Cocaine, Speed, and “Overdose”: What Should We Be Doing? Part 2

By Eliza Wheeler, DOPE Project, Harm Reduction Coalition, San Francisco

This is part 2 of a series about cocaine and stimulant-related deaths and what harm reductionists can start doing about it.  We published the first part last week, which was a collection of thoughts about how to move forward to address stimulant-related deaths. This second part deals specifically with stimulants and “overdose” (not the right word, but we’ll get to that). This is a draft of a manual for speed users created as a result of a meeting with some folks from the Speed Project here in San Francisco. We are looking for suggestions on how to improve this document and welcome any feedback on this draft. We’ve included some great quotes from our discussion.

OVERAMPING!

or speed “overdose”

“When I’m talking about overamping, to me when I’m on speed, right, I’m not happy until the second or third day. I’m trying to get there…the first one is just the preliminaries, the first time you’re not there yet, you’re not in the euphoria or where you wanna be. So I got my sack, the first one I’m snorting, now I’m gonna go look for my rigs, now I take my first shot, ok, now I’m gonna go look for who we’re gonna spend time with. It’s like a whole little adventure, I’m in Alice in Wonderland and all this shit’s happening, and then when you’re into your 3^rd or 4^th day and then you take that one shot, still a lot of dope around, still a lot of people around, whatever, it’s fun, it’s casual, everything’s happening cool, and you take that one shot all of a sudden you go damn, I shouldn’t have done that, you did one too many and you just crossed the line and I’m gonna tell you how that feels. It feels like if you’ve ever had an experience with crack and you’re takin a hit and you’re taking a hit and everything’s fine, and you take that one hit all of a sudden, paranoid, everybody’s looking at you, you’re in a fishbowl, but with crystal it’s different because it lasts 12 fucking hours…and the shadow people are watching, everyone’s just on that side of the door looking at you, the cops have binoculars three stories away…”—R

1.    What is Overamping?

Overamping is the term we use to describe what one might consider an “overdose” on speed. Overamping means a lot of things to a lot of people. Sometimes it is physical, when our bodies don’t feel right. Other times it is psychological, like paranoia, anxiety or psychosis—or a mixture of the two. It’s complicated because sometimes one person will consider something overamping, and the other person actually considers it just part of the high, or maybe even enjoys a feeling that someone else hates. There are many different definitions of overamping, but we’ve tried to simplify it down to some common elements.

Overamping can happen for a lot of different reasons: you’ve been up for too long (sleep deprivation), your body is worn down from not eating or drinking enough water, you’re in a weird or uncomfortable environment or with people that are sketching you out, you did “that one hit too many,” you mixed some other drugs with your speed that have sent you into a bad place—whatever the reason, it can be dangerous and scary to feel overamped.

“I don’t think speed users use a word like overdose, we use “overamped” and I think that’s a universal term for us “oh, he’s overamping” where that means a psychological breakdown… I think the term overamp is when you put yourself in dangerous life situations and it just doesn’t matter, or it’s funny and it’s just really weird… I think for speed or stimulants, it’s like when your mind can’t handle how fast you’re really going. It’s like when a computer is just going and then all of sudden the computer shuts down or a lot of windows come up on the computer and a lot of shit’s going down and then it frazzes out like a virus. I think that’s what an overdose is for us.” –R

2.    Is overamping an overdose?

Most of the time, when we hear the word overdose, we think of heroin, someone in a heavy nod, turning blue, not breathing. A lot of times people say “you can’t overdose on speed,” but then other people say, “I don’t know, I’ve passed out, or felt like I was gonna have a heart attack…is that an overdose?” The problem is actually with the word itself. “Overdose” isn’t really the best word to describe what happens when tweak turns bad…so we call it OVERAMPING.

Even the term “overdose” makes it sound like taking too much is the problem. With speed (unlike some drugs like heroin) it is much more unpredictable, overamping might happen regardless of how much or little you use, or how long you’ve been using. It might happen on the 3^rd day of a run when your body is getting run down, or when you get high with some people that make you feel weird.

“There is something fairly unique about speed overamping, because when you overdose on heroin or OC or something, half the time you’re not there, you’re kind of in a blacked out state but when you over-stimulate yourself with speed, you’re conscious during the whole thing, and I’m one of those people that in some way I kind of enjoy it, in a weird subconscious way and I try to figure out what do I enjoy about it, and they say that people who use drugs on a regular basis for years and years usually there’s been some trauma in their lives, not everybody, it doesn’t have to be the stereotype, like childhood sexual abuse although a lot of people have that experience, it can be also other kinds of trauma. But anyway, when I’m not high and I see someone put themselves through it, I think, why do people do this over and over and over again?  And then I think, well wait a minute, if there’s a trauma in the past, it’s very counterintuitive, but as Freud said, we kind of like that, so then when I take speed and I get into a space where I’m afraid, and there’s something going on, it gives me some sense of control over what happened in the past, because even though I’ve put myself in a similar situation, this time I’ve brought it on myself. No one did something to me, I created the situation, and then I get out of it. So my feeling about working with people in speed psychosis is not so much getting them to stop, because it is meaningful to them sometimes, but how do you work with people to help them not hurt themselves realizing at some point they’re helping themselves. I don’t know what the answer is to that, but I’m game to find out how to deal with it. I just wanted to bring it up, that’s how I feel.”—I

 “I felt like I would overdose when I would “miss the mark.” When side effects became so exaggerated that they were standing in the way…I can only speak for myself, but I feel in having conversations with other speed users that there is a place that we want to go, and it’s a place of harmony where the mind feels good, the body feels good, and when we miss that mark, it’s like “oh my god” and I can’t shut up or I can’t sit still or my adrenaline level is too stimulated, then to me, that’s getting in the way of my high, it’s not the actual high” –R

3.    Do people die from overamping/speed overdoses?

In San Francisco, there are around 35-45 speed-related deaths per year (2005-2009 Medical Examiner’s reports). We don’t know exactly what the causes of death are; sometimes they are listed as “drug-related deaths,” other times they are listed as “accidental deaths” where drugs were involved. In some cases, people died of things like firearm injuries, but they tested positive for speed. What we do know, is that sometimes speed can cause fatal harm.

This information in this brochure is to help prevent deaths from speed, but also the other stuff that happens when you overamp—when we feel paranoid, anxious, or have unpleasant, scary psychosis.

“When I was overamping…sometimes I’d actually be conscious, where I could hear shit going on…I could hear people playing dominoes in the room, I could hear people slamming doors, shit like that, but I would sweat and I could feel my heart, the tightening in the chest, my body just saying “hey, look dude, you pushed the limit.” And it would just shut down even though my heart’s still going thump thump and then I’m grinding my teeth and my jaws locked, it’s intense and all of a sudden, I’m halfway falling asleep but I’m going through all this, a bead of sweat would happen here (points to side of face) a bead of sweat coming off my back that’s what’s happening when I know I’m overamping, and sure, I would eventually fall asleep because my body is just going through all kind of fast and slow shit, all kinds of shit’s happening…” –R

Physical symptoms of overamping could include:

• Nausea and/or Vomiting
• Falling asleep/passing out (but still breathing)
• Chest pain or a tightening in the chest
• High Temperature/sweating profusely, often with chills
• Fast Heart Rate, Racing pulse
• Irregular Breathing or shortness of breath
• Seizure / Convulsions
• Stroke
• Limb jerking or rigidity
• Feeling paralyzed but you are awake
• Severe headache
• Hypertension (elevated blood pressure)
• Teeth grinding
• Insomnia or decreased need for sleep
• Tremors

“Hypervigilance, you know exactly everything that’s going on around you. Which ties into not only just the physical and but also the mental, because every sound is amplified, “what is that, where it is exactly coming from?” I know for me, in the beginning, when I would overamp, the physical thing is when I would shoot too much meth…I would immediately become rigid, like physically rigid, like everything was shutting down because I had done too much and that has not happened to me in decades because I learned what too much was, but in the beginning it was scary because I couldn’t move. It got to the point that I would put the needle in, I would inject, and I could not pull the needle out because literally I could not move. I had done way too much. I was aware of everything going on around me, but could not move, I had no control over my body at all and that was one of the scariest times for me. You know, until I got to where I knew what too much was, and to learn it took a long time.” –J

Psychological symptoms of overamping, or “mental distress” could include:

• Extreme Anxiety
• Panic
• Extreme Paranoia
• Hallucinations
• Extreme Agitation
• Increased Aggressiveness
• Agitation, restlessness, irritability
• Hypervigilance (being super aware of your environment, sounds, people, etc.)
• Enhanced sensory awareness
• Suspiciousness

“To me, I don’t think I’ve never watched anybody die in front of me off amphetamines, but I’ve watched people psychologically break and have breaks to where they’ve killed themselves in front of me. But I’ve never experienced, in my opinion, except in myself, I thought I was having a stroke, once again, maybe that was an overdose, but what is the definition of an overdose? To watch somebody die in front of me, never have I watched the drug actually do that in my opinion. I’ve watched the after-effects of the drug and the symptoms that come after that. When I hear the word overdose, I think of a psychotic break, if someone loses touch with reality they have now overdosed on amphetamines.” –D

Psychosis

Psychosis is described as a loss of contact with reality, usually including false beliefs about what is taking place or who one is (delusions) and seeing or hearing things that aren't there (hallucinations). (NIH)

Some ways to recognize psychosis: abnormal displays of affection, confusion, depression, occasionally suicidal thoughts, disorganized thought and/or speech, mania, delusions, illusions, hallucinations, unfounded fear or suspicion and paranoia.

Hallucinations: Hallucinations, or false perceptions, may be associated with any of the five senses.

• Auditory (Hear): This is the false perception of sound and the most frequent type of hallucination. Most frequently the user "hears voices." Command hallucinations are “voices” that may issue commands for violence to others.
• Visual (See): Seeing a person, object or animal that does not exist in the environment.
• Olfactory (Smell): This is the false perception of smelling odors that are not present in the environment. For example, someone smells his "brain rotting."
• Tactile (Touch): This is a false perception of the sense of touch, often of something on or under the skin. “Formication” is a form of speed-induced hallucination that makes you feel bugs on or under your skin.
• Gustatory (Taste): A false perception of the sense of taste. For example, someone who might refuse to eat because he tastes poison in his food.

Delusions: Delusions are false or exaggerated personal beliefs. Some common delusions include:

• Delusions of persecution: You feel threatened and believe that others intend to harm you in some way. For example, you think that the CIA intends to kill you.
• Delusions of grandeur: You have an exaggerated feeling of importance, power or knowledge. For example, you might think that you’re in control of the state or that you’re the Messiah.
• Delusions of reference: You believe that unrelated events or happenings are somehow connected to you, usually in a negative way. For example, you might be watching TV and think the news broadcaster is trying to get a message to you.
• Delusions of being controlled: You believe certain objects or persons have control over you. For example, you might think the president of the United States has control over your behavior.
• Somatic delusions: You believe your or parts of your body are changing or being distorted. Like you believe your brain is rotting.

Paranoia: Extreme suspicion of others, their actions or perceived intentions. For example, you see a duck on the river and think the police have placed a camera in the duck to watch you.


Obsessions: Compulsion or repetitive behaviors can be manifestations of long-term speed use. You can become obsessed or perform repetitive tasks such as cleaning, assembling and disassembling objects or washing hands several times in a 15 minute period. Other repetitive tasks include formication (speed bugs!), grinding of teeth, and pulling out hair.

“I think by sometimes overamping or doing methamphetamines that sometimes we tap into this realm that we have no business tapping into and in my heart of heart, my three overdoses or overampings that I’ve had have been the most terrifying experiences, the most horrifying things I’ve ever seen in my life. I literally have seen demons in other people’s faces, I’ve seen a fight between an angel and a demon in the sky. I have to say that anything physical that happened to me overamping pales in comparison to the psychological aspects of overamping or overdosing. Once again, you have to watch yourself, because it’s such a good high and you’re doing so well and then suddenly everything can change on a dime and you don’t really know what happened, except you did that last hit, didn’t ya? And it has to be a matter of your body and your brain just overdose themselves. There’s been several times physically where I know I’ve been close to having a stroke if not having a mild stroke probably. But what I’m talking about when I’m talking about overdosing and these psych breaks that I’ve had…I still have to take antipsychotic and anti-depressants for something that happened almost four years ago. I’ve never in my life experienced anything physical as scary as I have mental.” --D

4.    What to do if you feel like you’re overamping or you’re with someone who might need help?

First, figure out what is needed, MEDICAL ASSISTANCE, or SUPPORT and REST? For medical emergencies, here are some suggestions:

For overheating:

Overheating, or “hyperthermia” can be deadly. If you notice someone overheating get them to slow down and stop agitated movements and try to cool down with ice packs, mist and fan techniques. Make sure they are drinking water or a sports drink with electrolytes so they don’t dehydrate. Place cool, wet cloths under the armpits on back of knees, and/or on the forehead. Open a window for fresh air.

Hot, dry skin is a typical sign of hyperthermia. The skin may become red and hot as blood vessels dilate in an attempt to get rid of excess heat, sometimes leading to swollen lips. An inability to cool the body through perspiration causes the skin to feel dry.


Other signs and symptoms vary depending on the cause. The dehydration associated with overheating can produce nausea, vomiting, headaches, and low blood pressure. This can lead to fainting or dizziness, especially if the person stands suddenly.
In the case of severe heat stroke, the person may become confused or hostile, and may seem intoxicated. Heart rate and breathing will increase as blood pressure drops and the heart attempts to supply enough oxygen to the body. The decrease in blood pressure can then cause blood vessels to contract, resulting in a pale or bluish skin color in advanced cases of heat stroke. Eventually, as body organs begin to fail, unconsciousness and death will result.
When the body temperature reaches about 40 C/104 F, or if the person is unconscious or showing signs of confusion, hyperthermia is considered a medical emergency that requires treatment in a proper medical facility. Call 911. In a hospital, more aggressive cooling measures are available, including intravenous hydration, gastric lavage (pumping the stomach) with iced saline, and even hemodialysis to cool the blood.

For possible strokes:

Strokes are caused by a blood clot that blocks or plugs a blood vessel or artery in the brain or a blood vessel in the brain that breaks and bleeds into the brain. The symptoms of stroke are distinct because they happen quickly:

·       Sudden numbness or weakness of the face, arm, or leg (especially on one side of the body)

·       Sudden confusion, trouble speaking or understanding speech

·       Sudden trouble seeing in one or both eyes

·       Sudden trouble walking, dizziness, loss of balance or coordination

·       Sudden severe headache with no known cause

What should you do?

If you believe someone is having a stroke – if he or she suddenly loses the ability to speak, or move an arm or leg on one side, or experiences facial paralysis on one side – call 911 immediately. In addition to speed or other stimulant use, you are more at risk for a stroke if you also have this other shit goin’ on:

·       High blood pressure

·       Heart disease

·       Smoking

·       Diabetes

·       High cholesterol

Even if you don’t want to stop or cut down on speed use, a good thing to do would be to see your doctor to make sure you don’t have high blood pressure, high cholesterol, heart disease or other physical issues that could increase your risk for a stroke.

For Seizures

What is a seizure?

The brain is full of electrical activity. It is how the brain ‘talks” to the rest of the body. If there is abnormal or excess electrical activity in a part of the brain it can cause a misfire and result in a seizure or convulsion.

Seizures fall into two general groups: general and partial. A partial seizure affects small parts of the brain. A general seizure affects the whole brain and can cause loss of consciousness and/or convulsions. This is the type that most people think of when the word “seizure” is mentioned.

Some typical symptoms of a general seizure are:

• Drooling or frothing at the mouth

• Grunting and snorting

• Tingling or twitching in one part of the body

• Loss of bladder or bowel control

• Sudden falling

• Loss of consciousness

• Temporary absence of breathing

• Entire body stiffening

• Uncontrollable muscle spasms with twitching and jerking limbs

• Head or eye deviation (fixed in one direction)

• Aura before the seizure which may be described as sudden fear or anxiety, a feeling of nausea, change in vision, dizziness, or an obnoxious smell (not as common with drug-related seizures).

• Skin color may be very red or bluish.

What to do if someone has a seizure:

DO remain calm, be a good observer. Speak calmly and softly to the person.

DO help the person into a lying position and put something soft under the head.

DO turn the person to one side (if possible) to allow saliva to drain from the mouth. (If not possible during the seizure, do so once the seizure has stopped).

DO remove glasses; loosen ties, collars and tight clothing.

DO protect the head and body by clearing the area of hard or sharp objects.

DO NOT force anything into the person’s mouth or between their teeth. This is an old myth—people cannot swallow their own tongues. You can harm yourself trying to put things in their mouth, and you can also break their teeth or cause other harms to the person.

DO NOT try to restrain the person. You cannot stop the seizure.

After the seizure:

DO arrange to have someone stay nearby until the person is fully awake.

DO clear the airway of saliva and /or vomit

DO allow the person to rest. Most people will sleep soundly for a period of time following the seizure.

DO NOT offer any food or drink until the person is fully awake

Call 911 if:

The seizure lasts for more than 5 minutes

The person has one seizure right after another

The person appears to be injured

The person does not regain consciousness

This is a first time seizure

The person’s color remains poor

The person does not start breathing within one minute after the seizure has stopped (Start CPR)

Heart Attack/Cardiac Arrest:

“[With speed], it’s not a question of overdosing, it’s like you overdid it. But I also think it’s important to remember that there are single somatic [physical] events that can happen as a result of speed. I’ve never been present, but I’ve known several people that have died of cardiac arrest due to speed…I think it’s important to help people recognize what those events are when they’re happening because they can look like a lot of other things.”—J

Even though a heart attack may be related to drugs, it will still look similar to the heart attacks that might not be drug-related. So keep an eye out for the same symptoms, although sometimes it may be tricky to figure out what is from the drug (sweating, for example) and what may be the signs of a heart attack. Things to look out for:

• Uncomfortable pressure, fullness, squeezing, or pain in the center of the chest. These symptoms can range from mild to severe, and they may come and go.
• Discomfort in other areas, such as the neck, arms, jaw, back, or stomach.
• Shortness of breath, lightheadedness, nausea, or breaking out in a cold sweat.

Women may get chest pain or discomfort, but in many cases, it's not the most obvious symptom. Instead, women are more likely than men to have these symptoms:

• Unusual fatigue
• Nausea or indigestion
• Dizziness or lightheadedness
• Abdominal discomfort that may feel like indigestion
• Discomfort described as pressure/ tightness or an ache in the neck, shoulder, or upper back

If the person has lost consciousness and you notice that they are not breathing, call 911 and begin CPR if you are trained. Time is very important with heart attacks, so help your buddy!

CALLING 911/Dealing with the police and EMS:

“The cops will sit there and laugh when they know you’re on stimulants, they’re like “oh, yeah, he’s on one” and now all of a sudden they’re relaxed because they know you’re not going to die but now they want to watch you tweak so they’re sitting there hahahaha and they’re giggling and they’re like “watch what the fuck he’s going to do next, don’t do nothing, he’s going through the garbage can,” or “he’s doing this or he’s looking at the window really weird” or whatever the fuck you’re doin, and it’s not about care.” –R

Calling 911 can be lifesaving; it can also be a pretty unpleasant experience. Sometimes the first responders, whether they are police, fire or the ambulance can be great, other times they can be rude at best. There are lots of legitimate fears about calling 911, like getting arrested, having neighbors or landlords know your business, potential loss of benefits or housing if drug use is disclosed—and on an on. Drug users face a lot of stigma, which makes us very reluctant to call for help if we or our friends are in trouble.

The most important thing is to know your rights. In San Francisco, our police officers are not supposed to arrest people if they have called 911 for an overdose or drug-related emergency. If you feel safe doing so, remind the officers of this if they start giving you trouble.

But, police also have a job to do, so don’t make it easier for them. Make sure if you do call, not to leave drugs or paraphernalia around in plain view. Try to keep the area calm and quiet, if there are a lot of people around, tell them to leave if possible so there’s not a big group when the cops, fire or ambulance get there.

When you call, stick to the basics about what is physically happening to your friend: “My friend is having chest pains, or possibly a stroke.” NOT “My friend did a huge hit of speed and is acting crazy.” Don’t mention drugs or overdose, just stick to the symptoms that you see. Give them the address and hang up.

“My thing is that if I can’t communicate with you and you can’t tell me how you’re feeling then I have to call the ambulance because I don’t know you well enough. You could be sweating profusely, starting to throw up a little bit, and I just don’t want to take a chance. [So I called 911 for this guy], but when they came to my apartment, they were really all in my business and assaulting and everything because they saw the speed pipe around so they said “well what are you doing, are you doing drugs too?” I said I had some alcohol, they said “that’s it?” and I said “Hey dudes, I called you because my friend’s sick and what are you doing for him anyway? You’ve been here for 10 minutes and you’re just asking me these questions and you haven’t taken his pulse or anything like that.” And they said the ambulance is on the way, it was the Fire Department. So now that I know something’s going on I relaxed because I was really upset and they were like “Why do you need to know?” and I said, “Dude just leave me alone” and so then he said “Well you know, drugs are illegal” and I said “You know what dude? I’m not stupid and I know that the city of San Francisco has a policy that if you call for a drug overdose, I know I’m not going to get in trouble” and he said “Don’t even go there with me,” and then he got all… you know, I couldn’t smoke in my apartment, then everything was a hassle for them, it was a really bad experience and if I wasn’t as involved as I am in certain aspects of drug user politics, I would never call them again. Because I don’t need them getting in my business. Why would I want that in my apartment? I would just do the old way and drag the person in the hallway and shut the door and hope someone else would call. So that’s something that needs to be addressed because there’s no point in dealing with this issue if the people are supposed to help us are still going to be judgmental. So if we’re going to take speed overdose seriously it has to be a comprehensive approach with the police services and the drug users on the same page. And also they don’t know anything about overdose on speed because I said he did speed and he did some GHB and they got crazy and were like “Did you do speed here?” and what does it matter? You know it was bullshit.” –I

How to deal with the psychological aspects of Overamping:

“[Overamping] is like when you get the opposite of what you wanted. I’ve had many times where my anxiety level was so high that for whatever reason especially when my heart is stimulated I would find that raising my arms would do something to calm me down, so I’m in fucking public walking around the block again and again and again, shaking it off, shaking it off, and I don’t fucking care because I just want this feeling to go away.”—R 

If you are confident that the problem is not medical in nature (seizure, stroke, heart attack, overheating), but that you or your friend is experiencing anxiety or other psychological symptoms of overamping there are things you can do as well:

Here are some things that some fellow tweakers have tried, and they worked! You may have your own methods of relaxing, or getting yourself out of a bad space. Do whatever works, and share your strategies with friends.

• Drink water or a sports drink, eat some food
• Try to sleep
• Switch how you’re doing your speed, sometimes if you’re shooting, switching to smoking can help
• Change your environment or the people you’re with
• Take a benzo (small dose, like an Ativan)
• Breathing or meditation exercises
• Physical contact, like massaging yourself or having someone else do it for you
• Walking, walking, walking—walk it off!
• Take a warm shower
• Get some fresh air

The following quotes are from a discussion about ways that we practice harm reduction, and how tough it is sometimes!

“I’ve experienced speed psychosis many, many times…I was just reading, doing some research on methamphetamines a few days ago and I keep forgetting that the literature says that it has hallucinatory properties and so I think that if people remembered that, if I remember that when I do it, if I’m expecting that, it’s not going to be that startling and I can work with it. I think just knowing what the properties of speed are would be really helpful, and the underlying hallucinations are part of the process and they don’t always come every time you do it, but when they do come it’s part of the drug.”—I

 “I was taught a long time ago how to deal with visual hallucinations, you know, at one point every time I looked up in the window I’d see some man in the window, and someone taught me a long time ago to hold my finger up to that window, because a man is not going to be the full length of a window, he’s never going to be that tall and if you hold your finger up, you can start gauging size and distance. So that thing I’m thinking is a man would actually have to be 10 feet tall to be a man, so that’s one way of doing it. The other thing is that human beings always move. If you see what you what you think is a person up there, we can’t stand still, we are going to move even if we’re trying to be still we’re moving, so there’s one way of gauging what’s hallucination and what’s not. The other thing is, as I understand it, basically our eyes and ears take in all this information, we have all this information that comes in on all these cells, and when we’re fatigued not all those cells are working so only parts of the information come in so if I’m walking down the street and someone says “Taxi” and all I hear is the “E,” then I hear “Jesse” so I hear people calling my name all fucking day. And that’s just part of the fatigue. The other thing I want to talk about is that not everything is necessarily hallucination, sometimes it’s delusion, because speed gives you the delusion of optimism, it’s like we do speed and everything’s going to be ok, so that’s why we think that even though our rent is due tomorrow and we don’t have a buck in our pocket somehow we think we’re going to be able to raise the rent in those 18 hours because it’s like this delusion of optimism and that’s part of it as well.”—J

“That’s like my rule number 4 for Harm Reduction is don’t get high with anybody who I’ve never gotten high with before regardless, I don’t care, if he’s got the money, you got the money, who’s got the money, who’s got the best sex, what apartment we’re using, whatever the fuck’s happening, if I have not gotten high with you before, I am not fucking with you… I want to enjoy my high and that is gonna involve me doing my little ritual and my routine and if I don’t feel comfortable with you harm reduction says I don’t get high with everybody. I don’t turn on a dime. My relationship with drugs is my relationship so I make sure that I have my money, my dope, my partner, my whatever, because if I’m getting high with you just because you got the sack my experience is fucked up because you don’t get high like I do whether or not yours is safe for you, you don’t get high like I do.” –R

“I started modifying my behavior to avoid psychosis, and to make a long story short over the years I developed some strategies to deal with it. My pattern is, if I start smoking it instead of shooting it for a couple months everything’s fine, I never get psychosis. I never get psychotic on smoking because it’s hard to OD when smoking because you can grab it really slowly. Then I’ll go back to using the point and the first few times I use the point everything’s fine, everything’s great, and then there’ll be one time, for some reason I’ll do it and the minute I put it up my arm I just know I’ve done too much. It’s not necessarily after being be up all day, it could be the beginning of the month when I haven’t done anything for a while because I’ve been broke, so anytime. So my strategy is that when that happens, then I just can’t shoot it, I have to smoke it.”—I

“Sometimes if I’m having anxiety I will count to 900 and I figure, ok, if I don’t die in 15 minutes I’m going to be ok, so I count to 900 I’m alive and its ok. Or I go to movies, something to distract me. I find the deep breathing stuff, that kind of chanting and stuff, I’m still practicing using that.  Sometimes I’ll ask someone to massage me or hold me…I’ll massage my own foot, or massage someone’s foot or just hold them and kind of breathe with them so if they’re breathing too fast just try to get them to match my breathing. Just by being there with them, not even saying that out loud because that would just create more anxiety but just laying with them and doing that.”—J

“My doctor prescribes an anti-psychotic for me; it’s not a benzo…its Seroquel. The prescription is “take as needed,” so in other words, if I’m getting really psychotic I can take that and it will bring me down. And usually you can go to sleep a little bit later. The only problem with that is if I take that and then if someone’s with me, suddenly I go from being really crazy to being totally mellow, and you would think they would be happy…but fuck it, I just tell them, you don’t want to see me go crackers. Also I go for long walks sometimes, because if I get into a tweak in which I’m thinking that people are judging me or looking at me in my neighborhood I’ll walk where I don’t know anybody and I can find things that are genuinely new and I look at them, and I’ll be like “I’ve never seen this before.” –I

“One of the things I do, is after my first shot, which is always a good one because that means there’s always going to be a second…I promise myself, and this is a boundary for me and sometimes I make it and sometimes I don’t, but I always have one of those vitamin c drinks and after my first shot I don’t take another shot until I at least drink that because I’m not gonna eat, but I at least want some vitamins and to be hydrated because I’m doing all kinds of physical shit and I know I’m dehydrated, I know I’m sweating and I know that my fluids are gone and at least I get some minerals or vitamins or whatever the fuck that’s in that shit that’s good and I tell myself, look, if I’m not ready to drink this water because my mouth is dry like the Sahara, but just drinking water seems like such a bad idea its like really not cool it’s not what’s happening if I’m not ready to drink it, I’m not ready for another shot and I tell myself and sometimes I make it and sometimes I don’t but I know that uh oh, I need to start not being in public and tweak out in a room where I won’t get arrested that’s harm reduction for me. I got two strikes. I can’t be on the street where the police will get me and that’s super harm reduction, I don’t want to go to prison for life for having a needle or a sack in my pocket and that’s important for me.” –R

“I know for myself it’s walking, taking a shower, just taking a shower. It’s very calming, I’ve got the liquid soap, the bath soaps that actually have the scents, and I always use ones that are calming and just to sit there and feel the water, feel that sensation, it’s very distracting.” –J

“I can definitely speak very highly of benzos. I have taken Ativan several times, and I have found that especially if I overamped just moderately, 1 or 2 milligrams of Ativan is enough to take that bite out of what I’m feeling but it won’t put me to sleep. I’ve also found similar, and I don’t think it’s just an urban legend or power of suggestion sort of thing, but dairy products tend to be really sedative for me, especially like drinking half and half. Once again, it’s the sensation of that edge, that bite being taken off.” –R

“There have been times where I’ll wake up and the pipe is in bed with me you know, because I told myself you know what? Anything past three days is just a waste of good drugs because when you’re at a certain point where you’re probably dehydrated, malnourished, sleep deprived, your brain is even dehydrated, there is a physiological reaction happening in the body on basically every level and your body has changed and that’s what I would tell myself--I am no longer in a position to enjoy these drugs.” –R

“You know, we all know the rules but to this day sometimes I won’t follow the rules, you know, I won’t drink for 24 hours or I don’t, you know…it’s weird, to this day. I’m not harsh on myself about it you know I just want to acknowledge that it’s hard…”

–J

“I definitely know when I’m not on my boundaries, I not only let myself know but I let everyone know around me because I want support. I’m asking for support, like hey aren’t you supposed to go lay down? Aren’t you supposed to drink water? I’ll come here and talk [someone I trust] and its crisis time for me, and I’m not in any physical danger, but I know I’ve jumped off the edge and it’s like the rollercoaster ride where I’m past that point of rational thinking. I’m not going to sleep, I’m gonna go get that next high and if I don’t have any money that means doing shit to get the money to go get that next high and then I’ll go tell everybody “hey look I’m not minding my boundaries, I’m asking for help because I got egg on my face and I want you to say “go lay your bitch ass down, go lay your punk ass down go to sleep.” Help me enforce my boundaries, do something like that because I need help. And then you could come see me and I’ll be like I’m gonna go get high tomorrow and everything’s exciting because I got my boundaries in place, everything’s cool, but then sometimes I go off the edge and I come in here and I’m dirty and I got a five o clock shadow, same clothes on three days, and it’s like what the fuck? You know it’s just my boundaries went to hell.” –R

“For me, what’s been the saving grace for me, is that I’m able to recognize that I hear voices but I can differentiate between what’s in my head and what’s in reality and I think the reason I’m able to do that is because early on I decided not to be closeted about my drug use. I was working kind of in a professional position where I wasn’t allowed to speak about it but I was writing poetry and reading publicly and that’s what I would write and read about. I think that a lot of the schizophrenia that results from speed use is the fact that people are so closeted or feel so ashamed and have to hide their drug use.” –J