Not everyone goes to detox to become abstinent. People go for all kinds of reasons—reasons that may change from one day, or one minute, to the next. That includes people who believe in harm reduction.
I’m a fentanyl user who works in harm reduction, and I just walked out the door of a detox facility. It’s not necessarily my goal at this moment to quit using drugs for any extended period of time. Maybe I will; maybe I won’t. And even with that mindset going in, I still found detox helpful—imperfect and inadequate as it was.
This was not my first rodeo. Many nurses at my local detox knew me by name. We joked around; I asked about their kids. But it had been more than five years since I’d been in, and because of COVID restrictions there was barely anyone else in there—maybe eight or nine besides me. I recognized a regular or two.
I went willingly. I just needed a break. As much as I love using drugs, the way I’ve been using them recently is not sustainable.
I’ve been using, and then detoxing from, coke and opioids since I was 16. I needed to be away from my access points for a while, if you can call seven days a while. I still felt like I was still in physical withdrawal when the week was up. I’m not a light user.
When I first went into detox 11 years ago, they’d give us up to 120 mg of diazepam and 60 mg of codeine. I’d leave feeling like a million bucks.
Then for a while they were doing methadone tapers—people detoxing from opioids would get up to 40 mg, and they’d wean you off until you left. They’d wake you in the dead of night for your meds and bring your taper down way too quickly. I always went straight back to using after leaving those programs.
I isolated myself a lot, wondering more and more if it was all just a big waste of time.
Prior to going in this time, I’d been doing about a gram of fentanyl and a gram of pure cocaine every other day. I’d also binge on etizolam dressed up as Xanax bars. I still had my methadone take-home bottles, and they let me bring them in—then seemed to forget to monitor my intake. I brought in my etizolam, too; they never noticed.
With COVID and all the weird protocols that come with it, there really was no schedule or structural support. I was privileged enough to have a laptop and a phone; the facility let me keep them to occupy myself, which it would never have allowed last time I was there. Each day was just: breakfast, meds, lunch, meds, dinner, meds, late-night snack, meds, hopefully some sleep. Most participants just hibernated in their rooms. I isolated myself a lot, wondering more and more if it was all just a big waste of time.
They kept trying to do my blood work at 7 am, poking me over and over without being able to hit a vein. Eventually they had to take me off-site to a hospital so a team of phlebotomists could take over. I kept telling them to try my hand; they kept ignoring me. I felt like a pincushion. I felt like I was done with detox.
I didn’t eat or sleep for most of the last two days. The food seemed more fake and less palatable with every meal. And just when you’re finally on the verge of falling asleep, they march into your room to check your vitals.
There weren’t really any programs, aside from a walk outside here and there, or a few 12 step-like sessions. You’d never catch me participating.
I have all the love, compassion and gratitude for a number of the staff members, but the detox approach on the whole is not realistic for a lot of people a lot of the time. It can easily cause more harm than good—people getting their prescriptions disrupted, tolerance levels messed up, leaving in withdrawal with only one thought in their mind: Where can I get high?
The prospect of some peace and quiet away from the world—and my supplier—was enough to make me enter a place associated with “recovery.”
But I was there for one specific reason: to take a fucking break so I wouldn’t die. I live and breathe harm reduction, but the prospect of some peace and quiet away from the world—and my supplier—was enough to make me enter a place associated with “recovery.” If you think detox is only for 12-steppers who don’t carry naloxone, you’d be wrong.
Hundreds of people in North America are dying of overdose every day. And no wonder, if what we push on them as an alternative to the poisoned supply is an experience like the one I had.
Detox is, at best, an inadequate Band-Aid that doesn’t stick; so much more is needed. Any holistic program should help people meet their basic needs, starting with housing. And detox needs to be one item on a menu of options: syringe service programs, safe consumption sites, safe supply and accessible medications including, at the very least, buprenorphine and methadone.
Abstinence has its place on the harm reduction spectrum, and detox its place in the toolkit. But it needs to be more patient-centered, more sensitive to our individual circumstances and the underlying causes of our addictions, rather than just shoving us through a revolving door. In seven days, no staff member asked me if I wanted to talk to a housing case worker, or if I had any sort of exit plan. No one asked me if my opioid use disorder medication was working for me, or whether I was interested in making a change.
And yet, when I walked out those doors, sick and frustrated as I may have been, I was also just happy to be alive.
Did I think about fentanyl and coke? Of course. But was using my top priority? No. In the big picture sense, detox did what I wanted it to do: break the chaotic cycle that had become my daily life and help me settle back to the “me” that everyone loves, including my family and myself. That’s why I chose detox for this particular moment in my life. I’m glad I had that choice.
Photograph via National Library of Medicine