EP 3:37 Harm Reduction for Chemsex Recovery with Taylor

You know, best I can do is try to find some resources. Like, are you safe right now? Try to plan, right? I think I had the wherewithal, the safety plan with him, but just didn't— wasn't prepared and didn't know until I looked into it that, oh my gosh, this is an entire field. This is a phenomenon that is really— yeah. So it was very interesting.

Chemsex, sexualized drug use among men who have sex with men, typically involving methamphetamine, mephedrone, and GHB, among others. Chemsex misuse is a worldwide epidemic that needs attention, dialogue, and hope for those lost in it, which is the purpose of The Aftermath Podcast. Please note the views expressed by the host and guests on this podcast are not to be taken as medical advice, and the content around sex and drug use can be triggering. Hey, welcome back to The Aftermath Podcast. Welcome here, and I'm glad you're here. I'm glad you're going to take this tour with us today, this little journey into harm reduction. As you know, if you've listened to me for a while, that I like to present all sides of recovery, and I want to present a side of chemsex recovery that's been proven to be probably the most successful, and that is harm reduction of some kind. And we've discussed that harm reduction is just one big spectrum between abstinence and active use and everything in between. So We don't wanna separate it either from abstinence or harm reduction. But I will say, if you look, if you wanna do your own research, go out and research and see what's happening, see what's coming up in terms of long-term successful chemsex recovery and long-term successful measures that save lives. You're going to find harm reduction in the center of that in some form. So I want you to stay informed and I want you, if you're listening, And you just can't seem to stop and you just can't seem to fit in any other recovery abstinent program, look into some harm reduction techniques. We use it in my program. Some people are tapering off. We have planned uses. I mean, there's a lot of different managed use. There's a lot of different ways to do this with an end goal if it's negatively affecting your life of stopping. So today I have An expert, the expert, um, in, in the US actually too, uh, Taylor Edelman, who's a harm reduction consultant and healthcare compliance officer. Um, and he has— you have your own, you know, your own company that we're going to talk about too. Um, but I, I want to get some credentialed, informed, research-based professionals here so that you're not just hearing me talk about harm reduction. I want you to hear from the From the actual people in the field doing this. So Taylor, welcome to the Aftermath Podcast.

Yeah, thanks so much for having me here. It's a pleasure. Um, so I'm Taylor Edelman, use he/him/his pronouns. Um, I have my own consulting practice called Needle in the Hay Consulting. Um, I've been doing harm reduction and practicing it for, I would say, well over a decade now. Do a lot of work around gender-affirming care, harm reduction, health equity, organizational development. Yeah, and I have previously worked at the National Harm Reduction Coalition where I was overseeing a group that was focusing on queer and trans people who use drugs and engage in sex work. And currently I work with a number of different harm reduction organizations, recovery organizations, anyone who really has the desire to kind of level up their practice. I focus primarily on really incorporating and getting people to understand that harm reduction and gender-affirming care Or braided movements that are really undergirded by the concept and framework of bodily autonomy, which largely pulls from like the reproductive health space, but trying to get people to realize that we share a lot more than we have that separates us. Right. So just wanted to throw that out there.

So bodily autonomy, can you talk a little bit about that?

Yeah. So the way that I kind of talk about it and express it is really, really simple. It's just the ability to do with your body what you feel is right. and what you feel is appropriate and necessary and what you're entitled to, right? So that's really ensuring that people have the information, the education, whatever they need to make informed decisions, right? Like for example, in gender-affirming care, easiest thing I can think of is informed consent, right? 'Cause not too, too long ago, and even myself, yes, hi, trans person here, I had to go through the rigmarole of seeing a therapist before I was given You know, formal diagnosis to then go to an endocrinologist to start hormones, right?

Mm-hmm.

Where now it's very much, there's an exchange with a medical provider around, you know, these are the risks, these are the benefits, just kind of letting you know, informing you, um, so that you can then initiate, um, you know, that part of your transition, the medical transition. So really it's just overall having the ability to do what you want and what you feel is necessary with your body. Right? Nobody kind of imposing on you, which unfortunately we see happening, you know, at an accelerated rate here in the US, but really I would argue around the whole world.

Sure. Yeah. And as that, as that relates to drug use, so if I'm giving all the education, if I've given all the information and I'm making an informed decision, I want to use drugs.

Mm-hmm.

So the goal is, okay, that's your decision. That's your body. You have body autonomy. You want to use drugs. If you're going to, here are the ways to do it safely. And here are, here are some consequences that you may face, but if you're going to do it, please do it in a safe way that is healthy and that is, you know, that, you know, it will save your life. Is, is that correct?

Absolutely. And it's, it's, I love that you say that because a lot of people will assume Maybe not a lot, but there are definitely people who assume that, oh my gosh, you know, and I've had people say this, you harm reductionists, you know, you're, you're not pragmatic, which is very funny to me because if you actually look at the principles of harm reduction, pragmatism and realism is literally in there. Like, we accept the fact that there are risks and benefits, right?

Right.

So just because you, you purport and you talk about bodily autonomy doesn't mean that you're kind of obtuse or you're oblivious that there are downfalls, right? It's, I argue the opposite, that we are pragmatists, that we live in reality. Drugs have always been here, right? They're here right now. They'll continue to be here. People will continue to use. They have used. There's no sense in kind of shutting people down and stigmatizing them further. That's never going to work. It hasn't. We've seen it and we're seeing it in real time.

That's right. I mean, I think Somebody's gonna use drugs. You stigmatize them, you shame them, you tell them, you know, you shut them out. That's going to drive them to want to use more because shame got them to where they are for the most part.

Absolutely. People suffer in silence and the layer of not only substance use, but why it's so important to talk about this in the context of our, you know, queer and trans folks is that there are so many other layers there. Right. Like, I'm sure people have talked about this on the podcast before, and you yourself know, and a lot of the listeners probably know, is, you know, you have something like the minority stress model that was created, right, to specifically address the needs of gay and bi men. And really, you know, now that's been through several iterations and adaptations, but it's very real, right? There are very real external factors, right, happening at the structural part, the interpersonal part. Right? The individual part, those pieces add up and they accumulate. And those things are very specific to queer and trans people, right? Like what's going on legislatively, you know, having the most amount of anti-trans legislation ever. I mean, just the incessant attacks on the community and queer people in general, um, you know, hospitals closing programs and things, um, you know, organizations now being threatened with not being able to get funding if they even mention gender-affirming care or that they're providing care. To trans people and trans youth specifically. So when you shrink that, where are people gonna go? They're still going to identify and be themselves. They have no outlet. And where does that pain go? Right? It turns inward. Um, you know, people turn to substances more, which again, use drugs, absolutely no shame in that, but right, it can get you to a place where it's very difficult to get out of. And you're limited with your options. That's right.

That's right.

Yeah.

Yeah. What do you see as far as chemsex goes? Do you, what do you see the role of harm reduction in that? And I mentioned, I mentioned the research that's out there, but how do you see it helping?

Yes. So in my experience, 'cause in my previous, my previous kind of work and work that I still do largely, I work with many harm reduction programs. In New York, specifically in New York City. And what was very interesting to me is I kind of went in with this naivete thinking like, oh, okay, everybody knows about chemsex, right? Drugs are drugs across the board, not realizing that the majority of programs which weren't queer and trans-led, they were focusing on, you know, cocaine, crack, and opioids. So when I was talking about things like meth, like G, right, like ketamine, MDMA, it was kind of like, You know, it's almost like that meme with that lady looking around and it's all like the meth being done.

Yeah.

You can see kind of like, oh, um, there are other substances. Right. And there was a lot of work to be done. So I think first of all, it's being very real and assessing like, what is kind of your drug IQ? Like, do you even know about chemsex and what it is? Because yeah. I think we were talking about this in our initial conversation is that You know, I don't fault people for saying this, but I do think it's problematic framing when you say, oh yeah, yeah. Um, you know, um, straight couples, right? Cis-het people, we, we do chemsex. We, you know, we go out and have a couple drinks and we go home and we have sex and whatever. That's a very, very different context than what is going on.

Right.

Than circuit parties, right? Like things that are happening in communities, right? Sex work, whatever is going on. So I think harm reduction plays a really integral role also in advocating for contingency management, for groups, for really these models that have been emulated within harm reduction and making sure to incorporate it as part of kind of just the practicum, kind of the continuum of harm reduction because it really startled me, I think, just how many providers weren't comfortable, didn't know. And you can't just assume that because someone's a harm reductionist that they're automatically on board with chemsex. And even further, with queer and trans people in general. I mean, a lot of my job was going into these organizations and, um, I mean, I had several, you know, LGBTQIA staff come up and say like, I'm so glad you're here talking about this. Like, we're stuck on pronouns. Like, we can't even get past pronouns.

Yeah.

You know, the extent of a lot of people's knowledge is talking about, you know, the AIDS epidemic, right? And HIV and being stuck in like Ryan White land when—

Right.

Yes, that's part of it, but there's so much more. Um, and I think it's just, it's really bringing it back to that training. Um, so I know in a lot of the work I do, I've incorporated that as, as kind of like a base 101 chemsex training because, um, Yeah, I think without it, we're doing providers a disservice and they're uncomfortable. A lot of people are uncomfortable admitting that they don't know, right? 'Cause they're expected to be the expert or the practitioner. Um, and they could stand to learn so much. 'Cause one final thing that I'll say about this is that when I was part of that program, I actually, uh, commissioned a community member, someone who was engaged in ChemSec, and I said, you have these great ideas. I agree with you that I think that You know, the reason that there aren't queer and trans people going to these programs is because they don't feel comfortable. There's not that like drug IQ. So we did like a very, very small, I think it was like a dozen or so people, dozen or so queer and trans people who use drugs and do sex work. We found that probably only one of them went to an actual harm reduction program. The rest of them were self-medicating, trying to just handle things on their own, taking substances on their own to You know, feel liberated and kind of validated with their gender identity or the fact that they were doing sex work. So I found that really interesting, and I kind of used that as a way, like a wedge almost, to get into a lot of programs to say, you may think you're serving a lot of people, like even though we have a small N here, this is what people are really saying. And that report, if people are interested in reading it, I believe is still on National Harm Reduction Coalition's website and their Lighthouse Learning Collective program. But I had a hunch that something was going on and we were, we were pretty spot on.

Yeah. Yeah. Yeah. Yeah. It's interesting. This, the, the whole, even the term chemsex is so, it seems confusing in the US. I had a, I had a harm reduction organization reach out to me and try to— they were— they didn't like my, my Instagram and they had some problems with it. And they told me like, even if someone takes a caffeine pill, that's chemsex, you know? And I'm just like, I don't know, you know? I don't know, you know, and I don't want to like act like I know everything. However, you know, you're missing it. You're missing this, you know, and how are you helping people? Right? How are you helping people? Because also someone using meth for sex, they're not going to know the term chemsex either. And so then when they hear it and learn it from a facility that doesn't understand it either, it's so confusing.

Very confusing.

Yeah.

Oh my gosh. It's making me think so. Years ago, I was an HIV medical case manager. That's kind of why I brought up HIV and Ryan White, cuz I used to work in that program many years ago. And what was so fascinating was, um, much of my caseload was a lot of like monolingual Spanish speakers, a lot of like young gay and bi Latine and Black men and, um, trans women. And that was really so eye-opening in the sense that they didn't have the vernacular, like chemsex. I didn't have that in my kind of repository, in my vocabulary. They didn't either. And they had opened up, you know, cuz we had established a relationship and trust over many years. And they started talking about, you know, I had one guy call me, he was maybe like 25, 26, and he said, Taylor, I need help. And I was like, what happened? Like, you get hurt, you like lose your medication? What do you need? And he goes, I don't know what to do anymore. I, you know, was having fun, I was partying, but I'm scared. Like, I'm smoking meth. Like every, every other day now. Like I met this guy and I, you know, had fun at this party and like we hooked up and I was like, oh wow. 'Cause I, I honestly didn't have any clients. A lot of my clients who were using, they were using crack or heroin. 'Cause fentanyl was kind of like coming up at this, at this time it was maybe only like 2016, 2017 about. But anyway, so they were discussing it and kind of, and, and saying like, You know, I don't, I don't really know what to do. Like, is there a place that I can go? And, um, you know, again, naive, I was like, well, let me see what I can find for you. I was like, there's probably gotta be something out there, right? There's probably gotta be, if you wanna go to a treatment program, you know, I have my referral book. Nothing. There was nothing, right?

Yeah.

'Cause a lot of these centers, they're, oh yeah, just opioids. There's nothing for stimulants. There's no medications. There's no treatment. I didn't know about contingency management. I mean, there was nothing. I was working in a large city in Connecticut where I'm from. And so basically, and I had left maybe a few months after he had told me, you know, and I felt really bad about it. He wasn't the only one, but I think if nothing else, I was there to support him through it and not provide any judgment and just say, hey, you know, um, best I can do is try to find some resources. Like, are you safe right now? Try to plan, right? I think I had the wherewithal to safety plan with him, but just didn't, wasn't prepared and didn't know until I looked into it that, oh my gosh, this is an entire field. This is an entire phenomenon that is really—

Right.

Yeah. So it was very interesting. Um, but yeah, we didn't have the language, the shared language to really discuss what it was other than You know, I'm using this drug and I'm having sex and I don't feel good about my body. You know, I want to lose weight and this guy, you know, made me feel free and—

Yeah. Yeah.

Yeah. Wow.

Yeah.

So there, there really is a lack of resources, um, and for treatment. So, you know, I was just, I was in LA recently for a Chemsex conference and it was 3 of the, uh, they're, they're saying the top Chemsex treatment centers in the country. Um, they're, they're all in LA, but they're all abstinence-based due to insurance funding. So what do you think about abstinence-based treatment for Chemsex?

Uh, so the thing is people largely think that us harm reductionists are completely against abstinence, but what most people don't realize is that abstinence is folded into harm reduction.

Yes.

However, the biggest difference is we do not pretend that that is the where, like, be-all end-all, that's the only option, right? I know many people, they go to NAA meetings and that's worked for them and that's great, but they also know full well that that just works for them. They're not gonna throw that out and put that on everybody else, right? Do I think that there's a, a place for it? Sure. If that's what someone's asking for. But what I don't appreciate is one pretending like that's the only option, that's the best option. Um, and 2, you know, um, trying to get people to fall in line when that's not something that they're asking for and making them feel bad about it, right? Like, I'm sure you know many, many people who, right, they've gone into treatment and I, I don't even think I know anybody that has gone into treatment once, right?

Right.

It's this perpetual ping pong, but you're made to feel Largely bad, that it's a failure. Every time you go back, it's a failure.

Yeah.

Right. It's very, very expensive. It's not accessible. There are long waitlists and that there's like this cookie-cutter framework and that if you aren't suddenly better in 15 days, 30 days, 90 days, right? And you're also in this environment. I know you and I talked about this where that's not your everyday reality.

Right.

You're in this nice treatment center with the ferns and the this and the that, and you've got whatever, right? But that's not— when you go back home, you have those same triggers, you have those same relationships. So I think it's very, very difficult, and I think we need to be honest with people about how freaking hard it is, right? And also, there's a way to go to treatment but still use, right, if you want to.

Yeah.

Right?

And not feel bad about it.

Right?

I know many people who, they go to treatment, they were made to feel like you can't smoke weed.

Yeah.

You can't, like, you can't even drink coffee. You can't do anything for the rest of your life.

Yeah.

And they were like, you know, I have a drink every now and then. Right? They're like, I'll maybe do a line every now and then, but I have control over it. I have different relationships. I have different relationships to substances. And that's the part that a lot of these centers don't Talk about.

Mm-hmm. Right?

That's right.

That's right. Yeah, that's right. Exactly right. And that's what we're seeing is this cycle of coming out of treatment, going back in, you know, this pattern of that transition out of treatment between coming out of treatment and then getting some momentum going. There's a gap there that I think That hopefully like a coaching program, not to plug my coaching program, but like a coaching program or something that could fill in very easily and offer them if, so coming out of it, let's maybe start off with a managed use, like a tapered, you know, like there's a, there's a lot of, there's a lot of guys that come into my program. If they're using regularly, I'll say, let's do this. We're going to plan a use 3 weeks from now.

Mm-hmm.

So When you know a use is coming, it's easier to say no now. It just is. And then you get momentum under your belt, you get time under your belt, you start to feel better, you start to feel stronger, clearer, your relationships start to get better. And then it comes 3 weeks and you're like, most of them are like, can we push this out a week? I'm not, I don't want to use, you know, and maybe they do. And then when they do use, they, it's structured. Like, I'm going to start on this day. I'm going to use this much. I'm going to, you know, I want to stop here. Now it's not always, really gone to plan, but let's set up a metrics of 10 things. And if you can meet 7 of those, 6 of those, you've done great. Let's celebrate that. And then they're in charge of their use. And then they feel— the trust in themselves grows, their self-confidence grows, and they get an idea in their head that they can say no and they can decide when to use or not. And that helps them stop.

Absolutely. Yeah, absolutely. Because, you know, at the end of the day, hey, I have control over this, right? And it's something, it's almost like a muscle you have to exercise like anything else, right? You know, the big parallel I see, and when we're talking about this, is that, you know, when I was, when I was working case management too, we had a case manager that was dedicated to working with people who were coming, who were previously incarcerated. So I think of it as no different where, why aren't there specific programs, right, set up for chemsex for people who are coming out of treatment, just a transitional program to work with them because it's, you're going from one extreme to the next, right? And, and we know recidivism is a thing where people are coming outta prison, they're going back in cuz they don't have the resources. Mm-hmm. They're literally left with a little bag of clothes and, and left to their own devices.

Yeah.

It's the same kind of thing. I see it the same way where there should be that proper support there. Because that's a really tough transition. And a lot of people, maybe it's family, friends, right? They don't understand. They can't possibly understand what that experience has been like for that person. And also it's including them in the conversation too, because the onus is usually put on the person using drugs, right? It's always seen as their problem that they have to sort out, which it shouldn't be that way.

Yeah, exactly right. Yeah, like we, you and I talked about too, it's like sometimes you have to go through the experience of using to learn how not to, right? But inside the treatment center, you don't have that option.

Right.

It's like you have to live in the real world and you have to have this phone and you have to live with this and not use chemsex, you know, because that is paraphernalia as Mel McCracken says, from No Matter What, you know, it might as well be a pipe in your hand, the phone.

Mm-hmm. So yeah, it's the great connector to everything, right? Yeah, you can get sex, like you can get pizza, Uber Eats it, get it right. Yeah, it's very real. It is.

Yeah, that is right. Yeah. So could you tell us a little bit about how chemsex looks in the trans, across the trans population? Like, how does it differ? Yeah.

Yeah, I think there's a lot of, I think there's a lot of overlap. I mean, particularly, you know, when we talk about like body image, right? I don't, I don't think that's anything that's just specific to trans folks, right? I think, you know, when you're part of a very marginalized community and you're made to feel bad and there's certain body standards, right? Like, we know that very well. We were just talking about phones, like social media, you go on, You see a certain body type, you know, white, you know, full head of hair, ripped, masculine, the whole thing. However, I think that's leveled up in the trans community, right? You know, there's definitely this camp of folks who, you know, who are maybe more binary, they're more transfem or transmasc, and they're very much into kind of the medicalization aspect of, right, of getting all gender-affirming surgeries, not just hormones, but looking very binary and looking and holding up to a certain societal standard. Right? But there's also, what about non-binary folks, right? What about gender non-conforming folks? Um, so I think there's different levels to it where it can be a lot more intense within trans communities, um, because there's usually a bit more involved in terms of like, you know, how you want to modify or change your body. And I think chemsex can be a really liberating way to do it.

Right.

However, there's definitely a certain point Um, and I know this just from people who've gone through this is that it can get to a point where it's not so liberating anymore, right? Where it's kind of having like the opposite of the intended effect where you're like, you know, um, I'm just partying and playing with someone. They're making me feel good about my body. Maybe I'm not thinking about my chest, right? But maybe I get top surgery and I realize I really like the high that I was getting. I really kind of liked the fun time I was having. Right. The other part of it too is there are many, many, um, studies that have talked about and come out over the years about just the rate of, um, eating disorders in trans communities. Uh, trans women, trans men. Mm-hmm. Um, they're very, very high. And that feeds into the last point I was talking about, obviously with body image, right? Because what do we know about stimulants? They suppress your appetite.

Right.

Right. So that's a, that's kind of like a big emerging field of research. I have some colleagues who do a lot of amazing work in terms of like art therapy and, you know, mental health work around eating disorders with trans folks because it is a large issue. And I do think that there is more attention that needs to be paid specifically to trans men and transmasculine folks and the crossover into chemsex and, you know, having sex with men, with cisgender men, gay and bi men. And we also see kind of the same paradigm happening with HIV, right? Is that there's usually this big focus, you know, more on maybe trans women and sex work, right? But there's also this, this growing kind of pocket of trans men who are crossing over and having sex. Right? Condomless sex with men and not knowing, still thinking that their testosterone is birth control. That's a very real thing. Wow. Right? And yeah, it's a, it's a bigger phenomenon than people think, but many people are ashamed to talk about it. So when you build that shame, the shame of substances, it's a very nuanced, very complicated thing. So those, those are the big pieces I see. You know, I had mentioned sex work.

Yeah.

That can have its, its own complete topic, as it should, obviously with the important caveat that not all trans people are engaged in sex work, right? But I think that that is a very real connector and way for trans folks engaged in sex work to be able to do the job, right? To be able to do it. And that's actually something, when I mentioned that study before with that very small group of people in New York City, Most of those folks were sex workers and they were trans and they were using a myriad of substances.

Mm-hmm.

Right. Mm-hmm. Poppers was number one, which poppers is always number one, right? And meth and G, ketamine is huge, cocaine. Uh, but largely it was a way for them to really stay up, get more clients, right? To be able to push through and also kind of fight against any kind of body dysphoria. that might have been going on. Maybe they didn't have access to care, maybe they didn't want to seek care for whatever reason. It was a way to just kind of get out of that headspace. So there are a lot of overlaps, I think, with the larger queer community, but there are definitely things that I have seen that I think are a little bit more complex and specific to trans folks.

And some— I've heard from some trans folks that straight men will hire them, especially trans women, right? And expect them to bring drugs.

Yes. Like, you know, yes, I remember being— it was actually one of the first, I think, chemsex trainings that I was sitting in on when I was on my previous job. And it was a group of all Black and brown trans women. And we're having a phenomenal conversation about chemsex and drugs and things. And They said that exact thing where a lot of times they'll get hired, you know, these guys coming in from, you know, financial district, right? Wall Street. Yeah. Also Long Island hiring them. Yeah. With the expectation, right, that they're gonna party and play. Yeah. And offering more, sometimes not, but offering more to engage in that. Yeah. But also there was this shame I was picking up on where some of the girls were like, I actually kind of enjoy it, but I feel bad saying that. Like, I enjoy engaging in it sometimes, but I don't wanna admit that. Because everybody talks about how that's a bad thing. And I thought that was really interesting is that rarely is anything just good or bad, right? There's more in the gray. And a lot of us have a hard time sitting with that, but I'll never forget that conversation. That was really interesting.

Yeah. Yeah. It is interesting. It's interesting. So you worked with the harm, you worked with the Harm Reduction Coalition. If I'm thinking about if harm reduction is right for me, is there a set, is there a criteria, is there a set of questions that are asked?

Yeah.

You know, that, so, 'cause, you know, harm reduction, like you said, isn't for everyone. Maybe going into an abstinence-based treatment center is what you need based on the, maybe the severity of your use or something like that. But are there a set of Questions that someone could ask themselves or read or, or be asked?

Yeah, it's an interesting question. I mean, to my knowledge, there's not anything that's specific. I mean, I think, I think number one, I always invite people to go, I mean, NHRC has them on their website, but they're the ones that 30-some-odd years ago, they created the principles of harm reduction. So I think like if those resonate with you, I think then it's for you, right? I think that's kind of the base level. Okay. But again, going back to what I said much earlier is that abstinence is folded into harm reduction.

Right.

But I think the way that harm reduction gets branded, right, is that it's at odds, right? Like a lot of the recovery community, they'll have you think that like, oh, harm reduction is against us.

Yes.

Where it can absolutely be folded in. It's just not, it's like a PR problem, right? It's the way that people talk about it in media and frame it. Um, but I also think that if you're someone who's deeply uncomfortable with the idea of ever using in any capacity again, You might be more abstinence-focused and based, and that's okay. And if you're comfortable and you just want to call that abstinence and you don't want to even name that harm reduction, who am I to tell you that you need to call it harm reduction? But to me, it's folded into it. It just is.

Yeah. Yeah. I catch myself kind of when I'm articulating it, it sounds like I'm separating them out. Oftentimes it's to help people maybe understand what I'm trying to say, but I also agree, like it's all harm reduction, right? It's all together. It's just drug, right? Drug use.

Yes.

Either, you know, actively or abstinence, all in a spectrum. But you're right, like mostly because the accepted culture of recovery is an abstinence-based program, then that we think that's separate, but it really isn't. Yeah.

And there's also this, I'm sure many of the listeners and you yourself know this, there's this superiority too of, yes, I have this badge of like, I don't use at all. Right. I went through recovery, you know, I have my chips, I did this, I have my years.

Yeah.

Yeah. And there's a lot of people, and I've seen this in real time, I've seen it within like the peer workforce too, is just people feeling as though they can kind of instruct others to live as As they're currently living and not realizing that you need to give somebody the space, right, to make their own decisions and give them options. I always used to call it a buffet. I'm right. I'm like, I wanna bring someone to a buffet.

Yeah.

They get to choose what to put on their plate. You know, I might not like that food. That might not work for me, but it works for them. Who am I to tell someone I have a different lived experience, right? I don't know what they've been through that they need to walk the same line as me. That's just, that's not reality. That's not.

That's right. That's right. Yeah, I like that. Yeah. So if you're listening and you're thinking about what am I, maybe I'm better suited for harm reduction, I would go to the National Harm Reduction Coalition website and look at the principles. And like, like Taylor's saying, read them and see if they resonate with you as a start. Um, there, there are also plenty of harm reduction organizations, nonprofits. There's harm reduction therapists out there. Um, you know, I've talked, I've had a couple of people, well, one on the podcast, one not, who saw a harm reduction therapist who helped them, you know, eventually, um, eventually become abstinent from where they were. Uh, and so they, they did a managed use plan or something like that. So, um, okay. I wanted to, if it's okay with you, I'm going to Well, we'll talk about Needle in the Hay. I'm going to look at your Instagram page, but I want to share the screen and play the clip that you made for harm reduction or Chemsex Awareness Week. Yeah, sorry about that.

Mm-hmm.

Share this here and we'll listen to what you have to say. And for those listening, as you're listening to this, I want you to think about if you go see a healthcare provider or a therapist or even an addiction counselor or treatment center, there's some really important guidance that Taylor is giving the healthcare professional here that you could give the healthcare professional. Talk about autonomy, you know, right? Is you could actually volunteer these questions and tell them to ask them. Too. So I want you to listen to this and we'll put the link in the—

Chemsex isn't a fringe issue. It's showing up in the exam rooms you walk into every day, and most of the time no one's asking about it, or if they are, it's reduced to a yes or no question. Let's talk about why engaging your patients about chemsex is so important and what you can do differently starting with your very next visit. Chemsex carries real health implications. Overdose risk, HIV and STI exposure, and significant mental health impacts. There are also medication safety concerns most providers don't even think about. Certain HIV medications, benzodiazepines, and sleep aids can interact with chemsex drugs in ways that raise overdose risk. And chemsex can make it harder for patients to stay consistent with PrEP or ongoing treatment. But here's the thing, patients usually won't volunteer this unless we've shown them it's safe to. Many of them have been judged, lectured, or felt a provider shut down, pivot to abstinence, or document things in ways that felt punitive. In turn, patients learn to keep discussing things like drugs or sexual health to themselves. And when that happens, we lose the opportunity to offer harm reduction, talk through safer use, Or even just create a space where they can be honest about what's going on. Normalize it. Make it part of your social history for all patients, not a separate or exceptional question. And remember to start open-ended. You can always get more specific, but don't start with a yes or no. You might say, tell me a little bit about whether drugs play any role in your sex life, if at all. Then once they've opened the door, you can get more specific about drugs and medications. When you're reviewing their medications, you can add, walk me through anything else you might be taking, prescribed, recreational, or otherwise, so we can think about safety together. Lead with curiosity, follow with specifics, and respond the same way you would to any clinical information, with clarity, options, and respect. Screening is not surveillance. Done well, it's an invitation And a signal that your exam room is a place where patients can bring their whole selves. And that is the care our patients deserve. This Chemsex Awareness Week, it's not just about whether you ask, it's about how.

Very good. Thank you.

Yeah, that was a great campaign and it's, it's second year, which is amazing. But yeah.

Yeah. Yeah, I didn't even know about it last year, I don't think.

Well, we were just starting it out. Yeah, it was a project between National Harm Reduction Coalition, the program I manage, Lighthouse Learning Collective, and BHOC Partners, Building Healthy Online Communities. They're wonderful.

Yeah. Yeah. They connected me to, with you, or that's how I found you, was BHOC. Yeah. So, The, for the listeners listening to that, you just saying I do meth to a healthcare provider isn't enough when we're thinking, when, when we're talking about chemsex, because it's the meth and the sex together. It's the fusion of it. And the more specific you can get, the better, right?

Yes.

And you're like, you're saying, you're just saying the term chemsex, your healthcare provider may never have heard of that.

Absolutely.

Yeah.

Yeah, no, absolutely. So one of the things we did with the campaign is, you know, in that, in that clip, you know, I'm speaking directly, the audience is to medical providers, right?

Right.

For the reasons you just said. But one of the things we knew when we created the campaign was that it wasn't gonna just be enough. And also, is that reel even gonna get to a provider? So one of the things we did was work with partner organizations to actually make a toolkit So within it, there's a number of, of videos. There's also educational posts. Um, and it's really just a way to start the discussion with providers, right? I often argue that a lot of times, like, the people who are interested in it are, are the people who already have base knowledge. It's always the people who aren't in the room that need the message, right? But it's better than nothing, just trying to have a jumping off point to get these providers engaged to say, you know what, chemsex wasn't part of my clinical training.

Yeah.

Maybe drug use of any kind that wasn't part of my clinical training.

Mm-hmm.

And I'm gonna look into this and really treat the patient as they're the expert, right? And it's my job to look in, see if there are things I can do, right? Maybe it starts the conversation about, about PEP and PrEP, whatever it may be, different sexual health practices, how to taper their use. Right. It's just really important to start that conversation because like you're saying, so many people, providers don't even know that it exists.

Yeah. So it might be up to you as the patient to bring it up to, and because your life is at stake as well, like as, as this clip, as this reel says, some of the medications they may put you on could interfere with the drugs you've been on, especially GHB, right? And so really just, I mean, I know that some of the atmosphere, like you're saying, some of the environment might feel, that container might feel constrictive and it might feel judgmental and it might feel stigmatized. So it might be harder to do that. But this is a chance for you to use it, to use your agency to say, my life could be at stake here. So I'm going to make sure he understands, he, she, they understands exactly what's been in my body and what I have been doing. When's the last time I slept? All of that information.

Yeah. Especially since, you know, I'm sure many people know that our drug supply is absolutely awful, right?

Yes.

Although I will say, particularly with meth, there hasn't been a lot of instances, at least in New York City and the drug checking programs I was familiar with, there's been a lot of, you know, kind of poisoning or contamination of fentanyl with meth. Largely what they had found is that people were You know, using both substances but putting them in the same container. So they would inevitably, right?

Yeah.

Um, get cross-contaminated. But, you know, uh, with, with ketamine, with pressed pills, right? Some of the pressed pills look really damn good and you can't tell them apart. Um, you have no idea what you're taking, right? Um, so encouraging people to test their drugs, get a drug spotter. Um, if you don't know what drug spotting is, that you should look up an organization called Safe Spot where literally you call the line and there's someone who will sit with you on the phone while you're using to make sure you're safe. And they won't call the cops or anything unless you want them to. And they create a safety plan. Just a quick plug for them because that could really save somebody's life.

Yeah.

Right. And also that provider making sure that somebody has naloxone, something as simple as that. Right. And knowing how to use it and that the people around them have it. Um, I think those pieces are just really, really critical.

Yeah. Yeah.

Yeah.

I'm still, I mean, I, I did this when I used, but things were different, but you know, just the, the, the times that we pick drugs up from somebody we met on sniffies and just put it right in our bodies. To, in this day and age is just amazing to me.

It is.

And you know, one of the things too, and sometimes this pisses people off when I say it, I think that's because of the, their prevalence, but I talked about poppers earlier. I mean, poppers where you're like, what? I wouldn't even consider that porn. Like, you know, everybody, everybody's using it, whatever. But if you look at like the, the label or the indications for like Cialis and Viagra, they literally say on there, To not use with certain medications, right? To not use, you know, like particularly with poppers and like ED medications, they can bottom out your blood pressure.

Right.

Right. And you can pass out. I mean, I won't say it's a, a super prevalent thing that people are going to the emergency room and, you know, and, and dying from it, but it has happened, particularly as we age and our bodies go through a lot of wear and tear.

Right.

It, it happens, right? Especially if you have a previous condition. I think not to scare people, but like, talk to your provider about it because I see those medications as someone who works in healthcare, they're prescribed left, right, up, down. I mean, you can go on, you know, all these different services now you can get them and people just don't know because it's kind of like you pop it, you know, you're good. And whatever, but not knowing kind of the reality of it. And I feel like it's something that a lot of people don't talk about. And again, it's not to scare people, but just kind of a heads up, right? Like if you feel weird, it could be validating too, to be like, maybe there was an interaction I didn't know about. Yeah, no, that's right.

That's right.

Yeah.

Yeah.

Yeah. Okay. Can you talk to us about Needle in the Hay a little bit?

Absolutely. Yeah. So I officially started Needle in the Hay, my consulting practice, Earlier this year, although I'd been consulting, doing trainings, kind of doing technical assistance with different healthcare organizations. Yes, there's finally got the website up. I appreciate it. Yeah. So I had been doing training, consulting in different capacities probably for like the last 10 years. But I really wanted to have a place to put all of my work and connections and really put out there The things that I've been working on, largely a lot of my work is centered around what I talked about in the beginning, kind of this overlap of different movements. So whether it's harm reduction and gender-affirming care, also adding in sex work, reproductive healthcare, again, with that basis of bodily autonomy. So a lot of what that looks like is, like I said, trainings, doing different facilitations, I recently facilitated a spring retreat for a very large coalition in New York State, recently spoke at the New Jersey Harm Reduction Conference, you know, did a, and that was, that was on really gender-affirming harm reduction, which is kind of my like base, you know, flagship training. You know, I've done motivational interviewing sessions with folks, done some Keynote speaking. Um, I was able to speak last year at the Harm Reduction International Conference in Bogotá, Colombia, where I presented. Um, it was phenomenal. If, if you ever have the chance to go, I recommend it. I believe it's gonna be in Belfast next year.

Oh, okay.

Um, wonderful. And they do actually have sessions on, on Chemsex. They tend to, to get those abstracts in. Um, yeah, and that was largely, I was there to talk about a toolkit a gender-affirming harm reduction toolkit that I created over several years, which Chemsex is, is absolutely a part of. And it's, it's talked about and there are actually animations and that's also available on, you can look at that through the website cuz that was work that I did with NHRC and Lighthouse. But yeah, also a lot of it is organizational development and what that looks like is talking to organizations about what their goals are. You know, they'll come and say, well, we wanna be more gender-affirming. And I'll have them do an assessment and sometimes they're like, we're nowhere near where we need to be. We'll come back to you maybe in a year. Right? Right.

Yeah.

Well, right. Because I'm like, I don't want to waste your resources and time. And to be honest with you, I'm not just going to take your money and do whatever. You know, I really want to engage with people who are values aligned and really want to do the work. Right. So yeah, it's been a smattering of different things. I love creating resources and you can check all that out on the website. And there's even a version of the assessment that I put on there that you can take and you'll have the ability to get it scored. And I believe you can download your own PDF of it. So if people are interested, that's a free tool, but, um, yeah.

Right. Nice. You, you're busy.

Busy.

Yes.

Yeah.

It's probably the neurodivergence where many, many of us, right. There's a huge overlap there too.

Yeah. You have a lot going on here. A lot going on. I love it.

Yeah.

Well, I love, I really love meeting people like you here in this country and who are really doing the great work, um, and understanding the value of harm reduction. All of it's harm reduction, I know, but educating us too. Um, right. Yeah.

Thank you.

And what you're doing is really helping. Um, and I think that this, this podcast today is going to help. If we could just, if it just helps one person who finds themselves in front of a healthcare provider and knows what kind of questions to ask, you know, then, and if we found one person who just desperately trying to, maybe they want to stop and they're desperately trying a way to do it, this harm reduction could be the answer for you. And it's okay to consider that. You know, there's just such a, Such a misunderstanding, isn't there?

Oh my gosh. See it everywhere. I mean, I know, I mean, I know social media and the internet is not the greatest litmus test, but you know as well as I do in the comments, if anybody's talking about it, they'll say, why are you promoting? Why are you encouraging this? The point is completely going over their heads, right? Where we need more people vocalizing and talking about it. But I get that it's hard to do it when you get continually shut down and shamed for expressing yourselves. But let me tell you right now, more people are doing it than you think. It's just not being spoken about.

That's right. That's right. That's exactly right. Um, that's exactly right. And I will say too, if you, if you keep relapsing, if you keep using and you don't want to, and you're trying to stick to some abstinent plan, you're planning your use anyway. But it, it's just subconscious. It's, you're, it's controlling you.

Mm-hmm.

You know, so why not get ahead of it and you control it and you decide when and where and how long you wanna do it? I mean, it really does give you a sense of agency in your life when you're feeling powerless and unmanageable, right? As they say in the, the 12 steps. So, um, oh, Taylor, thank you so much. Um, is there something that I left out today that you wish that I had brought up or a topic we could have Discuss?

No, I think, I think we covered it all. We covered it all in a real short amount of time, which I appreciate. No, but no, I would just, I would just say to people that, you know, if you've been skeptical of harm reduction for a long time, maybe take this as a sign and a signal to look into it a little bit more. And there are a lot of good resources and look for yourself, right? Not just what other people are telling you. There's always more to it, isn't there?

Yeah. That's right. Listen, go to Google Scholar and just look up peer-reviewed research articles if you want, if you want to see what is going on out there. Most of the harm reduction studies that I see are, you know, in Europe, Europe and other countries like that. But there's, there's a lot of research happening right now and looking at the effectiveness of this approach. So there you go. Hopefully just do your own research. Just be the executive of your own recovery. I always say that. Just Just stand up, stop listening to everything else and see what resonates and fits with you and your body.

Absolutely. Be your own advocate.

Yes. Yeah. Taylor, thank you so much for your time today. Really appreciate it. Really appreciate you and your work.

Thank you. Thank you. I appreciate it. Love being here. Good.

All right, guys, if you have any questions, comments, you want to join this, the discussion, you can comment on Spotify, you can comment on YouTube, or you can DM me and I'm sure you could DM Taylor if We're going to put his Instagram information into the show notes. DM one of us, have a discussion. We'd be glad to talk to you. And that's it. We'll see you next week.

Take care.