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  • What Causes False Positives on Drug Tests?

    What Causes False Positives on Drug Tests?

    Most instant drug tests are notorious for picking up false positives from common medications like antihistamines, antidepressants, antipsychotics, antibiotics, and analgesics. Poppy seeds can give a “true” positive.

    I had a routine during my pregnancy with my elder daughter. Each morning I woke up as late as possible—which never felt late enough—took a quick shower, and waddled over to my bus stop. There, while waiting for the bus, my senses sharpened in the thin, crisp mountain air and the yellow morning sunlight stretching its way across Boulder, Colorado. Sometimes I snoozed a little more on the bus—I’ve always been a sucker for vehicular motion. On less sleepy days, I watched out the window for prairie dogs bopping across the acres and acres of lush green land.

    I was riding into town for Naropa University, where I was attending grad school in the footsteps of Allen Ginsberg, Anne Waldman, and William Burroughs. But every day I turned into downtown several hours early for my classes. It wasn’t by choice, but because I was taking methadone to treat my addiction to heroin.

    Being new to the program meant I hadn’t yet earned take-home doses, so I had to ride in every day before the clinic closed and drink down my syrupy pink dose in front of a nurse. It was annoying, but I discovered a small comfort: my bus dropped me off next to a small, vegan-friendly grocery store called Sprouts. So before I dosed, I would stop in and treat myself to piece of sticky-sweet, lemon poppy seed cake. It would not take long for me to discover the weird, unexpected consequence of my treat.

    How to Get a False Positive for Opioids

    “Your UA was positive,” the nurse said, lips pursed, about two months into the program. I wasn’t showing yet but all the staff knew about my pregnancy.

    “For what?” I asked.

    “Opiates.”

    I laughed. “Well I’m on methadone.” At the time, I didn’t know clinics could differentiate between synthetic and non-synthetic opioids.

    “No, not the methadone.”

    Now I was pissed. I hadn’t used—not since enrolling in the program. Earning a take-home would depend on my compliance with the program, which meant testing negative every time they demanded I pee for them. Worse, a positive drug test during pregnancy could mean a child services investigation down the line.

    “I didn’t relapse,” I insisted. The nurse just stared at me. Then I remembered that urban myth I’d heard—that eating poppy seeds could trigger an opiate positive on a drug test. “I’ve been eating poppy seed cake,” I told the nurse.

    “You’d have to eat a whole lot of poppy seeds for that to happen,” she said.

    But I insisted that the positive was wrong. Finally, she relented and agreed to send my sample for confirmatory testing. A few days later, she reported that the levels of morphine in my urine sample suggested it had, in fact, come from a food source. Turns out, poppy seed positives are not an urban legend at all—in fact, they are even recognized by the U.S. government, which actually raised the opioid detection cutoffs to avoid these types of false positives for military personnel and other government employees.

    The Problem with Poppy Seeds

    Poppy seeds trigger a positive for morphine. Opium and its derivatives—which means any naturally occurring opioid—come from papaver somniferum, a type of poppy plant. It is grown commercially for the development of pharmaceutical drugs and for the harvesting of food-grade poppy seeds. But because of their origin, these seeds can contain tiny amounts of opioid alkaloids, which metabolize similarly to morphine or codeine. It’s not enough to produce a euphoric effect—but it can be enough, depending on how much is consumed, to trigger a positive on a drug test. And that positive is, in fact, a “true positive,” at least in the sense that your body produced that metabolite.

    Poppy seeds will trigger a positive for opioids on a general panel, or for morphine and sometimes codeine on a more detailed test. The problem here is that other opiates—including heroin—will also trigger a morphine positive. Heroin has its own unique metabolite, 6-monoacetylmorphine, but that will only show up for about 24 hours, whereas morphine from heroin use can show for up to a week.

    When my nurse said the test confirmed my positive was the result of poppy seeds, she probably meant the levels were too low to show up in the confirmatory test. The truth is that there is no way to definitively link a morphine positive to poppy seeds, leaving the decision ultimately up to clinical judgment.

    “They do try to correct for this by establishing cutoff limits,” says Ryan Marino, an emergency medicine physician and toxicologist with the University of Pittsburgh Department of Medicine. “So the person who is running the test might see the positive but it’s below the threshold, so it gets reported as negative.”

    In the late ‘90s, the Substance Abuse and Mental Health Services Administration (SAMHSA) changed the detection cutoff for morphine from 300 ng/mL to 2000 ng/mL in an attempt to prevent federal employees from losing their jobs over a bagel topping. While a bagel probably won’t trigger detection at that cutoff, something with a higher concentration of poppy seeds still might, like a poppy seed paste. And the SAMHSA cutoff is a recommendation; if you’re a government employee, your tests should follow that guideline. But other drug test administrators are under no obligation to adhere to the SAMHSA regulations. Treatment facilities or doctors’ offices might use lower cutoffs, making their tests more likely to detect the consumption of poppy seeds.

    False Positives on Instant Urinalysis Kits

    Poppy seeds aren’t the only substance that might trigger an unmerited positive on some drug tests. Immunoassay tests, the kind used in most instant urinalysis kits and as a preliminary screening tool in the lab, are notorious for picking up false positives from common medications. These include antihistamines, antidepressants, antipsychotics, antibiotics, analgesics, and other over-the-counter medicines. Specifically included on the list are ibuprofen, dextromethorphan (an ingredient commonly found in cold medicine that has its own intoxicating properties), diphenhydramine, pseudoephedrine, and ranitidine (an antacid/antihistamine). These drugs can cause positives for different substances, including THC, opioids, or benzodiazepines, but the most common false results are amphetamines.

    Positives that result from poppy seeds are tricky because they are, in a sense, genuine positives. Your body has, in fact, metabolized an opioid alkaloid; it’s just that it didn’t come from an illicit source and it wasn’t in quantities that could produce an intoxicating or euphoric effect. But when a positive for methamphetamine is triggered because you took some cold medicine, that’s a false positive—and that can be determined conclusively by further lab testing.

    Marino says that many of these substances are structurally very similar, “so it makes sense that enzyme tests can’t tell the difference… but if you send it out [to a lab] for gas chromatography-mass spectrometry or liquid chromatography-mass spectrometry testing, that would be able to pick up most of these compounds.”

    The only issue here is whether whoever is testing you is willing to send the sample for another test. If you’re being tested on-site for a job, it’s entirely possible that your employer does not have a system in place for sending your sample to be examined in a lab. So you should definitely tell your employer in advance of the test if you have taken any medications. Hopefully, if it’s one that could trigger a false positive, your employer will give you the benefit of the doubt.

    What About CBD?

    Another substance that trips people up is cannabidiol (CBD). CBD is the non-intoxicating chemical compound found in the cannabis plant, which is generally credited for many of the plant’s medicinal properties. CBD was recently approved by the FDA to treat seizures and is marketed as a medicine called Epidiolex.

    But you don’t have to be prescribed Epidiolex to get your hands on CBD. It’s sold in a variety of stores and can often be found in smoke shops, vape stores, and recreational marijuana shops. People often wonder, however, if CBD can trigger a marijuana positive on a drug test. The simple answer is no: Drug tests look for THC, the intoxicating ingredient in marijuana. They don’t test for CBD, so CBD won’t make you pop positive for THC.

    The reality is a little more complicated. Because CBD is derived from the same plant species as THC, trace amounts of THC can end up in your CBD product. In order for CBD to be (mostly) legal, it has to come from a hemp plant (and there’s some weird politics around even that). That means the plant can’t contain more than a trace amount of THC. So if your CBD is coming from a hemp source—and if you’re buying it from a non-medicinal source in a state that has not legalized recreational marijuana, it probably is—then it’s unlikely to contain more than a trace amount of THC. And that should not show up on a drug test.

    But you do need to be careful to check your sources, especially if you’re buying from a rec store. Some companies intentionally add small amounts of THC because they believe it potentiates the therapeutic effects of the CBD. Those small amounts can range from 1 percent to 15 percent—and that amount can be detected in a urine test. It’s not a false positive, either. Even if you didn’t “feel” the THC, you still consumed it. So you won’t have much ground for disputing those results. Basically, if you’re going to use CBD, check your sources and make sure the THC levels fall below 0.3 percent, which is the legal limit for a hemp product.

    Drug testing is a politically complicated practice. Many people find it degrading, or feel that it adds an unnecessary element of surveillance into their lives. Nonetheless, if you find yourself in a position in which you have to take a drug test, it’s important to understand how and why a positive could show up even when you haven’t consumed illegal drugs. Bottom line: If you know you’re going to be tested, skip the poppy seed muffin.

     

    Have you ever gotten a false positive? Give us the details in the comments.

    View the original article at thefix.com

  • Dear Daddy, Why Didn't You Protect Me?

    Dear Daddy, Why Didn't You Protect Me?

    Instead of worrying about being attacked by some random person on the street, I lived with my attacker 365 days a year.

    My stepmom couldn’t remember if he whipped out a knife or a pipe of a similar size, but she recalled the moment the perp appeared over her left shoulder. She was leaning against my dad’s car, parked in front of the apartment building he owned on George Street in Norristown, Pennsylvania. They were there that night cleaning up after the first-floor tenant who’d recently moved out after dodging his rent for months. My dad was still inside when my stepmom stepped out for a cigarette. That’s when she says she was attacked. But just as the man who appeared over her left shoulder was winding up to bash or stab her, my dad popped out from the darkness and swatted him away. The details at that point get fuzzy because as my stepmom recalled, she was in shock, her body trembling as she collapsed into my dad’s chest like a wet noodle.

    “Your father saved me,” she’d lament whenever she told the story. “He’s such a good man…such a good man.”

    My dad began dating my stepmom before my parents divorced when I was four years old. As part of my parents’ agreement, my two older brothers, practically residents at the local juvenile hall, stayed with my dad while I moved with my mom to East Falls, Philadelphia. With the three of us kids figuratively gone, my dad was free to court my stepmom, and he did so with fervor. Newly divorced herself, and emotionally impaired by her allegedly abusive ex-husband, my stepmom basked in my dad’s undivided attention and unsolicited protection. It was through her stories about my dad’s acts of chivalry — rescuing her when her car broke down in a blinding blizzard or refusing to let her enter her apartment before he inspected every room and closet — that greatly influenced my perception of my dad. As a little girl, my father was more than a good man; he was my superhero. Until I realized he wasn’t.

    The disparity between my dad’s willingness to protect my stepmom and his inability to express even the slightest concern over my wellbeing became painfully clear while I was living with my mom and the man who eventually became my stepdad. They were both alcoholics with ravenous appetites for violence and our home was a war zone. Instead of worrying about being attacked by some random person on the street, I lived with my attacker 365 days a year. I spent many school nights and weekends watching my stepdad choke my mom on the living room floor. I scrubbed her blood off the sofa when my stepdad split my mom’s lips open, and when she turned her rage in my direction, I dodged the knives she thrust at my back and hid the patches of hair she ripped off my head.

    Literally and figuratively, I wore the scars of an abused kid. But unlike the thick coat of protection my dad offered my stepmom, he couldn’t be bothered to do anything about the hell I was experiencing. And it wasn’t because he didn’t know. My mom and stepdad didn’t keep their lifestyle a secret; on many occasions, amid a drunken fit, my mom called my dad.

    “I’m gonna kill your fuckin’ daughter,” she threatened. There would be a short pause while my dad responded.

    “Come and get your little bitch,” my mom screamed into the receiver while looking right at me.

    “You hear that?” she said. “Your dad’s not comin’, he doesn’t fuckin’ want you.”

    Despite the many things my mom got wrong when she was drunk, she wasn’t lying about my dad. He only lived a quick 30-minute drive away, but she was right. He wasn’t coming.

    When I was eight years old, my mom effectively kicked me out of her house. Oddly, it was the idea of me being homeless and not my mom’s drunken threats to kill me that motivated my dad to act. And although I was relieved to be moving away from the chaos, living with my dad and stepmom became a nightmare of a different kind.

    Slowly I realized it wasn’t only boogeymen lurking in the dark or tales of abusive ex-husbands that my dad protected my stepmom from. He was also willing to shield her from me if she felt she needed it, no questions asked. Once at a family gathering, my stepmom grew increasingly annoyed when I wouldn’t get off the couch and play with the other children. At ten years old, I was painfully shy and didn’t know how to approach a group of kids I’d never met before. When I wouldn’t budge, my stepmom stormed out of the house and my dad and I followed. On the front lawn, she turned to me and said, “Great, now everyone is going to think you’re retarded.” As I started to cry, my dad wrapped his arms around my stepmom and looked away.

    To this day, my dad has yet to acknowledge the life I lived with my mom and stepdad. He never asked me what it was like to watch my stepdad bash my mom’s face into a mirror or how sick it made me feel to have to tell my stepdad I loved him when there wasn’t a cell in my body that did. No, he never once inquired, but on several occasions he brought up my stepmom’s childhood. He shared how her father died when she was young and how her mother was never around. And while my stepmom’s upbringing may have been less than ideal and could have affected her behavior in certain ways, I’ve never understood how my dad could compare my experience to hers. I don’t know how he could look me in the eyes and say, “You know, your stepmom had it bad too.”

    A few months before my 18th birthday, my dad was hit by a car. One of his hips was nearly shattered, and after being released from the hospital, he spent weeks laid up in bed. One night we got in an argument over something trivial. As our exchange escalated, my stepmom burst into the room, grabbed me from behind and shoved me towards the bedroom door. Although she had occasionally spanked me for misbehaving when I was younger, this was the first time she put her hands on me as an adult. As I regained my balance, I turned towards my stepmom and paused. Although my body was still, in my mind I’d already lurched forward and pinned her against the wall.

    What happened next snapped me out of my fantasy. Off to my left, I watched my dad, who’d been bedridden for weeks, thrust himself out of bed. Although he barely had the strength or the balance to stand, I knew if I caused any harm my dad would call the police and I’d be the one leaving in handcuffs. Given my lack of options, I did the only thing I had the power to do. I walked away. I knew who my dad would choose to protect and defend.

    View the original article at thefix.com

  • What Is Evidence-Based Addiction Treatment?

    What Is Evidence-Based Addiction Treatment?

    12-step programs are an incomplete approach and do not meet the requirements for evidence-based treatment because they lack biomedical and psychological components, and they use a one-size-fits-all approach.

    When looking for treatment for addiction, there is a lot of information out there and countless opinions. Friends, family, doctors, researchers, and people in recovery all have their own beliefs about what you need to do to get well. Unlike in other areas of healthcare, addiction treatment is often deemed “effective” based on anecdotal reports. In fact, most people who seek or are forced into treatment do not receive health care that is aligned with evidence-based practice.

    A frequently-cited definition comes from a 1996 article in the BMJ Medical Journal: evidence-based “means integrating individual clinical expertise with the best available external clinical evidence from systematic research.” Other definitions also include the patient’s individual circumstances, preferences, expectations, and values.

    These variables are not necessarily constant, and there is no one-size-fits-all solution; any list of evidence-based treatments is going to include a wide variety of approaches.

    What is Addiction?

    In the United States, addiction is still treated more as a crime than as a chronic illness or disorder. Until that perspective changes, treatments will not meet their full potential and will not be as effective as they could be. Addiction, or substance use disorder (SUD), is a chronic medical condition that has remissions, relapses, and genetic components.

    Are Relapses Normal?

    A relapse is not a failure but a symptom. The brain of a person with SUD has gone through neurobiological changes that increase the risk of relapse because the damaged reward pathways stick around much longer than the substances stay in the body. Stressful events and other painful life experiences can trigger that maladaptive coping mechanism and cause a relapse.

    For other chronic illnesses we would consider a relapse to be an unfortunate symptom of the disease, and we might call it a recurrence instead of a relapse. When successfully managed, the condition is considered to be in remission. Remission is a term that is relatively new in addition treatment; substance use disorder was not always believed to be a disease but rather a moral failing and a problem of willpower. We now understand that addiction is a chronic medical condition and that remission is the goal of treatment. Remission, as defined by the American Society of Addiction Medicine, is “a state of wellness where there is an abatement of signs and symptoms that characterize active addiction.”

    What Is Successful Addiction Treatment?

    Let’s take a look at what it means to have an effective treatment outcome in terms of addiction. The primary goal is usually abstinence or at least a “clinically meaningful reduction in substance use.” To measure effectiveness, we must look at how and if treatment improves the quality of life for the patient. Improving quality of life is the aim when treating all chronic conditions that have no cure.

    Evidence-based therapies do not support the notion of “hitting bottom.” As with any chronic disease, early intervention is going to provide the best outcomes. Even more effective than early intervention is prevention because SUDs are both preventable and treatable.

    Pharmacotherapies to Treat Substance Use Disorders

    Addiction is an overstimulation of the brain’s reward pathways, and as the condition progresses, the brain becomes less sensitive to the rewarding effects of a drug and requires more of the substance to get the same effect. This overstimulation can play tricks on memory recall, turning experiences that were not good into ones that seem better than they actually were. It creates false memories to encourage re-indulging in the addictive substance or behavior.

    From a medical standpoint, this disparity needs to be interrupted and corrected. Akikur Mohammad, the author of The Anatomy of Addiction, argues that successful treatment of addiction “must first address the biological component and correct the brain’s chemical imbalance in the process.”

    Pharmacotherapy is used in medication-assisted treatment and recovery. Depending on the patient’s individual drug history, different medications may be used to mitigate the brain’s compulsive race to stimulate the reward loop.

    Therapy for Substance Use Disorders

    Most research on therapy for substance use disorders has been done on cognitive behavioral therapy (CBT)—a form of typically short-term psychotherapy that combines talk therapy with behavioral therapy. Patients are taught how to adjust their negative thought patterns into positive thoughts. There is clinical evidence that CBT can be as effective as medications for many types of depression and anxiety. For treating SUD, CBT has been shown to have a “small but statistically significant treatment effect” but doesn’t necessarily have a long-lasting effect. As it’s a chronic illness, it stands to reason that SUD requires further maintenance beyond any short-term treatment.

    Are 12-Step Programs Evidence Based?

    Alcoholics Anonymous and other 12-step programs use a social model of recovery. They are built on the basic notion of peer support in a safe environment. There is research on the efficacy of 12-step programs, which shows it works for some people and that there are benefits to this social model of recovery. The steps, or rather the principles of the steps, must be internalized into a person’s psyche in order for the person to achieve lasting abstinence. 12-step programs are an incomplete approach and do not meet the requirements for the classification of evidence-based treatment because they lack biomedical and psychological components, and they use a one-size-fits-all approach.

    One central tenet of the 12-step solution requires turning one’s will over to the care of a higher power. Certainly, letting go of the notion that force of will can change the trajectory of addiction is necessary for any treatment. It’s a disease, and willpower will no sooner cure addiction than it will cure diabetes or heart disease. An evidence-based approach could mean that a doctor recommends a patient attend a 12-step program, or other support group, as part of a maintenance regime.

    The addiction treatment world is overrun with rehabs that primarily utilize 12-step programs, which are touted as the only treatment for addiction. That simply isn’t true. Addiction researchers have found that individually, cognitive and behavioral therapies, including social supports like 12-step programs, are incomplete treatment for a chronic disease that is both physiological and genetic in origin. From a treatment perspective that is grounded in evidence-based practice, involvement in a support group would be merely one piece of the puzzle.

    Holistic Care

    In evidence-based practice, the treatment process individualizes care and uses a holistic perspective to see what combination of resources will work best for a particular patient. The combination of treatment tools depends on a clinician’s specialized knowledge, the patient’s values and preferences, and the best research evidence. We need more specially trained addiction clinicians who can help people with SUDs make informed treatment decisions.

    Are you in recovery from addiction? What worked for you? Tell us in the comments!

    View the original article at thefix.com

  • When Love Is Not Enough: How We All Failed My Sister

    When Love Is Not Enough: How We All Failed My Sister

    These are the ugly, dark parts of mental illness and drug addiction that no one talks about, and by not talking about it, it stays hidden, and shameful, and powerful, and deadly.

    My sister had 765 “friends” on Facebook. I don’t think I even know that many people. But I can count on one hand how many of those friends came to visit my sister during her four-month hospital stay. So apparently they were friends, but not quite that close.

    I believe that if regret had a smell, it would be the smell of something burnt and visceral, and sharp in your nostrils. I think of that every time I listen to the last voicemail that my sister left me. It was so normal, absolutely nothing special about it, like the countless other messages we had left each other.

    “Hi baby girl, it’s me. Call me back. Love you.”

    Sometimes I listen to it just so that I can hear her voice, but often I find myself straining to hear something that I must have missed. Did she know that she was dying? Was there some sort of resolve in her voice? Or was that loneliness? But mostly what I hear is regret. Mine, of course, not hers. Because no matter how much I loved her, I couldn’t save her. I am painfully aware that I failed my sister. Sometimes I think that we all did.

    Malika and I were two years and 10 months apart, and about as different as two people carved from the same parents can be. She was always the pretty one, the free spirit, and she had the goofiest sense of humor. The boys simply didn’t see me when we were together—she shone that brightly—and we could fight like nobody’s business. But above all, she was amazing to me.

    My sister was diagnosed with bipolar disorder and schizophrenia in high school, which apparently is a common age for that to rear its ugly head. We both shared a sort of rebellious streak borne out of a sometimes-tumultuous home life and an ugly divorce between our parents, but she never really grew out of hers. She had a self-destructive side but it was always directed inwards—she never set out to hurt anyone but herself. I can see clearly now that for years, she was self-medicating.

    There were many times over the last few years that I had no way of getting hold of her. She often changed her phone number, and she and her boyfriend moved around a lot, either by choice or necessity. That was the thing about my sister: when she was healthy enough and able to be around people, she was great. Absolutely great. But often, and particularly in the last several years, when she didn’t want to be found, she went completely off the grid. I had heard rumors that at one point she was seen in the city begging for money for drugs. Another time I heard she was staying in the house we had grown up in while it was empty and in foreclosure.

    I ask myself all the time what I could have done differently, or what I should have done. But you cannot save someone who doesn’t want to be saved, and you certainly can’t force them to get help. If you give them money, you know where it’s going to end up, but do you do it anyway? I’ve been on both sides of this, and I know that you’re damned if you do and damned if you don’t. And when you don’t, they hate you and disappear again—proving that it was the only reason they resurfaced in the first place.

    I don’t even know how many times my sister tried rehab over the years. I do know that she tried. She had been in a day treatment program and was on methadone when she was admitted to the hospital last August. She was confused, bloated, and had no idea where or who she was, and she didn’t recognize me when I first came to see her. She had every drug you can think of in her bloodstream. They said that the confusion was caused by a bacterial abscess on her cervical spine just below her brain that had developed from repeated IV drug use with a dirty needle, and they started treating her on a wide spectrum of antibiotics. About a week in, she started coughing up blood and spiked a fever. Despite being on so many antibiotics, the infection in her bloodstream had attached itself to a valve in her heart, and every time her heart beat, it scattered more of the infection throughout her bloodstream. She slipped into a coma at that point and ran a fever that ended up lasting for weeks.

    Watching her go through that was a special kind of hell, wondering if she was ever going to wake up. She went in and out of consciousness and agitation as the doctors wrote things down like acute respiratory distress (ARDS), MRSA, MMSA, endocarditis, pneumonia, and acute pulmonary edema. All the while her fever kept climbing and I sat with her completely helpless, watching the numbers climb and her cooling blanket sweating into a puddle on the floor. Eventually they had to do a tracheostomy because she wasn’t breathing properly on her own.

    At the end of October, they finally managed to keep her fever below 100 degrees for a full 48-hour window and were able to take her into surgery to replace the heart valve that by now had been completely destroyed. The surgeon very kindly and very gently told me to prepare for the worst because even in a very healthy patient, open heart surgery brings significant risks. In Malika’s severely compromised state, the odds were not at all good that she’d wake up from surgery.

    But true to form and consistent with her defiant and rebellious spirit, she did. Amazingly, I began seeing my sister come back to me. Despite all the odds, she started to bounce back and gradually brought her spunky personality and wicked sense of humor with her. I’ll never forget the day I walked into her room and she simply smiled and said “Hi Shawn,” like it was no big deal. I remember that I actually stopped walking and that when I tried to speak, I was so caught off guard that it came out in a strangled sob; just that morning, she was finally improving enough that the doctors were able to take her trach out, and she was able to speak for the first time in I don’t even know how many weeks.

    I wish I could say at this point that her story became a fairy tale and she walked out of the hospital and into a brand new life with the second chance she was given. But addiction is not all sunshine and roses. The truth is, the better she got, the more she simply wanted out, and all the talks we had about rehab gradually fell away. She made up her mind that she was fine and just wanted to be free of all the IVs and round-the-clock medical care. What everyone involved in her treatment overlooked was that during the entire four months she was hospitalized, there were no concrete plans being made for her recovery, no drug treatment, no 12-step program, nothing to work on the addiction that had been slowly killing her since we were teenagers.

    This realization fully hit me for the first time when she was caught by one of her nurses trying to drink the alcohol gel beads inside one of her ice packs. The nurse told me that she had been asking for them on a regular basis and had apparently been hoarding them for just this purpose. Up until that moment, I’d never understood why they took away perfumes and mouthwash and anything else with even trace amounts of alcohol when you check into rehab. Malika was not clean or sober during those four months she was hospitalized. She was simply separated from her addiction.

    Which is why, after seeing her nearly every day for those four months that she was in the hospital, she quietly pulled away from me after she was discharged at the end of December. She never did check into the rehab or residential facility that she promised she’d go to when she got out. Gradually, she stopped returning my calls and texts.

    So I wasn’t that surprised when the hospital called on May 25, 2018, just five months later, to tell me my sister was admitted back into the ICU and that, as her healthcare proxy, they needed my consent to treat her since she was wasn’t coherent. This time, the doctor said that the spots on her arms were a sign of heart failure, and an MRI showed that the confusion was caused by scattered spots of bacteria throughout her brain. That beautiful, robust new heart valve that had given her a glorious second chance at living just a few months before was now infected from a dirty needle again. And when the doctor said that her fever this time upon admission was 109 degrees, I was sure I heard him wrong. I didn’t even know that was possible, and that was while she was wrapped in a cooling blanket. They watched her around the clock for seizures and told me she would likely have brain damage when she woke up. When her fever finally broke and she came to a couple days later, I remember thinking that the light in her eyes had dimmed. She never really bounced back this time.

    When I went up for my daily visit with her at lunchtime on June 5th, we had one of the best visits we’d had in months. I remember very clearly telling her how much I loved her hair short, and how she was sitting on the side of her bed swinging her feet like a little kid. I remember her telling me that she was so sick of being in the hospital and that there was never anything good on television. But for the life of me, I cannot remember how we ended that visit. Every single time I left the hospital after spending time with her—every single time—she made me promise that I’d come back to see her. And I’d always laugh and tell her of course I would, I always do. It had almost become a ritual: I knew she’d say it, childlike and sweet, and she knew exactly how I’d respond. Maybe it was reassuring to her and she just needed to hear it. Or maybe I just wanted to remind her that I’d always come back. But I have replayed our conversations from that day over and over and over again, and I cannot remember her asking me to make that promise to her on that afternoon, or what I said to her when I left. And it haunts me.

    That night, just before midnight, I was woken by someone banging on the front door and the dog flipping out. My husband opened the door bleary-eyed. A friend of my mom’s stood there, frantic, saying that we had to come right away to the hospital; they had been trying to call me and couldn’t reach me. She said my sister’s heart had stopped and she was dying. I couldn’t comprehend her words. I told her I’d just seen my sister that afternoon and we had a great visit and she was fine. We don’t have time, she said. Just come. 

    When I grabbed my phone, I saw I had seven missed calls from the hospital. Seven. We got to the hospital in record time; a nurse was waiting for us and waved us to her room.

    Malika died a few minutes before we got there. Minutes. I will always believe her death occurred after one of those seven calls, and that I was too late to save her, again. They told me that the overnight nurse came to check her vitals and found her in bed, unconscious with foam on her lips. They think she must have had a seizure, and her heart, which had already been through so much, finally gave out. One of the nurses rode the gurney doing CPR all the way up the elevator and into the intensive care unit, but they were never able to bring her back. She was 43.

    Most of that night is a blur, stretched out unnaturally long in some places and disjointed and quick in others. But what I remember most clearly is the look on my sister’s face, and I carry that image with me, especially on the hardest days. I had come into her hospital room countless times when she was sleeping, and sometimes I just sat with her while she slept, while other times she woke up to talk with me for a while. But in all of those times, she kept this tiny wrinkle in her brow while she slept—like she was trying hard to remember something important. That night, though, that little wrinkle was gone, and she looked relaxed, peaceful, even. I realize that sounds so cliché, but it’s the only way I can describe it. She was finally, finally free of the demons she’d been running from for most of her adult life.

    These are the ugly, dark parts of mental illness and drug addiction that no one talks about, and by not talking about it, it stays hidden, and shameful, and powerful, and deadly. And I am not ashamed of any of this—just unbearably sad for what my sister went though—and I am so angry at myself for not having done better. For not knowing what to do, or what she needed, and believing that she wanted me to stay at an arm’s length when she must have been in so much pain. In all the days since my sister passed, I’ve promised her that I would do something on her behalf, so that what she went through wasn’t in vain. I am still working on this.

    But for now, I will continue to take my sons to the memorial bench that we bought for their Aunt Malika in the middle of a wildflower garden at a nature park near our first house, and I regularly talk to them about their goofball aunt who loved them more than life itself. I want to be sure they remember her at her best, while also understanding in no uncertain terms that if she could have beaten this horrific addiction, she would have, and she’d still be here to watch them grow up. I want to share her story because she was so much more than the addiction that claimed her life in a horrific and painful slow-motion free fall.

    Malika was beautiful, wickedly smart, funny, kind, and free-spirited. I want people to remember her as the girl who followed Phish for a month one summer with her old boyfriend and their dog in a piece of crap van that they took across the country. Or the girl who wore her long, curly hair in pigtailed knots while she danced with my sons in the kitchen to Christmas songs in July and would do absolutely anything to make them laugh. Or the girl who could talk to and make friends with anyone, absolutely anyone, with ease.

    It is that girl that I remember when I sit on her bench with the sun on my face and my eyes closed, remembering the sound of her laugh. I hope she knows how sorry I am that I didn’t do better for her, and how much I love her. And that even though I sat with her every day, I was ultimately no better than the 765 friends who did not. Because I didn’t know how to fix this.

    View the original article at thefix.com

  • Nice to Meet You, Will You Marry Me: Life as a Newcomer in Sobriety

    Nice to Meet You, Will You Marry Me: Life as a Newcomer in Sobriety

    Relationships make us feel good. And if we haven’t done the work to grow in the areas of emotional sobriety, we will quickly find that being in a relationship has become our new fix.

    One of the trickiest things to do in recovery is practicing mindfulness and awareness after putting the dope down and learning how to stay sober. Emotional sobriety is paramount when it comes to remaining sober. I believe that if I can grow in the areas of low self-esteem, codependency, anger management, and intimate relationships, then the act of not self-medicating becomes extremely easy.

    Those four areas are very important to address and work on while getting sober.

    I use because I am obsessed with the desired effect. When I put the drug in me I feel better. So when I’m not feeling good about my image or who I am as a person, I want to medicate. When I’m acting out in a codependent way, I want to medicate. When I’m struggling with anger, I want to medicate. I don’t feel good; I want to feel good. Drugs help me feel great.

    If it weren’t for all the consequences that come along with using, I’d be high right now.

    Love Is the Drug

    Let’s talk about the fourth area: relationships.

    A wise man once told me that relationships would be the hardest thing I’ll ever do in recovery. Those words never rang truer in my life than the day I finally got into one. It takes work, it takes patience, it takes a whole lot of faith and trust. It takes looking inward and being mindful of many things: who I am as a person, my morals, my ability to listen and show empathy, and making sure I’m living honestly with integrity. It takes courage and many other things that only come by living a holistic recovery lifestyle. When I do these things, my relationship is very rewarding for myself and for my partner. Even through conflict, we come out stronger.

    So factoring in all that, imagine being someone with low self-esteem; somebody that struggles with codependency and is quick to anger. Now imagine getting into a relationship when you haven’t grown in those three areas. On top of all that you’re still figuring out how to simply stay sober. What a beautiful recipe for disaster. It would be a miracle if you didn’t use in the end.

    If I haven’t grown in those three areas, it’s safe to say that I still don’t feel good about myself. And if I don’t feel good about myself, my knee-jerk reaction is to find something to make me feel better. And if the lifestyle of a person in active addiction is codependent in nature, imagine how potentially deadly it would be to engage in an intimate relationship.

    I mean, let’s be honest. Relationships make us feel good. We feel wanted, we feel important, depending on the situation we feel attractive, the endorphins are flowing, the dopamine is at an all-time high, not to mention the sex is probably amazing! Relationships make us feel good. And if we haven’t done the work to grow in the areas of emotional sobriety, we will quickly find that being in a relationship has become our new fix.

    It’s intoxicating and obsessive. The desired effect is immediate. Almost sounds like using drugs. Now the term “drunk in love” isn’t such a stretch, is it?

    And that’s why it’s recommended to stay out of a relationship your first year in sobriety. It’s not because sex is bad or being in love is wrong. It’s because relationships make you feel good too soon, too often. I need to give myself an opportunity to recover in all areas of my life before I can think about anyone else.

    Essentially, I have replaced the drug with a person, most likely another person in recovery because those bonds are deep. And now there are two lives at stake. It’s dangerous.

    I’m not trying to scare anyone away from pursuing a relationship, I’m simply saying to be mindful and aware. Assess where you’re at in your personal recovery before you start messing with someone else. Especially if they are in recovery as well.

    That reminds me of a story.

    Falling in Love at a 12-Step Meeting

    I remember one of my first 12-step meetings. I was at an all-time low. I had just gotten out of jail, I looked like shit, my car had gotten repossessed, I was jobless, on probation, and coming off of painkillers, my real true love. When I got to the meeting there was a woman standing by the door greeting everyone. She made eye contact with me, smiled, gave me a hug and told me her name. She opened the door and pointed towards the coffee. I’d finally found her! The one I had been waiting for my whole life! I was in love!

    I sat through that whole meeting obsessing over her. I couldn’t keep my eyes off her. When it was her turn to share, I thought I heard the voice of an angel. I imagined what it would be like to date her. I imagined the highs and the lows of being in a relationship with her. I thought about our wedding and how many kids we would have. I thought about the breakup and the make-up sex. I thought about her cheating on me and imagined what it would be like to win her heart back. I saw us growing old and dying together. The perfect couple, in love until the very end. I pictured all that in 60 minutes. The entire time I was at that meeting, that’s all I thought about.

    I didn’t hear about recovery that evening. I didn’t hear a solution to my drug problem. I just sat there and crazily obsessed over this woman. She was the one. Perfect for me.

    I never saw her again after that. I couldn’t even tell you her name.

    My first few months in early sobriety, that’s kinda how it went. I would show up at a meeting, meet a woman, live an entire life with her in my head for 60 minutes, and go home. I did that dozens of times with dozens of women. I know none of their names and they have no idea who the hell I am.

    It was a miracle I never engaged or acted on the thoughts going through my sick unrecovered head. I can’t imagine the damage I would’ve caused in those meetings.

    I’m blessed to have had sponsors who told me to leave the women alone; to give them a chance to recover too.

    They told me two dead batteries can’t start a car.

    I’m grateful for the men in my life who instilled good values in me during early sobriety. I haven’t lived a perfect life in recovery but I have been super mindful and aware of the fact that I don’t want to hurt anyone.

    If I’m still creating chaos and causing as much damage in recovery that I used to cause while in active addiction, what’s the fucking point in staying sober? I might as well use if I’m going to be a sober scumbag.

    How I Got Healthy Enough for an Intimate Relationship

    Today I focus on myself, who I am as a person. I work on my self-esteem every day. Some days are better than others. I combat codependency whenever it rears its ugly head. I address the areas in my life where I may struggle with anger and find ways to work through them. I’m a better man for it.

    And because of that, I have the ability to practice being in a healthy relationship. Because I’ve gained so many tools while on this recovery journey and I’ve found all are indispensable, interchangeable, and useful within my intimate relationship.

    It’s been a long time since I’ve walked into a meeting and asked a woman to marry me in my head.

    My hope for you if you’ve read up to this point, is that you find a place in your life where you have fallen in love with yourself; knowing all the good and all the bad that makes up who you are. I think when we can become our own best friend without all the false pride is when we finally become an awesome partner for someone else. I hope that happens for you (if that’s what you’re looking for).

    If nobody told you today that they love you, fuck it, there’s always tomorrow.

    View the original article at thefix.com

  • Zero Coping Skills: How Jackie Monahan Found Peace of Mind for the First Time

    Zero Coping Skills: How Jackie Monahan Found Peace of Mind for the First Time

    Contrast in life is inevitable, but I’m learning that I don’t have to have conflict. I don’t have to flip out because I got in the wrong line; I don’t need to make my poor planning everyone else’s emergency.

    I grew up being told over and over, “We are only given what we can handle.” I took that to mean, “If I flip out about the little things, nothing really bad can ever happen to me.”

    It has been said that if you have an alcoholic parent, the odds are good you will become an alcoholic. I had two. They say if you start drinking at 21, you might be okay. I did the inverse and started drinking at 12. I had a long run. I was surrounded by enablers. My mom still wants me to drink; she and my ex say things like “You weren’t this temperamental when you drank.”

    I want to be the best example of the program anyone has ever seen, but I am far from there yet. I have always been easily frustrated, and have always had zero coping skills, other than alcohol.

    My soul wanted to solve problems without alcohol, but I didn’t even know where to begin. If I got anxious for a second, everyone rushed to put a drink in my hand. It worked. I remember the one day in college that I didn’t drink. I was mad and yelling at all my roommates, wanting them to be as quiet as a mouse because I wasn’t drinking. Meanwhile, every other night I came home either with a party or from one, loudly.

    I entered parties saying, “You can start now, I am here.” I would black out and then yell at everyone the next day for letting me drink so much. They would say they had no idea I was blacked out; I was so funny and fun, they didn’t see what the problem was. I did. My life was getting really busy with stuff I wanted to do, and when I did have free time I wanted to enjoy the moment and remember it.

    My parents were functioning alcoholics. I say “were” because they are no longer functioning very well. My dad was far worse than my mother, but both are shells of what they could have been. They couldn’t get rigorously honest if someone paid them all the money in the world. I had to accept that at a very young age.

    There was never a way to know what I did to set my parents off. When either of them went into a rage, it was brutal. They were cheerful, cheerful, cheerful… then rage! They mostly raged when they were sober and it would come out of nowhere. I watched their tantrums work for them: with one another, with me, and with the unfortunate people who got my mother on the phone. You would think Colleen from Time Warner had stabbed her in the face. My mom unloaded all her marriage frustrations, alternately screaming at and belittling the customer service rep. And it worked every time — instead of getting overcharged, she got money off and reduced rates. She flew off the handle at everyone and got her way, then bragged about it.

    My parents would always say, “God made whiskey so the Irish could not rule the world.” Then they would laugh and laugh like they had something over on the rest of us. Meanwhile, I remember thinking, “Rule the world? How about trying to get through the week without throwing a plate?”

    With all this and more, it never even occurred to me not to drink. Of course I would drink, but I vowed to never be an alcoholic like you see on TV, or even a semi-functioning one like my parents. I could clearly see how their thinking was backwards, so backwards that my messed-up perception went undetected. They may have been successful financially, but their morals and values were out in space.

    In 2011 I made an independent movie and was too busy to drink. My wife at the time pointed out that I didn’t drink for two weeks. She was impressed with my work ethic. I was working 12-hour days because it took so long to put on and take off a bald cap for my role as an an alien. I couldn’t be hungover, so I wasn’t.

    A few years later I thought, “I wish another 12-hour a day project would come along to quit drinking for.” Now I know this should have been a red flag. But nope, instead I had an idea: “Wait, why don’t I make me the project. I will be sober for a while for me.” I was just going to do 11 days, until the Independent Spirit Awards. I would have to drink then. There would be free expensive wine and celebrity parties.

    The awards show came and went and I still didn’t want to drink. I felt almost addicted to being clear-headed. It felt euphoric. Then I was determined to tape Last Comic Standing sober. I was 33 days sober and I did great, but I just wasn’t myself. I wasn’t loose. I told a comic backstage who had five years sober that I didn’t feel comfortable. He said I was crazy, that he didn’t feel normal on stage until he had a year sober, and that I should have just had a drink. Looking back, he was right and I knew it. But I couldn’t drink. I liked being in my body so much. I hated blacking out.

    And I refused to do AA: I 100 percent thought it was run by the Catholic Church and I couldn’t go back there. I was a member of the CIA: Catholic Irish Alcoholic. I survived 12 years of Catholic school: priests living in a mansion with gorgeous antique furniture and driving fancy sports cars while the nuns lived in poverty, in what were basically jail cells. One nun siphoned gas—so she could sell the 20-year-old station wagon she had just filled—and accidently swallowed some of the gas. That same day, Father Zino threw a lit cigarette out of his brand-new Porsche and it hit me. It got caught in my coat.

    I had no intention of going back to the Catholic Church and saying yes to things I knew to be wrong. They told us not to lie, then made us lie.

    I had friends in AA, but they all seemed miserable and unhappy. I would rather drink than be miserable. And I had quit drinking on my own before: once for 90 days (I was proud because I hadn’t intended to go that long), and then for 200 days (I was disappointed I hadn’t made it to a year). Both times, when I finally drank, it was because of things happening that I couldn’t bear to feel. I called my friends and said, “I don’t want to drink but I can’t bear the pain anymore.” They said, “Just drink. Drink and don’t beat yourself up about it.” So I drank. I didn’t have a choice.

    Then I made a new friend who was in AA and thriving. She seemed genuinely happy. When I told her I could quit on my own but couldn’t stay quit, she said that happens to a lot of alcoholics. That was the first time I thought “Hey, maybe I am an alcoholic.” She also said “You don’t have coping skills.” Coping skills!?! I must have said those two words a million times since then. Coping skills sounded like exactly what I needed. I didn’t have coping skills. I’d never even heard of them.

    I said I wanted to give it a try. I really wanted to make it to a year without drinking, and I was willing to do anything. Once I made that commitment to myself, I gave myself over to the program and my higher power. That was a critical tipping point, and my life changed. I got a sponsor who I knew would kick my butt: she knew when I was lying. I wanted what she had—not the dream car, home, partner, killer style, and beauty (all impressive, considering she had been living on the street). I didn’t need any of those things. I did not have the same goals at all.

    What I did want was her close relationship with her higher power, her program, and her unquestioning belief in both. These qualities make her absolutely, positively unflappable and a force to be reckoned with. She gets annoyed by things, but as soon as she feels an ounce of anger, she takes a breath and realigns with her higher power and the solution.

    My sponsor knows I had major resentments, and that I had a lot to be resentful about, but she showed me how to let go of them, for myself. I am now two years sober and I have peace in my mind for the first time in my life. I wouldn’t trade this gift of sobriety and serenity for anything in the world. I treat it like a gem that I hold safe. I guard that gem with my life.

    Contrast in life is inevitable, but I’m learning that I do not have to have conflict. I don’t have to flip out because I got in the wrong line somewhere; I don’t need to make my poor planning everyone else’s emergency. I didn’t even know how anxiety-riddled I was. I thought I had ADD, and doctors were treating it as such, with Adderall. What I actually have is PTSD and chronic anxiety. That medication combined with those diagnoses was like treating schizophrenia with acid.

    All my life, I never wanted to be like other people. Even though my life was messed-up, I loved being me. I always wanted to live, but I really didn’t know how. I felt like I was improvising constantly, while everyone else had a script. It made me a great improviser, but I now have the ability to turn that side of me off. I feel like I am getting a new, revised version of my script every day. If something happens, I no longer go into fight or flight mode. I get upset, of course, but now I respond instead of react. I am proactive instead of reactive. I can have contrast without conflict. I can go into solution mode and stop focusing on and feeding the problem.

    I made a decision to be the change I want to see in the world—which is peace. To see peace, I first must be peace. Alcoholics do not have the luxury of a negative thought. A resentment can kill us. If someone hates me, that is on them. I cannot control how someone feels about me, but I can control how I feel about them.

    I feel safe for the first time. For a long time I hid my fear from everyone, even myself. Feeling safe, in the moment, in control, is better than any feeling in this world. I wouldn’t trade the solution for anything.

    Jackie Monahan appears in Wild Nights with Emily, in theatres on April 12th. Her album “These Lips” is streaming everywhere and on Sirius.

    View the original article at thefix.com

  • Relapse Prevention: Staying Sober Through Life Setbacks

    Relapse Prevention: Staying Sober Through Life Setbacks

    Without recovery tools or a relapse prevention plan, it can be difficult to stay sober while dealing with a significant life setback. The lure of the drink or drug to ease the pain and bring comfort becomes too great to resist.

    When people at treatment centers or in 12-step meetings say that relapse is part of recovery, it turns my stomach. Although the door to recovery remains open after a relapse—as long as a person survives such dangerous waters—relapse is not part of recovery. At the same time, however, the slip and slide process that leads to a relapse does happen in recovery.

    Whether we are newly clean and sober or have stacked up many years—even decades—of sobriety, the triggers that lead to a relapse happen before we pick up the first drink or drug. But if we have done the work and have recovery tools in place, these triggering events can be processed successfully instead of leading to a relapse. We acquire recovery tools through 12-step programs, SMART Recovery, therapy, or whichever recovery pathway we have chosen, and we use them for relapse prevention.

    Without recovery tools, it can be immensely difficult to stay sober while dealing with a significant life setback. The lure of the drink or drug to ease the pain and restore a sense of comfort becomes too great to resist. It reminds me of the mantra of Dr. Gabor Maté: “The question is not why the addiction, but why the pain.”

    But we have to know how and when to use the tools properly, which requires practice. We gain this practice by working the 12 steps or taking other constructive actions in our recovery pathway well before a triggering event occurs. Then, when we hit a life setback, we are prepared.

    Here are four life setbacks which can lead to relapse if we do not have recovery tools.

    1. The loss of a job, a promotion, or a major work opportunity

    One of my favorite sayings in 12-step programs is that an expectation is a resentment under construction. When you miss out on a significant work opportunity or you’re let go from your job or passed over for a promotion, it is natural to feel crushed and overwhelmed. Many people in recovery take professional setbacks personally, punishing themselves for a perceived failure. There is a reason alcoholism is called a disease of perception. We will drink or use to escape the pain of a perceived failure, or—in a masochistic fashion—to inflict more damage on themselves as the vicious punishment for such a failure. When you consider the consequences, this outcome can be devastating.

    Rather than sinking into depression and self-blame, you can use recovery tools to put the setback into context. Did you know people change jobs an average of 12 times during their career? In January 2018, the Bureau of Labor Statistics reported that the median employee tenure was 4.3 years for men and 4.0 years for women. The very nature of employment is a roller coaster ride of ups and downs.

    Given these statistics, it’s easy to apply the second and third steps to a career setback. If you turn over the disappointment to a higher power and have faith that another opportunity will arise, then relapse is less likely to occur. If you discuss the problem in a group, you will receive support and learn from the similar experiences of other people.

    2. Global events like elections, terrorist attacks, and natural disasters

    People in recovery tend to take everything personally. We sometimes use big events that may have no direct impact on our lives as reasons to drink or use. After the last presidential election, I heard many people in meetings bitterly joke that they were either moving to Canada or having a drink. Luckily, most of them did neither, regaining their focus on the microcosm of their own lives. They focused on what was right in front of them, remembering to take things one day at a time.

    When seemingly apocalyptic moments arise, there is an urge to console ourselves. We feel the pain and horror of terrorist attacks and natural disasters and use those feelings as a justification for a relapse.

    An essential recovery tool for sidestepping this kind of relapse is avoiding isolation. When we are alone and in our heads, we are in dangerous neighborhoods. By going out and spending time within a supportive community, the disaster loses some of its power over us. We come to understand that it’s not only our tragedy and can share our pain with others. We do not minimize the horror or sadness of what happened, but we also do not use it as a reason to relapse. We don’t have to make our lives worse in response to disaster.

    3. The death of a family member or a close friend, and the pain of mourning

    Death can be one of the hardest challenges to face for anyone in any context. The loss of a family member, a loved one, or a close friend can be incredibly painful, both spiritually and emotionally. For someone in recovery, the situations in which we grieve present their own unique difficulties. In circles of mourning, alcohol is a conventional lubricant. It can be easy for someone without recovery tools to pick up a drink during this time.

    By talking about your feelings and reaching out for support, you can be guided through the pain. You will learn that by staying sober and clear, you have the opportunity to be present for your family and friends. You can be of service in a time of great need. Moreover, you honor your loved one by maintaining your sobriety. If you feel like you were not able to make amends for a past wrong, then make a living amends by staying sober and honoring their memory.

    4. The end of a relationship

    Have you ever heard the story of a person in early recovery who started dating and turned their partner into their higher power? Rather than focus on their own recovery and sanity, they focus on the relationship. What they fail to realize is that whenever recovery becomes supported mainly by a human relationship, the recovery (and usually the relationship) are on thin ice.

    Sometimes, the end of such a relationship leads to a relapse. When someone in early recovery focuses with such fervor on a partner, they no longer can keep the focus on themselves. This is why you hear the recommendation to stay out of relationships during the first year of recovery, or until you’ve worked all 12 steps.

    The end of a healthy relationship in long-term recovery can be dangerous as well. Breaking up can hurt so deeply that you feel you can’t bear it; having a drink or taking a drug seems to be the only way to stop the heartache. However, the pain is so much worse when it’s kept inside and remains unspoken; and while drinking or using may look like a way to find quick relief, you can’t actually escape this hurt. You only postpone the feelings and frequently the relapse brings more misery. By sharing the pain and talking about it with other people, you can obtain perspective. Although applying the principles of recovery to a breakup may help you avoid a relapse, it’s not a cure-all. When love ends, we suffer, and such suffering takes time to heal.

    Whatever life setback you might face today or in the future, taking a drink or using a drug will not help resolve the difficulty and in the vast majority of cases, it will make a bad situation much worse. Instead, cut the cord that connects drinking and using with pain relief. It’s a temporary and usually ineffective fix. For people who have lived with addiction or substance use disorders, the most powerful recovery tool is the simple and honest realization that drugs and alcohol are never the solution.

    What’s in your recovery toolkit? How do you deal with life setbacks without using or drinking?

    View the original article at thefix.com

  • How Harm Reductionists Keep the Faith

    How Harm Reductionists Keep the Faith

    Morning to evening, nearly seven days a week, Karen and Michelle endure taxing commutes to bring harm reduction services to drug users in North Carolina’s hard-hit, rural areas.

    It’s a bitterly cold afternoon in early March as Karen Lowe and I pick our way down the broken sidewalks of a semi-abandoned neighborhood in Statesville, North Carolina. All around us, squatter houses stretch for blocks. Every window is busted or boarded up. Thin, dirty mattresses lie on sunken porches and feral dogs scrounge in the trash-strewn yards for scraps. Some residents are huddled inside for warmth, though in most of these homes, there is no electricity.

    The neighborhood is a depressing sight, but it’s hard to feel blue when you’re on outreach with Karen Lowe. Co-founder of the Olive Branch Ministry, a faith-based non-profit that brings harm reduction services to the seven foothill counties of North Carolina, Karen is the embodiment of love.

    Harm Reduction in the Deep South

    As I burrow into my thin jacket, Karen strolls down the middle of the street extending warm greetings to the few brave souls who venture outside. Though the pockets of her cargo pants are bursting with clean syringes, naloxone, and other supplies to prevent death and disease among people who use drugs, she doesn’t flaunt her wares.

    “I just want people to see me,” she explains. “It’s about building trust. They know why I’m here. If they need something, they’ll come to me.”

    As we walk, the 52-year-old fills me in on the colorful cast of characters who call this neighborhood home, including a man who claims he hasn’t bathed in a year and an old woman who pees on the sidewalk. Karen describes everyone with great affection.

    “There is a certain kind of love that goes with being an untouchable,” she says. “And [the people of this community] have it. But it’s not allowed to grow.”

    There certainly isn’t much growing in this neighborhood. Judging by the columned porches on every house and what looks like abandoned flower gardens, this was probably once a desirable place to live. But shifting economic winds have devastated entire cities in the South and Statesville is no exception. 

    A small inland city—population 26,000—Statesville boasts neither North Carolina’s green mountain range nor its sparkling coastline. It’s stranded in the flatland area of the state, mostly buried under strip malls and fast food restaurants. But despite so few bragging rights, Statesville embraces its Southern pride, describing itself on its website as “a city where fish is fried (as our Lord intended they be) and a bottle of Kraft French Dressing is good enough for anybody — so get over yourself.” Also true to its Southern roots, while Statesville has recently invested in a splash park and a $330,000 home for veterans (more than double the average price of a house in the area), the city has allowed this particular neighborhood, in which residents are almost all black, to fall into ruin. The only people who venture into this place are the churches who occasionally come evangelizing and of course, the police, who make neighborhoods like this one their second home.

    But Karen brings cheer to this desolate area. Twelve years ago, she was homeless herself, struggling with mental illness and depression, and searching for both a literal and metaphorical place to set down roots. She found a surrogate family and a calling in a faith-based organization in Greensboro that provides services to people living with HIV. The community welcomed Karen with open arms and she became a regular at meetings, outreach events, and retreats, which she describes as “mad love and dealing with yourself, everybody crying and snotting.”

    Not Your Typical Faith-Based Outreach Organization

    Karen says she knew then that her life was about to change in remarkable ways. And was it ever. A couple years into her involvement with the faith community she met the love of her life, Michelle Mathis, a woman who shared her passion for helping people in need. Though they have the same heart for harm reduction, the pair is about as opposite as two people can be. Michelle exudes elegance with a powdered face and coiffed hair that somehow survive even in the god-awfullest North Carolina humidity. Her partner is more salt-of-the-earth.

    “I did the make-up and heels thing when I was young…somebody should have stopped me,” Karen laughs.

    The yin to the other’s yang, the two married in a private ceremony in 2009 where they exchanged olive branches instead of rings, thus creating what would become their joint life’s work, The Olive Branch Ministry.

    Olive Branch is not your typical faith-based outreach organization—and not just because its founders are an interracial queer couple spreading the word of Jesus in the Deep South. True to the tenets of harm reduction, whose guiding philosophy is “meet people where they are at,” Karen and Michelle serve without pretense or expectation.

    “We say faith is why we do [this work], but it’s not what we do,” Michelle explains to me over the phone. “If someone asks us to pray for them, we will pray for people…We take the message of harm reduction to faith communities…but we don’t evangelize.”

    During afternoon outreach with Karen, she utters not a whisper about faith. And yet, if God’s love for others were perfume, you’d smell her coming from blocks away. Helping others comes as naturally to her as breathing. Several times during our conversation she offers to assist me personally with everything from community partnerships to my writing career, and after I mention casually I’ll be traveling abroad soon, she offers me money to buy a goat or chicken for a family in need.

    Morning to evening, nearly seven days a week, Karen and Michelle endure taxing commutes to bring harm reduction services to drug users in North Carolina’s hard-hit, rural areas. They ask nothing in return for their services. In fact, they seem critical of faith-based groups who use community outreach programs as a carrot to boost membership.

    “It’s hard to be trusted in a neighborhood like this [because people think] everyone wants to take them to church,” Karen explains, adding that this is why she maintains such a low-key presence on outreach. Instead of rolling up in a van stashed with free giveaways, she roams the streets where people can see her, offering nothing but a greeting unless she is asked.

    The Intersection Between Faith Communities and Harm Reduction

    The Olive Branch Ministry’s approach could serve as an example for how faith-based communities and harm reduction can work together. The relationship is not always harmonious: some in the faith community accuse harm reductionists of enabling drug use or not doing enough to discourage problematic behavior. Conversely, many harm reductionists criticize faith groups for the hypocrisy of claiming to serve “the least of these” while refusing to help drug users, who belong to one of the most stigmatized and marginalized of all groups. Even when faith-based organizations do offer assistance, some peddle a strict, abstinence-only agenda or approach outreach with an attitude that appears to place more importance on gathering lost souls into the flock than on addressing people’s immediate needs.

    But despite the tenuous history between the groups, there is much cause for hope. Across the country, faith-based groups like The Olive Branch Ministry, Judson Memorial Church in New York City, St. Paul’s Episcopal Church in Arkansas, the national Interfaith Criminal Justice Coalition, and many more are forming active partnerships with harm reduction groups. Other organizations, including the United Methodist Church, Presbyterian Church (U.S.A.), United Church of Christ and National Council on Jewish Women have publicly proclaimed their support for harm reduction programs.

    The relationship between the faith community and harm reduction shows promise and room for growth. Especially in the South where faith is so important and drug users have so few services, these alliances are critical to stem the tide of deaths and disease caused by an unregulated drug supply, draconian laws, lack of sterile equipment, dearth of adequate treatment, stigma, and misunderstanding about what causes drug use to become problematic for many people.

    “I feel that faith communities in general think that harm reductionists are a bunch of left wing radicals,” says Michelle. “They think that we will come in and demand that the church hold drug user union meetings and do syringe exchange, but they don’t realize that we meet the congregation where they are…we figure out where they are comfortable and [decide] how to go from there.”

    Harm reduction groups and faith communities need to work together rather than at cross-purposes in order to reach and help as many people as possible. It’s not always easy to find common ground; an olive branch is a good place to start.

    View the original article at thefix.com

  • How Suboxone Helped Me Until I Could Help Myself

    How Suboxone Helped Me Until I Could Help Myself

    I felt confident that I had no desire to use opioids again, not because the Suboxone had eliminated my cravings, but because I had changed my life. The pain I worked so hard to anesthetize with heroin had been addressed.

    Suboxone, while often controversial among addiction treatment professionals and people in recovery, has moved to the forefront in discussions about opioid treatment. The recovery community has no shortage of naysayers insisting that medication-assisted treatment (with drugs such as Suboxone, buprenorphine, and methadone) is simply trading one addiction for another, characterizing it as heroin in legal form and just another way for the big pharma companies – who are already blamed for the initiation of the opioid epidemic – to pull in profits. But Suboxone is not an illicit street narcotic with fatal overdose rates surpassing even automobile accidents, it’s a life-saving tool that many experts insist is our best hope for the current public health emergency.

    Medication-Assisted Treatment Is Effective, But Stigmatized

    According to Dr. Gavin Bart, Director of the Division of Addiction Medicine at Hennepin County Medical Center and Associate Professor of Medicine at the University of Minnesota, opioid addiction requires long-term management; behavioral interventions alone have extremely poor outcomes with more than 80% of patients returning to drug use.

    “Extensive literature and systematic reviews show that maintenance treatment with either methadone or buprenorphine is associated with retention in treatment, reduction in illicit opiate use, decreased craving, and improved social function,” Bart writes. “Extensive research shows that each of the three available medications used to treat opiate addiction have superior treatment outcomes to non medication based therapies. Increased retention reduces mortality, improves social function, and is associated with decreased drug use and improved quality of life.”

    Abstinence proponents may be skeptical about Bart’s research, but for me, it rings true. Reduction in illicit opiate use? Check. Decreased craving? Check. Improved social function and improved quality of life? Check, check. Abstinence-based treatment did not save my life. Medication-assisted treatment paired with specialized addiction therapy helped me save my own life.

    As an active member of the recovery community, I am mostly outspoken and typically very candid, even when it comes to mortifying revelations. And even for me, Suboxone is a touchy subject. I am more comfortable discussing random substances I’ve injected than I am discussing how Suboxone was a key player in my opioid addiction treatment. I think my discomfort is a result of the negative rhetoric that surrounds the medication, and ironically enough its harshest critics are often other people in recovery. The prejudice against medication-assisted treatment is harmful, and even deadly when the negative discussion derails someone from seeking the help that, according to the evidence base, may give them the best chance of staying alive.

    Is medication-based treatment the perfect fix to a horrific and increasingly deadly addiction? No. Suboxone has its burdens. I grappled with those too. When I first started taking Suboxone, I’d take it for a week and then relapse on heroin. I did that a handful of times before I was finally serious about getting clean.

    My Suboxone Journey: From Relief to Frustration

    My initial Suboxone dose was 8 mg buprenorphine with 2 mg naloxone. It was an orange strip with a tangy taste that I’d place under my tongue and wait while it dissolved into my bloodstream. Because I essentially switched directly from heroin to Suboxone (taking the first dose when I began experiencing opioid withdrawal symptoms), I didn’t have to suffer the weeks-long detox that frequently triggered my repeated relapses.

    Taking my daily dose of Suboxone was like a sigh of relief at the beginning: one more day that I didn’t have to suffer through withdrawal. But after a few years, the sighs of relief eventually turned into sighs of disdain. My once-considered reprieve from the consequences of my addiction was starting to feel like a rusty pair of shackles. I was sick of going to the doctor and refilling my prescription, I was sick of keeping this secret from everyone in my life, I was sick of being terrified to travel. This thing that had once made me feel normal now had me feeling like I was still, after so much time, tied to my painful past of addiction.

    Nothing else in my life reminded me of my past. There were no remnants of my previous addict self. I didn’t associate with any of my old using friends, I hadn’t seen or spoken with any dealers in ages, I never even got pulled over for traffic stops. I didn’t look like a junkie anymore and I didn’t act like one either. I had nurtured and repaired the ties with my family, I had a loving, healthy relationship, and I was well on my way to getting a college degree. I had successfully restored myself to sanity, as good ol’ Bill would say.

    Fear kept me stagnant, which didn’t feel fair. I had come so far and was nothing like the junkie I once was, but I still had this inevitable withdrawal from Suboxone hanging over my head. My one final detox. The big whopper. How would I go through with it? I was in school so I couldn’t miss two to four weeks of classes, and anytime a summer or winter break neared, I’d chicken out, despite telling myself it was time and trying to prepare for it. In the meantime, I’d slowly been cutting down. I went from the initial dose of 8 mg buprenorphine/2 mg naloxone strips to 4 mg/1 mg, and then even further to 2 mg/.5 mg.

    Suboxone Withdrawal

    I had no idea what to expect. Like many of us, I have some form of post-traumatic stress disorder from my time in active addiction, and a major part of that was the horrendous withdrawals. I was completely fixated on these impending withdrawal symptoms, and there was nothing I could do — I had to pay the debt.

    I finally made the decision to go through with it. I made the appropriate arrangements and was prepared to suffer for a couple weeks minimum, several weeks or maybe even months maximum. I watched YouTube to try to ease my frazzled nerves, but the videos pacified my anxiety like a game of Russian Roulette. Do not watch YouTube. Some videos had people detoxing, drenched in sweat and sobbing into the camera and others had people after just a week saying, “Not so bad guys!”

    The night before I took my final dose, which was a teeny tiny square cut from a buprenorphine 2 mg/naloxone .5 mg strip, I curled up into the fetal position, buried myself under my duvet and cried myself to sleep. I couldn’t believe I was about to enter junkie limbo after living as a functioning member of society for so long.

    The first few days weren’t pleasant, but it was nothing like I’d experienced in the past. I couldn’t sleep, I tossed and turned, I had tingling chills and clammy sweats, general anxiety and a sense of unease. I once detoxed from a $100 a day heroin habit and it was like I was the star of an exorcism horror film; compared to withdrawals like that, this one wasn’t nearly as bad as I’d anticipated. I think spending so much time tapering down to as small a dose of suboxone as I could handle really paid off when it came time to detox.

    Another big fear I had, mostly thanks to Google and YouTube, was post-acute withdrawal syndrome (PAWS). After the initial detox, the last time I felt any symptoms I knew were directly related to my withdrawal was about a month and a half after day one. I had a mini-panic attack when Target was too crowded. I started pouring sweat, rushed to my car, and burst into tears. And after that, I’ve simply felt normal. That thing we all desperately want to feel: “normal.”

    What If?

    The detox was tough, it was emotionally taxing and physically draining. But I realized that it was the fear of the withdrawal that had me suffering the way I was. It was a fear of the symptoms and a fear of the unknown. I felt confident that I had no desire to use opioids again, not because the Suboxone had eliminated my cravings, but because I had changed my life. The pain I worked so hard to anesthetize with heroin had been addressed. I did deeply introspective work in therapy and I changed my social environment, all while using Suboxone. I built up my self-worth by investing in myself and investing in healthier relationships, things I never could have done while still using heroin. I fixed my broken coping mechanism, I knew how to handle stress and sadness. Yet, there was still this tiny sliver of me that wondered, “what if?”

    What if it was all some magical mask that Suboxone created and none of this was reality and as soon as I stopped taking it I would revert to my old tormented life?

    That is what prompted me to finally write this piece — realizing that regardless of the discomfort I feel discussing Suboxone, there are other people in recovery using medication-assisted treatment right now, scared to talk about it and scared to get off, experiencing the exact same fears that plagued me. Once I made the leap and decided to go ahead with my final detox, and then when it was complete, I felt free. Finally free. Not because Suboxone had me stuck, but because Suboxone helped me move past the hardest time of my life. This withdrawal was the final chapter to that saga and it was finally over — and I survived.

    I closed the book, I’d won the war.

    View the original article at thefix.com

  • Four Advocates on How Harm Reduction Can Change the Trajectory of the Opioid Crisis

    Four Advocates on How Harm Reduction Can Change the Trajectory of the Opioid Crisis

    There is overwhelming evidence that harm reduction keeps people alive and can bring them into recovery, yet it’s still met with opposition. We ask four harm reduction workers what inspires them and what we can do to help.

    Harm reduction has been a contentious topic for a while: staunch 12-step proponents who insist that abstinence is the only way to achieve recovery are met with resistance from a growing number of harm reduction activists who consider the reality of drug use more holistically while advocating for individual choice and safety. Many of us have deep-seated beliefs and strong feelings about recovery, but now more than ever we need to analyze and hopefully remove our biases, accept the overwhelming data in favor of harm reduction, and face the failed policies that have led to a national crisis. Every day 130 people die from opioid overdose in the U.S., and misuse of prescription opioids costs us an estimated 78.5 billion dollars each year.

    Abstinence alone isn’t working. If it were, we wouldn’t have an epidemic on our hands. Perhaps this realization is why we are seeing an increase in harm reduction measures—increased naloxone access, fentanyl testing strips, Good Samaritan laws, and needle exchange programs. And they work: many individuals enter recovery through various harm reduction programs. But regardless of whether people get treatment or not, harm reduction measures prevent disease and save lives.

    What Is Harm Reduction?

    Harm reduction is frequently misunderstood. Often people think it means the use of medication-assisted treatments (pharmacology), or moderating drug use instead of eliminating it entirely. But these are narrow definitions. Harm reduction is not a particular pathway of recovery; it is a means of reducing the harm associated with drug use.

    According to the Harm Reduction Coalition, “Harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use. Harm reduction is also a movement for social justice built on a belief in, and respect for, the rights of people who use drugs.”

    The philosophy of harm reduction accepts that drug use is complex and multifaceted, and that it involves a range of behaviors from frequent use to total abstinence. It acknowledges that some ways of using drugs are clearly safer than others. Harm reduction includes strategies such as safer use, managed use, needle exchanges, supervised injection sites, treatment instead of jail, and abstinence. It advocates for meeting the individual where they are and addressing their reasons for using and the conditions surrounding their drug use. Successful implementation of harm reduction should lead to well-being for individuals and communities, but not necessarily cessation of all drug use.

    Tracey Helton Mitchell, Devin Reaves, Brooke Feldman, and Chad Sabora advocate for the acceptance and practice of harm reduction. We asked what motivated them to pursue their activism and how we can all be more mindful of harm reduction principles.

    Tracey Helton Mitchell

    Tracey Helton Mitchell came into the public eye when she was featured in HBO’s documentary Black Tar Heroin, which documented her life on the streets on San Francisco. After she found recovery, she rebuilt her life and went back to school for a bachelor’s degree in business administration and a master’s in public administration. She has dedicated her life to advocating for the individual needs of people with addiction. She documents her journey in her book The Big Fix: Hope After Heroin.

    In 2016 Tracey told NPR that “We need to have a variety of different kinds of treatment interventions that address people’s needs.” In response to the argument that harm reduction measures such as needle exchange enable drug use, she said: “We’re not encouraging people to do anything, we’re taking a look at their public health behaviors and then addressing what the particular needs are, so look at the cost of one syringe versus the cost of someone getting hepatitis C and having to take care of them for a lifetime.”

    What motivated you to work in harm reduction?

    I started in harm reduction in response to the overdose crisis that was happening in San Francisco and the Pacific Northwest in the late 90s. I knew many people who had died, including Jennifer H., a person I loved very much. 

    How can we include more of the principles of harm reduction when dealing with people in recovery, and those actively taking drugs?

    Harm reduction is seen by many in the recovery community as a crutch when it should be seen as a lifeline. Harm reduction should be included as part of a continuum of care with a wide variety of options based around what is best for the person. Too much focus has been made on “abstinence only” as the standard for recovery. We need to broaden our scope. 

    See also: Naloxone and the High Price of Doing Nothing

    Devin Reaves

    Devin Reaves, MSW, is a community organizer and grassroots advocacy leader who is in long-term recovery. He is also the co-founder and executive director of the Pennsylvania Harm Reduction Coalition (PAHRC), serves on the Camden County Addiction Awareness Task Force, and sits on the board of directors for the Association of Recovery High Schools. He has worked on the expansion of access to naloxone, the implementation of Good Samaritan policies, and the development of youth-oriented systems, and he is leading conversations to bring about public health policy changes in the area of substance use disorders.

    PAHRC’s mission is to promote the health, dignity, and human rights of individuals who use drugs and the communities affected by drug use.

    What motivated you to work in harm reduction?

    As someone in recovery who lost a lot of friends to substance use disorder, when I learned about Narcan, I wanted it to be more available because I was sick of my friends dying. Seeing that harm reduction wasn’t utilized made me want to fight to see more of it: syringe services programs or more innovative programs.

    How can we include more of the principles of harm reduction when dealing with people in recovery, and those actively taking drugs?

    We can provide Fentanyl testing strips, Narcan, and sterile needles to use. For those seeking recovery, we should also provide Narcan because they are still at risk. What people don’t know about harm reduction is that individuals in programs of harm reduction are five times more likely to enter treatment—it is a pathway of recovery. 

    Brooke Feldman

    Brooke Feldman, MSW, is a social justice activist who identifies as a member of the LGBTQ+ community and a person in long-term recovery from substance use disorder. She has spent the past decade advocating for wellness and long-term recovery being accessible to all.

    What motivated you to work in harm reduction?

    Well, I think I was pretty primed to embrace harm reduction principles over 10 years ago when I was taught what are called “recovery-oriented” care principles. Back in 2008, and only a few years into my own recovery journey, I was working for an organization called PRO-ACT at Philly’s first Recovery Community Center. We had a sign on the wall that greeted people with, “How can I help you with YOUR recovery?” and we were educated and trained in practices such as meeting people where they’re at, supporting people in working toward their own goals rather than our goals for them, recognizing that abstinence is not the goal for everybody, and embracing diversity in recovery experiences and mosaics of pathways. My experience with what we call recovery-oriented practice over the past decade set the stage for harm reduction principles and practices to fit perfectly. Unfortunately, while I have found my own professional experience, education, and training in recovery-oriented care to fit neatly with harm reduction, I still see many gaps between the harm reduction and recovery movements. A large motivator for me currently is the strong desire to bridge those gaps, to highlight shared goals and values, and to be part of unifying the two movements wherever possible. I believe people die in the cracks of the divide, and I hope to serve as part of the glue that seals the cracks.

    How can we include more of the principles of harm reduction when dealing with people in recovery, and those actively taking drugs?

    I think that if we center the human rights of choice, self-determination and autonomy when it comes to directing the course of one’s own life, we become more inclusive of harm reduction principles across the board. One concrete area for centering these principles is that of the use—or declined use—of medications to treat opioid use disorders. People have a right to utilize evidence-based medications to aid in their recovery, and people also have a right to decline the use of medication as part of their recovery. Nobody should face discrimination or refusal of resources, supports, and services based on this choice of what to put in their bodies. Also, one of the things I love about the harm reduction movement is the social justice focus. In my experience, the harm reduction movement centers the roles that oppression and marginalization play when it comes to how our systems, and society at large, respond differently to drug use depending on the skin color or socioeconomic status of the drug user. I think that centering social justice would put us all in the right position when it comes to both people currently using drugs and people in recovery, however that recovery is self-defined.

    Chad Sabora

    Chad Sabora is the co-founder and executive director of the Missouri Network for Opiate Reform and Recovery (Mo Network), an organization that offers services to those struggling with substance use disorder and their loved ones. He has been the focus of several episodes of the show Drug Wars on Fusion and was part of an Emmy award-winning episode of NBC News with Brian Williams. Sabora has been an expert correspondent on CNN and MSNBC. He is also president and co-founder of the nonprofit Rebel Recovery Florida, and he is on the board of directors of the Discovery Institute for Addictive Disorders in Marlboro, New Jersey. Sabora is also known for filming himself while touching fentanyl, thus debunking the myth that you can overdose through skin contact with the illicit substance.

    Uniquely experienced as a former prosecutor and a person in long-term recovery, Sabora left legal practice in favor of pursuing drug policy reform and advocacy. He founded Mo Network in 2013, where he heads their work on legislative policy reform. Sabora and Mo Network focus on expanding services based on evidence-based solutions, and they lobby for more effective drug policy locally in Missouri and also at the federal level.

    He has helped write, advocate for, and pass several pieces of legislation in Missouri, namely first responder access to Narcan, third-party and over-the-counter access to Narcan, 911 Good Samaritan immunity, and access to medication-assisted treatment in various environments such as addiction treatment, mental health facilities, family court, and for certain frequently-overlooked populations such as veterans.

    What motivated you to work in harm reduction?

    The overwhelming data, basic common sense, failed policies of the past, and unconditional love was the motivation.

    How can we include more of the principles of harm reduction when dealing with people in recovery, and those actively taking drugs?

    Inclusion will come in time, as long as we stay vigilant. Changing moral compasses and inherent biases could take a generation before we see the full impact.

    Read Chad’s rules for staying alive while using drugs (including how to use naloxone to reverse an opioid overdose)

     

    A Call to Action: We Need Harm Reduction Now

    The evidence is clear: If we provide the education and resources for people to use drugs safely, we reduce disease and save lives. Frequently we open the door to recovery. Isn’t it time for us all to start advocating for (or at least accepting) harm reduction wherever and whenever we can?

    View the original article at thefix.com