Back before I’d ever heard of harm reduction, I spent a lot of time preoccupied with whether my prescription stimulant use was a medical thing or a recreational thing. I got the prescriptions, Adderall mostly, off-label for treatment-resistant depression, which to this day hasn’t responded to therapy or clinical trials or something like 20 psychiatric medications but most definitely responds to stims. From pretty early on, I figured the effect the medications had on me was maybe not what doctors had meant. But I felt better than I had without them. Was that bad?
Over the years I stopped fixating on it. This didn’t really come from switching to meth, or from finding my way into harm reduction, but just from gradually learning that whether it was treatment or getting high made zero difference in the real world. I had the options that I had, and was using them to feel better. Therapy was no longer an option, for safety reasons, but therapy hadn’t been safe long before I started using meth anyway.
Though fentanyl and other adulterants do occasionally find their way into the meth supply, the overdose risk only really becomes meaningful at a population level when meth is combined with dope. With no disproportionate threat of overdose, and no equivalent to methadone or buprenorphine, the safe supply conversation for stimulants is a lot leaner than the one for opioids. So whenever someone balks at the idea of stimulant safe supply, there’s isn’t much they can hide behind; they’re bothered that drug users have autonomous access to euphoria.
“Addiction medicine is very uncomfortable with the ways that people like to use drugs because they don’t like people getting high,” Gillian Kolla, a Toronto-based harm reduction and public health researcher, told Filter. “And so when you start talking about safer stimulant supply, I think you have to actually say that this is not for an abstinence-based goal of ‘getting people off drugs.’ This is about giving regulated supply for them to use in the way they think is best.”
Euphoria can refer to a specific opioid response distinct from, for instance, warmth and comfort. But everyone’s euphoria differs, and our own experiences of it change as we develop tolerance. Personally I can’t tell you the difference between euphoria and depression relief. Let’s say euphoria encompasses the good feeling you get from a drug that goes beyond withdrawal management. The feeling that, in theory, separates medications for opioid use disorder (MOUD) from safe supply.
“Bupe just takes all the warmth and wholeness and not caring of opis and throws it down the garbage disposal.”
The big Stanford-Lancet Commission on the North American Opioid Crisis, published February 2, dismissed the concept of a “safe addictive-drug supply” as something very silly, possibly because it has confused medical safe supply with something that dispenses “as many opioids as possible with as few possible regulatory constraints as possible.”
The report described itself as a response to both substance use disorder (SUD) and overdose, but never uncoupled the two. Like addiction medicine as a whole, it only acknowledged euphoria as a risk factor for addiction, as if something with a notably positive connotation could have only a negative outcome.
Most people at risk of overdose don’t have opioid use disorder (OUD), meaning that MOUD—even if readily accessible to everyone who could benefit—won’t prevent the majority of overdose deaths. Nor do these medications meet all OUD patients’ needs.
The report did state this, further noting that MOUD programs have poor retention rates and that participants remain at risk from the toxic supply. After this point it stopped being correct by accident, concluding that the answer was tighter regulations on MOUD before veering into a call for universal mandatory prescription drug monitoring programs.
Some people can get euphoria from MOUD, to limited degrees. But it’s a whole lot easier and more effective to get it from the illicit supply. Euphoria is a valid human need. Any gesture toward ending the crisis that doesn’t acknowledge this falls somewhere between incrementalism and performance art.
So successfully has our puritanical approach to drugs demonized their use that we have a health care system in which it’s considered an unacceptable side effect for patients to feel good. A desirable outcome ensures, specifically, that patients do not feel good.
“Bupe just takes all the warmth and wholeness and not caring of opis and throws it down the garbage disposal,” Charles*, a street-based East Coast resident who’s been injecting opioids for about 25 years, told Filter of a recent attempt to get off illicit supply. “Flat, noneuphoric, clinical … that shit is lifeless as an Advil. Anesthetic trash.” He gave it up after a few days.
Oxymorphone, on the other hand: “euphoric, dynamic, lovable, huggable gold.”
A prescription for 120 mg would keep him off street supply completely, but there’s no way that’ll happen because it’s a Schedule II controlled substance and the US has no medications approved for safe supply. This leaves low-income drug users at high risk of death, but does protect from the risk that they might feel good.
Not everyone’s euphoria is criminalized.
Euphoria can trigger cravings, but it’s not what makes most people vulnerable to SUD. What does is being deprived of other sources of joy, comfort, relief and safety.
Not everyone’s euphoria is criminalized. Mine rarely is. The people whose drug use gets characterized as dangerous and frightening in the media—low-income drug users in predominately communities of color—are usually being deprived of basic needs, too.
There’s this persistent idea that drug-induced euphoria is artificial, that it’s not a real experience like euphoria induced by non-drug things. This kind of thinking assumes that people have equal access to those other sources, and that if we stopped pursuing this euphoria we’d be alright without it.
“Care providers should also consider that many patients with OUD have serious, unaddressed psychiatric, medical, family, employment and housing issues that medication alone will not solve,” the Stanford-Lancet report stated. “Opioid medications can be powerful and effective in the treatment of OUD, but should not be used as an informal system of pharmacological sedation of poverty.”
Where the “diverse” Commission of 17 people with advanced degrees, 13 of whom are white, somehow went wrong in its comprehension of poverty was presuming that people subjected to poverty have any less right to pharmacological coping mechanisms than anyone else. Or that an opinion on how low-income drug users should handle systemic trauma, written without any leadership from low-income drug users handling systemic trauma, would end up being relevant to anything.
*Name has been changed
Photograph of methamphetamine courtesy of Kastalia Medrano