a blocking effect on the brain’s opioid receptors, meaning that, until naltrexone has been eliminated by the body, more common, run-of-the-mill opioid drugs with high recreational values such as Percocet and Norco will not be able to cause euphoria or otherwise make you feel inebriated.

Despite this fact, naltrexone doesn’t manage to block these traditional opioids from having a physical effect on your body; in other words, this means that opioids, even if they don’t feel like they’re doing a number on your body, can very well cause overdose even in the presence of antagonists like naltrexone.

Ultra-low-dose naltrexone, also known as ULDN, is a certain way of using naltrexone so that it will have a substantial positive impact on the utility you’re able to derive from working ULDN into your routine so that it ultimately performs a benefit for you.

Normal doses of naltrexone are 50 milligrams. Low-dose naltrexone, or LDN for short, is anywhere between 0.5 mg and 5 mg. Ultra-low-dose naltrexone, on the other hand, are usually anywhere between 1 and 10 mcg — there are 1,000 micrograms (mcg) in a milligram (mg) and 1,000,000 micrograms in a gram, just so you can get an idea of how much difference there is in dosing for the three different modern dosage routines for naltrexone.

A good thing about naltrexone is that it’s not a controlled substance, meaning that it’s subject to less prescribing and dispensing scrutiny. This also makes the cost of naltrexone lower than their controlled counterparts.

The way that people can consistently make accurate measurements when it comes to dosing such small amounts of naltrexone — remember that ULDN doses are in the micrograms, so don’t lose context — is only possible through the power of volumetric dosing. This practice consists of dissolving naltrexone, for example, in a measured volume of water. With a simple, quick calculation, users can readily dose themselves and others with droppers, pipettes, and other liquid transferring tools.

Lastly, White Grapefruit Juice

I’m not a culinary expert, but I think it’s safe to say that white grapefruit juice isn’t the best tasting fruit juice in the world. However, it’s not that bad — it’s totally worth the opioid potentiating effects that it may offer to some users.

I do not like using white grapefruit juice as a means of improving my experiences with opioids.

The idea behind using white grapefruit juice — which needs to be entirely from concentrate and never mixed with any other fruit juices — comes from its ability to block a certain type of liver enzyme called the CYP450 cytochrome. This enzyme is one of the most important when it comes to processing opioids; as a matter of fact, the same enzyme that’s inhibited by the drug at the top of the list — good ol’ cimetidine.

I don’t like white grapefruit juice as a potentiator because its highly acidic nature ultimately has a direct decrease in the pH of your stomach. The more acidic it is, the lesser proportion of drugs your body will manage to secure for the opioids you put down the hatch.

As such, although you could take Tums or baking soda to lower the pH that was increased by the white grapefruit juice, I think white grapefruit juice is not a worthwhile potentiator that is alleged to effectively increase the duration of opioids’ working lives and even make them more potent. However, every person’s body is constructed differently; as such, how well you perceive white grapefruit juice to work as an opioid potentiator may be much different than mine.

Again, I want to reiterate that you need to purchase 100% white grapefruit juice. Some blends may be branded as “white grapefruit juice” even though they may only contain a dozen or two dozen percent white grapefruit juice.

Bad Opioid Potentiators

Alcohol, stimulants, and benzodiazepines are poor choices of potentiators for opioids, though many drug users across the modern United States routinely engage in mixing two or more of these drugs, which puts users at a serious chance of suffering an overdose and potentially dying.

When opioids and alcohol — or any other sedative, for that matter — are combined, they accentuate the sedative effects of one another, causing a greater risk of overdose or other unwanted adverse effects than by themselves.

Benzodiazepines are anxiolytic, meaning they help reduce anxiety; hypnotic, which means they help people go to sleep; muscle-relaxing; anticonvulsives, which stops things like seizures; and sedative, which helps people achieve calmness.

I’ll give it to you — alcohol and benzodiazepines are two of the single worst substances that people can mix with opioids; in other words, you probably were already aware of the potentially deadly results of mixing opioids with alcohol, benzodiazepines, or both. However, you might not know about the next one: stimulants.

Stimulants inherently offset the various effects of opioids. They also cancel the recreational value of one another. To get back to where opioid users want to go, they take more opioids than they normally would fight back against the stimulants. If your stimulant wears off and your increased opioid dose has not worn off, you could experience overdose — at the very least, you’ll be knocked out or unable to string any more than two steps, words, or thoughts together.

With this in mind, make sure not to go too hard on either of these drugs if you do decide to mix them. The best thing to do is not mix them in the first place — none of these three drugs are suitable complements to opioids.

In the Vein of Full Disclosure

I overdosed on alprazolam (Xanax), a benzodiazepine, and oxycodone, an opioid, in May 2014 shortly after arriving at UT Martin.

My roommate had just snitched on me for smoking pot in the dorm room I was in — this was less than a month after I arrived at UT Martin and just four months after getting kicked out of UT Knoxville for the same thing — a couple of hours prior. After getting arrested, booked, and released at the campus’ public safety building, Crisp Hall, I took 4 mg of Xanax.

Just a few months prior, I was used to taking 10 mg of alprazolam at once; at this time, I had fostered this five-bar-at-a-time habit while in junior or senior year of high school (boy, I sure knew how to treat my brain right… ugh) for at least a year at this point — what’s important is that I had a tremendous benzodiazepine tolerance.

I wasn’t big into opioids then, but, in previous escapades, I had taken more oxycodone at once in combination with Xanax before than I had this warm, calm summer night in my first few weeks at UT Martin.
Anyways.

About 60 to 90 minutes after the Xanax, I took 30 mg of oxycodone. My reasoning for taking what would turn out to be a far, far too potent dose was that I had built up a major tolerance over a year, if not even longer; also, I had never been sensitive to opioids.

So, I share this to inform you of the two mistakes I made that night:

  • First, I assumed my tolerance was more stout than it actually was.
  • Second, I was using the combination in response to my emotions, which is generally a bad idea.

I hope you won’t make the same mistake that I did that night.

What Are Opioid Potentiators All About?

Just to make sure you understand the concept of opioid potentiators, it’s time to answer what the purpose of potentiators is.

Opioid users get some kind of utility out of pain pills, heroin, and other opioids, whether it be analgesia, keeping depression at bay, or satisfying their bodies’ dependency for opioids.

You can get more utility by using potentiators. Most people can’t simply use more opioids to derive more utility from them because they may have trouble reliably sourcing black-market opioids; also, even more people don’t have enough money to satisfy their true hunger for opioids.

Rather than going broke or running through your stash too quickly, heading to Walmart or another retail store with twenty bucks to spend is an easy, efficient means of improving the experience you have consuming opioids.

Please don’t experiment with new drugs as “potentiators” without having thoroughly studied them and anecdotal reviews other recreational drug users have left on drug-related Internet forums — a better high isn’t worth risking your life for. Even if you have studied up on or have, in fact, practiced these combinations numerous times in real life before, keep in mind you’re taking a risk.

Although I’m comfortable with taking this risk, that doesn’t mean you should be — again, tread carefully in using opioid potentiators.

My Go-To “Recipe”

Note that I didn’t come up with the idea of opioid potentiators myself. I learned about it close to a decade ago online, particularly on an older drug-related website called The Hip Forums.

A user on this forum named Gdeadhead420 copied and pasted the opioid potentiation guide I learned from myself to this forum in 2008. The only scrap of evidence regarding the original author is that Gdeadhead420’s copied-and-pasted post identified “N0 W4RN1NG” as being responsible for having created the guide that ultimately exposed me to opioid potentiators.

So, my trusted cocktail of opioid potentiators over the years has been 600 mg of cimetidine taken between 0 and 30 minutes before dosing opioids, taking 25 mg of diphenhydramine anywhere from 10 to 30 minutes before dosing, and chewing two Tums or swallowing roughly a tablespoon’s worth of baking soda between 5 and 15 minutes before dosing.

N0 W4RN1NG’s combination includes using five more potentiators than my three-drug-combo above. I recommend trying my simpler trio of potentiators at least once sometime and doing the same for N0 W4RN1NG’s infamous recipe.

Good luck!

Avoid These Places When Buying Kratom

Kratom has steadily grown in popularity throughout the United States in recent years. I’m happy to see more and more people using the plant.

Personally, I’ve tried to turn about — I don’t know, exactly — two dozen friends or associates on to kratom. Only one of them liked it.

That person stopped using opioids, as he had for several years daily — he’s a few years past 50 and suffers from cerebral palsy; he also used pain pills to more easily get through the blue-collar jobs he worked — and replaced opioids with kratom, which serves as a fine opioid replacement to many.

Kratom was a miracle plant in his eyes. And it is in many other people’s eyes, too. However, that doesn’t mean you should be willing to pay an arm and a leg for subpar-quality Mitragyna speciosa. You should be selective in shopping for the drug.

Avoid Head Shops, Music Stores, and Gas Stations

I get it — Walmart isn’t willing to stock kratom. Because kratom is a drug, many other retailers aren’t willing to offer kratom. This has left an opportunity for head shops and gas stations to start selling kratom on their own accord.

Even if you like the cashier behind the register at your favorite neighborhood gas station, don’t go there to buy kratom. Even if you enjoy visiting your local head shop to browse the selection of cleverly-crafted bongs, pipes, and other paraphernalia for smoking “tobacco,” don’t buy kratom from head shops.

I’m not hating on gas stations or head shops. I just don’t want to hurt our chances of bringing kratom into our society’s selective class of “acceptable” drugs. And I say this even though I don’t take kratom anymore — if I do, only rarely.

Here’s why I feel we should avoid these types of retailers as kratom consumers.

We Don’t Want to Bunch Kratom in With a Bad Crowd

The American Kratom Association (AKA) and countless grassroots activists have done lots of hard work in trying to keep kratom legal. As sensible fans of kratom, we shouldn’t take shots at the foundation the AKA and its helpers have constructed for all of us to enjoy.

Wouldn’t you rather buy kratom at Walmart or another mainstream retailer?

In the meantime, you should stick with domestic e-commerce vendors that you trust. It also wouldn’t be a bad idea to do business with professional sole proprietors who sell kratom in your local area, though this should be second to choosing domestic, web-based sellers, in my opinion.

Where Do Head Shops and Gas Stations Get Their Product From?

One of the most important things in consumer retail is bag appeal. Business owners interested in bringing kratom to their head shops, gas stations, or other similar types of entities are much more likely to buy already-packaged kratom that looks comparable in terms of packaging quality to whatever you’d by in major retail stores as opposed to purchasing raw, unpackaged kratom, even if the latter is several times less expensive.

Why do I bring this up?

Pre-packaged kratom, on average, will be handled more than raw kratom. This gives these batches more of a chance to be exposed to contaminants or simply take hits to such kratom’s quality.

I’m confident that you would rather purchase kratom from a source that hasn’t handled it as much.

Also, know that you’re shelling out way more for kratom that’s been branded and packaged as opposed to raw kratom powder. If you purchase kratom from a retailer that purchased it from one of these pre-packagers, know you’re paying even more — way more than you need to, that’s for sure!

These Retailers Are Likely to Offer Lower-Quality Kratom

Companies that do not specialize in kratom are typically going to sell out of each batch of inventory at a slower pace than their kratom-focused counterparts. Traditional retailers keep their lights on for long periods throughout each business day, potentially lowering the quality of their kratom. Also, consumers are inevitably going to handle these businesses’ inventory.

While the potential downsides of these three factors might not be all that high, these things are something you should think about when shopping for kratom.