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Criminal Justice From Personal Experience

Probation From a Drug User’s Perspective — Failures of the Criminal Justice System

Ostensibly, the purpose of the criminal justice system is to get people’s lives on track. To right criminals’ wrongs. To bring justice to the world. That kind of stuff.

A common alternative to jail is probation, whereby criminals are required to maintain employment, check in with probation officers regularly, and be subject to drug screens.

I’ve found myself on probation three times now, all for drug use — more specifically, for violating T.C.A. §40-7-124, Possession of Drug Paraphernalia. I’ve never been in trouble for anything else.

What’s probation been like for me? Has it made me a better person? Has it curbed my drug use? Has it done anything good for me, at all?

Let’s find out.

About Me

I’m a long-term drug user. I’ve been using every day for over 9 years now. Opioids have been my primary drug of choice for about 6 years, the past 2.5 of which have been hallmarked by regular intravenous heroin use.

I’ve always been low-income. My mom was a long-term, seriously-problematic drug user who Dad and I left when I was 9. I am bisexual and am from rural Tennessee. I didn’t have insurance for much of my childhood and am still uninsured. I bring these things up because the stories of people like me aren’t well-represented.

I’m 24 years old and live in Martin, Tennessee — that’s in Northwest Tennessee, 10 minutes south of Kentucky and about an hour east of Arkansas — and am a self-employed writer.

How’d I Get on Probation in the First Place? — Chapter 1

In 2014, an on-campus college roommate reached out to either law enforcement or the University of Tennessee at Martin’s housing staff for my on-campus, in-dormitory use of cannabis.

Four RAs — resident assistants, as they’re called — marched into my dorm alongside two police officers. They claimed it was a routine room inspection and found a roach and some papers.

A few hours later, I found myself at Crisp Hall, UT Martin’s public safety building, slapped with my first two criminal charges: possession of controlled substance, Schedule VI, and possession of drug paraphernalia (violations of T.C.A. §39-17-418 and §39-17-425, respectively).

A month later, in July 2014, I found myself in Weakley County General Sessions court. The drug possession charge was dropped, thankfully, but the drug paraphernalia stuck. I was given a year’s probation and roughly $1,200 in probation and court fees.

I was forced to sign a probation contract and a plea agreement.

A month later, I was due to appear at my probation officer’s office for a monthly check-in. The probation office was a third-party entity which profited from its supervision of probationers.

What Was Probation Like? — Chapter 1

I was asked to present at that third-party entity’s office every month. I was required to pay an installment towards my probation and court fees every month. I was also forced to take an alcohol and drug evaluation, formally known as the Substance Abuse Subtle Screening Inventory (SASSI), at another third-party location not associated with the probation supervisory service provide.

Fortunately, because I was enrolled in courses at UT Martin, things like the SASSI evaluation was free at the school’s mental health department, Student Health & Counseling Services.

If you aren’t familiar with the SASSI, it’s similar to a fill-in-the-bubbles, Scantron-type test like you’d take in high school or college. You can google it if you’re interested.

Due to scoring high on the SASSI, I was asked to attend Narcotics Anonymous meetings twice weekly. This persisted for about two months before I was able to stop attending.

I never got a drug test. The probation officer didn’t want to interfere in my life. I think she understood that drug use shouldn’t be dealt with by the criminal justice system.

She — well, really, her employer and “the system” — just wanted money. She told me that from the jump. I’d heard people say it before, but it was at this point I understood that probation was all about money.

Every time I presented, I was scared I’d be drug tested. As a daily cannabis consumer — at the time, at least — I certainly would have failed every time. Although I hadn’t been formally diagnosed at this point, I very much dealt with at least one anxiety disorder and could have benefited from seeing a counselor. I’m glad the resources for mental health treatment were available to me at the time, but, due to stigma associated with seeking help for mental health disorders that are especially prevalent here in rural Tennessee, I hadn’t, at all, considered it.

I had to drive about 10 minutes from my place of residence to the probation officer’s place of work for monthly visits.

TL;DR (Too Long; Didn’t Read)

The only thing remotely helpful I got from probation was attending Narcotics Anonymous meetings for the first time. However, since I wasn’t ready to quit using drugs, I didn’t get anything from them.

I should have been asked to undergo a full mental health evaluation. This would have highlighted the underlying issues as to why I was using drugs.

Many probationers are unable to show up every month and pay money. This particular office required payment in the form of a money order, making things even more difficult for people who don’t have access to resources like transportation.

Many probationers fit this bill.

How’d I Get on Probation in the First Place? — Chapter 2

In March 2019, I got pulled over in Milan, Tennessee, for a seatbelt violation. Stupid me.

The officer asked to search. I said no. They brought a K9 and it alerted to the presence of drugs. I was found with “morphine” residue — was actually heroin — in a “cooker,” or a blank aluminum bottle cap that some use to dissolve drugs into an injectable solution, for which I was given possession of drug paraphernalia.

After that — and only after that — even though I was driving just fine, I was given the three standardized DUI field tests. I was charged with DUI, a total BS charge. I was asked to provide a blood sample to which I refused and was given Implied Consent, another BS charge due to the fact I shouldn’t have been charged with DUI in the first place.

I wasn’t able to prove that the vehicle was insured, although it was, and was charged with that, too.

I was put in jail then, luckily, bonded out thanks to help from my dad.

After monthly court hearings from April to July, I was given a plea deal of only possession of drug paraphernalia. My public defender, Jamie Kay Berkley — who was a great public defender, by the way; I can’t say enough good things about her — recommended that I take that plea deal.

Probation costs were about $500 and court fees were about $650. So, I’m working on paying off a total of roughly $1,150 for being found in possession of drug paraphernalia.

Not to mention the roughly $250 my dad was charged for bailing me out.

So, really, a total of $1,400. All for using drugs. Wow.

Oh, wait — I got my girlfriend’s car impounded, costing her another $200.

$1,600 total for using drugs.

God damn.

What Is Probation Like? — Chapter 2

I’m asked to present at a local, third-party entity’s office that provides supervisory services to Gibson County General Sessions court. This entity profits from providing these services.

This office is in Milan, a full 35 minutes away from where I live. I’ve been given one urine test so far, in the five or six months I’ve been on this probation, which was sent off to a lab that uses GCMS (gas chromatography, mass spectrometry) testing. GCMS is as strict as it gets in terms of urine testing, from what I understand.

The screen tested for the presence of five or six drugs and/or their metabolites.

I’m also forced to pay monthly installments toward court fees and probation expenses every month.

Again, I was asked to undergo a drug and alcohol evaluation. I had to pay $50 to a third-party entity this time. The counselor’s recommendation — the counselor who administered the test, that is — was for me to attend NA meetings regularly if I’m unable to abstain from the use of drugs, which, fortunately, I have been.

After a month-and-a-half of being on probation, I was arrested yet again for possession of drug paraphernalia. You can read the full story at “A Law Every Tennessean Should Know About,” but I shouldn’t have been charged with this because of T.C.A. 40–7–124 (that’s pronounced T C A, title 40, chapter 7, section 124, for the record).

T.C.A. 40–7–124 is a 2015 law that prevents Tennesseans who inform a presiding law enforcement officer (i.e., one that’s pulled you over or otherwise stopped you) about your possession of syringes that you’ve used as drug paraphernalia from being evidence used to charge you for possession of drug paraphernalia. Once being pulled over or otherwise stopped and before being searched, if you inform the officer about being in possession of syringes, you can’t be charged with or prosecuted for T.C.A. 39–17–425, possession of drug paraphernalia.

I should add that, due to my indigence (see: being broke), I couldn’t afford an attorney or to bail out. Because I had to visit my probation officer within 13 days of my arrest — remember how I’m required to check in every month? It just so happened that I was 13 days away from my next check-in date — and couldn’t afford to wait in jail to be appointed a public defender, I had to plead guilty to possession of drug paraphernalia, giving me on yet another drug paraphernalia charge.

It also put me on yet another probation. I was scared at this point. I’m not one to get arrested very often — or at least that’s what I thought.

This led me to enter a medication-assisted treatment (MAT) program, which practice opioid replacement therapy — a “Suboxone clinic,” in other words — just 4 days after being arrested. This was a great decision, but boydid it cost a lot of money. Also, I immediately began attending local Narcotics Anonymous meetings.

In 10 days, I’d gone to 6 meetings. I had financed the then-$843-a-month initial cost of entering a Suboxone program and filling a month’s prescription, not to mention manned up by immediately ceasing my heroin use following this arrest.

Despite these two factors, the probation officer couldn’t have cared less about my two accomplishments. I think these two things say a lot. A hell of a lot.

But the PO didn’t give a damn. That broke my heart.

Why wasn’t I given a pass on having to pay for, travel to, and take an alcohol and drug evaluation?

Why was I greeted with the words, “The only reason I didn’t violate you is because I didn’t have time to get around to it”?

Why wasn’t I congratulated for what I’d done?

Why wasn’t I, at the very least, given a high-five?

Why weren’t the costs of that MAT program supplemented by the state or, even, the City of Milan/Gibson County, the jurisdiction in which I was already on probation, or the City of Jackson/Madison County, the jurisdiction in which I had just been arrested?

Why wasn’t I even referred to a single fucking opioid replacement therapy practitioner?

I’m still on this probation today — well, both probations. I know it’s not wise to discuss it, but, what other drug users are sharing stories about their very personal experiences with the social services-criminal justice alliance? There are a few, certainly, but it’s important for me to share this information with the world.

I think it might help improve the treatment of drug use in modern American society — at least that’s what I hope.

TL;DR

I was wrongfully thrown in jail for DUI and Implied Consent charges that I 100% didn’t deserve. I incurred costs totaling $1,600 for eventually being charged with possession of drug paraphernalia.

I very much did deserve the drug paraphernalia charge.

Although I could have been violated and ultimately sent to jail for up to a year, my probation officer chose not to do so. I lucked up in this regard, in my opinion, although I’m not familiar with the personal experiences of other people who have been in this situation (i.e., being on probation, violating the terms of that probation, and what their probation officer or the presiding court of law decided to do).

I’m still on this probation today, which is slated to end about six months from now.

How’d I Get on Probation in the First Place? — Chapter 3

I mentioned above that I got arrested in September 2019 for being found in possession of drug paraphernalia.

Again, because I acted in concordance with T.C.A. 40–7–124, I shouldn’t have been charged with possession of drug paraphernalia or prosecuted for it. However, due to this law’s unfortunate obscurity, the arresting deputy wrongfully charged me with possession of drug paraphernalia.

Here’s how it happened.

I was leaving Jackson and was pulled over by a Madison County Sheriff’s Department deputy for speeding.

Speeding was the issue. If I weren’t speeding, I wouldn’t have been pulled over, and I would have made it home that night. Live and learn, hopefully, at least, right?

I was asked to consent to a search, to which I declined. A K9 was brought to the scene, where it alerted to the presence of drugs. No drugs were found. No drugs were in my vehicle, either. No drugs had been recently carried in the vehicle, too. Still, the K9 alerted.

Funny how K9s always alert on my vehicle. I’m sure it’s 100% legitimate and not bullshit at all.

Anyways.

I ended up getting charged with possession of drug paraphernalia due to being found with syringes, for which I was thrown in jail.

Every Tuesday morning — or maybe once every other Tuesday — recently-arrested, alleged criminals are arraigned in Madison County General Sessions court. Fortunately, it was Monday night.

Again, because I had to meet with my probation officer before I would have been appointed a public defender or found myself in court again, I was forced to plead guilty to a charge I legally — not just whining here, to be clear, I’m trying to reiterate that there was no legal basis for my charge thanks to T.C.A. 40–7–124 — didn’t deserve.

What Is Probation Like? — Chapter 3

I got put on unsupervised probation and was forced to pay roughly $600 over the course of a year.

I’m still paying this off.

The person whom I talked to when signing a probation agreement told me I’d have to pay $200-something within 3 weeks and pay the remainder off within a year. I was only able to pay that first installment about 2.5 months after my arrest, but I never faced any flak from any court staff members or probation officers, fortunately.

Since this is unsupervised probation, I’m not required to check in on a monthly basis or potentially be subject to drug screens.

I haven’t been provided any resources by Madison County, the City of Jackson, or any other entity.

Fortunately, I didn’t have to undergo another fucking alcohol and drug evaluation.

TL;DR

I was already on probation for possession of drug paraphernalia. A month-and-a-half in, I was arrested on another charge of possession of drug paraphernalia.

Due to my indigence, I had to plead guilty to that charge, though T.C.A. §40–7–124, a 5-year-old law, should have legally protected me from getting charged with it in the first place, let alone prosecuted for it.

Thanks to the fact I pled guilty, I paid about half of what I likely would have been charged in court fees — at least according to the court lady (I’m unaware of her official title) I talked to after pleading — if I had exercised my legal right to not plead guilty, given I would have ended up being charged with possession of drug paraphernalia.

Probation has been unsupervised, making things easier on me.

I wasn’t able to bond out, either, which also incentivized me to plead guilty.

How Could Probation Be Improved?

This question necessitates a complex, multi-faceted answer. There’s no simple fix for the modern American probation system.

The answer to this starts with not treating drug use as a criminal issue. At least, that is, where drug use doesn’t directly hurt the people who decide to use drugs.

For example, if people drive or work while drunk or fucked up and put people’s lives at stake in the process, criminal charges are at least sometimes appropriate. I don’t think this should be the first line of treatment, but it should certainly be available.

First off, and most importantly, I think all drugs should be made legal. This largely prevents almost-entirely-harmless problem drug users such as myself from being sentenced to probation as a result of drug use.

However, if drug decriminalization and legalization are off the table, here’s how the treatment of drug users by the American criminal justice system could be improved — in my opinion, of course.

Transportation issues shouldn’t be a factor. People shouldn’t be penalized for being unable to present at regularly-scheduled meetings with probation officers. People shouldn’t have to pay for things like alcohol and drug evaluations if they’re indigent. If probationers don’t have transportation, probation officers should come to them, or required meetings should be less frequent to make it more possible for probationers to actually attend them.

People should be required to have a full-scale psychiatric evaluation performed — not at their own cost, given they’re indigent, if not at no cost to everybody, regardless of financial standing — to uncover mental and physical health issues that lead to self-medication through drug use and other problematic forms of drug use.

Probationers should be able to consume cannabis, at the very least, if done so in an overall safe manner. I think mental health professionals should be involved in making this judgment, as chronic cannabis use can very well result in the worsening of existing mental health issues or the development of other disorders that weren’t previously present.

More specifically, long-term opioid users such as myself should be able to consume cannabis, as it’s been proven to improve the long-term substance use outcomes of people with opioid use disorders like me. I say this because cannabis very rarely injures or kills users, unlike opioids, especially unregulated opioids, like what are available to modern American illicit opioid users. Cannabis is a fine alternative to opioids in such people. Much research proven this to be true.

There are potential negative outcomes of this, though the benefits far outweigh the cons.

The high costs of court fees and probation fees make life difficult for long-term low-income substance use disorder sufferers like me. Thanks to these fees, in part, I struggle to afford paying for medication-assisted treatment program enrollment, which quite literally saves my life.

I also struggle to pay for everything else, in general, since probation diverts my money to pay wages of probation officers and ultimately end up as profit in the pockets of people who own third-party supervisory services businesses.

There are many other ways to improve probation. This isn’t an exhaustive list of the means that could improve modern American outcomes of people on probation in terms of long-term success.

What Is Probation Doing Right?

I like that alcohol and drug evaluations (e.g., SASSI) are required, but only because they are part of a comprehensive mental health evaluation.

Requiring people to maintain employment and show up to meetings on time instills a sense of responsibility in probationers.

Some probation officers who are nice, not intimidating, easy to talk to, understanding, and genuinely interested in the long-term positive outcome of their probationers — that’s the minority, most definitely — really do help correct probationers’ bad behaviors and instill good habits in them.

Probation should be a punishment that steers people away from making the bad decisions that resulted in their criminal charges. It shouldn’t suck money from their already-tight budgets, add charges onto their criminal histories, and otherwise make success more difficult to achieve.

Probation does some things right, but we need probation reform.

Categories
From Personal Experience Harm Reduction The Volunteer State

Solutions to Northwest Tennessee’s Area-Specific Challenges

Note: Since the publication of this article, I’ve been made aware of two Syringe Services Programs in West Tennessee. Both are in Memphis — A Betor Way and the Memphis Area Prevention Coalition’s SafePoint.

Northwest Tennessee (NWTN) is home to just as many drug users as anywhere else, though not nearly as many — if any — resources that other places have. Unfortunately, however, rural Tennesseans who use drugs, especially our injection drug users — note that I’ve been an injection drug user for about three years — largely suffer from a statewide lack of resources, among other issues, that lead to things like poor quality of life, shorter life expectancies, and so on.

This article is a follow-up to “Area-Specific Challenges in Northwest Tennessee,” an article I published in mid-November 2019 on my website, Northwest Tennessee Harm Reduction.

Note that this doesn’t contain all possible or appropriate solutions to the issues I posed in the aforementioned piece — which also isn’t a comprehensive guide to the area-specific challenges that we face here, though they apply to all of rural Tennessee, if not the entirety of the Volunteer State — though it certainly does cover several major points.

An Aside

I assume all readers don’t know my personal history, though you can find it over at “Who Am I?,” another page on my website. I speak from the perspective of a long-term drug user who has spent the entirety of his life in rural Tennessee. I grew up in Southern Middle Tennessee’s Hohenwald, which is very much a hole in the wall, lived in Knoxville for all of four months, and have been in Martin — that’s in Northwest Tennessee — since May 2014.

I have used drugs nearly every day since Dec. 2011. Opioids have been my drug of choice since roughly June 2014. Like so many others, I used opioid painkillers at first — though I didn’t use them for pain, only recreation at first and later as self-medication for mental health purposes — that I purchased off the street. Some 3.5 years ago, I turned to heroin as a cheaper alternative. Between 2.5 and 3 years ago, I first injected heroin. I am now on Suboxone to satisfy my opioid dependency and have been since mid-September 2019.

I’ve been active in harm reduction for anywhere from 2 to 3 years now. I do this work for free and hope to eventually become gainfully employed in this field — I’d love it if I could satisfy this aspiration while living in rural Tennessee, preferably West Tennessee or Southern Middle Tennessee, the two portions of Tennessee that I believe are currently most underserved by government agencies, non-profit organizations, and community groups that help long-term drug users.

For what it’s worth, I’m low-income and always have been. I say this not because I think it makes me special, but because I very much understand the issues my fellow long-term drug users here in Tennessee also face.

Why Just Northwest Tennessee and Southern Middle Tennessee?

I mention these areas because I’ve lived and used drugs in these areas personally. I don’t want to speak on what I don’t know.

East Tennessee is filled with programs like syringe exchanges, also called syringe services programs by the state’s Department of Health. Nashville has at least one such program. There have been talks about Memphis getting such a program, but there is not such an operation — at least not yet — to my knowledge.

Look at a map if you need to, but Northwest Tennessee (NWTN) and Southern Middle Tennessee (SMT) are farther away from large cities and other areas that already have a relatively greater support system for drug users. The entirety of West Tennessee also fits this bill, except for Memphis, found in the southwestern extreme of the state. As such, and non-Memphis West Tennessee and Southern Middle Tennessee are more “stranded” than any other regions of the state.

Again, what follows largely applies to the entirety of Tennessee.

If you live outside of NWTN or SMT, the following information still is relevant to you.

Solutions

1. Improving Trust and Reducing Discretion Exercised by Underserved Persons

Discretion, for the record, includes everything people do to avoid confrontation, keep from hurting themselves, and unveiling confidential information.

People don’t trust “the system” because it’s failed to protect underserved populations for so very long. Drug users can’t be honest about their substance use with law enforcement officers in fear of catching criminal charges, going to jail, potentially losing their jobs, and being separated from their families. People of color are less likely to be able to afford healthcare, including mental health treatment, even though politicians often swear to help these people; if they are able to afford it, they’re more likely to be discriminated against by treatment providers and therefore less likely to be honest with them about whatever issues they’re currently facing.

There are countless other examples of how people don’t trust the system. Here are two more specific examples.

In my efforts to distribute syringes, naloxone kits, and other harm reduction supplies throughout Northwest Tennessee, plenty of people have thought I’m either an undercover police officer or a confidential informant. People in the national harm reduction community have thought the same. I’m not a cop, a confidential informant, or otherwise working with law enforcement — I never have been any of these, either.

People are sometimes unwilling to trust me, for example, for a few reasons. No harm reduction infrastructure exists here and what I do seems totally out of the ordinary. When people note things are unordinary or out of place, they’re trained to not trust those things out of a sense of self-preservation.

For these reasons, as well as several others, people are unlikely to trust social services workers, first responders, or law enforcement, even though these very people are often employed to protect them.

Time for another example. Meet Josh, a totally fictional resident of rural Tennessee. He works, but struggles to support his wife and child. Josh lacks reliable transportation. Due to his manual-labor job, Josh’s chronic pain is constantly acting up, causing him to source opioid painkillers from family members and friends. He also suffers from an anxiety disorder. Josh has no insurance and can’t afford to visit a doctor.

A local church offers to pay for mental health treatment on Josh’s behalf so he can seek help for his anxiety disorder. However, once he’s there, he quickly realizes he can’t be honest to the counselor or prescriber about his opioid use. Even though mental health professionals are supposed to be able to be trusted by patients, Josh can’t be honest.

If Josh could be honest, he could better receive the help he needs and stop self-medicating. He’d be less likely to turn to substance use thanks to having his anxiety disorder under control, too. This example illustrates yet another “trust” problem that’s all too common.

So, how can we improve trust and limit the barrier of discretion between drug users and the social services-criminal justice alliance in rural Tennessee?

Here’s the Solution

This is a multi-faceted problem. Due to the complexity of this solution, I’ll try to keep my explanation concise.

Part 1A — Law Enforcement and Drug Users Need to Have a Better Relationship

First, law enforcement officers need to establish trust with drug users.

Another example. In September, I was pulled over by law enforcement for speeding. Probable cause for a search was established by a K9 alerting on my vehicle, despite the fact I didn’t have drugs. Before I was searched, I informed the officer I was in possession of syringes. Despite the fact I spoke up, I was still charged with being in possession of drug paraphernalia.

T.C.A. § 40–7–124 is a law that prevents people in possession of syringes or sharp objects that have been used as drug paraphernalia from getting charged with or prosecuted for a violation of T.C.A. § 39–17–425, a.k.a. possession of drug paraphernalia, as long as the person being searched speaks up and tells the officer they’re in possession of such objects before a search is conducted.

Despite this, I was still charged with possession of drug paraphernalia. The officer obviously wasn’t aware of this law, even though it’s been around since no later than 2015.

People, particularly drug users, don’t trust law enforcement for this very reason — they’ll send your ass to jail in a heartbeat!

Here’s what I propose: law enforcement officers shouldn’t be able to charge anybody in possession of drugs or drug paraphernalia with criminal charges as long as they’re honest about it. Why? Doing so promotes bonding between the long-underserved population of drug users and law enforcement. Ultimately, this leads to things like greater long-term drug treatment outcomes and an ability to better solve crimes.

Ever heard of the whole “protect and serve” thing? Police could better protect and serve our society if drug users like me could actually trust them and be honest.

Educating law enforcement about laws such as T.C.A. § 40–7–124 would improve the relationship between drug users and police officers. A few more possible solutions include changing legislation so that honest, upfront drug users who come clean to law enforcement officers about being in possession of drugs or drug paraphernalia shouldn’t be given criminal charges, giving people who find themselves in trouble more options to seek out substance use treatment where appropriate, and getting law enforcement involved in distributing naloxone.

Part 1B — Promoting Alternatives to Criminal Punishment Used by Social Services Professionals

Second, social services-criminal justice alliance professionals should eschew traditional punishments for substance use in favor of evidence-based alternatives that improve the long-term outcomes of substance use disorder treamtent.

For example, who in their right mind would tell their probation officer they recently relapsed or otherwise used drugs? People go to jail for this stuff.

Here’s another example. Assume a couple gets arrested for child abuse. Although nobody wants parents to be using drugs, it’s unavoidable — some parents will have drug problems. The couple’s home is visited by a Department of Child Services representative who performs a test for methamphetamine residue in the home. The representative finds meth residue on a window in the parents’ bedroom, where their child is never allowed. No drug paraphernalia or drugs was accessible to the child.

This is actually a reason why parents get charged with child abuse.

These social services workers should be less willing to turn to the criminal justice system in dealing with clients’ substance use problems. There should be more government funding for committing people in the above two examples — as well as anybody else who deals with the social services system in any way, not just these two manners — to evidence-based substance use disorder treatment.

One last example. Opioids have been my primary drug of choice for nearly 6 years now. I turned to heroin in mid-2016, which is much more dangerous than pharmaceutical opioids due to its unregulated nature. Heroin users don’t know what their batches contain or, even if they did, the amount of heroin, fentanyl, or other drugs they contain. This makes it very easy to overdose from heroin — this ideology also spills over to counterfeit opioid tablets, which are already common all over the country. They usually contain fentanyl, a highly-potent opioid that has little threshold between the amount required to (A) make users feel high and satisfy their withdrawal symptoms and (B) cause overdose.

Cannabis has been shown to be a powerful tool in promoting long-term treatment outcomes in people like me, long-term sufferers of opioid use disorder. Although cannabis can certainly be misused, it’s silly that probation officers widely violate probationees for testing positive for cannabis, particularly where cannabis use helps people stay clean from other drugs that are typically more dangerous than cannabis, such as opioids.

Part 1C — Healthcare Providers Should Be More Accepting of Drug Use

Healthcare providers shouldn’t be forced to fire patients who test positive for drugs of abuse or otherwise admit to using illicit or unprescribed drugs.

For example, let’s say I relapse on illicit opioids. If I tell my buprenorphine prescriber that I’ve relapsed, he’s likely to fire me from the program. That leaves me without a legitimate source of Suboxone, a drug that’s helping me avoid using heroin; quite literally, I face death every time I use heroin. Although we’d like opioid users in these situations to refrain from relapsing, is it really a good idea to have such a low-tolerance view toward accepting recovering patients’ slip-ups?

I should note that, while the prescriber has some discretion in choosing whether he fires me or not, the state outlines rigid guidelines for buprenorphine prescribers in Tennessee that prevents them from keeping patients who’ve relapsed too many times.

Another example. Simone is prescribed a controlled substance (e.g. Xanax, Norco, Percocet, gabapentin) from a physician. The physician is required to provide drug screens on at least a quarterly basis, if not every month.

Physicians face serious scrutiny from regulators if they don’t fire people like Simone if they test positive for illegal drugs like meth, cocaine, cannabis, or other drugs that aren’t prescribed to them.

Let’s say Simone is prescribed Percocet for a serious, debilitating spine injury. She tests positive for cannabis according to a urine drug screen performed by her prescriber. Simone is now refused a prescription by the physician.

Every physician is different. Some allow a few slip-ups from such patients, while others have no-tolerance policies.

One thing’s for sure, however — prescribers shouldn’t be forced to stop rendering services to patients who slip up like Simone did. This is especially true with cannabis, an effective pain reliever that’s already been legalized for at least medical use by more than 30 states.

Part 1D — Doing Things That Help Drug Users

This might seem obvious, but it’s the most important thing that can be done to address regional area-specific challenges—actually doing things that help drug users.

These things can be carried out by non-profit organizations, government agencies, groups of like-minded people, or even individuals.

Here’s a quick anecdote: I pick up litter around Martin regularly, and I’ve done so in a few other local communities. In the past month, for example, I’ve picked up 3 syringes and had one other person in my neighborhood tell me they found a syringe littered near their home. In total, I’ve found syringes on 5 occasions on my own; with that other person’s report, that makes 6 total instances of used syringes being improperly discarded in my immediate vicinity.

I’ve talked to a few neighbors about this and the reaction is always the same — surprise; concern.

I always tell them that injection drug users are incentivized to throw used syringes on the ground because of law enforcement or not wanting family members, friends, or coworkers to know that they inject drugs. I follow this by telling them that injection drug users, such as myself, don’t have anywhere to dispose of used syringes around here.

This holds true for the entirety of West Tennessee outside of Shelby County, in the far southwestern extreme of the state, that is, as the Shelby County Health Department offers syringe disposal services for a small fee.

Even in cities that have such programs, injection drug users still improperly dispose of used syringes.

  • We need gas stations to start putting sharps containers in their bathrooms. Doing this won’t welcome injection drug users to start shooting up there freely — we’re already using public bathrooms to do this! At least help us and everybody else on this planet, not to mention animals, stay safe by buying a sharps container for a few dollars and placing it in public bathrooms. This holds true for all other facilities that welcome the public: Walmart, other grocery stores, Family Dollar, Dollar General, restaurants, and so on.
  • Health departments and/or non-profit organizations and government agencies need to begin offering services that syringe services programs do, such as collecting others’ used syringes, referring drug users to evidence-based substance use disorder treatment providers, and distributing supplies that keep drug users safe (e.g. fresh syringes, clean tooters, alcohol swabs, tourniquets).
  • Lifting federal regulations on buprenorphine prescribing. Like I’ve talked about in “Suboxone Is Too Hard to Get,” SAMHSA, the Substance Abuse and Mental Health Services Administration, a federal government agency, only allows physicians who specialize in addiction medicine, undergo specialized training, and pay hefty licensure fees to prescribe buprenorphine (Suboxone, Subutex) as an opioid replacement. Thanks to this legislation, the nine-county region that is Northwest Tennessee, home to some 254,000 people, only has 19 buprenorphine prescribers — and a whopping 2 methadone clinics, each of which is located at the westernmost and easternmost ends of Northwest Tennessee in hella inconvenient form.
  • Requiring pharmacies to sell syringes to adults. Although I’m not a fan of authoritative governments and excessive market regulation, pharmacies throughout Tennessee, especially rural Tennessee, widely refuse to sell syringes to customers without insulin prescriptions. This encourages injection drug users like me to purchase syringes off the black market at best and share used syringes at worst. Revoking pharmacists’ ability to exercise discretion in choosing who they sell syringes to would increase access to clean syringes throughout all of Tennessee, especially chronically-underserved areas like Northwest Tennessee.

The more we do these things, the more likely people, particulary underserved drug users, will trust “the system.”

2. Educating Drug Users About Harm Reduction

I can’t speak for the entire drug-using population of Tennessee when I say this. However, here in Northwest Tennessee, drug users aren’t aware of things like the existence of naloxone (Narcan), where to find clean syringes in a legal manner, how to properly respond to opioid overdoses, or the recent state laws designed to protect drug users.

I’m dead-ass serious when I say that most drug users I’ve come across don’t know what naloxone is.

Even daily injection opioid users, who really, really, so very badly need naloxone largely don’t know what naloxone is. It’s not like they just don’t know where to get it; they don’t even know about it in the first place!

Here’s the Solution

Part 2 — Educate Drug Users, in Particular, About Harm Reduction

Like I mentioned earlier, even though the state has hired 20 Regional Overdose Prevention Specialists to promote harm reduction, reduce stigma, and boost public awareness of things like naloxone administration and how addiction actually works — these are the three things the state’s Department of Mental Health & Substance Abuse Services claims to do via its ROPS — they largely fail to reach people who actually are at risk of opioid overdose and other drug users.

This isn’t an empirical fact. Rather, it’s just my experience. Remember how I talked about people aren’t willing to trust “the system,” let alone people?

We need to do a better job of educating drug users, especially those who are most at risk of serious injury or death stemming from drug use (i.e. homeless populations, people of color, low-income individuals, those with lengthy criminal histories) about harm reduction.

Yes, both society and the greater cause of advancing harm reduction and improving the lives of people suffering from substance use disorder benefit from educating the general public about harm reduction.

However, long-term injection drug users and other underserved, problem drug users are harder to reach than run-of-the-mill drug users. After all, the majority of people are drug users, which includes cannabis, alcohol, and tobacco.

  • We need to reach these people and tell them about naloxone and how to use it, as well as provide them with Narcan or generic naloxone kits.
  • Educate them about how to properly inject drugs.
  • Inform people like me about what blood-borne diseases (e.g. HIV, Hepatitis C[HCV]) are and how they spread. Make clear how diseases can spread through sharing paraphernalia such as syringes or tooters. Provide safe, feasible options for drug users to stay safe while using drugs without having to incur additional costs or losing any of their drugs in the process.
  • Tell drug users why they should care about harm reduction. Getting end-users of drugs to adopt harm-reduction-related ideologies is the single most effective way to get them to practice it.
  • Most importantly, we need to know where to obtain harm reduction supplies. This includes the mail-based national distribution organization NEXT Distro, based in New York, diabetes and medical supply websites that sell things like syringes without prescriptions at low costs, and potential in-state distributors such as syringe services programs — if and when they’re implemented in currently-underserved areas like NWTN or SMT.

A Summary

Despite the fact I only labeled the above solutions as Part 1 and Part 2, there are actually five main solutions for addressing the area-specific challenges that drug users face here in Northwest Tennessee — remember, these solutions largely hold true for the entirety of the Volunteer State.

If you couldn’t be bothered to read the body of this article, that’s okay! Here’s a summary of the five solutions I proposed above.

These five solutions are summarized below, with the first paragraph representing Part 1A, the second paragraph representing Part 1B, and so on. The fifth paragraph represents Part 2.

Drug users and law enforcement need to have a better relationship. Law enforcement is directly responsible for improving this relationship. Benefits include officers having access to more information because more community members would be willing to proffer leads or direct evidence and improving long-term substance use disorder treatment outcomes.

Social services-criminal justice alliance professionals include probation and parole officers, judges, child custody social workers, and sheriffs, among others. These people are often keen on turning directly to traditional punishments (i.e. incarceration, strict drug court program enrollment) in dealing with substance use disorder. Members of the social services-criminal justice alliance should adopt other, more humane, evidence-based means of addressing substance use problems, including criminal charges that result from drunken behavior and parolees simply failing drug tests for illicit (or legal, in some cases) drugs.

Healthcare providers, whether because of personal preference, employer requirements, laws, or regulatory scrutiny, are too keen on discontinuing treatment as the result of patients’ unprescribed use of illicit (and sometimes legal) drugs. This even extends to treating long-term, dependent opioid users with buprenorphine, such as here in Tennessee, where prescribers aren’t allowed to tolerate many relapses and are forced to fire patients, leaving them without a legal source of reliable pharmaceutical opioids. Prescribers should ultimately be more accepting of patients’ consumption of unprescribed and/or illicit substances, ranging from primary care physicians, to mental health practitioners, to addiction medicine specialists.

It sounds silly, but we need to actually start rendering services that reduce harm to drug users, repealing existing legislation that works against the best interest of people suffering from substance use disorder, enacting new legislation that favors these persons’ lifelong treatment outcomes, and so on. This includes things like retail businesses adopting the use of sharps containers in their bathrooms, removing SAMHSA’s strict red tape around buprenorphine prescribing for opioid use disorder, and having non-profit organizations and/or health departments render services to local communities such as collecting used syringes, distributing clean ones at no cost, and referring problem drug users who seek help to evidence-based treatment providers.

Lastly, we should educate end-users of drugs about harm reduction. Simply educating the public about it isn’t enough. Despite the efforts of Regional Overdose Prevention Specialists in Tennessee, people paid by the state to distribute naloxone and reduce drug-related stigma, people who are most affected by drug use such as me are largely glossed over by the efforts of ROPS. ROPS fail to reach drug users themselves due to the population’s lack of trust in social support systems and their use of discretion. We need to develop and carry out new approaches to educating these people about harm reduction.

Putting It All Together

Yeah, this article is pretty long. There’s a lot of information to take in. I can hardly digest YouTube videos that are just a few minutes long, let alone articles that are 4,000-plus words long, like this one — hell, I usually can’t be bothered to read them in the first place, am I right?

And, again, this is by no means a complete aggregation of all the solutions to addressing Northwest Tennessee’s area-specific challenges.

There is no single way to address these area-specific challenges. To effectively, speedily integrate harm reduction — and not just grabbing the low-hanging fruit that is distributing naloxone — into Tennessean society, we need to explore all five of these avenues at minimum.

So, what can you take away from this?

We need drug users and law enforcement to get along. We need to develop and regularly use alternatives to criminal punishment to address problem drug use. Healthcare providers need to be more lenient in dealing with substance use. We need to actually do things that help drug users, like implement places for injection drug users to dispose of syringes without the threat of being slapped with criminal charges. Lastly, drug users, particularly those who are most damaged by how we currently deal with drugs as a society, need to be educated about harm reduction.

Also, existing members of the harm reduction community need to be active in laying down harm-reduction-related infrastructure in barren places like Northwest Tennessee. We’re not being helped by hardly anybody who knows what they’re doing!

Why haven’t people who get paid to do this — unlike me, unfortunately — in well-established areas such as California or New York focused their efforts on places like Northwest Tennessee or Southern Middle Tennessee?

I don’t know. But I sure hope this changes.

Even if I never get paid to do this for a living, even if I never have a part in implementing harm reduction on a large scale here in Tennessee, I sure hope some group, some organization, some government agency, or somebody makes change here and makes change quickly.

Categories
From Personal Experience Recovery The Volunteer State

Suboxone Is Too Difficult to Get

We’re in the midst of an opioid epidemic here in the United States. It’s worse here in Northwest Tennessee than most places across the country — not the worst, but it’s certainly not great.

There are a few central reasons why opioid use here is so likely to result in overdose, if not death. First off, the lack of regulation in the market means batches of opioids can’t be screened for contents or purity. Put simply, opioid users, like me, don’t know what we’re using.

Second, there’s a lack of resources necessary to healthy, fulfilling lives here in rural Tennessee. Many of us struggle to even find transportation to get to mental health practitioners or physicians, let alone pay for them in the first place.

Third, although this fits into the “resources” problem mentioned above, it’s difficult for long-term, dependent opioid users to seek out and secure opioid replacement treatment, also called medication-assisted treatment (MAT), in the form of buprenorphine (Suboxone, Subutex) or methadone.

A Personal Aside

I am a long-term drug user. Opioids have been by primary drug of choice since, give or take a month, June 2014. Not for pain — just ‘cause they’re hella fun. #ItsLit

But seriously, drug use isn’t cool. #ItsNotLit I self-medicated depression and anxiety with opioids before opioid dependency caused — well, worsened is the proper term — mental health issues on its own accord.

I began injecting heroin about two, maybe two-and-a-half or three years ago. I first snorted heroin for a few months or a year prior to graduating to injection drug use. I moved from street-sourced pharmaceutical opioid tablets to heroin, and later from sniffing heroin to injecting the drug, for cost’s sake.

Earlier this year, after an arrest, I was tired of the legal issues associated with illicit drug use. Thus, I sought out treatment at a buprenorphine prescriber in Jackson. I went as far as Jackson, an hour or more away from me, because there aren’t many prescribers in Northwest Tennessee. More on that below.

Things That Make It Difficult for Opioid Users to Get on Suboxone or Methadone

This article solely focuses on the area-specific challenges that plague long-term illicit opioid users such as myself here in Northwest Tennessee, though these issues aren’t just specific to Northwest Tennessee — they’re rampant all over rural Tennessee, if not the entirety of the state.

Due to the fact that the federal government upholds excessive regulation around buprenorphine prescribing, these things also hold true throughout the United States.

Cost

I’m not particularly a fan of airing my personal information out into the ether, but I want everyone to know just how expensive Suboxone really is.

The prescriber I go to charges $275 monthly for just one visit. The physician prescribes 28 days’ worth of Suboxone for that price. If you go weekly, it’s $100 per week. Everybody at this clinic has to start off going weekly for at least 6 weeks.

These excessive costs make it difficult for people to get their foot in the door — and $275 isn’t on the higher end, either; once people do gain entry to medication-assisted treatment programs, they’re still going to get their heads busted by facilities that specialize in opioid replacement therapy.

56 generic Suboxone films cost $388 at the pharmacy I go to. They don’t take discount cards. I don’t have insurance. None of the 11 health insurance plans I was offered by Healthcare.gov this year covered Suboxone.

Right now, it costs $663 per 28 days. It initially set me back $788 per 28 days.

Like, fuck — might as well stick to heroin!

Pharmacies Aren’t Willing to Fill

Pharmacies don’t like filling prescriptions for controlled substances.

Especially for Suboxone.

The idea is that people on Suboxone and other controlled substances are more likely to abuse their medications than run-of-the-mill medications and pester pharmacies for early fills and cause a scene.

Is this true? No idea. On the surface level, I totally understand the merits behind this ideology. Is it right? No.

The pharmacy I use is an hour away from my house. It’s a small mom-and-pop pharmacy that doesn’t take discount cards. I’m forced to pay cash. At least I get treated like a human, though.

I tried to fill at Walgreens in that city, but they said since I didn’t live there, they weren’t willing to fill. My prescriber is a quarter-mile — a five-minute walk — away from that Walgreens. Whatever.

I tried to fill at a CVS where I live, but the pharmacist said they were at capacity for buprenorphine prescriptions, meaning they couldn’t welcome any more. That’s a lie. There’s no such thing as an upper limit of Suboxone prescriptions — or any prescriptions — that a pharmacy can fill. Whatever.

I tried Walmart. They said they’re not licensed to dispense buprenorphine. That’s a lie. “While qualified practitioners are required to have waivers to prescribe or dispense buprenorphine under the Drug Addiction Treatment Act of 2000 (DATA 2000), pharmacists and pharmacies are not required to have any credentials for dispensing these medications beyond those for other Schedule III medications,” SAMHSA’s official website says. Whatever.

I tried the closest Walgreens to where I live. They don’t stock buprenorphine. Whatever.

Is it their responsibility to fill my prescription? Not at all. I shouldn’t have gotten myself into this situation in the first place. I should eschew drug use in favor of a better life.

All long-term opioid users should do the same — stop using drugs — unless given a prescription for chronic pain or something. However, this doesn’t work, in practice.

SAMHSA Limits the Number of Prescribers Who Can Legally Prescribe Suboxone

I’m not going into the specific limitations that SAMHSA, the Substance Abuse and Mental Health Service Administration, places on buprenorphine prescribers.

Just know that there’s a reason why less than 4% of all licensed physicians in the United States are able to prescribe Suboxone to chronic, dependent opioid users. That reason is SAMHSA.

Yeah, I get it — what if doctors started misprescribing Suboxone? I get it.

However, one thing’s for sure: not helping the already-underserved populations of people suffering from opioid use disorder by making buprenorphine and methadone, the two go-to opioid replacement drugs, widely available harms us. Family members, friends, and communities lose people to the opioid epidemic left and right, especially in rural Tennessee.

Statistics About This Lack of Prescribers

In the nine-county area that makes up Northwest Tennessee, there are about 254,000 people. There are only 19 buprenorphine prescribers licensed to prescribe Suboxone or Subutex for opioid use disorder.

Fucking awesome.

The United States Department of Health and Human Services designates certain parts of the United States as “federal shortage areas,” which, obviously, have shortages of health professionals based on various criteria.

7 of NWTN’s 9 counties have medically underserved populations (MUP) in terms of primary care physicians. The other 2 are medically underserved areas (MUA). MUA refers to the entire county’s geographic area, whereas MUP refers to the people in the area. To make it simple, all of the counties here don’t have enough doctors.

9 of NWTN’s 9 counties are considered to have a shortage of federal mental health professionals and are deemed “Whole County Geographic” shortages. That means no matter where you live in NWTN, the entirety of this region has a shortage of federal mental health professionals.

What You Can Take Away From This

Suboxone and Subutex both contain buprenorphine, a long-lasting, relatively safe opioid that satisfies long-term, physically-dependent opioid users’ brains’ opioid receptors. That means no withdrawal symptoms, physical or mental.

When I didn’t have opioids over the past 3+ years, when my opioid use really started to progress, I laid around, did next to nothing, and my depression and anxiety symptoms worsened.

Now, since I started Suboxone in mid-September, I haven’t felt depressed at all. I don’t have to worry about overdosing because I don’t use heroin. I don’t have to worry about the legal issues associated with illicit drug use.

Other long-term opioid users largely report the same: their mental health improves and stabilizes, they don’t have to live highly-dangerous lifestyles with short life expectancies, and they don’t have to worry about the legal issues arising from daily drug use.

We need to make buprenorphine and methadone more widely available. The single most effective means of doing this would be severely loosening the existing regulations supported by SAMHSA.

As more practitioners could prescribe buprenorphine, the cost of getting a Suboxone prescription would decrease big time. Filling the prescription would still cost a lot, but as demand for Suboxone increases and stigma associated with Suboxone users decreases — a direct result of loosening government regulation on buprenorphine prescribing — I feel that costs incurred by end-users of Suboxone would drop.

Categories
From Personal Experience The Volunteer State

Northwest Tennessee Needs Help

Tennessee county map.

We all know Cristoforo Colombo, the brave yet kind-hearted soul who pioneered sailing across the Atlantic Ocean. Although he did some not-nice things during his explorations, I’m bringing him up because he went to somewhere that had no infrastructure and was entirely foreign to him.

I feel that Northwest Tennessee is as foreign other harm reductionists across the United States as the “Indies” was to Columbus and his men.

Many other places in the States are rife with well-established harm reduction advocacy, syringe exchange, and related activity or program infrastructure.

Northwest Tennessee isn’t. Our crop of harm reductionists are bare as a baby’s ass.

It seems short-sighted to claim that there are no other practicing harm reductionists here in NWTN. However, I’ve been doing this stuff for two-and-a-half or three years now and have only met one person worth their salt — I don’t want to name him or her here, but they’re great.

Anyways.

Why don’t harm reductionists from other parts of the United States in which drug users are treated much, much better than they are here in NWTN come here and lay down infrastructure for us flatland hillbillies to follow?

Maybe I’m being selfish and making everything about me, me, me.

But I don’t think so.

It sucks to know that I could face arrest and/or prosecution for harm reduction advocacy here in Tennessee. I also don’t like knowing that I have to bankroll (the very few harm reduction-related) expenses tied to my advocacy.

I’d love it if an experienced member of this national community of harm reductionists came here and showed us how to be ‘bout it ’bout it.

From now until then, I’ll be spitting in one hand and shitting in the other.


As of February 2021, Northwest Tennessee still has no syringe services programs and no safe syringe disposal sites (not counting pharmacies, which charge for their services and often promote anti-drug-user stigma).

On the bright side, the state added more than a dozen recovery-oriented contractors across the state under its brand-new Lifeline Peer Project — each one is assigned regions, for which they’re called “Region X Lifeline Peer Project Regional Coordinator.” For more on the Lifeline Peer Project, read here.

Categories
From Personal Experience

The Modern Opioid Epidemic in My Words

We’ve heard it — opioid epidemic — plenty of times across news broadcasts, the radio, on billboards, in newspapers, posted by peers on social media, referenced in prose, and everywhere else imaginable. But what is the opioid crisis, exactly?

The opioid crisis is the collective body of issues stemming from opioid use that American society is facing right now. It was declared a public health emergency in 2017, though I’d argue that it dates back as early as 2010. The opioid crisis is still in effect today and isn’t showing any signs of stopping.

Let’s browse the basic timeline that follows to understand what caused this epidemic.

First, Look Back to the 1900s

From the early 1900s up until the mid-1980s, opioids were regarded as scary and highly dangerous. Around the end of this period, organizations in medicine began recognizing that opioids were widely underused and chronic pain wasn’t being appropriately managed.

The World Health Organization (WHO) is the public health agency of the United Nations. In 1986, the organization declared that post-operative and cancer-related pain weren’t being treated sufficiently via the Cancer Pain Monograph.

Physicians improved overall cancer pain treatment around the world. Easy fix, right?

This “easy fix” prompted a few publications that brought light to the undertreatment of pain.

Also, opioids, at the time, were largely reserved for cancer treatment and not lifelong, chronic pain. Cancer specialists applied ideologies common in cancer treatment to respond to non-cancer chronic pain. Soon thereafter, the leading way of treating pain — the leading modality, in other words — became opioid prescriptions.

An organization known as the American Pain Society called on the medical community to recognize pain as the fifth vital sign alongside temperature, heart rate, blood pressure, and respiratory rate. In the past, physicians had largely not quantified patients’ subjective reports of pain as they had quantified the four vital signs for many decades of operation.

The American Pain Society wanted pain to be quantified just like the other four vital signs to ultimately improve the management of Americans’ pain.

Here Came Purdue and Company

Purdue Pharma is a pharmaceutical company that was one of the first — among the initial stages of the current opioid epidemic, not one of the first in general — to create an opioid formulation with extended-release function, a larger dosage of opioids (oxycodone) per tablet as compared to traditional instant-released opioid tablets, and allegedly being unable to be abused, as well as being non-addictive.

Purdue’s creation was the infamous OxyContin, which came out in 1996. Leading up to its release, however, the company’s decision-makers paid for a Godzilla-sized marketing campaign that made pharmacists, physicians, patient advocates, politicians, and other figures of importance recognize OxyContin as a safe drug.

Other companies followed this same strategy in creating name-brand formulations of opioids that had been in use for the past several decades — they weren’t anything new, though they were marketed as such.

Back to the American Pain Society

A survey I can’t seem to find that was published in the late 1990s found that some one-third of Americans were suffering from chronic pain. This made the entire domestic healthcare system place greater emphasis on pain management.

In conjunction with the American Pain Society, as well as many other organizations, the Veteran’s Health Administration hopped on board the campaign trail in 1999 to get physicians across the United States to better treat symptoms of pain.

The Drug Enforcement Agency and the Federation of State Medical Boards issued official statements in line with one another that told doctors they could immediately begin prescribing opioids more liberally without having to face the intense scrutiny they were accustomed to.

All of these factors culminated in a series of new, improved pain management standards. Their speedy implementation yielded unwanted byproducts:

  • Physicians were soon forced to provide sufficient pain control or risk getting in trouble.
  • Hospitals’ decision-makers began to believe that if they didn’t go big on opioids to adhere to these standards, they would lose tons of grant funding.
  • Pharmaceutical companies sent physicians as paid consultants around the United States to promote opioid prescribing to physicians through the ideas of opioids having high margins of safety and offering great benefits.
  • Medical trainees of all sorts were taught to start relying much more on opioids than ever before around this time.

Prescriptions Go Up, and Up, and Up

The number of opioid prescriptions, as well as the total amount of opioids consumed in general, increased substantially from at least 1999 to the mid-2010s.

The first wave of overdoses in the modern opioid crisis began in 1999 due to this increase in opioid prescriptions.

Physicians largely weren’t informing patients of the potential dangers of taking these opioids. Since patients trust doctors, they blindly accepted such opioid prescriptions for pain management.

These opioids, whether they were used by people for recreational or self-medication use, were generally safe for opioid users because they came straight from pharmacies and users confidently knew what they contained. Although they were still capable of causing opioid overdoses, at least users knew what they were getting.

2010 Rolls Around and Big Changes Are Made

Purdue Pharma’s OxyContin had been on the market for 14 years at this point.

The original form of OxyContin could readily be crushed to be snorted, readily dissolved in water for users to inject them or rectally administer them, or inhaled by smoking them on foil. More tame OxyContain users could simply chew the tablets or break them into powder before stalling them for a faster onset.

As everybody who’s consumed an “old school 80,” as they’re so endearingly referred to, will tell you, they’re super fucking easy to prepare for recreational use.

In 2010, Purdue faced outside scrutiny for the true abuse potential of OxyContin. Working with the Food and Drug Administration to get a new, less-abusable form of OxyContin on the market, Purdue replaced its original formulation — which bore “OC” on one side and the dosage in milligrams on the other — with the new one — instead of “OC,” new tablets bore “OP.”

These OPs, as many drug users call them, including me, were made with new technology. OCs could be crushed within a few seconds, whereas OPs could not be crushed into powder — only small chunks at best. Whenever water touched OPs, they gelled up and could not then be broken down further.

The only way, as we drug users have found out, to reliably defeat this time-release mechanism is through leaving OPs in some Coca-Cola or another acidic drink for a few hours, which can be made faster by stirring. Although it can only be abused orally this way, it shouldn’t be a big deal to drug users, as oxycodone as a high oral bioavailability.

Another way is known as “crisping” and consists of breaking down OPs to a fine powder through steel files or Dremel tools. Next, a heat source is introduced to the powder, usually via a microwave or toaster oven, though it’s easier to spread the powder out on top of a piece of aluminum foil and then evenly, carefully run the foil’s contents over a flame — candles work the best, in my experience.

What’s important to remember is that OPs are frustrating as all hell and turned opioid users elsewhere to find opioids to stave off withdrawal and, in the case of legitimate chronic pain sufferers, keep pain at bay.

Immediately after OPs hit the market to replace OCs, users began turning to heroin to get their fix. Used to sourcing highly-regulated opioid pills that always contained the same amounts of oxycodone and other active ingredients, people used heroin irresponsibly and began overdosing like crazy.

Statistics show that, in total, the rate of opioid overdose deaths in the United States rose by a factor of four after OPs came around. Hepatitis C transmission also spiked following OxyContin’s reformulation in 2010.

The second wave of overdoses in the modern opioid epidemic began here.

Here Comes the Decline in Opioid Prescriptions

Great! That’s great news, right — to have fewer opioids pumped into the United States by physicians, correct?

Wrong!

In terms of creating future addicts and dependent opioid users, the reduction in opioid prescriptions ultimately helped out society. However, this forced people who were only using pharmaceutically-produced opioid tablets that were diverted from people who held legitimate opioid prescriptions or from people’s own prescriptions to seek out opioids somewhere else.

This further led to opioid users turning to heroin.

Around this time — in 2013, to be specific — heroin began being adulterated en masse by fentanyl known by researchers as illicitly manufactured fentanyl (IMF).

Fentanyl is super strong. IV fentanyl is about 20 to 25 times stronger than heroin, roughly 30 times stronger than IV morphine, and about 100 times stronger than oral morphine, per Wikipedia’s handy-dandy equianalgesic chart that is my favorite for comparing opioid potencies — opioid equianalgesic calculations are helpful for both recreational and medical opioid users, by the way.

This unfortunate condition plagued the illicit heroin market in the United States and set off the third major wave of overdoses from opioids in the modern opioid crisis.

When Will Overdoses Go Back to Normal?

The current opioid overdose rate isn’t slowing down in the near future, according to official U.S. government number-crunching.

Look at things this way — the opioid epidemic got several pain patients hooked on these drugs, many of whom ended up turning to the streets just to deal with pain and avoid withdrawal symptoms. Since a lot of opioids were diverted to self-medicating or recreational users, they, too, began hitting the illicit opioid market to keep having fun, medicating themselves, stop withdrawals, or all three of these things.

These two groups of people have died off en masse. The total population of these two types of people — those directly affected by the opioid crisis — throughout the United States will continue to shrink. Eventually, this class of opioid users will collectively end their involvement in the game through death, long-term incarceration, or ultimately quitting opioid use.

Only then will the domestic overdose rate return to a relatively normal level.

Here’s Another Potential Form of Fixing This Issue

Another way of reducing this overdose rate is to regulate the opioid market so that opioid users know what they’re getting. If they want to purchase heroin, they’ll always get heroin with absolutely no traces of fentanyl. People who use prescription opioids won’t have to face the risk of getting duped in terms of receiving counterfeit opioid tablets filled with fentanyl.

I think this solution is at least halfway reasonable. I couldn’t even begin to fool myself into thinking that the United States government would legalize and regulate opioids, even just for those who have been suffering from opioid use disorder for a long time and proven unable to see long-term positive outcomes through traditional forms of addiction treatment like buprenorphine or methadone substitution programs — at least not anytime soon.

Just because it’s not on our doorstep doesn’t mean we shouldn’t go out and get it (holy shit, a triple negative).

Categories
Chronic Pain From Personal Experience Internet

Using Opioid Equianalgesic Charts to Determine Equivalent Doses of Different Kinds of Opioids

No, I’m not a physician. I’m not into pharmacology. But, I do know what “equianalgesic” means. I don’t usually use medical or pharmacological terms like this, but it’s necessary for what I’m about to explain.

What Does “Equianalgesic” Mean?

”Equi-“ is a prefix that means “equal.” “Analgesic” is a complete word on its own and is simply a fancy, proper way of saying “pain reliever.”

When we put these together, what do we get?

Equal pain reliever!

Okay, that doesn’t make any sense…

Anyways, the World Wide Web is home to several reliable charts that make it easy to determine equal dosages of different opioids. When combined with simple math, we can do just this.

Keep in mind that I’m not a physician. I’ve never been professionally trained in medicine. My advice is not a substitute for advice from a professional clinician.

Let’s Head on Over to Wikipedia

The equianalgesic chart I, personally, prefer to use is quite comprehensive, at least for comparing mainstream opioids, and can be found on Wikipedia’s “Equianalgesic” page.

I encourage you to head over there now to build up some hands-on, practical experience with using this chart.

When Might Equianalgesic Conversions Come in Handy?

Physicians often use equianalgesic calculators or charts when switching patients over to new opioids for pain relief.

In my world, and likely yours, too, you may find utility from knowing how to perform equianalgesic conversions when trying out opioids that you don’t have much experience with.

Note: before going any further, know that simply using an equianalgesic chart is not sufficient if you plan on using routes of administration that aren’t covered on basic equianalgesic charts.

Take a shot for every time you read “equianalgesic chart” — doesn’t that sound like a fun game! Anyways, let’s get into crunching numbers and making sense of converting the potency of one opioid to another.

Example 1 — Converting Morphine to Hydromorphone

We’ll be assuming that all opioids will be consumed orally at first, then we’ll break out the bioavailability data. Keep in mind that most such charts — both equianalgesic and bioavailability charts for opioids — will feature slight differences. These differences are typically immaterial.

First, find “morphine.” Now, find the value in the second column. It should read 1. Now, take a visit to “Hydromorphone” Lane — you’ll see a value of 4.

This means hydromorphone is four times stronger than morphine when taken orally.

Use this conversion to determine how many milligrams of morphine are equal to 32 mg of hydromorphone.

I would solve this problem by multiplying 32 by four, the “exchange rate” from hydromorphone to morphine. We’d end up with 128 mg of oral (PO) morphine — “PO,” by the way, is an abbreviation for “oral” used in medicine.

For this problem, we used this conversion: PO H/PO M.

Let’s mix things up a bit.

Example 2 — Introducing Bioavailability Into the Mix

Bioavailability refers to how well the human body absorbs drugs based on how they’re administered. Intravenous administration (IV) is always 100%. As such, other routes of administration (RoA) are expressed in proportion to IV administration.

How many milligrams of intravenous hydromorphone is equivalent to oral morphine?

Before going further, let’s pull out our bioavailability chart. I will be using one found on the sidebar of r/Opiates, a subreddit dedicated to — you guessed it! — all things opioid-related.

We’re dealing with IV hydromorphone, which is absorbed by our bodies entirely — aka 100%. PO (by mouth) hydromorphone’s BA is just 35%.

Let’s convert 16 milligrams of IV hydromorphone — which just might be enough for an elephant — to oral morphine. First, I would divide 16 mg IV by 0.35, resulting in roughly 45.7 mg PO hydromorphone.

Just like above, we’ll multiply this figure by four, the factor by which hydromorphone is stronger than morphine, to get 182.8 mg PO morphine.

We’ve made the following conversions: IV H/PO H then PO H/PO M.

Example 3 — Let’s Go Double on the Bioavailability Stuff

It’s time to convert 18 mg of IV hydromorphone into an equivalent dosage of intranasal (IN) morphine. First, I’d divide 18 mg IV by the oral bioavailability of hydromorphone, 0.35, to get 51.43 mg PO hydromorphone.

Using Wikipedia’s handy-dandy chart, I’d then multiply 51.43 PO hydromorphone by a factor of four to get 205.72 mg PO morphine.

Now, all we need to do is account for the intranasal bioavailability of morphine, which, according to the BA chart I’ve linked above, is between 25 and 30 percent.

Since the oral BA of morphine is already 30 percent, we don’t have to do anything to get the lower range of this answer — 205.72 mg IN morphine.

I’d multiply 205.72 mg IN morphine by 0.3 and divide the result by 0.25. What results is 246.86 mg IN morphine. Since it is greater than 205.72 mg, we can deduce that this number is the lower bound, whereas 246.86 mg is the upper bound.

Nobody really snorts morphine — the FDA found just 4% of morphine users to sniff the drug — but, this is just an example.

Again, here’s the conversions we’ve made: IV H/PO H then PO H/PO M then PO M/IN M.

Am I a Physician?

No! I’m not a clinician in any capacity. You shouldn’t be making dose adjustments by yourself.

However, unfortunately, since illicit drug users often aren’t given any assistance by clinicians, it’s useful for us to have information like this available on the Internet.

People are going to use drugs whether or not they’re offered help by healthcare or pharmacological experts — better understanding opioid equianalgesia is a solid harm reduction practice.

Do not take any information I’ve written herein as a substitute for professional advice from a licensed healthcare expert.

Categories
Chronic Pain Advocacy From Personal Experience Internet

How ProPublica’s Prescriber Checkup Helps Chronic Pain Sufferers

ProPublica is a non-profit, primarily-investigative journalism organization that’s been serving society at large since 2007.

One of the outfit’s best works comes in the form of an interactive web-based tool that lets the general public compare drug prescribing rates of drugs on an individual, physician-to-physician basis. ProPublica’s Prescriber Checkup allows you to sort for physicians by name, zip code, city of practice, or state.

You can both look at physicians’ most commonly-prescribed drugs using this tool. It also comes equipped with comparisons of doctors both within their specialty and among many other physicians across the cities or municipalities they compete in, such as relative opioid and antibiotic prescribing rates.

How Is Prescriber Checkup Fueled?

Prescribing data comes solely from people who have filled prescriptions using their Medicare Part D coverage. This means that, just because a physician prescribed one or more medications, they’re not represented on ProPublica’s insightful gadget unless they’re filled at a pharmacy and paid in part or in full by Part D coverage.

How Did Checking on Prescribers Like This Come About?

In 2013, ProPublica’s first rendition of the Prescriber Checkup tool was published. A federal law known as the Freedom of Information Act, or FOIA for short, allowed the entity to get a hold of information such as physicians’ prescribing histories and share them with the American public.

Without getting into the details of FOIA, the bill provides a way for the American public to gain collective access to once-secret documents, files, or data. Prescriber Checkup is one of many successful applications of the endless heaps of useful, long-desired information that the FOIA played an instrumental role in obtaining.

Who All Is Covered by ProPublica’s Free Internet Tool?

ProPublica’s proprietary, one-of-a-kind tool is useful in the following ways:

  • Why waste time paying physicians for appointments when you’re not sure if they’ll prescribe something you feel you need?
  • Determine whether you want to visit certain physicians based on your personal experience with the things.
  • Compare how two or more physicians might tend to use medication or other treatments.
  • See where most of many individual prescription drugs are prescribed.
  • Check physicians’ receipt histories of monies from pharmaceutical companies and other lobbyists or influencers to determine how they might act.
  • Learn how likely physicians are to prescribe name-brand drugs on both an objective, general basis and on an individual, drug-by-drug basis.

Not all physicians show up on ProPublica’s Prescriber Checkup, however; only doctors and other prescribers who have both prescribed lots of drugs overall, as well as lots of particularl types of drugs.

The most important determining factor is what proportion of physicians’ patients are using Medicare Part D coverage to pay for prescriptions. If not enough people do this, physicians won’t have any data available about them regarding their prescribing habits.

ProPublica’s tool requires each and every physician to write 50 or more prescriptions for one or more drugs — not 50 prescriptions in total, but at least one category of medicine on a physician’s profile would tally 50 or greater prescriptions.

In 2015, says the organization, just under 450,000 American physicians, nurse practitioners, physicians’ assistants, and other prescribers were in active practice.

Also, patients are safe and are not mentioned anywhere else on this proprietary tech tool. There’s no reason for journalists to have an interest in the names of patients and what medicines they’ve been prescribed; this tool isn’t for physicians, it’s for the American public.

Here Are a Few Real-World Ways That People Might Use Prescriber Checkup

Everybody will use Prescriber Checkup differently. Since there’s no guide out there about the various ways to pull utility from ProPublica’s Internet-based tool, not everyone will use this application and its contents for good.

To Increase Their Chances of Receiving Prescriptions That They Purposefully Seek Out

Physicians across the 50 states now prescribe opioids far less openly than they used to.

Since there are fewer opioid prescriptions being given out today, people will have to set up appointments with more doctors than they would before in order to successfully receive the prescriptions they’ve got an eye on.

Assume that you have been prescribed a drug for 10 years. Your now-former long-term primary care provider passed away and now you struggle to find another prescriber to give you access to that drug again.

There’s a reason that we go to doctors — they understand how to apply the best treatments in nearly every situation. People who suffer from substance use disorder often self-medicate with common recreational drugs such as cannabis, opioids, or benzodiazepines, for example.

Self-medication comes hand-in-hand with being at high risk for various major side effects such as worsening people’s existing mental health issues. This is just a rule of thumb, however, and doesn’t always end up like this.

Modern Medicine Says Some Drugs Are Inherently Riskier – That’s Why These Categories Stick Out

Antibiotics have countless applications in dealing with infections caused by bacteria, which are present on and in our bodies to the tune of countless trillions. However, when misprescribed, they can negatively affect the cultures of good bacteria in our bodies. We also cause existing bacteria to build up stronger antibiotic resistance to modern antibiotics commonly prescribed both here in the United States and all over the world.

Antipsychotics are another type of risky drug that the nationwide class of American physicians has been known to prescribe in inappropriate conditions fairly regularly. In most cases of antipsychotic misuse, older people in nursing homes are prescribed them with the simple goal of sedating them, ostensively for nursing homes to make dealing with patients systemically easier. Their use can also result in serious harm and even death.

Opioids are the third special class of drugs on our list. They have great utility as painkillers, especially to improve otherwise-lagging quality of life in people’s older years and in people who suffer from serious bouts of chronic pain. People who are interested in purposefully seeking out an opioid prescription from a doctor can serve themselves well by looking at all prescribers in the area(s) you’re thinking about setting up an appointment in. With this tool, you can save money and time in your efforts to receive opioids from one or more prescribers,

On ProPublica’s Prescriber Checkup, there are three other important areas of prescribing that are found on the same row as antipsychotics, antibiotics, and opioids, which are the average rate at which doctors prescribe brand-name drugs, the average price of their prescriptions at pharmacies, and prescriptions per patient.

Don’t just stop here in learning about the ups and downs of these classes of drugs and finding out the utility of the other three metrics mentioned above — look across the World Wide Web, far and wide, to better understand how to take advantage of these things.

It’s Useful in Reducing How Much Average Physician Appointments Cost

We all want to go to a doctor that will take care of us correctly the first time around. However, many people throughout Northwest Tennessee simply don’t have enough money to go visit with multiple physicians.

Given that you use this tool correctly, you can effectively shave down the costs necessary to be seen by a physician and otherwise fill their prescription(s).

A Reason to Support Prescriber Checkup

Many people are curious about what goes on behind all sorts of closed doors. While some topics deserve to be kept private, others could benefit society at large. For example, the American public generally believes that they should be served by transparent societal systems and government agencies, preventing stuff like gross financial conflicts in medicine.

We deserve to know which physicians in the areas we live are more responsible than others for prescribing drugs too widely or not often enough. Also, for example, the U.S. federal government has made a handful of proclamations over the past few years that have ultimately resulted in the systematic change of opioid prescribing practices. Since physicians should be prescribing fewer opioid prescriptions today than they did, say, 10 years ago, the public stands to benefit from having access to Prescriber Checkup’s simple comparison tools.

Whether You Use It or Not, at Least You Know About It Now

I don’t expect everyone to have a use for ProPublica’s Prescriber Checkup tool. However, everyone should at least be exposed to information such as its uses, where to find it, and ways you can benefit from it.

Good thing you know at least a little more than you used to — I hope that’s the case, at least!

Categories
From Personal Experience Harm Reduction

How to Use Naloxone

Simply having Narcan, Evzio, or generic injectable naloxone kits around isn’t good enough when it comes to effectively responding to opioid overdoses. Rather, the effective administration of naloxone in cases of likely or certain opioid overdose is more about being educated about such.

In my personal experience, drug users across Northwest Tennessee (NWTN) are typically not aware of what naloxone or Narcan is, let alone how to use it effectively.

As with everything else on this website, this publication is not meant to be perused or referenced as an authoritative source. You should use your judgement in determining to what degrees I’m correct, reasonable, incorrect, and unreasonable.

Without further ado, here are a few ways to use naloxone safely and derive more utility — “utility” refers to happiness or use people get out of things — from educating others about best practices in naloxone administration for opioid overdose and actually carrying out the procedure in real-life yourself.

Naloxone-Reversed Opioid Overdoses Cause Immediate Withdrawal

Opioid withdrawal syndrome, a medical term that might be referred to as being sicker-’n’-shit, is how a rural Tennessean might describe the opioid withdrawal experience.

If you’re not familiar with how opioid withdrawal syndrome plays out, symptoms gradually show up and slowly get worse from roughly 12 to 18 hours after one’s most recent opioid use and typically peak by the third or fourth day of withdrawals.

This type of opioid withdrawal, which occurs naturally, is medically known as spontaneous opioid withdrawal. The “spontaneous” in the phrase refers to the spontaneous cessation of opioid use.

The opposite of this natural, gradual accumulation of symptoms is known as precipitated withdrawal and is caused when opioid-dependent patients are administered a sufficient dose of naloxone.

One time, I overdosed on a heroin-fentanyl mixture and was brought back with 0.16 mg of naloxone or less. Despite the fact I should have experienced mild withdrawal symptoms after being revived with naloxone, I didn’t.

I understand drugs from a real-world perspective shaped by my tenure as a long-term drug user, having grown up with a super-problematic drug user for a mother, and my experience from having served Northwest Tennessee as an active advocate for harm reduction. I say this because you might pharmacologically understand opioids, opioid dependence, and naloxone use in opioid-dependent persons in response to opioid overdose symptoms — that’s something I don’t understand at all!

However, Usually Only If It’s in Doses That Are Small Enough

Picture of Narcan nasal spray.
Narcan nasal spray

Traditionally, generic vials of naloxone, Narcan, and Evzio have carried various naloxone dosages. Generic naloxone vials typically carry 0.4 milligrams. Narcan nasal spray carried 4 milligrams of naloxone per dose. The rarely-used voice-assisted auto-injector known as Evzio contains either 0.4 or 2 milligrams.

Evzio auto-injector

All of these doses are high in terms of what’s typically required to reverse opioid overdose in typical modern cases. A recent study carried out by the American College of Emergency Physicians reported that, when median intravenous doses of 0.08 mg naloxone administered in just short of 10 separated bursts in stop-and-go fashion, it was easier to not overdo it on naloxone, resulting in more favorable outcomes, often entirely avoiding opioid withdrawal symptoms — this was even true for opioid-dependent persons.

Which one is better:

• (1) Using just enough naloxone to bring someone back from an opioid overdose without causing precipitated withdrawals, though with higher risks of death?

• (2) Or using plenty of naloxone despite patients almost certainly suffering precipitated opioid withdrawal for about two hours — as far as naloxone administration is concerned?

I think we’d much rather have better outcomes if we stuck with number two. However, opioid use scenarios that are more controlled and better supervised, especially in the presence of a confident, experienced, and well-researched partner.

Also, as far as reliable-and-gentle average intranasal naloxone doses go — including both Narcan and with atomizer-equipped syringes filled with injectable naloxone — ideal doses have been shown to usually be around 2 milligrams naloxone administered intranasally. In such cases, per the aforementioned American College of Emergency Physicians study, researchers have found an 83% successful response rate with this dosing approach.

Knowing About It Isn’t Enough; Trainees Need Practice

Most people aren’t required to take prescription medicine that necessitates the use of syringes and injections into muscles, veins, or under the skin. Further, most people also aren’t intravenous drug users.

Generic, vialed naloxone must be injected either directly into a vein, which requires skill to do quickly, a muscle, or under the skin — respectively known as intravenous (IV), intramuscular (IM), and subcutaneous (SC) use.

Six-panel infographic with written instructions about using naloxone for opioid overdose.
Harm Reduction Coalition

Although both SC and IM administrations are easier and straightforward, people are prone to experiencing issues when administering naloxone without having physically practiced the motions of intramuscular, subcutaneous, or intravenous use. This is even true for naloxone kits that contain step-by-step, picture-based charts that inform people how to use naloxone to bring people back from excessive opioid doses as they read it — not requiring prior experience for most people, that is.

Get your hands on sterile water or, if that’s not available, cold tap water that has been boiled for 5 to 10 minutes immediately preceding its use.

Now, you’ll need to find one or more guides or other information sources for intramuscular administration. Peruse their steps, make mental run-throughs of carrying them out, and practice at least two intramuscular injections before considering yourself or someone else as being able to carry out the administration of naloxone for opioid overdoses. Also, since you should have more than plenty of vials of naloxone in your possession just to be on the safe side, you should be able to burn through anywhere from two to a few vials of naloxone in practicing how to draw up solutions into syringes from vials.

Real-world practice and having an army of tips built up from many academic sources form the ideal combination to serve as the foundation that supports the home of reversing opioid overdoses with naloxone.

Check Out This Unconventional Concern to Consider Regarding Injection Naloxone Use

The Internet is packed to the brim with helpful content regarding harm reduction and staying safe while using opioids.

However, one thing that I picked up from the real world that I’ve never seen mentioned online is that injectable naloxone is prone to causing syringes’ needles to break of as the result of opioid overdosers’ having regained consciousness. To better explain, as you might know, people brought back from opioid overdoses are often confused and sometimes don’t take well to waking up to being essentially pinned down and hovered over by one or more people who are usually strangers (e.g., emergency medical technicians).

Since you’ll never know exactly how people will respond to understandably-disorienting naloxone-aided opioid overdose reversals, intranasal uses of naloxone are safer than those involving syringes because of their potential spread of blood-borne diseases from getting poked by the syringe used to administer naloxone or the possibly-yet-unlikely incidence of hypodermic needles breaking off inside people’s bodies.

Should this be a central reason in determining best practices for naloxone?

No! It’s more of a novel, though very real, practically-minded idea that was presented to me by Melesa Lassiter, Tennessee’s Region 6N — Region 6N is one of 13 regions that the state’s 21 Regional Overdose Prevention Specialists are assigned to — Regional Overdose Prevention Specialist. She covers all of Northwest Tennessee, a nine-county area home to roughly 250,000 people.

I haven’t since heard or seen this idea anywhere else and, although it shouldn’t be a central factor in determining how we use naloxone, I feel responsible for fleshing it out for the World Wide Web to see.

Always Use Around Others

Without being supervised by someone who fits all three of the categories below, you’re setting yourself up for an increased risk of suffering permanent damage or death as a result of opioid overdose:

• Aware of your opioid use.
• Trained in administering naloxone during opioid overdose.
• Well-versed in spotting opioid overdose very quickly after happening.

Unfortunately, not all of us are actually able to regularly use opioids around someone else. Some of us are forced to use without hardly ever being supervised by someone who knows what’s going on.

Others, especially in NWTN, where stigmas are high and people are particularly incentivized to retain information regarding their drug among themselves and keep it away from most others, are able to regularly consume opioids around other people except those people aren’t trained in the use of naloxone or spotting opioid overdoses, let alone being aware when their drug-using counterparts consume opioids.

Another important part of responding to opioid overdoses is performing CPR, or, at the very least, rescue breathing until paramedics arrive, You’re not able to perform these basic medical procedures on yourself — while it’s possible for people to self-administer naloxone successfully in the prevention of imminent opioid overdoses, it’s actually physically impossible to be able to perform CPR or rescue breathing on yourself.

Of course, this is another important reason why you should avoid using opioids without active, ample supervision.

Just a Few

Depending on how you classify things, this text covers either four or five tips — just a select few — for using naloxone in response to opioid overdose. Either way, there are many other tips worth reading that will improve various factors regarding this application of naloxone — in other words, this article just scratches the surface.

If you learned something, carry it with you and try to spread the word to other people. Even if you didn’t, being exposed to how different people explain things is a good way to improve your efforts in educating others about harm reduction.

Categories
Drug User Advocacy From Personal Experience Harm Reduction

Real-World Things Anybody Can Do to Advance Harm Reduction

The idea that any one person can have an impact on the world is nothing short of a cheesy cliché. We often feel that, since just one person’s labors aren’t worth the minute overall benefit to society that they could yield, we shouldn’t even bother with them in the first place.

However, no matter where you live, there are things that you — yes, you — can do to advance the society-wide adoption of harm reduction-positive policies, practices, and ideas.

I’m in rural Northwest Tennessee (NWTN). People in Tennessee are relatively inactive in social causes like voting, for example, the state securing 49th place for voter turnout rates in the 2016 presidential election. The Volunteer State’s 2014 midterm election turnout came in 50th place at just 28.5% voter turnout.

With this in mind, it’s easy to understand how this commonly-held fallacy — that individual efforts are not worthwhile — leads to people not being involved in efforts such as harm reduction advocacy.

On the bright side, however, the less progress that’s been made in an area harm reduction-wise, the greater the impact that individual harm reductionists have.

Before listing off a few real-world things that anybody can do to become a real-life, true-blue harm reduction advocate, here’s one more thing to consider:

Forward-thinking, progressive ideologies are often unwelcome in the Southeastern United States. This is especially true in rural NWTN, as locals are more likely to view practicing harm reductionists and the cause’s supporters as “less” than people who don’t advocate for the better treatment of drug users.

This is one of many issues preventing the implementation of harm reduction infrastrcuture in the Volunteer State.

What Can You Actually Do to Advocate for Harm Reduction?

It’d be great if more people spent time advocating for drug users. Our efforts would yield fruit much quicker if this were true.

One thing’s for sure — you aren’t helping advance a social movement unless you, personally, are involved. You can have a material impact on society by advocating for this cause, given you do so in an effective, open-minded, fair, well-thought-out way.

Without further ado, here are several real-world, practical ways to actively advocate for harm reduction.

Share Information With Others in Support of Harm Reduction

Technically, sharing a supportive article or crafting a positive post from scratch on social media — whether it be Twitter, Facebook, Google+, or YouTube — is a form of advocating for harm reduction. However, in actuality, simply sharing things on social media in the modern world of mass social media use is one of the weakest forms of advocating for this cause.

When this activity is carried out, seemingly most social media users fail to present their opinions in warm, caring, open-minded, welcoming ways. Rather, they do so in a mean-spirited, off-kilter, rude manner. How can you possibly expect someone else to adopt your way of thinking by being mean?

You really do, in fact, catch more bees with honey than vinegar.

So, if you do share this information with others, make sure to do so in a fair way in which you understand the merits of both or all common arguments for or against such practices.

Keep in mind that you’ll need to study up on how to most appropriately share such information in your social media advocacy efforts. It’s most definitely not as simple as making a run-of-the-mill post as you normally would on Facebook or Twitter!

Become Active in Looking Out for News That Supports Harm Reduction

Letters to the editor go a long way, especially when done so in accordance with contemporary best practices. The best way to support such articles, programs, news segments, or radio broadcasts is promptly. If you don’t respond within a few days of publication, the potential utility of your efforts drops quite a bit.

News that packs a punch moves people to consume it and talk about it with others in a rapid way. Make sure to keep up with articles like these in real-time to get the most from telling such publications’ editors or other people of importance that you strongly support them. News agencies will be more likely to continue writing like-kind pieces soon with the more positive reports they receive.

Community members not aware of or big on harm reduction will become more familiar with its basic principles and real-world applications through running harm-reduction-related content more frequently.

After all, local news sources are trusted quite more than publications active on broader levels. Local publications often set the tone for topics of concern across communities throughout the United States, too.

Regularly Attend Local Governments’ Community Meetings

Municipalities value the input of residents regarding important things going on in communities throughout the Northwest Tennessee area — however, this further goes for everywhere throughout the United States.

When you regularly attend these events and become active in them in a positive, constructive way, others will grow familiar with you and come to value your role as a wanted community member. Put simply, your words will carry a higher exchange rate than your peers.

You’ll learn what’s going on around you. Without understanding where harm reduction currently is, appropriately selecting the means of becoming active in such advocacy efforts is difficult.

Educating others about your community’s harm-reduction-related issues is more possible when you keep up with these municipal get-togethers. If you don’t know what’s going on, how can you hope to teach others important local-level things in a reasonable way?

Donating to Harm Reduction Organizations

Let’s take Next Distro, for example. The highly-active distributor of harm reduction supplies like syringes, naloxone, and other clean, high-quality drug paraphernalia is unable to provide fentanyl test strips to all of their patrons en masse. They’re too expensive to afford, for them, in this example.

This happened earlier this year in my dealings with Next Distro, a provider of free supplies that I’ve trusted for a while.

To be fair, I’ve fnever donated to the organization. I’m not able to afford giving away money to any good cause. Either way, what I’m trying to say is that I’m as guilty as everyone else insofar as having not donated to Next Distro.

If more people donated to Next Distro, for example — the New York-based harm reduction supply distributor founded by Jamie Favaro, who has personally helped me gain regular access to free harm reduction supplies — fentanyl test strips, which are highly useful among opioid users — specifically street heroin consumers — in today’s domestic heroin market. This drug checking would ultimately help people stay safer, as well as potentially accomplish a few other goals.

Other harm-reduction-related causes that are good to donate to also take the form of government agencies and community-based organizations. Treat them in a similar manner.

Not Moving Our Cause Backward

One way that you can harm the greater cause of harm reductionists is to give us a bad name by being uneducated regarding the harm-reduction-related positions you discuss with others and doing so in an unfair, illogical way. Being an asshat won’t get you anywhere, especially in today’s dicey American political landscape — it’s one side versus the other.

We don’t need to talk about harm reduction in such a manner. Always try to see the merits in other points of view opposing those held by contemporary harm reductionists. Engage them in a curious, level-headed, nice way. Don’t ever insult others or talk down in a condescending form.

The last thing any of us should be doing is chipping away at the growing, cinderblock foundation upon which our proverbial home of harm reduction will be erected upon.

Give Out Syringes, Naloxone, and Other Supplies

If possible, you should consider distributing such supplies to drug users. Naloxone should also be distributed to laypeople, not just drug users.

Doing so may be illegal where you live. Always check state and local laws regarding the distribution of naloxone, syringes, tourniquets, glass pipes, drug-checking tools such as fentanyl test strips, and so on before doing so.

Even if it’s illegal where you live, you can often bypass such laws by becoming approved by your state or municipality to distribute such supplies or otherwise engage in harm-reduction-related activities.

Educate Others About Safe Drug Use Best Practices

Naloxone can’t, in practice, be self-administered by opioid users who experience overdose. Although research has outlined a handful of cases of naloxone self-administration during opioid overdose, it rarely happens in the real world.

Tell others that opioids should never be used unless users can be accompanied by at least one non-drug-using person who is willing to keep a constant eye on you for signs of opioid overdose. This person — or people, ideally — should be informed regarding the administration of naloxone, as well as what to do following administration.

These are just a few important best practices in drug use. Inform real-life peers about these things, or feel free to do so online.

If you don’t know things well enough to explain them in your own words, you’re not in any kind of spot to even attempt to educate others about such things — in this case, it’s harm reduction as related to drugs.

This Isn’t an Exhaustive List

By no means is this an all-out, full list of practical things anybody can do to engage in harm reduction advocacy.

However, these are a few good places to get started.

Do what you’re best suited to do! Please don’t resign to just posting about this stuff on social media, as it’s so ineffective relative to the other practices mentioned above. Wouldn’t it be a shame to be passionate enough about a subject like this to do advocate for it only to not engage in effective strategies?

It certainly would be a shame nothing short of a complete, utter waste of your time.

There are several other issues with posting opinions on social media and attempting to advocate for things you believe in. Just know that you should try to do other things, given that you feasibly can.

What Should You Take Away From This?

If you don’t know what to do, reach out to trusted organizations like the Harm Reduction Coalition and the Drug Policy Alliance, as well as smaller, locally- or regionally-focused non-profit organizations and government agencies like Middle Tennessee’s Street Works and East Tennessee’s STEP TN both of which are syringe services programs, and ask for help becoming an active advocate for harm reduction or drug policy reform. Individuals who are also passionate about this stuff are also willing to help you do so. You can meet reliable, well-versed, reputable people who know their stuff and who are willing to provide mentorship to eager, open-eared beginners like yourself by becoming active in harm reduction groups on social media and elsewhere online.

Forums such as Reddit’s Opiates subreddit, also known as r/Opiates, can be useful in finding this kind of help, as well as seeking out references and vouchers for various individuals, organizations, and agencies across the U.S. — and the world at large, for that matter.

Categories
From Personal Experience Harm Reduction

Why Name-Brand NARCAN® Is Worth the Extra Price

Fortunately, many government agencies, caring individual advocates, and non-profit organizations give out Narcan nasal spray for free throughout the United States. As such, most Americans won’t be forced to purchase naloxone as their only way of obtaining the opioid overdose antidote.

Some people will, however. Also, these agencies and non-profits often purchase naloxone as a means of sourcing it for distribution. They afford to make such purchases through grants and donations.

The Average Cost of Generic Naloxone Kits

Generic naloxone comes in vials containing small solutions of naloxone. This liquid is intended for intravenous (IV), intramuscular (IM), or subcutaneous (SC) use, though it’s also fair game for intranasal (IN) administration.

The IV, IM, and SC modes of administration requires syringes along with the vials of naloxone. Intranasal use requires syringes with removable needles replaced with mucosal atomizers, which spray the naloxone in a fine mist suitable for rapid nasal absorption. Some kits also include printed-out instructions for proper naloxone use along with easy-to-follow pictures.

No matter what, each of these four means of administering generic naloxone requires between two and three separate, freely-moving pieces that aren’t as easy to use as one-piece formulations of naloxone, such as Narcan or Evzio.

Narcan nasal spray unit in front of its packaging.
Narcan nasal spray

The United States Food and Drug Administration indicates that the average invoice price of a naloxone kit is $29, on average, here in the U.S. “Average invoice price” refers to the total cost of getting together suitable syringes, naloxone, and instructions for on-the-spot reference.

Name brand Evzio naloxone HCl injection, USP.
Evzio naloxone auto-injector
AP Photo/Cliff Owen

These are more difficult to use than Narcan or Evzio, for example. Many people who administer naloxone are anxious, even to the point of full-blown panic attacks. Simplicity is key insofar as best practices for naloxone administration are concerned.

Naloxone kits, in my experience, are the second-most popular naloxone formulations in Northwest Tennessee and likely elsewhere across the U.S.

The Average Cost of Narcan

Narcan is a name-brand version of naloxone that comes in the form of a nasal spray. The sprayer comes loaded with naloxone and ready for immediate use. It’s also foolproof, unlike generic naloxone kits.

It’s only used intranasally — sprayed into the absorbent mucosal membranes of the nasal cavity — via the nose.

The U.S. FDA reports that the average retail price of Narcan in the United States is $142 per two-unit packages. This equates to $71 per dose.

Narcan is easier to use than naloxone kits. It’s also more widely-known than Evzio or Narcan’s active ingredient itself, naloxone. Also, people are more willing to accept Narcan from active harm reductionists than naloxone kits because kits contain separate syringes.

This is due to the stigma that surrounds the use of syringes for illicit drugs across the United States.

Narcan is, in my experience, the most popular and widely-used version of naloxone in modern NWTN.

The Average Cost of Evzio

Evzio is an auto-injector, name-brand form of naloxone that talks people through the administration process. Evzio is rarely seen in practice due to its exorbitant cost.

The FDA reports that each single-dose unit of Evzio costs $2,321. The average retail price of two-packs of Evzio, in other words, are $4,641.

Out of these three forms of naloxone, it’s the least common by far.

Which One Is the Most Valuable?

Narcan is the most valuable — here’s why:

When people return from being unconscious thanks to opioid overdose, they sometimes have an urge to resist whoever administered whatever form of naloxone was used — in practice, naloxone is naloxone is naloxone, as it all has the same medical effect.

With naloxone kits, people who administer the injectable form of the opioid overdose drug are prone to stabbing themselves, other people who are present, or the person being revived themselves with the syringe that was used during administration.

This can result in the spread of disease and development of infection. Needles could get broken off inside the recipients. The syringes they use also pose much more of a threat than Narcan or Evzio if not properly disposed of.

Evzio may help especially-nervous people through the process of administering naloxone, but it’s simply too expensive for how much value it delivers.

Narcan is roughly between three and five times the average cost of naloxone kits that use injectable, generic vials of naloxone.

However, the value derived from Narcan, which exists on multiple other levels, at this price is simply worthwhile for many buyers of the drug. They can also receive government assistance in paying for naloxone, as well as specifically for name-brand Narcan.

All Considered

At the end of the day, some naloxone is better than none. However, Narcan is a cost-effective formulation that offers several real-world benefits to generic naloxone kits and Evzio.