Friday, November 20, 2020

Harm Reduction in the Time of COVID: A Guide


Alright, we know this year has been stressful all around.   2021 is unlikely to be substantially easier in terms of public health, economic circumstances & morale.  Substance abuse is on the rise and, unfortunately, so are overdose deaths.  But it doesn't have to be that way.  You CAN get fucked up without irreparably damaging your body, killing yourself or even ending up addicted once all this is over.  (Most of us without a history of serious addiction, that is).  But even if you relapse after a period of sobriety, these tips can help save your life or minimize damage regardless of your drug of choice.  

There's a misconception that people who get high don't care about their health & deserve whatever terrible fate befalls them.  This attitude is abhorrent and has caused as much unnecessary harm as drugs themselves.  It's akin to the abstinence-only Sex Ed mantra that treats pregnancy as a 'punishment' for sex & forces girls and women to become reluctant mothers at the cost of the child's well-being. It's impractical & punitive and needs to die.  You don't.  

So without further ado, here are some tips to help you use your substance of choice more safely:


* Before trying a new drug, look up the safe dose & possible interactions on Google.  Sites like Erowid.org, Drugs.com & Wikipedia are generally reliable guides when it comes to providing this basic info. 

* If using non-prescription drugs, test a small "microdose" orally or nasally before using a larger amount.  Wait 15-20 minutes before taking a larger dose to make sure you don't have a negative reaction.  Do this with each new batch you buy even if you trust your source.  Even the best dealers don't always know what they have unfortunately.

* Buy a test kit for MDMA & other street drugs.  This will save you LOTS of uncertainty & headaches.   

*  If taking depressants like alcohol or benzodiazepines, set aside a specific amount beforehand & put the rest away & out of reach.  There's a tendency to "blackout-redose" with these drugs which can be dangerous & lead to taking far more than you'd intended.  NEVER drive under the influence of any drugs but especially this class. 

* If you vape or smoke cigarettes, consider stopping.  There's never been a better time with COVID-19 upon us.  According to otolaryngologist Willard Harrill, vaping increases the risk of developing severe COVID in young & millennial populations who tend to be the heaviest users of vapes.  

* Don't combine opioids with depressants like alcohol, barbiturates, Ambien or benzos.  The additive effects increase the risk of respiratory depression and death.  If you do combine them, cut the dose of both drugs roughly by half (or more).  

* When choosing a route of administration, choose oral over insufflation (snorting); snorting over smoking, and smoking over intravenous (IV).  This obviously doesn't apply to drugs like cannabis which can't be snorted or injected but it's a good rule of thumb with methamphetamine and similar drugs.

* Be aware of fentanyl and its analogues, which have been found in virtually every street drug in North America.  Assume every pill you buy outside a pharmacy contains fentanyl--ditto for heroin or even powders like cocaine.  If you can't source your pills overseas from countries without a fentanyl problem, you're better off using kratom or an opioid maintenance drug like methadone or Suboxone from a clinic.  

* Keep naloxone on hand & nearby if using drugs that are likely to contain fentanyl.  And always use with a friend or sober tripsitter who can administer it in a worst-case scenario.

* Keep an eye on your drinks at bars, parties or raves.  Countless date rape drugs exist that are odorless & tasteless.  Cruise ships are another hot spot for drugged drinks but it can happen anywhere.  BYOB when possible.  

* Avoid buying cannabis vape cartridges anywhere but licensed medical dispensaries.  And do your due diligence on various brands before buying to ensure quality.  When buying cannabis from an unlicensed/black market dealer, stick with flower or edibles.   

* If you've been clean from your drug of choice & are relapsing, do not attempt to use your old dose as this will result in overdose.  Cut it by about 1/2 or 3/4ths depending on how long you've been clean (the longer clean, the more you should reduce the dose).  The vast majority of overdose deaths occur after a period of sobriety.

* Don't share joints, bongs, pipes, nasal tubes/straws or other paraphernalia during the COVID pandemic.  

* When using "more-ish" stimulants like cocaine or meth, set limits ahead of time & plan breaks for things like eating and sleeping.  Drink plenty of water or Gatorade to stay hydrated & avoid strenuous activity and overheating.  Much of the damage done by these drugs is caused by failure to eat, sleep & maintain hygiene under their influence.  

* If engaging in casual sex under the influence, always use condoms, dental dams & other barriers to reduce the risk of spreading STD's.  And remember to gain enthusiastic consent from your partners every time.  If your condom breaks or you fail to wear one, you can access Plan B birth control or PrEp (HIV post-exposure prophylaxis) meds at your nearest pharmacy.  Both of these need to be taken as soon after unsafe sex as possible to be effective.  

* Always consider dose, (mind)set and setting when taking psychedelics as they tend to magnify how you're already feeling.      

* If schizophrenia runs in your immediate family, use psychedelics like LSD or magic mushrooms with extreme caution or not at all.  While not proven to cause these conditions, they can cause bad trips which are stressful and may trigger a first episode in people with an underlying genetic predisposition.  

* Do not share or reuse syringes.  If you do reuse them, wash them with cold water > bleach > water.  

* Avoid using MDMA or MDA more often than once a month at the most (preferably no more than every 3-6 months).  These drugs can have neurotoxic effects and may "lose the magic" if abused.  

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Above all, remember that your life matters regardless of how low your addiction or mental illness makes you feel.  You have a right to live & thrive even while in active addiction or while using drugs as a recreational escape from the stresses of the world.  You are more than your productivity, income or job title and are not defined by the sum of your mistakes.  With this in mind, you're more likely to take care of yourself & plan ahead which will have a positive effect on every other part of your life.  

Staying out of the hospital right now is absolutely vital as healthcare workers are stretched to the breaking point and many states are forcing them to work while sick with active COVID infection.  You could go in with drug-related complications and come out with COVID.  Trust me, you don't want to end up in the ER right now if at all possible.  (But don't hesitate to call for help if you or a friend has an emergency).  Wear your mask, keep a safe distance of 6+ feet in public places & wash your hands frequently.  

If you have any additional tips or questions, add them in the comments below!  





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