In an era marked by synthetic opioids and an adulterated drug supply, it is of paramount importance to take additional precautions when deciding to use drugs. This takeaway is not novel to most in people active substance use and/or people who are working to reduce drug-related risks.
However, in the midst of the winter-holidays, I find myself especially fortunate to have cherished companions to celebrate wins, mourn losses, and provide support when I need it. For people in active substance use, having hands-on support can save lives. In a recent study of ours, we heard from several people with lived substance use experience who took pride in looking out for others in their community who used drugs. More specifically, participants discussed the strategy of using together and/or spotting for one another so they were able to act if their partner suffered an overdose.
Data for this study are from semi-structured qualitative interviews (n=74) conducted in three US states (California, Michigan, and Pennsylvania) to better understand practices related to naloxone use and preferences for overdose response. While open-coding transcripts, we picked up on themes related to people with lived substance use experience supporting one another - including the preference and perceived importance of co-use and spotting for one another.
Hannah (alias to protect identity), who lives in California and predominantly uses meth and weed shared in one of our studies,
“if I see one of my friends who do fetty [fentanyl]… if they're by themselves, I'll just hang out with them while they're smoking or whatever. So they don't have to be alone in case they do OD”
Cathy from Michigan further exemplified how people may stagger when they use,
“We were in the hotel room, and he just got out of jail. And I always wait till everyone's done using before I do mine, if I'm in a group of people. And so I'm like just waiting and I was specifically watching him, because I knew he just got out.”
Cathy understood the added risk for potential overdose because their acquaintance had just been released from prison and likely had a lower tolerance.
These strategies are common and effective, but may not always be practical. For example, some people may not have someone to use with (due possibly to the lack of a trusted and willing companion, fear of facing stigma, etc.), or they simply prefer to use alone.
Julia, also in Michigan, uses with their boyfriend now, but before they “would rather use alone” due to personality differences and how they preferred to experience their high.
Whether or not someone feels comfortable using their drug of choice in someone else’s presence is a highly individual and personal decision. Still, using alone carries considerable risk, as Hannah has experienced,
“I have friends that did fetty and shit and died by themselves, cause no one was with them.”
As such, it is critical that people who may not have someone they feel comfortable using in the presence of are aware of resources that exist that allow people who use drugs to be supported from afar.
A Safer Way to Use "Alone"
One free hotline option, open 24/7, is “SafeSpot” (1-800-972-0590). SafeSpot connects callers with an informed operator that stays on the line until after the caller completes their use. The hotline is judgment free and confidential, and only collects an address in case of emergency (the address is not stored in any database after the call is finished). If an overdose is detected (the caller stops responding after use), the operator on the line will contact their predetermined responder or local emergency medical services. SafeSpot’s 60 Hotline Operators have collectively supervised over 28,000 use events and detected 30 overdoses.
What Can I Do?
If you know someone that prefers to use on their own, making sure they know about resources like SafeSpot can be lifesaving. If you are a treatment provider or work for a syringe service program and are looking to display SafeSpot information on behalf of your participants, printable infographics can be located here.
If you are in charge of your state’s Opioid Settlement Funds and want to have a relationship with SafeSpot, reach out to us at opioiddatalab@unc.edu or info@massoverdosehelpline.org
Acknowledgement: Data collected and analyzed in this post were made possible by funding received from the U.S. Food & Drug Administration Center for Drug Evaluation & Research under a broad agency announcement (75F40122C00193, PI Dasgupta). This post does not necessarily reflect the viewpoints of the U.S. Food & Drug Administration. We also thank the people with lived experience that were willing to share their time and stories with us.