Drug User Advocacy Harm Reduction

Where Drug Users’ Unions May Fall Short

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

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

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

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

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

That’s What Drug Users’ Unions Are For

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

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

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

Being Badly Organized Hurts

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

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

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

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

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

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

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

Are Drug User Unions Worth Their Salt?

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

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

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

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

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

Drug User Advocacy Harm Reduction

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

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

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

And, Yes, I Do Have Skin in the Game

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

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

Being Overly Politically Correct Hurts Us

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

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

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

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

It’s Not About the Number of Words

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

If I Wasn’t Already Clear

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

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

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

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

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

How Social Media Use Potentially Turns Off Newbies

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

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

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

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

What Am I Getting At?

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

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

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

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

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

Drug User Advocacy Harm Reduction The Volunteer State

What Can You Do to Advocate for Harm Reduction and Drug Policy Reform Here in Tennessee?

If you’re reading this, chances have it you probably support harm reduction or drug policy reform, if not both. While you likely wish things were different, there’s only one way to actively accelerate social change other than the inevitable passage of time — advocacy. 

Google defines “advocacy” as “public support for or recommendation of a particular cause or policy.” Here’s one example of harm reduction advocacy: creating a brochure that explains the basics of harm reduction, describes examples of it, and tells readers why adopting harm reduction-friendly practices is a good idea; after printing the brochure out, copies are distributed to laypeople throughout the distributor’s local community. 

There are countless forms of harm reduction and drug policy reform advocacy. Few are objectively better than one another, though all have unique pros and cons. As such, all forms of advocacy can be better than others depending on how they’re being used — I think advocates should always be situationally sensitive.

Local News Agencies Are Valuable

Keep an eye on local news agencies’ most recent releases. You should keep tabs on at least several local news agencies, preferably those in and around your current area of residence. Subscribing to at least a few elsewhere is also a good idea.

When you find articles or broadcasts that favor the progression of harm reduction and drug policy either on a national level here in the United States, a state level, or even a local level, try reaching out to these agencies and identify whether you think they had a positive or negative effect on advancing harm reduction or drug policy. 

To define what I mean by “negative,” negative pieces include those that sensationalize drugs, spread misinformation about them, or damage our collective cause to advance harm reduction and drug policy reform.

Whether you’re looking to (reinforce/punish) the publication of harm reduction-(positive/negative) or drug policy reform-(positive/negative) pieces, you should always seek help from other advocates who you’re connected with. When one of your advocacy group’s members locates a piece that one of you wants to reply to, each of you should write a letter to the news agency in question for added effectiveness. 

The person who initially floated this idea to me said it may prove useful to send multiple replies from different identities. Of course, this isn’t illegal, but could very well contribute positively to our cause. Only you can determine if doing so is within your ethical boundaries — honestly, I’m still on the fence about it.

Coming Out as a Person Who Uses Drugs

Although sexuality and drug use are two entirely different things, just as people can out themselves as bisexual — I, too, am a member of the Alphabet Gang — widely outing oneself as a drug user can prove similarly difficult. Of course, there are many downsides to outing yourself as a drug user. If we all out ourselves as persons who use drugs (PWUD) — not that any such widespread, preplanned coordination would be feasible — the stigma associated with drug use is likely to start fading away. 

However, you should understand that everything you do will reflect on the other few people who have come out as PWUD. These people have already risked outcast, relationships, criminal justice problems, work opportunities, friendships, and much more. 

As such, you shouldn’t come out as a PWUD if you’re not in a good place to do so. Soon enough, fortunately, the stigma surrounding drug use won’t be as strong. The more people who do decide to come out as PWUD will make coming out easier, so, by coming out, we’re helping drug users as a whole.

This should go without saying, but you’ll be less likely to make others look bad if you’re responsible, well thought-out, maintain employment, and so on. 

Again — if you decide to do this, make sure you won’t make others look bad in the process. 

Realistically speaking, I know at least some drug users would take initiative, but those people would likely be of a more-responsible, go-getter nature. In other words, getting the people who most frequently and most intensively make us look bad — for the record, I’ve made us, as drug users, look bad countless times — would prove difficult, likely rendering our efforts better channeled via another effort.

Befriend or Get to Know the Following People and Places

Some people and entities are inherently more drug-friendly than other people and entities. These include law enforcement agencies, law enforcement officers, correctional officers, wardens, jails, drug rehabilitation facilities, prevention coalitions, churches, libraries, health departments, public defenders, parole boards, etc. 

By cultivating relationships with these people and places, you’ll generally be in a better position than most people to influence them. 

Understand you’ll get further with those who are already more drug-friendly or drug user-friendly. Still, I’d argue that our collective efforts would be better spent in areas that are more drug-averse or drug user-averse.

Never Spend Time Trying to Change Others’ Minds on Social Media

This is self-explanatory. Arguing with others doesn’t get you far, especially on social media. This is because people on social media are often set in their ways regarding hot-button issues like abortion, gun control, or how society treats drug use. 

Trying to advance your cause by attempting to persuade these people either wastes your time and gets you nowhere or results in people thinking worse about your cause. 

The unconventional measures that harm reduction-friendly policies propose don’t seem like good ideas upon first glance. Because social media doesn’t lend itself to answering complex, multi-faceted questions — or even hearing them out in the first place — spending time trying to change others’ minds, especially on social media, isn’t a good idea.

If you do try to attempt this, your posts should be placed in highly-visible areas, must be easy to understand, must be non-argumentative, and must not be placed in communities that are inherently or largely against such ideas already — sharing posts in more moderate areas may be a better use of your time.

Ultimately, the only reasons why I post on social media about harm reduction or drugs in general is to expand my network, relentlessly self-promote my writing, or boost my chances of finding gainful employment in this harm reduction space. I believe that posting to social media with the goal of changing others’ minds is nothing short of a waste of time.

Activating Drug Dealers by Giving Them Harm Reduction Supplies

Many people who use illicit opioids via injection, for example, like myself would much rather be able to source syringes from the same place they purchase their opioids of choice from than having to visit syringe exchanges, pharmacies, or — what often happens in rural Tennessee, where I am — elsewhere on the black market. 

Syringe, likely used, found on the ground with the plunger pulled roughly halfway back. The syringe itself is empty.
Syringe litter

Dealers who offer clean syringes to customers, whether it be for free or not, can cultivate and maintain a competitive advantage.

In areas where clean, free syringes are available, dealers aren’t likely to source syringes in an above-ground, legal manner. Rather, they’re more likely to accept syringes from below-ground resources, such as from one of their customers, for example. This is something I’ve done, myself.

Activating drug dealers by providing them with syringes, naloxone, and other harm reduction supplies is a good way to advocate for harm reduction because:

People who activate dealers in this way should also educate them, if possible, about the basics of harm reduction. Ideally, these aforementioned activators should provide dealers with hard copies of educational material in the form of brochures, pamphlets, or even single, printed-off, black-and-white sheets of basic harm reduction information.

In my experience, dealers aren’t as interested in learning about harm reduction as they are the prospect of building a competitive advantage. I’m not saying dealers are heartless, soulless criminals — I just think humans are more interested in capitalizing on opportunities that benefit them in the now rather than advancing abstract ideologies and the very-potential benefits that may come from them.

Also, even if dealers you come across are interested in the ideology of harm reduction, let alone adopting it and practicing it, they should be — at least I’d hope any business-minded person would be — averse to supporting something that would ideally cut them out of contention (i.e., harm reductionists generally support safe supply, which involves things like allowing doctors to prescribe pharmaceutical-quality heroin; this would unarguably harm any illicit drug market’s bottom line).

In Conclusion

Advocating for causes is time-consuming and often frustrating. Further, many people don’t advocate in effective ways. One of the number-one ways that people think is an effective way to be an advocate is by posting on social media. In most cases, this is simply ineffective, if not wholly counterproductive. 

These aren’t the only ways to advocate for harm reduction or drug policy reform. However, these five methods are all solid means of advancing our cause as harm reductionists or drug policy reformers — if not both.

Drug User Advocacy Harm Reduction

Proving Facts and Dispelling Myths About Drugs

We’ve all heard heard dozens of fellow users spout countless inaccuracies, misleading statements, and flat-out incorrect assertions about drugs, drug use, and drug laws as if they were all fact.  

There’s no way this article could even hope to cover a half of a percent’s worth of the myths, half-truths, and facts we’ve heard as drug users since 2010 — that’s when I first began using illicit drugs — and address them to help readers better understand them. 

Without further ado, let’s get started. 

Myth #1 — You Should Disinfect With Alcohol Swabs Before AND After Injection

A few weeks ago, I asked a fellow local intravenous heroin user whether she used alcohol swabs prior to injecting. She told me she used alcohol swabs both before and after injecting. This is actually worse for your health as opposed to just using an alcohol swab immediately prior to injection, no matter the type of injection used: IV (intravenous, or directly into the vein), IM (intramuscular, or directly into the muscle), or SC (subcutaneous, or under the skin).

Put simply, isopropyl alcohol — the active ingredient in rubbing alcohol and alcohol swabs — is an antiseptic, or something used on the skin to shrink the possibilities of infection.

Injections make small holes in the skin through which bacteria and other potentially-dangerous microorganisms can enter. Following an injection, blood rises to the surface and closes the hole made by the syringe. The faster this happens, the less likely foreign objects are to make it inside the human body. 

Using an alcohol swab after injection prevents blood from clotting. This is why it’s not a good idea to use alcohol swabs after injection.

Fact #1 — All Adults in Tennessee Can Purchase Syringes Legally

Many injection drug users in Tennessee struggle to get their hands on clean syringes. They usually are forced to hit the black market to source clean syringes, but, unfortunately, due to the underground nature of the black market, market participants can’t be sure that their sharps are fresh. 

Although pharmacists in Tennessee are legally required to ask everyone without a prescription for syringes what they plan on using syringes for prior to completing the sale, it is possible for all adults with valid identification to purchase syringes from pharmacies. However, at least in my experience, pharmacists in rural Tennessee routinely turn customers down.

It’s possible to purchase larger-diameter syringes without a pharmacy’s help — think of veterinarians, vet supply stores, or pet stores. However, these syringes are absolutely not intended for the injection of illicit drugs. 

Again, in actuality, injection drug users have one hell of a time trying to purchase syringes from pharmacies. Those who have tried to get syringes from pharmacies, especially in rural areas, often feel discouraged from trying other pharmacies in hopes of getting a “yes.”

I understand the rationale behind not wanting to feel responsible for helping an injection drug user shoot up, but people who inject drugs will get high whether or not they have access to clean, fresh syringes or not. As such, this idea doesn’t make much sense — shouldn’t pharmacists want to help underserved, at-risk persons from reusing sharps or sharing them with other users? Also, even if you purchase syringes off the black market, the only choice for most rural Tennessean injection drug users, there’s no guarantee they’re clean.

Anyway. To wrap this “fact” up, know that it’s legal to purchase syringes from pharmacies here in Tennessee without prescriptions but, in the same breath, understand you’re highly likely to get turned down.

Myth #2 — If You Have a Reliable Illicit Source for Diverted Prescription Medication, You’ll Never Come Across Fakes

Assume you occasionally consume prescription opioids (Norco, OxyContin). It doesn’t matter how often you take them. What does matter, in this scenario, is the source of the opioids. 

According to federal government statistics, beginning in 2015, the rate of opioid prescribing in the United States dropped for the first time in some two full decades. This caused major supply chain issues on the American illicit opioid market. 

People who were then able to regularly, reliably source prescription opioids from trusted sources had to do things like:

  • Start paying more for the same pharmaceuticals they were once getting. 
  • Go longer between their chances to source opioids since many people got completely cut off from opioids by their physicians. 
  • As time progressed past 2015, the likelihood of purchasing counterfeit opioid tablets off the American illicit opioid market drastically increased. 

These counterfeit tablets can either be made in a clandestine lab or in a fully-fledged pharmaceutical manufacturing operation would operate. The former is made possible by people selling small-time pill presses via the mail. They are usually sent part by part to avoid detection.

Their counterpart, the big labs mentioned above, are typically operated by Mexican drug cartels. Due to the widespread availability of pill presses, there are hundreds, if not thousands, of clandestine, one-room pill-pressing operations across the United States — but do we really know how active they are? Of course not — I’m just pointing out that pill pressing doesn’t just happen in big-time, Mexican-drug-cartel form.

Both are able to purchase pre-made mixes of inactive ingredients online. In most cases, these counterfeit opioid tablet manufacturers choose fentanyl as an active ingredient. Fentanyl has a lower threshold between the point at which consumers feel its effects — both analgesic and recreational — and the point at which opioid overdose symptoms manifest.

Another factor that makes counterfeit opioid tablets so deadly are “hotspots.” Hotspots are simply clumps of active ingredients. Fentanyl is much more potent than other opioids — extremely so. Because the volume of only a grain or two of salt can cause death in a human adult, it’s easy to understand why fentanyl “hotspots” are such an issue with counterfeit opioid tablets. 

Dude, There’s No Way My Pills Could Be Fake

Counterfeit oxycodone tablets seized by law enforcement that contain fentanyl
Counterfeit opioid tablets, intended to imitate Qualitest and Mallinckrodt 30-milligram instant-release oxycodone tablets

I’ve heard this rationale from countless drug users I’ve been around. I understand the thinking, especially from people who happen to have better connections to the diverted prescription opioid market, though it’s not a valid idea.

As you know, just one run-in with fentanyl-laced counterfeit opioid tablets can cause a potentially-fatal overdose.

Over the past few years, the quality of counterfeit pharmaceuticals — things like fake Xanax and pain pills, namely, not counterfeit blood pressure pills from India or anything, just to be clear — has improved drastically. It’s no longer possible to routinely tell fakes from their real counterparts just by identifying their characteristics.

How do we spread this message to people who use diverted prescription opioids — that they should view everything they come across as potentially counterfeit? I’m not sure. It’s often difficult to make the case to diverted prescription opioid consumers that their pills could be fake and contain the-super-easy-to-overdose-on drug fentanyl.

I think our best hope is to continually spread this message — that your pills could be fake and contain drugs with higher overdose potential like fentanyl even if you purchase them from trusted sources — to people who use drugs.

Fact #2 — Non-Opioids Can and Do Contain Fentanyl

We’ve all seen reports of non-opioid drugs like cocaine, methamphetamine, and even cannabis containing fentanyl. Although opioids are more likely to contain fentanyl than their non-opioid counterparts, other drugs can and do contain fentanyl — this isn’t just an over-sensationalized narrative pushed by news outlets.

There are a few reasons why batches of drugs on the American illicit opioid market contain fentanyl — and if you’d like to read more about why fentanyl is so deeply ingrained in the modern American illicit opioid market, check out this previous article of mine. They include the following:

  • Because fentanyl is much more potent than heroin, distributors don’t have to transport as much volume or weight when they adulterate their heroin with fentanyl. The more fentanyl in an opioid mixture, the easier distribution is. 
  • Fentanyl furthers people’s addictions and dependencies. Once the illicit opioid consumers in an area become dependent on fentanyl in addition to heroin — or another opioid like oxycodone, for example — the less satisfied they’ll be by batches of opioids that are fentanyl-free. 
  • Fentanyl-heavy batches effectively provide free marketing to dealers. Dealers have been known to push exceptionally strong or unevenly-mixed batches of illicit opioids that also contain fentanyl, causing more overdoses than usual — and potentially more deaths. Full diclosure — dealers are people, too, and they often don’t want to see their customers die. However, it’s undeniable that dealers stand to benefit by selling batches of “heroin” — really, almost all American “heroin” is a fentanyl-heroin mixture — that are more likely to cause overdose.
  • Fentanyl-positive “heroin” hits different. Even though opioid users know how dangerous fentanyl is — at least they should know for the sake of their well-being, and all — many report that they’d rather use heroin-fentanyl mixtures than just heroin, or whatever opioid-fentanyl mixture is at hand.
  • The last major reason is that fentanyl is much easier to manufacture than opioids like heroin. Heroin requires farmhands to cultivate broad, wide-open fields of Papaver somniferum, better known as the opium poppy. Fentanyl is manufactured with chemical precursors, meaning there’s no need for massive farming operations. Further, well over 90% of the world’s illicitly-manufactured fentanyl (IMF) actually comes directly from professional-yet-illegal manufacturers in China. These manufacturers use the Internet to sell high-quality, nearly-pure fentanyl and countless fentanyl analogues at low prices. 
Comparison of lethal doses of heroin, fentanyl, and carfentanil, a fentanyl analog.

As you can reason, there are plenty of reasons to add fentanyl to other opioids. But why would anybody include fentanyl in non-opioid drugs?

There’s no question that high-level distributors have made mistakes during the adulteration process that resulted in the cross-contamination of other, non-opioid drugs like meth with fentanyl. 

For example, assume a high-level distributor just got done adulterating their heroin with fentanyl. The distributor used a few blank credit cards/gift cards to mix the two opioids together. Rather than cleaning the cards off before attempting to adulterate their cocaine, for example, the distributor inadvertently contaminates their cocaine supply with fentanyl.

A personal anecdote from a Northwest Tennessee man — I’ve referred to him as Jonah before in one other article — is that, after he was court-ordered to go to rehab twice in two or three months, he ended up testing positive for opioids both times. Jonah never uses opioids and doesn’t like them. 

The one thing that stayed consistent between the two drug screens is his meth consumption. 

Further, other meth consumers in Jonah’s local area have also reported that they’ve tested positive for opioids following their consumption of local meth, despite the fact they didn’t otherwise consume opioids. 

Since fentanyl was — and still is — regularly found in the local illicit meth supply to which Jonah has access, I think it’s reasonable to assume that people higher up the supply chain intentionally cut meth with fentanyl. It’s not very feasible for high-level distributors to continually make the same cross-contamination mistake over, and over, and over, and over again. 

Here’s Jonah’s hypothesis as to why his community’s local meth supply contains fentanyl: after a few days of binging on meth, almost certainly bringing no sleep and — in many other methamphetamine consumers’ cases, too — an insufficient nutrient load into the mix, it’s not hard to reason that these people’s bodies would feel sore, worn out, or otherwise bad. Jonah feels as if the distributors who are responsible for adulterating methamphetamine with fentanyl provides the distributors with a competitive advantage because consumers’ aches, soreness, and lethargy would be better dealt with than by consuming methamphetamine without fentanyl included. 

Could Jonah be wrong about this idea? Yes. I think it’s a valid idea, however, and I haven’t seen it floated anywhere else.

What’s important to know is that all drugs, not just opioids, are liable to contain fentanyl. The problem with this is twofold: (1) users don’t know they’re consuming fentanyl and (2) since there’s such a low threshold between the amount of fentanyl needed to cause physiological or psychological effects and overdose, it’s easy for people to potentially die from unknowingly consuming fentanyl.

Myth #3 — You Can “Narcan” Yourself

Before Anything Else, Let’s First Understand Naloxone

Narcan nasal spray juxtaposed with its packaging
Name-brand Narcan nasal spray

First off, “Narcan” isn’t technically a verb — it’s a proper noun officially stylized as NARCAN® Nasal Spray — though you’ll inevitably hear it used as such somewhere. Narcan is a pre-loaded, single-use nasal spray that’s available over the counter in pharmacies across the United States. Drugs are available over the counter when they have little to no contraindications, or negative reactions to other medicines or people who have certain health conditions. 

Evzio naloxone auto-injector

Naloxone, the sole active ingredient in Narcan and Evzio — similarly styled EVZIO®, an auto-injector that talks users through the entire process — has no contraindications outside of people who are allergic to naloxone. 

Many people who overdose on opioids are opioid-dependent, meaning their bodies need to maintain minimum levels of opioids or else they’ll face opioid withdrawal syndrome, which shares many of the same symptoms of the flu. Although this isn’t a true contraindication — which means, according to Google, “suggest or indicate that (a particular technique or drug) should not be used in the case in question.” — opioid-dependent people experience precipitated opioid withdrawal for an hour or two following administration.

Depending on what opioid an opioid-dependent person is reliant on, the peak of opioid withdrawal syndrome takes roughly 72 hours to be reached. Precipitated withdrawal, on the other hand, causes the full slate of peak opioid withdrawal syndrome symptoms to rear their oh-so-ugly heads in opioid-dependent people.

This is a small price to pay in exchange for having your life saved, though — an hour or two of pain to have another shot at this beautiful experience we call “life.” 

Naloxone acts as a powerful public health tool. Whether you think reviving someone who knowingly uses opioids and understands they can die from doing so is a good idea or not, since naloxone is cheap and has no true contraindications, naloxone is an effective tool for preventing death.

And, although off-topic, you may come across people who aren’t supportive of responding to opioid overdoses with naloxone. No matter their reasoning, I think the vast majority of all reasonable-minded humans agree that nobody should die while suffering. Many regular drug users — especially those suffer from drug addiction — use drugs to fill the gaps created by long-unmet needs not being fulfilled. I genuinely believe that every stint of problematic drug use comes to an end, however long it might take; this thinking lends itself to the idea that every addict will has a real, tangible shot at recovery.

Most people will get behind the idea of making sure people in active addiction don’t die in pain. This approach may be useful in educating laypeople about naloxone or persuading them to get on board the naloxone train.

Naloxone has been used extensively to reverse overdoses throughout the United States, especially recently.

According to the U.S. Centers for Disease Control and Prevention, more than 26,400 opioid overdoses were resolved from 1996 to 2014 through the administration of naloxone in the United States alone. Many opioid overdoses, as well as their reversals thanks to naloxone, go untracked, though.

For example, I had at least two opioid overdoses — I say “at least two” because I was given naloxone a third time when I was potentially just a few minutes away from experiencing overdose; I’m not sure if I can definitively count that as an “overdose” — in 2019. Both times, fortunately, I was revived with naloxone. Would I have died or experienced permanent brain damage without naloxone’s help? There’s no way to know.

I enrolled in a medication-assisted treatment (MAT) program after that third potential overdose, though not at all because of the overdose — rather, I was facing legal consequences as the direct result of my ongoing illicit drug use. My life is better now that I’m on buprenorphine (Suboxone, Subutex). It is impossible to get help for drug addiction, after all, if you’re dead.

When Should Naloxone Be Administered?

Knowing when to administer naloxone is the same thing as knowing how to recognize an opioid overdose. 

Bluish lips, fingertips, and toes are one of the most widely-reported symptoms of opioid overdoses, according to friends, family members, peers, first responders, physicians, nurses, and other medical professionals who’ve seen people experience opioid overdose.

While opioid users sometimes nod out, if an overdose is, in fact, present, they’ll be unconscious or very close to completely losing consciousness. Just like when people are unconscious for any other reason, people experiencing opioid overdose won’t be able to respond to any stimuli, even an air horn, a bright flashlight shined into their eyes from inches away, or a loud, blood-curdling scream.

The skin will turn a different color, though what color it turns depends on the person’s regular skin tone. Lighter-colored people, such as most White and Asian people, skin may begin turning hues of blue and purple. For darker-complected people, like most Middle Easterners and Black people, skin tones may start to become any one of a range of gray colors. Keep in mind that these aren’t scientific facts — just concerns we should play with.

If you’re unsure of what to look for or think you might not be good at recognizing these color changes, always first look to the lips for help. They’re the easiest to read, generally. Also, fingertips and toes may be of help, too. 

Assume you’re not sure of what to do. You see someone exhibiting one or more of these opioid overdose symptoms, but you also see that their current cohort of symptoms could very well be caused by another drug’s pattern of overdose symptoms. 

Here’s what we’re going to do. I’ll explain how to administer naloxone, as well as what signs you should look for to know when it’s an appropriate time to “Narcan” somebody. 

Once you’ve identified an opioid overdose, you should immediately call 911. If you have to move away from the person who’s overdosed to call first responders, you should place them in the recovery position, seen here.

This prevents them from breathing in a foreign object. Opioids, especially in excessive doses, are known to cause puking; the recovery position neutralizes the risk of asphyxiation by vomit — opioids, since they’re also known to cause unconsciousness, can make it difficult for people to clear vomit from their airways.

Now, it’s time to administer Narcan. Don’t worry about getting their body in a certain position; simply spray one spray in each nostril. Make sure the nozzle is firmly inserted inside each nostril before spraying.

If you’re using injectable naloxone, draw the naloxone solution into the syringe and inject it into the thigh or upper arm. To bridge the gap from now until paramedics alive, perform rescue breathing. There are several other best practices to follow in responding to opioid overdose, though I won’t list them here — I’m just trying to give you an idea of what administering naloxone is like, if you didn’t already know.

That’s how the naloxone administration thing works. But can you revive yourself with naloxone?

But Can You Revive Yourself With Naloxone?

Let’s Cover a Real-World Example, After Reading Which You’ll Determine the Answer Yourself

Opioid overdoses can happen anywhere from a few seconds to a few hours after opioids are taken; the fastest overdoses usually happen with intravenous administration, since no absorption barriers have to be passed.

Oral consumption, on the other hand, is sure to take the longest in terms of causing an opioid consumer to experience opioid withdrawal syndrome. One time — and it’s not like I’m proud to admit this; not at all — I experienced an overdose in 2014 that involved oral administration.

It was early June 2014. I won’t get into why, but I was angry at the time — very angry. I had almost never, ever used drugs in direct response to my emotions. I first took oxycodone — relative to my opioid tolerance at the time, I just took a standard dose; nothing special. Then, maybe 45 minutes later, I took alprazolam, and, relative to my benzodiazepine tolerance at the time, it wasn’t a large dose, either. 

I had actually combined alprazolam (Xanax) with oxycodone before several times, not to mention in larger doses than I did on this super-humid evening. About an hour after I took the Xanax, I decided I wanted to walk back to my room, as I wasn’t having any fun with the people I was hanging out with. 

Keep in mind that pretty much all students at this school had left a week or two prior, as the spring semester had just come to close.

On my way back to my room, I passed out. The only thing I remember is leaving the room. The room was no more than ~40 steps away from where I’d passed out, including a small flight of stairs.

Here’s what ended up happening: I stayed that way, collapsed in a lump on the carpeted hallway floor. All by myself. With nobody to help me. Not a soul. 

Everybody else had left campus just a week or two prior. I ended up coming to about three to four hours after I’d passed out. I was extremely disoriented, dehydrated, and confused. I felt more confused than I ever had in my entire life for about 15 minutes. I puked, and I puked, and I puked. And then I puked some more. 

I’m very lucky to be alive. 

Could I Have Administered Naloxone Myself and Prevented That Overdose?

Again, I don’t remember anything about falling out. Even if I knew what naloxone was and I had it with me, how would I have recognized the “point of no return”?

Therein stands the central issue with the prospect of naloxone self-administration in response to opioid overdose — you don’t know when you need to hit yourself with the life-saving drug.

I very well suspect that some opioid users could successfully prevent an impending overdose via naloxone self-administration. However, if you miss the mark just one time, game over!

Also, keep in mind that opioid users often can’t afford to ruin their high, which is exactly what naloxone does. Or, they might just not want to blow their high.

Put simply — and if you want to read more about my take on naloxone self-administration, check out my article on it — you can’t rely on yourself to administer naloxone in the event of overdose.

One last thing about naloxone — after I’ve been given naloxone, I’ve never experienced precipitated opioid withdrawal syndrome. This is because I just happened to be given enough naloxone to resume consciousness, though not enough to forcefully remove the opioids that were occupying my noodle’s opioid receptors from those receptors — that’s what causes precipitated withdrawal, if you didn’t know. I also still felt high after all three of my run-ins with naloxone.

Fact #3 — Kratom Is an Opioid

Many advocates of kratom, including the American Kratom Association, argue that kratom is not an opioid despite the fact it causes effects oh-so-remarkably similar to opioids, mitigates opioid withdrawal syndrome, and acts on the brain’s opioid receptors as its mechanism of action.

I wholeheartedly disagree — I think kratom is, in fact, an opioid.

What Is Kratom?

Kratom leaves in the wild

Kratom (Mitragyna speciosa) is a deciduous evergreen tree — the tree would lose its leaves if grown in a non-tropical area, though, since it’s found in tropical areas, kratom trees don’t ever shed their leaves for the winter, making it both deciduous and evergreen — that is native to Southeast Asia. People have used kratom for at least hundreds of years, usually by laborers to power through workdays thanks to its stimulating and analgesic effects.

Kratom contains a couple dozen alkaloids, or psychoactive compounds, that are responsible for its effects. People typically use kratom by swallowing ground, powdered kratom leaves, making tea, or chewing fresh leaves raw a la chewing tobacco.

Although the pro-kratom advocacy organization American Kratom Association considers kratom not to be an opioid, I disagree. There’s no single, widely-accepted definition of “opioid,” which makes arguing whether kratom is an opioid or not difficult — without agreeing on a definition, you can’t reasonably discuss whether kratom is, in fact, an opioid or not.

How Do Opioids Work?

Again, in order to make this case, I first need to define “opioid.” It’s reasonable to say, no matter which definition you’re using, that an opioid is something that acts on the brain’s opioid receptors and has morphine-like effects.

Why does morphine — and, of course, other opioids — relieve pain, cause analgesia, and potentially lead people to addiction or dependence?

We’ve got a few different kinds of opioid receptors. One of them is the mu-opioid receptor.

A 1996 study found that, by comparing humans to mice that lack the mu-opioid receptor, the mu-opioid receptor is responsible for both the “therapeutic and the adverse activities” of morphine. Mice without the mu-receptor gene are more sensitive to painful stimuli, don’t pull as much reward from drugs of abuse, and lack the same dependence, reward, and analgesia from morphine that mice with the mu-receptor gene.

Here’s Why Kratom Is, in Fact, an Opioid

Chemical structure of 7-hydroxymitragynine, also known as 7-OH, 7-OHM, and 7OHM
7-hydroxymitragynine (7-OH)

Two of the most prevalent and powerful alkaloids in kratom are mitragynine and 7-hydroxymitragynine (7-OH). Primarily, the effects of these alkaloids come from partial agonism of the mu (µ) opioid receptor.

Chemical structure of mitragynine, the chief alkaloid of kratom

Mitragynine acts as a partial agonist at hMOR (EC50 = 339 ± 178 nM) and a weak antagonist at hKOR and hDOR. 7-OH acts as a partial agonist at hMOR (EC50 = 34.5 ± 4.5 nM) and as a competitive antagonist at hDOR and hKOR.

Some kratom fans may argue that, since kratom is only a partial agonist, it can’t be considered a true opioid. LSD and THC, for example, are both partial agonists of the 5-HT2A and CB1 receptors, respectively. LSD is still considered a classic psychedelic based on its effects; THC is defined as a cannabinoid for the same reason.

Myth #4 — Kratom Is a Deadly Drug

The other ideas I’ve addressed so far are likely more familiar to you than this one. While this might not be a widely-held misconception, I’ve come across a handful of people who think kratom is a deadly, dangerous drug.

The only people I’ve heard say this in real life were all involved with a medication-assisted treatment program in Jackson, Tennessee — two of them were physicians and the other was the program’s director and a registered nurse. I’ve seen people online say the same things, too.

These two physicians and the director-cum-registered-nurse told me kratom causes worse opioid withdrawal symptoms than buprenorphine (Suboxone). That could be the single most ignorant thing I’ve ever heard. I’ve taken kratom for three-plus years. Never did I have serious withdrawal symptoms.

Now, since I’ve been on Suboxone, I can’t even begin to feel the effects of kratom, even in high doses. Also, before enrolling in the MAT program, I never had a material physical dependency to opioids. Now, I do.

Comparing Kratom to Other Opioids

Opioids are notorious for causing respiratory depression, the most common direct cause of death stemming from opioid overdose.

Kratom has less potential for causing respiratory depression than classical opioids. It’s also less likely to be abused like other opioids, as it just doesn’t have the same recreational potential.

Kratom, Alphabet Soup’s Best Friend

The Centers for Disease Control and Prevention (CDC) have published research that fingers kratom as a direct cause of death in about 100 people after examining some 27,000 accidental drug overdoses across a 17-month stretch in the United States.

The U.S. Food and Drug Administration, as well as other federal government agencies, have used similar research as a tool to campaign against kratom. Ostensibly, officials hope to have the drug viewed as a deadly, dangerous drug by the American public.

I feel that the three aforementioned medical professionals — although they’re obviously incentivized to slam alternatives to opioids other than buprenorphine, considering they work for a medication-assisted treatment program, and all — may have been led astray by FDA and CDC reports.

Also, these reports have spurred news agencies around the country to write about kratom as a potentially-harmful or definitely-deadly drug, further pushing people to view kratom negatively.

Here’s the Verdict

Yes, kratom is a drug. Like all drugs, kratom can prove harmful. However, kratom doesn’t pose much of a threat because:

  • Kratom has little recreational potential.
  • It’s less likely to cause respiratory depression — or vomiting, for that matter.
  • Kratom is much, much safer than classical opioids, especially those sold on the black market, not to mention readily available and cheap.

Kratom, which is often used to curb anxiety, depression, chronic pain, and other health problems, can be used irresponsibly, especially by people who are self-medicating to deal with anxiety or depression.

Also, because the kratom market is largely unregulated, there’s no way to reliably enforce manufacturers to prevent kratom from being contaminated with pathogens, heavy metals, other active ingredients, bulking agents, or any other adulterants. Kratom needs to be regulated — at least if we want the kratom industry to be safer, that is.

Tying Everything Together

I hope I’ve been able to shed some light on commonly-held myths, misconceptions, and half-truths that are common among people who use or are otherwise involved with drugs.

Please do reach out to me if you think I got anything wrong.

Drug User Advocacy Harm Reduction

How Mailing Syringes to Drug Users Helps — The Merits of Mail-Based Supply Distribution

People like San Francisco’s Tracey Helton and organizations like New York City’s NEXT Distro have long distributed syringes, naloxone, and other harm reduction supplies via mail.

Mail-based supply distribution (MBSD) is so very helpful for people who live in areas where there isn’t much, if any, access to harm reduction supplies, drug-related education, or drug user health support. Although MBSD isn’t an equal substitution for in-person syringe services programs and other resources that help drug users like me, they’re unarguably the next-best alternative.

I regularly distribute supplies like these from mail-based supply distributors to fellow drug users and dealers here across rural Northwest Tennessee in an underground, unfortunately-illegal, grassroots fashion. Here, syringe access is nonexistent and finding naloxone is like pulling teeth.

Here are some insights on MBSD that I’ve gathered during my time as a harm reductionist.

Drug Users Often Lack Access to Necessary Supplies

Across West Tennessee, there are only two syringe services programs (SSP) overseen by the Volunteer State. Both of them are in Memphis, which is in the far southwestern extreme of Tennessee. No matter where you’re at in Northwest Tennessee, a nine-county area home to 254,000 people, Memphis is at least a solid 90-minute drive away, rendering legal syringe access essentially impossible.

Pharmacies can legally sell syringes, though pharmacists routinely turn down customers without prescriptions for syringes. The only access we have to syringes here in rural West Tennessee is the black market.

Here, there’s an objective, pervasive lack of access to supplies like syringes.

Even in areas where there is syringe access, many drug users get left behind for reasons like not having reliable transportation, having to work during program operation hours, not wanting others to know about their drug use, and fearing incarceration because they have outstanding warrants for their arrest.

Mail-based supply distribution circumvents these barriers and many others — though, just to be clear, MBSD isn’t a panacea.

At Least Here, We’re Trained to Exercise Discretion in Everything We Do

As drug users, we’ve been trained to avoid new people or things that seem too good to be true. In my own efforts to distribute syringes, naloxone, and other supplies to people who use drugs, I’ve been turned down countless times by people who simply don’t trust me.

The people of rural West Tennessee aren’t used having access to syringes, let alone getting free syringes — we’re used to buying them illegally from other users, family members, or dealers — which has made reaching out to people who use drugs and could stand to benefit from what I do difficult. As you might imagine, many here aren’t comfortable with the idea of receiving syringes through the mail, either.

In full disclosure, I’ve tried to turn people on to mail-based supply distributors, many of which offer supplies for free, but nobody’s taken me up on this offer. Once syringe access expands and rural Tennessean drug users become familiar with it, I know they’ll slowly come to trust such opportunities as legitimate.

Even if we did have open access to syringes here in rural Northwest Tennessee, the most vulnerable drug users likely wouldn’t be able to visit syringe services programs’ outlets or be comfortable with showing up in person. MBSD would help reach some of these people, assuming they’re housed or otherwise have an address to accept mail at.

Last thing — there will be a transitory period following the expansion of syringe services programs here in rural Northwest Tennessee in which drug users will slowly come to accept such resources as legitimate. Abruptly shaking us out of our discretionary habits, which, again, are so prevalent here in rural Tennessee, isn’t possible. During this period, I predict that some people who stand to benefit from access to syringes and other harm reduction supplies may only be comfortable participating in supply distribution programs if they can receive supplies via mail.

MBSD may prove useful during this transition. Maybe not.

Well-Served Drug Users Are More Likely to Support Harm Reduction Than Those We Haven’t Helped

It doesn’t take much thought to reason that a well-served drug user is more likely to aid in harm reduction than an underserved counterpart.

This is just an anecdote, but I only became active in harm reduction after I was given syringes, naloxone, and other supplies — they came by way of mail, too. We don’t have much access to things like that here.

Although you could, in theory, purchase syringes from pharmacies, pharmacists rarely sell syringes without prescriptions here in rural Tennessee — I’ve heard pharmacists are more lenient in cities, such as Memphis or Nashville — this rarely happens. Those who have tried to buy syringes without prescriptions usually don’t bother after a few tries, anyway.

One more anecdote — I’ve only been able to welcome aboard other drug users or dealers as secondary distributors after giving them supplies myself.

If We Drug Users Demonstrate Responsibility, We Stand to Gain More Support

Despite research that shows otherwise, most Americans — at least this is true for rural Tennesseans — don’t support expanding syringe access.

Many people think opening up syringe access simply enables injection drug users. While I understand this reasoning, the fact that regular injection drug users by the boatload who only have black-market syringe access suggests this idea falls short.

Let’s face it — often-problematic drug users like me have often lived up to the stereotype of “junkie” or “druggie.” I know this is true for me. And I’ve been around so many others who fit the bill, too.

If we drug users can prove ourselves responsible in handling syringes given to us, views toward improving syringe availability may brighten.

Of course, I’m sure syringe access will be portrayed negatively by local news agencies if syringe litter becomes prevalent or complaints arise even if most of us are, in fact, responsible with the supplies we receive. Still, we stand to improve our overarching reputation as drug users through proving responsibility. But this is something we should strive for, anyway.

For the record, if I wasn’t already clear, I’ve made myself — and all drug users, by extension — look bad countless times before. And, even though I try to act more responsibly now, I still find myself giving drug users a bad name from time to time.

Is it reasonable to expect everyone who uses drugs to act responsibly? No. Actively making drug users like me aware of this responsibility will, inevitably, encourage at least some of us to shape up.

Mail-Based Distribution Can Promote Safety During Pandemics

Times of pandemic don’t rear their ugly heads very often, to be fair, but MBSD reliably reduces pathogen transmission.

Although this is a very real benefit, I feel it’s auxiliary to other points expressed herein. Despite this, I think we harm reductionists could benefit from making the public aware of this benefit before the ongoing novel coronavirus pandemic slows down. Maybe not — admittedly, I’m not well-versed in communications or public relations.

Providing Opportunities to People as Potential Secondary Distributors Gives Them Purpose

I know a handful of people, one currently-incarcerated dealer and a few active drug users, who are willing to distribute the supplies I provide to others who use drugs.

The dealer, of course, was motivated by the prospect of selling syringes or increasing sales by offering supplies customers might not have access to. However, the others, I believe, are motivated by the prospect of helping others.

Long-term, often-problematic drug users like me often have less to live for than the general population. We are also less likely to actively pursue passions and hobbies. We lose interest in things we used to like.

Activating current drug users as secondary supply distributors gives them purpose, which can very well lead to outcomes like ceasing or decreasing drug use, securing gainful employment, or enrolling in college or trade school. Put simply, by giving people purpose, we improve their quality of life.

Just to be clear, I don’t think MBSD should be solely reserved for people interested in community distribution. Mailed harm reduction supply access certainly got me engaged in secondary distribution and harm reduction in general, though I think I’d have been less likely to seek out supplies if the senders considered me responsible for further distributing them.

In my time distributing supplies to other drug users and, less commonly, dealers, I’ve found that most recipients haven’t been interested in distributing syringes, naloxone, and company themselves. I do think, however, that people who seek out supplies from mail-based distributors are more likely to engage in secondary distribution than their counterparts.

They Help Kickstart Harm Reduction Efforts in Underserved Areas

I live in Northwest Tennessee. The closest syringe services programs are each two-and-a-half hours away. Syringes currently aren’t available anywhere else, as pharmacists — the only other legal source here — don’t usually sell syringes to people without prescriptions despite being legally able to do so.

I’ve only ever received harm reduction supplies from out-of-state, mail-based sources. These suppliers effectively advanced efforts to improve the treatment of people who use drugs by activating me as a harm reductionist, whether or not they had this in mind.

Mail-based distribution can inspire recipients to support future harm reduction-positive measures in grassroots form or, as in my case, encourage them to actively practice harm reduction in a tangible, hands-on manner (i.e., distributing supplies, educating others about safer practices in drug use).

One of the major challenges that American harm reductionists face, in my opinion, is expanding resources that help drug users to rural areas. MBSD is one of our most valuable resources in doing just this.

Tying Everything Together

MBSD isn’t just for reaching people in underserved areas. I think mailing syringes, naloxone, and company to people in areas where there aren’t currently any available resources is an effective way to reduce HIV and hepatitis C transmission, prevent injection drug users from potentially harming themselves by using worn-out syringes or other supplies, and connect people in active addiction with much-needed resources.

I also think health departments and state-sanctioned syringe services programs (SSP) can find utility in mailing supplies to areas that aren’t currently served. Mailing things isn’t free, plus, governments that allow SSPs to operate often require them to dispose of participants’ used syringes — mail-based distribution doesn’t lend itself to direct used syringe disposal by such programs.

Like all things in life, mail-based distribution isn’t problem-free. The altruistic distributors who send syringes and other supplies out of state often worry about legal action being taken against them. Some funding sources might not allow organizations to send supplies to out-of-state recipients, either, potentially resulting in loss of funding. There may be other issues, such as safety concerns.

All considered, mail-based supply distribution is a great thing—and something we need more of.

Harm Reduction

Uproar Follows Philadelphia’s Supervised Injection Site—But Is It Well-Placed?

Taken from Philadelphia Magazine.

Philadelphia, Pennsylvania, has long been one of the heroin hotspots of the United States. Drug Enforcement Administration (DEA) reports have long indicated that Philly has the highest-quality heroin in the nation.

Philly has been hit quite hard by the opioid epidemic. Fortunately, state and municipal governments in places like New England, the Pacific Northwest, and California have implemented programs and resources designed specifically to help people who use drugs.

The City of Brotherly Love was — was being the keyword — set to break ground on a supervised injection facility, or a facility staffed with medical professionals trained to respond to drug overdoses on Thursday, Feb. 27.

Expressions of disappointment and disdain have littered social media, websites, and forward-thinking news agencies since then. The supervised injection site (SIS) would have been the first of its kind in the United States, becoming the 11th country to implement such a facility, following behind Canada, Switzerland, Norway, Spain, the Netherlands, Germany, France, Luxembourg, Denmark, and Australia.

Yeah, It Sucks, We All Wish Philly Got the Supervised Injection Facility

As fans of harm reduction, drug policy reform, etc., it’s safe to say we all wish Philly would soon be home to the long-planned Safehouse-brand supervised injection site. Wish in one hand, spit in the other — that’s how it goes sometimes, right?

It’s not like Philadelphia is flat out of resources to help people who use drugs. Philly is home to some of the most forward-thinking policies, programs, and ideas related to harm reduction and drug policy reform.

Living in rural Tennessee, home of essentially zero drug-user-related resources, I wonder, where’s the support for expanding such resources here?

Why aren’t people seemingly as worried about equalizing the playing field across the United States instead of building up Philadelphia with a stronghold of drug-user-related resources?

I think trying to take advantage of this “failed supervised injection site” wave of popularity might help spread word of area-specific challenges for rural West Tennessee.

What Resources That Help Drug Users Does Philadelphia Have?

According to the City of Philadelphia’s website, the city’s residents are privy to considerably more valuable resources than other cities’ populations, such as Police-Assisted Diversion, for example:

• People stopped by law enforcement for certain minor crimes (e.g. illicit drug possession, buying controlled substances, prostitution, retail theft) in only the 22nd, 24th, and 39th Districts OR people who ask for help from the police, even if they aren’t reasonably able to be charged with one of the aforementioned crimes are eligible for Police-Assisted Diversion (PAD). Put simply, PAD steers a high volume of people eligible to be arrested for petty crimes away from jail and into “supportive, peer-based social services,” says the Philadelphia Police Department’s website.

Some people have proven themselves to use drugs irresponsibly or in a self-destructive manner. These people, of course — at least if they want what’s best for them, that is — shouldn’t be using drugs. I very much fit this bill — even though I constantly experience problems resulting from my drug use, I still use drugs.

Many long-term drug users struggle to outright quit their drug or drugs of choice when it’s primetime for them to do so. Lasting physical and mental effects can seriously improve the likelihood of bad things happening, such as continuing to engage in criminal activity. People who are forced to kick their dependencies and/or addictions in lockup are highly likely to relapse upon release.

Providing medication-assisted treatment (MAT) to incarcerated populations can reduce violence, improve quality of life, prevent inmates from further accumulating any other charges, and reduce the chance of recidivism upon release. Here’s what the Philadelphia Department of Prisons did with MAT:

• Just over two years ago, the Philadelphia Department of Prisons rolled out medication-assisted treatment in the form of buprenorphine (Suboxone, Subutex, Sublocade), naltrexone (Vivitrol), and methadone. Although officials only tested a small portion of their entire female incarcerated population, now MAT is available for all females who are currently incarcerated in the Philadelphia Department of Prisons.
• Speaking of MAT, the city’s Department of Behavioral Health and Intellectual Disability Services operates an around-the-clock MAT treatment facility in the heart of the city. In some cases, opioid-dependent persons who are unable to secure buprenorphine or methadone maintenance right when they feel they need it most are liable to move back to illicit opioids that, as we all know, are much deadlier than naltrexone, buprenorphine, or methadone.

People suffering from opioid use disorder need to get not just referred, but delivered directly to treatment providers so as to reduce rates of relapse, overdose, and other bad opioid-related outcomes from happening. This concept is known as a warm handoff:

• The City of Philadelphia has long known that people suffering from opioid use disorder are disproportionately likely to end up in hospitals’ emergency rooms. Whether the opioid-dependent people end up there because of overdose, unbearable withdrawal syndrome symptoms, or something else, physicians who are currently in charge of patients with opioid use disorder are now given help by the city to assure that such patients end up directly in the hands of necessary treatment providers — whatever treatments that may be.

We’re all familiar with naloxone, the opioid overdose antidote. Although providing naloxone to a municipality’s or state’s populace is one of the lowest-hanging fruits on the harm reduction tree — this is so because naloxone has no real contraindications, has a long shelf life, requires no prescription many places, and is so highly effective against opioid overdoses — Philadelphia’s distribution of naloxone to its people has proven to be an integral part of its multi-faceted response to the opioid crisis, with naloxone-related programs including:

• Giving everyone who has been released from jail within Philadelphia a naloxone prescription.
• Every month, the city holds a free training event during which anybody can learn how to recognize opioid overdose, how to administer naloxone, and otherwise respond to opioid overdoses.
• Here’s another thing: in many places, first responders are the number-one target of the people, government entities, or organizations that have been tasked with distributing naloxone. However, in Philadelphia, city-wide naloxone distribution targets community members, too, in a major fashion.

I’m Sure Philadelphia and the Quaker State Have More Resources That I Haven’t Mentioned

People who live in Philly are obviously more likely to know about all major drug-user-oriented resources that exist than residents of rural Tennessee.

I picked the aforementioned resources from the City of Philadelphia’s website — in particular, a section titled “The City’s Response” — and am sure I mentioned all the major ones.

However, since I don’t live there and haven’t talked to anybody who does live there, residents of Philadelphia and elsewhere in Pennsylvania may have more resources or programs than I’ve mentioned here.

Now, It’s Time to Explain What’s Available to Us Here in Rural West Tennessee

In August 2019, West Tennessee welcomed its very first syringe services program (SSP), A Betor Way. Although, I suppose, it’s “cool” to say that West TN has an SSP in its jurisdiction, since Memphis is in the southwestern-most extreme of the state, only people who live in Memphis, just outside of its city limits, or within a 15 or 30 minutes’ drive to the Birthplace of Rock ’n’ Roll would even think about sourcing clean, free syringes, naloxone, and other harm reduction supplies from either of the two Memphis-based SSPs.

I live in Martin, about 10 minutes south of Kentucky and an hour east of Arkansas. I’m about 150 miles — two-and-a-half hours’ drive — away from Memphis. Even people who live in the southwestern-most extreme of Northwest Tennessee still are at least an hour away from the city, if not closer to 90 minutes.

Like many states, the Volunteer State distributes naloxone to residents of the state. But who ends up getting the naloxone, and who or what organization gives it out?

About two years ago, the state put 13 Regional Overdose Prevention Specialists (ROPS). They primarily give out naloxone to first responders, law enforcement, and, according to the state’s website, people who are at risk of opioid overdose. ROPS give naloxone out at regularly-held training events that are free to attend.

Here’s the bad thing about ROPS — illicit opioid users are highly unlikely to attend the highly-public, town hall-type meetings.

So, what do we have here in rural West Tennessee? Nothing outside of outdated rehabs, exclusionary 12-step programs, drug courts, and profit-minded probation officers, unfortunately. This also holds true for rural Middle Tennessee.

In Closing

After seeing the rash of people speaking out against Philadelphia canceling its plans to house the supervised injection site, I wondered why people weren’t as worried about expanding ground-level programs in places like rural Tennessee.

That’s all I want — resources and programs that help drug users like me in criminally-underserved rural Tennessee.

Harm Reduction

How to Properly Dispose of Syringes and Other Drug-Related Equipment

In some places, such as Tennessee, possessing syringes after they’ve been used to inject drugs is illegal. As someone who’s lived in rural Tennessee his entire life, I understand that some people—think people who are devout, stubborn Christians, largely-right-leaning political ideology holders, those who believe problem drug use is caused by a moral deficiency—look at self-administered injection drug use as inherently wrong and synonymous with going off the proverbial deep end.

No matter how “strung out” or messed up any person who uses drugs is, I think it’s safe to say that nobody feels okay with littering used syringes

Here’s an anecdote — I live in Martin, a small town in rural Northwest Tennessee with about 10,000 people; our county, Weakley, is home to roughly 33,000. I have semi-regularly picked up litter for about a year-and-a-half, maybe two years. I’ve gone as long as three months without litter-picking and, on the other hand, have probably have spent as many as 7 to 10 days a month picking up litter

All in all, I don’t devote much time to litter-picking; truthfully, I enjoy being outside and picking up the mess that we’re all responsible for. 

In the grand scheme of things, finding used syringes on the ground five times is nothing! However, when you realize I only spend two or three hours picking up litter each month —tops — and live in a small, laid-back town that’s home to just 10,000 people, it’s easy to get alarmed.

Criminalizing Drug Use Directly Caused Those Syringes to Be Thrown Away Improperly

We all want medical waste such as syringes to be thrown away in sturdy sharps containers or otherwise securely disposed of. We don’t want used syringes to be found anywhere else. 

Then why did I find syringes on five occasions in a year’s time? Let’s juggle a few ideas and sort out what’s up and what’s down.

No Sharps Container Usage

Injection drug users are supposed to use sharps containers to protect people from used, potentially disease-ridden syringes. However, my friend Jane, a 47-year-old injection heroin user who helps me distribute harm reduction supplies who lives in Northwest Tennessee and is well-connected in the area, told meme yesterday that she’s never, ever seen an IDU dispose of their dirty sharps in a sharps container!

One reason for this is that sharps containers aren’t something that most IDUs are willing to buy, as anything not spent on drugs is a waste of resources. Sharps containers keep their contents in place quite well. As such, syringes discarded elsewhere are more likely to move around.

To Face Criminal Charges or to Quickly Throw Syringes Out the Window?

No injection drug user wants to risk going to jail because of a pesky syringe—that’s for damn sure!

Smart IDUs aren’t the only ones who are able to ascertain that throwing a syringe out of a moving vehicle could potentially injure a person or animal; doing so could also transmit serious, eventually-fatal diseases such as HIV. I’m confident in saying that we all know that.

Getting caught with just one syringe can cause people like me to violate their current probation, potentially resulting in the probationer going to jail for as long as the probation term originally was. We can lose significant others and spouses who aren’t aware of our injection drug use. Employment opportunities might not be extended to us, even if we’re otherwise-stellar candidates, because unappealing criminal records could very well—and often do—hold us back.

Just one syringe can lead to forced enrollment in a city’s, county’s, or municipality’s draconian drug court program.

Why risk it? Most injection drug users would agree that it’s better to chuck a used, uncapped syringe outta a moving vehicle rather than even risk getting caught with it.

No Legally-Approved Syringe Disposal Receptacle

Here in West Tennessee’s southwestern-most corner is Shelby County, home of Memphis. For a few years now, the Shelby County Health Department has maintained its Needle Disposal Program.

For a small fee, the government-run health facility provides injection drug users and anybody else who uses syringes, ranging from testosterone replacement therapy patients, to people with diabetes, and patients taking other hormones with a sharps container and an invaluable service: disposing of participants’ full sharps containers in a safe, legal manner.

Other than A Betor Way and Safe Point, Memphis’ two syringe services programs, which was founded in August 2019, there are no other places to throw away syringes in West Tennessee—at least not legally, that’s for sure.

Another Note for My Fellow Tennesseans 

T.C.A. § 40-7-124, put simply, is a 2015 law that protects people who, before a search is executed on their person, vehicle, home, or something else, tell law enforcement that they’re in possession of syringes or sharp objects that could otherwise be construed as evidence for violating T.C.A. § 39-17-425. 

The purpose of this law is, ostensibly, to protect law enforcement officers. I’ve read that some 30% of LEO end up experiencing needlestick injuries at least once in their careers.

It’s true that needlestick injuries are unlikely to transmit blood-borne diseases like HIV. Experts currently consider the risk of HIV transmission from a needlestick injury to be between 0.1% and 1%.

Transmission risk aside, nobody wants to risk being pricked, poked, or stuck by a used syringe’s needle, whether it’s their own or a complete stranger’s.

This law (T.C.A. § 40-7-124) helps law enforcement stay safe, reduces risks of criminal charges, increases the likelihood of cooperation from the officers or deputies who are at the scene, and gives drug users more personal liberty. 

Here’s How We Dispose of Syringes:

The item you want the most is a sharps container, sometimes colloquially called a “sin bin.”

Sharps containers owe their success to characteristics like its rigid plastic walls, self-locking seal, and impossible-to-overlook design. Arguably the only bad thing about them is that safely reusing them is all but impossible. If you’re involved in any grassroots efforts in which you struggle to afford supplies like sharps containers and reuse them in an attempt to save money, you should immediately quit the behavior because we should all strive to reduce movements made of and time spent in handling used syringes.

Simply open the sharps container, insert the used sharps, then close it once you’re done.

Most sin bins only recommend that the injection drug users who use them should stop filling their sharps containers around the three-quarter-full point, give or take a hair.

Let’s Say We Can’t Get Our Hands on Sharps Containers

Recall the characteristics of sharps containers above that make them so ideal for their intended use? Your mental list should start off with the first three items below in no particular order; you may not know about the latter-most three:

  • Rigid, all thanks to its thick, dense, structured, virtually-impenetrable walls.
  • In-your-face color scheme helps people locate full sharps containers and avoid potential unwanted health-related outcomes.
  • Although not all of these receptacles fit the bill of their counterpart described above, the best out there all create their own seal and lock any lids, windows, or panes.
  • Sharps containers are designed to stay in one single spot when recently-finished injection drug users fill their sin bins full of used sharps.
  • Biohazard waste is appropriately kept away from unwanted areas, people, or things, via sharps containers’ ability to prevent liquids from leaking out of the disposable-yet-reliable sharps containers.
  • How many times can you completely unseal and reseal a sharps container? The more times you can make this happen,

The closer your makeshift sharps container adheres to the aforementioned six characteristics, the better off you will likely be going forward.

Not sure how to go about crafting a makeshift sharps container? Aim to get the best raw “body”—or the “sharps container” part of the sharps container, if that makes sense —to place syringes and other unwanted biohazard supplies in.

Try Out Laundry Detergent Bottles

Of course, first, you’ll need to rinse out the detergent container. Before actually putting any syringes in the makeshift sharps container, make sure there are no holes in the container currently and ensure that it’s sturdy enough to take a beating if need be. Filling the container with water and examining it for leaks is a great way to save time and find the potential flaws of a makeshift sharps container.

Once they’re full, I recommend shoving paper towels, a mass of cotton, or wadded-up paper in the opening followed up by a generous amount of tape to prevent the used syringes from falling out. Also, aim for bright orange or neon yellow — or any bright, loud color of strong, reliable tape — so that you and other people can better see the makeshift sharps container.

How About the Thickest Plastic Bottles You Can Find?

We don’t need any special volume of plastic bottle now, really — what’s important is its thickness. Plastic bottles’ thickness is usually considerably thin, though most run-of-the-mill, two-liter drinks will be plenty thick enough for keeping the contents of your makeshift sharps container and the outside world.

20-ounce bottles are convenient for securely — well, at least as securely as you currently reasonably can, that is — putting away a handful of used syringes. These bottles are just about the thickest on the market, if you didn’t already know. It’s said that people who drink any kind of coke or brown, carbonated soda are more likely to be able to jam syringes in a half-full soda bottle, for example, which 20-ounce bottles lend themselves to.

Other plastic bottles that are sturdy enough to withstand punctures from anything in its environment are must-haves. 

Since plastic drink bottles aren’t intended for use as sharps containers, they are many times more likely to sustain a puncture in its exterior than their counterpart, the real-deal sharps containers. 

What If You Don’t Have ANYTHING to Put Your Used Sharps in?

This is a tough situation. Think for a moment—the most dangerous part of a syringes is the needle, right? Try breaking the needle off, though make sure you’re careful enough not to lose it. Next, pull the plunger from your used syringe and drop the now-broken needle inside the syringe’s barrel. Return the plunger to the barrel to reduce the chance of the needle coming out and getting in anybody’s or anything’s way. 

Again, relatively-thick plastic bottles and laundry detergent containers are both sufficient for placing used sharps in.

If you don’t mind asking around, try local prevention coalitions, churches, pharmacies, police departments, sheriff’s departments, and health departments for sharps containers.

How Can We Tennesseans Get Somewhere to Legally Throw Our Used Syringes Away?

The Shelby County Health Department, from as far back as September 2018, gave people a sharps container and then emptied it for them. SCHD charged “a small fee” for each sharps container.

Tennessee is home to—I believe—seven syringe services programs (SSPs): four in East TN, one in Middle, and two in West. One of roughly a dozen things that SSPs do is taking participants’ used syringes and throwing them away. Participants cannot get in legal trouble for being involved with them as a result of the protections that the state grants SSPs.

In Knoxville, Chattanooga, Johnson City, Nashville, Memphis, and a small city in East TN that I forgot the name of, people can throw their syringes away without any interference from law enforcement. 

At the very least, we need health departments, police departments, etc. to serve as the place to “trash” the used syringes. This costs little money. I think everybody, regardless of how conservative or anti-drug they are, could be in support of these used syringe receptacles; since the syringes have already been used, what “bad” could those conservative/anti-drug people be doing? They’re not contributing anything to the situation, in other words. 

So, Again, How Can I Advocate for the Adoption of Law Changes or Law Enforcement Officer Policy Changes in Terms of Handling Laws?

  1. If you live in an area in which high-gauge insulin syringes are very difficult to find, consider sourcing them—whether you have to do that from a syringe services program or syringe exchange, an e-commerce website that specializes in diabetic supplies or all sorts of general medical supplies, or an organization that sends them for free to people all across the United States via the mail like NEXT Distro of New York City, New York—yourself and then distributing those clean syringes for free to injection drug users throughout your local area. 
  2. Educating your fellow drug users about harm reduction and why distributing supplies, educating others, and maintaining contact with others in the harm reduction space to identify market trends is a great way to advocate for this cause. 
  3. By having other people in your network besides you, you can learn things, catch onto opportunities that are potentially of value, and maybe even become lifelong friends! 
  4. Out yourself as a drug user, but only if you are fully capable of CONSTANTLY representing yourself as an upstanding, reasonable, understanding, contributing member of society. If you choose to venture this path, just know that you might be hurting our greater reputation as problematic drug users single-handedly.

Although there are other methods of advocating for harm reduction-positive policy and practice adoption, these four are more than enough to get you started. 

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Harm Reduction

Stop Demonizing Synthetic Opioids

Two-dimensional chemical structure of fentanyl, a synthetic opioid.
Chemical structure of fentanyl

We’re all familiar with the rash of opioid overdose deaths currently plaguing the United States. You may also know how that fentanyl is often to blame for these fatal overdoses. While it’s true that fentanyl is a synthetic opioid, writers, reporters, and news agencies have widely placed undue blame on fentanyl’s synthetic nature for causing the opioid crisis.

Demonizing synthetic opioids will restrict access to other synthetic opioids that are valuable in treating opioid use disorder or managing chronic pain. It also encourages Americans to support causes that won’t reduce opioid overdose deaths, reduce the incidence of opioid use, or improve long-term treatment outcomes.

Fentanyl isn’t bad because it’s synthetic. Fentanyl is single-handedly responsible for more deaths than any other opioid right now because consumers never know whether fentanyl or fentanyl analogues are present, in what amounts fentanyl or its analogues are present, or if their street heroin is mixed evenly.

Most Americans don’t know that fentanyl is here to stay. Here’s why:

  • The primary issue is that the American opioid market is unregulated. Legalization and subsequent regulation is the only way for users to know without fail what they’re consuming.
  • Fentanyl’s synthetic nature means that manufacturers can create the drug in labs as opposed to growing vast fields of opium poppies. Laboratory synthesis is easier, quicker, and less risky.
  • Fentanyl is cheaper to produce than heroin and other opioids (e.g., oxycodone, morphine).
  • Dealers can selectively add more fentanyl to batches of street heroin to drastically increase the likelihood of an overdose. News regarding the opioid’s source spreads like wildfire among local users, often boosting business for dealers in the short-term. What profit-minded entrepreneur would give up this valuable marketing tool?
  • American illicit opioid users have grown accustomed to fentanyl. If, overnight, all fentanyl left the American illicit opioid supply, consumers would likely not feel satisfied at their current doses (i.e., 500 milligrams of fentanyl-free street heroin might not hold a flame to 100 milligrams of fentanyl-positive street heroin).
  • Fentanyl is relatively easy to source. Through Tor-based online markets, it’s easy to find reputable vendors selling high-quality fentanyl at low costs. While few people have access to high-quality heroin from high-level distributors or manufacturers, virtually anybody who purchases fentanyl online can compete with local low-level dealers.

Synthetic Opioids Aren’t Inherently Deadly


Bottle containing bright pink oral methadone solution.
Oral methadone solution

Methadone is a popular opioid replacement drug in the United States. It’s also a synthetic opioid. Methadone has a strong binding affinity to the brain’s opioid receptors. Put simply, this means that users can’t take other opioids (e.g., heroin, oxycodone, morphine) and get high; this blocking effect lasts anywhere from a few hours to upwards of two days after dosing.

Patients who are prescribed methadone for opioid use disorder won’t ever feel withdrawal symptoms unless they stop taking the drug as prescribed. This withdrawal-fighting quality reduces the likelihood of methadone-maintained patients of missing work or other obligations; as opioid withdrawal syndrome is often compared to the flu — illicit opioid users like me often call it being “dopesick” — it’s easy to understand how methadone helps opioid-dependent persons stick to schedules.


Tramadol tablet with the markings "AN 627"
50-milligram tramadol tablet

Although opioids are considered by many chronic pain patients to have high utility as a pain management tool, physicians across the United States have become considerably reserved in terms of prescribing opioids, even for patients with easily-diagnosed, legitimate, well-documented issues that cause chronic pain.

Opioid prescriptions have decreased in number, quantity of tablets prescribed, and dosage because they have a high potential for abuse. Although the vast majority of patients who are prescribed them don’t end up addicted to them, opioids are more frequently abused than other medications used to manage pain.

Tramadol is a synthetic opioid that has significantly less potential for abuse than other opioids (e.g., oxycodone [Percocet, OxyContin], hydrocodone [Lortab, Norco], hydromorphone [Dilaudid], morphine). Although it’s not ideal for all types of pain, modern research shows that tramadol “is now regarded as the first-line analgesic for many musculoskeletal indications.”


Generic transdermal fentanyl patch.
75 microgram/hour transdermal fentanyl patch

Although fentanyl is responsible for more opioid overdose deaths than any other opioid in modern America, pharmaceutical fentanyl isn’t to blame; rather, illegally-manufactured fentanyl is found in essentially all fentanyl-positive counterfeit opioid tablets and street heroin.

Fentanyl is, again, a synthetic opioid that isn’t used very often to manage pain. The drug should only be prescribed to opioid-tolerant patients who exhibit a well-documented need for such a potent analgesic. Physicians sometimes use fentanyl to manage acute pain in hospital settings.

The drug is also used in combination with midazolam to sedate patients via general anesthesia — however, fentanyl is only for analgesic (pain relief) purposes, not for actually putting patients under.

Although I struggle to find facts or statistics about how infrequently physician-prescribed, pharmaceutical fentanyl causes death in patients or diverted for illicit use, as a long-term opioid user who’s been around the block, I know that pharma fentanyl isn’t commonly found on the streets. I also know that people don’t isolate fentanyl from prescribed formulations of fentanyl (e.g., transdermal patches, nasal sprays, buccal tablets) to go on to adulterate street heroin or manufacture counterfeit opioid tablets.

Restricting the prescription or dispensing of pharmaceutical fentanyl in the U.S. won’t reduce the incidence of fentanyl-involved overdoses.

What’s the Problem With Suggesting That Synthetic Opioids Are Inherently Bad?

Laypeople aren’t that interested in illegal psychoactive drugs like opioids. It’s easy to understand why the public doesn’t have a good understanding of them. When people are told anything about opioids or other illicit drugs by the news, they often blindly take what they hear at face value.

Even those who support the criminalization of all drugs — throwing non-violent users in jail and all that jazz — know friends, family members, classmates, coworkers, local community members, and others who have struggled with drug addiction.

We — you and me both — all know people affected by the opioid epidemic. This fuels Americans to want to improve long-term outcomes for people suffering from opioid use disorder, reduce drug consumption rates, and cut down on opioid-related deaths.

Here’s the Issue

Most of us support ineffective methods of dealing with drug use, namely the ongoing opioid crisis. When we don’t understand why the opioid crisis has claimed so many lives, we similarly don’t understand how to respond to it.

Local news agencies, their national counterparts (e.g., CBS, NBC, CNN, FOX), and non-news writers alike need to make clear that fentanyl’s synthetic nature isn’t responsible for the opioid crisis, the rash of fatal opioid overdoses, or any other problems. The problem isn’t synthetic opioids. The problem is that illicit opioid consumers never know what active ingredients are present in the opioids they use or in what amounts; they also can’t be confident that an entire bag’s contents are evenly mixed, which ensures that one part of the batch won’t have a disproportionate amount of active ingredients. These discrepancies — illicit opioid users like me often call them “hot spots” — are the reasons why the modern American illicit opioid market has churned out so many fentanyl-related overdoses in recent years.

One thing’s for sure: if we don’t change our approach — and quickly — the opioid epidemic will keep on truckin’.

From Personal Experience Harm Reduction

I’m Burnt Out from Practicing Harm Reduction

Verywell / Cindy Chung

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

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

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

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

Shit Gets Old

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

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

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

A Culmination of Things

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

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

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

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

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

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

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

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

In Closing

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

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

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

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

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

Drug User Advocacy Harm Reduction The Volunteer State

Why I Support Safe Syringe Disposal in Tennessee

One of my few hobbies is picking up litter around my community. I’ll go litter-picking, as I call it, anywhere from once a month to three or four times a week. In just the past year, I’ve found used syringes in my small, rural area on at least five occasions.

After posting about my most recent run-in with irresponsibly thrown-out used sharps on Facebook in November, a local resident commented and claimed they, too, found a used syringe less than a mile away from me.

Although the potential of catching diseases like HIV or hepatitis C via needlestick injuries is low, nobody wants to come into contact with errantly-discarded used syringes.

Why Don’t We Increase Police Presence and Clamp Down on Prosecuting Syringe Possession?

This is a common response from people who I’ve told this story to. Small-town Martin, Tennessee, a low-key college town with great public schools, is a great place to grow up, say residents. Every local resident I’ve told about my run-ins with used syringes is baffled.

They usually respond by sharing sentiments that wholeheartedly disapprove of drug use. After all, people who inject drugs (PWID) know what they’re getting into ahead of time. Why tolerate such tomfoolery?

Police Are Already Harsh on People with Syringes

Police are already unforgiving of people found in possession of syringes. Judges aren’t fond of these “criminals,” either. Possession of syringes without a prescription often results in criminal charges.

Here are two recent, local examples of how law enforcement typically isn’t fond of people found in possession of syringes.

Example #1

A young, 25-year-old who lives in Martin named Zack — that’s not his real name, of course — got pulled over about a year ago here in Martin. A naloxone kit I’d given Zack was in his truck’s glovebox. The officer(s) found the naloxone kit and immediately thought the packaged, unopened, 25-gauge syringe was intended for injecting drugs. This kit, which included the syringe, two vials of naloxone, and a sheet of instructions, was in a bag clearly decorated with a large, white sticker that read “Intramuscular Naloxone Kit.”

Zack was not in possession of drugs at the time he was stopped. He also wasn’t under the influence of any drugs. Fortunately, he wasn’t arrested on any criminal charges.

It surprised me that the presiding police officers weren’t aware that 25-gauge, Luer-Lok, 3-mL syringes are almost never, ever used by injection drug users.

Example #2

In September 2019, I was pulled over by a sheriff’s deputy for speeding in Madison County, about an hour south of Martin. The deputy asked to search the vehicle. I refused. Before a K9 was called to the scene, I informed that deputy that I was in possession of syringes. I said nothing else and was not in possession of drugs or other paraphernalia.

The K9 alerted to drugs that weren’t there, giving the deputy and his crew probable cause to search the vehicle. Only the syringes I reported were found.

T.C.A. 40–7–124, a 2015 law, prevents Tennesseans from getting charged with possession of drug paraphernalia, a Class A misdemeanor punishable by a year in jail and a $2,500 fine, if they inform law enforcement that they’re in possession of sharps that have been used as drug paraphernalia prior to getting searched.

Further, syringes that haven’t been used as drug paraphernalia cannot be construed as evidence for charging someone with possession of drug paraphernalia, a violation of T.C.A. 39–17–425.

No matter what, I shouldn’t have been charged with possession of drug paraphernalia.

Here’s Why Criminalizing Syringe Possession and Use Won’t Work

Why do people throw syringes on the ground? Why don’t they properly dispose of them like self-respecting human beings? Here’s why:

  • Injection drug users (IDU) are scared of catching criminal charges from syringe possession.
  • IDUs have nowhere to legally or safely dispose of used syringes in Tennessee outside of the six syringe services programs (SSP) recognized by the state. The closest SSP to Martin is over 130 miles away. The next closest SSP is over 145 miles away.
  • People who inject drugs (PWID) around here haven’t been educated about how to safely dispose of syringes. The most appropriate, 100% free option is to dispose of used syringes in a 2-liter bottle, empty laundry detergent bottle, etc. The bottles should then be marked as “biohazard,” “sharps,” or “syringes.” It’s also a good idea to secure the top with tape once full.
  • PWID are scared of coworkers, loved ones, friends, and even fellow drug users finding out about their injection drug habit.

Benefits of Instituting Safe Syringe Disposal Locations

Social isolation is closely tied to problem drug use. PWID are more likely to seek treatment and have better long-term outcomes when they have closer ties to their communities.

Improves local residents’ relationships with the communities they live in.

Reduces criminal charges incurred by drug users, the majority of whom aren’t violent.

Many people in active addiction struggle from mental health problems that need to be dealt with via evidence-based mental health treatment providers. By creating areas in which IDU feel safe, they’re more likely to be interested in, seek out, and ultimately enroll in treatment.

Prescription Drug Take Back Day is an event held annually throughout Tennessee. These events are often manned by law enforcement officers, public health workers (e.g., physicians, nurses), and social services employees (e.g., counselors). By accepting used syringes at these events, PWID would: grow closer to the community; feel better about themselves since community leaders are accepting of them, even in active addiction; be more likely to seek out help from law enforcement, social services, and public health sectors; and encourage PWID to be more trusting of resources provided by cities, counties, and the state.

What Can We Do to Hasten the Adoption of Safe Syringe Disposal Locations?

Here are several things everybody can do to effectively encourage politicians, stakeholders, and laypeople alike to support the adoption of safe syringe disposal locations:

  • Talk to people you know in person — not on social media — about potentially crossing paths with used syringes in unexpected places (e.g., public bathrooms, sidewalks).
  • Write, call, and talk to local judges, police chiefs, sheriffs, state representatives and senators, health departments, and prevention coalitions about the benefits of safe syringe disposal locations.
  • Get involved with community-based organizations and local meetings such as those held by chambers of commerce and city boards. Befriend people who regularly attend them and share your ideas with them in a friendly, open-minded, understanding, well-researched manner.
  • Find brochures and pamphlets about syringe exchanges, for example, online or from harm reduction peer educators like myself, print them out, and distribute them to laypeople in your community — even if you don’t know them personally.
  • Connect with entities that deal with addiction treatment and drug use prevention such as rehabs and prevention coalitions. Share your ideas, such as expanding syringe access, with them.

Oftentimes, when people try to advocate for causes via the Internet, other people aren’t willing to listen. Neutral parties and opponents alike are likely to argue with proponents of adopting safe syringe disposal locations, ultimately causing rifts between those who do support the idea and advocates’ target audience members.

The best way to avoid this is to simply avoid using the Internet to spread this cause. It’s okay to organize advocacy efforts with like-minded advocates using the ‘net, as well as to perform research. Otherwise, avoid using the Internet, especially social media!