Everyone needed a hobby in 2020. Some people started roller skating. Others baked. A few people got really into... snorting ketamine. Since the pandemic hit, regular users used more street drugs overall. Many others haven’t used anything harder than weed in a while and may be wondering how to handle themselves and their substances now that we’re starting to hang out—and even party—again.
Whatever a person’s relationship to recreation, drugs, and recreational drugs has been during the long months we spent inside, it’s a good time to check in on some baseline questions: What’s the right balance between doing drugs and overdoing drugs? What if your tolerance is different now? What if drugs are different now? As people poke back into (or maintain) the key-bump lifestyle, the game may have changed, but many harm reduction strategies remain the same. Here’s a refresher course.
What do I need to keep in mind about my rate of use, and my tolerance, if I haven’t done drugs harder than weed in a while?
Nobody’s exactly the same person they were before the pandemic started, and drug tolerances might have changed along with their ability to feel comfortable being social. As vaccines roll out, COVID restrictions loosen and parties resume, it’s important to remember that social anxiety can trigger people to use more substances.
Hailey Shafir, a duly licensed clinician specializing in addiction, said that when people are anxious about being socially rusty, they might be inclined to use more than they otherwise would, and COVID-19 has done a number on people’s nerves. “You have this interesting environment, where people who’ve been in lockdown are coming out,” she said. “You’ll see an uptick in social anxiety, including in people who have never experienced social anxiety before. They may drink or use drugs more to calm their own inhibitions.” Avoidance by way of overdoing it with drugs or drinking (or drugs and drinking) isn’t going to help you, though. “Avoidance increases anxiety over the long run,” Shafir said. Even though your anxiety might be really high in your first few encounters, it won’t take long to reacclimate to social situations, she said.
Whether or not you’re feeling anxious, your tolerance may also have lowered in terms of a given drug’s effects on you if you haven’t taken it in a long time.
It’s easy to take more and impossible to take less later, and you don’t know how much your tolerance has changed or strong a drug is until you take it and do a biological self-assessment. Case in point: One of my friends died from a cocaine overdose because he failed to account for his reduced tolerance after being in jail for three months. A dose that might have guaranteed a good time pre-lockup was deadly post-lockup. It’s easy to see how this might be applicable to people who weren’t using (or weren’t using as much) drugs during quarantine.
What’s changed about drugs since early 2020?
The biggest change to be aware of is the increased presence of the synthetic opioid fentanyl, which is 50 to 100 times more potent than morphine, according to the Centers for Disease Control. Street drugs being cut with illicitly manufactured fentanyl was already a problem before the pandemic, but it has only gotten worse: People are dying from drug overdoses in record numbers, according to the CDC, and most of those overdoses were caused by synthetic opioids—especially those containing fentanyl.
“There’s been a significant increase in opioid overdoses since COVID started,” said Henry Smith, an emergency medicine physician practicing around the Gulf Coast whose name has been changed to prevent workplace retaliation. “At least two or three a shift. I’ve seen quite a few deaths.”
Smith said fentanyl is found in street drugs because it’s cheap and potent, which is an effective combination for a cutting agent even for non-opioid drugs, but experts aren’t sure of the exact reasons for its surge in prevalence.
You don’t have to be a heroin user to die from an opioid overdose anymore—fentanyl is ubiquitous. While you mostly used to find fentanyl in street-level opioids, it’s showing up in party drugs (which is what we’re talking about here today, and by which I mean “cocaine, benzodiazepines and MDMA”). “Just because you don’t think you’re using opiates doesn’t mean you aren’t taking opiates,” said Mitchell Gomez, executive director of harm reduction nonprofit Dancesafe, who has tested cocaine that was positive for fentanyl.
There’s reason to question the idea that drug dealers are adding fentanyl indiscriminately and with malicious intent to the drugs they sell, but it’s possible for laced products to end up on the market in a variety of different ways. So it’s worth being careful, especially when getting reacquainted with the process and any new-to-you dealer.
Another change, in addition to the prevalence of fentanyl and its resulting epidemic of overdose deaths? Drug analogs—newly synthesized, unscheduled substances that are psychoactively and molecularly similar to their illegal counterparts—are also everywhere, thanks to a rapidly changing research chemical market accessible via the dark web. It’s possible that the MDMA your dealer is selling you isn’t molly at all, but one of its analogs.
“I don’t think most sellers of drugs are intentionally misrepresenting drugs,” Gomez said. “They just might not know it’s one of a galaxy of research chemicals that exist out there. It changes fast now.” For example, remember the whole bath salts craze and the Floridians who took it and ate each other’s faces off? They were actually on mephedrone, which is often passed off as molly. Methoxetamine (MXE) is another common analog and a chemical analogue of ketamine that shares its dissociative properties. “Terms like molly are branding terms. They mean nothing about the composition of that particular drug,” Gomez said. That K-hole, in other words, might actually be a MXE-hole, which doesn’t have quite the same ring.
How can I tell if a drug is what it’s supposed to be?
If you want to learn more about what you’re taking, Gomez recommended using testing kits. Dancesafe sells test kits that detect the presence of genuine MDMA, MDA, ketamine and LSD. They also detect adulterants commonly found in these drugs, including methamphetamine and amphetamine (which are often added to MDMA) and levamisole (a deworming agent that’s used to cut cocaine).
Dancesafe’s kits range from $20 for a kit that tests LSD to $105 for a kit that tests ketamine, MDMA, cocaine and LSD. Each bottle contains enough reagent for 50 to 75 tests. You can also mail your drugs to DrugsData.org for analysis in its DEA-licensed laboratory (which costs $100 to $150, depending on the drug) or visually check them against the pictures in its online database. Keep in mind that, like visually checking drugs, test kits aren’t a foolproof system. "Test kits are not proven to detect everything,” said Patil Armenian, who is associate professor of clinical emergency medicine and co-director of medical toxicology at UCSF Fresno. “I wouldn't recommend using those results to guide every decision."
The exception is fentanyl test strips, which Smith said are pretty reliable. Gomez agreed, with the caveat that fakes abound: Drug users should seek out the BTNX brand, which Dancesafe sells for $2.09 a strip. “We tested some ‘fentanyl test strips’ from China of various brands that I'm pretty sure were just paper,” Gomez said. “They didn't react even with pure fentanyl. I wouldn't use anything other than BTNX.”
Unfortunately, fentanyl testing strips are still considered drug paraphernalia in many states and aren’t widely available. NEXT Distro, a not-for-profit harm reduction agency, offers information on where to find and buy fentanyl test strips if you’re not sure how to get them in your area. There are exceptions to what you can test for fentanyl, too: It’s a good idea to turn down any street-bought opioid or benzo pills, said Armenian. That’s because you can’t easily test pills for fentanyl, which is commonly found in them.
Because of the ubiquity of fentanyl, it’s crucial to get familiar with naloxone, an opioid antagonist that can reverse narcotic overdose, which is also commonly referred to by one of its brand names, Narcan. “Everybody should have naloxone at home,” said Armenian. All major pharmacies, like CVS and Walgreens, carry naloxone over the counter. Prices range from $25 to $80, according to GoodRx, which offers coupons and price info for naloxone at a bevy of national chains, and it may be covered by a person’s health insurance either partially or in full. If you live in an area without access to naloxone, you can also get it mailed to your house and take free online training to learn to administer it via NEXT Distro.
How can I be safer about using, more generally, if I decide to dip back into it?
If you’re going to do drugs, approach it the way you would approach buying a used car and research the heck out of it first. Google the drug you plan to do, and learn about its interactions with any prescription medication you take or substances you might imbibe. “It’s been a year since any of us got to party, but spend time on Google and decide before you get high what drugs you will take,” Gomez said. “Googling the interactions is worth doing. It’s always easier to make good decisions ahead of time rather than in the moment.” You can sort trip reports by drug combination on Erowid.
“Over-research is acceptable when you’re fucking with your own neurochemistry. Recognize that, Oh, I shouldn't mix Xanax with alcohol,” Gomez said. “I’ve lost friends that way. Even cocaine and alcohol produces metabolites that are pretty unhealthy.”
Don’t buy drugs on the street or online if you can help it. Instead, get a referral from a friend or do some outreach to local groups—a full guide to more safely finding a dealer is here. Make a game plan. This may involve setting a budget or even just telling your friends you want to go slow, substance-wise. “Social accountability is important,” Shafir said. “If I was going out to a bar meeting with friends for the first time in a long time, maybe I’d tell my friends I’m only having two drinks, or maybe I only bring $10 to the bar.” Whatever substance you’re using: Don’t carry more than you can individually take safely, and don’t buy more while you’re out. Start with the smallest possible dose and see how you feel before potentially taking more. Make sure you stay hydrated, and, again, don’t drink too much alcohol.
Have someone to check in with. For B.M. Gardner, a 40-year-old mental health professional in New Orleans, having a trusted sober person to check in with was a “lifeline” during his time using intravenous drugs. “Everyone in drug culture should feel comfortable reaching out to someone when they need to,” said Gardner. (His name has been changed to prevent workplace retaliation.) Gomez recommended the harm reduction organization Zendo Project’s training for people who want to provide support to people using drugs.
Making sure you’re with or can reach someone for help is an immediate safety concern, as well. “Have people around that can call for help. If somebody gets sick, don’t be shy about calling 911,” said Gardner. “Getting help as soon as possible is going to be your best shot at the best outcome.”
When the time comes that we’re going to outdoor events again, Gomez pointed out that medics at festivals and concerts aren’t there to arrest you. Don’t hesitate to enlist their help, even if you’re not sure you need it. “It’s better to err on the side of going to the medical tent and having them tell you that you didn’t need to come in,” Gomez said.
Overall, according to Smith, harm reduction follows the same basic principles as the ones you hopefully already knew back when. “[The considerations] are the same,” he said. “If you’re buying drugs from people you don’t know, you should have a test kit, and have Narcan on hand.” Stay hydrated. Above all: Start small.
This story has been updated with added context about the possible sources of drugs laced with fentanyl.
Follow Missy Wilkinson on Twitter.