Kat Humphries, Author at Filter

Three Harm Reduction Zines From People Who Use Drugs in Denver

Kat Humphries — Wed, 07 Apr 2021 15:04:09 +0000

The Harm Reduction Action Center made these three harm reduction zines in collaboration with people who inject drugs in Denver, Colorado. We all agree that there isn’t enough honest drug education accessible to those who need it, so we pooled our collective knowledge around the topics most sought after by those in our community.

We made them in “zine” (mini magazine) format so they could be passed out to street-based substance users who may not have internet access, but who could carry a small booklet that they may find helpful.

While I initially authored these zines, they were reviewed by countless people who use drugs. All the artwork was contributed by talented Denver-based artists who use drugs. Here are some excerpts, as well as links to the complete zines.

Methamphetazine

You can access a full digital copy of Methamphetazine in English here and in Spanish here.

Benzodiazezine

You can access a full digital copy of Benzodiazezine in English here and in Spanish here.

Wound Care Zine

You can access a full digital copy of the Wound Care zine in English here and in Spanish here.

If you’d like printable PDFs of any of the full zines to distribute at your local syringe service program—or just to any friends and neighbors who could use them—email kat.harm.reduction@gmail.com.

All images courtesy of Kat Humphries. Each zine was translated from English to Spanish by Luna Suescun-Garcia and Mariela Hernandez.

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Wound Care and Stigma: Healthcare Must Do Better for People Who Inject

Kat Humphries — Thu, 14 Mar 2019 11:53:36 +0000

There is a common misconception that people who inject drugs (PWID) don’t care about their health. However, their widespread participation in syringe access (needle exchange) and other available health services suggests otherwise. Stigma, complex involvement in shared experiences around substance use disorder, and moral investment in a patient’s substance use nevertheless frequently act as barriers to PWID accessing healthcare.

When someone breaks their skin multiple times a day or week to inject drugs, they face unique risk for contracting blood-borne pathogens and developing soft tissue and bacterial infections, meaning they frequently need more medical attention than their non-injecting counterparts.

Most commonly, people injecting will face abscesses (pus pockets) formed by the body to fight off skin tissue infections. Abscesses can run from moderate to severe, and at times require medical attention for proper lancing and draining. When not treated properly, abscesses can result in serious, ongoing health complications. There’s a financial cost of inadequate initial care, too. Denver, where I live, currently spends roughly $7,000 per day treating skin infections of this kind.

People who inject also face a range of other potential infectious foes. From cellulitis to endocarditis, bacteria in your bloodstream is serious business.

With that in mind, the tenuous relationship between healthcare providers and PWID is harming people at alarming rates—through factors such as lack of access to MAT and lack of care for blood-borne diseases, as well as injection-related infections.

When people feel their access may be threatened, they tend to avoid self-disclosure and attempt to self-care wounds that require professional care.

Beyond typical barriers such as ability to make a copay, transportation, enrollment in health insurance, health literacy and communication skills, as well as provider bias, marginalized people who inject drugs face specific challenges to having their health needs met in a sustainable way.

When people feel their access to insurance may be threatened by disclosing their behaviors around substance use, they tend to avoid self-disclosure and attempt to self-care wounds that require professional care. Regular participation in syringe access programs where people who inject drugs are given access to sterile supplies returns autonomy to people using drugs and allows them to stay free of preventable illnesses.

We know that drug use functions as a coping mechanism for many who experience trauma or simply cannot access traditional healthcare channels for one reason or another. But that’s where healthcare providers come in—they have the power to make all the difference.

Many PWID are jaded from a stigmatizing and judgmental healthcare system. Providers frequently display biases due to perceived socioeconomic status, race, gender, and a myriad of other intersecting identities that leave many vulnerable to substandard care or no care at all.

When you’re homeless and injecting drugs, the issue of getting adequate healthcare can quite simply be a fight to stay alive. You’re also a lot more likely to be branded as “drug-seeking” and to not have your pain taken seriously; having such marks on your record can permanently impair your prospects of access.

There are also countless horror stories of people who inject being searched and arrested out of hospitals on outstanding warrants, despite HIPAA protections, or having naloxone and other vital supplies confiscated. With risks like these, it’s easy to understand why going to the doctor is often the last thing someone experiencing homelessness who injects drugs would risk.

Conversely, accessing that care—being treated with respect and dignity, and having genuine human contact—can start a ripple in someone’s life that improves countless outcomes.

When people who inject drugs cannot access healthcare in a reliable way, they do not simply cease to need health care. They instead suffer worse health outcomes, and die.

Based on statistics from Colorado’s largest syringe access program, where I serve as the programs director and data evaluator, we know that accessing sterile syringes leads to PWID accessing other health-related referral services such as HIV and hepatitis C testing, access to naloxone to reverse opioid overdoses, access to Medicaid, access to mental health and substance use referrals, and health education classes.

In fact, of the 121,973 times a participant has come up to our syringe access table and gotten sterile syringes, they have asked for other referrals of this kind 55,807 times. None of that is possible without building rapport and caring for people regardless of the situation they find themselves in.

When people who inject drugs cannot access healthcare in a reliable way, they do not simply cease to need health care. They instead suffer worse health outcomes, and die. When people are labeled as drug-seeking, and are dependent on opioids and not given adequate opioids to maintain wellness, they will leave against medical advice to seek relief. This is the unfortunate reality for anyone who has experienced the effects of drug withdrawal in any compelling capacity.

No one is asking healthcare providers to get people high. However, if your patient is opioid-dependent, it is necessary to meet that need in order to treat any other health ailment and keep them well long enough to heal and improve.

When providers get emotionally invested in the cessation of a person’s substance use, it sets both parties up for failure. Many healthcare providers are in dire need of the principles of harm reduction, to meet people where they are, and to help them take any positive step to improve their long-term outcomes.

Forcing someone to cease use to treat them is not in their best interest, and for many can result in life-threatening side effects that they are not prepared to handle without medical supervision. For many, drug use has been a lifelong coping mechanism, one that cannot be abruptly replaced without support and understanding. Without access to housing and food security, forced sobriety is a tall demand.

Barriers to healthcare weren’t drawn from thin air.

For any healthcare provider reading this and feeling attacked, please do not. People who inject can be difficult patients—sometimes the most difficult. They may assume you do not know their struggles and will not respect them before you enter the room. They may have spit on you or run from your advice and care. Perhaps someone you love has experienced problematic or chaotic substance use, and you want to be more understanding but haven’t been able to connect with a patient because of the barriers they put up themselves.

These are real problems for many healthcare providers who got started because they care about marginalized people’s health outcomes. They may feel jaded and at a loss to help because they have seen so many die from substance use. They may feel they can’t make a difference.

But a key point is that barriers to healthcare weren’t drawn from thin air. People’s experiences dictate their attitudes towards future experiences, and any difficulty you may encounter with someone who injects drugs is likely the result of countless negative medical interactions in the past. Countless times they’ve tried their hardest and been treated as subhuman.

As a healthcare provider who cares, the only hope is you. You can treat someone with respect and dignity regardless of their situation, and you can be the person who changes their attitude toward engaging with the system. Just as it may only take one negative interaction to irreparably change how someone chooses to (or not to) engage with health care, one positive interaction can be a catalyst for lifelong change.

Building rapport and respecting your patient, even if you disagree with their choices for their own health, can build a bridge to an open and honest relationship with someone they can trust and someone they will undoubtedly return to when they need help. This means showing humanity, treating people’s wounds and infections, offering other services non-coercively, and not putting them under pressure to immediately abandon their coping mechanism.

Without these positive relationships, people who inject drugs have been left to fend for themselves to determine the level of severity for wounds and abscesses.

Homeless service providers like myself have worked with local communities to provide basic wound care information for people who refuse medical assessment This, however, is nowhere near optimal for street-based injectors. If you truly want to improve the health outcomes of the most marginalized in our communities, pausing to listen, building rapport, and taking their needs seriously is the first step.

Photo via Pixabay

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We Need to Talk About Benzodiazepines—Including Their Use in Drug Combinations

Kat Humphries — Tue, 04 Dec 2018 13:54:16 +0000

Opioids like heroin and fentanyl have grabbed the media and legislative spotlight—from soaring overdose fatalities to the misguided prescription restrictions and drug-induced homicide laws ostensibly intended to combat them. What’s glossed over is that our overdose crisis primarily relates to polysubstance use. Around 80 percent of deaths involving a synthetic opioid in 2016, for example, also involved another drug. When we only focus on partial data, we only come up with partially effective solutions. With our cultural narrative failing to acknowledge this, people who use drugs need to make the effort to learn more to keep ourselves safer.

Most forms of polysubstance use carry potential negative effects and risks. Mixing uppers and downers—whether using one drug to come off of another, or intentionally creating a “speedball” effect —presents a unique set of challenges to your body. It can be deadly.

Super-potent fentanyl showing up in illicit drug supplies in many places across the United States and being taken unwittingly by consumers of heroin, meth and cocaine is obviously a big factor. But other areas, such as Denver, where I work in a syringe exchange, are seeing heightened overdose rates without significant presence of fentanyl in their supply. Mixing other drugs with plain old opioids is commonly the culprit.

Many people have started to shift the narrative to include stimulant-involved overdoses (or “overamping”). Fewer emphasize the role of benzodiazepines—typically when mixed with opioids or other depressants like alcohol. Part of the reason is that benzos are commonly prescribed and therefore wrongly assumed not to involve risks. Yet over 30 percent of opioid-related overdoses also include benzodiazepines. One study published this year showed that using benzos with opioids increases overdose risk five-fold compared with using opioids only.

An Intro to Benzos

Benzodiazepines are often prescribed to combat acute anxiety and panic as well as longer-term anxiety disorders. They include well known brands such as Xanax, Valium, Klonopin and many more. Benzos were first synthesized in the 1950s and introduced to the US medical market in the ‘60s. They quickly became popular as replacements to barbiturates (which were associated with the deaths of Marilyn Monroe, Elvis, Jimi Hendrix, John Belushi and many other stars). By 1999, 8.1 million prescriptions for benzos were written annually in the US; by 2013, that number had increased to 13.5 million.

It’s important to note that benzos on their own can absolutely be used safely. Even when taking over the prescribed or recommended limits, people who use benzos are most frequently at risk of blacking out, poor judgement and sleep—as opposed to the respiratory depression associated with potent opioids.

However, this risk assessment changes drastically when multiple substances are used at once—or even with overlapping effectiveness intervals. Many people do not account for taking their anxiety medication in the afternoon with an evening of binge drinking on the horizon, for example. Consuming strategically can be a lifesaver.

As with any drug, general harm reduction guidance for benzos includes:

*avoiding high-risk combinations—above all, mixing benzos with alcohol, GHB or opioids

*avoiding situations that present heightened danger (e.g, driving while on high doses)

*setting personal boundaries to avoid excessive or compulsive redosing

Reducing the Risks of Pressed Pills

Many doctors have become increasingly hesitant to prescribe benzodiazepines over the last decade. And like many formal or informal restrictions, this has unintended consequences: People pursuing the anxiety-suppressing, sedative and disinhibiting effects of benzos may have to turn to the streets to obtain their supply, and illicit production and distribution of similar substances without oversight increases.

We have seen this play out with heroin, for chronic pain patients refused opioids, and we’re watching it unfold with benzos. Unregulated benzos, like other “street” drugs, can contain fentanyl and many other dangerous substances. Having naloxone on hand and knowing how to use it is always a good idea, even if you’re not intending to use opioids.

Demonizing “pressed” pills won’t help, however. People seek street benzos as a response to lack of access to needed medication. But without fueling media panics around “fake” Xanax and other pressed pills, we need to look calmly at practical ways to reduce risk for people who use them. Not all pressed pills are created equal—quite the opposite—and understanding what you’re ingesting is paramount.

When obtaining benzos at street level—including at a friend’s house—it’s always good to know the source. If you don’t know for certain that a doctor has prescribed the pills you intend to ingest, here is a non-exhaustive list of ways to identify a pressed pill:

*Imperfect markings

*An asymmetrical shape

*Inconsistent thickness

*No waxy covering

*It has a chalky consistency, and dissolves or disintegrates when held

*It lacks a bitter taste when consumed

These checks are imperfect, however. Some pressed pills may seem pharmaceutically produced in every way.

Some pills are manufactured to contain fentanyl or fentanyl analogues and are sold as such. Others are manufactured in facilities where fentanyl is present, and cross-contamination occurs due to lack of oversight and proper hygienic practices. Regardless of intent, if you spot a pressed pill or don’t know the origin of any pill you intend to ingest, checking a chunk of it—using resources such as those offered by Dancesafe—is a potentially lifesaving strategy.

It’s also important to note that if a pressed pill does contain the correct substance, the dosing may still not be homogenous (evenly distributed across the pill), and it may contain more or less of the substance than anticipated. So if you’re splitting a bar of “Xanax” that hasn’t been produced with homogeneity testing, there is a high likelihood of unknown dosing. Starting by ingesting a smaller amount than you think you want is an obvious harm reduction step.

Combinations, Dependence and Withdrawal

If you’ve decided that you want to use benzodiazepines in combination with any other drug, another important harm reduction tactic is taking the other drug first if possible (granted, this is complicated when many people need benzos to function through debilitating panic, anxiety and trauma-related disorders).

This is because benzos lower inhibitions (the same applies to alcohol). Once under their influence, it can be easy to decide to take more of another drug than you intended, heightening the risks of the combination. If you intend to mix opioids and benzos despite the risk, do your heroin or other opioid first. Then see if the benzos are necessary. Taking the opposite approach frequently results in death.

Many people also experience dependence to benzos. Ways to increase your chances of a non-problematic relationship with them include: understanding that all drug use exists on a spectrum; drawing amount- or time-related boundaries around your use when possible; and considering using different drugs on different occasions, rather than constantly using benzos.

Finally, it’s also vital to know that cessation of benzodiazepine use at high dosing can quickly turn deadly. Understanding a tapering regimen, in which someone slowly reduces the amount of drugs they’re taking to avoid drug-induced seizures, is important. Seeking proper medical advice, when possible, is always advisable.

Keeping Sight of the Bigger Picture

Beyond this elementary introduction to benzodiazepines, we also need to address the larger issues at hand: an uninformed populace in an unequal society, vying desperately to numb daily or past trauma and anxiety with no access to honest drug education, is a recipe for an endless overdose crisis.

People scared of losing health insurance and support are incentivized not to be honest to health professionals about their consumption of non-prescribed drugs, and therefore less likely to be given the information they need to keep themselves safer.

We must reduce the stigma attached to consuming drugs in prescribed and non-prescribed contexts, and treat people with problematic drug relationships with compassion, arming them with knowledge and resources to protect themselves. The alternative is to continue to lose those we love to preventable drug-related deaths.

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This article has been amended to reflect the fact that over 30 percent of opioid-related overdoses also include benzodiazepines. An earlier version initially stated that the 30 percent figure applied to opioid-related deaths.

Image via: Medicine for the People

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