Category Archives: Harm Reduction

Why Meth Is Adulterated With Fentanyl

We’re all familiar with sensationalized news stories about cannabis, cocaine, and other illicit drugs being adulterated with fentanyl.

On the street, however, I’ve yet to cross paths with cannabis or any other drugs that actually are adulterated with fentanyl — outside of heroin and other illicit opioids, of course.

I have no personal experience with meth (drug nerds like me might use its full name, methamphetamine). However, I do have ties to people whose drug of choice is meth.

Earlier today, I talked to a fellow long-term sufferer of substance use disorder and resident of Northwest Tennessee (NWTN) who shared with me the fact that multiple major sources of meth here in NWTN are routinely adulterated with fentanyl. He, whose drug of choice is meth, also provided his take on why this is.

For the sake of simplicity, I’m going to refer to my friend as Jonah, which is not his real name.

What’s the Purpose of This Article?

As you may know, Northwest Tennessee is unarguably one of the most underserved regions throughout the Volunteer State. We are more far away from major cities than any other part of Tennessee — except for Southern Middle Tennessee, where I’m from — and have no organizations that practice harm reduction (See “An Aside” at the bottom of this article for an elaboration on this; in short, however, I’m not familiar with any persons, government agencies, organizations, or businesses that practice harm reduction in this area).

People like me need to report on the area-specific challenges that plague the Tennesseans who are most harmed by the opioid epidemic: long-term opioid users themselves, and now even people who don’t use opioids like the chronic meth consumer I mentioned earlier in the article. It’s important for me to do this because virtually nobody else in Northwest Tennessee is voicing the personal experiences of drug users to the world.

Note that this article is largely based on Jonah’s anecdotal report. This doesn’t mean that we should ignore what Jonah said just because he’s not a researcher, academician, medical professional, etc. — we should very much place weight on his report because few sources are voicing the anecdotes of long-term drug users living in Northwest Tennessee.

Also, Jonah’s insight may help the national harm reduction community better understand why non-opioids with complete opposite effects of opioids are adulterated with the ultra-powerful opioid fentanyl.

Typical Patterns of Methamphetamine Users

Yes, I understand that not all meth users go on days-long benders. However, many people whose primary drug of choice is methamphetamine do, in fact, use several days in a row and eschew sleep in the name of getting geeked out.

Oftentimes, chronic, daily meth consumers fail to drink and eat as much liquids and food as their bodies need.

These two factors — the lack of sleep and lack of proper nutrition — cause meth users’ bodies to feel tender or sore, if not outright hurt.

Here’s What Jonah Told Me

Jonah, who has been incarcerated for several months, shared with me earlier today that he was court-ordered to enter two rehabs. As a part of the two programs’ intake processes, Jonah was given a drug screen. Each time, he tested positive for both meth and opioids — specifically fentanyl — though Jonah never uses opioids.

Jonah hadn’t been drugged or anything like that. He is not prescribed any opioids from physicians. Put simply, there’s no way he could have had opioids in his system other than if the meth he had been using were adulterated with fentanyl.

And that’s what happened.

Here’s the Most Important Part of This Article

Why, exactly, does Jonah think he’d been using meth that was adulterated with fentanyl?

Remember just a few paragraphs ago when I identified the typical patterns of methamphetamine users and how those two things cause users’ bodies to hurt?

That’s why Jonah feels that fentanyl is actually purposefully included in the domestic illicit methamphetamine supply — to help ease the discomfort and pain associated with using meth several days in a row.

This Was Unbeknownst to Me

Of course, I don’t know everything — but I at least know a few things about the real-life use of illicit drugs and harm reduction. With that being said, I had absolutely no idea about the reasons for including fentanyl in the domestic illicit meth supply before talking to Jonah earlier today.

I’m sure that dozens, if not hundreds — hopefully even thousands — of people have proposed this very reason to explain why participants in the North American illicit drug market adulterate methamphetamine with fentanyl. If you, the reader, haven’t yet heard of the idea that Jonah proposed to me earlier today, please consider its merits and share this idea with others. Or, if you think Jonah’s idea is nothing but a crock, reach out to me — my contact info can be found at the bottom of “Who Am I?”, another page on this website. I’m very much interested in hearing what you have to say about why fentanyl has been found in illicit drugs other than opioids here in North America.

What I Learned From Jonah Today

Before today, I thought there wasn’t any legitimate purpose to include fentanyl in batches of methamphetamine.

I thought the only reason why there had been instances of fentanyl found in the non-opioid portion of the domestic illicit drug supply in the United States — and Canada, for that matter — was because manufacturers and high-level distributors had not exercised due diligence in adulterating their inventory with other suitable active ingredients or inactive cuts, either one.

For example, assume Bob is a high-level distributor. He stocks and distributes both heroin and methamphetamine as part of the United States’ illicit drug market. Assume that Bob breaks down his heroin supply, adds fentanyl, and combines the two. Further, assume Bob used a credit card, gift card, or driver’s license in the adulteration process.

Now it’s time for Bob to adulterate his meth supply, though he forgets to clean the fentanyl from his card, coffee grinder, or other drug adulteration equipment.

Assume that Bob blows up (adds inactive cuts to bulk up his supply of meth) his meth with methylsulfonylmethane (MSM) — and for the record, I have no experience with adulterating any drugs, so I’m not sure if MSM is a high-quality, safe, inactive adulterant.

Anyways, so Bob breaks down his supply of meth into a fine powder, mixes in MSM, and then recrystallizes his supply to return his meth to shard form (I think that’s how meth is adulterated, but, then again, I have absolutely no experience in doing this; please forgive me if that’s not how this process works, but, either way, whether this is the or a common way meth is cut, it doesn’t have any bearing on my example).

Although Bob might not care about keeping fentanyl out of his meth supply, there’s still fentanyl in his batch of meth now as a direct result of being careless.

This example was the only reason I could come up with to explain why non-opioid drugs on the domestic illicit drug market ever tested positive for fentanyl.

Putting It All Together

I’m glad I ran into Jonah earlier today and even more glad that he shared his ideas with me.

Jonah isn’t a genius and neither am I. He may very well be wrong. He may very well have hit the nail on the head. I encourage you to take this article with a grain of salt and not take it as fact, just as you should with all information — not just harm reduction stuff, but all types of information — you come across, whether a long-term drug user such as myself or Jonah with lots of real-world experience, an academician with limited real-world experience, a social services professional, or someone else presents it to you.

I think both the reasons I presented in this article are valid as to why fentanyl is included in non-opioid drugs on the American illicit drug market.

However, I’m sure there is at least one other valid, legitimate reason explaining why fentanyl has been reportedly found in illicit non-opioid drugs here in the United States. I’m more than open to hearing your suggestions — if you have any suggestions as to why fentanyl appears in drugs other than opioids here in the United States, please contact me.

About Jonah

I’ve known Jonah for about a year. I met him through one of my now-former dealers. I offered to give him syringes, to which he obliged — since then, Jonah has played a role in community distribution here in Northwest Tennessee.

Jonah, a White, working-class male, is about 45 years old and has lived in or around his current county of residence since birth. He uses “weed, speed, and beer” — the phrase has a nice ring to me — and has for a very long time. Meth is his primary drug of choice.

Jonah works manual labor and did not complete high school, though he did get a GED. He has been in and out of jail throughout his adult life, though not because he’s a bad guy — he’s simply been slapped with criminal charges related to drug use several times.

An Aside

Note: The only practitioner of forward-thinking, evidence-based harm reduction efforts that I know of in NWTN is Melesa Lassiter, who is paid by the state as a Regional Overdose Prevention Specialist (ROPS). ROPS distribute Narcan and train people to use it. Melesa has been helpful to me, personally, as I’ve reached out to her for guidance several times, though she and other ROPS — there are 20 throughout Tennessee in total, though only one in Northwest Tennessee, known officially as Region 6N by the state — are largely unable to reach at-risk users throughout NWTN. Of course, I’m not throwing any shade to her; I’m simply stating that the sate of Tennessee has largely failed to reach populations of opioid users within the state, including through the Regional Overdose Prevention Specialists the state government has hired to distribute Narcan.

Solutions to Northwest Tennessee’s Area-Specific Challenges

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

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

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

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

An Aside

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

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

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

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

Why Just Northwest Tennessee and Southern Middle Tennessee?

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

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

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

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

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

Solutions

1. Improving Trust and Reducing Discretion Exercised by Underserved Persons

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

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

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

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

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

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

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

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

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

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

Here’s the Solution

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Part 1D — Doing Things That Help Drug Users

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

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

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

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

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

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

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

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

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

2. Educating Drug Users About Harm Reduction

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

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

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

Here’s the Solution

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

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

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

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

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

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

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

A Summary

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

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

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

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

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

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

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

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

Putting It All Together

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

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

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

So, what can you take away from this?

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

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

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

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

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

Reasons Why the Illicit Opioid Market’s Participants Are Incentivized to Use Fentanyl

Fentanyl is an opioid that is much stronger than most opioids. It’s actually more responsible for fatal overdoses here in the United States than any other single opioid.

Most heroin here in Northwest Tennessee contains at least some proportion of fentanyl.

Whenever I use “heroin” in this article, just know I’m referring to mixtures of fentanyl and heroin. Although, in some cases, American heroin users might not receive mixtures of fentanyl and heroin all the time, most of the time, fentanyl is present. Also, don’t forget that the market contains counterfeit pharmaceutical opioids that contain fentanyl.

Here are a few reasons why dealers — a less fancy way of saying “the illicit opioid market’s participants” — are incentivized to keep using fentanyl.

Fentanyl-Free “Heroin” Might Not Satisfy Users’ Dependencies

Fentanyl causes much more intense opioid withdrawal syndrome symptoms than other less-powerful opioids, generally speaking, that is. Most people who use “heroin” actually use fentanyl-heroin mixtures whether they know it or not.

Dealers may notice a drop in sales or complaints from customers if they seek out fentanyl-free street heroin.

Exceptionally Strong Batches Bring Extra Traffic

It is true that news of overdoses spreads like wildfire within drug-using communities. If Jimmy’s most recent batch is rumored to have caused a number of overdose deaths, many users in that community will flock to Jimmy in search of heroin.

Jimmy may be incentivized to sell “heroin” that contains greater proportions of fentanyl than usual to achieve such short-term notoriety among opioid users in his community.

Note that such instances are more common among open-air markets, such as in Philadelphia.

Fentanyl Is Easier to Smuggle

Since fentanyl is much more potent than heroin, dealers are incentivized to continue using heroin mixed with fentanyl, if not use batches of “heroin” that contain nothing but fentanyl, as opposed to just heroin.

Fentanyl — when comparing IV fentanyl to IV heroin — is anywhere from 10 to 25 times stronger than heroin.

Stick out your pinky. Now make a fist. The difference in volume between your pinky and fist is a rough analogy between how much fentanyl one would need to smuggle, as compared to heroin, to get however-many users high.

Even if participants in the illicit opioid market aren’t smuggling pure fentanyl, for every bit more fentanyl that they include in their heroin-fentanyl mixtures, the less bulk they have to carry.

Users Report Drawing More Utility From Heroin-Fentanyl Mixtures

In my roughly three years of using heroin intravenously, I preferred my batches to include at least a little bit of fentanyl. I’d get more bang for my buck that way. Plus, the rush was a little stronger.

Many anecdotal reports from fellow opioid users, tons of which can be found online, indicate that they, too, preferred their heroin to contain fentanyl.

Fentanyl Is Easier to Manufacture

Although I don’t have any history whatsoever in manufacturing fentanyl or any other drugs, I do understand that fentanyl is easier to manufacture than other opioids. This is due to its synthetic nature.

The main reason why illicitly-manufactured fentanyl is easier to make is that its manufacturers don’t have to cultivate opium poppies en masse. Rather, they can source already-made chemical precursors. This reduces the burden on manufacturers in a number of ways.

What You Can Take Away From This

Put simply, fentanyl is far more dangerous than other opioids. When using street heroin — or any other opioid, for that matter — you should use fentanyl test strips to determine if your drugs have fentanyl. Fentanyl test strips are cheap and can even be sourced for free from Next Distro, though only in limited quantities.

If you don’t have any means of testing drugs before you use them, always use around other people and take super-small test doses with every new batch you get before dosing as you normally would.

Also, of course, make sure to have naloxone around, as well as someone who knows how to use it.

How the Deep Web’s Illicit Drug Markets Promote Safe Drug Use

Most of us have heard about the dreaded, oh-so-evil “dark web,” as well as the seemingly-interchangeable term “deep web.”

The dark web is the collection of websites that require advanced, specialized configurations and setups to access. The deep web is simply all websites that cannot be found on Google, which includes companies’ in-house web-based tools and applications. To help you better understand them, remember that the dark web fits within the greater deep web — kinda like how rectangles are squares but squares aren’t rectangles.

Believe it or not, the majority of the Internet takes the form of the deep web.

How Do People Access the Dark Web?

In the modern world, most Internet users who access the dark web do so via the Tor Browser, where “Tor” is short for The Onion Router. Tor, which contains the Tor Browser — all these things with Tor in their names are made by The Tor Project — helps people engage in anonymous communication. Tor is entirely free to both download and use; it’s also open-source software.

Using Tor Browser itself isn’t enough to protect your identity while browsing the dark web, though it’s a great start. Downloading the Tor Browser Bundle is as easy as making a quick google search — better yet, it’s a quick download.

One of the most common websites on the modern dark web is those that help people sell and purchase illicit goods and services. These operate similar to eBay, in that such sites simply act as an intermediary between buyers and sellers. AlphaBay Market, for example, was one of the largest online darknet markets before being shut down in mid-July 2017.

Drug Users Benefit From Exchanging Illicit Drugs on Tor-Based Websites

In real life, very, very few drug users are familiar with any local area’s list of dealers. Buyers often know anywhere from one to a few local dealers, but usually never all of them. Assume that you know all the dealers in Joshuatown.

You can shop among this network of dealers and potentially leverage one dealer’s offer against another. However, while you, personally, might be able to peruse your fully-unlocked menu of illicit drug salesmen, almost everybody else in your locality will not.

I bring this up because if they were able to, they’d likely pay less for drugs due to increased competition among vendors.

Provides Access to Legitimate Forms of Drugs That Are Sometimes Hard to Get

Darknet markets make it easy for drug users around the world to get their hands on drugs of higher quality than they could get among their real-life drug connections, drugs they couldn’t otherwise purchase within their localities, and to shop for the safest, most highly-reviewed goods on such digital storefronts.

Wider competition forces vendors to offer up their most potent, least-adulterated substances. Also, because people in other parts of the world who str able to access drugs that are hard to find in other people’s lives, they’re incentivized to register on these illicit eBay-like websites and capitalize on their valuable sources of sought-after drugs.

Many drug users who are familiar with dark web markets know how seriously useful they are in obtaining these harder-to-find psychoactive substances. Since only people with legitimately high-quality sources are likely to even begin to succeed on the market, they’re not likely to proffer illegitimate drugs.

Reviews Form the Backbone of E-Commerce-Based Illicit Drug Markets

Reviews mean the world to the participants of the dark web’s drug markets. Just two or three bad reviews in a row can mean significant business declines for these Internet-based dealers.

On these types of markets, since users’ identifies are safeguarded, the only way to gauge how much users mean to others is by turning to their reviews and other means of gauging reputation.

What’s so good about these reviews? Most sites anonymize identifying information about reviewers, such as the exact times that they made purchases, their usernames, or the exact amount of dollars spent. As such, in most cases, they can freely leave reviews on vendors without having to worry about facing repercussions.

Reviews are typically posted within a few minutes or hours of their publication. This is done for user safety.

Less Violence Is Associated With This Mode of Purchasing and Selling Drugs

Drug dealers and other criminals engage in violence to assert dominance over competitors. One such application of violence by a drug dealer or a group of like-minded dealers is to perform a drive-by shooting if a member of a rival gang or group of drug dealers. The intended result of such violent activity is to dissuade those rival gang members or dealers, ultimately resulting in more business for the party who shot.

This is one way drug users can find themselves on the receiving end of violent crime.

It’s safe to say that everybody who has used drugs for any stretch has been robbed of or taken advantage of for drugs at least once. We know all too well that users and dealers alike are prone to gather up weapons and other criminals’ help to rob others of money or illicit drugs.

If someone does, in fact, manage to get over on you in real life, you may be inclined to act violently to the perpetrator(s), ranging from a sucker punch to point-blank sprays of gunfire. That’s right — violence here, violence there, violence everywhere in the world of drugs.

Unless you arrange to meet a buyer or seller in real life — something you should never do — you’ll almost certainly never find yourself victimized by violence as a result of drug deals going bad or other criminal behavior.

You Don’t Have to Leave the Comfort of Your Home

Purchasing drugs without having to leave your home — or wherever you order them from — is safer than having to drive or otherwise meet your dealer and venturing back to your place of residence.

Life is risky. You never know when a car accident could take place, for example. Not having to get out reduces the risks of such real-yet-unlikely threats.

Law enforcement agencies stress the importance of carrying out traffic stops to the best of their government-given abilities. Pulling drivers over leads to so many other things for law enforcement officers, such as finding drugs or drug paraphernalia. This is a risk that drug users like me have to face.

Eventually, we’ll all get pulled over or apprehended by law enforcement. Put simply, the less you drive in sourcing your drugs of choice, the less likely you are to experience interference from law enforcement.

If Done Correctly, Curious Government Officials Will Almost Entirely Be Unable to Intercept Mailed Packages Containing Illicit Drugs

When it comes to mailing things within and outside of the United States, the three couriers that we Americans have access to are FedEx, UPS, and USPS.

FedEx and UPS are both private businesses. By paying for postage, you’re agreeing to several terms and conditions that ultimately give workers employed by UPS or FedEx, to look inside any and all packages that make their way through these two companies’ facilities.

USPS — also known as the United States Postal Servicemust obtain a search warrant before searching any packages or parcels that have any of its workers, facilities, or vehicles. As such, illicit goods are almost always shipped via USPS as a best practice.

What About the Legal Statutes Violated by People Buying and Selling Drugs via the Internet and the Mail System?

As you might imagine, the laws people violate for buying and selling drugs via mail within the United States carry much more harsh punishments than small-time drug possession and drug paraphernalia possession charges.

Federal crimes like narcotics trafficking, money laundering, and computer hacking are three of many examples of punishments that can stem from selling drugs via the Internet and the mail.

I’m not an attorney, so I don’t know exactly how many more years in jail that buying or selling drugs online might bring as compared to doing so in traditional, face-to-face form; however, it’s safe to say that, in most cases, using the mail and the Internet to engage in these activities hold serious sentences.

Also, because darknet markets are relatively new, U.S. law enforcement agencies are more than willing to make examples out of people caught up in this stuff.

Bringing All the Loose Ends Together

Am I telling you to purchase or sell illicit drugs online? No!

I am simply recognizing the handful of very real benefits to drug users that can be derived from using Tor-based websites to purchase and sell illicit drugs.

Also, because it’s possible to safeguard your identity when using darknet markets, drug policy reform and harm reduction advocates can engage in darknet-market-based commercial activity related to illicit drugs without standing very much of a chance of risking their freedom.

People who are unwilling to come out as drug users, such as how I have, due to the obvious potential consequences associated with it, might find utility in Tor-based markets that oversee the sale and purchase of illegal drugs. In other words, they might prefer to engage in advocacy on this level as opposed to being active in the real world.

Less Common Safe Drug Use Supplies That Your Syringe Exchange Should Give Out

Tooters

One of the most commonly-distributed forms of drug paraphernalia by entities engaged in harm reduction is syringes. Cotton, tourniquets, and alcohol swabs are also commonly given out to help drug users, particularly injection drug users (IDUs), stay safe. Supply distributors often fail to include people who sniff drugs.

Intranasal administration is a common form of administration with many popular drugs, including cocaine, opioids, and amphetamine. People use things like rolled-up currency notes to cleanly transfer drugs to users’ mucous membranes that line their nasal cavities. They also often share these homemade, disposable tooters. Many people don’t know that sharing tooters can spread HCV — Hepatitis C — and other diseases.

Few harm reductionist agencies, organizations, or well-intentioned individuals give out clean tooters, whether they be permanent and sturdy or reusable and pliable.

Meth and Crack Pipes

Traditionally, crack pipes, also known as stems, were made from “glass roses” often available at head shops and gas stations. The roses themselves were simply filler items so that their “vases” — crack pipes in poor disguise is more like it — could be more easily sold. All that needs to be done is buy some steel wool, known by the brand name of Chore Boy, and place a small piece in the smoking end of the pipe.

After this is done, crack pipes are ready for use.

Keep in mind that you don’t have to use Chore Boy — just as cotton swabs are widely known as “Q-Tips,” a popular brand name of cotton swabs, crack users often refer to steel wool as “Chore Boy,” irrespective of the actual brand name or manufacturer.

Meth pipes are also disguised in similar ways in convenience stores, head shops, and gas stations, as well as web-based drug paraphernalia stores.

Lightbulbs can be modified to smoke — technically, you don’t want to cause meth to combust; rather, to get more bang for your back, you want it to vaporize — meth by simply adding a hole and removing their insides.

Just recently, Next Distro began stocking both crack and meth pipes. Now, as one of the largest distributors of harm reduction supplies across the United States, thousands of drug users will soon find it easier to locate new or lightly-used crack or meth pipes that, just like clean syringes, help these stimulant users stay safer.

Syringe Disinfectants

Fortunately, we’re at a point where harm reduction programs here in the United States are readily able to provide others with brand-new syringes ideal for intravenous drug use. As such, we don’t often find syringe disinfectant aids, such as chlorine tablets that help eliminate all diseases that may be present on and within used syringes.

These chlorine syringe disinfectant tablets, which actually contain sodium dichloroisocyanurate, or NaDCC, are used as follows:

• First, take the chlorine tablet and drop it into a glass of clean water.
• The used syringe in question should be thoroughly, fully rinsed at least twice with water.
• By now, the tablet should have dissolved.
• Flush the syringes at least once with this chlorine solution.
• Next, follow up by at least one rinse of only water.

Colored Syringes

Of course, syringes are used to inject drugs. They consist of a needle, barrel, and plunger. Syringes truly are that simple.

Colored syringes aren’t common in the United States. One benefit of colored syringes to their plain, like-kind counterparts is that it’s easier to differentiate between whose syringes are whose. As long as two or more intravenous drug users set out to each get different-colored syringes for their current using session, they’re going to be at a much, much lower risk of mixing up one another’s syringes and potentially transmitting blood-borne diseases.

Truly Single-Use Syringes

All syringes — at least it seems to be this way — that modern American drug users administer intravenous drugs with are supposed to be used just one time.

However, due to various issues in our modern society here in the United States, people don’t always have steady access to free, clean syringes. As such, they end up reusing them.

A man named Marc Koska, who I do not know and have never met, developed a brand-name syringe known as the K1 Syringe. Put simply, the K1 Syringe is a true single-use syringe, as it is designed with safeguards that render these units unable to be used for second or further administrations.

Although this does encourage intravenous drug users to seek out new syringes, IDUs sometimes put themselves at greater harm by trying to bypass these safeguards and use K1 Syringes again. They might also try to make makeshift syringes, which are inherently more dangerous than reused syringes.

A few other generic names used to describe syringes like the K1 Syringe are difficult to re-use (DTR), lockable, auto-disabled, and retractable syringes.

There are several good reasons as to why these DTR syringes are not provided by modern domestic harm reductionists to drug users, including:

• They, by design, leave a small portion of the drug-containing solution behind.
• DTRs sometimes make registering to make certain you’re in a vein difficult.
• If the needle itself clogs, drug users sometimes harm these syringes just to use what they already loaded up.
• More widespread reliance on DTRs would probably result in non-DTR units being re-used and circulated on second-hand markets more often.
• These well-intentioned auto-disabled syringes are roughly three times the price of other syringes.
• Leaving IDUs to deal with syringes that do include safeguards assumes that they’re unable to be responsible as a greater social class.

Here in the United States, Ascorbic Acid Is Uncommon

Some American federal agency classified freebase diamorphine as heroin #3 and diamorphine hydrochloride as #4. #3 is typically found throughout Europe and originates, most times, from the Middle East. It’s one step short of being fully-fledged heroin.

Just like freebase cocaine, freebase heroin — aka heroin #3 — doesn’t dissolve in water without the help of ascorbic acid, also known as vitamin C.

There’s not much of a use for ascorbic acid among American heroin users due to the fact the seriously-overwhelming majority of heroin in the country is #4 and readily breaks down in water.

Although ascorbic acid is used by some American users to prepare crack cocaine for intravenous use, ascorbic acid is typically rarely seen among modern harm reductionist organizations’ and agencies’ supply lists.

These Aren’t the Only Rare Ones

Some of these supplies are solid ideas and would do nothing but increase the benefits derived from modern harm reduction advocacy. However, others are proven to be detrimental to our cause as harm reductionist advocates or drug policy reformers.

Can you think of any other rare, uncommon, or outdated harm reduction supplies? If so, please share them in a comment or by reaching out to me directly.

How to Use Naloxone

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

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

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

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

Naloxone-Reversed Opioid Overdoses Cause Immediate Withdrawal

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

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

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

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

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

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

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

Picture of Narcan nasal spray.
Narcan nasal spray

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

Evzio auto-injector

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

Which one is better:

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

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

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

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

Knowing About It Isn’t Enough; Trainees Need Practice

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

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

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

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

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

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

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

Check Out This Unconventional Concern to Consider Regarding Injection Naloxone Use

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

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

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

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

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

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

Always Use Around Others

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

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

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

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

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

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

Just a Few

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

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

People Who Sell Drugs Should Also Be Included in Harm Reduction Efforts

When we think of harm reduction, most people rarely think of helping people who sell drugs. Rather, helping general drug users out pops to mind.

In actuality, many illicit drug users sell drugs to others or otherwise facilitate the exchange of illicit drugs through one another. This includes acting as a “middleman” and using connections that your drug-using partners make available when you attempt to source drugs together by piling both of your money together, for example, among many other types of facilitation, harboring, or furthering.

Either way, no matter how many people actually sell drugs on occasion, it’s important for us harm reduction advocates to activate vendors as harm reductionists.

How Might You Activate a Dealer as a Harm Reductionist?

There are many ways to get dealers involved as harm reductionists. Unfortunately, they have historically been drastically under-utilized as assets in advancing our cause as harm reductionists. Here, I’ll be covering a handful of practical ways to get your sources of illicit drugs to engage in harm reduction practices and spread such ideas with others.

Make Sure to Build Tight Relationships First

Establish relationships with sellers first before attempting to establish them as harm reductionists. Doing so without having first established tight relationships, especially in rural Northwest Tennessee (NWTN), where people are largely unaware of harm reductionist’s ideas, practices, and policies, is less likely to be welcomed by your targets.

In areas where the local or regional cohorts of drug users and sellers alike are more likely to be aware of the availability of clean supplies and safe drug-using strategy education, you won’t be forced to develop such close relationships.

Unfortunately, this isn’t true here in NWTN. This ultimately slows how quickly harm reductionists can engage in the distribution of supplies to dealers throughout Northwest Tennessee.

Encourage Sellers to Share Supplies and Education Between One Another

Dealers might develop a competitive advantage by having regular access to clean, suitable harm reduction supplies, especially if those objects are provided at no cost. As such, they would be incentivized to keep such information quiet and to themselves to maintain that advantage.

However, dealers often work in loosely-fitted organizations known economically as cartels — for the record, I’m not referring to what we think of as “drug cartels,” but the true economic use of “cartel” — that operate through participants adopting like principles to protect common interests.

One example is a group of dealers fixing their prices at market-wide lows on the local drug market.

These groups of like-minded competitors, in the name of preserving the welfare of their long-term operations and reducing competition between individual cartel members, are also likely to share resources among themselves such as ideal sources of harm reduction supplies.

Keep in mind that in your exposing of people who sell drugs to such free harm reduction supplies, they’re going to be inherently incentivized to stock them in the name of more effectively attracting customers. The more people you establish such trusting, working relationships with, the more likely you’ll eventually stumble across members of such cartels who are more likely than other dealers to share harm reduction supplies among their drug-vending counterparts in a peer-to-peer fashion.

Putting Dealers On to the Utility of Standardized Drug Checking

Experts in the modern world of drug checking have mentioned that, once one major dealer in most towns, cities, or other relatively small areas regularly check the contents of drugs through chemical means when selling them to resellers and end-users alike, all other dealers are forced to also adopt the practice or be forced to compete with such a massive competitive advantage.

Even though some customers might not be interested in drug checking, most will either appreciate it from the jump or come to develop positive opinions about drug checking pretty early on.

Mandelin, Marquis, and Mecke reagent tests are the three most popular such reagents used in drug-checking. Using them simply requires chipping off a tiny amount of the drug in question. Separate the drug sample into three roughly equal parts, dropping one of each flavor of reagent on each sample. By simply reading the colors of these tests’ results, dealers can prove the contents of what drugs they’re selling to customers in real-time.

Instant urine drug screens use one or more paper strips to determine whether drugs or their metabolites are present in urine samples. One particularly sensitive such strip-based drug test is that of modern fentanyl urine screens.

Fortunately, these fentanyl test strips can also readily be used for detecting fentanyl in drug samples within anywhere from a few seconds to a couple of minutes. Simply dissolve a tiny bit of a drug in question in water, dip the strip in the solution for a few seconds, then read the strip’s results shortly thereafter.

These are both — the reagent tests and fentanyl test strips above — easy to understand and therefore useful among potential buyers, they are cheap to purchase and implement, as well as easy to source, whether they come from for-profit drug-testing-supply resellers or their non-profit counterparts.

Seek Out “Community Guide” Services From Well-Connected Individuals

This particular piece of advice also applies to drug users or people who are otherwise involved with drugs who don’t use or sell them.

Harm reductionists, both individuals and organizations, have experienced success in activating people who sell drugs as harm reductionists by building bridges between themselves and well-connected individuals among local or regional illicit drug markets.

These people are widely respected and trusted by dealers when they tell inform them about harm reduction. Also, dealers are more likely to welcome offers of being given free syringes, naloxone kits, and other drug-using supplies.

Although it’s not always possible, this is arguably the most effective and highest-valued approach to activating a market’s vendors as harm reductionists.

Know that, as you might imagine, these people will likely not be willing to share the identities of local dealers or introduce dealers to such harm reduction advocates directly. People who are fortunate enough to find such “community guides” should be thankful for having their help in any capacity, form, or fashion.

Making Sense of It All

Although I know it’s especially true particularly in Northwest Tennessee, there aren’t any established infrastructures for carrying out harm reduction activities on a large, state-approved scale. I’m sure it’s also like this many other places throughout the United States.

Since the contemporary drug-related roots of harm reduction only date back to the 1980s, I feel the general domestic realm of harm reduction is largely unexplored. It’d be nice if we could follow tried-and-true, already-tested guidebooks that include pictures for better understanding and step-by-step guides.

However, this is nothing more than a pipe dream.

Just know that it’s normal to not experience even moderate levels of success in activating drug dealers as harm reductionists. Be patient, street-smart, and don’t ruin individual relationships that must be based on trust.

Please report any strategies or approaches that you’ve found to be successful in activating dealers as advocates for our cause to me, directly, or elsewhere online, such as in popular, active web-based harm reduction and drug advocacy forums.

Real-World Things Anybody Can Do to Advance Harm Reduction

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

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

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

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

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

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

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

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

What Can You Actually Do to Advocate for Harm Reduction?

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

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

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

Share Information With Others in Support of Harm Reduction

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

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

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

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

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

Become Active in Looking Out for News That Supports Harm Reduction

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

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

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

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

Regularly Attend Local Governments’ Community Meetings

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

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

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

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

Donating to Harm Reduction Organizations

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

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

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

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

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

Not Moving Our Cause Backward

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

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

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

Give Out Syringes, Naloxone, and Other Supplies

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

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

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

Educate Others About Safe Drug Use Best Practices

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

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

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

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

This Isn’t an Exhaustive List

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

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

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

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

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

What Should You Take Away From This?

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

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

Why Name-Brand NARCAN® Is Worth the Extra Price

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

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

The Average Cost of Generic Naloxone Kits

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

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

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

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

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

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

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

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

The Average Cost of Narcan

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

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

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

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

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

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

The Average Cost of Evzio

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

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

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

Which One Is the Most Valuable?

Narcan is the most valuable — here’s why:

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

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

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

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

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

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

All Considered

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

Can You Use Narcan on Yourself?

Naloxone is the active ingredient in Narcan, a nasal spray formulation of the drug that reverses opioid overdoses nearly instantly. You may have heard about Narcan or naloxone in recent news headlines related to the rash of opioid use that culled 47,600 Americans in 2017.

Naloxone most often comes in two forms: intramuscular naloxone kits and the more convenient name-brand Narcan nasal spray. Narcan is easier in that it only requires the nasal spray unit itself which is fool-proof and comes loaded with ready-to-go nasal sprays from the time they’re manufactured.

If you aren’t already familiar with intramuscular naloxone administration, it requies drawing naloxone solution into a syringe for injection is time-consuming and may prove difficult during the panic that witnesses might feel immediately after friend, family member, or running partner experiences opioid overdose. This is the main reason why Narcan is superior — it’s hard to mess up administering the drug with this name-brand nasal spray.

How Long Does Opioid Overdose Take?

Opioid overdoses can take place anywhere from seconds to hours after an opioid user’s last dose. Intravenous use (shooting up) typically manifests overdose symptoms most quickly, followed by intramuscular use. After that, intranasal (snorting) and rectal (boofing, booty bumping) overdoses happen pretty quickly, though not as quick as with injection use. Oral administration usually takes the longest to result in an overdose.

But how long, exactly,” you may ask, but there’s no set-in-stone time frames during which opioid overdose can be expected.

I’ve overdosed some 10 minutes after injecting opioids intravenously, which is supposed to cause overdose instantly — at least that’s what many people think, both users and laypeople.

About two hours after I took a combination of oxycodone (Percocet, OxyContin) and alprazolam (Xanax), I experienced my first overdose. Most people think that OD’s never take this long to manifest — think again, as they very well can.

In Practice, Only Others Can Reliably Use Narcan

Most opioid users don’t want to forego the high that their expensive opioids bring them. Most of us, especially those in rural Northwest Tennessee, are not able to readily afford opioids to our liking. This makes us not want to waste the high that disappears when naloxone is administered.

Despite its life-saving capability, still some people are averse to using it at the risk of spurring precipitated withdrawal, a beefed-up version of opioid withdrawal syndrome caused by administering naloxone.

Many users whom I’ve distributed supplies to here in Northwest Tennessee weren’t familiar with “naloxone,” let alone how to use it. Those who are familiar with it tend to think self-administration is both feasible and reliable.

This couldn’t be further from the truth.

As a four-time opioid-overdose-experiencer who’s been given naloxone thrice, opioid overdose feels like going to sleep out of nowhere, often with no sense that an overdose is imminent.

Self-Administration of Naloxone Isn’t a Reliable, Feasible Option

Most people fall unconscious before they can prepare themselves to administer naloxone. Once you’re unconscious, it’s kinda hard to do anything, let alone revive yourself. For this reason, self-administration of naloxone isn’t possible.

Besides, even if you could walk that thin line, just know that you don’t get any second chances — the first time you fail, you die.

What Opioid Users Should Do

  • Always use around someone else who isn’t also using drugs, at least not those that can cause deadly overdose. Inform them when you’re using, make sure they know where naloxone is, and ensure they understand how to spot overdose symptoms and administer naloxone.
  • People who are prescribed opioids should also be aware of the risks of opioid overdose. They should follow the same protocol that I’m covering right here.
  • Learn how to spot signs of opioid overdose and how to administer naloxone via an online training course like this one to help others improve their OD response efforts.
  • Join a local harm reduction coalition or recovery alliance.
  • Look for more insight on administering naloxone and spotting overdose by googling the topic. I implore you to always research things — at least things of importance, which I hope you consider administering naloxone to be — you find online.

Both opioid users and laypeople should strive to educate themselves about naloxone and how to use it, which can easily be done online.

Where to Find Naloxone

In most places across the United States, it’s relatively easy to find free naloxone around close or online. Here are some resources for people in

Government agencies provide naloxone and related training on local levels, such as the municipal-level, Tennessee-based Weakley County Prevention Coalition.

State-level Narcan provision is also done, such as by the state of Tennessee’s Department of Mental Health & Substance Abuse Services, which is carried out by 20 Regional Overdose Prevention Specialists (ROPS) responsible for various regions throughout the Volunteer State. Melesa Lassiter, for example, is Region 6N’s ROPS, which covers the nine-county spread making up the entirety of Northwest Tennessee.

Non-profit organizations such as NEXT Distro of New York City, New York, are even active on a national level, which spreads harm reduction supplies and education across the 50 states.

See my other article, “Accessing Naloxone in Martin, Tennessee,” to learn one effective, reliable means of sourcing Narcan in Martin, Tennessee, one of many small towns in Northwest Tennessee. If you’re not in Martin or Weakley County, Tennessee, google your local area’s services. Find more general drug-related resources here.