A couple of years later, their veins were in bad shape so they tried smoking their heroin from a dab rig. But they didn’t know that adding the whole bag would be too much for that type of pipe. It bubbled up and coated the whole nail, clogging the rig so much they just threw it away.

“There weren’t any instructions on how to do it,” Anna recalled of these attempts to smoke their drugs. “Dab rigs can totally be used for black tar, but without anyone explaining … so instead, I just ended up [injecting] a lot of speedballs at that time in my life.” 

Smoking drugs—technically vaping, wherein drugs are heated to produce inhalable vapor rather than the combustion process of cigarettes—generally involves fewer risks than injecting them. Yet harm reduction programs provide much less access to pipes than to syringes.

There are a few reasons for this. Sterile syringe access is more critical for reducing transmission of HIV and hepatitis C, which is why drug users mobilized around them during the HIV/AIDS crisis.

During the overdose crisis—which policymakers portray as an “opioid epidemic”—syringes have also been prioritized because they’re more associated with opioids. This is despite the fact that many people inject stimulants, or smoke opioids, and are increasingly likely to overdose after combining stimulants with fentanyl, whether intentionally or not.

“Drug use patterns are shifting. It’s all polysubstance use now.”

“It’s typically cross-contamination. But when it does happen, it leaves people more vulnerable to an overdose,” Ryan McNeil, director of harm reduction research at the Yale Program in Addiction Medicine, told Filter. “You can’t respond to this crisis unless you immediately identify that … drug use patterns are shifting. It’s all polysubstance use now.”

Another reason for the disparity in supply access is that syringes cost pennies; glass pipes cost more.

In some states, authorized syringe service programs (SSP) can legally distribute drug use supplies that are otherwise criminalized as “paraphernalia.” Yet a long-standing rider on annual Health and Human Services (HHS) spending bills continues to ban federal funding for paraphernalia, despite multiple attempts to remove it.

This means that even the programs authorized to distribute syringes and pipes can’t use federal funds to buy them. Rather than use up any non-federal funding, staff or volunteers sometimes pay for pipes out of pocket even though some programs have rules against that. Donations don’t make for reliable supply.

And then there’s the fact that safer smoking kits are usually for smoking crack, and the “War on Drugs” continues, as it has always done, to associate crack with Black people.

Racism and Funding

Isaac Jackson, president of the San Francisco chapter of the Urban Survivors Union, has been hearing complaints about “drug paraphernalia” in the city since he moved there 30 years ago.

“I think if anything, being a Black man maybe made it more intense,” he recalled of the vitriol he experienced for once injecting meth in public. “You’re definitely a subclass, or untouchable or something.”

In 2014, the local HIV prevention council went before the Department of Public Health (DPS) and presented data on how pipe distribution reduces blood-borne disease transmission. Jackson witnessed the presentation and was impressed. City officials were not, though there were around a dozen local SSP at the time.

“The [council] recommended that it happen. And the mayor said no,” Jackson told Filter. “Which is a completely political decision. It’s nothing to do with health care.”

Jackson began distributing pipes himself, doing outreach in the city’s Tenderloin district with other USU members. It didn’t take long for DPH to request a meeting, apparently unsure whether it wanted to stop him or work with him. A DPH rep said “something to me that really rubbed me the wrong way. She said like ‘Yeah, we could use this as a way to get to the Black community.’ I was like, wait a minute. People who smoke crack are not all Black. I’m sorry, but you know, that’s really a racist stereotype.”

The bill never explicitly named pipes and syringes as eligible for funding, but there was a chance to interpret it that way.

In March 2021, the American Rescue Plan Act allocated $30 million in federal grants for harm reduction services. One-offs like ARPA are not subject to the same restrictions as the annual spending bills, and the legislation stipulated that, among other things, “safer smoking kits/supplies” were eligible. The language of the bill never specified what those kits would comprise—HHS never named pipes or syringes as eligible for federal funding, but there was a chance for some programs to interpret it that way.

In February 2022, right-wing opponents seized on the idea of “crack pipe” funding and leaned heavily on racist tropes to link it to “crime.” The media frenzy prompted HHS to issue a statement explicitly assuring the public that safer smoking supplies did not include pipes.

Glass pipes with a bulb at one end work better for holding meth; straight pipes, or stems, are the ones commonly used for crack. Many programs distribute both, if they have access to them and participants who’d use them, but the bulbs are generally just handed out piecemeal because using them doesn’t require much besides drugs and a lighter. The straight stems involve a few more components, which is why safer smoking kits are associated with crack.

“The pipes, they’re donated right? Well, nobody’s donating them right now. So I lend mine out.”

There is no standardized safer smoking kit. Each program has its own variation, which itself tends to vary as supplies go in and out of stock. A robust kit will include not just the glass stem but also Chore Boy or something similar, rolled into a filter when pushed into one end of a pipe; something like a chopstick to push things back into place; something like a paperclip for scraping out valuable resin; alcohol pads; lip balm; fentanyl test strips; and, most critically, a smoking guard. 

These mouthpieces are usually rubber or plastic, and reduce risk of blood-borne disease transmission—especially hepatitis C, once stems overheat and inevitably crack. Unlike HIV, the virus that causes hep C doesn’t die right away once outside the human body. If someone with hep C cuts their lip on a pipe, the smallest amount of blood left on the glass can transmit the virus to someone who uses the pipe with a cut lip too, even weeks later.

Pipes are reused and shared because even the programs that can afford them never have sufficient quantities. But also because crack produces a very brief high, which makes smoking it an inherently social activity. People will always share stems, and it’s not necessarily unsafe or undesirable as long as they have the right supplies, like separate mouthpieces.

“The pipes, they’re donated right? Well, nobody’s donating them right now. I lend my stem out, because someone won’t have a stem, and then they have to break me off,” New York City resident Veronica* told Filter, referring to getting a free hit.

Usually the amount packed in for one hit is a $10 “dime,” but an experienced smoker can turn one hit into two. “If they spend $50 on hard, I get a free dub [$20 hit] and I keep the resin. But that’s why you want the Pyrex.”

Strong Glass

Thin glass stems, like the Love Rose or the kind designed to look like pens, are somewhat commercially accessible in the US. But they don’t last long, and once they crack there isn’t much to salvage. 

“Back in the day we used to joke about, that’s why they call it crack—because the pipe break after one or two use,” Charles*, a 60-year-old New York City resident, told Filter. “But when we had the strong glass, you could use that—I used to tell people, you can drop it, it bounce right back up.”

These thicker Pyrex stems are more expensive, but preferred by just about everyone. They can last for weeks, and when they eventually do crack the jagged edges are easier to file smooth. Or you can simply fit a mouthpiece over whatever’s left. The Love Roses and other cheaper versions are more likely to be abandoned in favor of smoking out of TV antennas or soda cans or apples, or injecting if that’s easier.

Charles was using Pyrex in the ’80s when freebase came on the scene, before SSP were even authorized. Whenever glass wasn’t available, “we’ll make it out of the little liquor [bottles], the nips. Or, remember the 25-cent juices? Only thing we didn’t have when we started off was the rubber tips.”

Pipes are often the bridge to harm reduction services for people who wouldn’t have accessed them otherwise because they don’t use syringes. Many people like Charles at some point need treatment for hep C even though they don’t use opioids and have never injected anything, even once.

Points of Distribution, an online harm reduction marketplace, pioneered a buyers club model in 2018 to sell harm reduction supplies full-price to groups that can afford it, and on a sliding scale for everyone else. Boston-based Smoke Works built on that to operate a mutual aid model focused on pipes and other smoking kit components.

Smoke Works’ cofounder, Executive Director Jim Duffy, first saw the gap in stimulant harm reduction while working at Boston SSP AHOPE. “We had 150 people come through every day, and you get to build relationships with them,” Duffy told Filter. “But there were another 100 people outside that had no reason to come in because they don’t inject … I don’t think people realize how robust the ancillary services are behind the term ‘needle exchange’ or ‘syringe service program.'”

By 2021, as overdose reached an all-time high, more people were shifting to smoking.

Straight stems are the least expensive shape of Pyrex pipes. They also have the fringe benefit of being the most versatile for people with the know-how to use them creatively. With a sufficiently hot torch, you can blow a bubble into one end of a stem to make a meth bulb in minutes. You can also use them to inhale the vapor from smoking off tin foil, but the foil is the necessary part.

In the Western US, the onset of the pandemic saw black tar heroin overtaken by fentanyl pressed pills, or “blues.” The Harm Reduction Action Center of Denver recently developed a foil smoking kit because injecting is no longer the most common route of administration among participants. By 2021, as overdose reached an all-time high, more people were shifting to smoking.

On the East Coast, where most dope is powder fentanyl, smoking off foil is less common. Veronica, who smokes crack but prefers injecting for dope, wasn’t surprised to hear people were smoking the blues off foil; she’s smoked pharmaceutical pills that way and knows it works. She wouldn’t mind smoking her dope sometimes if she had the option. She hadn’t heard of “hammer” pipes.

Most “paraphernalia” isn’t designed for drug use. Syringes are manufactured for insulin. Rubber mouthpieces are spark plugs. The best resin scrapers are the metal bristles that break off street sweeper trucks. Pyrex pipes are just glass tubing. But the hammer Pyrex pipe was specifically created for people to smoke black tar heroin, and works for powder dope, too.

“I’d try it,” Veronica said after studying images of the hammer for a minute or two. “Yeah. You can’t smoke [powder] off foil, it’s like throwing money away.”

A few harm reduction programs have trialed hammer pipes, but they’re expensive and hard to find. Points of Distribution sells them, but Smoke Works is currently out of stock. In August, $5,000 of hammer pipe inventory was lost to a Customs and Border Patrol seizure; Duffy and his colleagues so far haven’t been able to recover it.

Many people are in the same situation Anna was a decade ago: shooting drugs they’d rather smoke.

“We’ve run into problems in every direction. At one point we had an issue with a payment processor shutting us down,” Duffy said. Inordinate amounts of paperwork are a given. “It’s kind of part of the fight.”

Without access to affordable Pyrex pipes—for crack, meth and heroin—along with meaningful education around injection alternatives, many people are in the same situation Anna was a decade ago: shooting drugs they’d rather smoke.

“Either I’m going to quit cold turkey or I’m going to kill myself,” they recalled thinking at the time. “Those are my two options. I feel like, had smoking been an actual route of administration that I could have pursued, I could have avoided both of those situations. Which were pretty detrimental in the long term.”

*Names have been changed to protect privacy at sources’ request.

Kastalia Medrano contributed reporting to this piece.

Photographs courtesy of Kastalia Medrano

R Street Institute supported the production of this article through a restricted grant to The Influence Foundation, which operates Filter. Filter‘s Editorial Independence Policy applies.

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Psychedelic drugs are closer than ever to becoming mainstream, FDA-approved medications. MDMA, also known as Molly or ecstasy, shows remarkable efficacy for treating severe post-traumatic stress disorder. Most recently, the results of a phase 3 clinical trial published in Nature found that 67 percent of participants who took MDMA no longer met the diagnostic criteria for PTSD, which is a big deal for this hard-to-treat condition. Meanwhile, psilocybin, the drug in “magic” mushrooms, has been shown to be as effective as a common antidepressant, according to new research in The New England Journal of Medicine.

Both drugs have been deemed “breakthrough therapies” by the Food and Drug Administration and appear poised for approval, if no sooner than 2023.

Many scientists are now engaged in searching for other ways in which psychedelics may help people. And among them, a growing number of researchers are turning their attention to relieving symptoms of autism spectrum disorder (ASD).

“After the study … All these things that really required a lot of social interaction, they were completely fine.”

This month, Nova Mentis Life Science Corp announced the launch of an observational study on the microbiome and genetics of patients with ASD and Fragile X syndrome. Part of the research is focused on serotonin signaling, the chemical in the brain most associated with psychedelic effects. That’s because the Vancouver-based psychedelics company plans to test psilocybin to illuminate “the neural underpinnings” of social anxiety relating to ASD, the company said in a press release.

MAPS, the Multidisciplinary Association for Psychedelic Studies, has been especially interested in this question, and has explored using MDMA to treat social anxiety in autistic adults. So far, the nonprofit has been the only organization to complete such a clinical trial in the 21st century. It was a small trial with just 12 participants (four receiving placebo) but it “demonstrated rapid and durable improvement in social anxiety symptoms,” according to results published in Psychopharmacology in 2018.

“The results had a large effect size, which means that it’s a strong signal that we might be able to alleviate the social anxiety symptoms that they were suffering from,” Berra Yazar-Klosinski, one of the study authors, told Filter. “We had a six-month follow up and many of the participants had completely transformed lives after the study. These were folks that never left their parents’ home. And after the study, they moved out, and they started school, and they joined a soccer team. All these things that really required a lot of social interaction, they were completely fine.”

For Yazar-Klosinski, the interest in studying this was personal. Her brother is autistic, and she wondered if such a treatment could someday help him with his social challenges. “He’s in his 40s, and he still lives at home with my parents. And so I was always really motivated to try to find a way to help him.”

It could be a while before another study with a larger sample size is conducted and MDMA for autism symptoms is granted FDA-approval. Although the University of Chicago is currently recruiting for such a study, it’s the only active autism-and-psychedelics trial currently registered through the National Institutes of Health.

“I found that it was really helpful in making me feel connected to people.”

Regardless, a small, growing group of people with ASD aren’t waiting for the science to catch up. They’re trying these drugs now—and creating social networks based around these promising therapeutics—sometimes with life-changing results.

For author and journalist Maia Szalavitz, who identifies as autistic, psychedelics like LSD and mushrooms are what helped her connect to her peers at a time when she attended “about 100” Grateful Dead shows in her youth.

“I really was just socially clueless and couldn’t figure out how to fit in with people until I discovered drugs,” she told Filter. “I found that it was really helpful in making me feel connected to people, and in having me understand that being overwhelmed and intense is not that horrible.”

Autism and a Checkered Research History

According to Johns Hopkins Bloomberg School of Public Health, the prevalence of ASD has nearly tripled since 2000, from 0.67 percent of 8-year-olds to 1.85 percent. Some experts believe this is due to better reporting and screening standards; in other words, that we’re finding more instances of autism because we’re looking harder and better.

Autism remains an often misunderstood and stigmatized condition, and its definition is not always easy to pin down. Its traits exist along a spectrum, and it manifests differently in different people. It’s not always debilitating—in fact, many people are delighted by the way their brain works and resent any notion of being “cured.” As Anya Ustaszewski put it in the Guardian, “people on the autistic spectrum are disabled more by society than by their autism.”

“As long as they can find a good fit for how their brain functions and find work that’s rewarding, it’s often possible for them to have completely fulfilling lives,” Yazar-Klosinski said. “Actually, I don’t think that being autistic is a mental health condition. It’s more of a way of being.”

That doesn’t mean having autism is always easy. Some people can struggle with social interaction, especially with making eye contact or interpreting nonverbal communication. Hypersensitivity to sound, light or other stimuli is also commonly reported.

“Autistic people are often very used to dealing with sensory overload and I think it’s very interesting that LSD in particular acts on the serotonin system, which is involved with sensory gating,” Szalavitz said.

Psychedelics seem to be able to address the more uncomfortable symptoms of ASD by helping people adjust better to their environment, Yazar-Klosinski said. “The part we can treat is the social anxiety and the trauma that comes with being autistic.”

Psychedelics are not being promoted as a “cure” for autism. However, research hasn’t always been so considerate.

“When the participants were under the influence, they didn’t actually feel like anything was different sometimes, which was interesting,” she continued. “They’re already living their lives in a pretty altered state. So having the psychedelic on top didn’t seem all that different.”

It’s important to note that psychedelics are not being promoted as a “cure” for autism in modern research. However, research hasn’t always been so considerate.

From the late ‘50s through the ‘70s, experiments were conducted that gave drugs like LSD to autistic people without controls or rigorous study designs. In addition, the studies often lacked participants’ informed consent.

In 2007, a group of researchers reviewed this research in Developmental Neurorehabilitation and concluded, “the vast majority of these initial Autism/LSD studies were so flawed that the resulting data are little better than anecdote.”

We have a much better understanding today of how psychedelics can help. These drugs are best known for the powerful hallucinations they can produce: time dilation, enhanced sound or color, visual trails, warping textures and a diminishing sense of self or the ego. But psychedelics also promote what’s known as “plasticity” in the brain—allowing this ball of fat and electricity inside our skulls to “rewire” itself and even grow new neural connections.

While psychedelics have been shown to have some benefit on a biological level, it’s not the drug alone doing the work when it comes to our minds. According to experts, pairing psychedelics with therapy is key to their efficacy.

“It’s not enough to just open the door, you have to walk through the door, then go and make some new connections after that,” Yazar-Klosinski said. “Any psychedelic that creates that kind of an altered state, that is capable of rewiring the brain, would create such an opening … it’s really that integration [and] psychotherapy that I think is where it’s really important to have both the preparation and integration.”

Autistic People Trying Psychedelics for Themselves

Aaron Orsini was diagnosed with ASD at 23 and tried LSD at 27. “For myself, it was coming into this awareness that I was missing this sort of energetic signature of other beings in my proximity,” he explained, noting that he was often stuck in “mental rumination mode.”

“Psychedelics showed me that there was something other than the voice inside my head to navigate the world,” Orsini told Filter. “I had the conventional psychedelic experience that many people would report, as far as connecting to nature, to myself and a sense of oneness or wonder. But the thing that stood out was a deep kind of [experience] that’s referred to as interoceptive processing. And this sort of heightening of my ability to detect inner feeling states.”

Orsini wrote about his experiences in the book Autism on Acid: How LSD Helped Me Understand, Navigate, Alter & Appreciate My Autistic Perceptions and started a website, AutismOnAcid.com. Soon, other autistic people with an interest in psychedelics began to contact him, including Justine Lee, a graduate student in pharmacology at University of California.

“Before psychedelics, when I heard a dog barking outside, or a loud car, or a door slam, or someone dropping a plate, I was getting very angry.”

Together, they began hosting weekly Zoom meetings throughout the pandemic, simply to meet and talk with folks with similar interests. The two co-founded the Autistic Psychedelic Community and later compiled a book, Autistic Psychedelic, which contains a series of testimonials from neurodivergent people who have tried these drugs.

One testimony, for example, comes from someone named Thomas, who wrote: “Before psychedelics, when I heard a dog barking outside, or a loud car, or a door slam, or someone dropping a plate, I was getting very angry, almost raging, especially if I tried to concentrate. And this is 100% gone today. When there’s a loud noise anywhere, it doesn’t hurt anymore. I’m totally calm.”

“It’s been kind of an amazing journey,” Lee told Filter. “I can’t express enough gratitude for all the community members who have shared their stories and who just like allowed me to be present and listen to them.”

“What we’re really trying to do is just build this conversation and just create a space for it,” Orsini said. “And one of these questions ongoing is like, are these changes happening only during the exposure to these substances, are these changes carried forward?”

Cautions and Optimism

Despite the uplifting nature of these testimonies, it’s also important to note grounds for caution. “With most of these off-label, anecdotal reports that we’re getting about MDMA or LSD being used, the important part is actually that they need to be done in the context of psychotherapy,” Yazar-Klosinski said.

Szalavitz also doesn’t recommend anyone take psychedelics outside of a clinical trial, but she understands why some may be attracted to these drugs and offers some harm reduction advice.

“The main thing is just the same advice you’d give to somebody that didn’t have autism, which is you must be in a safe place. You want to have control over the music, over the people, over the environment that you are, in case it goes bad,” she said, emphasizing that you need to trust the source of any unregulated chemicals and prepare to take a few days off before, during and after the experience. “I really do think that a day to prepare, a day to experience and a day to like, chill out afterwards, is important.”

“I can’t emphasize enough that there’s avenues other than psychedelic substances to get there. It’s just that those were teaching tools for me.”

And Orsini himself acknowledges a kind of potential confirmation bias: People with positive experiences are more likely to contact the Autistic Psychedelic Community, whereas someone who had a “bad trip,” or experienced no change, may be less motivated to join such a group.

“We’re aware of that. We do also hear of challenging experiences. We’ve done our best to include those as well in this anthology,” he said. “We’re trying to encourage harm reduction and safety at every turn. Yes, this is exciting, but we don’t want harms to befall anyone out there at all.”

Orsini added that he now tries to tap into the psychedelic space using meditation and breathwork, rather than drugs. “I can’t emphasize enough that there’s avenues other than psychedelic substances to get there,” he said. “It’s just that those were teaching tools for me at that time that showed me that this was possible at all.”

Another thing to make clear is that the people choosing to take psychedelics to treat less comfortable aspects of autism are adults, not children. But while a psychedelic experience can be quite intense, the drugs are generally well-tolerated, including by autistic people.

With the right research and implementation, psychedelics show immense possibility for improving life for many autistic people in a way that prohibition has long denied them.

Photograph via FreeIMG

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When I first spoke to Casey William Hardison last October, he was calling from a Wyoming jail cell. Now he’s running for president in 2024. It’s yet another weird turn in the life of a legendary chemist and advocate for the freedom to expand one’s consciousness with drugs. But his current legal troubles could have a much bigger impact than a statistically unlikely chance at the White House.

Dedicated psychonauts may have heard of Hardison. The entheogenic activist has his own “Character Vault” on Erowid, he’s rubbed shoulders with many legends in obscure psychoactive chemistry—Sasha Shulgin and Darrell Lemaire, for example—and he traveled with Hamilton Morris to Burning Man for the Hamilton’s Pharmacopeia episode “The Lazy Lizard School of Hedonism.”

Hardison, 49, has earned this reputation, of course, because he’s a talented chemist who once spent years cooking up everything from LSD to DMT to 2C-B, with plenty of MDMA in between. When he was eventually arrested and convicted in the United Kingdom for his unsanctioned psychedelic laboratory, the local press branded him a “drugs wizard.”

But Hardison defended himself in court, arguing he had the fundamental right to alter his consciousness using drugs. Essentially, Hardison was arguing for cognitive liberty, a concept he adopted from legal theorist Richard Glen Boire, who wrote in 2001, “the so-called ‘war on drugs’ is not a war on pills, powder, plants, and potions, it is war on mental states—a war on consciousness itself—how much, what sort we are permitted to experience, and who gets to control it.”

“I believe firmly that the Controlled Substances Act is an attempt at mind control.”

There’s little doubt drugs can change the way you think and feel—whether it’s caffeine or heroin, that’s kind of the whole point of taking these chemicals. Czech psychiatrist and LSD researcher Stanislav Grof described psychedelics as “nonspecific catalysts and amplifiers of the psyche.” And Hardison valiantly defended his right to “amplify” his mind. Why are some chemical tweaks allowed while others are verboten?

“I believe firmly that the Controlled Substances Act is an attempt by the state, by the government, by the federal government at mind control of the American population,” Hardison said. “It’s pretty obvious if the state doesn’t want you to engage in the multiple modes of thought that are available with these forbidden thought catalysts.”

Despite his best efforts, the UK courts disagreed with Hardison—a judge labeled him a “dangerous individual”—and he served nine years of a 20-year sentence, before being deported back to the US in 2013.

“I went into that original argument with just a single book in my hand and not really knowing at all what I was doing,” Hardison told me in a phone call that cost him $4 every 15 minutes. “By the time I had crafted the argument, five years had already gone by and it was too late for appeals and everything. So I’ve been working on this argument for years and when I showed up in jail here, I now have standing in the courts with a real case of controversy.”

Unfortunately, Hardison now has a chance to try this defense again, this time in a US courtroom. In 2018, he traveled to Jackson, Wyoming and attempted to sell three pounds of marijuana to undercover cops. They tried to arrest him, but he sped off in his car. “I thought I was being robbed, really,” Hardison said.

He eluded police until August 2020, when he was arrested in Yorkville, California and shipped back to Wyoming, where he’s now facing two felony counts of delivery of marijuana. With the help of his lawyers, he’s filed a motion to dismiss, claiming that the Wyoming Controlled Substances Act discriminates against him in an “arbitrary and unequal manner.”

“When I went to look at the face of the legislation, I noticed that they have a little get-out clause,” Hardison explained. “It says this act doesn’t apply to alcohol and tobacco, which is a no-no in the world of equal protection and due process, to exclude classes of individuals or persons from the operations of what would otherwise be a neutral law of general applicability.”

“I don’t want to be a pharmaco-chauvinist and say, ‘Oh, my drugs are special, yours aren’t.”

He’s arguing six counts, citing a flurry of legal precedent dating as far back as 1891, including Brown v. Board of Education and Planned Parenthood v. Casey. They are summed up as follows:

1) the right to be free from arbitrary imprisonment;

2) the right to property;

3) the right to privacy;

4) the right to freedom of thought;

5) the right to pursue happiness; and

6) the right to be free from discrimination.

While it isn’t his main defense, the cognitive liberty argument is juicy, as it involves, as Hardison put it, “the indispensable matrix of nearly every other form of human freedom.” He emphasized that he’s not arguing for the religious right to use psychedelics. “I don’t want to be a pharmaco-chauvinist and say, ‘Oh, my drugs are special, yours aren’t.”  

The big question, of course, is whether his argument has a snowflake’s chance in Hell of winning.

“I’m exceptionally confident,” Hardison said. “My argument is explicitly simple. It’s an equal protection issue. Under the Wyoming constitution, there is a rule that says that all general laws must be of uniform operation. And if you have an explicit exemption for alcohol and tobacco on the face of the legislation, then that makes it not a general law anymore.”

So far, the judge overseeing his case has not agreed, Hardison said, and he took a plea deal, which he plans to appeal to the state Supreme Court.

“I finally received the Judge’s Order [regarding] my constitutional arguments and he answered the questions he wanted to and dealt not at all with my non-uniform law or arbitrary law claim,” Hardison wrote in an email. “He recreated my argument as an argument for a fundamental right to use cannabis rather than a fundamental right not to lose my liberty, in line with those who use and commerce alcohol and tobacco arbitrarily excluded from the law. So, it’s off to the [state] Supreme Court.”

From there—and this may be unlikely—the case could be nudged all the way to the US Supreme Court. It’s a longshot, but because the Wyoming Controlled Substances act is modelled after the federal version, if Hardison wins, it could overturn the CSA and essentially end the drug war.

While this effort is certainly unique—Hardison claims it’s the first time this argument has been used in a US courtroom—it’s only one attempt among many to undermine prohibition, of course. Many contemporary arguments for ending the War on Drugs lead instead with the racist origins and implementation of narcotics laws, or illustrate how the harms of prohibition vastly outweigh the harms of drugs. Relatively few people, with Dr. Carl Hart prominent among them, argue that altering consciousness is a fundamental human right.

Casey is also running for president, with the aim of reviving the Democratic-Republican Party, which formerly dissolved in 1834. “We are working out policy positions at the moment,” Hardison told the Jackson Hole newspaper. “But liberty is fundamental.”

Wherever this court battle steers him, “I am not stopping,” Hardison said. “Something else really pertinent to the argument is that there can be no illegal drugs. That’s a complete misnomer. It’s a sleight of hand that distracts people from what’s actually being controlled in this class. What’s being controlled is humans.”

Photograph of Hardison in 2017 by JonRHanna via Wikimedia Commons/Creative Commons 4.0

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Palamar’s team found that cocaine use roughly doubled over the years studied, while use of ketamine, a psychedelic anesthetic, has nearly tripled. Use of the psychedelic LSD and the sedative GHB are also on the rise, while use of MDMA, sometimes called “ecstasy” or “Molly,” has remained stable.

Palamar, an associate professor at New York University School of Medicine, recently described these results in the journal Drug and Alcohol Dependence. But he also discovered a concerning trend, published in a separate paper, which suggests people are increasingly taking ketamine without knowing it.

During nine months in 2019, his team interviewed nearly 800 people. “Roughly 15 percent of the people we surveyed reported ketamine use in the past year,” Palamar said. “But the number that tested positive in hair samples [141 people], was about triple that.”

Those who tested positive for MDMA were more likely to test positive for ketamine after not reporting use.

While many people seek ketamine for its tranquilizing, dissociative high, it can be uncomfortable or unsafe if someone isn’t expecting that experience or accidentally takes too much. It can also be dangerous to mix with other drugs like cocaine or alcohol.

Those who tested positive for MDMA were more likely to test positive for ketamine after not reporting use. Palamar theorizes that more MDMA is being cut with ketamine or baggies are being contaminated, because it seems unlikely that his survey responders would lie about taking ketamine when many of them openly reported other drug use.

“I don’t see why people would report use of ecstasy and cocaine, maybe even meth, and then deny ketamine use,” Palamar said. “If anything, you’d lie about the meth use or something else. People need to be aware that the drugs they think they’re using might in fact be different drugs.”

Palamar also speculates that intentional ketamine use could be rising due to positive media coverage of the drug—regarding, for example, its uses to treat depression or chronic pain. Social media may also play a role; Sky News has reported, in sensationalized fashion, that videos of ketamine use are going viral on the video-sharing platform TikTok.

“It’s hard to tease out why drugs become more or less popular over time, but the availability of ketamine has noticeably increased,” said Mitchell Gomez, executive director of DanceSafe, a nonprofit drug education association. Since 1999, the group has provided free drug checking services at EDM concerts or festivals across the US, with volunteers using forensic technology to measure the composition and purity of drugs. Pill testing could tell you if your MDMA was cut with ketamine, for example.

You don’t have to take your drug to a venue to find out what’s in it. You can also order testing kits online or anonymously mail a sample to websites like EcstasyData.org, for example, which use lab-grade equipment to scrutinize every speck of drug dust they receive.

While Palamar’s two studies focus primarily on New York, their data on increases in certain drug use seem to reflect what DanceSafe is seeing nationally, according to Gomez.

“Now real ketamine seems to be relatively abundant.”

“There’s been a noticeable increase in LSD, ketamine and GHB [use] throughout the country,” Gomez said, noting that ketamine may previously have been less available. “A few years ago, virtually all of the supposed ‘ketamine’ in the US was actually a research chemical (most commonly MXE and deschloroketamine), but now those research chemicals have vanished and real ketamine seems to be relatively abundant.”

Gomez’s observations don’t match Palamar’s finding that people are increasingly using ketamine without knowing it, however. He said that he’s only come across a “tiny handful of cases” where MDMA was sold contaminated with ketamine, mostly in trace amounts. “I suspect these ‘trace’ samples are from just sharing baggies,” Gomez said.

It could be that only New York is seeing a rise in unintended ketamine use due to a local supply issue, but more research would be needed to determine that.

One frequent NYC clubber, who asked to remain anonymous, reported that he has witnessed a lot more intentional LSD, cocaine and ketamine use while clubbing, raving and attending festivals in recent years. “People use ketamine in a variety of ways,” he said. “Most of the time people just take key bumps during the event to feel that high of being drunk without actually being drunk. This means people appear to be intoxicated and disoriented and swaying back and forth, responding to music utilizing almost trance-like movements. Some other things I have seen are people sneaking in [ketamine] through Vicks snorting inhalers.”

There isn’t all that much data to demonstrate a large-scale national rise in ketamine use, however. According to results from the National Survey on Drug Use and Health, lifetime ketamine use among US adults was an estimated 3,602,000 individuals in 2018, compared with 3,417,000 in 2017—an increase, but hardly a surge. Reported use among people aged 18-25 actually fell over that year.

Palamar’s research does, however, suggest that ketamine use should be the focus of more research and harm reduction education efforts.

“Drug checking is the best harm reduction method … You need to know what you’re taking.”

There is some good news, too: According to Palamar’s research, New York clubbers are using unknown powders a little less often than before. It’s impossible to safely dose crushed-up drugs if you don’t know what they are to begin with.

“Drug checking is the best harm reduction method … You need to know what you’re taking,” Palamar emphasized. “It probably helps if you know the person you’re getting it from, but I’m not really sure, cuz I think a lot of people who sell don’t even know what the hell they’re selling.”

Gomez agreed. “Misrepresentation and adulteration are just rampant in black markets. Although nothing short of full legalization and regulation of all drugs can end misrepresentation, drug checking can certainly help.”

Photo by Aaron Paul on Unsplash

The post Are More Clubbers Taking Ketamine Without Knowing It? appeared first on Filter.

Yet we’re constantly warned never to try meth—”not even once,” goes the refrain—or it will instantly cause addiction and ruin your life. Before fentanyl was the demon drug du jour, meth was seen as the worst, most destructive, most evil chemical you could find on the streets. Even of late, if you ask the New York Times, NBC or Vice, you’ll learn that meth, “the forgotten killer,” is back with a “vengeance.” Other outlets, from Rolling Stone to CNN to the Daily Beast, have raised the alarm about meth use in the context of the opioid-involved overdose crisis.

Stimulant-related deaths are indeed on the rise in North America—in some regions, meth is even more prevalent than heroin. Surveying drug overdoses in America from 1979 through 2016, researchers wrote in Science in September 2018 that “Methamphetamine deaths have increased most dramatically in the western and southwestern United States.”

Meth poisonings accounted for an estimated 14,845 hospitalizations in 2015, according to the Centers for Disease Control and Prevention (CDC), and another 15,808 emergency room visits. In 2016, around 7,500 people died from overdosing, or “overamping,” on stimulants, including meth. If you ask most people, including policymakers, you’ll hear that meth is a scourge that can do no good.

Procter & Gamble tries to obscure this fact by spelling the active ingredient “levmetamfetamine.”

But if you’ve ever used something like Vicks VapoInhaler, you’ve experienced the healing benefits of meth firsthand. That’s because the over-the-counter nasal decongestant contains levomethamphetamine, the levorotary form—or “mirror image“—of the same stuff from Breaking Bad. Procter & Gamble tries to obscure this fact by spelling the active ingredient “levmetamfetamine.” Selegiline, a drug for treating Parkinson’s and Alzheimer’s diseases, also metabolizes into levomethamphetamine.

There is a significant difference between these two opposing molecules. D-methamphetamine is what generally appears on the street—although it’s often cut with other chemicals—whereas l-meth provides a shorter-lived high that is less desirable among drug users and less likely to lead to dependence. People can and do use it recreationally. But problematic use is rare, in part because the high is shitty, but also because d-meth is so widely available. It’s easier to buy a more powerful form of the drug on the street than it is to try to extract it from over-the-counter medications.

Other Americans are prescribed actual, pure meth by their doctors. It happens less frequently these days, but in ADHD, obesity or narcolepsy cases where nothing else has worked, a drug called Desoxyn (methamphetamine hydrochloride) can sometimes help. It can even be prescribed to children as young as seven.

It’s important to make these distinctions. Meth didn’t make a “comeback”; it never left. It can’t return with a “vengeance” and it can’t be “evil” because we’re talking about a chemical compound here. It has no personality, no feelings, no intentions.

Thus it does a disservice to science and to medicine, as well as to the people who use these drugs responsibly, to treat a molecule with dualistic properties purely as a poison. And as recent research has shown, we’re still uncovering some of the potential therapeutic benefits of methamphetamine. Confronting the stigma associated with meth and highlighting its benefits can better inform drug policy and addiction treatment.

A Stimulant Like Any Other

For Jordan*, the meth he’s prescribed works better against his ADHD with fewer side effects than the Adderall he’d been on for 20 years. About five years ago, Jordan asked his doctor if he could try methamphetamine. The doc said sure.

“The first time I brought it to the pharmacy, the pharmacist actually said to me, ‘Oh, your doctor wrote this prescription wrong, this is the stuff that they make in meth labs,'” Jordan tells me by phone. “I told him to type ‘Desoxyn’ into the computer, and he did. He kind of backtracked, [but] he obviously had no idea.”

Jordan, a middle-aged man from North Carolina who works in clinical research, now switches every three months between Adderall and Desoxyn to avoid building a tolerance to either stimulant.

“The medications have been important for me, to be productive, to be successful, not just at work but also in my personal life.”

Methamphetamine and amphetamine (one of the active ingredients in Adderall) are almost identical chemicals. The main difference between the two is the addition of a second methyl group to methamphetamine’s chemical structure. This addition makes meth more lipid-soluble, allowing for easier access across the blood-brain barrier. Meth is therefore not only more potent, but also longer-lasting.

“The medications have definitely been important for me, to be productive, to be successful, not just at work but also in my personal life,” Jordan says. “I’ve been on the medications for years, but I can take Adderall or methamphetamine and take a nap afterwards. I don’t have any noticeable side effects.”

Jordan also doesn’t feel “high” from the doses he takes—approximately 10 to 15 milligrams of meth per day. Doses at this level are well tolerated by most people. It’s very difficult to estimate the typical dosages of illicit meth taken on the street, but they are generally many times higher and taken every couple of hours. Further, the route of administration—typically, people smoke or inject illicit meth—allows for more of the drug to enter the bloodstream than taking a prescription pill.

At high doses, meth gives a rush of euphoria, boosting attention span, zapping fatigue and decreasing appetite. Intense sexual arousal, talkativeness and rapid thought patterns are also common. Body temperature and heart rate shoot up, which can cause irregular heartbeat, increasing the risk of seizures. If taken repeatedly over long periods, street meth can be highly neurotoxic, inducing paranoia and psychosis.

“One misconception is that meth is always very addictive.”

But illicit meth is also often used to self-medicate, according to Mark Willenbring, an addiction psychiatrist from St. Paul, Minnesota, with over 30 years of practice treating substance-use disorders. In Willenbring’s experience, most of his patients who use illegal meth are treating undiagnosed ADHD.

“There’s a high degree of comorbidity between substance-use disorders and ADD,” Willenbring says. “They used meth for years in a controlled way, they never over-used it, they just used enough to get an effect, and then they stopped. One misconception is that it’s always very addictive.”

With most people who are addicted to meth, Willenbring says, you can’t tell it just by looking at them. Carl Hart, a neuroscientist in Columbia University’s Department of Psychology, agrees that the image of a snarling “meth addict” with bad teeth is a false stereotype. The dental damage so prevalent in anti-drug propaganda, he says, is more likely due to poor nutrition and lack of sleep—not to the drug. “There is no empirical evidence to support the claim that methamphetamine causes physical deformities,” Hart wrote in a 2014 co-authored report.

“It’s just a stimulant, like any other stimulant,” Willenbring says. “It’s a marketing issue.”

Part of the reason Jordan asked to try Desoxyn in the first place was to see if he’d develop any of the “stereotypical meth addict problems,” as he puts it. He hasn’t.

“Those of us that know the reality have a responsibility to say, ‘Hey, not that shooting up meth isn’t bad, but the chemical itself isn’t bad,'” Jordan says. “It’s just misuse of the chemical that’s bad.”

For Joan*, a 66-year-old grandmother living off the grid in northern Georgia, Desoxyn makes her feel normal. “Not high, not hyped up, just normal,” she tells me. She’s been taking prescription meth since 2006, but first tried many other ADHD meds, such as Ritalin and Concerta, with poor results. But Desoxyn has not only helped her socialize, manage bills and finish her master’s degree in social work; it’s also helped with Joan’s depression and self-esteem.

“The only downside is the cost,” she says. “It’s one of the oldest drugs on the market, but even generic, it is outrageously expensive.”

Still, meth isn’t for everyone, of course. Kevin*, a 31-year-old artist from the Midwest, was first prescribed Desoxyn at age 15 to treat extreme fatigue and trouble focusing. But misdiagnosed mental-health issues—his doctors thought he had bipolar disorder, when in fact he had post-traumatic stress from childhood abuse—led to worsening symptoms.

“Being able to just take a bunch of pills that made the exhaustion go away for a while felt like a blessing, but it was just a Band-Aid on the problem,” Kevin says. “I became completely dependent upon Desoxyn to function, and any lapse in taking my dose would result in a terrible energy crash.”

“In retrospect, my neurologist at the time would have done well to consider the effects of intense stimulants on someone already prone to mania, insomnia, and hallucinations,” he says. “I think Desoxyn has its merits as part of a treatment plan for attentive disorders, but that’s the thing—it needs to be part of a larger understanding of how and why it might have a negative impact upon the patient’s overall health, and should remain closely monitored throughout.”

Meth for Strokes and Traumatic Brain Injury

Street doses of meth can be extremely damaging to your health. The purity of such drugs is often unknown, and repeated, high doses of meth have been proven to be neurotoxic. But in low, pharmaceutical-grade doses, meth may actually repair and protect the brain in certain circumstances.

This was first discovered in 2008, when researchers at Queen’s Medical Center Neuroscience Institute in Honolulu, Hawaii, analyzed five years of data on traumatic head injuries. They unexpectedly found that patients who tested positive for methamphetamine were significantly less likely to die from the injuries. The authors suggested that meth could have neuroprotective benefits.

To learn more, in 2011, a different team from the University of Montana applied meth to slices of rat brain that had been damaged to resemble the brains of stroke victims. Then they induced strokes in living rats, using a method called embolic MCAO, and injected them with methamphetamine. At low doses, the meth gave better behavioral outcomes and even reduced brain-cell death. At high doses, the meth made outcomes worse.

Because meth stimulates the flow of important neurotransmitters—dopamine, serotonin, and norepinephrine—the Montana researchers theorized that methamphetamine may provide neuroprotection through multiple pathways. David Poulsen, one of the researchers involved, says this was a “serendipitous discovery.”

“So we decided, well, if it worked in stroke, it’s probably going to work really well in traumatic brain injury,” says Poulsen, now a neurosurgeon at the University of Buffalo who specializes in treatments for protecting the brain after severe damage.

Traumatic brain injury, or TBI, occurs after a violent smash to the skull. Its consequences include concussions on the mild end and coma or death on the severe end. TBI kills around 50,000 Americans annually, according to the CDC, while about 2.8 million of us visit the emergency room for TBI-related injuries every year. There is currently no Food and Drug Administration-approved treatment for TBI.

So, Paulson and his team reasoned, if meth can already be prescribed for children, why not to adults with TBI?

The team found that low doses of meth were protecting immature neurons, while also promoting the birth of new brain cells that are important for learning and memory.

To test the proposition, Poulsen and colleagues gave TBI to rats. Giving an animal brain trauma isn’t easy, but for more than two decades, there’s been a trick called the rat lateral fluid percussion injury model: Simply cut a hole in the skull of a rat and apply water pressure to the brain.

About half the rodents—19 male Wistar rats—were given this treatment, and eight of these were then given meth. The rats given meth performed better at a task called the Morris water maze, a widely used experiment that involves plopping a rat into a pool of water with a hidden platform. By tracking how long it takes the rodent to find the platform, scientists can measure many different aspects of cognitive function.

“By the third day of training, there were no statistically significant differences between the uninjured control rats and the injured rats that had been treated with methamphetamine,” Poulsen and his colleagues wrote.

But the team also found that low doses of meth were protecting immature neurons, while also promoting the birth of new brain cells that are important for learning and memory. The same was also true for rats that were given meth, but not injured.

“We see not just little, but very significant improvements in cognition and behavior,” Poulsen says. “Their memories improved, functional behavior is improved…. It’s not a trivial difference.”

“In light of the fact that low-dose methamphetamine is FDA-approved for use in juveniles and adults, we see no valid reason why it cannot be utilized in human clinical trials for stroke and TBI,” Poulsen and colleagues concluded in 2016.

But those clinical trials, considered the gold standard for testing medication, have yet to materialize, even while a 2018 retrospective study found similar results to the Hawaiian neuroscience report: Out of 304 patients with TBI, those who also tested positive for meth had better recovery results than those who did not. “The potential neuroprotective role of meth and other similar substances cannot be ignored,” the authors wrote in Clinical Neurology and Neurosurgery last July.

There are limited conclusions that we can draw about these rodent and retrospective studies, and it’s probably unlikely that nurses will soon start giving meth to people who have cracked their skulls. Still, a wide variety of stimulant therapies for TBI is being explored, with positive results. These include trials with modafinil, a narcolepsy drug; amantadine, a Parkinson’s drug; and dextroamphetamine, one of the components of Adderall. But there’s still no indication of a single clinical trial for methamphetamine for TBI registered with the National Institutes of Health.

Methylphenidate, also known as Ritalin, seems to be the stimulant most popular in these trials. For example, in 2004, researchers at Drucker Brain Injury Center at MossRehab Hospital in Pennsylvania gave methylphenidate, better known as Ritalin, to 34 patients with moderate to severe TBI. They reported significant improvements in information processing and attention.

Twelve years later, in Gothenburg, Sweden, another 30 patients suffering from prolonged fatigue following TBI were given methylphenidate and observed for six months. They also showed improved cognitive function and reduced fatigue. But a 2016 meta-analysis of 10 controlled trials found the main benefit of giving methylphenidate for TBI was increased attention, “whereas no notable benefit was observed in the facilitation of memory or processing speed,” the authors wrote. They encouraged more research into appropriate dosages and length of prescription.

Birgitta Johansson, a neuroscientist at the University of Gothenburg and lead author of the Swedish study, suggests caution whenever treating someone with a brain injury. “With methylphenidate, it is important to be aware about possible side effects, [such] as increased blood pressure and heart rate and also risk of anxiety,” she says. “It is always very important to prescribe medication with care and follow the patient carefully.”

“Stigma is the lens through which we see all drug issues. It keeps us from making the best decisions. It is fear-based, not rational, not creative.”

But the reason meth isn’t studied more rigorously—for TBI, for Alzheimer’s and Parkinson’s, for stroke—could also come down to money. Methamphetamine is off-patent, meaning there may be less financial incentive for pharmaceutical companies to explore the drug’s potential uses. Consider Vyvanse, a drug first marketed in 2007, with a new formulation introduced in 2017, that racked up $2.1 billion in sales in 2017. Desoxyn, which is sold by three companies, only earned about $9.3 million in 2009.

While Methamphetamine may not be widely recognized as medicine, it clearly has potential to heal as well as harm. Recognizing the duality of meth is arguably all the more essential in the face of a rising crisis of stimulant-related deaths.

“Stigma regarding any substance use or substance use disorder is counterproductive,” says Dan Ciccarone, professor of family medicine at the University of California–San Francisco. He says the overdose crisis is shifting from opioids to stimulants and that we are not prepared for the next wave. “Stigma is the lens [through] which we see all drug issues. It keeps us from making the best decisions. It is fear-based, not rational, not creative. Because of stigma, we have not fully addressed the opioid crisis.”

That stigma remains a major hurdle, and until doctors and public health officials counteract this kind of messaging, it seems unlikely that a multinational pharmaceutical company would risk marketing a substance only believed to be toxic and deadly.

“Everything will kill you, if you take enough of it,” Poulsen says. “Some things don’t require a lot to do that. Meth is one of those things. But just like any drug, the difference between a poison and a cure is the dose.”

*These names have been changed, as requested by sources to protect their privacy.

Photo by Kendal on Unsplash.

A slightly different version of this article was originally published in May 2019 by Pacific Standard, which later shut down. The author owns the rights to the piece and it is published here with permission.

The post Meth Has Many Medical Benefits. Stigma Holds Them Back. appeared first on Filter.

Because it takes extra effort from the body to metabolize certain drugs, heavy use—or withdrawal symptoms from stopping—can sometimes cause loss of appetite and anorexia, leading to a disruptive diet and nutrition imbalance. An overworked liver may have trouble absorbing some nutrients. This in turn increases the risks of infection and other health problems that don’t usually exist when a drug is taken under optimal nutritional conditions.

So when it comes to reducing harms from drugs, why isn’t nutrition a bigger part of the conversation?

Christiana Miewald, an adjunct professor at Simon Fraser University’s geography department, has a strong interest in this connection. In 2017, she co-authored a paper titled “Food as Harm Reduction” in the Journal of Critical Public Health, which explored the barriers to food access some drug users have in low-income communities in Vancouver, Canada.

Her team went to the Downtown Eastside, interviewed 42 people who currently or formerly used drugs, and asked them how their drug use impacted when, what and how they ate. They also spoke to 35 staff members at 27 programs that provide harm reduction services in the area.

It’s not very helpful to receive donated canned goods or fresh vegetables if you have nowhere to cook them.

They discovered several unique challenges for nutrition access in their community. Drugs can directly and indirectly impact nutrition, and improving that relationship, they wrote, “[S]hould be viewed as central to public health and harm reduction and should, therefore, be supported by the state, rather than left to ad hoc charitable providers.”

“There’s sort of this contradiction that we came across: There are a lot of food programs in Vancouver for people who are low-income, but at the same time, they also experience high levels of food insecurity,” Miewald told Filter in a call. “It ran the gamut of everything from the effects of actual drug use to the larger structural issues that some of the people that we were talking to experience on a daily basis.”

Those structural issues include income inequality and access to housing. While most of the people Miewald’s team spoke to weren’t homeless, many lived in small, single-occupancy rooms, such as hotels, without much in the way of kitchens. It’s not very helpful to receive donated canned goods or fresh vegetables if you have nowhere to cook them. For many people in this position, fast food or convenience store food is simply more accessible.

Food insecurity, or inconsistent access to food, affects more than 2 billion people globally—a number that has been rising since 2015—including approximately 40 million Americans and a similar proportion of one in eight households in Canada.

Why Harm Reduction Isn’t Centering Food

Many programs do exist to fill this gap, yet they often aren’t catered toward a demographic that uses drugs—requiring sobriety to eat at a soup kitchen, for example—while services that are focused on helping people who use drugs often ignore nutrition as a way to reduce harms.

“If we’re talking about harm reduction, then nutrition should be part of that. It’s not just about needles, it’s about a lot of other things.”

That isn’t to say that harm reduction operations, such as syringe access programs or overdose prevention sites, aren’t aware of their clients’ need to eat—it’s just that many of them don’t explicitly address nutrition as a way to offset negative drug effects.

“Even though a lot of the [harm reduction] organizations were providing food at various levels, when we asked them how does harm reduction link in with nutrition, that was like the first time they had really thought about that,” Miewald said. “There wasn’t really a philosophy. It was just more of, ‘We have people here, they’re hungry.’ But if we’re talking about harm reduction, then nutrition should be part of that … It’s not just about needles, it’s about a lot of other things.”

A 2011 report in Addiction agreed on what researchers at Oxford Brookes University called “an under-researched and frequently overlooked issue.” They challenged service providers to reconsider how they might assist heroin users more effectively with their eating practices, writing, “nutritional interventions should be part of the package of services comprising good holistic care.”

Like many issues, this problem comes down significantly to funding. Harm reduction programs often just aren’t financially equipped to be directly concerned with nutritional health. What’s more, the Canadian government doesn’t provide food stamps like in the US.

“If they’re on social assistance, they’re given a check, but that is supposed to cover everything. There’s no specific allocation for food,” Miewald says. “Food provision is really sort of devolved down to individual organizations … Relying on donations is very hard for these organizations. They’re constantly applying for grants or having to shift money around. It just puts additional burdens on them.”

That puts the duty of eating well on people who use drugs themselves, which can be difficult for those who may be struggling with an addiction that takes up their time and concentration.

How People Who Use Drugs Can Take Control

Nonetheless, lack of access doesn’t equal lack of desire. People who use drugs know that the benefits of food security can be profound.

“If you don’t have to worry about where your next meal is coming from, you actually reduce anxiety,” Miewald says. “One interesting thing that we really found is that a lot of the people who had been using drugs for decades, a lot of them in their 40s and 50s, had actually learned how to manage their nutrition, had sort of internalized these messages about getting proper nutrition.”

“They had learned to try to eat, even if maybe they weren’t hungry,” Miewald goes on. “Or you know, go get a meal or a smoothie, even if it was just Gatorade or something like that, to keep up their vitamins or make sure they didn’t become dehydrated or malnourished.”

“As a person who is living with hepatitis C, I noticed a huge change in the inflammation and how I felt.”

Ria Tsinas, a Portland, Oregon harm reduction worker who has herself struggled with drugs, knows the importance of nutrition first hand. When she worked as a residential counselor at an emergency service center in downtown Seattle, she noticed that people’s diets were generally terrible and that most of the foods being offered were cheap starches and fats. At one point, she began taking her own diet more seriously—mostly eating roasted beets, sweet potatoes, kale and salmon—and found some unexpected positive changes.

“As a person who is living with hepatitis C, I noticed a huge change in the inflammation and how I felt,” Tsinas told Filter. “But also, in my viral metabolic panel, my counts were actually decreased because I was inadvertently eating a lot of foods that were really good for your liver.”

Tsinas later took a college nutrition class where she designed a diet for people who are using drugs that, critically, was accessible for people without access to a full kitchen. She argues that food can function as an intervention—but it’s not a method many are using.

“I started looking around and I noticed that there wasn’t really a lot of anything published about this, which I was really surprised about because it seems like such a no-brainer intervention,” she said. But Tsinas was able to pull data from general sources about food deficiencies—including some from scholarly sources and some from for-profit recovery centers—and she plugged this into the US Department of Agriculture’s Dietary Reference Intakes calculator.

The diet she designed called for, among other things, five servings each of fruits and vegetables, especially those high in things like omega-3s, protein and calcium—as well as recommended foods to reduce sugar cravings, because sugar can greatly damage teeth in people who use stimulants.

In her research, Tsinas found meal plans that can make withdrawals less extreme or stabilize blood sugar or regulate mood. For example, if you’re experiencing cramping, it may be due to a lack of potassium, so it can help to eat a banana, or electrolytes that don’t come from sugary energy drinks.

“There were a few holes, but for the most part it did what it was supposed to do,” Tsinas said of her diet, which Filter has published, with her permission. “Somebody can make it better, I’m sure. I would just love for somebody to use it or at least start having a conversation about how food is medicine, and it is a really important pragmatic tool in our toolkit of harm reduction.”

Obstacles and Food Empowerment

In the US, however, the idea of giving food to people who use drugs is often met with scorn. In some cases, people who sign up for food stamps are actually tested for drugs before they’re allowed to receive benefits. These demands are typically sold on the premise of somehow saving the state money, but invariably cost millions more to enforce, not reducing expenses whatsoever. They also rarely catch anyone engaging in illicit drug use. Last month, Maine repealed its urine analysis requirement for food assistance after it only detected 10 people in three years.

Being Canadian, Miewald is shocked by this idea, and says it will only put greater burdens on charitable food programs and the healthcare system. “Nutrition is part of health. It’s not a luxury,” she said. Decreasing nutrition “actually increases health costs potentially down the line. You are not saving any money by doing something like that—it’s crazy.”

“Food is one way of really harnessing control over your own situation … one last act of resistance is what you put in your body.”

Even with funding, offering healthy food options to populations that use drugs can be challenging. Some people may be reluctant to change their diets. But ultimately, Tsinas said, the people receiving the service should be the ones dictating what’s offered.

And like many aspects of harm reduction, that means providing accurate health information and meeting people where they are. Sack lunches and mobile smoothie carts have proven effective in Canada.

Tsinas also suggests providing perinatal vitamins for pregnant people, while feedback in Miewald’s research suggests that food providers who cater only to women can provide a much-needed safe space, especially for sex workers.

Ultimately, focusing on nutritional health can be an effective way to empower people who use drugs. “Food is one way of really harnessing control over your own situation,” Tsinas said. “It’s very personal, but one last act of resistance is what you put in your body.”

Photo by Vitalii Pavlyshynets on Unsplash

The post Nutrition Is an Overlooked Aspect of Harm Reduction appeared first on Filter.

Prohibition of cannabis and psychedelics is slowly unraveling in some places, but for stimulants it’s a tougher sell at the moment. Even someone who thinks psilocybin mushrooms should be allowed in therapy, or that cannabis should be sold as freely as beer, may have trouble accepting a legal market for cocaine.

That isn’t stopping Steve Rolles, a senior policy analyst at the Transform Drug Policy Foundation, a UK think tank. He’s hoping that nations will soon regulate and legalize the sale, possession and use of “uppers.” He isn’t saying these drugs don’t have risks—but he notes that prohibition does nothing to address these risks, and that we need a different approach.

“The danger of a particular drug is the reason to regulate it, not the reason to run away from it,” Rolles said in a call with Filter. “For me, it doesn’t really matter how dangerous a particular drug is. If people are using it, we have to accept that prohibition is still going to make it more dangerous and regulation is going to make it safer. It’s a fundamentally pragmatic position.”

Rolles is the author of How To Regulate Cannabis: A Practical Guide, a book used in Canada and Uruguay to help shape their marijuana legalization frameworks. Mexican officials recently cited his work in drafts of recreational marijuana legislation. It’s a pretty big deal when a country’s top policymakers consult you on how to model an industry involving psychoactive substances—especially ones that still carry heavy stigma.

Now Rolles is crowdfunding his next book, which he hopes will be a blueprint for governments to follow in undoing stimulant prohibition. Use of drugs like crack and meth is on the rise, but seemingly ignored by most media and governments in the context of ever-increasing opioid-related deaths. That means this could be a pivotal moment to consider this kind of legislation. Rolles cites evidence that access to pure drugs with known dosages could not only prevent fatal overdoses, but help put an end to the bloody cartel wars in Latin America.

“There’s been an alarming rise in stimulant deaths. [Of] about 70,000 deaths in the US [in 2017], 10,000-15,000 of them are stimulant-related,” Rolles says. “I think if it hadn’t been for the opioid crisis, people would’ve paid more attention to that fact, and they’re not. Even in the UK we’ve seen a rapid increase in deaths from cocaine and MDMA. Around the world, this is a growing issue that is not getting the attention that it needs.”

“Unregulated cocaine is already widely available and used, but regulating cocaine will make it much safer.”

Legal markets could address this growing problem. To choose an example, let’s focus on cocaine. A legal market for coke may seem absurd, but the drug was sold widely in the US a century ago, as a baldness cure and more famously as an early ingredient in Coca-Cola. Could a regulated market for cocaine work 100 years later? And what could convince policymakers to seriously consider this idea?

“It’s worth reminding ourselves that unregulated cocaine is already widely available and used, but regulating cocaine will make it much safer,” Julian Buchanan, a harm reduction veteran and retired professor at Victoria University of Wellington, told Filter. “The question is not ‘should cocaine be legal,’ but why on earth, given the evidence before us, should we continue with drug prohibition? The regime is a global disgrace that will be remembered in history as one of the greatest atrocities and human rights abuses in living memory. Where do we stand in this historic period of change?”

So what would it look like to bring cocaine in from the shadows? Would it resemble cannabis dispensaries like in California or Canada? Or operate more like prescription heroin programs in Switzerland and the UK?

Where Cocaine Is Already Legal

A handful of countries have already legalized, rather than just decriminalized, small amounts of cocaine. Colombia, currently the world’s biggest cocaine exporter, allows possession of up to a gram, but forbids sales. Mexico has a similar model, but only permits possession of half a gram. In Peru, it’s two grams, but in 1949 the government created ENACO, the state-run National Coca Company, which cultivates coca for medicinal products like teas.

Incidentally, the US is the only country that buys Peru’s medical-grade cocaine, which is (uncommonly) used for sinus surgeries. (This is a great example of why the Controlled Substances Act makes little sense: it labels cocaine Schedule II, having some accepted medical use, while marijuana in the US is Schedule I, having no accepted medical use.) Cocaine is a great vasoconstrictor—it narrows the blood vessels—and as a 2016 review noted, “there is no direct replacement for its useful unique characteristics.”

Bolivia is the only other country where cocaine is truly legal, not just decriminalized like in Portugal. In 2008, the country dramatically expelled the US Drug Enforcement Administration and withdrew from the United Nations’ Single Convention on Narcotic Drugs. The nation re-enrolled in 2013, but with an exemption for coca. Today some 3 million people in Bolivia use coca leaf.

At the same time, Bolivia began its “Coca sí, Cocaína no” program, which enshrined coca into the constitution but demonized cocaine in powder form. This makes some sense, given coca is historically deeply intertwined in Bolivian national identity, whereas cocaine powder is associated with “neoliberalism” and capitalist exploitation, according to Paul Gootenberg of Stony Brook University.

“It’s also ironic—if predictable—that the United States has failed to recognize the legitimacy of the Bolivian national experiment in drug control, despite evidence it works—probably since it is an open challenge to supply control ideology,” Gootenberg noted in a 2017 analysis.

Legal cocaine markets in other countries might expand on these Latin American models. But in addition to the nature of regulation and sales, we need to consider potential limits on grams purchased per person—and which forms of cocaine might be permitted.

Different Approaches to Different Forms of Cocaine

Whether it’s leaves from the coca plant or a line of white powder or freebased coke (crack), it’s all the same drug—but differing concentrations and routes of administration can have vastly different effects.

“Cocaine is actually a very good illustration of how the preparation of the drug and how a particular drug is used can have hugely significant impacts on levels of health harm,” Rolles says.

For 3,000 years, Andean communities in South America have chewed coca leaves to combat altitude sickness. The buzz is about as mild as coffee and may even have some health benefits. The leaves are sometimes mixed into teas and other drinks, but the concentration of cocaine is so small, it’s difficult to get very high or become dependent.

Coca leaves prepared as a tea. Via Flickr

Then, of course, you have powdered salt forms of cocaine, which are typically insufflated, or snorted. The results are more immediate, with a stronger kick. Because cocaine salt is water-soluble, it can also be injected.

Finally, cocaine in freebase form has a lower boiling point, so it can be vaporized and smoked, giving the drug a powerful rush. Low-purity freebase made with baking soda is known as “crack” due to the sound it makes when heated. Freebase cocaine has a shorter duration, but the high is more intense, lending to greater patterns of problematic use than snorted cocaine or coca tea.

Rolles supports making milder alternatives to salt or freebase cocaine available—but says that continuing to ban the other forms outright wouldn’t do much to dent the damages of prohibition.

So clearly not all forms of cocaine are created equal. Should some be allowed while others are banned? To start, Rolles supports making milder alternatives to salt or freebase cocaine available—but says that continuing to ban the other forms outright wouldn’t do much to dent the damages of prohibition. The severe and continuing harms to black communities caused by the US government’s extra-harsh approach to crack cocaine are a stark illustration of this.

“From a public health point of view, if people are going to use cocaine you’d want them to be moving away from the more potent and risky products,” Rolles says. “I’m quite interested in some of these milder cocaine products that sit between coca leaf and cocaine powder.”

He suggests cocaine gums, lozenges and energy drinks—even snus-like packets that are placed in the upper lip, simply replacing tobacco with coca leaves. Regulating these and other “mild” forms of the drug would put a dent in the illicit cocaine trade, disempowering gangs and protecting people from adulterated products.

“What prohibition does is it tilts the market towards the most dangerous products because they are the most potent and profitable,” Rolles explains, summarizing what’s known as the Iron Law of Prohibition. “Now, you’re never gonna get rid of all of it. Some people are always going to want cocaine powder. They want that rush, they want that sensation. But if you could draw away 30, 40, 50 percent of the cocaine powder users … from a public health point of view that’s still a good thing.”

A powder cocaine market should be much more strictly regulated than one for milder products, Rolles suggests, and vendors should be required to highlight safer products and discuss harm reduction approaches with customers. He also suggests forbidding secondary sales and requiring licensed access to prevent folks from buying in bulk. “It’ll be limited,” he says. “Something sensible like two grams a week or whatever.”

How Feasible Is This?

Progressive drug policy seems to be taking hold in the US. Just a decade ago, recreational cannabis wasn’t legally available anywhere, but now 10 states have adopted legalization, with many others moving in that direction. Considering esketamine’s recent FDA approval—with MDMA and psilocybin psychotherapy not far behind—psychedelic drugs seem like the next in line to be released from prohibition, at least in part.

But are stimulants really that far behind?

“Getting widespread support for relaxing laws concerning the use of stimulants will be difficult, especially under the current administration in DC,” Khary Rigg, a researcher at the College of Behavioral and Community Sciences at University of South Florida, told Filter. “But that said, even though it may not be the best time politically to propose these ideas doesn’t mean it shouldn’t be proposed. If it’s a good idea, it’s a good idea.”

You have to start somewhere—and discussing the issue is a first step.

Legalizing cocaine will require a major shift of the Overton Window—the range of ideas acceptable to the general public. One 2016 poll showed 76 percent of Americans were opposed to the decriminalization of cocaine, with only 16 percent in favor.

But you have to start somewhere—remembering the dramatic rise achieved in public support for cannabis legalization—and discussing the issue is a first step. This year’s Global Drug Survey, for example, is asking respondents whether they would be prepared to pay extra for ethically sourced, “fair trade” cocaine. Rolles aims for his yet-to-be-titled book, which he hopes will be published later this year, to further rouse that dialogue.

“When policymakers are interested in moving forward with this, they will have a solid foundation to base their advocacy on,” Rolles says. “The time is right to push the regulation debate beyond cannabis to starting to look at some of these other drugs. Stimulants seems like the obvious next place.”

Top image via Alpha Stock Images

The post Here’s What a Legal Market for Cocaine Could Look Like appeared first on Filter.

Some businesses have been taking measures to prevent injection drug use in these spaces. This has included the installation of blue lights in bathrooms, under the impression that they deter drug use. In fact, most research suggests that lighting does little to dissuade people from shooting up in public washrooms, so these sapphire fixtures exist as little more than annoying, stigmatizing décor— described by some harm reduction researchers as “symbolic violence.”

On the other end of the spectrum, Starbucks recently began a pilot program of installing syringe disposal boxes in some of its bathrooms. The move follows a petition started by Starbucks employees, who are voicing concerns about filthy restrooms and accidental needle pricks on the job. The petition has gained nearly 5,000 signatures, while some media reports suggest needle pokes are becoming more prevalent in fast food chain restaurants.

The coffee giant’s move makes perfect sense at a time when we’re experiencing a sharp rise in infectious blood-borne diseases like hepatitis C and HIV. So why aren’t more businesses following Starbucks’ lead?

A “No-Brainer”

According to Ayden Scheim, this “no-brainer” would benefit not only employees, customers in general and injection drug users, but also, for example, people with diabetes who use syringes for insulin.

Scheim is an associate scientist at the Centre on Drug Policy Evaluation at St. Michael’s Hospital in Toronto and a postdoctoral fellow specializing in infectious diseases and global public health at UC San Diego. He says the effort involved in providing a syringe disposal unit is so minimal that there’s no reason other companies shouldn’t follow suit.

“I think that people often panic unnecessarily about syringes,” Scheim says. “Nevertheless, people don’t want to come across them and people who are injecting in public washrooms also don’t necessarily want to leave [them] behind.”

The risk of contracting diseases from a used syringe is pretty small. Per WebMD:

“About 1 out of 300 health care workers accidentally stuck with a needle from someone with HIV get infected. But for hepatitis B, the odds can be as high as nearly 1 in 3 if the worker hasn’t been vaccinated for it.”  

Still, the risk is uncomfortable and unnecessary. Those affected are often treated with preventative antiviral drugs with flu-like side effects.

“It’s almost a daily occurrence that there is blood on the floor or remnants of empty baggies.”

At a Starbucks in Portland, Oregon, cleaning the bathrooms is a dreaded assignment that can sometimes be kind of scary, according to Allison, a shift supervisor who has been with the company for six years. In August, she was accidentally pricked by a syringe while throwing a trash bag in a dumpster—the second such episode at her location in the past year.

“It’s almost a daily occurrence that there is blood on the floor or remnants of empty baggies … we find empty condom wrappers,” Allison says in a call. “And within the last six months or so, there’s been a high prevalence of syringes.”

After her stick, Allison, who asked me only to use her first name, went to urgent care, where she was prescribed a round of antiviral drugs that gave her minor flu-like symptoms. Her visit and drugs were covered by worker’s compensation.

While her Starbucks location won’t yet be getting disposals, Allison says the coffee chain is listening to the concerns of her and others. The stores with the greatest need will be getting the disposals first, with others added on a store-by-store basis. “But I do think that there could be more training on how to deal with needle disposal, how to deal with partners who might come into contact with a customer who is under the influence or potentially even overdosing,” she adds.

“These societal issues affect us all and can sometimes place our partners (employees) in scary situations, which is why we have protocols and resources in place to ensure our partners are out of harm’s way,” a Starbucks spokesperson told Filter in an email. “I can’t emphasize enough that if our partners are ever in a position where they don’t feel comfortable completing a task, they are empowered to remove themselves from the situation and alert their manager. As we always do, we are constantly evaluating our processes and listening to partner feedback of ways we can be better.”

Filter also reached out to McDonald’s, Burger King, Dunkin Donuts and Intelligentsia to ask whether they have any plans to follows Starbucks’ lead, but at publication time had not heard back.  

The Coffee Bean & Tea Leaf does have a needle disposal program, with sharps containers available to employees. “The sharps disposal program has been in place for just over 18 months,” Kregg Carney, the company’s director of loss prevention, told Filter in an email. “The Coffee Bean & Tea Leaf implemented the program as an effort to make a safer work place against blood-borne pathogens and other contagions while conducting restroom cleaning duties. If a needle or sharp object is found while cleaning, employees are instructed to never touch it with bare hands. Employees are required to use the company-issued personal protective equipment to dispose of the needle or object in the provided sharps container.”

Jon Perry, VP of retail for Stumptown, also responded, and said in an email, “We constantly evaluate barista safety and make decisions to mitigate risk. We do not currently have sharps boxes installed in our bathrooms but should the need become apparent, we would address the issue.”

Maybe Don’t Blame Open Bathroom Policies

Last year, Starbucks did something else unconventional for a mega-corporation: opening its bathrooms to everyone, not just paying customers. That decision followed a notorious April incident at a Philadelphia Starbucks where an employee called the police on two black men who used the restroom without making a purchase. Now, anyone can relieve themselves at Starbucks, regardless of whether they’re swelling the company’s coffers.

This new policy has led some to speculate whether opening your bathroom to literally anyone leads to more injection drug use—as well as whether sharps disposals will make the issue worse. However, Allison doesn’t think so, and there’s not much evidence to support either theory. (Research on syringe exchange programs, for example, shows that they do not result in increased syringe litter.)

“There’s a little less barrier there, but I don’t think that that has made [injection drug use] any more common,” Allison says. “It’s just important to keep in mind that the syringe disposal and the workplace needle pricks are symptomatic of a larger societal problem.”

In other words, the overdose crisis probably didn’t happen because a coffee company was responding to allegations of racial bias.

Starbucks was one of her favorite places to inject when she was on-the-go during her time as a heroin user.

Danielle, a 34-year-old grad student in Phoenix, Arizona, says that Starbucks was one of her favorite places to inject when she was on-the-go during her time as a heroin user. She is now on methadone, but years ago, the chain’s private single stalls were sometimes a godsend when she had nowhere else to “get well.” She says she never left syringes behind because they were hard to come by and she would often reuse them.

“As a white-presenting woman, I have never had issues being admitted to a Starbucks restroom,” Danielle, who also asked me to only use her first name, says in a call. “I don’t see how it would encourage it. It’s not something that played into my decision-making process, whether there was a box or not. It almost seems absurd.”

Ultimately, if companies like Starbucks want to discourage drug use on their premises, they might want to lend their not-insignificant voices to lobbying efforts for supervised consumption spaces, places where people can use drugs under the supervision of medical staff, Allison says.

“I would really like to see Starbucks as a corporation lead the way on supporting efforts of supervised injection facilities in these high-incident areas,” she says. “If they’re really looking to create a safer space for customers and for our partners in our bathrooms in general, having a place for some of those people to be able to go and use safely that is not our bathrooms would be a huge improvement.”

But Allison is also quick to remind people that Starbucks is, essentially, in the business of selling drugs, and that shaming people who may use drugs in the bathroom doesn’t help the situation.

Is what safety precautions Starbucks puts in bathrooms really such an important conversation? Yes, Allison argues, because whether to deploy blue lights or sharps containers is part of the much larger discussion about how we frame and treat drug users in society.

“If you’re coming to Starbucks, you’re also coming to enjoy a mind-altering substance,” she points out. “Thinking about people as people, not just people who are in the bathrooms to use drugs, and thinking about larger societal solutions that we could bring to make the situation and the scenario safer for everyone.”

This article was edited on January 24 to include a newly received response from The Coffee Been & Tea Leaf.

Photo by Nick Hillier on Unsplash

The post More Companies Should Offer Bathroom Syringe Disposals Like Starbucks appeared first on Filter.

Kratom’s leaves are usually brewed as a tea. The organic chemicals contained can give stimulating or opioid-like effects, which advocates call life-saving and the federal government labels addictive and dangerous. A Schedule I ban seems imminent, which would likely devastate the estimated 5 million kratom users in America and deepen the US overdose crisis.

The effects of kratom on pregnant people and their babies are largely unknown. Before 2017, one of the few mentions of kratom use during pregnancy was a single paragraph buried in a retrospective report from a poison center in Thailand, describing a two-day old infant experiencing withdrawal symptoms. The child improved with “supportive treatment,” although it’s not clear what that means.

In the last two years, however, at least six case studies of pregnant kratom use, totaling seven infants in North America, have been published. The newborns in these reports exhibited symptoms consistent with opioid withdrawals. For example, in one of the earliest reports, “The baby had breathing difficulties, irritability, jitteriness, muscle hypertonicity, and a high-pitched, inconsolable cry.” Another report claimed it is “vital” that healthcare workers be aware of kratom’s potential impact on maternal and infant outcomes.

Notably absent from these government agency positions and media narratives—and from most of the case studies—are the voices of pregnant people themselves.

Because two chemicals in kratom, mitragynine and 7-hydroxymitragynine, are “atypical” opioids and have potential for problematic use, the drug was implicated as the cause of these side effects. In all of the cases, the babies were stabilized using morphine or another opioid, and kratom did not seem to cause any long-lasting, damaging effects, although it’s hard to be sure without long-term follow-up.

These micro-scale studies have spawned numerous media reports, from CNN to Fox to CBS, proclaiming that doctors are “sounding the alarm” about “horrifying” withdrawal symptoms. Yet virtually no data show kratom use during pregnancy to be harmful, and there is no established link between kratom and neonatal abstinence syndrome. A 2013 review simply recommended that pregnant people avoid kratom “due to a lack of sufficient data.”

Lack of evidence of safety is not evidence of harm. But the Drug Enforcement Administration seems to have made up its mind. In 2016, the agency announced intent to schedule kratom, making it highly illegal. Due to public backlash, including from several congressmembers, the DEA backed off, in an unprecedented move.

But the agency then reached out to the Food And Drug Administration for scientific review. This was completed, and a DEA decision is now pending. The FDA has issued a series of attacks on kratom, attributing multiple deaths to the herb, although researchers have disputed the interpretation of this data. In a statement to CNN, FDA Commissioner Scott Gottlieb described kratom pregnancies as “a tragic case of harm.”

“What’s important to remember is that there are no scientific data from studies of kratom in humans. Kratom is an inherently addictive product that can cause harm, and it has no demonstrated medical benefit,” an FDA spokesperson tells Filter in an email. “The FDA continues to urge consumers not to consume kratom for any purpose [including pregnancy] and urges those who may be addicted to the opioid kratom to seek help from their healthcare provider.”

Notably absent from these government agency positions and media narratives—and from most of the case studies—are the voices of pregnant people themselves. To learn more, I reached out to multiple women who have used kratom during pregnancy, as well as a couple of experts.

Experiences of Women Who Use Kratom While Pregnant

With no epidemiological data on kratom and pregnancy, we have no idea of the number of pregnant people using the drug. Kratom’s metabolites don’t appear on standard drug tests, so unless users tell their OB/GYN they take it, their use will probably go unnoticed. Many mothers are reluctant to report drug use to their doctors, even legal drug use, for fear their kids will be taken away by Child Protective Services.

“Women have a hard time coming forward about this information and that’s why it’s hard to find it out there,” says Barbara*, a 32-year old mother of three and kratom user from the US, who asked me not to share her location.

About three years ago, Barbara started a private social media group to help kratom-using moms connect. Today, the group has around 2,500 members. The vast majority began using kratom to replace pharmaceuticals, especially buprenorphine, a drug used to treat opioid addiction. (Unlike with kratom, there is relatively clear evidence that buprenorphine can cause withdrawals in newborns.)

Barbara says that hundreds of birth stories have been shared in the group. “Almost all of the birth stories, the babies are born perfectly healthy without any issues at all,” she tells me on the phone. “But there are a very small percentage, about 3 percent, that have mild withdrawal symptoms. Of those cases, about half of those the moms were taking other medications and those medications have the same possible side effects, so we do not know whether it was kratom or the other medication. And in those cases if it was withdrawal, it was very mild. In almost every case it just included fussiness and sneezing, which ended on the third day.”

“We’ve had about 150 people contribute to that poll, and all of them say that their kids have either met their milestones or are ahead of their milestones.”

Barbara herself began taking kratom to replace gabapentin, an anti-seizure medication she was using to manage breathing attacks that sometimes cause her to collapse. During her second pregnancy, she initially quit kratom. But her expanding uterus began pressing against her lungs, causing her pain, so she resumed kratom use as needed, usually once every other day.

Barbara’s daughter, who is now three, was born without complications. Encouraged by this and by testimonials from the group, Barbara later took kratom regularly during her third pregnancy, with her son who is now one. “I didn’t have any complications or problems,” she says.

Curious if other mothers experienced the same, Barbara has been polling her group over the years, including about long-term development. “We’ve had about 150 people contribute to that poll,” she says. “And all of them say that their kids have either met their milestones or are ahead of their milestones.”

That doesn’t mean there haven’t been complications, but Barbara notes that none have been life-threatening. “Nausea was probably the biggest thing … Women have complained about being more constipated.”

“Most women do not tell their doctors about their kratom use when they’re pregnant because they are afraid of CPS,” Barbara continues. “But a couple have told their doctors and two of those cases did have CPS get involved. Of course it was a nightmare, because CPS is always a nightmare, but the case was always closed at the end fairly quickly.”

For other mothers, kratom has played a determinant role in pregnancy.

“If it wasn’t for kratom, I wouldn’t have had another baby because I was on so much medication,” says Jen, 39, a mother of four from northern Utah. Jen has suffered from chronic pain and PTSD since her teens. During her first three pregnancies, she took low-dose Percocet to handle the pain. “When I found kratom, it literally saved my life. I was on seven different prescriptions and over 60 pills a day. I could barely get off the couch and my life was wasting away … after two months of kratom, I was able to stop taking everything.”

“I had no side effects while using and pregnant,” Jen says. She was taking about 18 to 20 grams of kratom per day. “My baby was perfectly healthy and beautiful. She is now 15 months and talking more like a three-year old, ahead of all milestones.”

Eliza tells me that because she admitted to using kratom, she was held in observation at the hospital for five days.

Eliza*, 38, is a mother of three from Kingston, New York. She has spinal stenosis and degenerative disc disease, and first learned about kratom through a chronic pain support group two years ago. Kratom helps her pain like nothing else, she says.

“After learning that I was pregnant [a third time], I made a tremendously difficult decision to keep taking kratom rather than switch back to opiate pain medication, as my doctors recommended,” Eliza says in an email. “I was constantly stressed about unknown consequences, as there isn’t adequate research to-date on kratom in pregnancy, but I trusted my gut; it felt like the right way to proceed.”

During Eliza’s second pregnancy, she was prescribed oxycodone, which brought her daughter to the NICU with opioid withdrawals for 12 days. But during her third pregnancy she took 30 grams of kratom tea per day, which she fully disclosed to her doctors. Her son, now seven months old, was born without complications and is ahead of all his milestones, according to Eliza.

“My doctors were very skeptical of the decision that my husband and I made for me to continue taking kratom during pregnancy,” Eliza says. “During labor and while recovering from childbirth, in the first days with our son, many of my nurses had negative reactions to my kratom consumption. I declined their Percocet, but I hid in the bathroom to mix and drink my tea.”

Eliza tells me that because she admitted to using kratom, she was held in observation at the hospital for five days. “I also didn’t feel comfortable telling anyone other than my husband, my doctors, and immediate family members that I was taking kratom during pregnancy for fear of disapproval or judgement,” she says. “I had a beautiful and uncomplicated vaginal birth, yet we declined visitors and told friends that I’d had a complicated C-section delivery to justify such a long postpartum hospital stay.”

The Need for Perspective

Anecdotes, of course, are not data, and none of this should be taken as advocating kratom use during pregnancy. But these stories do illustrate that there’s more to pregnant kratom use than dominant narratives suggest—and that more research in this area, which will become much harder to conduct if the DEA schedules kratom, would be welcome.

There’s also the question of whether kratom use during pregnancy is really so widespread as some suggest.

Joelle Puccio is a travel nurse currently based in Oakland who specializes in neonatal intensive care, working on the units where babies suffering withdrawals often wind up. In her cross-country travels, she says she has never encountered a pregnant person who says that they use kratom. She believes it’s pretty uncommon.

“Of course, the misapprehension that it’s perfectly benign is a real problem, but if it were a newly discovered synthetic, everyone would be very excited about it,” says Puccio. “It’s as if the medical establishment is pouting because somebody else found it first. This hysteria is the direct result of capitalism and racism, like the rest of the drug war.”

“It’s not surprising that people can get tolerance and dependence, but it really does seem like the infant effects are a lot milder than other drugs that we know about,” she continues. “The case [studies] where babies needed longer treatments more similar to what we currently see with heroin, methadone and buprenorphine, were all complicated by other factors and other medications. Only a couple cases described only kratom, and [in] those ones the babies were out of the hospital and done with their withdrawal in a week.”

Kratom use may bring some risks, but if it becomes illegal, it may leave some mothers with fewer options, including prescriptions that may have greater risks.

On the other hand, Marcela Smid, a maternal fetal medicine specialist and a high-risk obstetrician, believes kratom use during pregnancy is going undetected. In Utah, she manages a specialty prenatal clinic for pregnant and postpartum women with addiction. Smid co-authored one of the case studies published in October, detailing two mothers whose babies were exposed to kratom in the womb.

One mother made the switch from kratom to buprenorphine and gave birth to a healthy girl with no withdrawals. The other reported smoking kratom (uncommon in the kratom-using community), switched to buprenorphine and continued using prescriptions for escitalopram, lamotrigine and quetiapine—respectively an antidepressant, an anticonvulsant and an antipsychotic. Her daughter was born healthy, but did suffer opioid withdrawals, which were treated with morphine.

“In a year, I have seen three women with kratom,” Smid tells me on the phone. “It makes me think that the prevalence is probably much higher than we know about [because] we’re not asking about it, and it doesn’t come up on any drug screen.”

Smid says that more doctors need to be aware their patients could be using kratom. According to her, kratom is quite familiar in the addiction treatment world, but in the obstetric world it’s almost completely unknown.

“I do not recommend kratom use in pregnancy and postpartum as we simply do not understand enough about the herb to know what the risks and benefits are,” Smid says. “If someone is using kratom to self-treat an opioid addiction, I encourage them to seek care with an OB knowledgeable in perinatal addiction or an addiction specialist. The risk of relapse with untreated addiction is high, especially postpartum when the risk of relapse, overdose and death is highest.”

“Seeking treatment for addiction while pregnant can be a scary notion for many women,” Smid adds. “Getting treatment is the best things moms can do for themselves and for their babies.”

“I really don’t want to do that and it just makes me want to cry.”

If, as Smid says, the prevalence of kratom use during pregnancy is high, it would suggest that the prevalence of reported associated problems is relatively low. And while no one would argue against the availability of addiction treatment for those who seek it, such programs are often scattered or expensive, making access to drugs like buprenorphine more about privilege than desire. Which gets us to the root of the issue: why pregnant people are using kratom in the first place.

“If she’s using kratom instead of heroin, I would consider that to be harm reduction,” Puccio says. “If she was using it [instead of] cannabis, that I maybe would not consider to be harm reduction. It just would depend on the context.”

“Pregnant people take drugs for the same reasons that anybody takes drugs,” Puccio adds. “Even in the case studies, a lot of people were taking it to get off other opioids. There was the one gal that had the chronic back pain and fibromyalgia, there was one lady that had uncontrolled anxiety and depression. These are the reasons that people take any drug and a lot of these conditions tend to be exacerbated by pregnancy, especially lower back pain, anxiety and depression.”

In other words, kratom use may bring some risks, but if it becomes illegal, it may leave some mothers with fewer options, including prescriptions that may have greater risks. “I see [kratom] as something that could really help babies, to be honest, just because of what the alternatives are,” Barbara says.

If kratom is banned, Barbara hopes that she and other moms in her kratom group are given enough time to wean off it slowly. “Especially the moms that are pregnant, that’ll be important,” she says. “And then, I don’t know, I’d just have to go on my track of trying one medication after the other again, which is a complete nightmare, and I really don’t want to do that and it just makes me want to cry.”

*Names have been changed.

The post Fears About Kratom Use During Pregnancy Are Overblown appeared first on Filter.