Riverbend at that time was a haven compared to other state-run and private facilities I’ve experienced in nearly 30 years of incarceration. The prison chaplain, who has since left, was an abolitionist who brought in hundreds of volunteers to help facilitate a robust catalog of academic and recreational programming. We had access to one-on-one mentoring and workshops on subjects like conflict resolution. We took Vanderbilt University classes with non-incarcerated students, and completed the same coursework that they did. 

For Lucky, now 46 and currently incarcerated with me at South Central Correctional Facility (SCCF), this programming was a lifeline. It taught him new skills and kept his mind off the reality of his situation. Unless something changes for him in court, Lucky will not be eligible for release until 2054.

“I don’t see myself being here until 2054—I’ll either be dead or released before then,” Lucky told Filter. “Talking about things that weren’t prison-related took me to another place. At least for a short time.”

The classes and workshops were gone; the level of daily violence was high.

One day, out of the blue, Lucky found himself on the transfer bus to a different facility—an experience all too familiar to many of us in the prison system. The prison he was sent to had a very different culture. The classes and workshops were gone; the level of daily violence was high.

“I immediately had to fight to keep my property, and for anything else that I needed,” he said. “It felt like all the years I had spent trying to better myself were wasted and just thrown away. The state just looked at me like a number.”

A few years later, Lucky’s mental health was showing the strain. At night his racing thoughts robbed him of sleep, and then during the day he was exhausted and withdrawn. Friends urged him to request an appointment with a mental health counselor; maybe some mood-stabilizing medication would help.

Lucky reported to his appointment, where the counselor asked him how he’d been feeling recently. After establishing that Lucky had no immediate plans of suicide, the counselor seemed to have all the information he needed.

“He told me that life is hard in prison, and [intrusive thoughts] were probably over a guilty conscience, and I should pray before I went to sleep,” Lucky recalled. “I thought, What the fuck?”

He never went back, and never sought mental health care again after that. But if the prison system wasn’t going to provide any support, that didn’t mean he couldn’t find it himself.

“I grab everything and anything that can bring me relief,” he said. “I wouldn’t dare deny a cancer patient morphine, so what’s the difference?”

“Like it or not, meth has kept me from killing myself many times.”

Drugs had been a part of Lucky’s life since eighth grade, when a friend’s father who sold marijuana and assorted pills offered him an opportunity to make some money. For a long time his relationship with drugs had been based on selling them, not using them. But with no other way to keep his mind occupied, he found that methamphetamine made life bearable.

“I’ve got this wheelbarrow load of time to do … Like it or not, meth has kept me from killing myself many times,” Lucky said. “That must sound strange to folks, but it has been the one thing that has not abandoned me.”

Meth and other state-banned drugs are often inaccurately described as being almost instantly addictive. But many people, including Lucky, use meth regularly without experiencing cravings, or going into withdrawal during the times they’re not using it. It’s simply a tool he uses to get him through hard times, to keep moving forward and not dwell on what he can’t change.

Prison sentences are getting longer, as prisons themselves are giving us fewer ways to pass the time. As the understaffing crisis drags on and prisons cut costs any way they can, workshops, religious services and outside volunteers have fallen away. Those days at Riverbend are but a fond memory.

“I would love to be in college classes and learning new things. But that’s not my reality right now,” Lucky said. “Prison administrators force you to play this sick, Hunger Games style of living, where you kill or be killed. They want you to fail. They set you up to fail. Surviving any way I can is me flipping them the bird and saying, Fuck you.”

Photograph via Pennsylvania Department of Corrections

The post As Prisons Shutter Classes and Mental Health Care, Drugs Fill the Gap appeared first on Filter.

At 15 I landed a night job making change at a poolhall frequented by bikers, and it wasn’t long before I was riding with a club. Marijuana was smoked like cigarettes. Beer was consumed like water. Cocaine I valued as a pain reliever, but didn’t have much use for it otherwise. Meth was what helped me keep up, with drinking and long rides alike. Opium complemented that best, and was smoked like hash. Hash was just good marijuana. 

These substances were the day-to-day lifestyle, but psychedelics were the vacations. Mainly LSD, which materialized suddenly a few times a year and caused all other activity to be set aside for the next few days. You didn’t save it for later. Part of the magic was in giving oneself over to the trip when and where the opportunity appeared.

This was true of psychedelics broadly. For example, there was a known supply of psilocybin mushrooms on private land in Lizella, but police had been arresting trespassers for years and so access was sporadic. It was generally accepted that one did not go to the shrooms, but waited for the shrooms to come to you.

I had less experience with shrooms than with LSD, but enough to perceive the difference between the two highs. To me, it was like LSD allowed light to be colorful, while shrooms showed you that color and light were the same. DMT revealed the light to be intelligent, but that story is for another day.

The club frowned on injecting anything. If you shot up, someone was keeping a mental tally of how often. 

The club frowned on injecting anything, especially heroin. Doing so was viewed as a tipping point into addiction, past which men became unreliable. If you shot up, someone was keeping a mental tally of how often. 

A friend and I began injecting meth and coke, and heroin just to see what it was like. Despite the palpable stigma, syringes were a novelty to us and we set about experimenting with what could be injected and how. 

When I decided to inject a reduction of psilocybin tea, I wasn’t thinking about the fact that mushrooms are a fungus. Maybe the spores did not begin growing inside my veins because of the amount or quality of the shrooms; maybe I just got lucky. Either way, this is how I remember the experience playing out.

There was no gentle onboarding of the kind typically associated with psilocybin. Injecting the reduction of psilocybin tea was like being sucked suddenly into the vacuum of space. A flash of red, a ringing in my ears …

I woke up a day or two later in a mobile home that I did not recognize; some furniture barricaded against the door. The snoring emanating from somewhere within a cocoon of blankets by the far wall indicated that my friend was present and accounted for. His sister’s home, as it turned out. No harm done, no permanent damage; good trip.

In the past, whenever I’d felt a trip winding down I’d ease it off with a little meth. That way, a few hours later when the meth started winding down, the psychedelic substance was long gone. Some valium mixed into a jar of Kool-Aid would then bring on much-needed rest. That was not in the cards this day.

Through the rest of the day, the three of us tried ever-more-creative attempts to circumvent my newfound aversion to needles.

I drew up my shot and injected it as usual. And then, feeling as lucid as I ever had in my life, I felt that my very consciousness was plunged into the vein along with the meth, so that I could see inside my bloodstream, the yawning chasm of the needle’s bore looming massive behind me. I could hear my blood cells squealing in terror, as if invaders had arrived to forcibly displace them from where they lived. Perhaps they knew what I didn’t.

When I came to, the syringe was next to me on the floor, nearly full. It seemed that the instant the needle had pierced my skin, I’d simply passed out from some sort of shrooms PTSD flashback.

Through the rest of the day, the three of us tried ever-more-creative attempts to circumvent my newfound aversion to needles. Each time, I’d black out and see the flashback of squealing blood cells. Different needles made no difference. Nor did trying with no actual substance in the barrel, just water. Nor did the sneak approach of, I’ll just gaze off this direction and whomever has the needle, surprise me.

It was kinda fun at first, passing out then telling them what I had seen as soon as I woke up. Except that I really wanted that shot, and thus wanted the phenomenon to wear off. 

As it turned out, that was the beginning of the end of my injection drug use. I was never able to use needles without blacking out with my ears ringing with the squeals of my distressed blood cells the flashback.

Eventually I lost interest in trying to inject anything. These days I’m a completely sober person who gets a buzz off coffee or allergy meds. Some 40-odd years later, needles only come into my life through the very occasional circumstances like COVID vaccines. I don’t black out anymore, but I do hear the faint ringing in my ears. 

Photograph via United States District Court Middle District of Florida

The post Meth Was the Routine in Our Biker Club. Psychedelics Were the Escapes. appeared first on Filter.

Bell was able to move about his new environment without much fear, something incarcerated people rarely experience. His age, combined with his soft demeanor and his college-educated conversational skills, moved some of his prisoner peers to show him the ropes and look after him. Everyone else was content to leave him alone. Most were simply confused as to what exactly had landed him in here, and they were no less confused when they learned it was selling meth.

“If I had not found a community of friends in prison to help me,” Bell told Filter, “I would have never made it.”

Though his personal use never became chaotic, his relationship with meth did change.

Bell had grown up in a small town in Georgia, with a perfectionist mother who equated wealth and social status to success and happiness. She subscribed to the idea of children being seen but not heard. When his father left, Bell dutifully suppressed his emotions to please his sole caretaker, and took to heart that public perception mattered over all else. Decent people went to school, got respectable jobs, got married, had children, and kept their secrets buried deep. Not until the late 1990s, when Bell’s wife found a half-finished letter he was writing as part of their marriage counseling homework, did he begin living as an openly gay man.

In 2008, life threw Bell a curve ball he could not catch. In fact, it threw him several, smacking him in the head one after the other: He was diagnosed with HIV, cancer and shingles. He had to go on short-term disability, then long-term disability, and eventually lost his job and with it his health insurance. It wasn’t just his lifestyle—the nice car, the fancy neighbhorhood—that he could no longer afford. He couldn’t afford the many expensive medical treatments and medications he suddenly needed to stay alive. Though this was years before the Affordable Health Care Act, even today in 2023 Tennessee remains one of 10 states that has not expanded Medicaid coverage.

Some years earlier, Bell had used meth for the first time while on a business trip. He remembered the temporary escape from reality that the drug had brought him back then, and longed for a few more such moments. For a new friend who didn’t ask questions, who didn’t judge. Though his use of the drug never became chronic or chaotic, his relationship with it did change—once he realized that it represented a new revenue stream. He didn’t need to use it nearly as badly as he needed to sell it.

“I had to learn to live, or prepare to die. [So] I became a wholesaler.”

“I had to learn to live, or prepare to die,” Bell told Filter. “I became a wholesaler. I bought it cheap in one location during my travels and made a profit when I sold it back at home … I was able to pay the rent, buy my meds and just survive.”

When he came out about his sexuality all those years ago, the shame he’d been taught to feel about it was washed away. Today, he doesn’t see the point in pretending to be ashamed of anything. He served his time, got out and remained close friends with those who took him under their wing when he was incarcerated.

Despite the demonization of meth and the people who use and sell it, Bell doesn’t blame the drug for his detour into prison. It saved his life in that way, too; while incarcerated, at least his HIV medication was covered. Meth hasn’t been a part of his life in any capacity since the day he was arrested, but the personal-use aspect was always manageable for him. The reasons he no longer uses it have more to do with parole than anything else.

“I don’t have any choice, I have to pass drug screens,” he told Filter. “I have to live differently and find different coping mechanisms now that I’m in the system, and if I want to live free and not in a cage.”

“But I have to say, meth did not do bad by me. When I needed it, it came through.”

Photograph courtesy Kastalia Medrano

The post Selling Meth Sent Him to Prison. It Also Saved His Life. appeared first on Filter.

The next day, The New York Times reported that according to doctors, the mother had irreversible brain damage and the children were all going to die. It ran the story under the headline: “MEXICAN FAMILY GO INSANE.”

After the federal government created the created Bureau of Narcotics, an early predecessor of the Drug Enforcement Administration, Commissioner Henry Anslinger found an effective way to engineer the criminalization of marijuana. He would scour the country for the most salacious reports of the most bizarre or violent behaviors by Black and Brown people, and then he would funnel them to journalists and suggest they print abhorrently racist stories about marijuana making people psychotic criminals. And they did.

Harm reduction is moving into the public consciousness, but drug-war propaganda is not moving out. Law enforcement and media found a mutually beneficial model using propaganda that’s no more subtle today than it was 100 years ago, it just moves from drug to drug. Over the decades, the public has more or less accepted that weed doesn’t make entire families go mad, but that NYT story would still fly if you swapped in different drugs.

If you were a PCP user in the late 1970s, you attacked bystanders at random. You had unusual strength. You were unstoppable, you could jump, you could fly.

“It’s a real terror of a drug,” National Institute on Drug Abuse Director Robert DuPont said in 1977. “Everything people used to say about marijuana is true about angel dust.”

In 1977, the year the DEA created a Special Action Office to investigate phencyclidine (PCP), the media coverage was beside itself. If you used PCP in the late 1970s, the NYT or the Washington Post or your local paper of record reported that you were about to “go berserk and commit violent crimes.” You attacked bystanders at random. You had unusual strength. You were unstoppable, you could jump, you could fly.

The post Media Never Changed Its 1970s PCP Propaganda, Just Repurposed It appeared first on Filter.

Unlike opioid use disorder, methamphetamine use disorder doesn’t yet have any medications approved by the Food and Drug Administration. InterveXion is developing an “anti-METH antibody treatment,” which some will probably call a “meth vaccine” (as with cocaine and opioids) but is more or less the equivalent of long-acting injectable buprenorphine.

“Pharmacotherapies for treating methamphetamine addiction have traditionally sought to lessen [central nervous system] effects by substituting for (agonist therapies) or blocking (antagonist therapies) methamphetamine at its site(s) of action,” InterveXion states on its website. “[T]his development strategy has thus far failed to produce an effective, non-addicting, safe medication.”

“Agonist therapies” would refer to pharmaceutical stimulants like Adderall or Ritalin. They do in fact have evidence substantiating their safety as meth substitutes, but the reason they aren’t considered effective in the United States is because the only outcome metric these studies ever use is sustained abstinence. If you evaluated them in terms of alleviating withdrawal and reducing cravings, which is more along the lines of what a meth vaccine would do, agonist medications would look a lot more promising.

InterveXion, which has been getting federal funding for anti-meth endeavors since at least 2009, is also pursuing a second application for IXT-m200 as a short-term emergency department intervention for alleviating meth overdose, AKA overamping.

Overamps tend to safely alleviate themselves, and that’s really the crux of why none of these proposed meth meds are ever going to be relevant—they’re going after the wrong thing. The biggest harms associated with meth use aren’t medical. They’re legal.

Police don’t respond to overamps as medical emergencies. They respond to them as public disturbances, and crimes in progress. No other state-banned substance is woven into the criminal-legal system the way meth is, and if any of the researchers interested in pharmacological interventions for meth use were a bit more invested in reducing harms, they’d measure success by whether it reduced arrest and incarceration. 

“In some areas of the country, [meth] poses an even greater threat than opioids, and it is the drug that most contributes to violent crime,” National Institute on Drug Abuse (NIDA) states on its website. “Beyond its devastating effects on individual health, methamphetamine misuse threatens whole communities, causing new waves of crime, unemployment, child neglect or abuse and other social ills.”

Though NIDA’s citation for that claim doesn’t say anything about “violent crime” one way or the other, it is true that law enforcement departments frequently cite meth as the catalyst for doing crimes. Government materials on meth overwhelmingly characterize users as uniquely dangerous, warning that “[t]weakers tend to arm themselves” before they go do crimes, or that meth turns parents into pedophiles.

The link between doing meth and doing crimes is definitely real, but mostly involves property theft undertaken to pay for meth rather than, say, child abuse. Stimulant agonist medications like Adderall could alleviate much of the need to engage in criminal activity, but this is complicated by the fact that prescription stimulants are subject to a version of the same stigma.

Even in overdose data, the Centers for Disease Control and Prevention usually divides stimulants into one category for cocaine and another for “psychostimulants with abuse potential.” The latter lumps methamphetamine together with things like amphetamine and methylphenidate—Adderall and Ritalin.

Intentionally or not, InterveXion’s website kind of makes the same point: “IXT-m200 has a relatively long elimination half-life suitable for use in the chronic abuse setting, where recidivism is notoriously high, to help a patient overcome their drug dependency.” 

“Recidivism” can technically refer returning to drug use, rather than returning to prison, but the only time you’ll ever hear it used that way is when a government agency is talking about both and doesn’t bother to distinguish recidivism from “relapse,” because it doesn’t matter. In their view, “relapse” is recidivism—an unfortunate slip-up by people too addicted to the criminal lifestyle to stay out of prison for long, no matter how badly they might want to.

Top image via State of Nevada. Top inset image via Druguse.Alabama.gov. Bottom inset image via United States Department of Justice.

The post Meth Users Don’t Need Meds to Avoid OD. We Need Them to Avoid Cops. appeared first on Filter.

In 2020, I was transferred to another prison and recognized him right away. There was a rare authenticity in the care he showed for others, and I knew I could trust that he cared for me. We fell in love.

After years of using meth to cope in prison, I’d stopped just a few months earlier. I didn’t expect to lean on anyone during this time, but I also didn’t expect to meet anyone who knew how to support without judgment. Paul encouraged me to honor my recovery because that was the path I wanted. He also promised that if I ever chose a different path, he’d love me and support me just the same.

Meth had always helped me through breakups. Now, it was like the cravings flooded in through my every pore.

In May 2023, Paul was shipped to a different facility. There was no warning; that’s just how it happens. We barely got to say goodbye.

As a trans woman, the decade I’ve survived incarceration in men’s prisons has brought trauma I wouldn’t wish on anyone. I didn’t think there was a kind of pain I hadn’t already experienced. But this was something different, a separation that cut deep into my peace. Fatigue and depression crept in. And soon, for the first time in a long time, I recognized a familiar feeling: I wanted to be high.

Meth had always helped me cope with breakups. Now, it was like the cravings flooded in through my every pore. I could almost taste the bitter ammonia that would hit the back of my throat after I snorted a line. I remembered how boofing good dope would make my stomach clench and drop. And how I’d then (after a bathroom break) be off in a tilt-a-whirl of productivity, of losing myself in music or sex. A brief escape, from the reality everyone here wants to leave. I longed for that so badly.

I don’t think of drugs with any moral value attached to them. I wouldn’t have been ashamed to get high. But I chose not to because I liked the path I’d been walking these past few years. As much as I missed meth, I was also used to not having it. I was used to being the person I am without it. Paul had made sure my recovery wasn’t clouded by any fear of losing him, so I could know I was doing it for myself. I’ll always love him for that.

Many people would call this trading one escape from reality for another, and those people are 100-percent right.

I still got absolutely shitfaced. I searched for a healthy coping mechanism and found chain-gang liquor, savoring a weekend of intoxication and Latina love ballads. 

Many people would call this trading one escape from reality for another, and those people are 100-percent right. It was a good decision. Alcohol helped me dial back the intensity of loss enough to process it, and the fact that it wasn’t meth was empowering in and of itself.

After that weekend, I continued on the path I’d been walking—the one without substances, including alcohol. Instead of running from my pain, I sat with it and allowed myself to feel it. I grieved for everything I missed.

I appreciate the many times I’ve used drugs to amplify my life, and I recognize when I’m using them to hide from it. I don’t want to spend any more time ducking what I feel. I want to feel it all.

Photograph courtesy of Kastalia Medrano

The post A Prison Breakup Tested My Meth Recovery. Alcohol Helped Me Keep It. appeared first on Filter.

In a meth overamp the way people often experience it, as soon as you consume an amount that takes you past a certain threshold, the meth essentially flips on you and starts doing the opposite of what you want it to do. In terms of user experience, it switches from an upper to a downer.

If this sounds implausible, it’s only because the first kind of overamp is so dangerously overrepresented in the public consciousness. Meth is a convenient scapegoat for almost any societal ill, and a meth-induced state of agitation or aggression—when it happens in public—really lends itself to media outlets looking for clickbait, police departments looking for people to criminalize, and the DEA forever looking to justify its own existence.

Once that narrative is out of the way, the concept of a drug that functions like a stimulant at lower doses and a sedative at higher doses becomes more familiar. Lots of drugs work this way: alcohol; synthetic cannabinoids; GHB; CBD; kratom. In pharmaceutical circles, a medication having the opposite effect it’s expected to—like when Adderall makes you tired—is a well-established outcome called a “paradoxical reaction,” and sometimes associated with the dose being too high or low.

Though I’ve kicked the subject of meth overamps around with a couple of toxicologists and other harm reduction-based academics, I’m describing my understanding of what is happening rather than something doctors have confirmed to me. That said, my understanding comes from talking about the experience at length with other chronic meth users, across different parts of the country over a long period of time, and doctors tend to have a somewhat less nuanced understanding of meth use than meth users do.

An overamp often looks like the nod we associate with opioids.

I can count on one hand the number of times I’ve been with someone acutely agitated from meth, and to the best of my knowledge it’s always been when someone either hadn’t been using it regularly, or injected when they normally smoked. Whereas it’s normal—expected, even—for someone to do a shot or take a hit and then, moments later, simply power down.

Often this looks like the nod we associate with opioids—slowly sinking lower a millimeter at a time, hands still holding whatever they were holding, snapping back to consciousness as soon as you say their name or give them a gentle nudge. 

A lot of meth users naturally assume that when the “sleepy meth” kind of overamp happens to them it’s the meth that’s at fault, especially as the escalating drug war means repeatedly losing access to the sellers they trust. But overamps have nothing to do with fentanyl or sedatives being cut into meth. They predate fentanyl entering the illicit drug supply. And in the year and change I’ve had access to drug-checking, the NYC-area meth used by everyone I know in person, including myself, has remained 100-percent meth.

The threshold at which this happens for each person is not constant; it can jump around a lot.

Overamping is not the same thing as falling asleep because meth had kept you up for so long you eventually couldn’t help it. It’s a direct physical response to having just introduced more meth into your system than it can handle, triggering a sort of temporary shutdown. This is not life-threatening in and of itself—some people feel better after—but it’s often inconvenient and at worst unsafe, depending on the setting.

The threshold at which this happens for each person is not constant; it can jump around a lot. Individual tolerance to meth sets the general range, but the thing that determines someone’s overamp threshold at any given moment really seems to be sleep. The more sleep-deprived you are, the less meth it takes.

Usually overamps happen when someone consumes a large quantity of meth all at once. I also think they can be triggered by using smaller quantities frequently enough, without a break, so as to reach a point where the intake comes to the same thing, because that’s what happens to me. Almost everyone I know uses larger amounts at a time than I do, but I also use pretty much hourly and know no one else who does, so my knowledge here is limited to just my own experience and secondhand accounts.

Nationally, rates of meth use have increased substantially in the past few years; I don’t think I’m the only person in this position.

Overamps only started happening to me a little over a year ago. Recently, my tolerance has gone down—by a lot. Right now anything over 0.05 grams at a time—an amount many meth users would consider very teeny, by any method of consumption—means an instant headache and overpowering fatigue. I do sometimes overamp and fall asleep, but because I use little doses continuously it feels sort of like I’m hovering just under my threshold during most waking hours. The biggest issue has been constant brain fog, plus this neat thing where I can start a sentence but not find my way out the other side.

The solution would be to take a break and let some tolerance wear off, but functionally this would be not unlike inducing a coma, and it’s hard to find time in your schedule for something like that. Nationally, rates of meth use have increased substantially in the past few years; I’d guess I’m not the only person in this position.

Rotating with other stimulants, like Adderall, can go a long way if you have the means. Portable oxygen canisters can also help mitigate overamps, and though I haven’t had any luck with them personally, I have seen them be versatile stimulant harm reduction tools for others.

I use meth because without at least a half-gram rolling around in me at all times, I revert back to my natural form: a big ball of depression with an unfortunate immunity to antidepressants. But for more than a decade, stimulants have allowed me to manually override this problem (not perfectly; just in the big-picture sense), and for the past couple of years I’ve used meth to open up the brief windows during which I’m able to go about my day. When I feel the window starting to close again, that used to mean it was time for more meth. These days, it means an annoying Catch-22 wherein doing more meth and not doing more meth produce pretty similar results.

So far, the best approach I’ve come up with is tentatively dosing itty bits at a time—as low as 0.02-ish grams, currently—and feeling out whether my system can absorb a bit more or whether it’s already too late. If I hit the right amount, I get to be myself for a little while. If I go over or under, I end up as myself that way too.

Photograph courtesy of Kastalia Medrano

The post Meth Overamps Come in Two Forms. Mostly the One We Don’t Talk About. appeared first on Filter.

When headlines warning of a looming Adderall shortage started to appear late summer 2022, it was nice to experience them as more of a bystander rather than someone about to have an urgent problem. In October when I couldn’t fill my script, I felt pleasantly detached from the situation.

I didn’t need Adderall that badly at the time. If I did need to find it or buy it, there were still people I could call whom the shortage hadn’t reached quite yet. It wasn’t worth the time it’d take to cold-call pharmacies every day. For a while now I’d been using meth, and there definitely wasn’t a meth shortage.

So much dread, panic and constant worry used to go into maintaining my Adderall prescription. All the hours on hold and in waiting rooms for the privilege of being talked down to, choosing which days to function and which days to ration, for something that was never secure for more than a month at a time anyway, like trying to bail water out of a boat that was always leaking.

I’d assumed a high tolerance to one stimulant applies to stimulants across the board. That isn’t entirely true.

Adderall—or technically, the amphetamine salts that comprise it—is neither safe supply meth nor medication for meth use disorder. But that doesn’t mean it’s not a useful alternative.

Regulated pharmaceutical meth is Desoxyn, which is FDA-approved for ADHD but not commonly prescribed. Methadone and buprenorphine are full and partial agonists, respectively, of the brain’s opioid receptors, but with stimulants the mechanisms involved are more varied and complex. Adderall is an indirect agonist of dopamine, as well as serotonin and norepinephrine, meaning it doesn’t bind directly to those receptors but does affect them. Meth is an indirect agonist too.

Adderall is FDA-approved at up to 40 mg/day for ADHD, and up to 60 mg/day for narcolepsy. I have neither as far as I know, but FDA indications aren’t, like, laws. Diagnoses for approved conditions aren’t the only way to convince insurance companies that something’s medically necessary, and over the years I got prescriptions written mainly for off-label treatment-resistant depression. If your prescriber will prescribe it, your insurance will cover it and a pharmacist will dispense it, then that’s all that matters, at least when not in times of drought such as now. These things line up easily for some people, and don’t for most.

I didn’t figure out I could rotate stimulants until I had access to meth and Adderall at the same time.

For the two years before I switched to meth, Adderall barriers had left me using mainly Vyvanse, another stimulant indirect agonist. Vyvanse works fantastically well for me after something like COVID or being institutionalized has compelled me to detox for a week, but works slightly better than nothing the rest of the time. Though it’s never really fit me, it is FDA-approved for binge-eating disorder and as such has been much more accessible.

There were times in that period when I had Adderall, too, but I didn’t really figure out the potential in having multiple stimulants until I had consistent access to meth at the same time as one or both of the prescription drugs.

Up until that point I’d kind of assumed that if your tolerance is high for one stimulant, then that applies to stimulants across the board. This isn’t entirely true. With access to multiple stimulants, you can rotate them, keeping your tolerance to one from climbing too high by shifting to the other for a bit. This has been the only genuinely useful stimulant harm reduction measure I’ve found to date (boofing of course, but that’s not stimulant-specific), and it’s extraordinarily inaccessible to just about everyone, whether or not there’s a shortage.

Multiple times, when I’ve painted myself into a corner with meth, I got myself out of it by switching to just Adderall for as long as I could—two weeks maybe, until I ran out or got into a bad place there, too—while the meth tolerance reset. I spent one winter using meth from morning through mid-afternoon, then swapping in Adderall for the rest of the day.

Finding the right balance was always a moving target that only stayed put for a few days, weeks or months at a time, but rotating stimulants—primarily Adderall and meth—has allowed me to function these past couple of years. Until around December or so, since when I’ve been increasingly overdue for a tolerance break, and—like everyone impacted by the shortage—have been having kind of a bad time.

Even before the shortage, rotating stimulants was something I could tell people about but not bridge them to.

The Adderall shortage, which is also shortage of Vyvanse and Ritalin, and likely all common ADHD meds by now, was first attributed to manufacturing delays at Teva Pharmaceuticals. Then to prescription demand increasing substantially during the pandemic, and the Drug Enforcement Administration’s production quotas for ADHD meds staying the same. Then to new pharmacy caps on all controlled substances resulting from a 2021 national opioid settlement.

Meth use has been climbing steeply the past couple of years, too. The shortage will contribute to that one way or another. For many people meth is cheaper, more accessible and less demeaning to acquire; it’s also often what’s in counterfeit pressed Adderall tablets.

After a decade of using stimulants, my list of stimulant harm reduction tips still pretty much starts and ends with the concept of rotating them, which even before the shortage was something I could tell people about but not really bridge them to. For many people who use meth, the barriers to prescription stimulants are a lot higher than the ones that were in the way of me being able to use Adderall effectively, which are now somehow in the way of being able to use meth effectively, too.

Feature art by Brooke Alexandria Paine

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The most common complaint I hear is that someone tried it and it didn’t work. But over time, the more people I talked to both in person and online, a few other patterns have emerged: that boofing was too much of a hassle; that it took too long; that it hurt.

This gives me anxiety. All those descriptions are valid in the sense that they’re all relative, but not relative to injecting or smoking. Boofing should be faster and simpler than injecting or smoking, about on par with sniffing and second only to swallowing. It should not hurt at all.

People who are introduced to boofing in a social way, like chemsex or conversations with friends, aren’t usually the ones reporting these problems. The reason I never experienced them is that in early 2021, prior to which I was mostly smoking (mostly meth), comrade Sessi Kuwabara Blanchard gave me a little boofing care package and we had a nice talk about it, and since that day I have never looked back.

The disconnect seems to happen more when people are introduced to boofing through their local syringe service program (SSP). A lot of SSP do distribute boofing kits, but there’s not always much overlap between the people who make them and the people who use them. With that in mind, the following are suggestions for making better kits—using only the supplies SSP already have—as well as talking about boofing’s utility as a harm reduction tool.

Syringes

The best thing to boof with is a syringe that doesn’t have a needle. SSP boofing kits I’ve come across use the 25g blue tip syringes, the Luer lock kind with the needles you can twist on and off. The 25g is the size that straddles the range of larger needles suitable for injecting hormones into muscle or tissue, and smaller needles preferred for injecting drugs into veins. But, in my experience at least, they’re very rarely used for the latter and therefore SSP don’t tend to run out.

The shape of a Luer lock tip is not an intuitive or efficient or comfortable thing to put in your butt.

Respectfully, the blue tips do not make good boofing syringes. Just because a syringe is designed for the needle to come off does not make it good for boofing. Blue tips are just the default SSP boofing syringes because they’re the only Luer lock ones many programs distribute.

The shape of a Luer lock tip is not an intuitive or efficient or comfortable thing to put in your butt, and the 3ml barrel attached to the 25g is three to six times bigger than what most people are used to. This combination makes it difficult to get the full dose where it needs to go. Particularly for people using opioids, this can mean a bad enough experience that they don’t bother to try again. (Anything you can dissolve in water or is already liquid you can boof, although I would not recommend doing it with things like GHB or liquor. It will hurt.)

This could be regional or otherwise skewed by personal experience, but I’ve never been to a well-resourced SSP that didn’t also have stacks of BD 28g and 29g syringes sitting around. These are very cool for the few people who get the hang of the BD needles and despised by everyone else, and lots of SSP just sort of have them around for times of drought. 

The needles on the BD .5cc syringes aren’t interchangeable like Luer locks, but they are detachable, kind of. Once you prise off the plastic cover that holds the needle, what you’re left with underneath is a much better shape for boofing than a Luer lock.

Left: BD 28g .5cc syringe with plastic cover removed. Right: BD 3ml Luer lock syringe with detachable 25g needle removed.

Bend off the needle (dispose safely) and then put the orange cap back on. Bend the tip back and forth, slowly, working your way around so you’re bending evenly on all sides, until the dome-shaped part separates from the syringe. Sometimes the plastic is brittle enough that the whole tip of the syringe will snap off; this is still usable if you don’t have any spares. If you have a small-ish pair of pliers, you can skip all that and just pull everything off in one go.

These .5cc syringes also let you eliminate dead space in the tip. Pull the plunger back two or three units before you draw up, and you’ll just have airspace stuck in the tip once you’re done; not drugs. This doesn’t really work with the 3mL barrels—they’re too big to hold pressure in the same way, so the air bubble tends to slide around, and the tips already have about twice the dead space as the .5cc syringes anyway.

Without exception, boofing had not worked for them because they thought the syringe is supposed to go, like, fully up your butt.

You can pull the needles off the BD 28g 1cc, or any other syringe made by any other brand, and still use it to boof. But the tips on other common SSP orders have those pokey ridges, and a boofing kit with a syringe that is a friendly shape has the best odds of actually being used. But the ridged kind are still viable if you need them to be—boofing is much gentler process than many people assume.

Whenever someone tells me they tried boofing and didn’t get anything out of it, it’s an easy fix. Without exception, 100 percent of the time, boofing had not worked for them because they thought the syringe is supposed to go, like, fully up your butt.

It’s supposed to go about half an inch up your butt. You’re aiming for the tissue just inside the rim, which will absorb things into your bloodstream. Any deeper and you’re just kind of shooting the drugs into space.

Insert just the tip of the syringe, then depress the plunger very slightly—do you feel the coldness (or lukewarmness) of the water, the way you would if it was on your skin?

If you feel the water, you’re in the right place; proceed with the rest. Try a test shot with just water if you don’t want to risk wasting anything. This is best, and also only, technical skill there is to learn about boofing.

Modifications

Start to finish, boofing takes maybe two minutes once you get the hang of it. But most of that is waiting for your drugs to dissolve. For situations where you don’t have the luxury of much time or privacy, you can cut the process down to about 10 seconds by pre-loading a syringe and being mindful of how you carry it so the plunger stays in position. (With the BD syringes especially, make sure the plunger isn’t pulled back past the cc lines or it becomes annoyingly prone to falling out.)

You can make a cap by taking the rubber seal off the plunger of any 1cc syringe. It’ll fit over any .5cc or 1cc syringe, including the blue tips. It’ll also fit over an opened Addipak sterile water vial so you can get multiple uses out of them rather than one, which only took me several hundred vials drying out at the bottom of my backpack to realize. If you’re using stimulants, or opioids that you don’t need to heat, you can just use the plastic plunger cap as a cooker and pretty much have an all-in-one product.

Myths and Stigma

Even in harm reduction circles, talking about boofing elicits a subtle but unmistakable suspicion wherein people really want to find something wrong with it, in a way I have never experienced when talking about other injection alternatives. Not just from medical professionals, but from drug users too. People will chime in that they’re not so sure, that they’ve heard something about how in the long-term it rots your colon, or something like that.

Some people I’ve had the boofing conversation with had previously had been told that for it to work properly, they needed to lie down and leave the plunger in for at least 20 minutes. One had been told an hour. Some had been told that if they boofed more than a few times, or more than a certain number of times within a certain number of days, they would get tears in their anal tissue. 

Boofing in a chemsex setting, or otherwise just boofing and having unprotected anal sex, can cause tearing that can subsequently put you at increased risk for HIV transmission. But some people had simply been told boofing increased their HIV risk, but not given any context as to why, or at least not in a way that they remembered.

If the whole thing was less noticeably homophobic I’d have my doubts too, because boofing really does feel like cheating. Drug consumption methods tend to have risks and benefits that are proportional to one another: Intravenous injection has 100 percent bioavailability, and is also the highest-barrier to do safely. On the other end of that spectrum is oral consumption. Smoking and sniffing fall somewhere in the middle.

Boofing is the most potent way to use drugs other than injecting them, and it’s faster and easier and safer and more portable and discreet than everything except taking a pill. The only real inconvenience is that if you have not pooped recently, boofing (especially stimulants) works like a suppository, so it’s not a great idea without an accessible bathroom. But you can do it sitting or standing or however you want, and you don’t have to leave the plunger in or do anything else after you’re done.

I boof anywhere from maybe three to eight times a day. So in total—best guess—somewhere between 2,000 and 3,000 times, pretty much consecutively. I wouldn’t be surprised if long-term boofing does involve complications that will reveal themselves to me at some point, but that’s even more true of injecting or smoking or sniffing. The only way to not find out is to stop using drugs, which like many drug users I have no plans to do.

Boofing is a pretty workmanlike route of administration. You’ll never miss. You don’t need steady hands. You’ll always get it on the first try.

Boofing is a pretty workmanlike route of administration. There’s no artistry or intuition or expertise to acquire. You’ll never miss. You don’t need steady hands. You’ll always get it on the first try. It will always take the same amount of time.

We don’t really do people any favors by framing boofing as a replacement for injecting. Regardless of whether boofing provides sufficient effect, that approach devalues the attachment many people have to the physical ritual of injecting. It’s more useful to frame boofing as an option—especially for situations where injecting is risky or isn’t working.

Because we associate syringes with needles, it’s understandable to fall into the familiar talking points we use for injecting—sterile water, sterile syringes, new syringe every time, filter out particulates. It’s not wrong to approach boofing this way, but it’s not necessary for the process to be safe and effective.

While it’s not advisable to share boofing syringes, you surely can reuse them. It’s actually better harm reduction to suggest that people do hang onto them, to be sanitized and stored in whatever way makes them feel not icky. Folks aren’t exactly picking up a whole box at a time.

If someone has access to sterile water and wants to use it, they should of course do so. But we need to frame this as a matter of personal preference rather than a form of harm reduction, because it serves no one to take a perfectly good form of harm reduction and make it seem more complicated than it actually is.

When someone doesn’t have sterile water to inject with, they’ll do it with blood or urine or the rain water we’re not even supposed to drink anymore. Those are harmful because they’re going in your veins, which makes any situation when someone doesn’t have sterile water a very good time to boof. The water doesn’t have to be sterile. It doesn’t even have to be water. You don’t have to filter out impurities. It’s going in your butt.

Photographs courtesy of Kastalia Medrano

The post A Harm Reduction Guide to Better Booty-Bumping Kits appeared first on Filter.

This conversation has provided a shred of hope to Ottawa’s harm reduction community, But with limited supervised consumption capacity and a constantly evolving drug supply, the clock is rapidly ticking on the how and the when.

“Even [since] we opened three years ago, the drug supply changed and the demand for services increased,” Rob Boyd, director of the Oasis Program at the Sandy Hill Community Health Centre in Ottawa, told Filter. “This really outpaced the level of services that we have available in the city.”

“We have seen a shift from crack cocaine to crystal methamphetamine—we have predominantly been a crack cocaine city for decades.”

Boyd has long been following trends of drug consumption in Ottawa, as he oversees the operation of one of its four sanctioned supervised consumption sites (SCS). The unforeseen shifts in drug use that he has witnessed make harm reduction provision more difficult and add urgency to the decriminalization question.

“We’ve had benzodiazepines appear in the drug market,” he explained. “Sites are generally not set up to monitor people who are sleeping off a benzo overdose. Additionally, we have also seen a shift from crack cocaine to crystal methamphetamine—which is new to Ottawa, we have predominantly been a crack cocaine city for decades, even prior to the opioid problem.”

Amid these trends, Ottawa’s SCS have been scrambling to seek ways to reduce harms for people who use drugs in the city. But compared to a raft of options around opioids—including naloxone, referrals to opioid agonist therapy and hydromorphone offered under a safe supply program—they have relatively few resources around meth, say, save for providing safer-use supplies like pipes and foil.

Complicating matters, much drug use involves combinations of substances, rather than people using just one or the other. “When we were consulting and thinking about our service and checking in with sites about what we can do, in the back of our minds it was all about injection, opioids and overdosing,” Boyd said. “We were certainly anticipating a lot of stimulant use, but what we didn’t anticipate was people combining their injecting of a ‘down’ with the smoking of a stimulant.”

Boyd cited instances where large portions of SCS participants have moved directly from an injection tent to a stimulant consumption tent in an effort to balance out the effects of both substances. This phenomenon is boosted by the adulteration of opioid supplies, as in many other parts of North America, with fentanyl and its analogues, he added. The effects of a more potent opioid supply on Ottawans have resulted in a corresponding higher demand for stimulants.

It’s in this context that conversations around harm reduction solutions and general decriminalization have accelerated. Ottawa Public Health’s recent strategy illustrates this, and it was formed after the city communicated with several harm reduction organizations. The Community Addictions Peer Support Association (CAPSA) is one of those organizations.

“In the beginning, we reached out to Ottawa Public Health,” Gord Garner, CAPSA’s president of strategic partnerships, told Filter. “We believe that we have loving wisdom that can help educate, make a change and increase people’s health around substance use. One of the ways to end stigma is taking that knowledge in a measured way and bringing it to health service providers and organizations.”

Garner has a personal stake in the fight for education and solutions, as his own past experience with substance use led him to take on a prominent advocacy role.

“We’ve been very fortunate to be a part of this,” he said. “There have been a couple of action plan meetings that have rolled out, and we’ve had a chance to train our public health nurses on stigma and person-first language. These are pretty critical things because we’re coming in as people with lived experience and educating health service providers.”

“It’s when the oppressors change their minds.”

CAPSA operates with a heavy emphasis on ending the stigmatization of people who use drugs—and the link with decriminalization is clear when persecution and criminalization both result from stigma and increase it, making everyone less safe.

If any governing body wants to address the problem, Garner emphasized, it needs to be all-in. “This is the approach we’re taking with substance use health and discrimination, it’s when the oppressors change their minds, and how to do that is you find people in the oppressing community—who are non-malicious but ignorant of some issues—and change their minds.”

A primary example of this is a recent unofficial shift from the Ottawa Police Service, where according to harm reductionists, officers are opting to avoid arrests for simple drug possession within the municipality.

“They’ve spoken to the fact that they’re not actually charging people with simple possession, they have no interest in doing that at this point,” Boyd said. “They’re not interested particularly in the types of folks who would use harm reduction services [nor do they] want to proceed with simple drug charges, that doesn’t solve the problem of crime or poverty.”

With a number of initiatives working towards decriminalization in all but name, the question still remains: What about decriminalization proper?

Wendy Muckle is the CEO of Ottawa Inner City Health, a harm reduction program that operates in the city’s downtown core and provides services such as a safe supply program. She has been observing the moving pieces of government institutions and harm reductionists in Ottawa.

“I feel like the conversation around decriminalization needs to be separated from what the drug supply is,” she told Filter. “The decriminalization/regulation conversation needs to happen, irrespective of anything that’s happening within the drug supply.”

Muckle is fairly certain that the writing is on the wall.

Muckle additionally pointed to the COVID-19 pandemic’s role in disrupting supply, saying it has added to the shift to methamphetamine use. She has noticed the substance being used both as a substitute for opioids and as a self-administered tool used in the opioid detox process, she said.

As for what the municipal government of Ottawa can do in the face of this crisis, Muckle believes the city’s ability is not as far-reaching as some organizations may hope. “I think at the municipal level there are lots of discussions to be had but they have very limited powers.”

Where all this is likely heading is to Ottawa following other municipalities in eastern Canada, by applying for an exclusion from the federal Controlled Drugs and Substances Act.

Muckle is fairly certain that the writing is on the wall. “[The strategy motion] passed unanimously at the Board of Health in Ottawa, with the recommendation to write to the federal government,” she said. “I think most of the city councillors who are part of the Board of Health participated in the Getting to Tomorrow dialogue, and a lot of them were profoundly impacted by what they heard.”

Decriminalization in Canada’s national capital would have symbolic as well as practical significance. But like many other harm reductionists, Muckle believes that decriminalization without regulation and increased provision of resources would be a very limited positive step.

“I think like anything else, the devil is in the details, so decriminalization on its own is pretty meaningless. It’s what’s behind it that actually helps people’s lives, that’s where that attention needs to go.”

Photograph of Ottawa’s Alexandria Bridge by Intiaz Rahim via Flickr/Creative Commons 2.0

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