Despite the narrative of a meth overdose crisis, on some level the public understands that people using fentanyl are at risk in a way that people using just meth are not, because it’s not quite okay to openly demonize the victims of a mass death situation. But if you want to openly demonize meth users, that’s okay. And yet, if we take a closer look at meth in the context of the larger unregulated drug supply, we can see that public opinion has gone a little off course.

Most meth overdose isn’t physically harmful; occasionally someone might have a seizure, but it won’t hurt them. The supply is consistent. The supply is pure. The global supply chain is decentralized.

Meth has a withdrawal process, kind of, but nothing gastrointestinal. It’s shelf-stable dry or in liquid for months, probably years. It’s rural but also urban. It’s health care amid an Adderall shortage. It’s working class. It’s gay. It’s trans. It’s pretty. It’s invisible. It’s cheap.

Like it or not, meth is the people’s drug. It’s there for the people who need to stay awake when it’s not safe to sleep, or when their jobs won’t allow them to sleep. It’s there when people can’t afford food. It’s there for the people who can’t access antidepressants. It’s there to facilitate sex work. It’s there to give people the energy to carry their stuff around. It’s there to let people feel alive—or numb, depending—even in the most miserable of circumstances where they’re supposed to feel only bad things.

And the state hates that. You go and make all these laws to ban certain people from every place they could possibly try to get a job, get a home, go to sleep, go to the bathroom, you cut every social support out from under them and chase them out of anywhere they try to rest, but no matter what you do to get them to finally just lay down and die, meth picks them up and keeps them going.

I have some bias. I used meth for three or four years, every day, and while it made a lot of things in my life harder I’m not sure how else I could have managed the things it made easier. Plus when meth causes problems for people I don’t interpret that as the meth being, like, sinister, it’s just a function of whatever else people have going on in their lives at that time. I also never would have met my husband if meth hadn’t kept him alive for the decade or so when the rest of the world was trying to kill him, so even though it’s not part of my life anymore (or his) I default to a warm opinion of anyone who is using it. 

People look down on meth like it’s the drug you do when you’ve given up on life, which bugs me because I do not see that at all. I always saw it as something people use to participate. And in pretty much any context, but especially with anyone who doesn’t have housing, it always seems like meth is what people use when it’s hard to keep going, but they want to.

Opioid users hear all day long about how the supply is dangerous because it’s adulterated. Meth users are punished because the supply is pure. Even though consistent purity and potency are traditionally good qualities for a drug supply to have, from a public-health perspective.

“[M]ethamphetamine is less physically dangerous or addictive than heroin or cocaine, yet methamphetamine is now punished more severely than any other drug,” the National Association of Criminal Defense Lawyers wrote to the United States Sentencing Commission in 2025, referring to federal meth sentencing being determined by purity rather than by weight the way it is for other drugs. “Not only do the current methamphetamine guidelines lack a legislative basis, they also lack any empirical justification … sentences now receive massive arbitrary enhancement based entirely on whether the methamphetamine received laboratory testing [to establish purity], something that is obviously beyond the control, and unrelated to the culpability, of any defendant.” 

And then there’s police violence, which benefits from the same bias driving the narrative of a meth overdose crisis—once you say someone used meth, nobody questions why they died. They were unarmed and police shot them 10 times? Well, they were on meth. It’s so potent these days.

“We started to see a pattern of kind of irrational, aggressive behavior on the part of the people that were being shot or shot at,” a special prosecutor in a New Mexico told Colorado Public Radio of rising meth use in 2020, describing the case above. “It didn’t make any sense to us.”

Okay. 

In 2024, a Black man died after 40 minutes naked in a Wyoming county jail restraint chair, with two straps across his chest in addition to the restraints on his limbs, saying he couldn’t breathe. The forensic pathologist found no evidence of restraint-related death, but instead cited “methamphetamine overdose and the cardiac effects of excited delirium.” Remember excited delirium? The racist and unscientific diagnosis has been rejected by the medical establishment as a valid cause of death, because it was just how cops covered up excessive force. But this is “excited delirium due to methamphetamine overdose.” So it’s different.

Over the past decade the US harm reduction movement has been defined by the overdose crisis, and so services and policies have been designed for people who use opioids, then retrofitted for people who use stimulants.

Which is understandable; opioids are straightforward. We have methadone and buprenorphine, we have naloxone, we have the policy goal of overdose prevention centers and eventually safer supply. We have a clearly defined mechanism of overdose death, and we have a target demographic that—broadly speaking—uses fentanyl in similar settings and for similar reasons.

Stimulants are less straightforward. They interact with a wider range of systems in the brain and body, they produce a wider range of physical and psychological effects, and meth specifically appears in extremely different contexts in different people’s lives—chemsex, sex work, shift work, street homelessness, studying. Daily daytime use, monthly nighttime bingeing. And so on. It’s more difficult to categorize meth users and pin down what common services they need. If they need housing there’s only so much that harm reduction groups can do, and if they need a harm reduction resource other than sterile syringes and fentanyl test strips, whatever it is probably hasn’t been legalized yet anyway.

We’ve organized around access barriers to methadone and buprenorphine for opioid use disorder. But for stimulant use disorder this would require a policy leap more in the direction of safer supply, and so rather than organizing around stimulant agonist medications we just observe that we don’t have any. Instead we have contingency management, the practice of telling meth users that if they do a good job peeing in a cup they will be eligible for Walmart gift cards. And, now that they have something to look forward to, they don’t have to get their dopamine rush from stimulants anymore.

The movement hasn’t known what it’s supposed to offer meth users because it approaches the problem through a fentanyl lens, thinking in terms of meth’s physical effects and risks and harms. When it shouldn’t really be looking at meth, but at the people who use it. Queer communities, Indigenous communities, sex workers, people living with HIV, people living outside, people cycling through the criminal-legal system. The harms that the movement can reduce for meth users come primarily from being overpoliced. And from really bad public relations.

Artwork by Brooke Alexandria Paine. First inset image via County of Fresno. Second inset image (cropped) via Reentry Council of the City & County of San Francisco.

The post Big Shoutout to Meth appeared first on Filter.

However, a recent study published in Harm Reduction Journal warns that change is coming. Reviewing data across three key countries, the authors chart a potentially dangerous turn in South American drug markets. Synthetic opioids, ketamine and Tusi (known as “pink cocaine,” but typically including a mix of synthetic substances) have all rapidly increased in popularity—on a continent where harm reduction services, especially for opioids, are sorely lacking.

According to the study’s lead author, Ignacio Bórquez of New York University’s Grossman School of Medicine, these new trends are a stark departure from the traditional local drug supply.

“What we’ve been seeing since, I would say, 2010 onwards in Latin America is the emergence of synthetic drugs.”

“Latin America and the Caribbean really have a history using cannabis and cocaine,” he told Filter. “[T]hey’re locally produced, so they’re very cheap. A gram of cocaine is around $10 in Latin America—here in the US, it’s $100.”

Bórquez and his team compared multiple data sources, including forensic analyses, law enforcement seizures and surveys of people who use drugs, to get a pulse on substance use in Brazil, Chile and Colombia. Clear trends quickly emerged.

“What we’ve been seeing since, I would say, 2010 onwards in Latin America is the emergence of synthetic drugs. Particularly in the party scene, things like MDMA, ketamine,” Bórquez said. “And then we’ve also been seeing seizures of synthetic opioids and some evidence of diverted opioids from pharmaceuticals.”

In Chile, the volume of ketamine seized annually by law enforcement rose by over 5,000 percent from 2017 to 2023, and that trajectory was corroborated in Chilean wastewater analysis. Oral samples from Brazilian nightclub attendees also showed ketamine use rising—often along with cocaine, in the combination known as Tusi.

The data tell a similar story for opioids. According to a nationally representative Chilean survey, opioid use has nearly quadrupled since 2002. While fentanyl is not a major factor in Chile or Colombia, law enforcement seizure data do show a rise. In addition, other synthetic opioids, including nitazenes, are being manufactured in Brazil.

“We are a continent torn by violence … because with crops like cocaine or cannabis, you really need territorial land.”

Globalization and online connectivity have propelled these new substances’ popularity, with rapid distribution available on social media platforms like the gay dating app Grindr. And relative to the region’s traditional plant-based drugs, these new options require far fewer resources to produce.

“We are a continent torn by violence … that has been very linked to drug trafficking and drug production, because with crops like cocaine or cannabis, you really need territorial land,” study co-author Francisco I. Bastos, of Brazil’s Fundação Oswaldo Cruz, told Filter. “And with these new substances we’re looking at, they don’t need that.”

In part because South America has not faced a major overdose crisis, the continent’s harm reduction infrastructure is vastly underdeveloped. Citing the Global State of Harm Reduction 2024, the authors note that of the 34 countries in this region, only three have syringe service programs, and only four offer opioid agonist therapy. Naloxone is also largely inaccessible.

The solution, however, is not simply to import North American and European harm reduction models, because South American patterns of drug use remain very different. While these new substances are on the rise, they still represent a minority of drug use, which continues to be dominated by stimulant smoking and concurrent alcohol use. Injecting remains largely taboo.

Bórquez loses sleep at night thinking about how to adapt harm reduction models like supervised consumption sites to communities in South America.

“It would need to be a place where stimulant use, which is very different from opioid use, could be contained in a non-harmful way,” he said. “[Y]ou’re not gonna have 30 people using stimulants together in a room … it’s hard to think of a [harm reduction] service for people who use stimulants and alcohol.”

“It is a very different balance from the US. The US is the largest producer and importer of opioids in the world … Brazil is on the other side of the balance.”

Meanwhile, attempting to combat synthetic opioid diversion by restricting importation of medical opioids would threaten the availability of these substances for their clinical uses, such as pain relief for cancer patients and palliative care.

“If we just put pressure on the supply, we cannot have medicines for the people who need the medicine,” Bastos explained. “It is a very different balance from the US. The US is the largest producer and importer of opioids in the world, so there are opioids for everything—opioids for cancer patients, opioids for the streets. Brazil is on the other side of the balance.”

Yet there are still many promising paths forward. The authors highlight drug checking, overdose prevention training and naloxone accessibility as relevant harm reduction services. They also suggest increasing investment in nonintrusive surveillance, such as local wastewater monitoring programs, to stay abreast of this rapidly shifting market and target harm reduction efforts accordingly.

“[These efforts] will be essential to mitigate future harm and prevent another synthetic drug epidemic from taking hold in the Americas,” the study concludes.

Photograph of Rio de Janeiro by Rafael Rabello de Barros via Wikimedia Commons/Creative Commons 3.0

The post South America’s Drug Supply Is Rapidly Becoming More Synthetic appeared first on Filter.

The data, announced July 15, cover the 12-month period between February 2025 and February 2026. So far jurisdictions have reported 67,531 overdose deaths for that time period. The predicted number of deaths, which is considered to be more representative since death records aren’t all reported at the same time and a small portion (0.24 percent) are still pending investigation, is 68,641. That puts the national overdose rate approximately where it was in 2019.

Overdose rose sharply at the onset of the COVID-19 pandemic, after already rising almost continuously since the CDC began tracking this data in 1999. But in 2023 the trajectory abruptly reversed, and for the past two-and-a-half years the provisional data have shown the national rate continuing to drop each month. In 2024 the rate of fatal overdose decreased by more than 26 percent. But in 2025 this decrease slowed to half-speed. In the most recent report, the national rate of decrease is 12.1 percent.

Behind the national average, there’s always been a wide range in how the crisis is experienced in different parts of the country. Nebraska and South Dakota were still reporting slight increases even when the national rate first began to plummet in late 2023. 

In New Mexico, where overdose has been rising the most sharply, the predicted number of deaths is 1,037, a 27.1-percent increase from the 816 deaths predicted during the 12 months leading up to February 2025. In Colorado the increase is 14.2 percent, with 1,852 predicted deaths up from 1,622 in the 12-month period a year earlier.

South Dakota (+12.5 percent) is predicting 90 overdose deaths, up from 80 during the same 12-month period a year earlier. Other states in which overdose has continued to rise are North Dakota (+7.1 percent) with 120 predicted deaths; and Minnesota (+1.7) with 1,008 predicted deaths;  Montana (+1.2 percent) with 175 predicted deaths. In Nebraska the rate of change was 0, with 149 predicted deaths.

Outside of the Western corridor, overdose has continued to drop.

In the previous monthly report that list had included Alaska and New Hampshire for the first time. The most recent data show overdose in both states starting to drop again, with Alaska (-6.2 percent) at 324 predicted deaths and New Hampshire (-0.8 percent) at 258 predicted deaths.

Though Arizona had previously experienced a surge comparable to New Mexico’s, the past several monthly reports have showed that surge slowing to half-speed, which is not the case in New Mexico and Colorado. The latest number of predicted deaths for Arizona is 2,914, up from 2,695. 

Between the provisional death count published in April and the most recent one in July, New Mexico’s rate of change increased from about 16 percent to over 27 percent. Colorado’s increased from 10.3 percent to 14.2 percent. But Arizona’s rate of increase fell, from 21 percent to 8.2 percent in the most recent report.

Outside of the Western corridor, overdose has continued to drop. The latest data show the jurisdictions with the steepest decreases are Rhode Island (-34.3 percent) with 203 predicted deaths; Oregon (-29 percent) with 1,044 predicted deaths; and Puerto Rico (-25.8) with 435 predicted deaths.

Overdose data are subject to a ton of inconsistencies, stemming from the various ways death investigations are conducted at the county level, and so these reports are most useful when viewed in terms of the overall scope and trajectory of the crisis rather than putting too much weight on fluctuations between smaller numbers. Alongside the latest monthly report, the CDC also published county-level overdose death data covering December 2024 through December 2025.

Fentanyl pill purity has dropped sharply in recent years. But this is not the same thing as supply reduction, and is not the result of fentanyl seizures at the border. There is still no evidence that fentanyl interdiction reduces overdose, not just because the federal government doesn’t actually evaluate what if anything its fentanyl seizures accomplish but because this strategy has never been shown to meaningfully reduce drug-related harms. It’s usually shown to increase them, in the long run.

Image (cropped) via Centers for Disease Control and Prevention

The post Overdose Data Show Two Paths Within Western Corridor of Rising Deaths appeared first on Filter.

A recent survey of over 2,000 British pouch users—from Haypp, an international e-commerce company specializing in safer nicotine products, and its subsidiary Northerner.com—explored how and why nicotine pouches were being used. The resulting Nicotine Pouch Report 2026 additionally looked at purchasing data for over 50,000 UK customers from December 2025 to January  2026.

“The UK nicotine pouch market is expanding rapidly,” it concluded, saying that demand for pouches on the company’s platforms grew by 60 percent in 2025.

Respondents viewed pouches as “healthier,” “more discreet” and “less intrusive to others.”

But why pouches, more than other options? According to the report, it’s a mixture of practicality and “perceived health benefits.” Survey respondents viewed pouches as “healthier” (64 percent), “more discreet” (also 64 percent) and “less intrusive to others” (52 percent), compared to other nicotine products.

That makes sense, when research has found pouches to be at the very lowest end of the nicotine-products continuum of risk, and clearly they don’t produce smoke or vapor that other people might object to.

The report found that 48 percent of pouch consumers used the products to quit smoking —unsurprisingly, given pouches’ success for smoking cessation in other countries. But perhaps more surprising is that 40 percent began using pouches in order to quit vapes, which have been the UK’s most successful smoking-cessation tools.

“This isn’t about pouches replacing vapes,” Marina Murphy, Haypp’s director of scientific affairs, told Filter. “Different tools work for different people, and both are doing important work getting people off cigarettes.”

But Murphy said pouches appeal to a particular kind of quitter: “someone who wants something private, with no vapor and nothing to change or refill.”

That resonates with Jessica Harding, a director of the Global Forum on Nicotine (GFN Ltd.). After 26 years of smoking and many attempts to stop, she was finally able to quit in 2011 when she was persuaded to try vaping, as she once described for Filter. Harding continued to vape for years—but now exclusively uses pouches.

The fact that they’re discreet is a big plus in a world that loves to criticize women’s choices, Harding said.

“The benefits of pouches for me are they are low-tech and simple, so there’s a lot less to carry around with you and you don’t need to think about charging or mixing,” she told Filter.

Hayyp’s report indicated that women are leading the way in migrating to nicotine pouches—with purchases by women more than tripling in 2025, compared to a 25 percent increase among men. This phenomenon has previously been seen in Sweden.

Harding can understand why pouches are particularly appealing to women. They’re less “geeky” and “fiddly” than vapes, she said, and the fact that they’re discreet is a big plus in a world that loves to criticize women’s choices.

“Getting a vape out these days is a license for someone to tell you that ‘those things are worse for you than smoking’—which is absurd, but gets a bit wearing,” Harding said.

While pouches have many benefits for people who smoked, this hints at another factor that might be prompting people to switch from vapes: misinformation about the latter.

Cullip is unsurprised that people are switching from vapes to pouches. “It’s undoubtedly because they think vapes are harmful,” he said.

Tobacco harm reduction advocate Martin Cullip uses both. He prefers vapes, but uses pouches in places where vaping isn’t permitted, such as on planes. He’s unsurprised that people are switching from vapes to pouches. “It’s undoubtedly because they think vapes are harmful,” he told Filter.

Recent research shows the majority of people in the UK incorrectly believe that vapes are either just as harmful as combustible cigarettes or worse. Demonization by the media and political moves to restrict vapes have fueled these damaging misperceptions.

However, Dr. Thomas Nahde, head of harm reduction and engagement at Imperial Brands Science, a division of the tobacco company that develops safer nicotine products,  cautioned against jumping to the conclusion that this is the whole explanation for the vapes-to-pouches trend.

“Without further data it’s hard to know if that’s reflecting misconceptions around the risks of vaping or many other potential reasons,” he told Filter. “These could include format, flavors, taste, social acceptability, or simply curiosity to trial a newer nicotine category.”

Some of those factors match Harding’s experience; she said her switch to pouches largely happened simply because she was looking to expand the ways she could consume nicotine safely.

It should also be noted that pouch uptake among people who vape often doesn’t mean they’re quitting vapes entirely. Most of Harding’s friends, she said, oscillate between the two products depending on where they are, much like Cullip.

“As regulatory pressure on vaping products increases … many consumers are looking for alternatives.”

But to the extent the transition is happening, it’s driven in part by regulations restricting vapes, said Stephen Buss, a researcher with a specialization in tobacco harm reduction who has worked for a number of different companies and organizations.

“As regulatory pressure on vaping products increases through disposable vape restrictions, environmental legislation and evolving regulatory frameworks, many consumers are looking for alternative reduced-risk nicotine products,” Buss told Filter.

In April the Tobacco and Vapes Bill became law in the UK. It will restrict the visibility and variety of vapes, banning advertising and limiting flavors. What’s more, in October the new Vaping Products Duty will add £2.20 per 10ml in tax to the cost of e-liquids, doubling the price of some bottles.

Pouches, as Murphy noted, “aren’t touched by the tax.”

“Combine that with the Tobacco and Vapes Act, which introduces a dedicated regulatory framework for pouches for the first time, and you’ve got a real cost-effective and legitimacy shift happening at the same time,” she said.

“I’d expect more smokers to find pouches the simpler, more affordable option—alongside vapes, rather than instead of them.”

Buss sees it similarly. “As restrictions tighten around one reduced-risk nicotine category, many adult nicotine users will naturally explore other legally available alternatives,” he said, adding that the regulatory challenge is to ensure legislation is “proportionate and evidence-led.”

Whatever the combination of reasons, Murphy expects that the popularity of nicotine pouches will continue to grow in the UK.

“Pouches don’t need to take over vapes to matter here,” she said. “But as vaping gets more expensive and people become more familiar with pouches, I’d expect more smokers to find pouches the simpler, more affordable option—alongside vapes, rather than instead of them.”

Photograph by Jakubdrastich2 via Wikimedia Commons/Creative Commons 4.0

The Influence Foundation, which operates Filter, has received donations from GFN Ltd. Filter‘s Editorial Independence Policy applies.

The post What’s Behind the UK’s Migration to Nicotine Pouches? appeared first on Filter.

By the time Amy Massey reached out for help in 2016, years of heavy ketamine use had left her with severe bladder damage. She had a bladder removal scheduled—according to the doctors, it was the only option—and faced lifelong disability. 

Desperate for an alternative, she came across a YouTube video of harm reduction advocate Mat Southwell speaking about ways to reduce ketamine-related harm. 

Southwell introduced her to ketamine harm reduction strategies pioneered by drug-user activists. After adopting these approaches, Massey’s symptoms improved so significantly that her surgery was cancelled.

Today, Massey works alongside Southwell—now founder and technical director of harm reduction organisation Coact—as a peer trainer, helping health care workers and policymakers understand what works.

“When you go to a drug service, there’s nothing on ketamine. They’re asking us the questions.”

She is also a member of the Ketamine Peer Advisory Group (K-PAG), a growing community that’s become a trusted source of expertise on ketamine—not because its members set out to be, but because they had little choice after decades of ketamine-related harms falling through the cracks of a failing health care system. 

“Even now, when you go to a drug service, there’s nothing on ketamine,” Massey said. “They’re asking us the questions.”

Ketamine (AKA Ket, K, Special K) occupies a unique place in Britain’s drug landscape. Used medically as an anesthetic and increasingly in supervised treatment for depression, its non-medical use is also surging.

Unlike stimulants or opioids, ketamine is a dissociative. Small doses can produce euphoria and detachment. Larger doses can lead to the “K-hole”—a state where people feel disconnected from their body, surroundings and reality.

While those psychological effects of ketamine are immediate, physical harms, including debilitating bladder disease and chronic pain, may develop quietly over months or years. Heavy use may also lead to dependence.

Over 5,300 adults entered treatment for ketamine problems in England in 2024/25—more than 12 times as many as a decade earlier. The crisis is heavily concentrated among younger adults, with over two-thirds of users aged 16 to 24. Anecdotally, it’s often even younger than that. 

“We’re seeing children starting at 11 or 12,” Southwell told Filter. “They’re turning up in children’s urology services at 13, 14 and 15.”

The UK Advisory Council called for a coordinated public health response built around education, workforce training, harm reduction and treatment pathways.

As the number of people living with ketamine-related harms has increased, much of the public debate has focused on whether the drug should be reclassified from Class B to Class A.

Earlier in 2026, the United Kingdom’s Advisory Council on the Misuse of Drugs (AMCD) recommended against reclassification, concluding that the harsher criminal penalties it would entail were unlikely to reduce use. Instead, it called for a coordinated public health response built around education, workforce training, harm reduction and treatment pathways.

That recommendation now sits with the UK government.

But while the government weighs its decision, people with lived experience aren’t waiting. They’re already building the public health response the ACMD says is needed.

The workshops run by Southwell and Massey are among a growing number of peer-led initiatives working to fill the public health gap. They will also pilot a new festival outreach model, reaching peers with harm reduction advice in environments where ketamine is used. 

In the workshops, while Southwell explains the science behind ketamine-related harms, Massey brings the lived experience, sharing stories from K-PAG members that are often just as harrowing as her own.

Massey is still shocked by how unprepared many frontline health services remain. “They literally just don’t know,” she said. “They’re overwhelmed. People are coming into services, and they don’t know what to do with them.”

“The first thing that needs to happen is an acknowledgement that we’ve really, really fucked up.”

But Southwell isn’t surprised. For more than two decades, he has worked alongside clinicians, researchers and people with lived experience to understand the harms associated with chronic ketamine use. The knowledge has been there for years. The response hasn’t.

“The first thing that needs to happen is an acknowledgement that we’ve really, really fucked up,” he said. “For years, people using ketamine have been saying exactly the same thing: ‘We have to explain our condition in order to get a service.'”

For Southwell, that’s the real failure. It’s not that clinicians don’t care. It’s that knowledge about ketamine has never filtered into everyday health care, leaving frontline drug services, emergency departments and GPs trying to respond to a drug they were never properly equipped to understand.

He believes this has reflected what he describes as “intentional negligence” by the government.

“It didn’t fit with the recovery model,” he said. “It was too inconvenient, so we’re just not going to tell anybody about it.”

Another peer-led initiative started in 2021, with a single anonymous Reddit post. 

The anonymous person created r/KetamineAddiction. Mason Stillings, who is one of the community’s moderators, said it emerged during the post-COVID “boom” in ketamine dependence. 

“It was a lighthouse,” Stillings told Filter. “A lifeline.”

Today, the Reddit community has grown to more than 10,500 members. Many arrive after developing bladder pain or other symptoms they never expected.

Today, the Reddit community has grown to more than 10,500 members, while a companion WhatsApp group, launched in 2024, supports more than 700 people across the UK and beyond.

Many arrive after developing bladder pain or other symptoms they never expected. 

“There is still an incredibly dangerous misconception that ketamine is ‘safe,’” Stillings said. “I am regularly speaking to people in their early 20s—and sometimes teenagers—who are waiting for surgery to reconstruct or remove their bladders. Most are stuck at home, bed-bound by chronic pain, wondering if they will ever physically recover. It is heartbreaking.”

Abbie Christie is also a moderator on the group. She believes that misunderstanding begins long before people become seriously unwell.

“Ketamine is commonly thought of as a ‘safe’ drug compared with other drugs,” she told Filter. “There is no ‘comedown’ as such, and the damage from heavy use builds up quietly over time.”

According to Christie, there’s also a belief that you can’t get addicted to ketamine. She worries, too, that growing awareness of ketamine-assisted therapy has blurred the distinction between medically supervised treatment and street ketamine.

Ketamine doesn’t fit neatly into treatment systems built around alcohol, opioids and stimulants.

“We see people with huge platforms sharing positive experiences with ketamine to help with trauma, depression and other mental health conditions,” she said. “I think this leads people to believe that ketamine is not only safe, because it is used in medicine, but that it is beneficial and they can use it to self-medicate.” 

As more people find themselves confronting harms they never expected, these online communities have evolved into something much bigger than simply information-sharing. Members exchange practical advice on bladder symptoms, reducing use and finding ketamine-aware clinicians. They help people navigate the health care system, recommend rehabilitation services and share resources people can take to GPs and specialists.

Beyond the screen, the community organizes sober hikes, camping trips and meet-ups that have grown into lasting friendships and recovery networks.

“It has become almost a central hub for passing on information for people to be able to advocate for themselves where there is still a lack of awareness among professionals,” Christie said.

Stillings said people aren’t turning to Reddit because they prefer strangers on the internet: “They’re doing it because there are some people fortunate enough to access specialists who understand ketamine—but they’re few and far between. Receiving appropriate treatment remains a postcode lottery.”

The problem isn’t simply that health care professionals know too little about ketamine. It’s that ketamine doesn’t fit neatly into treatment systems built around alcohol, opioids and stimulants.

With ketamine, there is no single harm reduction message. The advice for someone experimenting with it at a festival is very different from someone living with ketamine bladder syndrome after years of heavy use.

Some strategies are deceptively simple: Staying well hydrated, avoiding daily use where possible, pelvic floor exercises, breathwork such as box breathing, natural supplements, and even understanding how the drug is snorted can all reduce harm.

“I don’t think people understand the whole snorting process,” Southwell said. “There are some really basic fundamentals of harm reduction that people just aren’t being taught.”

For people already living with bladder damage, however, the conversation changes.

“What we understand now is that ketamine essentially strips the lining of the bladder,” Southwell said. “I mean, we’ve got pictures of people holding their bladder lining. If people aren’t well hydrated, urine passes over exposed nerves, causing enormous pain.”

For people using ketamine, the main focus has been building the response they needed, long before the government even realized it was missing.

Treatment also needs to look different. Many people using ketamine aren’t initially seeking abstinence. They’re looking for practical advice, someone who understands what they’re experiencing, and help before irreversible damage occurs.

“Drug services have this way of saying, ‘Come to us when you’re ready,'” Massey said. “That doesn’t work for ketamine users. The damage has already been done.”

Instead, she believes services need to meet people where they are—helping them reduce immediate harms while building trust over time.

Whether ministers ultimately accept the ACMD’s advice or decide to reclassify ketamine remains to be seen.

For the people already using ketamine or living with associated harms, however, the main focus has for years been something else. It has been about building the response they needed, long before the government even realized it was missing.

Photograph (cropped and adapted) by Coaster420 via Wikimedia Commons/Public Domain

The post As UK Debates Ketamine Status, Peers Are Building the Response appeared first on Filter.

When her husband quit smoking, it had a profound impact on their whole family. “I don’t think either of us realized just how much it affected our lives until he finally stopped,” Gorley said.

Her husband lives with PTSD; like many people experiencing mental health challenges, he depended on cigarettes. But smoking being a large part of her husband’s life meant it featured heavily in hers, too. “Every outing, every holiday, every family event revolved around cigarette breaks,” Gorley said.

Then he switched to a much safer, smoke-free form of nicotine use: vaping. Gorley was initially cautious—vapes get a lot of bad press, after all—but soon found that it transformed family life. “He seems more present, more engaged, and enjoys being active in a way that wasn’t as common before,” she said.

“When we talk about quitting smoking, we typically focus on the person quitting, but not necessarily how it can impact their closest loved ones.”

Besides the positive health implications and the absence of secondhand smoke from their house and clothing, Gorley credits her husband’s switch with strengthening their relationship and their family. She particularly values a better quality of time without the cigarette breaks, especially when she and her husband recently became grandparents. “Being able to spend uninterrupted time with our granddaughter has meant the world to us.”

The Gorleys live in Melbourne, Australia, where vapes are heavily restricted and can only be obtained through participating pharmacies or a doctor’s prescription. This very limited access costs other families the chance of similar outcomes.

“When we talk about quitting smoking, we typically focus on the person quitting, but not necessarily how it can impact their closest loved ones,” Todderick Prochnau, a pharmacist in Canada who has run smoking-cessation clinics, told Filter. “Importantly, quitting can improve the health of those that they live with too!”

Prochnau said that 1 percent of all deaths internationally are due to secondhand smoke exposure—some estimates put it even higher—and transitioning to smoke-free options, like vapes, pouches or heated tobacco products, removes that risk for loved ones.

The results overwhelmingly indicate positive changes in emotional wellbeing, sociability, quality of life and shared experiences.

But the fact that it’s not only about eliminating passive smoking is illustrated by a recent survey, published by the research and media organization We Are Innovation. 

Aiming to measure “the perspectives of friends, partners, and family members on the transition from traditional cigarettes to innovative nicotine products,” the survey involved 4,000 respondents in five countries to find out what “quitting looks like from the outside.” The results overwhelmingly indicate positive changes in emotional wellbeing, sociability, quality of life and shared experiences.

These knock-on benefits of smoking cessation are often overlooked. Asked why the survey focused on the loved ones of people who quit smoking, Federico Fernandez, CEO of We Are Innovation, replied: “Because nobody has asked them before.”

“Every survey on smoking cessation asks the smoker how they feel,” Fernandez told Filter. “Nobody asks the partner who used to smell of smoke on every hug, or the daughter who could not have friends over because the house smelled like an ashtray—these people live with the change too.” 

Policymakers who determine people’s access to smoking-cessation tools need to hear these important voices, Fernandez added.

Caz Humphreys works at a smoking-cessation clinic in Leicester, England. In her 18 years as a stop-smoking advisor, she has witnessed the introduction and development of vapes. 

Humphreys recalled an occasion when a woman brought her father into the clinic, an ex-servicemember who had served in the Falklands War. He had spent most of his adult life self-medicating his stress with cigarettes.

“This case changed my mind completely about vaping as a method to quit smoking,” Humphreys told Filter.

“Of course he has benefited, but so have I. I have a partner who is fit and well, and I’m not his carer, which I may have become.”

“Within just one week, he entered the clinic looking totally different,” she continued. “Upright, breathing easier, pink in hue with much more energy.” This, she said, was “positively life-changing” for his family.

Another client of Humphreys who switched to safer nicotine products was then able to play soccer with his son—something he had struggled with before. With the money he saved from quitting cigarettes, he took his son to tournaments and bought tickets to watch a soccer game abroad. 

Stories like these are close to Humphreys’ heart when she lost her own father to a smoking-related illness. Her partner, who also smoked, switched to vapes after she suggested it to him. He now walks in the hills with her, after joining her walking club.

“Of course he has benefited, but so have I,” Humphreys said. “I have a partner who is fit and well, and I’m not his carer, which I may have become. Money saved has also made a good impact on family finances.”

There are so many more stories like these. Grove Mitchell smoked for 30 years until he switched to vapes. “A smoker leads a whole other second life, away from everyone but other smokers, huddled around an ash bin in the freezing cold,” he told Filter. 

“Partners that both smoke now have more options available: One may quit nicotine altogether and the other may successfully transition to a smoke-free form.”

Alongside the other benefits, switching made Mitchell feel more connected to those closest to him. “A huge increase in the baseline feeling of wellbeing leads one to be open to more activities with the family,” he said.

While the loved ones of the person who smoked stand to benefit greatly, it is often their support that is critical to the person being able to make such a positive change. Prochnau noted that in his practice he has witnessed how, if a couple both smoke, it is difficult for one of them to quit if the other has not made the same decision. “Data also shows that it is much harder to successfully quit smoking if your partner continues to smoke,” he said. 

“Smoke-free forms of nicotine provide another option to those partners who may not be able to quit smoking by conventional means,” Prochnau continued. “Essentially, partners that both smoke now have more options available: One partner may quit nicotine altogether and the other partner may successfully transition to a smoke-free form of nicotine, allowing substantial improvement in risk and health for both partners.”

All in all, Fernandez said, the testimonies of partners, family members and friends emphasize one important reality: “Quitting is not a solo act.”

Photograph by Alberto Casetta on Unsplash

The post “Not a Solo Act”—The Impacts of Smoking Cessation for Loved Ones appeared first on Filter.

I set out to remedy this when I founded the nonprofit HAMS in 2007. HAMS—an acronym for Harm reduction, Abstinence, and Moderation Support—is a lay-led, free-of-charge support group for alcohol harm reduction, which today has over 13,000 online participants. 

HAMS supports any positive change in regard to alcohol use, and supports members in goals they choose for themselves, ranging from safer drinking to reduced drinking to quitting altogether. What does success look like for HAMS members? The answer is different for every individual. Below are 10 stories by way of example—told in the person’s own words, edited for length, and shared with consent. All names are pseudonyms.

Wally

My HAMS story began around 2012. At the time I was drinking about a fifth of tequila and snorting about 2 grams of cocaine on a daily basis. I had been in and out of AA meetings for about 25 years, with mixed results. I quit trying the AA approach because of the toxic personalities there. 

It was at about this time that I came across a HAMS video online and it caught my attention. I’ve been following HAMS articles and using the HAMS Facebook group for support/education ever since. Over time I have been able to drastically reduce the amount of alcohol and cocaine that I drink/use. 

Some of the harm reduction techniques that I use are: counting the number of drinks that I have daily and recording them in the HAMS online drink tracker; only drinking at home by myself; drinking only after 4 pm; never driving while intoxicated; skipping drinking days; cost-benefit analysis, eating food when drinking; and smoking cannabis. I use the HAMS Facebook group for support/friendship daily, and find it highly useful. 

Most days I drink about eight shots of bourbon and use cocaine about twice a month. I’m happy with this number of drinks but have to abstain from coke ASAP. Trying to get there. Overall, my drinking/using is much much lower, and causes me far less trouble than they did before I started trying to change my habits with HAMS techniques.

“One of the biggest shifts for me is that I no longer see drinking as all-or-nothing. If I choose to have a drink, I do not see that as failure.”

Rachel

Before HAMS, I had been drinking daily for approximately three years. I never drank in the mornings and continued to maintain my professional responsibilities, so for a long time I did not see my drinking as problematic. During the height of my drinking, I would start drinking after seeing my last therapy client, and drank both socially and at home. Although I was not drinking heavily every day, there were periods where I drank to blackout. Over time, I realized alcohol had become automatic and something I relied on socially. It negatively affected my mood, social life and overall well-being. 

I first learned about HAMS while taking a drug and alcohol class where we discussed alternatives to traditional abstinence-based programs. What appealed to me was the focus on harm reduction, personal choice, and reducing shame rather than labels or perfection. 

Today, I am mostly abstinent. In the past seven months, I have only had a couple of cocktails. One of the biggest shifts for me is that I no longer see drinking as all-or-nothing. If I choose to have a drink, I do not see that as failure. Alcohol does not control me—it had simply become too important in my life, and I changed that relationship. 

The most helpful tools for me were the cost benefit analysis and the accountability culture within HAMS. Kenneth’s drink count posts were especially meaningful because everyone reported honestly—whether they had zero drinks or 10—without judgment. I also tried naltrexone, but it was not the right fit for me because I felt like it reduced enjoyment overall. I read the HAMS book and found it insightful (although I’m still hoping for an audiobook someday). 

Joe

My drinking before HAMS was excessive, especially around 2021 when I joined the group. I blacked out in Las Vegas, was denied access to my flight home and had to stay another night. That’s when I realized I had to change. 

My drinking now is more controlled, most of the time. I still go on benders when I’m stressed, but I’ve been leaning more into the A in HAMS, spending time alcohol-free so I can focus on fixing the problems in my life. HAMS gave me a community of like-minded people who don’t judge and don’t believe in “tough love,” but will also offer rational, logical advice. Also, HAMS, and especially How to Change Your Drinking, helped me understand what is going on with my brain and my behavior around alcohol, giving actual insights based on scientific studies and a more modern understanding of addictions and use disorders. 

My main tools for supporting my plan are definitely charting my drinks—I still notice a huge difference in the amount consumed if I don’t track and keep that number at the forefront of my mind while drinking—timing my drinks to better pace myself; not relying 100 percent on shots when drinking; taking regular alcohol-free periods of at least two weeks (usually longer at this point); and I create a cost-benefit analysis and written plan about every month, taking into account how I want my drinking to change. 

I am a huge fan of the HAMS book, and I read it about twice a year to keep myself accountable. I also am very active on the Facebook group, and I’ve found helping others has assisted in my own recovery journey. I didn’t join the Zoom meetings for my first few years in HAMS, but now they are something I look forward to, getting to share what’s been going on, and being able to connect with others about their struggles and wins. All in all I’ve struggled with life since around COVID, adding kids, losing jobs with long-term unemployment, and general mental health issues, but one thing that has remained constant is HAMS. I’ve tried a lot of the other groups and books […] but nothing I’ve experienced has gotten to the core of the apple like HAMS, and I’m eternally grateful.

Mary

I’m just about to hit four years abstinent from alcohol with my partner. We did it together after he puked blood from a day-long binge, and I lost a very dear friend from alcohol-related suicide and feared I might follow him. I’d come very close to checking out myself in 2021, and ended up in hospital three times in one week. We’d tried moderation but always failed miserably. 

We ran a harm reduction charity in the UK for 10 years, but when we lost our funding in 2014 we slowly slipped into a pattern of binge drinking ourselves, which soon became a nightmare for me due to the kindling effect, which I learned about in the HAMS group. 

HAMS helped me ground myself and not feel guilty or embarrassed about messing up, even though I knew all the dangers and pitfalls of drinking again inside out. It’s easy to help and advise others, but hard to apply that same compassion to yourself sometimes. HAMS was a safe space for me to vent and share without judgment. I’d had terrible experiences with AA in the past, so it’s wonderful that alternatives like HAMS exist now. 

“Being amongst others who shared similar struggles helped me understand that I am not alone and I am not the monster I was acting like.”

 

Martha

Before HAMS I was drinking two-to-three fifths of liquor a day. Drinking would make me act paranoid and erratically. My partner at the time was not helpful, and I was also struggling with my mental health. I’d cause bodily harm to myself and property damage around me when I’d have my paranoid fits. I ended up in the psych ward three different times in the first half of 2025. 

I found HAMS looking for a secular support group for drinking, because I knew my relationship with alcohol was not healthy and needed to change. I started scrolling HAMS, and being amongst others who shared similar struggles helped me understand that I am not alone and I am not the monster I was acting like. Reading other people’s success stories gave me hope I could also get out of this rut I found myself in. 

I met someone who was nice and kind, who didn’t drink, and didn’t enable that behavior. I moved in with him in September 2025. And now, almost a year later in August, I will be one year sober. I didn’t use any medications or tools to help with quitting. For me, it was about leaving behind the environment I was in. Not wanting to be in that survival mode state anymore… And surrounding myself with people who share my value of wanting to not drink. And willpower. 

I never experienced any withdrawal symptoms other than the hangxiety. I simply went to the psych hospital one final time and never took another sip after that. I took a Greyhound out of state and away from that environment. Drinking isn’t for me. I don’t know if there will ever be a day where I can casually enjoy a drink again. But if not, I’ve accepted that reality. 

Naomi

I became active in HAMS after suffering a life-threatening bout with alcohol last year. I was drinking vodka 24/7 and ended up in the ICU in critical condition. I had to call an ambulance for myself. 

Since then, I’ve joined HAMS Zoom meetings multiple times per week and have made real friends. Through support of my goals of not necessarily full sobriety, they’ve met me where I’m at. Today, I’m drinking far less, have regained partial custody of my kids and wouldn’t be here without my HAMS support network. They mean the world to me. The vodka is gone. The 24/7 drinking is gone. HAMS got me there, due to group accountability and work on my own. I have my life back with my children, and that’s a gift from HAMS I can never overstate. The Zoom calls are life-altering for me, and I’d recommend them to anyone struggling. 

Esther

I am one that chooses to be alcohol-free. Before I detoxed, I was in a cycle of blackout drinking, being sick throughout the workday until I could have a drink on the way home from work. Weekends were just a blur. I medically detoxed three times within a year. It was a never-ending cycle. 

I choose to be abstinent because I have too much to lose, as a single mother whose children lost their father to alcohol. I found the HAMS Facebook page after my last detox, and felt a sense of relief. HAMS has been immensely helpful to me because there is no judgment. I’m not flawed, I’m human. There is nothing wrong with me. My current plan that works for me has been bi-weekly therapy to deal with my trauma from my ex husband. I do utilize legal THC/CBD edibles at night, which helps with sleep and anxiety. I interact on the HAMS Facebook page. 

Grace

I stumbled across HAMS one night when I was completely wasted. I wanted to do something about my drinking, and I was like messing around on Facebook and that’s how I found it. At that time I was drinking about a handle (1.75 liters) of booze a night. 

I did the HAMS taper, and just having the support from other people who knew where I had been and being able to talk to people and communicate with people who had been there was so helpful. Now, I drink alcohol maybe once a month, about two drinks. Instead, I drink THC beverages, and that helps to curb my, you know, craving for alcohol. Actually, I’d rather drink those than alcohol now. I tried AA and that didn’t work for me. And I tried Antabuse and that was god-awful. I find the HAMS Facebook group and the Zoom meetings really helpful; in fact, I facilitate the Zoom meeting once a week. I’m totally happy that I’m not drinking like I was before, because it was going nowhere good, if you know what I mean. 

“I think one of the main things that HAMS taught me is that I’m not powerless. I’m in control.”

 

Theresa

I was in HAMS before there was even a Facebook group, back when we did a text-based chat. Someone sent me the link to the HAMS taper, and I tapered off of a half gallon of vodka a day. 

Now, that didn’t last and I ended up going back to AA. I was sober in AA for six years and I was miserable, and then I decided to try controlled drinking again and that’s when I found the HAMS Facebook group and I joined. So, both times that I went to HAMS, my drinking was out of control. 

What is it like now? It is non-existent now. I have been alcohol-free for over three years. I’m on daily naltrexone. I never have cravings. I don’t think about it. Alcohol is not a part of my life, but I’ve also rejected all of the AA norms and stigmas and slogans and bullshit that they taught me over the years. For example, the AA saying that “non-alcoholic beers are for non-alcoholics,” and you shouldn’t go to concerts alone. I go anywhere that I damn well please—because I’m not powerless, and I think one of the main things that HAMS taught me, even though I’m one of the people that are abstinent, is that I’m not powerless. I’m in control. I’m in control of my choices, and when I got away from AA my life actually began.

Samantha

I was going through alcohol withdrawal and searching the web for information because I thought I was going to die, and the HAMS website popped up. I learned about tapering with beer, and ordered a case of beer. It took me eight months to taper down to zero. 

I find the Zoom groups very helpful. It’s a sense of community. It’s like a family within a family, and there’s a lot of support—whether you’re going to moderate your drinking, or if you’re going to quit drinking or if you’re just going to be an active drinker. Everybody supports you where you’re at, and I’ve gotten a lot of support over the last six years and it’s definitely the way to go. 

I don’t drink at home anymore, so basically if I go out to dinner, I’ll have two cocktails. If I’m at a dinner party, I’ll have no more than four drinks. I’m only drinking once or twice a month now. I’m also on the Mounjaro shot, and they say that actually can help curtail some of the cravings. I’ve lost 81 pounds and my diabetes is well under control now. I don’t know if the Mounjaro is helping the alcohol, but like I said, I’m basically doing weeks on end without anything and no cravings or anything like that, and keeping it to a maximum of four drinks when I do partake. 

Photograph by Edward Howell on Unsplash

The post “No Judgment”—Ten Personal Stories of Alcohol Harm Reduction appeared first on Filter.

The Advisory covers all three Food and Drug Administration-approved MOUD, but the crux of it is about buprenorphine (commonly known by brand name Suboxone). Unlike methadone, which is confined to its own clinic system, and naltrexone, which is unhelpful, bupe is an evidence-based medication that can be picked up from a pharmacy once a month like most other prescriptions. It’s the most widely prescribed of the three MOUD, but access is still limited in many regions and for many demographics, and patients and prescribers alike still face inordinate surveillance from the Drug Enforcement Administration. In recent years, there’s been a growing push for pharmacists to be able to prescribe bupe to patients directly.

Some pharmacists have been able to prescribe bupe through collaborative practice agreements with licensed physicians—but only in the minority of states that authorize them. In 2022, the Mainstreaming Addiction Treatment Act eliminated the X-waiver and allowed bupe to be prescribed to more patients by more types of providers, including pharmacists, with fewer bureaucratic hurdles. But pharmacists’ ability to prescribe bupe was still restricted at the state level.

In late 2025, the SUPPORT Act authorized DEA-licensed pharmacists to prescribe bupe independently after completing an eight-hour training that’s specific to buprenorphine (rather than one more broadly focused on substance use disorder). But to date, only California and Idaho have approved pathways for pharmacists to prescribe bupe independently.

“A pharmacist’s ability to prescribe and dispense MOUD is especially important for communities that have limited access to or awareness of OUD treatment,” the Advisory states. “[P]harmacists are often the first point of contact on the continuum of care for people with OUD, and most pharmacies have longer hours of operation than other medical providers. These considerations mean that, where state laws allow, DEA-registered pharmacists are well-positioned to provide patients with streamlined, low-barrier access to MOUD.”

“Medication diversion is a complex topic and is often misunderstood,” the Advisory states.

SAMHSA has recently been shifting its rhetoric around long-term MOUD maintenance toward tapering, validating the very dangerous idea that bupe and methadone are only step-downs on the road to “full” abstinence—which encourages scrutiny of the many people who have been stable on those MOUD for years or even decades. But rather than push the concept, the Advisory frames tapering only as a possibility that some patients might decide to pursue, while “clinical experience shows that [others] may require long-term treatment with medications.”

It also addresses pharmacists who might be wary of prescribing bupe to patients who also use other substances besides opioids, stating that in the context of the overdose crisis “it is safer to initiate MOUD without requiring abstinence from multiple substances.”

Urine drug-testing is discussed only briefly, to note that the practice “may be useful for assisting with treatment adherence,” but in isolation “has limited utility and effect on patient outcomes,” and “may be viewed as punitive by patients.”

For pharmacists concerned about “diversion,” meaning the bupe getting used in some way it wasn’t meant to, or by someone it wasn’t prescribed to, SAMHSA states that they shouldn’t decline to fill a prescription without first talking to both the patient and provider.

“Medication diversion is a complex topic and is often misunderstood,” the Advisory states. “Pharmacists who have concerns about the prescribed buprenorphine treatment regimen should not automatically decline to dispense it … buprenorphine is rarely associated with fatal overdose, and, when it is, other substances are almost always present.”

The government is always lamenting how there are too many barriers to accessing bupe even though its risks are negligible, how the overdose crisis makes this a matter of utmost urgency, how only a fraction of the people eligible for a prescription are able to get one. Then when the people take matters into their own hands it’s called “diversion,” and we have to stop them before too much life-saving medication gets into the community, where just anyone could take it. This is why these resource guides always overlook the fact that the more appropriate way to dispense bupe, compared to the current restrictive setup, would be to just launch it into the streets with a T-shirt cannon.

Image (cropped) via California State Board of Pharmacy

The post SAMHSA Pubs Surprisingly Harm Reduction-y Guide for Pharmacists Prescribing Bupe appeared first on Filter.

A new study published in Harm Reduction Journal highlights the health risks of this policy. Surveys with over 700 English people who smoke crack cocaine reveal that one-third have been hospitalized for respiratory illness, and the majority have recently experienced respiratory issues. Follow-up interviews indicate that people having to resort to homemade smoking devices contributes greatly to these startling figures.

“It was a bit of a risky study. How do you generate evidence about something that’s not within the law?”

The data come from the Safe Inhalation Pipe Project (SIPP), led by Dr. Magdalena Harris of the London School of Hygiene & Tropical Medicine. SIPP provided safer smoking kits in six locations across England to evaluate their impact on drug-user health.

“It was a bit of a risky study,” Harris told Filter. “How do you generate evidence about something that’s not within the law?”

Harris and her team overcame this “catch-22,” as she described it, by obtaining temporary police approval. They also received a generous donation of pipes from Exchange Supplies, since government research funding could not be used to fund the intervention.

While analysis of SIPP’s impact is still in progress, data from the baseline phase of the study document clear respiratory health issues among people who smoke crack in the UK.

“Looking at the baseline survey data from 733 people, 60 percent of them … had respiratory symptoms within the last 28 days,” Harris said. “In terms of hospitalization, 31 percent had been hospitalized for a respiratory condition ever. And diagnoses are really high—31 percent have been diagnosed with asthma, and 12 percent have been diagnosed with COPD.”

She also warned that even these high figures are likely underestimates, due to this population’s relatively limited access to medical care.

“We know that COPD is really underdiagnosed in this population,” Harris noted. “So if 12 percent have been diagnosed, I’m sure there’s a lot more undiagnosed, particularly given the high [prevalence of] symptoms.”

“People would often start out with tin cans.”

In addition to the survey questions about respiratory harms, Harris and her team also conducted 33 in-depth interviews with participants, asking them to share their strategies for making their own pipes in the absence of safer supplies.

“People would often start out with tin cans,” Harris said. Other common materials included miniature liquor bottles, asthma inhalers, umbrella handles, naloxone syringes and disposable vapes.

A tin can pipe, which Harris noted can be made “in less than a minute”

While these approaches were innovative, they also tended to be dangerous. Plastic containers, for instance, release toxic chemicals when heated or scraped for valuable residue, while certain glass containers cause severe burns and cuts.

“One of the biggest issues in terms of respiratory harm with homemade pipe use is unsafe suspension devices,” Harris said. When smoking out of tin cans, for example, people tend to place their crack on top of ash. “The issue there is that you’re inhaling a lot of ash, which is really bad for your lungs.”

“[People] talk about burns to their lips or their tongue. But … there’s also the impact of inhaling that hot vapor on their lungs or on their esophagus.”

Other popular suspension materials included stainless steel scrubber (also called “steel wool”), which quickly breaks apart into inhalable metal fragments, and small metal bolts, which reach scalding temperatures. Since stimulants like cocaine have numbing effects, the damage caused by these high temperatures is often greater than people are able to perceive.

“[People] talk about burns to their lips or their tongue,” Harris said. “But then what they’re probably not realizing is that there’s also the impact of inhaling that hot vapor on their lungs or on their esophagus.”

A repurposed metal cannabis pipe, which may cause severe burns

To mitigate use of these homemade alternatives, SIPP provided study participants with pipes made of heat-resistant glass and a more robust suspension material. However, not all participants preferred these safer, purpose-built pipes.

“We collated all of that participant information and took it back to Exchange Supplies and … developed a better pipe.”

“[T]he filter was too dense—it was a good, steel filter made specifically for using crack, but it was just too dense for people,” Harris said. “So what we were seeing is that often people might throw it away and go back to using stainless steel scrubber or whatnot.”

Many people were also unhappy with the size of the pipe and its carrying case, preferring a thinner, more discreet option.

“We collated all of that participant information about the pipes and took it back to Exchange Supplies and … developed a better pipe,” Harris said. “That was a really nice output of the study—something practical that reflects the participants [and] their preferences.”

The new pipe kit, redesigned based on SIPP participants’ feedback

While SIPP is based in the UK, the challenges it’s addressing are global. Many countries continue to crack down on pipe distribution, including the United States, where modest efforts to provide safer smoking supplies under the Biden Administration were met with political outcry.

Harris hopes that SIPP will provide an evidence-based perspective on how pipe distribution can impact the health of people who smoke stimulants. The final results—which will compare this baseline data to new surveys collected six months after the intervention—are still in progress, but preliminary evidence suggests positive effects.

“Our impact evaluation has shown reductions in crack pipe sharing, injecting of any drug, use of homemade pipes and use of ash as a suspension device,” Harris said. “This is a very positive outcome, with longer-term implications for reducing respiratory and injecting-related health harms.”

All photographs courtesy of Magdalena Harris

The post UK Stimulant Pipe Program Tracks the Risks of Homemade Options appeared first on Filter.

On June 17 the Centers for Disease Control and Prevention released its latest monthly provisional overdose death count report, which covers the 12-month period ending in January 2026. During that time the US has so far recorded 67,895 overdose deaths, a number that’s predicted to rise to 69,147 once the remaining available data have been added. Because death records are updated and submitted unevenly, the predicted number is considered the more accurate one.

After overdose surged during the early COVID-19, the 12-month death count peaked at 112,996 between August 2022 and August 2023. Then the trajectory reversed, and the national overdose rate has decreased continuously month after month. Between 2023 and 2024, the data showed fatal overdose decreasing by nearly 27 percent. But in 2025 the decrease slowed to about half-speed. The latest CDC report shows it decreasing 13.2 percent, compared to the 12-month period ending in January 2025.

Nationally, the rate of overdose is back down to approximately where it was in September 2019. But over the course of the past few monthly reports, it’s become clear that overdose is going back up in the West even as it continues to go down—at half-speed, on average—almost everywhere else.

Though their rates have varied from month to month, the two states where overdose has been rising the most are Arizona and New Mexico. The latest report shows New Mexico with 1,010 deaths predicted, a 24.1-percent increase compared to the same 12-month period a year earlier. In Arizona, the predicted death count is 2,932, an increase of 11.5 percent.

In November 2024, fentanyl-involved deaths suddenly began to climb even faster than they’d been falling.

The other states where overdose deaths have increased compared to a year earlier are South Dakota, with 96 predicted deaths (+14.3 percent); Colorado, with 1,819 predicted deaths (+11.3 percent); Nebraska, with 155 predicted deaths (+6.9 percent); Montana, with 174 predicted deaths (+4.2 percent); Minnesota, with 1,017 predicted deaths (+3.9 percent); North Dakota, with 125 predicted deaths (+2.5 percent); Alaska, with 329 predicted deaths (+1.23 percent); and lastly New Hampshire, with 266 predicted deaths (+0.4 percent). This is the first 12-month period in which Alaska and New Hampshire have joined that list. 

For most of 2024, fentanyl-involved deaths in Arizona declined rapidly. But that November the data show a sudden, sharp turnaround as fentanyl-involved deaths began to climb even faster than they’d been falling. Methamphetamine-involved deaths, which for years had been increasing at a steady-ish pace, jumped up sharply and rose in tandem through May 2025.

Between November 2024 and January 2025, fentanyl-involved deaths took a similar trajectory in New Mexico, Colorado and Minnesota. Patterns in less-populous states aren’t as readily apparent, not just because of the smaller numbers but because these states tend to have more gaps in their reporting. Nebraska didn’t report any overdose deaths between April 2024 and May 2025, and North Dakota didn’t report any for about half the months from the same time period. Death investigations are such a skewed and unstandardized business from one jurisdiction to the next that this could mean a few different things, but probably does not mean that no one died of overdose in those states during those months.

Though overdose deaths in Arizona still increased compared to the previous 12-month period, in October 2025 they began to slowly drop back down. The latest data show deaths in Arizona continuing to go down through January 2026. New Mexico and the other western states with rising overdose deaths haven’t yet followed suit.

Image (cropped) via Centers for Disease Control and Prevention

The post Overdose Death Data Patterns Emerge as Crisis Surges in Western States appeared first on Filter.