Categories
Harm Reduction

The “Community Guide”

Jane, 52, is a long-term sex worker and often-problematic drug user. She preferred cocaine for some two decades, drifting in and out of jail, rehab, and places to stay along the way. Now, she uses heroin to treat her chronic pain. I believe the unfortunately-illicit opioid satisfies her nearly-lifelong craving for stimulants, although she still uses meth from time to time to scratch that proverbial itch.

Jane, a tried-and-true oldhead, distributes more safe drug use supplies throughout Northwest Tennessee and Jackson-Madison County than likely anybody. Well, I’m sure her numbers are behind Northwest Tennessee’s sole Regional Overdose Prevention Specialist — who only distributes naloxone, might I add — but she’s up there.

How did Jane, a “community guide,” become a leading figure in drug-related public health here in rural West Tennessee, yet still not be employed, commended, or even recognized for her contributions?

The answer lies in the intersection of Tennessee’s painfully-slow response to the opioid epidemic and its unusually-harsh criminal justice-social services alliance. Oh, and the fact that rural communities in the Volunteer State still don’t have a single syringe exchange. Y’know, problems with community buy-in and stuff like that.

Introducing the Community Guide

Other harm reductionists and public health officials have long aligned with well-connected sex work/drug-involved people like Jane to further distribute safe drug supplies and, thus, reduce transmission of blood-borne diseases like hepatitis C and HIV, encourage drug-involved people to improve their lives, and all that good stuff.

Yet, I haven’t seen anybody define the role that Jane plays here in Northwest Tennessee. Or anywhere else. I think “community guide” is a fitting term because, although Jane might not have the glowing reputation of a mayor or city council member, she’s super-integrated in Northwest Tennessee’s sex work/drug-related underworld.

Tennessee, as well as every other government or government-related entity in the realm of public health, needs to begin using — hell, not “using,” but employing — people like Jane as community guides to start reaching the most deprived members of society, those that the criminal justice-social services alliance has done nothing but harm.

Categories
Harm Reduction

Harm Reduction Isn’t Inclusive — Here’s Why

Right off the bat, let’s get shit straight. Not everybody in harm reduction (HR) is unwelcoming. Not everybody in HR has shut out me or my opinions. Not everybody in HR has been uninclusive. Many people in HR have been good to me — or, at the very least, fair. I hope to be involved in HR until we’ve achieved the fair treatment of drug users across the United States. This is the only thing I’ve ever had a passion for.

When I say “harm reduction isn’t inclusive,” I mean this: Because some of my opinions haven’t fit the mold of the average American (or Canadian) harm reductionist, they have been written off by some or even most of the HR community. Not only that, I fear my reputation has been irreversably damaged by well-known community members — particularly one community member — speaking out against me. I worry this may also happen to others who wish to get involved in HR, especially those in rural, largely-right-leaning America. These areas, which make up the bulk of the United States, currently aren’t well-represented within HR.

Let me be clear:

  • The primary goal of this article is to ignite the discussion that the HR community might not be as inclusive as it wants to be.
  • Ultimately, I want to de-homogenize HR. In other words, I hope more diverse viewpoints will enter the fray, particularly those of people from rural, largely-right-leaning America; this will result in the tenets of harm reduction being adopted (1) more widely and (2) more extensively (in other words, people will adopt more of our views as opposed to just one of our views) by people in rural, largely-right-leaning America.

I’m choosing not to call anybody or any organization out by name — I don’t want to play into “call-out culture.” If I did, I’d be guilty of the same convention I’ve fallen victim to. Even if I were okay with calling others out and causing harm within my own community, that’s not my goal here. I also don’t want to identify those who have treated me well out of fear they, too, might face pushback from the community or its members.

Most of this article doesn’t chronicle my subjective experiences in harm reduction. Rather, the first several sections investigate the nature of HR, commonly-shared characteristics among harm reductionists, problems newcomers to all communities face, issues with entering communities online (specifically on social media), and human nature in general.

Again, I don’t want to push us apart. I want to bring us closer together. In order to become more inclusive and improve the adoption of HR across the country, we must examine ourselves and HR at large.

Understanding the Nature of Harm Reduction and Commonly-Shared Characteristics Among Harm Reductionists

The American mainstream has long written off drug users. Of course, alcohol, coffee, and tobacco are okay, but anybody who uses anything else is nothing short of a dirty, degenerate dopehead!

Of course, I don’t believe this, but the American mainstream long has — and, in large part, still does.

Harm reduction, although there isn’t a single widely-accepted definition, has included people who’ve long been cordoned-off from society — particularly people who use drugs (PWUD). PWUD who are interested in HR or who’re active in the field often fit the bill of “long-term, often-problematic drug user,” just as I do.

I became interested in HR after learning about it on Reddit’s r/Opiates subreddit some three or three-and-a-half years ago. I often visited r/Opiates and other drug-related subreddits because I felt as if I couldn’t talk about drugs IRL (in real life); further, there wasn’t enough solid information about drugs IRL, nor was there enough of it.

I love that HR welcomes people who’ve long been considered worthless or who’ve otherwise been unwelcomed by the rest of society.

However, when opinions that even kind of resemble those of the mainstream — those that people have faught against for decades, literally decades, before I became interested in HR — are floated in HR, they’re sometimes (if not often) met with disagreement, if not hostility.

The divisiveness of the modern American political landscape doesn’t help, nor does the fact that many (if not most) discussions about HR take place on social media. I don’t know how social media lends itself to divisiveness, but it unarguably does. Further, the fact we’re still living in the times of “cancel/call-out culture,” which arose around 2014, doesn’t help. If you’re not familiar with call-out culture, people get career prestige points by calling out others who don’t share similar opinions — so, even if someone doesn’t like the idea of dogging someone online (or IRL), they’re incentivized to do so; even further, further, it’s not just the missed opportunity of career prestige that’s at stake — not calling someone out can implicate a community figurehead (or even an average community member) as being complicit in fostering “uninclusive” or “microaggression-friendly” or otherwise-bad environments.

Many — I’d go as far to say most — harm reductionists have faced substantial drug-related harms in their own lives. Who else would be pushed to openly supporting “radical” things like syringe exchanges or supervised consumption sites? Again, I don’t consider these things radical, but it’s safe to say most people do.

Harm reductionists are sensitive to people, organizations, government agencies, and groups that could take away what they’ve worked so hard to secure. Wouldn’t you exercise caution, yourself? Or distance yourself from people who claim to be down with the cause but seem to have ulterior motives?

The Very Real Disadvantage of Being a Newcomer

This goes without saying, but newcomers to any community are discouraged from sharing unpopular opinions or sticking up for anybody — especially those who’ve been “canceled.” This is especially true online.

Newcomers to communities are likely to be scrutinized before being embraced. This makes newcomers less likely to share their opinions on hot-button topics or that are otherwise potentially-controversial than established community members.

Even then, established members are unlikely to speak out on topics for which they hold views that differ from the average community member. For example, in HR, a field that has little funding or employment opportunities, people who lead or work for funded organizations are unlikely to challenge popular opinions or otherwise “break the mold” out of fear they’ll lose funding, have their pay docked, be put on administrative leave, or outright fired. This can result in reduced community participation. Socially-astute individuals will “play the game” — they’ll unquestionably embrace widely-held opinions, avoid rearing hard-hitting questions, or even tolerating important conversations that seek to change long-held group norms.

We all “play the game.” In our lines of work, whether HR-related or not, we put our heads down and do what’s best for self-preservation. Well, at least anybody with half a brain would “play the game” (whatever that means). My dad has told me that dozens of times — “Just play the game, son, you’ll get farther in life. I’ve done it. You need to do it, Dan, just get with the damn program!”

Note: My dad is awesome and I love him very much. Rhetoric like this comes from nothing but the best place; he wants to see me succeed, and we all need people in our corners who’ll tell us shit that might be hard to listen to — shit that damn near nobody else is willing to tell us.

Newcomers Are Especially Disadvantaged in Online Discussions and Largely-Web-Based Communities

Like I said earlier, newcomers to any community are likely to go through an informal probationary period where established community members judge whether they’re worthy of inclusion. This isn’t an HR-specific thing — it’s a humanity-wide thing.

Online, we can actually quantify how well community members are supported in the form of post engagements, favorites, likes, reactions, shares, retweets, replies, followers, friends, and so on. Even if nailing down precise community support figures is difficult, it’s easy to gauge where community members stand on the proverbial totem pole.

Assume a newcomer shares an unpopular opinion in good faith on Twitter, Facebook, or in an email-based Google Groups community. The opinion has been developed over many months or years and was shaped by the newcomer’s real-life experience. The newcomer tries to be friendly, respectful, and level-headed in how they approach the issue. Do you think the newcomer’s idea will be taken seriously or given merit? How about if a well-trusted, long-established community member shared the same idea? Which one would get more community support for the same idea?

Almost certainly, the community figurehead — they don’t have to be a true figurehead for this example to work; just a well-trusted member of the in-group — will find more support for the same idea.

Newcomers are likely to get discouraged from sharing their off-kilter ideas after just a few unsuccessful tries — hell, maybe even after just one try!

If community support is the goal — of course, social inclusion is a basic human want, so doesn’t everyone operate with community support in mind? — community members are incentivized to discuss safe topics rather than veering off the well-trodden path.

“Just play the game,” right?

Isn’t that something we all do? Especially when we first get a job or start hanging out with a new group of friends — don’t we all do things to promote or, at the very least, protect our perceived value?

Don’t get it twisted — “playing the game” isn’t bad. It shouldn’t be frowned upon. Doing tried-and-true things in the interest of self-preservation is as old as humanity itself. If I knew what’s good for me, I’d play the game myself. That’s actually how I got into writing: I wanted to do something from home and travel to work, wear uniforms or adhere to dress codes, punch time cards, or put up with potentially-asshole bosses — I could make much more if I just played the game.

The “Rock-Star Effect”

Again, many people who’re active in HR have long been mistreated. They haven’t been included elsewhere. Wouldn’t you be protective of the one place you call home? I would, that’s for damn sure.

Some people in harm reduction have amassed relatively large, loyal followings over the years. I don’t think any of these people got into HR because they saw an opportunity to become a “rock star” — rather, they got involved because they’ve personally been adversely affected by drugs and wanted to spur change.

HR is one of the few spaces former/current drug users and sex workers can be accepted in — at least be accepted for who they truly are. These “rock stars” are largely responsible for gatekeeping, or deciding who can become bona fide members of the HR community and who can’t.

Calling people out for their mistakes — hell, even their unpopular opinions, even if they were expressed in good faith — is a form of fodder for HR rock stars. Do all harm reductionists with substantial followings or in-group clout “cancel” fellow community members? No. However, “cancel culture” has piqued the interest of countless pop culture fans over the past few years. Emotionally-dense social media posts involving “cancellations” disproportionately elicit likes, shares, responses, and other interactions from interested community members.

Of course, no “rock star” would turn down a chance of openly, harshly criticizing someone. After all, it drives social media engagement like wildfire. Further, as mentioned earlier, community figureheads can be held responsible by other community members if they have a chance to “cancel” — or call them out, in other words — someone and choose not to.

Are most HR “rock stars” aware of their “rock star” status? I don’t think so. However, we can’t deny the influence of social media engagements over our actions. We all do things on social media with the intention of eliciting attention from others in the form of sweet, sweet post engagement. Even though I like to think I’m better than that, I’m no different.

Reliving Trauma When Facing Viewpoints That Our Oppressors Have Used to Keep Us Down

Trauma, contrary to popular opinion, isn’t tucked away in the mind; rather, we physically relive trauma when triggered. Once a spouse is undeservingly yelled at or beaten, they relive the horror of seemingly-inescapable domestic abuse every time someone yells at them. I’m not a psychologist, so I can’t explain the mechanisms behind this phenomenon, but it’s true — trauma is stored in the body, for lack of better words.

HR community members aren’t used to seeing opinions that break the mold. When they are, they’re especially averse to idly letting them pass by without openly criticizing those views — and oftentimes their creators in ad hominem fashion. Even though damn near all of us know that personal attacks aren’t logical or cash money, we’re still prone to insulting people, rather than reasonably deconstructing their ideas, particularly when sensitive topics are at play.

If I say drug users should take more responsibility for their actions, it’s easy to understand why harm reductionists might take offense. This sounds like something a police officer would say to someone arrested for drug possession while transporting them to the local jail, or a loved one — y’know, one of those who thinks doing anything for someone in active addiction constitutes “enabling” behavior? — might offer up to a drug-addicted family member.

I better understood such outlash once I learned that trauma was stored in the body — and our emotions can easily overtake reason, which is even more likely when such a super-sensitive topic is at hand.

Why Are Most Harm Reductionists Left-Leaning and Seemingly Not Familiar With Rural, Largely-Right-Leaning America?

Admittedly, I don’t have any research to back any of this shit up — I think all of my assertions and postulations are well within reason, though — but most harm reductionists aren’t just left-leaning, they’re largely-left-leaning. They’re used to hearing accusations of being “radical,” whether or not they actually are. This long-term mmmmmm-blockin’-out-the-haters (Brandon Bowen’s Vine, remember this one?) is conducive to not accepting differing viewpoints now or in the future, especially when surrounded by fellow harm reductionists.

But, seriously, these people are used to fighting opposing viewpoints. That’s how they got here to harm reduction. They’re still used to fighting opposing viewpoints. Can you see how this would breed intolerance, despite how inclusive people in this space strive to be?

Many, if not most, people in HR are from areas that are left-leaning and already have HR-type resources in place. Whether or not these resources were in place when they started isn’t relevant, in my opinion, because you can’t draw parallels between ass-backwards rural Tennessee and, I dunno, fuckin’ Massachusetts 20 years ago.

Here’s My Point

It’s been difficult for me to share my opinions within HR. Just to put a timeline on things, although I’ve been giving out supplies and educating people about drugs for much longer, I started writing about HR-related issues as Daniel Garrett (that’s my government, in case you’re wondering) around November 14, 2019. I did so to let others know that I’m out here putting in work. How else would people know I’m here? The grapevine ain’t that long.

When I try to stick up for Poor Whites or say that shit really is that different here in the rural South… it’s difficult. Because some of my opinions — like we often-problematic drug users should, in fact, try to be more responsible for our actions — I’ve been widely unwelcomed to the space of harm reduction.

I thought this space was inclusive — but I gets no clout tokens for growing up bisexual in rural Tennessee, being involved in sex work for some four years, having used drugs in an often-problematic fashion for a decade, nun-a-that. And that hurts. It’s so tempting to give up this HR shit. To give up being the only motherfucker in Northwest Tennessee giving out syringes and shit, which I’m doing on an unpaid and unfortunately-illegal basis. Don’t forget I’m on two probations. I often hear people say they’re willing to go to jail for this shit — have fun with that! I went to jail for the first two times in 2019 and I’m too much of a pussy for that shit. It’s in my best interest to never illegally distribute another syringe, but I know I’ll be doing this for a while — no matter how difficult it is for me to spread my unconventional opinions in this space.

And hopefully, one day, I’ll be able to help some other youngblood find his footing in this very space. Maybe even for sharing unpopular, somehow-controversial opinions.

Here marks the end of the article. If you’d like to learn more about my subjective experience, keep reading.

My Experience With the Harm Reduction Community

I’ve been giving out safe drug use supplies for about two years now. Much of the syringes, naloxone, fentanyl test strips, etc. I’ve given out have come from a mail-based supply distributor based in New England. I don’t want to name them here because the outfit isn’t supposed to mail supplies outside of the state they’re located in.

In the past few months, two individuals — one in Washington, one in Indiana — have sent me a collective 3,000-or-so syringes, not to mention single-use bacteriostatic water containers, tourniquets, cookers, cottons, fentanyl test strips, antibiotic ointment, and even condoms (I’ve never really given out condoms, as they’re already widely available here; I’m primarily interested in giving out supplies that aren’t often available active drug users in rural West Tennessee).

I haven’t paid a dime for these supplies.

I’ve had long, rousing, stimulating chats with dozens of harm reductionists online and over the phone. I only came across these people on social media — I’d “cold messaged” them on social media or via email and, luckily for me, they were willing to entertain my requests for help. I still keep in contact with some of these folks today.

Through Facebook, I reached out to a lady in East Tennessee, some six hours away from me, who I heard was involved in HR. Over the past 15 months or so, she’s taken me to two HR-related conferences and given me other opportunities that I wouldn’t have had otherwise. In a field that’s full of organizations “held together with twigs and bubble gum,” as a more-experienced counterpart told me in late 2019, I’ve found several diamonds in the rough who’ve done a whole lot for me.

Don’t mischaracterize my words and say I hate all harm reductionists and they’re all pieces of shit — that’s not at all the truth. Like all humans, most people have good intentions.

However, due to several factors already mentioned — not all of which are HR-specific, as you might recall — as well as the fact that most American (and Canadian) harm reductionists are largely-left-leaning people, I think the modern HR community isn’t as inclusive as its membership thinks it is.

Here’s an Anecdote

Back when I first got active in HR circles on social media, I challenged someone who said something I didn’t agree with.

The other person was a panelist at a rural-oriented, HR-related speaking engagement at November 2019’s International Drug Policy Reform Conference in St. Louis, Missouri, which was put on by the Drug Policy Alliance. They shared some solid advice at the event and I looked up to them. On Twitter, they quoted an article in which a licensed social worker and state public health official stated that “[Naloxone] is not meant to be the solution to a person’s overdose.”

The state official was more or less saying that, while naloxone should be readily-accessible and is a useful tool in reversing opioid overdose, it shouldn’t be the cure-all for dealing with opioid addiction or otherwise-problematic opioid use.

I agree with this statement. Although I’ve been revived from opioid overdoses thrice with naloxone and even though I give the life-saving drug out to fellow drug users and laypeople throughout West Tennessee, I think we should invest more in programs that intervene early on in children’s, teens’, and young adults’ lives; schools should expand sports programs to include more than basketball, football, and baseball (which seem to be the Holy Trinity here in the South); and so on. Will this solve drug addiction or otherwise-problematic drug use? Of course not. However, I think such measures will reduce problematic drug use. These solutions resonate with me, particularly, because I wasn’t involved with any social programs in school outside of basketball for one year (I wasn’t good enough to make the team again), I wasn’t engaged in many healthy activities, I didn’t have a mom for the latter half of my childhood (the full list is rather lengthy; I’ll stop here for the reader’s sake). I picked up drugs because they satisfied otherwise-unmet needs in my life. I actually ended up attempting suicide at 16, almost certainly due to a many-layered combination of intersecting issues in my life at the time.

Note: The article doesn’t specify what is meant to be the solution to opioid overdose, but I assume medication-assisted treatment and improved early-life social involvement are both fine alternatives — though they aren’t alternatives for reversing opioid overdose (that’s naloxone’s job), exactly, we’d rather not have people experiencing overdose in the first place. I do agree that naloxone should be the first-line reactive (rather than proactive) treatment for opioid overdose.

I piped up — this was on Twitter and I had, like, literally zero followers at the time; I just made my account a few minutes prior — and argued the state official’s ideas were worthy of merit. I was shamed for not understanding (illicit) opioid use here in the United States and also advised not to speak to women if I wasn’t spoken to first. The Twitter user got several favorites, retweets, and co-signs from fellow harm reductionists and other people who’re interested or active in public health, medicine, pharmacy, and related fields.

Of course, I got zero.

Some More Anecdotes

I won’t explain these as extensively as the story above — it’s just not necessary. Just know that sharing off-color opinions within this community has proven difficult for me.

Even though I’m openly bisexual, I’ve been called a “cis White male” by people who know I’m bisexual at least a dozen times, likely more. And this isn’t in general — this is only within the HR community. If these people weren’t aware of my sexuality beforehand, once I made it clear, they still denied that I could take the title of “queer.”

Sometimes, when I share opinions that unarguably fit that of the average harm reductionist, I’m shot down just because people recognize that others have said bad things about me. This holds true when others share my writing or interact with me.

I’ve been told several times that people won’t associate with me openly because of the bad reputation I’ve picked up for myself. So, they feel like shooting down my viewpoints are necessary to avoid being viewed as guilty by association.

In my time as a harm reductionist, I’ve never heard anybody talk about Poor Whites — actually, yeah, I heard one talk of Poor Whites at a conference/convening back in March. Outside of that, it’s only been about racial justice.

I don’t like dwelling on this shit. I don’t wanna think about it anymore. There are dozens, if not hundreds of times where others in HR have wrongly slighted me or not given me the chance. I haven’t yet mentioned that time that one popular harm reductionist called out my writing and got hundreds of comments and hundreds of likes on her posts for “canceling” me. I still face the fallout of that today. Just for having a different fucking opinion.

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Categories
Harm Reduction Vaping

We Gotta Start Associating Harm Reduction With Tobacco and Vaping More

The phrase “harm reduction” is most often associated with drugs and, to a much lesser extent, sex work — specifically, street prostitution and escorting as opposed to web-based, non-contact sex work — here in North America.

So much of our struggle as harm reductionists comes from trying to get our fellow laypeople rolling with SS Harm Reduction. Really, most of us who want to help drug users are interested in drug policy reform, drug user advocacy, and harm reduction, but most of us tend to lump it all under the umbrella of “harm reduction.”

Like damn. Those three are wayyy too fuckin’ long to say together just to identify ourselves.

Anyways.

I live in a rural, largely-right-leaning area that has virtually no HR infrastructure. You can imagine how few people are on board with harm reduction in bum-fucked-Egypt — in this case, BFE is Northwest Tennessee; my fellow injection drug users aren’t used to being able to source syringes in an above-ground manner. We’re used to the social services-criminal justice alliance not treating us right — why would we trust anything that seems too good to be true?

When it comes to my efforts in “drug stuff” — the aforementioned trio of things that help drug users — I feel like I’m responsible for making sure HR itself (i.e., mentioned by name) and HR-positive ideas thought of by people who don’t label their actions “harm reduction.”

We Gotta Normalize HR

People in the largely-right-leaning areas that dominate the United States by land mass are averse to ideas that seem overly left-leaning or excessively politically correct.

The modern American political landscape is more divisive than ever — check out this minute-long video that uses imagery to show just how discordant (yes, fancy word, I have big brain) we are in these times.

Social media also contributes to divisiveness among Americans. I don’t know what characteristics of social media lend themselves to this gross argumentativeness, though I know it’s true.

Also, I think largely-right-leaning people are all but averse to “radical,” high-level harm reduction applications like supervised consumption sites or safe supply; however, they are, in my opinion, likely to see the merit in switching to vaping largely-harmless nicotine solutions from smoking tobacco, which exposes smokers to dozens, if not hundreds of carcinogens. Hell, I’d think that many Americans wouldn’t even be down with syringe exchanges.

With such barriers in mind, it’s absolutely essential that we actively start involving tobacco and vaping in general harm reduction messaging. And, I’d go as far to say that harm reductionists, as individuals, should strive to associate entry-level harm reduction applications — or low-hanging fruit on the proverbial harm reduction tree, in other words — like switching to vaping from smoking or making sure to pace alcohol consumption and drink water in between every alcoholic drink, for example, with the phrase “harm reduction.”

In other words, if it’s appropriate for you to mention these entry-level ideas alongside “harm reduction,” do it! If more of us adopt this habit, we’ll undoubtedly improve the spread of harm reduction.

Not-So-Guilty by Association

Although tobacco so reliably causes cancer and other often-fatal health problems, since the drug is legal and has long been socially accepted by Americans from Fairbanks to Miami, it’s viewed many times more favorably than just about all illicit drugs.

The most widely-recognized application of harm reduction here in the United States is — and this is whether people actually think of it as “harm reduction” or not — switching from dip, chew, or another form of tobacco in favor of vaping.

Already, I can see how some people might not want to mar together the two worlds of (a) “hard” drugs that are viewed as inherently bad or high-level, “radical” ideas like supervised consumption sites and (b) basic, common-sense strategies that the American public is generally already on board with. Admittedly, it does seem disingenuous to associate non-radical, non-“hard”-drug-related ideas with what we’ve come to accept as “harm reduction.”

However, isn’t our cause as harm reductionists to help as many drug users as we possibly can to the greatest extent achievable? I think it is. Wanting to actively avoid easily-achievable, entry-level applications of harm reduction in favor of their way-more-advanced counterparts isn’t based upon solid reasoning — there’s nothing wrong with working smarter, not harder.

Well, at Least a Little Guilty

Vaping doesn’t have a smooth, buttery-soft image, unfortunately. Throughout 2019, people across the country developed often-serious pulmonary injuries, dozens of which died. News reports incorrectly linked the injuries to regular-ol’ vaping — the vaping smokers and dippers use to get clean of tobacco, that is — to the lung injuries. In actuality, the bulk of the injuries, if not all of them, were caused by counterfeit cannabis concentrate cartridges.

With legalization and regulation, states’ cannabis industries have become just like any other consumer goods market. Rather than, for example, cannabis concentrates being made in unregulated, illegal, often-unsafe makeshift labs and packaged in whatever’s convenient, these legal state markets offer branded products to customers.

You likely know that legal cannabis markets’ wares are often super duper pooper scooper mooper super fuckin’ expensive. Many people have eschewed the legal, well-regulated state cannabis markets in favor for the black market cannabis they’ve grown up with. With these two factors comes a perfect storm for tons of counterfeiting — and that’s exactly what caused the 2019-2020 vaping lung illness outbreak (that’s not my name for it; I ripped the name from Wikipedia), or so we think.

Admittedly, I’m not a vaping expert — I’m pulling this info essentially straight from Wikipedia. Centers for Disease Control and Prevention believes that patients who presented symptoms of vaping-associated pulmonary injuries were often exposed to cannabis concentrate cartridges that used abnormally-high proportios of vitamin E acetate, a thickening agent that’s regularly used in cannabis concentrate cartridges.

Usually, such cartridges wouldn’t contain more than 20% vitamin E acetate. Many illicit cannabis concentrate cartridge sellers were using vitamin E acetate to the point that cartridges were made up of at least 50% vitamin E acetate.

Vitamin E acetate is used because, to the untrained eye, it closely resembles THC oil, the most common cannabis concentrate.

Most Americans, so it seems, aren’t aware of the fact that counterfeit cannabis products were widely associated with observed vaping-related pulmonary injuries.

Ultimately, the vaping lobby ended up taking a net loss in terms of reputation. Still, it’d be beneficial to us to associate our cause with entry-level HR applications like this.

Associating Harm Reduction With Protective Measures Against COVID-19

Of course, global pandemics don’t come around too often. Like all of us, I hope the threat of catching COVID-19 goes away super soon.

However, while the pandemic is still very much in full swing, we should seize the opportunity to associate “harm reduction” with any and all entry-level, common-sense applications (e.g., wearing face masks or respirators, offering free novel coronavirus test facilities) that virtually everybody will recognize as effective.

And, just so we don’t get confused, potentially-controversial measures like forced stay-at-home orders shouldn’t, in my opinion, be linked to “harm reduction” — it seems like right-leaning people are responsible for much of the stay-at-home order protests; since we already desperately need to involve right-leaning people (especially those in rural areas) as harm reductionists, distancing ourselves from supporting such stay-at-home orders might be a good idea.

In Other Words, Let’s Make Harm Reduction Not Necessarily Drug-Related

If we could collectively brand “harm reduction” as a collection of common-sense, practical strategies for reducing all sorts of harms — not just drug-related harms — we’d be so, so much better off.

And, to be clear, I’ve already seen people associating the phrase “harm reduction” with the measures mentioned herein. But these harm reductionists are the exception, not the rule.

Lastly, since the vaping/smoking thing isn’t exactly in most harm reductionists’ wheelhouse, a lot of us — me included — might have to educate ourselves before we start making these associations publicly.

I want to hear what you have to say on this issue. And, no, this isn’t some generic call-to-action I close all my articles with; I really, really do value the community’s insight on this issue.

Categories
Fentanyl Harm Reduction

An Easy Guide to Understanding Why Fentanyl Is So Deadly

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

What Is Fentanyl?

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

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

Why Are People Dying From Fentanyl?

Opioid use is popular right now in the United States. Heroin is used by many in place of prescription opioids. Most heroin found in the modern American opioid supply actually contains a mixture and fentanyl and heroin. Fake prescription opioid tablets marketed as real ones are used similarly.

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

Even if people are prepared to use fentanyl, it’s so potent that measuring out accurate doses is difficult. Also, because heroin, fake opioid pills, and other illicit drugs aren’t made in safe, regulated, pharmaceutical-quality environments, one customer could get sold product that has several times as much fentanyl as another. Concentrations of active ingredients like fentanyl are called “hot spots” among people who use drugs (PWUD) like me.

How Does Fentanyl Cause Death?

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

Oftentimes, fatal opioid overdoses result from a combination of drugs, not just opioids. Also, all opioids can cause death — not just fentanyl.

PWUD Don’t Know How to Stay Safe

I’m a long-term opioid user. My history includes over three years of heroin use — intravenous heroin use, that is — and three overdoses. Today, I do things like give out free, clean syringes and naloxone (the opioid overdose antidote) and educate people how to use drugs safely.

Why do I do this? Because dead people don’t recover.

Up until just three years ago, I wasn’t aware of how to stay safe while using drugs. All I knew was that drugs are bad and that I shouldn’t be using them in the first place.

There are many, many issues that plague modern American opioid users. The solutions below aren’t a cure-all in any way. If you know somebody who uses opioids — including yourself — these things can help keep you safe:

  • Enroll in a medication-assisted treatment (MAT) program immediately. In the United States, buprenorphine and methadone are prescribed as an alternative to other opioids. One way to find these programs is through this free tool.
  • Get naloxone (Narcan) immediately. In Martin, Tennessee, where I am, for example, you can hit up Melesa Lassiter, Northwest Tennessee’s Regional Overdose Prevention Specialist, for free Narcan. Live somewhere else? Visit naloxoneforall.org for state-by-state information about where people can access in-person naloxone and other free resources.
  • Use around at least one other person who knows you’re using, knows how to use naloxone, and isn’t also using at the same time as you.
  • Get fentanyl test strips. The ones I’m familiar with are the green-label “Rapid Resposne 1 Strip.” Find them from harm reduction organizations like FentAware (though only 6 at a time) for free, or from health product supply stores online. DanceSafe has got some, too.
  • Always assume any drugs you use contain fentanyl.

It’s always safer to not use drugs than to use drugs. Even if you follow the precautions above, it’s still possible to overdose. I don’t condone drug use. If you haven’t already started using drugs, please don’t use.

Categories
Harm Reduction

Why We Need “The Big Book of Harm Reduction”

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

I still haven’t found it.

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

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

Here’s What I’m Trying to Say

We need to collectively build “The Manual of Harm Reduction.” It’ll help mobilize grassroots harm reductionists like me and the many drug-related organizations that are held together with twigs and bubble gum — and that, unfortunately, happens to be a lot of them.

How can we go about doing this?

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

One thing I think we need to do for sure is start talking about “The Manual of Harm Reduction” among fellow harm reductionists.

What Might “The Manual of Harm Reduction” Look Like?

Most likely, we’d have a collection of essays and articles as opposed to a textbook-type thing. In order to decide what issues and pieces of work are most important, we’d get together and decide what’d make a final, more-condensed version.

It also might behoove us to categorize “The Manual’s” content by location, if not come up with an entirely separate manual for places like the American South.

But Most Importantly…

You need to start talking about the idea for “The Manual of Harm Reduction,” or whatever the hell you wanna call it. It doesn’t matter what we call it — and it also doesn’t matter who gets credited for this idea.

In other words, don’t float this as Daniel Garrett’s idea — rather, consider it the entire (North) American harm reduction community’s idea.

Categories
Harm Reduction The Volunteer State

Why Tennessee Lacks a Harm Reduction Infrastructure

Here in Tennessee, we ain’t got shit in the way of harm reduction. We’ve got six syringe services programs (SSP). And other than the often-exclusionary 12-step programs, the outdated rehabs, and the entirely-bullshit drug courts, probation, and parole programs, that’s about it.

But why? Why is Tennessee — and much of the South, particularly the rural South, by extension — so ass-backwards when it comes to harm reduction or drug policy? Why don’t we have what New York, California, or Washington has?

Is it because we’re evil?

Maybe because we hate “druggies” like me, the stereotypical behavior of which I’ve exemplified hundreds of times?

Or is it for other, more practical reasons?

The “Radical” Nature of Modern American Harm Reduction

Person holding three used syringes giving them to somebody with an open hand.
Syringe exchange in action in Burlington, Vermont. (Robert Nickelsberg/Getty Images)

Things like syringe exchanges, widespread drug-checking, supervised consumption sites, and access to a safe drug supply have long been viewed as “radical.” Of course, I don’t think they’re radical, nor do anybody else who considers themselves a “harm reductionist.”

However, the majority of Americans, especially Republicans and other right-leaning people, definitely do consider some or all of these things “radical,” even though two-thirds of Americans don’t support the criminalization of now-illicit drug possession and only one-tenth believe the War on Drugs is a success.

Areas that are more left-leaning than Tennessee have been more open to things like harm reduction-positive ideas, practices, and policies. These ideas have traditionally been a left-leaning thing — that’s the simplest way I can put it.

Politicians, Stakeholders, and Other Decision-Makers Have Pushed for Ineffective Approaches

Second, not only have right-leaning politicians and stakeholders failed to support effective strategies for dealing with drugs, they’ve actively campaigned for ineffective, largely-prevention-based strategies that actively hurt drug users like me.

Here in Tennessee, prevention coalitions are quite popular. According to the Tennessee Department of Mental Health & Substance Abuse Services’ “Substance Abuse Prevention Coalition Provider Contact List” — god damn what a mouthful! — there are 46 local prevention coalitions across the state, plus two statewide outfits.

We’ve got Prescription Drug Take Back Day, which raises awareness for dozens of secure prescription drug disposal bins around the Volunteer State, though they don’t accept syringes. This leads injection drug users like me to improperly dispose of syringes, sometimes throwing them on the roadside out of fear of being caught with them and catching criminal charges, having friends or family discover their injection drug use habit, or incur a work-related issue.

The Volunteer State is also home to 21 Regional Overdose Prevention Specialists, positions that were created in late 2017 to respond to the still-ongoing “opioid epidemic,” as many call it.

ROPS, as they’re known — pronounced “ropes” — hold public naloxone trainings and give out naloxone in Tennessee. The naloxone and the trainings are free, though ROPS systemically fail to reach active opioid users and others who are most at risk of opioid overdose.

I talked to one ROPS here in West Tennessee who told me they weren’t willing to distribute naloxone unless the recipients got trained to use it first — directly under their supervision, too. It’s easy to imagine how the long-mistreated, long-term, often-problematic drug users who the state claims to help aren’t too keen on visiting these trainings or accepting naloxone from ROPS.

Again, this isn’t to say ROPS are bad — our ROPS here in Region 6N, Melesa Lassiter, is great; she’s also laced me up several times over the past year or two, putting me on to tons of things I wouldn’t have otherwise learned. It’s just that, due to the distrust of resources that government agencies claim are for the most disadvantaged people, my fellow long-term, often-problematic drug users aren’t very open to the knowledge and naloxone ROPS provide.

I should note that naloxone is the lowest fruit on the proverbial harm reduction tree. Naloxone has no real contraindicationsdrug interactions, in other words — outside of causing precipitated withdrawal syndrome in opioid-dependent persons. Still, trading a second chance at life via naloxone-aided revival for an hour or two of peak withdrawal symptoms isn’t a bad deal.

Another note — naloxone doesn’t always cause withdrawal. I’ve had naloxone administered thrice — all in 2019 within a three-or-four-month period — and never experienced withdrawal as a result. A big reason for this, I think, is because my significant other, the person who administered the naloxone on all three occasions, never used a full dose of naloxone to bring me back. I know many people think you can’t reverse an opioid overdose without welcoming precipitated opioid withdrawal, but this isn’t true.

Third — We’ve Fallen Short, Ourselves

We harm reductionists haven’t done a good enough job of framing harm reduction-positive ideas in a way that most largely-right-leaning people will agree with — me included.

As I fleshed out in “How Outwardly Left-Leaning Harm Reductionists Hurt Our Cause,” people in the American South — rural Middle and West Tennessee, in my case — aren’t fond of things that seem politically correct or those that are associated with left-leaning values or ideas. Since many modern American harm reductionists are largely-left-leaning people, they tend to conflate our shared cause of helping active drug users like me with other things like non-drug-user-specific social equity efforts (e.g., pro-LGBT efforts).

I get it — some people want to bring about social change and level the playing field for traditionally-disadvantaged groups. This cause is worthy of merit — and I’m not just saying that because I’m bisexual and stand to benefit from pro-LGBT social equity efforts or because I was a sex worker for about four years and similarly stand to benefit from pro-sex worker social equity efforts. Oh, plus, I’ve always been low-income, so it’d help me triply if this playing field were leveled out. Just so you know I’ve got skin in the game — that’s all.

Regardless of what you, independently, value, we can’t escape the fact that most residents of Tennessee are averse to left-leaning or politically-correct things. If you want to expand harm reduction from states like Washington, California, and New York out to the completely-fucking-bare Volunteer State, you must be sensitive to the beliefs and attitudes of Tennesseans.

And, like I’ve mentioned, this isn’t just true for Tennesseans — it’s true for North Carolinians, Georgians, Kentuckians, and any other Southeastern state’s residents. Well, it also holds true for the largely-right-leaning states of North and South Dakota, Montana, and Wyoming, for example.

What’s the Solution for Tennessee and the Rest of the South?

I’ll be the first to tell you — I don’t know. While I know what Tennesseans don’t like, I’m not well-versed in Christian literature, values, or culture, which seem to be supported by the overwhelming majority of the Volunteer State’s residents.

People who understand these values and, by extension, how to frame harm reduction-positive messaging are vital to our efforts. Here in Tennessee, specifically, we don’t have any networks of harm reductionists or others who are interested in harm reduction-like things. I’ve looked through countless resources online with magnifying glasses and fine-toothed combs and have uncovered very few contacts.

For example, I went to the HepConnect Grantee Meeting in Raleigh, North Carolina, in March 2020 and met several Tennesseans who are active in harm reduction — not just interested in it — and have been for longer than me. I know there are several dozen others out there, too, if not more, but I just don’t know how to get a hold of them.

So, admittedly, it’s not like we Tennesseans have our shit together when it comes to harm reduction. We just — of course, I can’t speak for everybody in saying this, but every Tennessean harm reductionist who I’ve talked to largely agrees with these general sentiments — feel that we’ll need to modify the “harm reduction” that has worked for states like New York and California or countries like Canada and Portugal in order to effectively roll out harm reduction infrastructure in the Volunteer State.

Going Forward

If I haven’t already made this clear, I don’t have the answers for building harm reduction infrastructure in Tennessee.

However, I do know that we grassroots harm reductionists — many of whom, like me, are people who actively use drugs or are former long-term, often-problematic drug users — need to hop to action before the state does.

Right now, if you’re an active drug user, you can’t work as a Regional Overdose Prevention Specialist. From what a ROPS has told me, you’ve got to have something like a couple years’ clean time from regular drug use in order to hold the position. That person said regular drug users wouldn’t be able to work for the state in any capacity, unfortunately.

We’ve seen countless manifestations of seemingly-drug-user-oriented organizations that don’t hire active drug users or involve them in decision-making processes and, as a direct result, fail to do things that best help active drug users, especially “long-term, often-problematic drug users,” as I call them.

There will come a time when harm reduction goes mainstream. If we haven’t positioned ourselves well enough by then, I worry that the best interests of us active drug users won’t be kept in mind.

Categories
Harm Reduction The Volunteer State

Syringe Services Programs in Tennessee

Syringe exchanges, known as Syringe Services Programs (SSP) by the Tennessee Department of Health, aren’t very common in Tennessee. There are two in West Tennessee, one in Middle Tennessee, and three in East Tennessee.

According to the state’s Allison Wilhelm, as of April 21, 2020, there are seven current SSP sites — two in Memphis, two in Nashville, and three in East Tennessee (Chattanooga, Johnson City, and Knoxville). 

Memphis

The Memphis Area Prevention Coalition’s Safe Point operates each Wednesday from 2:00 to 4:00 p.m. It can be found at 28 N. Claybrook Street in Memphis, Tennessee. 

A Betor Way is also in Memphis, though at 1571 Sycamore View Road. It operates every Friday from 6:00 to 9:00 p.m.

Although it’s not an SSP, the Shelby County Health Department operates a Needle Disposal Program. Visit 814 Jefferson Ave.’s Central Laboratory, found in Room 258, between 8:00 a.m. and 4:30 p.m. to get a sharps container and to turn in used syringes. Note that, unlike every other SSP listed here, Shelby County Health Department charges a “minimal fee” for its syringe disposal services.

Nashville

Nashville is only home to one SSP, Street Works, which ran for years on an underground, illegal basis before earning an official title as one of the Volunteer State’s few Syringe Services Programs. In Madison, on 907 Gallatin Pike, Street Works operates from Monday to Friday from 9:00 a.m. to 5:00 p.m.

You can also call (615) 779-4840 for more information. 

Note: I claimed there were two SSPs in Nashville. According to the Tennessee Department of Health, both of which are operated by Street Works. One is located in Nashville at 101 Old Trail Court, the other at 907 Gallatin Pike in Madison. I don’t know the difference between these two locations — call Street Works at the aforementioned phone number to learn more.

East Tennessee

East Tennessee is home to three SSPs, two of which are run by Cempa Community Care, the other by Choice Health Network.

Chattanooga

Chattanooga’s SSP is run by Cempa and can be found at 1042 East 3rd St. It operates from 8:00 a.m. to 5:00 p.m. on Monday, Tuesday, and Thursday; an additional hour in the evenings on Tuesdays; and closes early on Fridays at 12:30 p.m.

Johnson City

The Tri-Cities’ area’s sole SSP, also known as the Syringe Trade and Education Program of Tennessee (STEP TN), is found at 615 North State of Franklin St. in Johnson City and runs Monday to Friday from 8:30 a.m. to 4:30 p.m., though is closed for lunch from 11:45 a.m. to 12:45 p.m.

Knoxville

Operated by Choice Health Network, Knoxville’s SSP is found at 701 N. Cherry St. and operates for two hours on Monday and Thursday, from 1:00 p.m. to 3:00 p.m.

Since publication, someone from Choice Health Network told me these times and this address are wrong. They asked me to include their phone number — (865) 208-7356.

Rural Areas

As of now, unfortunately, there aren’t any syringe services programs in rural Tennessee. This leaves most of Tennessee’s injection drug users shit outta luck.

I recommend visiting pharmacies — try independent ones — for syringes, though you may get turned down. If this doesn’t work, try out diabetes or medical supply websites or the free mail-based supply distributor NEXT Distro.

Categories
Harm Reduction Internet

How Online Drug Reporting Yields Better Harm Reduction

When I used to regularly browse Reddit’s r/Opiates subreddit, I’d sometimes see posts titled “Fentanyl Warning: (City, State).” Even though the site isn’t that active in hosting such warnings, sharing reports on drug forums like fentanyl warnings is an effective harm reduction practice.

Screenshot of the header of opioid-centered drug forum r/Opiates, a subreddit of Reddit.com.
r/Opiates’ header

The most recent fentanyl warning on r/Opiates is three months old. Looking back on other “fentanyl warnings,” they’re few and far between — there seems to be no more than two per month over the last year. Jynxies Natural Habitat is a Blogspot-based website dedicated to sharing the owner’s own stamp reports and relaying submissions from readers, though it’s been defunct for a half-decade. Reddit’s r/Glassine, too, was dedicated to stamp reports prior to its closure over two years ago. Free-standing sites like the now-defunct Opiophile, Drugs-Forum, and Bluelight have also been home to similar reports — though the latter two sites aren’t defunct, they’re not as active in subjective drug experience reporting as we’d like them to be.

While I’m not privy to all online subjective drug experience reporting platforms, something I am sure of is that we’d all benefit from having access to readily-accessible, active drug experience reporting websites.

The Need for Drug Reporting Sites Comes From the “Black” Part of the Black Market

All across the United States — hell, even across your county — the quality of illicit, unregulated drugs varies. As drug users, we never know what we’re getting.

Ever heard of that myth that fentanyl sometimes finds its way into the meth supply? It’s not a myth — it’s 100% true! Fentanyl has been found in non-opioid drugs like cocaine, and, of course, illicit opioids like heroin and counterfeit pharmaceutical opioid tablets.

Roughly 25 fake Mallinckrodt oxycodone pills, marked M 30, that contain fentanyl.
Fentanyl-laced counterfeit opioid tablets made to look like Mallinckrodt’s 30-milligram, instant-release oxycodone tablets. Courtesy of DEA.

We all know, as active American drug users, that fentanyl can very well be in any sack of dope you get. The concern with fentanyl is that there’s a relatively small threshold between an active dose and a potentially-fatal one. Another problem is that, due to the unregulated nature of the illicit drug market, manufacturers don’t use pharmaceutical-quality manufacturing processes — in other words, this results in “hot spots,” or areas of varied strength across batches of illegal drugs.

Keep in mind that we don’t need drug reporting websites or other platforms solely because of fentanyl. Rather, we need drug reporting sites because of the nature of the black market — without the often-pesky regulatory bodies that oversee commerce, the market lacks even a shred of accountability.

Dark Net-Based Illicit Drug Markets, in a Way, Act as Drug Reporting Sites

In the “real world,” of course, we don’t have to do any drug reporting. However you may get drugs, you’re not required to leave any reviews or reports of batches you come across.

On “the onions” — the phrase colloquially refers to dark net markets that can be visited via the Tor Browser, the logo of which is an onion — you’re incentivized to leave reviews.

With most modern platforms, the more, the better, and the more accurate reviews bring you more value in the eyes of vendors. Vendors like doing business with people who’re both motivated and thorough in leaving reviews, as better reviews stand the chance of boosting business.

If you didn’t already know, the path to success on any dark net market is to pull in great reviews on a consistent basis who are also well-reviewed themselves. On an above-ground peer-to-peer sales platform like eBay, for example, we can take accusations of theft to police and — who knows? — maybe even to court. We can leave reviews on other platforms, too, even if we have’t done business on them.

With dark net markets, you’re not taking any complaints to police or industry regulators — unless you like going to jail, not passing go, nor collecting $200 (yes, that’s a Monopoly joke). You might not be able to leave reviews on other platforms because the vendor might not be active on them. Also, with all dark net markets, you have to buy something from vendors in order to have the opportunity to review them. You can post on forums, naming-and-shaming vendors that’ve done you wrong, but that’s about it in the line of recourse.

The Importance of Drug Checking

If you don’t know what you’re consuming, you can’t truly be safe. Also, if you don’t know how pure your drugs are, you face similar safety issues. Drug checking helps people make better decisions.

Drug checking also gets people involved in harm reduction.

Here in Northwest Tennessee, most fellow drug users aren’t familiar with rapid fentanyl test strips — or, I should say, at least they weren’t familiar with them before I put them on game. These test strips are the most popular, in-demand supply I give out. I wish I had more, as they get more people interested in harm reduction in general. Hell, they make people more interested in taking care of themselves.

Thirdly, drug checking boosts “public health surveillance and response strategies to prevent harms associated with illicit drug use,” says a 2018 International Journal of Drug Policy study.

By extension, online drug experience reporting accomplishes similar results — it improves drug users’ decision-making, boosts involvement and interest in harm reduction, aids public health surveillance, and helps build well-rounded, effective public health responses.

Drug checking, defined by DanceSafe as “a harm reduction service that helps drug users avoid ingesting unknown and potentially more dangerous adulterants found in street drugs,” varies from drug experience reports in several ways:

  • Drug checking objectively, empirically determines what samples contain and (though not very often) in what proportions; experience reports don’t.
  • Experience reports are often entirely subjective in nature. Sometimes, reporters do use rapid fentanyl test strips or reagent tests, for example.
  • The primary focus of drug experience reports is on people’s personal experiences with drugs, not their guesses as to what to what they’ve consumed contains.
  • Lastly, drug experience reports are typically shared in real-time, whereas there’s often a several-day delay in the empirical chemical analyses reported by outlets like DrugsData.org.

Are There Any Widely-Used, Go-To Platforms for Finding and Leaving Drug Reports?

DanceSafe, for example, is one of the largest drug-checking entities in the world. The non-profit organization also creates and distributes educational material; at festivals and other events, the entity offers water, earplugs, condoms, peer counseling services, and event patrol oversight (i.e., making sure dance floors are clear of potential hazards). DanceSafe doesn’t publish its results, unfortunately, but the group said “we are hoping to when [Fourier-transform infrared spectroscopy] has been more widely introduced” in a Facebook message dated Monday, April 20th.

The Erowid Center runs DrugsData.org, which happens to be “the best option for test results right now,” according to DanceSafe. DrugsData.org’s list of samples of often-illicit drugs that have been tested via gas chromatography–mass spectrometry, or GC-MS for short.

While this organization is good at what it does, tests can be downright expensive, ranging anywhere from $40 for whole, pressed ecstasy tablets; research chemical samples, any non-pressed ecstasy, and blotter costs $100. Testing herbal supplements and pharmaceutical tablets, powders, and capsules costs $150.

To get an idea of how active the site is, it’s got two entries from April 17th, 15 from April 8th, 23 from March 22nd, two from March 20th, six from March 13th, 38 from March 9th, and four from March 6th. I believe this resource is the best publicly-available aggregation of empirically-tested drug samples on the Internet right now.

Just one glance at DrugsData.org and it’s easy to see that the Erowid Center project isn’t the type of resource to host drug users’ personal, anecdotal experiences — again, keep in mind DrugsData.org is for drug checking, not subjective drug experience reports. While Erowid, also an Erowid Center property, hosts these subjective drug experience reports, they don’t feature images or location.

At least in my experience, people tend not to turn to Erowid for location- or batch-specific drug experience reports — “stamp reports,” in other words. It seems like many drug users in my area, especially those that are the most disadvantaged or at the highest risk of experiencing drug-related problems, aren’t aware of web-based drug resources. Of course, they aren’t too keen on sifting through lengthy personal accounts of drug use.

Don’t get it twisted — Erowid is a solid resource. We just don’t have any active online platforms for sharing short-form, readily-digestible drug experience reports. Also, of those that do exist, none of them — to my knowledge, and please correct me if I’m wrong — condone location sharing. And I think location-sharing is very important in sharing drug experience reports and empirical drug-checking results.

The Importance of Location in Online Drug Experience Reporting

On Reddit’s r/Opiates subreddit, for example, community members aren’t allowed to share their location. Moderators are incentivized to discourage such sharing and actively censor such posts out of self-preservation. Reddit doesn’t want to help people find illicit drugs. By avoiding location, r/Opiates stands a much better chance of avoiding a swift banhammer strike.

For example, in March 2018, Reddit banned r/DarkNetMarkets for “a violation of Reddit’s policy against transactions involving prohibited goods or services.” Countless other drug-related subreddits have been dismantled for similar reasons. 

I agree, we’re better off with a r/Opiates subreddit that doesn’t allow location-sharing than without one at all. However, we need somewhere that facilitates location-specific sharing.

Batches of illicit drugs vary wildly by location — this is why location-specific drug experience reporting is so important. For example, in Philadelphialots of street heroin contains xylazine, known colloquially as “sleep cut.” Also, due to a lack of regulation, illegal drug markets’ batches similarly vary wildly.

The Issue With These Tests

Remember how expensive getting a DrugsData.org test is? The layperson can’t readily afford these tests.

Also, these tests aren’t performed instantly. In the real world, how often are drug users like me willing to wait after copping drugs?

Oh so often, we use drugs within minutes or hours of buying them. Many of us can’t afford to wait to use — well, it’s more appropriate for me to say that we’re not willing to wait to use, whether we’re just impatient or we want to send withdrawal symptoms packing.

Lastly, chemical analyses might not always match up with subjective drug experience reports. Although these breakdowns identify what substances drugs contain, we can’t always predict how people will react to them.

In other words, DrugsData.org-style analyses just aren’t practical. They’re important, yeah — don’t get me wrong. They’re just not readily available or practical for the vast majority of active drug users like me.

Virtually Anybody Can Get Involved

In order for an online drug experience reporting website to have utility, it needs to be readily-accessible. In other words, for it to be worth half a shit, it needs to be easy to access.

In my experience, people who use drugs in rural West and Middle Tennessee aren’t generally aware of web-based drug resources, whether it be Erowid, a drug-related subreddit, or a mail-based safe drug use supply distributor like NEXT Distro.

When People Get Active in Harm Reduction, They’re More Likely to Support Harm Reduction

Used rapid fentanyl test strips (FTS). One line, as shown in the left, represents a positive result, whereas two lines, as shown in the right, represents a negative result.
Used fentanyl test strips (positive result on the right, negative result on the left)

Like I already mentioned, around here, people are usually blown away by how “cool” fentanyl test strips are. Some people have been impressed by the small, already-balled-up, perfectly-sized cottons I distribute.

These people are more friendly to accepting syringes, naloxone, and other safe drug use supplies; solicit advice about proper injection practices and general drug-related best practices; and becoming interested in what we call “harm reduction.”

Platforms that allow people to share subjective drug experience reports will similarly get people, particularly active drug users, interested in harm reduction — even if they don’t know what “harm reduction” is.

Drug-Checking Websites Aren’t a Bad Thing

Don’t think that drug-checking result sites like DrugsData.org are a bad thing — they’re great!

What I am saying is that we don’t have a sufficient means of readily sharing subjective drug experience reports with others. And, while DrugsData.org is drug-related, subjective drug experience report-sharing is an entirely different thing.

What Does Sufficient Drug Experience Reporting Look Like?

I’ll be the first to tell you — I don’t know. I don’t know what the ideal drug experience reporting hub or framework would look like. I don’t know what problems might arise in creating or operating one.

I’d imagine that creating such a platform is risky because of its tie to illicit drugs. What if you get accused of helping people buy or sell illicit drugs? What if someone sources drugs from someone they met through your website and experiences a fatal overdose — don’t you think you could potentially be implicated?

Also, again, drug-checking reports from DrugsData.org and company are beneficial to our cause as harm reductionists. We don’t need to get rid of any existing sites to bring about a better world of subjective drug experience reporting.

Categories
Harm Reduction Recovery The Volunteer State

What Do Tennessee’s Regional Overdose Prevention Specialists (ROPS) Do?

Nestled deep inside the Bible Belt, Tennessee is big on tradition and conservative values. As you might imagine, harm reduction — reducing harm done to and experienced by drug users — isn’t very big here.

Here’s a good rule of thumb — the more left-leaning a state is, the more likely existing harm reduction infrastructure can be found there (e.g., California, New York). Places like Tennessee don’t have much in place; we’ve got at least six state-recognized Syringe Services Programs, at least one county health department-run syringe disposal program, and 21 Regional Overdose Prevention Specialists (ROPS).

Billboard from the Tennessee Department of Mental Health & Substance
Tennessee billboard promoting free naloxone.

ROPS are employed by the Tennessee Department of Mental Health & Substance Abuse Services to hold regular naloxone trainings and distribute the life-saving drug. Although the Volunteer State certainly isn’t the only government to employ people acting in such roles, Tennessee is unique in its use of “Regional Overdose Prevention Specialists” as a title.

Man holding a single unit of Narcan naloxone nasal spray still in its packaging.
Man holding Narcan (naloxone) nasal spray.

The Background of ROPS

In late 2017, the Tennessee Department of Mental Health & Substance Abuse Services released its “TN Save a Life Program.” Ostensibly, this four-pronged program was rolled out due to the rash of opioid use and resulting opioid-related deaths that initially broke out some 10 to 15 years prior.

The TN Save a Life Program was designed to deal with fallout from the opioid epidemic and consists of the following components:

  • The so-called “Project ECHO,” a project with Vanderbilt University touting the end goal of helping clinics, hospitals, and emergency rooms beef up access to medication-assisted treatment programs, a.k.a. opioid replacement therapy, through the provision of telemedicine services.
  • The creation of “regionally-specific resource guides.”
  • The staffing of 20 “Regional Overdose Prevention Specialists” throughout 13 regions within the Volunteer State. These people hailed from a variety of backgrounds, including “recovery, paramedics, and Certified Peer Recovery Specialists,” taken directly from the DMHSAS’s website. Now, there are 21 ROPS.
  • A state-wide media campaign.

Who Do ROPS Serve?

This comes from the same website mentioned above: ROPS primarily tend to first responders, entities that provide treatment and recovery services or community-oriented resources, and people considered at risk of overdose — including their family members and friends.

These aren’t the only beneficiaries of ROPS — “all interested community members” can be trained in responding to opioid overdose with naloxone.

Regional Overdose Prevention Specialists hold training sessions across the region they’re assigned to. There are 13 regions in terms of ROPS distribution. Northwest Tennessee, a nine-county area home to 254,000 people, is labeled Region 6N.

What Do Trainings Consist of?

Just as there are three primary audiences, there are three main topics that ROPS’ training events cover:

  • Raising public awareness for facts about the opioid crisis and the trends that currently define it, how addition works, and best practices for administering naloxone.
  • Attempting to nip drug-related stigma in the bud.
  • Spreading knowledge of harm reduction, why it’s important, and defining what the practice consists of.

A Real-World Example of a Regional Overdose Prevention Specialist

Melesa Lassiter, Region 6N's Regional Overdose Prevention Specialist, running a naloxone training seminar in Humboldt, Gibson County, Tennessee.
Melesa Lassiter holding a naloxone training event in Humboldt, Tennessee, on Oct. 2, 2018.

Melesa Lassiter has served as Region 6N’s Regional Overdose Prevention Specialist since Oct. 2017. She’s part of the Weakley County Prevention Coalition (WCPC), which oversees her role as ROPS.

Although WCPC engages in prevention-based drug use efforts, thanks to Ms. Lassiter’s status as ROPS, she stands out as one of the only prevention coalition employees in Northwest Tennessee to be active in harm reduction — even though naloxone distribution is the lowest-hanging fruit on the harm reduction tree, we very well can consider it “harm reduction.”

Via a local public housing authority office, Martin Housing Authority, name-brand Narcan is made available for pickup. She also holds naloxone training events, including specialized sessions designed just for law enforcement, among other intended audiences.

By no means are these all the things ROPS engage in, though everything mentioned here collectively acts as the meat-and-potatoes of their job duties. What each individual Regional Overdose Prevention Specialist does will vary based on the organizations that oversee their duties for the state.

Ms. Lassiter, for example, may be more likely than the average ROPS to carry out prevention-based programming at local schools — such messaging is a major focus of local prevention coalitions like Weakley County Prevention Coalition.

In Full Disclosure — Do ROPS Fall Short of Their Intended Goals?

Regional Overdose Prevention Specialists, due to the town hall-style nature of their trainings, often fail to reach the most disadvantaged regular drug users (e.g., injection opioid users). This isn’t to say they completely fail to train these people or meet them where they’re at with naloxone, though. As ROPS continue to make a name for themselves across the Volunteer State, more injection opioid users, for example, will come to perceive these state-sanctioned harm reductionists as legitimate and worthwhile.

Much like anywhere, people here — especially long-term, often-problematic drug users like me — exhibit discretion in assessing new or otherwise-too-good-to-be-true opportunities. I think the average level of discretion exhibited by the most disadvantaged drug user here in Northwest Tennessee is higher than average, nationally-speaking, that is.

People can be surprisingly unwilling to open themselves up to offers of free safe drug use supplies. One time, I visited an area of West Tennessee that was populated by a relative fuckton of people experiencing homelessness to have my help refused by all but one person despite the fact I shot heroin in front of them!

Here in Northwest Tennessee, for example, the overwhelming majority of locals who’ve received syringes, naloxone, and other harm reduction supplies from me weren’t aware of ROPS when I first met them — since then, little has changed.

The most disadvantaged people who use drugs — those who are cordoned off from society — are unlikely to trust opportunities like opioid overdose response training or free naloxone because people here aren’t used to having others provide them safe drug use supplies.

To reach these objectively-worse-off, often-problematic drug users is by continuing to advocate for harm reduction and the fair treatment of drug users.

In places like rural West and Middle Tennessee, where there’s little interest in drug user advocacy, activating drug users, illicit drug retailers, and laypeople alike as grassroots harm reductionists is arguably our best tool.

In Closing

All considered, Regional Overdose Prevention Specialists are a valuable resource in improving the treatment of drug users. Although they only pluck the harm reduction tree’s lowest-hanging fruit — naloxone distribution and training — I think we’ll look back at ROPS as being pioneers of modern-day harm reduction here in the Volunteer State.

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From Personal Experience Harm Reduction The Volunteer State

Understanding Syringe Access in Rural Middle and West Tennessee

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

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

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

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

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

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

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

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

Do Pharmacies Play a Role in Syringe Access?

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

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

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

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

But Seriously — What Resources for Drug Users Are Here?

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

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

More About Sharps on the Black Market

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

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

Drug Users Benefit From Performing Services for Fellow Drug Users

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

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

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

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

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

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

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

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

Dealers Aren’t Likely to Offer Syringes to Buyers

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

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

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

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

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

Understanding Syringe Laws in Tennessee

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

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

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

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

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

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

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

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

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

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

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

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

What Can We Do for Syringe Access in Tennessee?

Tough question.

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

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

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

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

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