What’s the difference between substance use, substance dependence, and addiction?

Addiction

Someone is considered “addicted” to a substance if they meet the criteria for Substance Use Disorder (SUD) in the DSM V. The DSM V is the manual that mental health professionals use to diagnose mental health issues. Addiction encompasses both a mental and physical reliance on a substance. It is marked by a change in behavior that is caused by the biochemical changes in the brain after continued substance use.¹ Only clinicians can diagnose mental health concerns such as SUD. However, the following behaviors are potential signs that someone may be addicted to a substance:

• Taking the substance in larger amounts or for longer than you’re meant to
• Wanting to cut down or stop using the substance but not being able to
• Spending a lot of time getting, using, or recovering from use of the substance
• Cravings and urges to use the substance
• Not managing to complete work, home, or school tasks because of substance use
• Continuing to use, even when it causes problems in relationships
• Giving up important social, occupational, or recreational activities because of substance use
• Using substances again and again, even when dangerous
• Continuing to use, even when you know you have a physical or psychological problem that could have been caused or made worse by the substance
• Needing more of the substance to get the effect you want (tolerance)
• Development of withdrawal symptoms, which can be relieved by taking more of the substance
• Skipping classes, declining academic performance, dropping out, or recent disciplinary action.
• Poor personal appearance.
• Avoiding friends or family.
• No longer participating in activities they once enjoyed.
• Lying about drug or alcohol use.
• Needing to drink or use drugs to relax or have a good time.
• Mood changes, such as being depressed, irritable, or angry.
• Physical or mental problems, like bloodshot eyes, poor concentration, or memory issues.
• Withdrawal symptoms (like headaches, cravings, or depression).
• Continuing substance use despite the negative consequences.
• Legal troubles, like arrests, accidents, or DWIs.
• Using substances in hazardous situations (like while driving).
• Risky behavior while high or drunk, like starting fights or having unprotected sex.^{2 3}

“Process addiction” is the clinical term for non-substance addictions. Examples include gambling, video games, social media, food, and sex. Someone who has a process addiction will likely exhibit similar signs as listed above.

Substance Dependence

Substance dependence is classified in two ways: physical dependence and mental dependence. Physical dependence is characterized by the symptoms of tolerance and withdrawal. Someone is physically dependent on a substance if they need to increase the amount/frequency of use to achieve the same high OR if they experience symptoms of withdrawal when not using. These symptoms include: nausea, vomiting, irritability, anxiety, headaches, sweating, confusion, shakes or tremors, etc. Physical dependance often leads to addiction.¹

Mental dependence is when use of a substance is a conditioned response to an event or feeling. These are known as “triggers.” Something as simple as the act of driving can trigger a desire to use. These triggers set off biochemical changes in a person’s brain that strongly influence addictive behavior. Triggers can be emotional responses to events, certain people, places or anything a person associates with using a substance. When the symptoms of mental and physical dependence are apparent, an addiction is usually present. However, the main characteristic that distinguishes addiction from dependence is the combination of mental and physical dependence with uncontrollable behavior in obtaining and using a substance.¹

Substance Use

It is common for college and university students to use substances at a higher frequency/amount than older adults. Alcohol use tends to be higher in college students compared to non-college youth and a higher percentage of college students report binge drinking in the past two weeks compared to non- college youth (30.4% vs. 24.5%).⁴ (Source) Experimentation is a part of young adulthood. If you choose to use drugs, be sure to use safely and to look out for signs of dependence or addiction. If it no longer feels fun, talk to someone! Click here for addiction treatment resources.

¹ https://www.addictioncenter.com/addiction/addiction-vs-dependence/
² https://www.verywellmind.com/dsm-5-criteria-for-substance-use-disorders-21926
³ https://americanaddictioncenters.org/rehab-guide/college
⁴ https://www.bestcolleges.com/research/alcohol-use-in-college-statistics/#fn-2

Caring for a friend or family member who is struggling with substance use can be challenging. It is normal to want to do something to help and to feel helpless at times. The most important action you can take is to meet your friend/family member where they’re at. They may not know they have a problem with substance use, they may be in denial, or they may know they have an issue but are not yet ready to ask for help. Clinicians call these different stages the Stages of Change. Below is a description of each stage:

• Precontemplation – Not yet acknowledging that there is a problem behavior
• Contemplation – Acknowledging that there is a problem but not yet ready, not sure they want help, or afraid to make a change
• Preparation – Getting ready to change (ex: seeking therapy, asking for help, etc)
• Action – Changing behavior (ex: engaging in behavior change, in detox, therapy, or a recovery program)
• Maintenance – Maintaining the behavior change⁵

These stages are fluid and it’s common for people to move back and forth between them at various times. Your role as a friend is to be as safe space to talk about their substance use with. Decreasing stigma and responding without judgmental saves lives.⁶ As much as we’d like to, we can’t force people to move to a certain stage. All you can do is let the person know how their behavior is impacting you and let them know you will do your best to be there for them while they get through this. Try talking about your feelings/emotions rather than criticizing their actions. For example, “When you use, I feel scared. I am afraid of losing you. I want you to know I am here for you and want to help in any way I can.” Or “I see how this is affecting you and I feel helpless sometimes. I know this is hard to talk about this but I’m not going anywhere. I care about you.” If they haven’t yet acknowledged that their behavior is hurting themselves or others (Precontemplation stage), you can start by getting curious with them about what they’ve noticed. Try asking, “How does it feel when you’re not using?” or “What’s it like for you when you get high?” The purpose here is to try to understand what they’re going through and where they’re coming from. Often, substance use is a coping tool that people are using to escape intolerable feelings/situations. Get curious about what might feel intolerable in their lives and why.

It is also important that YOU get support through this. You can’t be your friend/family member’s therapist and it’s important to check in with your own boundaries about what you can/can’t do in your relationship with them. It’s totally valid to need space from your friend/family member at times. And it’s okay to say “I can’t take that role in their life.” It’s even okay to say “I don’t want to take that role.” Make sure to lean on your other friends/family members as well. You may also find support through individual therapy or groups such as AlAnon or CODA. You should not do this alone.

Your friend can only recover once they are ready to change and start receiving support. You can always offer your friend referrals *link to harm reduction resources or treatment resources at any point. If you’re not sure what to do, ask your friend what they need and what they’re ready for.

⁵ https://www.ncbi.nlm.nih.gov/books/NBK556005/
⁶ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5854406/

First, congratulate yourself on taking a huge step. It takes a lot of courage to start examining your relationship to substances or other addictive behaviors. If you have supportive people in your life or anyone who feels like a safe person to confide in, let them know what you’ve been going through! You can’t do this alone.

Support groups can be a great place to start. There are 12 step groups for virtually every type of addiction. Hearing about others’ experiences may validate your own and help you better understand how substances/addictive behaviors are impacting your life.

If abstinence is not achievable or even a goal at this point in your journey, there are many harm reduction techniques you can use to keep yourself safe.

Due to harmful societal messaging and stigma around addiction and drug use, it is common to feel shame or want to hide your addiction from others. It is also common to fear others’ reactions to this news and it can feel scary to even name it. Please remember that you are not alone in this and that there are millions of other people who going through/have gone through the same thing. Reach out to others who feel safe for support (friends, a therapist, community members, etc.).

Appropriate Substance Use Disorder care depends on the substance being used, the frequency/amount, the Stage of Change the person is in, and other similar factors. This treatment assessment may help in determining the level of care a person needs: https://www.treatmentconnection.com/assessment

Below is a description of the various levels of care from lowest means of intervention to highest:

Education

Maybe your friend is just hearing about addiction and wants to learn more. If so, you can refer them to the following educational resources

Harm Reduction

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.⁷ Harm reduction approaches acknowledge where each person is at. Some people are simply not ready or able to stop using a substance or maintain abstinence. Harm reduction techniques can keep people safe and alive as they navigate the complexities of drug use.⁸ Addiction is a complex, multi-faceted phenomenon that encompasses a continuum of behaviors from severe use to total abstinence (National Coalition for Harm Reduction). Harm reduction is non-judgmental, empowering to the person using substances, and recognizes the realities/role of social inequity in drug use.⁷ Harm reduction strategies vary per drug and circumstance, but the following are some examples:

• Only using substances with a friend who is not using
• Refraining from driving while intoxicated
• Using a clean needle
• Smoking or snorting rather than injecting a substance
• Testing your drugs for Fentanyl first
• Carrying Narcan/preparing for an overdose ahead of time
• Staying hydrated or drinking Gatorade

See the services below for more information on harm reduction and for additional resources

12 Step/Support Groups

Support groups are a great way to connect with others who are going through a similar lived experience. It can be healing to know you are not alone and to receive support from people who truly understand what you’re going through. 12 Step is a program that is geared towards maintaining sobriety and abstinence. All 12 Step groups are self-supporting, and peer led. There are several different types of 12 Step support groups such as Alcoholics Anonymous (AA), Narcotics Anonymous (NA), Cocaine Anonymous (CA), etc. Although the 12 Steps are based on spiritual principles, many nonreligious people have found the program helpful. The language emphasizes the presence of a Higher Power, allowing for different interpretations and religious beliefs. For those who are not religious, a “Higher Power” can be viewed as the interconnectedness of beings or a part of yourself. As the name indicates, the program involves working through 12 steps to recovery and operates on standard principles.⁹

AlAnon and Codependents Anonymous (CODA) are 12 Step groups geared towards supporting the friends and family of those who are struggling with addiction.

SMART Recovery is another peer-led support group. Unlike 12-Step programs, there are no sponsors, discussion of a higher power or being powerless, or prayers. It emphasizes self-empowerment and self- reliance while providing education and support. Peer-led support is encouraged and it’s okay to “cross talk” to address a peer member’s comments during a meeting.¹⁰

You can also find therapist-led groups in the community! *link These types of groups include: Process Groups, CBT Groups, Psychoeducation Groups, and Skills Development Groups. These groups tend to focus on evidence-based treatment modalities that are led by a trained therapist.

Outpatient Therapy

Outpatient therapy refers to meeting with an individual therapist anywhere from once a month to twice a week. Clients live at home and visit their therapist’s office or meet with them virtually. Therapists who specialize in addiction can help clients identify where they are at in the Stages of Change and support them with their recovery goals. Individual therapy is beneficial for clients who want to understand themselves better in a non-judgmental and confidential space. Therapists utilize different techniques based on theoretical orientations and evidence-based practices. There are many different approaches to treating Substance Use Disorder (SUD), but many therapists focus on the underlying causes of addiction. Their job is to help clients figure out why they are using and guide them toward developing alternative coping tools. Addiction isn’t caused by just one thing – it is impacted by a complex system of societal, cultural, psychological, and biological forces.

Many therapists approach addiction from a trauma-informed lens and see substance use as a way that clients cope with the symptoms of trauma. There are many modalities that therapists use to treat SUD including, but not limited to: Cognitive Behavioral Therapy (CBT), Motivational Interviewing, Dialectical Behavior Therapy (DBT), Eye Movement Desensitization and Reprocessing (EMDR), Seeking Safety, Mindfulness Therapy, Somatic Therapy, Trauma Resiliency Model (TRM), Psychodynamic Therapy, Neurofeedback, Equine Therapy, and Relational Therapy.¹¹

Interventions

An intervention is a carefully planned process that may be done by family and friends, in consultation with a doctor or professional such as a licensed alcohol and drug counselor or directed by an intervention professional (interventionist). The purpose of an intervention is to express concerns and to direct the person using towards treatment. During the intervention, loved ones gather to confront the person using substances about the consequences of addiction and ask them to accept treatment. The intervention:

• Provides specific examples of behaviors and their impact on them, their family, and their friends
• Offers a prearranged treatment plan with clear steps, goals and guidelines
• Spells out what each person will do if your loved one refuses to accept treatment and plan for follow-up

Interventions are a surprise to the person and are intended to be led with care, not as a venue to express anger, to shame, or to criticize. There’s little data available on the effectiveness of interventions. The primary risk posed by interventions is a disruption in your relationship with the person. Some people respond to interventions with anger and storm out before the process is complete. In other cases, the person may refuse to go to treatment.¹²

Partial Hospitalization Programs (PHP) and Intensive Outpatient Programs (IOP)

Partial Hospitalization Programs (PHP) are intensive therapy programs that include multiple therapeutic sessions per day. A typical PHP schedule is about 5-6 hours of therapeutic sessions a day for about 5 days a week. Some examples of these sessions are: group therapy, medication management with a psychiatrist, individual therapy, treatment planning, body work, and family or couples therapy. Clients in a PHP are living at home and coming in to the office or completing their sessions virtually. PHP is appropriate for clients who need a higher level of care than standard outpatient therapy. A full schedule of therapeutic sessions allows clients to address multiple mental health needs, as often their schedules are individualized based on their unique treatment plan. For example, a day of PHP could look like: 8am – Process Group, 9am – Individual Somatic Therapy, 10am – Individual CBT Therapy, 11am – Recovery Group, 12pm – Lunch, 1pm – Acupuncture, 2pm – Individual Trauma Therapy.

Intensive Outpatient Programs (IOP) are a step down from PHP. They have a similar structure but will typically consist of about 3-4 sessions per day for about 3-5 days a week.

Most PHP and IOP programs address co-occurring mental health concerns such as depression, anxiety, eating disorders, etc. IOP and PHP programs are most appropriate for clients who are severely impacted by addiction and are in need of daily support and structure but are still able to complete the functions of daily living independently.

Sober Companion

A Sober Companion is hired to accompany a person in recovery from addiction throughout their daily life. Some Sober Companions live with their clients in their homes, while others meet up with their clients in the mornings and stay with them throughout the day. Sober Companions may be recommended by a person’s treatment provider if there is a high risk of relapse after leaving a Residential or Detox program. Many Sober Companions have lived experience and are also in recovery so they are best fit to help clients adjust to life after rehab. Sober Companion duties include:

• Remove drugs and alcohol from home environment
• Keep watch over clients during recovery for behaviors that may lead to relapse
• Encourage clients to implement/practice new coping skills learned in treatment
• Help clients get to appointments
• Monitor whom clients associate with to prevent relapse
• Help clients bond and reconnect with family members and loved ones¹³

Inpatient/Residential

Residential treatment (sometimes called Inpatient treatment or “Rehab”) is designed for clients who are either recovering from a recent mental health crisis/detox, are at a safety risk, or at a high risk of using or overdosing if they are alone. Clients in residential treatment may be having difficulty completing the daily functions of living on their own and benefit from being monitored regularly. Residential treatment typically involves a combination of mental health and medical services. Medical doctors prescribe medications to help assist with the physical symptoms of withdrawal or to curb cravings. Some of these medications include: Naltrexone, Vivitrol, Suboxone, Modafinil, etc. Clients may also be prescribed psychopharmacological medications that treat various mental health issues such as depression or anxiety.¹⁴

Clients in Residential treatment are living on the premises and are attending a combination of individual therapy sessions, group therapy sessions, and medication management sessions. They are under the constant care of mental health professionals.

Detox

Detoxification (or Detox) refers to the process of clearing a substance from a person’s body. People who have been actively using a substance for a long period of time can experience uncomfortable, painful, and sometimes deadly symptoms of withdrawal if they stop using abruptly (or “quit cold turkey”). A detox is a medically assisted method of clearing the body of the substance. A medical doctor meets with the client and helps them to slowly wean off a substance by coming up with a treatment plan and administering medications that help to ease withdrawal symptoms. Some substances are dangerous to quit cold turkey including alcohol, benzodiazepines (Xanax, Valium), and opioids (heroin, fentanyl, Oxycontin) so a medically assisted detox is necessary for prolonged use of these substances. Aside from the dangers of withdrawal, the person is likely to use the substance again to rid themselves of the withdrawal symptoms if not medically supervised.¹⁵

A medically assisted detox can be done at home, in a hospital, a residential treatment center, etc. People can also benefit from an assisted detox if they are using other substances such as cocaine or marijuana.

Detox is often the first line of treatment when someone has been addicted to substances for a long period of time and is ready to make the choice to stop using. If you’re unsure where to start or if you’re not sure whether a person needs a detox, consult with a medical doctor or call the Substance Abuse and Mental Health Services Administration (SAMHSA) helpline at 1-800-662-HELP (4357). It’s a free, confidential service that anyone can use to get information about substance abuse treatment.

⁷ https://harmreduction.org/about-us/principles-of-harm-reduction/
⁸ https://nida.nih.gov/research-topics/harm-reduction
⁹ https://www.addictioncenter.com/treatment/12-step-programs/
¹⁰ https://drugfree.org/article/recovery-support-groups-for-addiction-one-size-does-not-fit-all/
¹¹ https://americanaddictioncenters.org/therapy-treatment
¹² https://www.mayoclinic.org/diseases-conditions/mental-illness/in-depth/intervention/art-20047451
¹³ https://www.therecoveryvillage.com/treatment-program/aftercare/sober-companion/
¹⁴ https://sbtreatment.com/medications-treat-addiction/
¹⁵ https://www.webmd.com/mental-health/addiction/addiction-detox-what-to-know

• Test your drugs for fentanyl using fentanyl test strips
• Keep naloxone readily available on you and at home. Talk with your healthcare provider or pharmacist about being prescribed naloxone (e.g., Narcan) if you or someone you know is at risk for an overdose. You can also check with your local health department or community-based organization to see if they distribute naloxone at no cost.
• Avoid mixing drugs. Mixing multiple stimulants like methamphetamine and cocaine, depressants like opioids and alcohol, or a combination of both can cause harm and potentially death.
• Don’t rely on a previous source or experience. Knowing where your drugs come from doesn’t mean they’re safe. And even if you have used drugs before, your body could react differently every time.
• Never use drugs alone. Make sure the people around you are aware when you have taken drugs in case they need to give you naloxone or call for emergency assistance. The safest bet is to use with a friend who is not using.¹⁶

¹⁶ https://www.cdc.gov/stopoverdose/fentanyl/fentanyl-test-strips.html

Overdose signs vary depending on the substance ingested. The most dangerous substances to overdose on are the ones most likely to lead to overdose death. Those substances are: Fentanyl, Methamphetamine, Cocaine, Heroin, Prescription Opioids (OxyContin), and Benzodiazepines (Valium, Xanax)¹⁷

Fentanyl

• Small, constricted “pinpoint pupils”
• Falling asleep or losing consciousness
• Slow, weak, or no breathing
• Choking or gurgling sounds
• Snoring (apnea)
• Limp body
• Cold and/or clammy skin
• Discolored skin (especially in lips and nails)¹⁸

Heroin (or other opioids such as Oxycodone)

• Uncontrolled vomiting
• Drowsiness and lethargy
• Body going limp
• Loss of consciousness
• Inability to wake the person up, even if applying a painful stimulus, such as knuckles rubbed along the sternum
• Making choking or gurgling noises
• Shallow or labored breathing
• Slowed pulse
• Low blood pressure
• Skin that is pale, blue, clammy, and/or cold
• Complete respiratory arrest¹⁹

Methamphetamine

• Agitation
• Chest pain
• Coma or unresponsiveness (in extreme cases)
• Heart attack
• Irregular or stopped heartbeat
• Difficulty breathing
• Very high body temperature
• Kidney damage and possibly kidney failure
• Paranoia
• Seizures
• Severe stomach pain
• Stroke²⁰

Cocaine

• Elevated heart rate
• Rise in body temperature
• Nausea and vomiting
• Pain in the chest
• Tremors
• Panicked feelings
• Anxiety
• Delirium
• Paranoia
• Heart attack
• Seizure
• Stroke²¹

¹⁷ https://www.cdc.gov/drugoverdose/epidemic/index.html
¹⁸ https://www.cdc.gov/stopoverdose/fentanyl/index.html
¹⁹ https://americanaddictioncenters.org/prescription-drugs/opiate-overdose
²⁰ https://americanaddictioncenters.org/meth-treatment/overdose
²¹ https://americanaddictioncenters.org/cocaine-treatment/overdose-symptoms-and-dangers

It may be hard to tell the difference between being high and experiencing an overdose. If you aren’t sure, treat it like an overdose! Any suspected drug overdose needs immediate medical treatment. And with any drug overdose, minutes can make the difference between life and death. The safe choice is getting professional medical treatment as quickly as possible.²²

Fentanyl, Heroin, or other opioids such as Oxycodone

• Call 911 Immediately
• Administer naloxone (Narcan)
• Try to keep the person awake and breathing
• Lay the person on their side to prevent choking
• Stay with the person until emergency assistance arrives¹⁸

^{Methamphetamine or Cocaine}

• Call 911 immediately
• Try to wake the person up if they appear unconscious.
• Start CPR if they don’t wake up. If they don’t wake up, check for a pulse and start CPR if you can’t immediately feel one. You don’t need to be certified in CPR to give chest compressions. And if you’re still on the phone, 911 operators can guide you through it.
• Give them Narcan only if they have also used opioids.
• Stay with the person until the paramedics arrive.
• If they are having a seizure, gently hold the back of their head to prevent injury. If possible, turn their head or body to the side in case they vomit. DO NOT try to stop their arms and legs from shaking or put anything in their mouth.²²

Benzodiazepines

Benzodiazepines such as Valium and Xanax can be fatal when ingested with alcohol or opioids. If you suspect someone may be overdosing and have taken Benzodiazepines, call 911 right away.

18 https://www.cdc.gov/stopoverdose/fentanyl/index.html
22 https://www.goodrx.com/methamphetamine/overdose

No. California has a Good Samaritan law. Good Samaritan laws offer legal protection to those who are assisting others in peril. Before you call 911, it would be best to have this information ready, if possible:

• Person’s approximate age and weight
• How much of the drug was taken
• How the drug was taken (For example, was it smoked or snorted?)
• How long it has been since the person took the drug²³

²³ https://www.mountsinai.org/health-library/poison/methamphetamine-overdose

Signs of Being Roofied

The signs and symptoms of being roofied are very similar to those of having consumed too much alcohol or other substances. Therefore, it can sometimes be difficult to discern the difference between being roofied and being drunk or high. The common drugs used to roofie are: Rohypnol, Ketamine, and GHB. Here are the signs that someone may have been roofied:

• Extreme brain fog
• Disorientation
• Difficulty focusing or concentrating
• Loss of muscle control
• Paralysis
• Feeling something is “off” or “not right”
• Nausea
• Memory lapses
• Feelings of euphoria²⁴

It’s common not to realize you’ve been roofied until the next day. The aftereffects are similar to having a really bad hangover and include headache, muscle pain, sensitivity to light, general drowsiness and confusion, nausea and the inability to recall certain events of the night before. It’s not uncommon for those who’ve been roofied to experience complete memory loss of that period.

What to Do

• Have the person drink as much water as possible
• Keep person safe and away from potential predators
• Take person to ER to seek medical attention right away²⁴

The ER physicians will take a urine toxicology screening to see if the person has roofying drugs in their system and can check levels. It’s important to do this screening in case the person decides to press charges or alert the police in the future.

Roofying typically occurs as a means to rape or sexually assault someone. If you believe your friend has been sexually assaulted, take them to the ER or a rape crisis clinic right away. Rape crisis clinics can do comprehensive medical exams and collect evidence if the victim chooses to press charges or report the incident to the police in the future. Most clinics will hold evidence for a certain period of time. Many clinics also employ therapists and clinicians who are trauma-informed in their care and offer mental health referrals.

Victims of sexual assault can receive free care 24/7 at the UCLA Rape Treatment Center by calling 424- 259-7208.

²⁴ https://fherehab.com/learning/signs-of-roofied

Fentanyl is a synthetic opioid that is up to 50 times stronger than heroin and 100 times stronger than morphine. It is a major contributor to fatal and nonfatal overdoses in the U.S.¹⁸

There are two types of fentanyl: pharmaceutical fentanyl and illicitly manufactured fentanyl. Both are considered synthetic opioids. Pharmaceutical fentanyl is prescribed by doctors to treat severe pain, especially after surgery and for advanced-stage cancer.

However, most recent cases of fentanyl-related overdose are linked to illicitly manufactured fentanyl, which is distributed through illegal drug markets for its heroin-like effect. It is often added to other drugs because of its extreme potency, which makes drugs cheaper, more powerful, more addictive, and more dangerous.¹⁸

¹⁸ https://www.cdc.gov/stopoverdose/fentanyl/index.html

Naloxone will only reverse an opioid overdose, it does not prevent deaths caused by other drugs such as benzodiazepines (ex: Xanax, Klonopin and Valium), bath salts, cocaine, methamphetamine, or alcohol. However, naloxone may also be effective for polysubstance overdoses such as combined opioid and alcohol overdose or a combination of an opioid and stimulant. It cannot be used to get high, is not addictive, and only has an effect on opioids.²⁶ Naloxone is safe and effective; emergency medical professionals have used it for decades. For more detailed information, visit www.drugs.com/pro/naloxone.html

Anyone can carry and administer Narcan and it can be purchased at most pharmacies. In some states, you can get naloxone from a pharmacist even if your doctor did not write you a prescription for it. It is also possible to get naloxone from community-based distribution programs, local public health groups, or local health departments, free of charge. If you would like to receive free training and/or free Narcan nasal sprays, contact the following organizations:

TACO

https://harmreduction.org/resource-center/harm-reduction-near-you/

End Overdose: https://endoverdose.net/

²⁵ https://nida.nih.gov/publications/drugfacts/naloxone ²⁶ https://www.nchrc.org/programs/syringe-services-old/naloxone-101/

Yes. Fentanyl is often added to other drugs because of its extreme potency, which makes drugs cheaper, more powerful, more addictive, and more dangerous. It is impossible to see fentanyl, taste it, or smell it when it’s laced in other substances. The only way to tell if your drugs have been laced with fentanyl is to test your drugs with fentanyl test strips.

Testing your drugs for fentanyl is an easy process with fentanyl test strips. Every drug can and should be tested for fentanyl before consumption. Test strips are inexpensive and typically give results within 5 minutes, which can be the difference between life or death. Even if the test is negative, take caution as test strips might not detect more potent fentanyl-like drugs, like carfentanil.

Below are steps to test your drugs for fentanyl using fentanyl test strips. Depending on the types of drugs you’re testing, the steps may be slightly different:

• Step 1: Put a small amount (at least 10mg) of your drugs aside in a clean, dry container.
• Step 2: Add water to the container and mix together.
  • Please note: For most drugs, you need ½ teaspoon of water. If you are testing methamphetamines, use1 full teaspoon.
• Step 3: Place the wavy end of the test strip down in the water and let it absorb for about 15 seconds.
• Step 4: Take the strip out of the water and place it on a flat surface for 2 to 5 minutes.
• Step 5: Read results.
  • Positive results: A single pink line on the left-hand side indicates that fentanyl or a fentanyl analog has been detected in your drugs. If you receive a positive result, it is much safer to discard the batch. Using it could kill you. Illicitly manufactured fentanyl is extremely potent and can be deadly.
  • Negative results: Two pink lines indicate that fentanyl or a fentanyl analog has not been detected in your drugs. Remember that no test is 100% accurate and your drugs may still contain fentanyl or fentanyl analogs even if you receive a negative result. You should still take caution as the strips might not detect more potent fentanyl-like drugs, like carfentanil, and fentanyl might not be everywhere in your drugs and your test might miss it.
  • Invalid results: A single pink line on the right-hand side or no lines at all, indicates an invalid test. If you get an invalid result, test your drugs again using a new strip.²⁷

²⁷ https://www.cdc.gov/stopoverdose/fentanyl/fentanyl-test-strips.html

Click this link for more harm reduction information: https://harmreduction.org/issues/safer-drug-use/facts/

Stigma is a discrimination against an identifiable group of people, a place, or a nation. Stigma about people with substance use disorders might include inaccurate or unfounded beliefs like: they are dangerous, incapable of managing treatment, or at fault for their condition. Stigma around addiction may come from old and inaccurate ideas, or fear of things that are different or misunderstood. Today, we know that addiction is a chronic, treatable condition. We also know that people can recover and continue to lead healthy lives. ²⁸

How does it affect people with SUD?

• Feeling stigmatized can make people with SUD less willing to seek treatment.
• Negative stereotypes about people with SUD can make others feel pity, fear, and even anger towards them.

That’s why it is important to use words that aren’t stigmatizing when talking about addiction.

• Use person-first language, which focuses on the person—not their illness. It focuses on removing words that define a person by their condition or have negative meanings. For example, “person with a substance use disorder” has a neutral tone and separates the person from his or her disorder.
• Let people choose how they are described. If you’re not sure what words to use, just ask! Check in with friends or loved ones about how they refer to themselves and how they would like others to refer to them. ²⁸

²⁸ https://nida.nih.gov/research-topics/addiction-science/words-matter-preferred-language-talking-about-addiction