Keeping safe over Christmas | Sione’s tips
Well, it’s Christmas time again. A number of things come up for users at this time of year: organising pharmacotherapy doses and inter-state transfers; wondering if your dealer is going to be working on Christmas Day; sorting out injecting equipment when NSP hours change over Christmas as staff have a well-earned break!
But for many of us, there is no break from being a user. And the holiday period brings additional health issues for users, particularly overdose prevention and bloodborne virus awareness.
Christmas time is, of course, a time of excess consumption. It’s a time when it’s okay to get drunk and go silly at the office party and overdose on pork or turkey at Christmas dinner. For a drug user, however, excess consumption can sometimes have more serious consequences than a hangover or indigestion. Both “up” drugs like cocaine and methamphetamine and “down” drugs like heroin and other opioids can have negative consequences when used to excess or in combination with other substances.
Alcohol is always present around Christmas in Australia. Workplaces often throw parties with loads of booze or large bar tabs. For many people, Christmas Day itself begins with a drink and the drinking continues through and beyond Christmas dinner.
As some of us know from silly behaviour at past work parties, alcohol lowers our inhibitions and makes silly ideas seem brilliant. Usually these are harmless – photocopying your bum or getting it on with that person you’ve had your eye on all year. Likewise, alcohol can make taking drugs seem like a great idea. Again, this is often harmless and fun. But to make it so, we need to remember a few key ideas.
Our limits are not limitless
To use more safely, we need to know about the drug we are taking and how it interacts with other drugs. Checking for any recent drug alerts is a good habit to get into before you use a new batch: https://nuaa.org.au/drug-alerts [Editor's note: on 22/12/22 a NSW drug alert was published about 'Heroin' found to contain a potent opioid ('nitazene’)]
We also need to know ourselves and our own limits.
The most obvious candidate for overdose potential is taking heroin or other opioids (morphine, oxy’s, methadone, etc.) on top of alcohol. Alcohol and opioids “potentiate” one another (they make each other stronger when used together). Overdose becomes far more likely in this situation, no matter your experience or tolerance levels.
If you are drunk then trying a drug for the first time might be irresistible. If this drug is an opioid the best thing to do is to not do it while drunk. The results are just too unpredictable. If you absolutely insist, make sure there is someone with you who knows something about opioids. (Better yet, go to a Medically Supervised Injection Centre if you live near Kings Cross in NSW, or Richmond in Victoria and let them know exactly what else you have on board.) Mix up a smaller amount than you usually would. There’s an old wise saying: “You can put more in but you can’t take anything out!”
If you are an experienced user using for the first time in a long while, then treat yourself like a total beginner. Your tolerance will be low – nowhere near the level it was when you were using regularly. It will be even lower if you have been drinking or have benzos on board.
Even if you are a current user running a habit, remember that you are not invincible. Experienced users overdose too — very often when opioids are used on top of alcohol or benzos. Use less than usual.
If you intend to use and drink, the least harmful way to go about it is to have your opioid dose first, then moderate your drinking. But remember: even the next day can be a dangerous time to use as people are often still drunk enough when they wake up for the alcohol in their system to interact and potentiate the opioids.
Carry naloxone. It can temporarily reverse an overdose from opioids but is not effective for benzos. Naloxone will not make a benzo overdose worse.
You can get Naloxone as a nasal spray (nyxoid) or as an injectable (prenoxad). Both are very easy to use. Prenoxad contains more doses of naloxone. We are currently encouraging people to get Prenoxad because sometimes to reverse an opioid overdose you need multiple doses.
NUAA can mail you naloxone for free in a discreet package. Order via shop.nuaa.org.au or call (02) 8354 7343.
There are different issues when using “up” drugs on top of booze. Having a few lines of coke on top of a few drinks is pretty common. But having loads of lines on top of loads of alcohol can lead to problems. Firstly, it’s pretty well accepted that people drunk on booze and way high on coke can be obnoxious. A room full of other drunk people can be a volatile place. Violence or unacceptable behaviour are not unknown in these situations. Be mindful of this as you drink and use and try to avoid arguments and so on.
Another possible outcome of using a lot of coke, and in particular, a lot of methamphetamine, is lack of sleep. If it’s one night out, that’s one thing, but days on end without sleep can be bad for both your mental and physical health. We need sleep and food and going without can lead in extreme cases to psychosis. Even in less extreme circumstances, the strain that lack of sleep puts on your mind can lead to poor decision-making. For instance, it might be tempting to have a few benzos or some opioids to help you relax or sleep after a long night or three, but the same issues outlined earlier remain: for both experienced and inexperienced opioid users it is a dangerous time to take them. If you do take opioids or benzos, particularly on top of alcohol, go slowly. Take small amounts and have gaps between using to ensure you are safe. This is called “titration” in medical talk and it’s about safely and slowly increasing dosages until the person is comfortable but safe.
Finally, just think a little bit about the strain you are putting on your body over this period. Eat healthily and sleep well when you have the opportunity.
Sharing and re-using injecting equipment
Injecting drug use often takes place in a sociable way. Often, we have a using buddy and often we use in groups. This has the risk of blood-borne virus transmission. Even if we fully intend to use our own equipment, it can be confusing at the best of times. Add in alcohol and other drugs to the mix and the chances become greater of using a piece of equipment that could transmit hep C or HIV.
There is a concept called “mindfulness” which is useful when thinking about these issues. If we’ve been using and injecting for a long time, we undertake many actions almost unconsciously. We don’t even need to think about them. But that can almost be a bad thing because we can stop thinking about what we are actually doing. Mindfulness is about being in the moment, thinking about what you are actually doing and being aware of the possible consequences.
When using in a group this is really important. A few people all mixing up and using together generates a lot of activity. That increases the possibility of accidentally sharing equipment (and blood particles, which are often invisible to the naked eye). It takes an effort to keep all your using equipment to yourself.
An example of not being mindful: two of you have a shot and as you finish up, you put down your fit uncapped because you’re focussing on your rush. That fit is now a danger to your using partner. Another example: you and your friend put your fits down next to each other. Later on, you get confused about whose is whose. This might not matter if you have more sterile equipment, but over Christmas many NSPs are closed, forcing some people to reuse equipment when they ordinarily wouldn’t.
In these circumstances, planning is everything: think about what could go wrong or get confusing beforehand and your chances of confusing your equipment with someone else’s is substantially reduced. The simplest trick, of course, is to have plenty of spare equipment. If this is not possible, then mark your own equipment and only use your own.
Clean your equipment well away from anyone else and store it in a safe place (a tin pencil case, for example) in your bag or pocket.
Don’t leave things lying around to get confused. Recap your own equipment and ask others to recap theirs.
It’s not just the sharing of needles and syringes that can spread blood-borne viruses: make sure you have your own spoon, swabs, tourniquets and other equipment and mark them so you don’t get confused. Swab your fingers and think about where they have been before you make filters to put in the mix, for example.
The fly in the ointment, of course, is the excess alcohol and/or other drugs on board which can make being “mindful” very difficult. But establishing good habits is a great place to start.
Although it is difficult at this time of year, the key to keeping safe is thinking about what you are doing. Don’t just use how you always use if you have been drinking. Hep C doesn’t care if it’s Christmas, so be extra careful when using with others.
Too often we misjudge our limits at this time of year. No matter how drunk or high we are, we’re not invincible.
This is a republished article from 2010, written by Sione Crawford, who is now the CEO of Harm Reduction Victoria and member of the AIVL Board of Directors.