I’m Worried About My Friend’s Use of Fentanyl. How Should I Talk With Them?

My friend just told me that they like doing small amounts of fentanyl. I don’t want to judge them for doing opioids, but I am worried about them overdosing or getting addicted. How should I talk with them about this?

Ah, THIS is a complicated question. Almost all of my answer revolves around two things: the source of the fentanyl, and the relationship you have with your friend. 

We’ll start with the most important bit, which is the source of the fentanyl. Fentanyl itself is actually a very well-tolerated drug, so much so that it’s on the World Health Organization’s list of top 100 most essential medicines. It’s used in a huge percentage of surgeries, and it’s a critical part of chronic pain management for hundreds of thousands, possibly millions of people. 

An aside: The popular media representation that you’re guaranteed to be “addicted” after “doing [an opioid] one time” is pretty much always baloney except under fairly specific circumstances or in outlier situations, like when someone is already predisposed to having a toxic relationship with a certain kind of stimulus (like a type of drug). There’s a reason why people don’t come out of surgery craving fentanyl, and why many people who use fentanyl for chronic pain don’t have any sort of mental preoccupation with it. Virtually no one is aware that they were even given it as part of their pain management.

The major concern with fentanyl is not only that it’s extremely potent, but that it’s potent and an opioid, which means that taking too much can cause fatal respiratory depression. This means that it could slow your breathing until it stops altogether, which will cause your heart to stop too. Medically manufactured fentanyl is, therefore, a completely different animal than illicitly-obtained fentanyl, specifically because of the dosing and adulteration issues. It is really not about fentanyl itself, but how it’s obtained, how it’s dosed, and how it’s ingested. 

If your friend is taking medically manufactured fentanyl, even if they are not taking it for pain management, they’ll be able to have an exact understanding of the quantity they’re taking. They’ll know that what they’re consuming contains fentanyl alone, and be able to consent to the experience they’re having. 

If your friend is taking illicitly-obtained fentanyl, either through counterfeit pharmaceutical pills like oxy blues or through straight powder sold as fentanyl or heroin, the risks they face are substantial and very different. 

My advice for how you’d approach this conversation will vary enormously, depending on which form of fentanyl is being used here:

• If they are using pharmaceutical grade fentanyl, make sure your friend knows they can talk to you about how the relationship is unfolding. This includes making changes to the route of administration (such as switching from a transdermal patch to oral use), dose, or frequency. Taking higher doses or using a more potent route of administration makes the importance of having a sitter even more critical.
• If they are consuming illicit fentanyl, I’d ask if your friend is aware of how contaminated fentanyl-related products are right now, and how easy it might be to overdose. Reiterate that your priority is making sure that they can consent to the drugs they’re doing. 

These tips are all important for immediate safety, but I’m sure that the risk of addiction and/or dependence is on your mind as well. That’s an enormous topic by itself. It’s important to first establish that there is a difference between those two terms: addiction refers to a compulsive pattern of use that takes place even when someone doesn’t want it to, and dependence refers to a person’s body adjusting to the presence of a substance and going through withdrawals in its absence. 

Addiction doesn’t always include dependence, and vice versa. Someone who is taking opioids for a long time for pain management may become physically dependent on them without having any sort of mental preoccupation or compulsive (automatic and impulsive) behavior. Someone who has a mental preoccupation and compulsively uses fentanyl might not actually be physically dependent on it. There is a lot of unfolding science and psychological thought around this topic, but the gist of addiction is that it refers to a relationship between person and drug (or sex, or gambling, etc.) that is very specific. It is an extremely personal experience that has different causes, developments, and presentations for everyone.

Certain drugs may be more appealing to certain people for specific reasons, for example. Genetic predispositions, environment, upbringing, core wounds, and all sorts of other factors will determine someone’s relative risk level of using a certain drug. With opioids, the one thing that’s more concrete is the risk of physical dependence and withdrawal – using opioids on a regular basis, especially multiple days in a row, can and does cause dependence. The cognitive portion of things is way less predictable. It’s important that your friend is aware of the risk of physical dependence, and is able to make informed decisions about their personal relative risk of addiction. 

I’ll note that people who are struggling with basic needs, especially those related to love, health, security, and joy, may be at substantially higher risk than developing a compulsive use pattern with something like fentanyl. Opioids emulate the natural chemical experience of being in love, and many of us know what a beacon of hope love can feel like when we’re struggling.

Harm reduction is about meeting where they’re at, and sitting with them as they learn about themselves rather than trying to guide them to a specific outcome. “Sitting, not guiding” is a popular phrase in psychedelic support circles, to demonstrate the importance of supporting people’s autonomy by offering resources and security.

Some additional notes about immediate safety: 

1. Sit down with your friend and look at the submissions on drugsdata.org to get an idea of what kinds of other stuff are ending up in the supply. Depending on where you’re located, xylazine, benzos, or diphenhydramine may be a concern, since all three of them can make overdoses much harder to treat and may also cause skin, psychological, or digestive issues depending on route of administration. 
2. Provide them with the Never Use Alone and Brave COOP hotlines/information so they are able to consume with supervision, and talk about what happens in the event of an overdose. Ask what kind of support, if any, they’d like from you, and discuss what might happen if something goes wrong and they do overdose. 

You can see how this is so complex, and it’s just the tip of the iceberg in considering how people use fentanyl. Some people who rely on fentanyl for the management of chronic pain have lost or almost lost their prescriptions because of concerns over the use of illicit fentanyl. This has even driven some people to suicide. 

What I’d always suggest emphasizing is that you want to support your friends as they explore a given substance, and part of that means checking in with them, asking them what they need, and offering support and resources. Work together with your loved ones. You can also refer to my article on talking to your friend about their ketamine use for more specific tips if you end up feeling more concerned.

My dad is quite traditional and doesn’t agree with drug use. I work in drug policy and take psychedelics, but I’m afraid if he knew that, it would cause a problem in our relationship. I’m tired of keeping quiet to keep the peace though. Do you have any suggestions on how to broach the topic with him?

Another great question. As much as I hate to say it, I’d suggest incrementalism, which is the process of gradually making change one step at a time. There are really two main ways to crack the barrier with someone who’s anti-drug and not in the mood to change: 1) Research, and 2) promising therapies. 

Fortunately for you, those are two of the most-discussed aspects of drug policy and use right now. “Traditional” views around drugs are usually informed by many generations of internalized stigma, racism, and political marketing, so challenging deeply-held moral ideologies can be difficult or impossible. People with traditional anti-drug views are usually only swayed in their opinions when a trusted entity announces that the drug in question is okay after all because the research has progressed.

I don’t know your father (as far as I’m aware), but it seems like the long game would be easiest here. Start by opening small conversations about interesting new research, endorsements, etc. from allied media that he’d resonate with, and let the seeds germinate on their own. Eventually you can start having discussions about the subject matter, and when you feel comfortable, you can casually drop the “I actually had an interesting experience with this, I’ve been tracking this research for a while. I’ve been feeling nervous about talking to you about it, but I love you and I wanted to tell you about this part of my life.”

Alternatively, do what I did and compile a huge folder of resources, articles, and links to drop on him at the same time that you have an explosive tell-all conversation, and then announce that you won’t talk to him about the subject until he’s taken the time to learn more. Fair warning that this method, while being very rip-the-bandaid oriented, might lead to a pretty serious blowout depending on your dad’s personality.

Either way: When the time comes to open up about who you are (just to reiterate that that’s what this conversation is about), I recommend setting the container first. Say you want to have a conversation about a topic that’s important to you, express that you’re feeling nervous about it, and ask if he’s feeling stressed/in a place to be open-minded or if the conversation should wait a few days. You might even request that he just listens to you while you talk, without responding, and you regroup in 3 or 4 days after he’s had some time to think about it. 

I do want to note that I have not personally experienced this kind of dynamic and therefore am therefore not the most qualified to speak on the subject. I bulldozed my way through my mother’s opposition by very proudly displaying my drug use and career in drug education. We had a bad relationship already and this didn’t help, so it’s not exactly a success story, but at least there were no secrets.

I don’t know if your dad doesn’t know what you do for work, or just that you like to do drugs too, but either way: You deserve to have your bodily autonomy respected. Sometimes love looks like staying up late reading the DanceSafe website because your kid told you something new about themselves. Learning to challenge confirmation bias and cognitive dissonance is a lifelong process, and he can participate in it too, even if it’s hard. The most amazing changes can happen when we try to become better to support people we love.

What’s the best way to test for the potency of mushrooms?

Some time ago I started seeing ads for “mushroom potency tests.” Anything related to at-home purity or potency tests is pretty much always flat-out false advertising, so I wrote it off immediately… BUT I do vaguely remember having a conversation with someone who thought that this particular testing method might actually work.

I’m not sure if any follow-up was conducted, but for the time being, there’s no test or method that I’d endorse. Which is a bummer, because the psilocybin content of mushrooms varies enormously from batch to batch, species to species. Weighing your mushrooms is probably the best thing you can do still, which I’ll maintain until I see proper science validating actual test methods. 

A fun side note, though. There’s a lesser-known substance called 4-AcO-DMT that is very similar in structure to psilocybin and psilocin, which is the active ingredient that psilocybin is broken down into in the body. It’s sometimes sold as “synthetic shrooms” as a powder in capsules, and is theorized to be a psilocin prodrug, meaning that it’s converted into psilocin in the body – just like how psilocybin is broken down into psilocin in the body. Sometimes affectionately known as “4-echo,” it’s often favored by people who struggle with the stomach upset and nausea of regular shrooms. 

A major benefit of 4-AcO-DMT is the fact that it can be weighed and dosed accurately. Since it’s dosed in the low milligrams (about 15-25 mg as a standard range), it should be dosed volumetrically; standard milligram scales are inaccurate at measuring quantities below about 50 mg. 

Obviously most people can’t get their hands on 4-AcO-DMT (or would balk at the idea of buying and consuming such an alphabet soup drug), and additional risks of the illicit market come into play with novel substances: without lab analysis, powder in a capsule is a total mystery, but you can dose it accurately IF it’s not bulked or adulterated. Mushrooms are either shrooms or they’re not, but dosing them consistently is difficult because the psilocybin content varies so much. 

You can’t win. Wouldn’t safe supply be nice?

About Your Psychedelic Auntie

When we have questions about psychedelics, we often consult our Auntie. An Auntie can be a person of any gender who offers wise advice about psychedelic substances and how to effectively use them. Lucid News is asking a collection of well-informed people to step in as Auntie and answer your questions about psychedelics. Some of the best peer-based, accurate information about psychedelic substances and harm reduction comes from DanceSafe, a nonprofit educational organization founded in 1998. DanceSafe provides health and safety services at festivals and events. This month, our Psychedelic Auntie is DanceSafe Programs and Communications Coordinator Rachel Clark. Send your questions to the Psychedelic Auntie via the Lucid News contact page and watch this space for the answers.

The post I’m Worried About My Friend’s Use of Fentanyl. How Should I Talk With Them? appeared first on Lucid News.

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