Episode 2:2: Chemsex Harm Reduction

Hey y'all, I am so pleased to have one of my favorite people and my mentor, even if he doesn't know he's my mentor, back on the show, Dr. David Fawcett. David and I are going to tackle the topic of harm reduction. For some reason, this topic seems to be very controversial in the United States. Other places like Europe and Australia are way ahead of us in philosophy and in practice, so I'm happy to use this podcast as a platform to advance the concept and encourage the conversation. You're gonna hear in an upcoming episode that when I talk about contingency management, where people are incentivized to be abstinent from stimulants, that I also had my perspective shifted in that podcast by the guest. I learned that harm reduction in a broad sense is a continuum from active use to abstinence.

So guess what?

No matter where you are, you are practicing harm reduction. But so many people who are locked into traditional and outdated mentalities categorize harm reduction as its own separate topic and one that runs in opposition to abstinence. And that just is not the case. And I've also heard some ignorance out there of people saying that we are enabling addicts and/or giving them permission to use drugs through the use of harm reduction.

Wrong.

There is a huge misconception about harm reduction and the entire chemsex recovery process as a whole anyway. It is actually proven that fact that relapse happens more often when men are trying to stop using crystal meth. And look, the fact that the addictive patterns are tied to sexual urges make it very different than other drugs anyway. So we can't expect every man to be able to stop Cold turkey right away. There are often cases where these men need to step down gradually. That is harm reduction. And look, as I heard from a TED Talk somewhere, some people are going to use drugs anyway. We have some that are going to use. So if we can help them use safely and avoid an overdose, let's do it. Because the more we treat these guys with respect and dignity, the less they're going to want to use anyway. This is also some— a drug that people are using because they feel stigmatized and they feel like they're treated like shit. So if we can treat them in a different way, they're going to want to use less. That's what I think. Harm reduction then, of course, has many forms, right? We use certain tactics to keep from using crystal meth, or we use certain tactics to use it safely. But no matter the tactic, we aren't accepting this topic enough. We aren't advancing it enough. We aren't talking about it enough or providing opportunities for men to partake in it. The successful implementation of harm reduction could sharply reduce chemsex use, in my opinion. And especially the deaths that occur. This is a topic that will catch on eventually, and it is catching on slowly. But look, as an example of mentalities, I went to a roundup last year, which is kind of like a 12-step convention. One of the workshops was about the gray areas of 12 steps in terms of you— the use of medicine and plant medicine.

I was excited to go because I was like, okay, this Out of this convention, these are definitely going to be my peeps, right?

But it started with an older man saying that when he was coming up through the ranks of the fellowship, they didn't have and they didn't need SSRIs.

Wow.

In other words, he was taking a no-medication stance. Have a long way to go. I stood up and I left, obviously, immediately. That meeting wasn't what I thought it was. So I'm using that example to say that those types of closed-minded philosophies still exist in 2025 somehow. But I believe the tide can turn, and I believe we can see recovery as an individual journey, not a set of broad rules about what everyone can and everyone can't do without consideration of personal context. I believe that we can empower our men to create their own recovery track. And if harm reduction is a part of that, and if it includes some kind of plant medicine, or if it includes some other tactics that stretch our mind a little bit, awesome. All right, enjoy the episode.

Yeah, definitely. The idea that, um, people have a right to kind of compassionate care at whatever level they need is maybe a new one for people, and I think it's really rooted in this approach that's nearly 100 years old now in our country of really criminalizing drug use and looking at it as a legal problem or a moral problem instead of a medical problem.

The Aftermath Podcast is an outreach tool to help men who have sex with men break free from the addictive patterns associated with chemsex, otherwise known as crystal meth or Tina. I'm your host, Dr. Dallas Bragg, a former crystal meth user, now recovery coach. Here you will find a repository of tools and resources intended to eradicate the epidemic that is plaguing our MSM population. Please note that the views expressed on this podcast are not to be taken as medical advice. Also, we will be talking about drugs and sex, so if you feel triggered to use, stop listening and contact your local emergency system and/or your support network. Let's go.

So today we are talking about harm reduction. Harm reduction is a topic that is near and dear, uh, near and dear to my heart, um, because I have seen it work. I have seen it work with my clients. I have seen it work anecdotally. And, um, I am excited to talk to Dr. David Fawcett about this topic. Um, I want to introduce Dr. David Fawcett, but if you're listening to this podcast and you don't know who Dr. David Fawcett is, where have you been? What are you doing with your life? You have to know who David—

Dr.

David Fawcett is. Uh, Dr. David Fawcett is a PhD, LCSW, and a psychotherapist and sex therapist who specializes in the sexualized drug use, LGBTQ issues, trauma, and mental health concerns related to physical illness, especially HIV/AIDS. You're also a hypnotherapist, right? Is that right?

Yeah.

Um, he is author of Lust, Men, and Meth. Um, if you're watching, I'm holding the book up. As you can see, it's marked all the way through. It's A Gay Man's Guide to Sex and Recovery, which explores the intersection of gay men, drug use, and high-risk sex, and is also the author of Sex Under the Influence. And I'm holding that one up, Understanding and Healing from Sexualized Drug Use. He co-created the residential treatment program for compulsive sex, porn, and chemsex behavior at Seeking Integrity in Los Angeles, and is the executive producer of 2 documentaries about sexualized drug use. David frequently presents workshops around the world on topics concerning addiction and co-occurring mental health issues, particularly those related to long-term survivors of HIV. His blogs, webinars, and podcasts can be found at www.sexandrelationshiphealing.com. Sorry, that'll be in the show notes. Online resources for sexual behavior, relationship intimacy, couples therapy. Um, have questions over sex wellness and sexual sobriety? Sex and Relationship Healing has information from sex addiction to couples Therapy. So that's— yeah, and the website there will be— we'll put all of David's information in the show notes. Ah, okay. So much more too. So much more too. Um, well, I, you know, I am learning more about harm reduction, and what I like seeing out there is less of this Harm reduction versus abstinence and seeing this more of a continuum of recovery. And that some people in— if you look at recovery as a continuum itself, on one side might be abstinence, one side might be harm reduction, and then some people fall somewhere in that, on that continuum. And we're seeing more and more people being treated fairly and with dignity around that. And more people finding that they just need a step down from active use before they get into abstinence, and especially around this particular drug with this particular demographic that we're talking about. Is that, is that what you're saying, Dr. Fawcett? And welcome to the show, by the way.

Thank you, Dallas. It's always a privilege to be here. I appreciate it. Thank you. Yeah, I think you really captured exactly my thinking on this, which is really as opposed to this dichotomy, uh, of either this or that, um, which we have been kind of in this almost a power struggle, it seemed, between recovery-based, uh, things and, and harm reduction. Um, I do see them on a continuum. And I think certain, you know, one of the basic principles of any kind of mental health work is to start where the client is at. And, and I think, um, if we— a lot of clients, uh, a lot of people that use methamphetamine or other chemsex drugs, um, may be seeking information, maybe seeking ways to make it safer, maybe seeking ways to make the experience better, not seeking information on how to quit, you know. And, and then it may not be necessary. And I think in this country, I think we're— this kind of is dawning on us that harm reduction has a real place in this. And of course, we think of needle exchange and other kinds of things that are important parts of harm reduction, but there's a lot of other things that I think, like, we'd like to talk about today, relating regarding chemsex, that where harm reduction can be applied. I might say the opposite is true in Europe, by the way. I spent a lot of time in Europe, and over there harm reduction has really been the dominant way of dealing with substance use issues. Um, and they have been realizing over the last 5, 10 years that there are certain people that cross a line, right? And, and I call that a problematic use when it becomes— when, when harm reduction actually in my opinion, can be actually harmful. When once somebody's crossed the line and they really need to consider abstinence, if we keep encouraging them to cut down or cut back, that may actually be doing them harm. So it's really a matter of identifying where the person is and trying to match the intervention to what they need.

And I'm guessing one of the issues here is that maybe our treatment centers or our specialists aren't equipped with the knowledge to know where, how to assess that. Is that true?

Yeah, I think I, um, a mentor of mine in graduate school once said to me, you know, people find what they're trained to look for. And, and I think a lot of people in traditional treatment centers have been trained in that view, and they tend to see, um, an addictive model wherever they look. And, and, you know, granted, often in a treatment center, people don't end up there by accident typically, but But there are a lot of users out there who, um, who really deserve other kinds of, um, interventions like harm reduction than, than are offered. And I think it's simply because we haven't had the awareness, we haven't had the training. It's not— I think this continuum perspective that we just talked about is not common. I think people are still caught in that either-or thing. And frankly, I think there's a lot of belief out there that when it comes to chemsex and the dangerous drugs that are involved in chemsex, There is no such thing as harm reduction. I hear that a lot, and I think that's a big mistake, um, because it's, it's essential. Harm reduction has incredibly potent and powerful tools that can save lives when people are using drugs. Yes.

Yeah, yeah, yeah. So I'm going to read for those of us, those of you that are listening that maybe aren't familiar with the term. This is from the National Harm Reduction Coalition. Harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use. So harm reduction is also a movement for social justice built on a belief in and respect for the rights of people who use drugs. I think there's a lot of people who have a problem with that, is that drug users have rights and they They are worthy of being treated with dignity and respect and have programs associated for them. Do you see that?

Yeah, I think I see that concept kind of struggling to take hold, especially in this country. I think we are so still burdened with shame and stigma when it comes to substance use, misuse, addiction, uh, that, that I think people have a hard time kind of getting their head around that. So yeah, definitely the idea that, um, people have a right to kind of compassionate care at whatever level they need is maybe a new one for people. And I think it's really rooted in this approach that's nearly 100 years old now in our country of really criminalizing drug use and looking at it as a legal problem or a moral problem instead of a medical problem. And, and so I think it really— the seeds of this lie, you know, nearly a century ago. But, but it's very much alive and well in our society, this kind of, uh, belief of addicts are somehow second-class citizens. Uh, and I'm speaking as a recovering addict myself, and I know you've— I've been public about that too. So I think we've been on both sides of that. But, but I think that's very much alive and well.

Yeah, yeah. You know, The thing that I've seen so far in working with men who have sex with men in this particular seedy, quote unquote, seedy world of chemsex is that there, there's such a stigma and such a shame of, of actually admitting it anywhere, much less asking for help to say, I'm going to use, can you help me do this safer? You know, there's, there's such a wall there. And what people don't understand is that when you are stuck in this cycle of shame already, if, if someone comes and cares for you and says, let me help you, you know, you are accepted, let me help you use better or less, that, that actually is much more effective than saying you have to stop using altogether. You— because Then it becomes more shame-filled because listen, this drug, as you know, is fused to your sex drive. And it's not just— it's not that easy to quit cold turkey. It's statistically proven that most can't. So with this particular, I would say addiction, I guess with this particular addiction, it's just something that we may need to really address and put into place here because It's just, it's counterintuitive because you don't think that giving them this avenue of using actually stops them from using, but it really does. It's proven all over the world. In other countries, they do studies about this, but it's proven all over the world that it works.

Yeah. Yeah. It keeps people alive. It keeps people safe. And yeah, that's the bottom line.

Yeah.

Yeah.

So I want to say too, in terms of exploring or explaining harm reduction, um, you know, I heard this TED Talk and this lady said— she said there's just one sentence that helps you understand it, and it's, some people are going to do drugs anyway, right? They're going to do drugs anyway, so why not help them be safe with it? Why not help them feel some type of less shame, less guilt around it. Um, and so this concept of harm reduction, in my own experience, came when I started running around with a straight dealer. I had been using, you know, in the gay scene for years, and then I met up with the straight dealer. He employed me, quote unquote, um, to— actually, I was good at hitting veins, so I was his I was his injector in exchange for, you know, free food, free drugs, free whatever. Um, and so, but he actually was the very first person that taught me harm reduction. Now, all the straights were doing it. They were just, they were just more open about it. You know, we were using, we strained everything through cotton and we got, we did needle exchanges. I had never heard of a needle exchange. We had little sanitized water packets, alcohol wipes. I mean, we had it. There was just this whole new world that had opened up to me. And for some reason, I had never heard of it in terms of any of my gay cohorts. Why do you think that is?

You know, I think especially with Cam sex, because of the drugs involved, because it involves sex, and because it's often kind of taboo behavior. I think it's just, it's really kind of an underground phenomenon. Of course it's not, right? It's everywhere in our communities and getting more and more kind of bold-faced about it. But, but I think it really is just, um, kind of in the background and in the shadows. That's a better way to put it. And I think because of that, it's really hard to talk about it.

Yeah.

And, and people don't want to talk about it because it's shameful to admit it may be going on, right? How many people do we know that have been using meth for years and sometimes their best friends don't even know it?

Yeah.

If they can hold it together and keep them from finding out because it's such a shameful event. So I think, I think people don't ask for help, people don't talk about it, people don't admit they're using because that would be in that paradigm we spoke of earlier, sort of saying, you know, there's something morally and, and, uh, something terribly wrong with me. And as opposed to just being a, being a substance user, which most of the country is, right? It's just different substances. And I think meth particularly— I remember 20 years ago, I think it's in my first book, I mentioned this, I was talking to an older gentleman in a gay bar, um, who was falling down drunk and nearly— I think he did fall off his bar stool eventually, but he was just— couldn't believe how scandalous it was that all these guys were using meth and how awful that was.

Yeah.

And what addicts they were, kind of the implication of what kind of lowlifes they were, you know. And addicts, they just have other drugs. I think it's a generational thing, frankly. So, you know, it's just all that stigma and shame we do to ourselves, and we really need to pull it back. And without getting some kind of neutralization of all that negativity, it's going to be really hard to talk about How can we help? Right? What can we do to make it safer?

Yeah. Yeah.

So I want to kind of toss it to you in terms of what you're seeing right now as important topics for harm reduction. And if I'm listening, how do I know if I could be a candidate for harm reduction? And it's somebody, you know, if I've been trying to stop and I can't, I'm just stuck in this cycle. Is there a way for me to be— to kind of know if I'm past the point of harm reduction? You know, what are we looking for here?

That's a really, really important question. I think it can be very difficult for an individual to discern that themselves. You know, if they've crossed that problematic line, just because of the nature of addictive disorders with denial and kind of, um, not getting a full reality-based grip sometimes on what our problems are. So I think really looking at what's around us, I go back to those criteria we use from the DSM-5, which is diagnosing addictive disorder. But there are a couple of them, there's 11 of them. But I think the main ones are one of them you just talked about, you know, can you— have I tried repeatedly to cut back and I can't, right?

Mm-hmm.

Have I— am I not paying attention to really important things in my life and using drugs and having sex instead? So, you know, paying bills, going to work, paying attention to relationships, caring for myself, going to the doctor when I need to, that, that kind of stuff. And that also, if that's just kind of really getting out of control, right?

Mm-hmm.

And then consequences, right? Am I— what's happened to me? Am I getting arrested? Am I going to the hospital. I mean, I had— remember a meth user friend of mine who would go to the ER so much when he was using, like almost every weekend.

He, he—

and the last time, he said, sort of dark humor for meth users— he had the ambulance stop at like a Dunkin' Donuts. He picked up a dozen donuts for his friends in the ER because they, they knew him by that time. So it's like, so those kind of things. I mean, the un— I guess we would call unmanageability.

Yeah.

Is it So those are certainly things that anybody can observe, but it may take running that by an outsider or not. I don't know. Someone with outside eyes. It could be someone very close to you who could really help you evaluate that.

Yeah.

Yeah.

And, and, you know, it sounds controversial, I guess, to some people in the recovery industry, but sometimes it's a trial and error thing I have found. And again, these is this is my these are my opinions, not the opinions of Dr. Fawcett. But in terms of trying, like if you're going to use, I've I've helped guys like like look, I'm going to use this holiday weekend. It's it's happening, right? So what can we put into place to make sure that you use only within the container of the weekend? That you only use. a certain amount, that you only smoke it, you don't slam it, that you have all the— you know, take your doxy-PEP with you, put a reminder on your phone to take your HIV viral meds, um, have plenty of hydration. I used to use a gallon jug because in your meth state you forget to drink water and you lose shit all the time. So I'm constantly losing my water bottle, but if I had a gallon jug, it's right there, right? But Hydrate, hydrate, hydrate. You know, there's a lot of these guys, they say, well, I— my teeth are safe because I slam. No, your, your gums dry out because you're dehydrated.

Um, right.

Hydrate. Take snacks with you. I mean, so, I mean, there is a safer way to do it. Fentanyl strips. I cannot, I cannot stomach hearing another guy tell me that all you have to do is put your meth on a tissue and, and dabble, um, fingernail polish remover over it to see if it has fentanyl in it. Have you heard this?

Yeah.

It's this homegrown test to see if it has fentanyl in it, and, and we feel safe doing that. And so fentanyl strips are, are, are— there's— they're free and they're available for you. Um, not— yes, yeah, really. Um, test it. No matter if the other guy just used it, test it as well. He might have used out of his own supply. That's how they do. I mean, you know, so you're, you're putting your life in the guy that you just met on Grindr. But also, but also, a harm reduction for me is using with somebody that you know and trust already, if you're going to. So these are the things that I, in terms of harm reduction, these are the things that I have helped men do and participate in, if they're going to use anyway. What do you think?

You just named several of the really common strategies that I really endorse as well. You know, putting some kind of container around the use. I think it's when it bleeds off into our sort of everyday life that That's, that's an indicator that's a problem. And I think where I have seen guys really successfully avoid becoming problematic users is when they, they use around a certain event, or place or something that's circumscribed, right? There's a boundary around it that kind of contains the use, and it doesn't— they don't use other, other places. You know, I've seen a lot of guys, for example, use it at sort of circuit parties, right? The circuit parties are where they use— they don't use it at home, they don't use it at weekends. Um, but yeah, the, the drug safety issues you just mentioned, the, uh, knowing, um, about mixing stuff. If I'm using GHB, it's really good not to use alcohol. Um, looking at the impact, the drug interaction between erectile dysfunction drugs, which are very common.

Mm-hmm.

um, in, in chemsex because of issues that occur. Um, the interaction between, you know, erectile dysfunction drugs and poppers, you know, they both really drop bottom-out blood pressure. Um, the, the test strips you just described, the, um, the different kinds of ways, um, to, to have an exit plan, you know, when, when is the time to go? Who is there? Who's watching out for me? Who knows where I am? Um, all these kinds of things are really important, in addition to the common ones we think of as safer injection.

Exactly.

But you hit a lot of the categories, the physical health, the drug safety, the social condition in which I use. These are all elements, I think, of harm reduction that we just need to be aware of, and everybody needs to implement, whether they may be problematic or not, if they're going to be using. These are all really just common sense practices that that really do pay off. Uh, the one thing that, um, I hear all the time is just a real misunderstanding of GHB and what an overdose on G looks like. And it's incredibly easy because it's liquid. People are often mixing in the bathhouse cubicle or on a dark dance floor, you know, in the back of a car somewhere, and then not really paying attention. It's so easy to overdose. And of course, that involves respiratory shutdown and—

Yeah.

Uh, it's a medical emergency. You can't just take somebody and put them to bed, which is what happens every year down here a couple times. I, I live in Fort Lauderdale. A lot of the gay cruises leave out of this port, and every year they come back and 3 or 4 guys have died on the ship, uh, because of these kind of stupid things with drug interaction, mixing alcohol and G to an extent, or, or having their friends not understand what the kind of 911 protocol is. for GHB. And I will say, and we're talking about the difference with the US and other places, in the UK, for example, they actually have these kind of publicly administered first aid, drug first aid classes, you know, what to do if your friend ODs on, drops into the G-hole, right? What to do in certain situations. What if somebody gets really paranoid and tremulous? You know, what do you do? I think just having those kind of information publicly available is really important.

Yeah. And we have to get away from this thought that we're giving people permission to use. They're going to use anyway. So let's help them not overdose and be safe. And the thing is also, I'm not advocating that we plan a relapse and in a container of a weekend and we— and that's the way you're going to live the rest of your life. This is a temporary step down from active addiction. Like, people misunderstand that too. It's a misconception that I'm enabling them to use for the rest of their life. And I get asked all the time by men saying, isn't it possible to use this recreationally? Isn't it possible to use this once in a while? It's like, if it was possible, we would all be doing that.

It is not possible.

Um, you, you run into men who they look like they're functioning well, like they're, they're working, and they do it— they say they do it once in a while or once a month or something like that. You are viewing them at one stage of their Tina journey, of their crystal meth journey, one stage of that. You don't see what happens 6 months down the road or a year down the road. But this is the same thing, is that this is a point on your journey. Your intention is to quit But there's a reality of the situation of that you may need to step down. You may need to, you know, what also it comes to this is the trust factor of I set boundaries and I kept them. And all of a sudden I'm in more of control of my life, you know, than just trying to stop altogether. But, you know, coming out of this saying I'm only going to use This, this little baggie worth, I'm only going to use for 2 days. I'm only going to use with 2 guys. You know, I mean, when you set these boundaries and then you follow through, you start to build trust and your word means something again. And that's huge in recovery. Huge. You become the, you become the expert in your own life. And that's, that self-empowerment is just, is so crucial.

Right. And I think that, that agency that you're investing someone with is really, just from a personal point of view, really empowering. Because it, you know, it's, it's little steps they can set themselves and, and accomplish or not. But if they can, if the, if the layout of what the expectations are is designed well for that person, I think it's very empowering. And they can start to get little steps as opposed to— this sort of black and white, you're sober or you're not, right? And just— and that's so difficult for people, as we spoke at the beginning, and the shame and the stigma of that. And the, frankly, I think almost statistical impossibility of anybody in recovery from meth or in their journey getting sober from meth or trying to cut down on meth even, there's going to be relapses along the way. No one can just say, okay, done with that.

Right.

And it's, you know, Right. And it's a new day, right? Uh, it doesn't happen that way. And that, that builds— and meth does this to the brain anyway because of the disruption of process, neurological processes— but there's a hopelessness that sets in and a depression. I think these kind of constant— I'm going to call them failures, if you will— of expectation really adds to that hopelessness, to the point where people really believe it's not possible, yeah, to get past this drug. You know, I might as well just use. And, and it is, of course, but we have to really be smart about it. And I think harm reduction is a key part of being smart about it.

Thank you for that. Yeah, that this, this idea that it'll never happen, I hear that a lot, you know, because they, they've tried the abstinence thing 2 or 3 times and they just think it's impossible. And they don't believe in themselves. Right.

Yeah, right.

And so I want to say also another part of harm reduction that, that I help men with is sometimes if you're going to use, sometimes men just use online, like with Zoom, um, or whatever. There's some other, other ways you can do that. Sometimes they stay at home and use on Zoom, not Safest, not the best if you're using alone, but it's, it's a step down from going out, you know, and it's easier to contain.

Right.

Um, some guys are using other, other things like gummies, THC gummies, in terms of their cravings, um, which is not, you know, not a, a well-accepted, um, tactic in a lot of the recovery circles right now, but I've seen it working. a lot. And again, it's temporary. We're not saying get, you know, take THC gummies for the rest of your life. We're saying you have a craving, you, you're getting squirrely and you want to go out, you take a gummy and all of a sudden you're one with the couch for the rest of the night. It's great. It's, it's grounded you, you know. I mean, it— you're right.

Literally.

Literally. Um, you know, these are things that I, I don't think that we feel are alternatives But again, if you look at it as a point on the journey and what it takes to get free from this, then I think it can open up a lot of doors for people.

Right. I just— helping people with expectations. I know it's standard practice in Europe to really, even in abstinence-based programs, you make a commitment for a year.

Yeah.

You're gonna make it for the rest of your life, you know. And somehow a year is a horizon that people can kind of get and deal with and manage somehow. It's a lot— seems a lot better than never ever doing this the rest of my friggin life, you know. That, that's overwhelming. And to set somebody up for failure— and suddenly, you know, we— 12-step program has that same sentiment with, you know, a day at a time. But, but I think there's also this expectation that, well, That's gone. And I think we have to remember addiction is a coping mechanism for people. It's how they deal with stuff or not deal with it. And I think we have to help people build new coping mechanisms. That's essentially what you're saying is this is buying people time to find maybe other ways of learning to live in a healthier way that at least are less consequential or destructive.

Yes. And helping them feel like they're seen. And alleviating the shame, the stigma. You know, there's something about the message that I'm okay and this is okay for now and we're working. There's something about that that reverses the desire for it. You know, I think about when my kids were teenagers before my meth stint, I let them They wanted to smoke weed, they wanted to drink beer. I let them do it. I said, you're going to do it, but do it here. So, you know, some of the friends came around because their parents wouldn't let them. But I said, test it, try it, do it, you know, do it safe though, because I want to be here. And it wasn't a year and they just stopped. They were like, what's the, you know, what's the fun in this if it's not something I sneak around to do? You know, and they tried it. And neither one of them ever stuck to it. And they still don't, you know, they drink a little bit here and there. But I kind of think it's, it's almost the same mentality in terms of let's bring it into the light, take the shame and stigma away from it. And for some reason, in that, in that space, you don't want to keep turning back to it.

Right. It's true. I think especially, I think with chemsex, a lot of appeal is, yes, the taboo, right? And kind of the And that, that goes for the sexual aspect of it, but also the behavior itself, the COVID behavior, the kind of, um, you know, into that shadow thing we were talking about before. I think that, that can be really destructive because it's— that's where people get in trouble, right? If they don't have the help systems built in and the connections, which I think is the antidote to a lot of this behavior, is, is social and human connection.

Yeah, yes, very much so. Very much so.

I've even heard, by the way, 12-step program framed as a harm reduction technique, right? Going to a meeting. Um, maybe some people call that a stretch, but I think it actually fits into the paradigm because it, it, it is helping people not use. Yeah.

Um, so that's a— that's a—

I like that.

I like that a lot, that, that frame of reference. because I put out a, uh, at Christmas time I put out a, a reel, uh, a content of Tina harm reduction. You know, if you're going to use during the holidays, here's some things to do, right? I even talk about Biotene spray, you know, for the mouth. Um, I talk about just all, you know, all those things that you can do, taking a buddy that you trust with you, all that kind of thing. But I, I got a lot of— I get a lot of feedback From people in the 12 steps saying that what I'm doing is wrong, you know, and that it's— they have— that the addict has to hit rock bottom first and all that kind of stuff. So there are some, there are some people who are having a hard time accepting it. But I also— it's funny you say that because I also thought to myself, when reading some of these messages, I'm like, but going to a meeting is what I also suggest. And maybe I should have put that on the list. of harm reduction, you know, techniques in the first place. But, you know, is getting to that meeting and just being there and hearing and seeing and making contact with people that aren't using, I mean, there's something powerful in that as well. Yeah.

Right. I mean, all the layers of things that can happen in a in a 12-step meeting or Smart Recovery meeting or any other kind of meeting that, you know, it's the social connection, it's the information, it's the I'm not alone, it's the dragging this thing into the light because other people are talking about it. All the— that's all harm reduction stuff, right? And one piece of that is maybe this expectation of abstinence, for which is appropriate for a lot of people, may not be appropriate for everybody. So yeah, I think just kind of understanding that it's again not just black and white, we have to become a little more nuanced. in our feeling about this and our understanding of it.

Yes.

Yeah, yeah. You know, in some of these— in some of these other countries, you mentioned the UK, Australia as well, um, lots of research coming out of Australia on harm reduction. Um, Madrid— in Madrid, you can order a harm reduction chemsex packet to come to your house, you know, with all sorts of, you know, clean sterile supplies. And, um, you know, it's a play packet, I think it's called. And they even have— they even have those for, um, you know, for HIV, um, as well. But the thing— the thing about these studies coming out everywhere is that it's proven that there's lower spread of HIV, higher access to healthcare, um, that, you know, there's just so much good coming from the harm reduction tactics. But one thing that comes from this as well is the, the effectiveness of, of peer, peer support. In this particular drug, in this particular realm, there, there's this camaraderie with gay men who are using this drug. I mean, it is like, to me, it's almost like you are a veteran now. You've been through the war together. You know right away if you say, I'm, I'm a partier, you know right away in any part of the country what that means. You know what it's like, and you know what that secret world is about. And so there's just like this instant bonding that happens. And so coming out of this, peer support seems to be Coming up as the most effective way to reach these guys, um, and, and to help them, like, help them execute harm reduction and help them understand harm reduction, um, and that, that they have hope in working with a peer, somebody who's actually been there. That's been what I keep reading as very, very, very powerful.

Yeah, I think more and more programs, whether they're harm reduction programs or treatment programs or both, are incorporating this peer-based model for, for just the reasons you mentioned, right? It's, it's— in fact, a lot of groups now employ a, like, a therapist or professional and a peer.

Mm-hmm.

And, and that combination has been really— has a powerful punch because it, it has kind of the the therapy-level kind of insights and stuff that can go, and then peer, the practical support, and a good bit of insights as well from that peer. And so I think, yeah, that model is incredibly important because, again, it's with the shame that goes with chemsex particularly, I think that people— the relief people have in knowing they're not alone, knowing they're not the only one. And I think that's, that's huge. Someone actually gets them in a place where— and I think part of this also is the consequence of meth in the brain— people feel a little more disconnected, people a little less trusting of other people and their experiences, and, and just kind of feeling that their experience is unique and beyond help.

Mm-hmm.

And I think just having— seeing anybody who is a little bit down the road and is doing it Is really inspiring. And I think that's what people need to see, the kind of the victory messages that it can be done.

It is possible.

It is possible.

Yeah. Well, I think I'm probably missing a lot here.

Am I?

What am I not covering around this topic?

I think mental health, I would add to this. We talked around, around it, but kind of knowing, um, your mental health state and, and the, the role that plays in using or not using, or the exacerbation of, say, depression after use, that kind of thing. So just really understanding the— This other kind of layer of mental health that's impacted by all these decisions, that can also be a good cue and reminder as to where we're at. I think that you mentioned physical needs, staying hydrated, eating, taking your meds, taking time for rest, and so on. Safer injecting, you mentioned. Trusted people, you mentioned the social considerations, really having— people that are around you that you trust, a safety buddy, people that know where you're at. You know, one thing that maybe is important to talk about explicitly in terms of harm reduction is the idea of boundaries and consent.

Oh, yes.

You know, consent and chemsex is a really difficult thing to talk about because, I mean, at some point when you're impaired, can you really give consent? And, and this— they've talked about rolling consent and So it's an issue, and it's particularly an issue in that there's a really an epidemic of sexual assault. Another thing we don't talk about too much in the chemsex community is GHB. You know, GHB is a close cousin of Rohypnol. It's happening a lot, and I think people don't want to talk about it. So anyway, understanding some of the risks, and just like we would say to people in a bar, don't, don't leave your bar—

Yeah.

Don't— sorry, don't leave your drink at the bar. You know, take it with you to the restroom, put a cover on it. Just be conscious about that kind of thing. Because it's not exactly— I think we want to believe everybody out there is kind of a comrade and a buddy in this, in this scene. And that's not the case, right? There's some people that are really—

That's right.

Not nice folks to encounter when you're so vulnerable in that position.

Yeah.

Yeah. Those are some of the things that occurred to me when you were talking about this. I'm sure there's a lot more.

Um, yeah, you know, I'm not, I'm not advocating for the listener. I'm not advocating that you distrust everybody, but think about when you, when you party with somebody you've just met, and in particularly what this drug does, like the taboo. I mean, there, it's a known fetish in this realm to fuck people up, you know, to make them use if they don't— if they say they don't want to use, trick them into using, you know, putting a booty bump into their anus without them knowing. Um, you know, putting too much G— I've seen it, you know. I was with a couple once and the, the, the one of the partners put too much GHB in his partner's drink on purpose just to knock him out, you know. I mean, it's like, this is, you know, it, it— because of the taboo, because of the The, the way that the, the meth is affecting the brain, you just can't be too sure about anybody, especially somebody you just met on sniffies. You know, you're putting your life in someone's hands. And so it's okay to have a bag ready. Like, take some— I know how hard it is to eat too while you're using. Take some Ensure and sip it through a straw.

Yeah.

I mean, you know, there's a lot— there's— you could be creative with this. If you, if you're in that harm reduction phase, if you are stepping down, then, you know, you're going to come out of it too. The comedown's not going to be so bad because you're going to be, you're going to be hydrated, you're going to be nourished. You've, you've proven to yourself that you can do this, that you can set boundaries. The comedown just isn't as quite as bad. Another thing I want to mention too is that the Wellbutrin and naltrexone Combination.

Yeah.

Thank you. I have a few clients on that. And cravings are so much more diminished. Plus, when they have used, the comedown is, is not, you know, is emotionally not what they usually face.

Right. Right. Yeah, I've had the same thing. And it's been quite a game changer for a lot of people, not everybody, but I'd say 3 out of 4 people that try it have some kind of benefit from it. So yeah, that's an important one for sure.

Yeah. And so if you're listening, if you don't know what we're talking about, we're going to do a podcast on it as well. But ask your doctor about the Wellbutrin, and it is naltrexone. Am I saying it right? Okay.

Yes.

It is rough at first. The guys that I know that have got on it, it's It makes you very nauseous. And, you know, there's a little bit of an adjustment to it. But once you get rolling with it, you know, your cravings go—

the one—

I mean, like you said, it's not everybody, but cravings do decrease. And when you do use, it's lessened. So I think that's a harm reduction technique.

And I will say, and Dallas, I can provide this to you if you don't have it, a lot of— in my experience, a lot of doctors want to see the evidence before they prescribe this because it's off-label prescribing. And there is an article in the New England Journal of Medicine, okay, that talks about this that, um, is helpful to the prescriber to see. Yeah, yeah, show notes.

I see that. Let's do that. Um, I'm going to have a nurse on the podcast who is administering these, this, these 2 medications to veterans who are having addiction who are addicted to meth. Um, yeah, and it's working. It's working for the most part with them. You know, of course they have PTSD as well, so the Realbutrin I think is helping with, with that. Um, so yeah, so there's, there's a lot you can do, guys. Um, and the thing is, is that getting over the shame of asking for help is a big part of this. Um, and, and again, like I, I volunteer for Controlling Chemsex. It's an organization out of London. And so the name Controlling Chemsex— so we give— the guys can come forth, they get 8 to 10 free— they call it key working sessions, but I call that coaching sessions. They can decide their own goals, like I want to control it and reduce it for an amount of time, or I want to stop altogether. So those ones that— when you give the option like that, And when it is an option, it's funny, for the most part, most people don't—

they decide not to.

They decide abstinence when it is an option, when they know that it's okay to maybe step down from it. But we help them do that if they want to do that. And they taper off, they get more trust in themselves, they see what life is like without it. more than in it. And they end up stopping. So it's, you know, it works.

Yeah. It's a marvelous organization. Yeah, I think just this idea of really believing in yourself, right? And I know that one of the core beliefs that I've seen, I've talked about this in my books too, is this statement by a lot of meth addicts say, I feel like damaged goods. Right? But there's so much wrong about me. And there's that kind of very, very low self-esteem, low self-worth. And when we have that low level, it's really hard to empower ourselves to do these things and ask for help even. So I think just all that, there's kind of a little bit of an attitude shift that helps. We have to remind ourselves we deserve help. This is not a moral— an issue of moral. uh, value or anything like that. It's a medical concern. And just like any other medical concern, we would have a right to talk about it in the open, right? And ask for all different kinds of help that might help us depending on where we're at. So I think it's just, just really talking about this, having this conversation on this podcast is really helpful because it's just people somehow think the only option is you know, treatment and abstinence, and like right away without these processes we're talking about in the meantime. And that's really a critical distinction, to have that broader view of this continuum that we spoke of.

Yeah, I love that.

I love that. Um, and the thing that I'm seeing too, that a, um, inhibitor of feeling this way is even in our own community You know, when I, when I was talking about starting this, my coaching business, I had a lot of my gay peers say, you're not going to be able to help those tweakers, you know, or meth heads aren't going to be able to be coached, you know. And these were guys in the community. These are our brothers, our, you know, our gay brothers. And so we're facing that as well, you know. We're facing that That pressure from our own people to, like you said, the guy that was on the stool falling over, calling, you know, thinking it was horrible that we were using meth. I mean, we're facing that layer of shame from our own people. And that's something that's prohibiting us from getting well too.

Yeah. Right. Right. And, you know, just Talking about just the danger of the drugs with the new so-called—

Yeah.

Super meth. Not everyone uses that term, but this is, you know, the manufacturing process was changed by the cartels, and, and there is much more paranoia, much more lasting psychosis, um, much more conversion to schizophrenia in some cases, and just memory, massive memory loss that we never had. There's all kinds of other new dangers with the drug as it's being made now. And so just all the more reason to just really know your stuff in terms of what are my signs and symptoms, what is the safety protocol, and so on. Just, it's up to us to take care of ourselves.

Yeah, thank you for bringing that up. Um, I don't know that we've talked specifically about super meth. I think we talked a little bit when you were on before, but for those of you that, that aren't aware, so the Biden administration really cracked down on Sudafed distribution in the U.S. And so it shifted the supply, the— or shifted the— it shifted all the making of meth to the Mexican cartel labs, and they have perfected it. So it's like 99% pure, and it's cheaper now. And so, yeah, we're seeing an increase in psychosis, an increase in schizophrenia, like you said, but also a huge increase in overdose.

Wow.

Mostly because of the fentanyl, but you're seeing like in the last few years, like the triple amount of people overdosing on crystal meth than before. Um, and, and so it is important for you to know signs and symptoms of what does it feel like when I'm going into a psychotic break? What are signs and symptoms of somebody else going into a psychotic break? When do I know how to exit? You know, or can I go to the emergency room? Is it okay for me to go? You know, all those things, um, are, are good to know. And listen, there— if you go online, there's all kinds of great resources. Most of it comes out of other countries, like I said, but, um, I can put this in the show notes too. It's a whole PowerPoint of harm reduction in the context of chemsex. It's a training manual. Um, it's out of AIDS Action Europe. Um, I sent it to some of my clients because it's packed full of rich information for you to use. And why not? Why not do your research? If you're going to do it, do it safely.

Absolutely.

Okay, anything else I missed? What do you think?

No, I think it's pretty, pretty thorough discussion. I mean, we could, we could talk all day in detail, but I think this, this big framework, uh, is really important for people to understand.

Yeah.

And it's just like with anything else on this podcast, it's a dialogue. It's something— it's getting the discussion out there. It's getting, you know, hopefully people are talking about it over there, over there at the water cooler, as so to speak, um, and getting some more awareness out there. And if you're listening to this, and if one person takes an effort to, to use safer, if one person takes— tapers off and then and then is able to stop because of this podcast, then it's all been worth it today. So, Dr. David Fawcett, thank you again for joining me. I am so in appreciation of you and your expertise and what you're doing for the community. Just really appreciate it.

Same, same to you, Dallas. Thank you for all the great work you're doing.

All right, guys, hope you enjoyed this podcast. And don't forget to share, rate, and review. 5 stars if you can. I'll see you next week.