#11: Club Drugs
COMMUNITY VOICE: Brad Loekle | HEALTHCARE EXPERTS: Darien Sutton, MD; Perry Halkitis, PhD, MS, MPH | COMMUNITY REVIEWER: Eric Kutscher, MD
SHOW NOTES
Setting the scene
What are club drugs?
Simply put, substances used in the cluuuuurb.
But because it’s 2023, we’re tired, and don’t always have bandwidth to pick a cute outfit out, know that club drugs…don’t actually have to be used in the club.
A broader definition: drugs used to facilitate “chem sex,” or sexual behaviors/interactions that are heightened/enhanced by the use of a substance or substances.
OK but which drugs are club drugs?
Traditionally, these included substances like cocaine and ecstasy - uppers used by folks to stay awake at parties.
However, let’s be ~expansive~ in 2023 and define club drugs as anything that may elevate/heighten the experience of sex. Including alcohol - famously a drug, though legal! - and cannabis.
Why are you talking about club drugs on your queer little podcast?
There’s observational data out there suggesting that queer folks use substances with higher frequency than their cis/straight counterparts.
The minority stress theory is a useful framework for understanding this - arguing that the stress of showing up in the world as a queer person can lead to certain behaviors - including drug use.
There’s particular relevance here with queer sex, which can come with Big Feelings - stigma, resilience, pleasure, resistance. In this context, drugs are often pulled into the orbit.
It’s a prominent and normalized part of queer culture - think circuit parties, among other facets of queer life (remember, not a monolith. Like who truly knows what’s going on during the lesbian knitting club?)
Safer drug use: in the immortal words of Dua Lipa, “here are some rules, let’s count them”
Note: we – and our guests – are employing a harm reduction approach here. In other words, the goal is to help folks use drugs in a more informed/safer manner.
Rule 1: be thoughtful about acquisition
Whenever possible, find trusted/vetted sources from whom to purchase your drugs.
Buy in familiar territory – particularly, avoid transactions on the street, or anything else that may resemble a “Don't Do Drugs” video from the eighties.
Rules 2/3: use in familiar/safe territory with safe/familiar people
The ideal environment:
Somewhere physically safe (read: not at the top of a skyscraper without a guard rail) with people you know and trust.
Bonus points if there’s a designated sober person or “babysitter” to help problem solve anything that might come up.
Especially important when using a new substance!
Rule 4: avoid mixing drugs
Specifically uppers/downers – though they traditionally have “opposite” effects, these categories of drugs interact in unreliable ways and can introduce additional risk to the picture.
Consider talking to your primary care provider about any drug combinations you’re hoping to try – they can give you more tailored counseling around what to expect/look out for. We know, we know - easier said than done.
To avoid unintentionally mixing, consider using fentanyl test strips (they’re available on Amazon among other places) to ensure your cocaine isn’t laced with an opioid, which is unfortunately common these days.
Troubleshooting
Overdoses
Bottom line: if you’re concerned someone has overdosed, call 9-1-1 and get paramedics or EMTs in the room.
While waiting for help to arrive, you can place the dispatcher on speaker phone and receive directions/prompting on what to do.
We recognize that calling 9-1-1 isn’t an easy choice.
Police presence often arrives with medical assistance, and this opens the door for stigma, discrimination and violence. But there will be time for folks to leave the party space before police arrive.
It’s unlikely that you’ll get in legal trouble – unless the living room looks like something out of Boogie Nights. The focus – from ambulance all the way to the ER – is on stabilizing the person with the medical need, not on prosecuting them for using substances not permitted by the law.
Seizures
Do:
Put someone on their side so they don’t choke on their own vomit.
Consider using the jaw thrust technique to help someone keep their airway open.
Call 9-1-1.
Don’t: put your fingers in the person’s mouth.
Opioid overdose
You might expect to see this if someone is using heroin or pills like oxycodone/vicodin, but keep in mind that uppers are commonly laced with fentanyl. Think: that person who did a big bump of cocaine then got reaaaaal sleepy.
What to do:
If you have narcan (you can buy it over the counter), consider using it – it’s an easy-to-administer nose spray that will reverse the action of any opioid.
Call 9-1-1 even if the person who received it looks better; the narcan will wear off relatively quickly and the person may need more.
A little redux, substance-by-substance
GHB, or “G”
Can cause seizures – see above for details on what to do if you encounter this while using.
Be aware that simultaneous alcohol use will amplify the effects of GHB as both work as depressants – or, said otherwise, they slow down the nervous system.
Molly AKA ecstasy AKA MDMA
“Serotonin syndrome”
A syndrome which manifests as increased temperature, increased heart rate and confusion.
Most often seen when folks are also taking another drug that increased serotonin – like, for example anti-depressants in the “SSRI” category
Excess water consumption causing dilution of blood and low sodium
Which can cause confusion, lethargy, and in severe cases, seizures.
Make sure to swap out pure water with an electrolyte-based solution – big fans of Pedialyte and Electrolit.
Cocaine
Pay close attention to chest pain.
Particularly In those with a personal or family history of a heart condition.
And while drug use can be difficult to discuss with a medical provider, disclosing cocaine use will prompt a medical team to perform a more intensive workup for chest pain.
Be aware of drug-drug-interactions with cocaine
Adderall - another upper/stimulant - can "stack" with cocaine and amplify its effects. This can occur even if the subjective effects of adderall have worn off.
Simultaneous alcohol use – when cocaine and alcohol are in someone’s system together, they can form a substance caused cocaethylene, which can increase the health risks associated with either substance individually.
Poppers
When used at the same time as viagra, can cause significant drops in blood pressure – and with that, fainting – since both work on the body in very similar ways.
Be aware that while some effects of poppers can be short-lived, the blood-pressure-dropping effects can linger for a bit longer.
TRANSCRIPT
Brad: First of all, lots and lots of people do drugs. And in the gay community, there are both, you know, stereotypes of gays using a lot of drugs and realities of gays, especially gay men using a lot of different kinds of drugs. I myself have used drugs and many, many, many, many, many kinds of drugs in my life. And certainly know a lot of people who have. And I've experienced all the highs and lows of that figuratively and literally.
[QHP THEME MUSIC]
Gaby: Welcome to Queer Health Podcast.
Richard: QHP is a podcast about queer health topics for sexual and gender minority folks.
Sam: My name is Sam, I use he/him pronouns, and I'm a physician in training to be a primary care doctor.
Gaby: I'm Gaby, she/her pronouns, and same job title as Sam - as usual.
Richard: And I'm Richard Greene. I use he and him pronouns, and I'm the director of LGBTQ Clinical Services at Bellevue Hospital in New York City.
Gaby: And you're listening to Queer Health Pod Season two, episode one: Club Drugs.
[QHP THEME MUSIC ENDS]
Gaby: For the QHP super fans at home, you may have recognized that earlier voice at the top of the episode as Brad Loekle, who joined us for our first ever episode on our first ever season of this podcast. ,
Sam: Brad, who could forget him?
Brad: My name is Brad Loekle. I'm a standup comedian, a television writer, theatrical writer, columnist and large homosexual.
Sam: I hope that my homosexuality is never described as anything other than large
Gaby: Well, given that you host this podcast, I'm pretty sure you're manifesting that big gay energy just fine. Anyway, we loved hearing about what Brad put into one end of his body, so of course we asked him back to hear about the other things he's putting into the other end.
Richard: MAYBE putting into the other end. What we're trying to say is today's episode is about club drugs.
Gaby: Cocaine, ecstasy, ketamine, GHB, bundles of sage burned his incense during a cleansing spell. Is that just me for that last one?
Sam: Gaby, your horoscope is showing. But on this episode, we'll share information and strategies that will make using these drugs. If you choose to do so a little bit safer.
Gaby: We're also gonna touch upon how to take care of folks around you who may be using drugs as well as some red flags to be on the lookout for.
Richard: And as always, we’ll beg and plead that your affirming healthcare provider really actually does want to hear about which drugs you use, especially if it's this “sage" that Gaby's talking about that I haven't heard of yet.
Gaby: …you’re not a Wiccan, obviously.
Richard: I actually dabbled in Wicca in my twenties. Just FYI.
Gaby: Ooh. Well, before I circle back, to unpack that new piece of knowledge, if you've got a second right now, pause this podcast and subscribe to us on our streaming platforms at Spotify or Apple. Doing so makes me look good as the social media lady and also helps this information find a larger audience.
Sam: And this is the Daily. Just kidding. Don’t – don't sue us.
[TRANSITION MUSIC THAT IS NOT THE DAILY THEME SONG]
Gaby: Okay, so here's my question. What makes club drugs a queer health topic?
Richard: I think we should have Brad lead us off on that one.
Brad: Well, I mean, like it or not, they go hand in hand. They go limp wrist in limp wrist. And - I mean, again, let's, let's let the lesbians off the hook for this. This is mostly, we’re talking about gay male experience. There is a big difference when you go to, like, an all gay male nightclub versus when you go to all lesbian event so far as the drug and alcohol use and how it's being used and the responses to it. They're just – not to live in the binary, because obviously there are non-binary people who move within both those communities, but the fact of the matter is like a giant gay circuit party is predominantly people who would identify as gay male. And you know, the gay community that kind of circuity party community is drawn to club drugs
Gaby: All I'm saying is that Brad does not know what goes on in my queer lady's backgammon club. Just kidding. It's actually a knitting circle of one me. I digress. Let's bring on one of our healthcare experts to talk a little more about this connection between queerness and club
Halkitis: I'm Perry Halkitis. I am the Dean of the School of Public Health at Rutgers University. I'm also professor of biostats and urban global public health. And I run a center called the Center for Health Identity Behavior and Prevention Studies, which is a bio-behavioral research centers focused on, you know, sexual gender, minority health. All of my work for the last 25 years has really looked at the intersection of sexual behavior, mental health, burdens in the population and substance use and the extent to which a biological behavioral, social, and structural factors drive up, quote unquote risk behaviors in primarily in the population of gay men.
Sam: Drugs, risk behaviors, social and structural factors. Tell me more.
Richard: Traditionally “club drugs” included substances like cocaine and ecstasy, which were used by folks for their stimulant properties in order to stay awake for the parties.
Gaby: But in the year of our Lord 2023, the term club drugs can include a lot more than just uppers like coke and E.
Halkitis: In my perception, the term relates to drugs that are used in the population of LGBTQ people which facilitate sexual behavior – which are associated with the term "chem sex” – you know, sex under the influence of chemicals that heightens the sensation of sexual behavior, that disinhibits people and allows them to engage in certain kinds of behaviors and that, you know, sort of escalates, elevates, heightens the sensations associated with sex.
Richard: The good old S word.
Sam: Sensations.
Gaby: Sage.
Richard: Um, no. Sex.
Halkitis: I don't think the term "club drug" is appropriate anymore, because you know, it just assumed that people just use these drugs in clubs. And in fact, we know that people are using drugs like meth and ecstasy and K and G and others – molly – in their homes or at partner's homes or what have you. But now here's the more provocative thing that I want to put out there: which is, you know, why isn't alcohol, a club drug? Because alcohol is probably the drug that's used the most in our population of LGBTQ people. It is a drug that people often turn to, to facilitate sexual behavior to disinhibit themselves. So why is that not a club drug? Because it's a sanctioned drug? I'm saying that in a provocative way, because I would like the audience to start thinking about any kind of substance that people use in relation to their lives or their behaviors, which ultimately is very linked to partying and sexual behavior. So these are feel good party drugs, right? Alcohol and poppers, and meth and K and pot could be part of that mix.
Richard: The through line Dr. Halkitis is describing – and has studied for decades, by the way – is that how queer folks experience sex – the stigma, shame, resilience, pleasure, all of it – oftentimes pulls drugs, some sanctioned and some not so much into the orbit of the queer experience.
Sam: Whether that explanation is consistent with why you or your friends use club drugs. It's worth noting that there is population level data suggesting that queer folks use club drugs in higher frequencies than other identity groups. If you look at it, by sexual orientation.
Halkitis: If you look at the few epidemiological studies that are out there are coupled by the numerous behavioral studies, that are out there, there are certain substances that are used at higher rates but it's hard to really decipher like what exactly those patterns are. I will make a more global comment, which is that there is a reliance on substances that takes place among sexual and gender minority people that might be higher than in non-sexual and gender minority people.
Gaby: But let's be clear about something. This isn't about directionality or blaming an identity for a particular behavior. Rather, it's about acknowledging how our lived experiences, how existing in the world with certain identities, can impact or influence our actions, proclivities and behaviors. Which is basically much more elegantly described by this concept called the minority stress theory.
Halkitis: So minority stress theory, that's been postulated by several researchers, including Ilan Meyer and others, argues that when a person is burdened because of who they are, whether it be their sexual identity or their gender identity or their race, or, you know, their immigration status, their level of education, what have you, that those stressors created by society, create burdens. And those burdens, if not handled effectively – i.e. one is not resilient or has low levels of resilience, often leads to the risk behaviors, including substance use, as a means of coping with those stressors. There is a reliance on substances as a means of coping for some SGM [sic: sexual and gender minority] folks. I think it is normalized behavior in the SGM population. I think that context and social navigation and environments facilitate this. And I think there is a desire for a certain kind of sex that facilitates the use of this drug.
Sam: Certain kinds of sex. So, like, letting a feathered bow slowly fall from your shoulder, right?
Richard: Thanks for sharing your kink with us, Sam. But I think what he is talking about is how these massive expectations and experiences that make sex so emotionally loaded for people often end up pairing them with club drugs.
[TRANSITION MUSIC STARTS]
Gaby: Also, like, it’s drugs. Some people do them just for fun sometimes because of stigma, and sometimes because straight people just don't know what poppers are yet.
Sam: The image of khakis, boat, shoes and poppers is concerning to me
[TRANSITION MUSIC ENDS]
Gaby: So now that we've got you thinking about lacrosse bros doing poppers, we can safely move into less traumatic territory into a conversation on harm or risk reduction. Which is just another way of saying, lowering the chance that something bad or unexpected or undesired will happen when using drugs.
Richard: Here's how Brad approaches this:
Brad: I think it's better in my opinion, to just teach people to try to be more responsible and their irresponsible behaviors. You know what I mean? If everyone's going to speed when they, when there's no one else on the road and they know there's not a cop but we've all, you know, bred into our brains, culturally, the idea that speeding in the rain or in the snow is more dangerous. So I think risk mitigation to me should be the concern amongst, like gay club drugs and day partiers.
Sam: Risk mitigation, risk reduction, or in Brad's phrasing, potentially irresponsible things more responsibly done. All of these are a concern for our other expert guests today.
Dr. Darien: My name is Dr. Darien Sutton. I am an Emergency Medicine physician. My pronouns are he and him.
Gaby: Dr. Darien is an emergency medicine doctor, and he also goes by the same name, @doctordarien on Instagram, where he's actually kiiind of a celebrity. Whether online or in person, he spends a lot of his time talking about harm reduction.
Dr Darien: The idea of risk reduction is really important and I think flies over the heads of many people. But what we as doctors are really trying to do is simply advise. We know we're not going to change whether or not you choose to use something, but how can you use it in the safest way possible? And the way that I educate my patients about that is simply by being simple. And by that, I mean, picking one substance that you've decided to use and sticking to that. And understand that obviously each and every substance that people partake in comes with risk, but you increase your risks when you do “poly-pharmacy substance use,” which is introducing more than one drug into your system.
Sam: Brad rephrased that very bluntly.
Brad: Know who you're getting shit from because none of this is FDA approved. [laughs] So like a huge amount of cocaine in America right now is cut with fentanyl. And that's a huge problem for people who use cocaine. Because fentanyl, first of all, is going to get you addicted to something that's completely unrelated to the cocaine plans. And it's more likely to kill you in the short term than, than, you know, reasonably cut cocaine would.
Richard: As Brad alluded to many advocates argue that drugs should be FDA approved, screened, and made available in safe supply. But we'll put a pin in that conversation for now.
Gaby: And precisely because many of these drugs aren't regulated, Brad had some important advice about where you source your supplies.
Brad: First and foremost: don't buy drugs on the street literally or figuratively which is both a legal advice and medical advice. Anyone who has a legitimate purveyor of narcotics or illegal substances would not do transactions on a street corner. Like anything that looks like a, like a “Don't Do Drugs” video from the eighties. None of that. You should know who you're purchasing these things from. Because especially a lot of these things like ecstasy and cocaine in particular can be cut with a lot of stuff.
Gaby: This is the perfect time for me to plug fentanyl test strips. They're cheap, you can find 'em on Amazon and they're easy to use and they are gonna tell you if what you're using is cut with fentanyl.
Richard: So Brad's first rule, buy drugs in familiar or safe territory rule. Number two, use them in safe territory.
Brad: Know your environment. That's another big one when you're using any sort of substance and your environment includes the people in your environment. So the first time you do acid, you should be in a controlled – the first time you do any drug you should be in a controlled group. Anytime I've tried something new, I've never done it in an environment that I didn't think about its safety. So, you know, again, taking hits of acid while at the top of a skyscraper with no railing on the building would probably not be the best advice as opposed to like in a lovely backyard pools, surrounded by friends who, if you freak out, someone can say, "Hey, relax. You're just hallucinating because you took a hallucinogen."
Richard: Which brings us to rule number three, surround yourself with people you feel safe with.
Dr Darien: Any substance should never be your first time with someone new. That should never be your experience. I think that that's really the main, the main thing for me, the reason why is because I get so many patients who come in on late nights who have had experiences, unfortunately been exposed to violence and trauma that they were not planning on being exposed to, obviously, because they were partaking in a substance for the first time with someone that they did not know. So I'm not really concerned about the substance. I'm concerned about the person you're doing it with.
Richard: When we say people you feel safe with, we mean people who won't take advantage of you if you're intoxicated or who you trust to do something if something goes wrong.
Sam: And you can take that one step further and include a babysitter or a designated driver since one of the most common reasons for harm in club drug use is accidents that occur while people are intoxicated but aren't really related to the drugs themselves.
Gaby: Let's move into rule number four, which is when possible avoid mixing drug types.
Dr Darien: So common things that I'll see people use and I'll use the term uppers and downers to be as simple as possible. Sometimes people will use an upper and feel like they've gone to up, and then they'll try to combine it with a downer. I'll see patients that will use cocaine recreationally, and that is an upper, it is a stimulant and they may feel as though they're too high up in the air and so they want to get a downer. And they'll involve an opiate or a suppressant – that can be a choice of heroin or fentanyl – where they feel as though it relaxes them. But they may not realize that they're introducing more risk into them and into their health by combining these substances.
Gaby: And I just wanna say, you know, obviously if you're talking to your doctor, the hope is you're talking about the drugs you're using and you're able to get answers about what you can and can't mix. But the list of things that you can and can't mix generally for any individual human being is so long that it's super helpful when folks are asking us about specific combinations. Cuz I might cover like nine out of 10 hypothetical combinations in a general speech about mixing drugs, but I may not cover the one other combination that applies to you and your drug use. And so that is a way that if you're able to have that conversation with your physician or your provider, it can really help you make more informed decisions about what things to mix and to not mix.
Sam: One way to make sure you are not mixing unintentionally is to use drug testing.
Brad: They make tests that you can literally, you know, test the drug against it. Or you can break off some of the pill or take some powder or liquid and just put it in a little water and put the urine strip in and it'll test positive – in my experience, it will test positive or negative. So for things like cocaine right now that, you know, there's a, there's a new kind of epidemic amongst people who use cocaine in America. And it's really a fentanyl problem. It's not a cocaine problem. And it's fentanyl being in cocaine. So even if you really trust someone, you should still be testing what you get. If you're willing to spend two or three or four or $500 on a eight ball of cocaine or on a bag of pills or on a – you should be willing to spend, you know, five or $10 per test just to test that batch.
Gaby: I do wanna be clear really any drug tests are not definitive. They are not a guarantee of what you are taking. They are not a purity test.
Sam: But today we're in the business of harm reduction and drug tests. Even if they're imperfect are a step in that direction.
Dr Darien: And my personal perspective, is there any layer of risk reduction or mitigation is better than nothing?
[TRANSITION MUSIC]
Sam: With those risk reduction tools under our collective queer belt.
Gaby: Actually, I feel that belts are distinctly Butch.
Sam: I think we have different belt styles in mind, but I'm not gonna fight you on this Gaby. But my point is that: we wanna talk about what to do when something bad or unexpected goes down after using drugs, whatever your belt style is aside.
Gaby: We can start with the most obvious way that drug use can go wrong. Which is overdoses.
Brad: I'd say the truth is overdoses are kind of the easiest thing to intervene in. Because they tend to be dramatic. And, and they're definitely life or death, you know? I do think someone living should be the biggest concern. You know, I do think Rick surviving his overdose should be the biggest concern. Even if that means one person calls 9-1-1 and stays with the person, and everybody else leaves the party because it's going to take 20 minutes for the EMTs to get there anyway. So maybe the party should be over when Rick ODs. That should be the last call for the party.
Richard: Calling 9-1-1 can be a fraught choice, but as Brad pointed out, folks who wanna leave and may not feel safe around the police, will have time to leave before they arrive, but it's really essential to get the help that you need.
Brad: If the cops show up to your house and they, and they now have been invited in with the EMTs to your house and your entire place looks like, you know, the second half of Boogie Nights, and there's just drugs everywhere, and it looks like a Scarface party. The cops might have something to say about it. I can tell you I've, I've been with a lot of people in the emergency room who have OD-ed, and I've never seen any of them wake up with handcuffs on. If they just show up and somebody has done drugs and has a medical need, it's going to be a medical issue, not a police issue. And I think people do confuse that. I think people think that if you go to the hospital, when you're on drugs you're going to wake up with handcuffs on and the police are going to be like, “Why did you take acid? Why were you doing cocaine? Why –?” That's not how real life works.
Gaby: And if you are going to call an ambulance, here's what to expect.
Dr Darien: So call 9-1-1, and then check the person. are they breathing? Do they have a pulse and when you call 9-1-1, if you put it on speaker they will help direct you in what to do. And it will help take some of the pressure off of you. But again do not feel fearful if you're using a substance and we can go down and talk the legal repercussions. But honestly, for patients and my personal experience in New York and here in California is that that patient just gets brought to the hospital and then gets left there to be treated by the medical personnel. It's not something where the police wait around to figure out what you were using or who used it. No one's really asking those questions. The simple fact is that our goal is to get you to be back to life. So, hopefully people realize that like when you call 9-1-1, it's not going to be police showing up. Although they may be there if they're the closest. The goal is not to arrest you. The goal is to take you to the hospital and most patients get left there alone.
Richard: Police presence can be really harmful if you're a person of color or someone of another minoritized group. And we know that there's significant discrimination, so have a plan to get out if something goes wrong. But whoever has overdosed absolutely needs the first responders, whoever they might be.
Sam: Since we're talking about overdoses, let's get into some specific scenarios and what to do if you encounter them. First up is seizures, which can happen from overdoses, from drugs like G, Ketamine or more rarely, molly.
Dr Darien: Seizures are terrifying to watch. They're traumatic to see, and they're scary as hell. If you notice that they're having a seizure, put a pillow under their head. If you notice that they're biting their tongue, do not put your hands in their mouth. Not only might you lose a finger, but you might cause them to choke some more. Some tactics that I like to do with patients who are having seizures is a chin thrust. You can Google jaw thrust if you're curious about how to do this, but it's really helpful. And it helps people to prevent themselves from choking. And of course, before you do any of this call, 9-1-1.
Gaby: Where seizures can be a common side effect of too much GHB, drooling – and the choking that it can cause – are things to keep an eye out for when you're using ketamine.
Dr. Darien: It can cause salivation. Which many people don't think is a big deal, but if you feel disassociated and mildly sedated and you're salivating or drooling a lot, that can cause you to aspirate or choke. So make sure that you pay attention when you're using it and make sure that you pay attention to the dose. Because small increases in the amount that you're taking can have really drastic effects on the body.
Sam: Let's move on now to ecstasy or molly.
Dr. Darien: I had a patient who was a babysitter and come in with symptoms of increased heart rate confusion, and a syndrome called serotonin syndrome. And so molly or ecstasy can basically hit these receptors that cause inappropriate release of serotonin, which can have really dangerous effects. And in that case, the babysitter was eating what they thought was candy and it ended up being ecstasy. And they overdosed on it and required an admission to the hospital.
Gaby: This serotonin syndrome that Dr. Darien describes can happen if you're taking too much Molly on its own. But it can also occur if Molly is taken by someone who is on other medications with effects on serotonin, like certain antidepressants and even some uncommonly used antibiotics.
Richard: I do wanna make the point that if you're drinking a lot of alcohol, if you're using other recreational drugs, you might be sweating and you might need to drink some water, but drinking too much water can dilute the electrolytes in your blood to dangerously low levels because you're drinking faster than your kidneys can put the water out. Which can result in seizures or even brain damage.
Sam: So please, if you feel like someone is going for their fifth, sixth, seventh glass of water at the bar, and you know, they're on molly or ecstasy, please make sure you take the water out of their hand and give them something like Gatorade, Powerade, or Pedialyte – something with salt and electrolytes in it. So they're not just diluting what's in their blood.
Gaby: On a side note, it does feel really good to be using the word “electrolyte” earnestly, because Gwyneth Paltrow has really taken that from me.
Richard: But I love Gwyneth.
Sam: DM us for our deeply felt multidimensional responses to Goop.
Gaby: Actually, don’t, because I'm manning the DMs and this is a emotionally fraught conversation for me.
Richard: When it comes to overdoses from opioids like fentanyl, heroin, or pills like Percocet and Vicodin, the thing to focus on is people's breathing rate. People who have taken too much of an opioid will breathe much more slowly, slowly enough that they may not be able to get enough oxygen to their brain.
Gaby: This is a fantastic time for me to mention Narcan kits. Narcan is a nose spray that you can get for free over the counter at a pharmacy. It's super easy to use and it will directly reverse the action of any opioid. So it's really useful in the overdose of things like fentanyl, morphine, heroin, or Vicodin. And it really is something that, because it's so easy to use and so effective, should be around when any drug is being used, especially given the fact that so many drugs these days are being laced with things like fentanyl.
Sam: Right. That person napping after they did a big bump of cocaine has ingested something other than just cocaine. If you use Narcan with someone and it looks like they've recovered, that's awesome. But they still need to go to the nearest emergency room immediately because that Narcan can wear off and you can be back to exactly where you started without any Narcan to use.
Richard: We've just highlighted two specific scenarios, seizures and slow breathing from things like fentanyl. But there are a lot of times when quote, too many drugs, end quote, doesn't fit a clear cut picture or set of symptoms. All you're seeing is someone who's really intoxicated. Dr. Darien has some wisdom on what to do in those scenarios too.
Dr Darien: I think that zone is what I call that observational zone. As a friend, the best you can do is observe and simply wait. You can talk to them switch their drink out, give them some water with a lime in it. You know, these are simple mechanisms that we do for all of our friends. But unfortunately, when someone is not well and they have capacity, meaning they understand their decisions and they can say yes to no, and they clearly get it, then I think that you should just observe. If you feel as though they're losing their capacity, and by that I mean, they don't understand what's going on around them and they can't make their own decisions and their own valid thought process – that’s concerning for me. And so then that's when I go, “Okay. We need help. This patient does not have capacity and I need to call 9-1-1 because I'm concerned that they may hurt themselves.”
Gaby: And while you're waiting for help, know that there is stuff you can do. For example, that time when Brad was in a room full of people who had accidentally snorted a ketamine thinking it was cocaine.
Brad: One girl was 90 pounds and dragged herself into the bathroom. This sweet young girl who I had never met before. And puked so hard that she knocked the caps out of her teeth and didn't realize it and flushed them. And she was an adult film star and she had a shoot the next day. So now she also had no front teeth. So that was now a work problem. Two people in the room stopped breathing twice and I revived them. And they basically stopped breathing because they were so ketamined out they exhaled and their body was forgetting to inhale. Their body was kind of so relaxed and so paralyzed by the anesthesia they had just snorted that they were forgetting to breath. And so I literally had to just, like, force them to remember to breathe. You know, so moments like that are very dramatic and you can intervene.
Richard: You can totally intervene, but so can trained medical professionals. So if someone's not responding or they've lost control over their body, or they need their front teeth for that film shoot tomorrow, please consider calling 9-1-1.
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Gaby: Because here's one thing that no active bystander is gonna do, impromptu cosmetic dentistry
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Brad: So mixing and not mixing is the big concern for me. And in my opinion, there's only a couple that really can't be mixed or that are highly, highly dangerous, even in singular dose.
Richard: What are those very dangerous combinations or the highly dangerous ones alone?
Gaby: Highest on our list is G H B or gamma hydroxybutyrate and alcohol.
Brad: There's a reason GHB tastes like jet fuel and a burned Barbie doll is because it's a really harsh chemical to just be ingesting into your body.
Gaby: The more biological take on GHB is that it tells receptors in the brain whose job it is to slow down to do just that, to slow down, and alcohol also works on these receptors, so you're getting double receptor stimulation, which normally double stimulation isn't the worst thing, but… [laughter]
Richard: So in combination, they can really pump the brakes on very important functions in the brain, like breathing.
Brad: GHB really doesn't mix well with most things, including itself. GHB absolutely cannot be mixed with alcohol. I have seen people G out, which is truly just an overdose – gay men don't like to use the word overdose, it seems, for most thing, but G-ing out is overdosing. Any amount of alcohol with G can trigger a G overdose. And G I've just also found to be really inconsistent. I've seen people who use G frequently and successfully so far as they don't have any problems. And then they get a bad batch, or they get a stronger batch or a weaker batch. And so these are people who are already using G in a way that they're like setting timers on their phones. They're measuring out to the milliliter. They're being as responsible as one could be for, and it more oftentimes than not has, has negative effects. I've definitely watched a lot of people die on G and I've watched a lot of people G out. I've been bitten by a lot of people accidentally who are in the middle of a G convulsion as you're trying to kind of keep them from hitting their head against the ground profusely.
Sam: In addition to the seizures that can accompany a G overdose. Dr. Darien brought up its effect on how fast you're breathing,
Dr Darien: Most of the common problems with GHB come because people mix them with other things. And so I honestly would say, you have to be careful with anything and everything. Because it. can sedate you very deeply and it can cause respiratory depression, AKA your breathing rate will decrease to a rate that's not accommodating to your life and your body. And so that can cause death. And so GHB especially avoid anything that is a downer.
Sam: Other downers we wanted to mention are alcohol and benzos and opioids.
Gaby: Benzos include things like Xanax and Klonopin, and opioids include things like pills, Percocet, Oxy, or also substances, fentanyl and heroin.
Richard: All of those drugs can slow your breathing rate, and in combination they can slow it even more, which is the most common reason that someone might die of an overdose.
Gaby: Now on the other side of downers are uppers.
Sam: Please welcome to the stage a cocaine. Should I say that faster? Please welcome to the stage cocaine.
Richard: Stop grinding your teeth. [laughter]
Dr Darien: Those who use cocaine I would say understand your risk factors. If you are older, if you have a strong family history of cardiac disease, or if you yourself are overweight or have a history of a prior cardiac issue like a heart attack or a stroke. These are reasons why you. should really, really take caution with that upper, because it can increase your risk of those diseases and unfortunately not only cause death, but cause lifelong harm, which is something that we're trying to prevent.
Richard: Dr. Darien also pointed out that even though cocaine isn't a downer, you can still overdose on it.
Dr Darien: So the common effects of a stimulant like cocaine and include increased heart rate, increased blood pressure, and so the effects that we look at is if you're having chest pain – pay attention to it. It's not something that's just anxiety. Get help as soon as possible. If you have changes in sensation, weakness, a headache or dizziness, don't talk it up to just saying it's my mind. I'm paranoid. It might be a real medical problem. And be honest, once you get to that doctor. Because we really, really take to heart when someone says they've been using something like cocaine and they have chest pain, our workup is usually a little bit more intensive and it can help you.
Gaby: And look, I acknowledge that this honesty is much easier to preach than practice, but that honesty point really does bear repeating. Letting your healthcare providers know if you have cocaine in your system may mean guiding you towards a more tailored workup. And it can also mean avoiding medications that could cause more harm. And it's especially important to know if there are multiple uppers in your system as combining them can actually increase their side effects.
Dr Darien: Adderall is something that people use very commonly it is a stimulant. And unfortunately, if you have that in your system, it can last for a relatively longer time than you think. And by that, I mean, it can be in your system when you don't feel the effects. And if you use that in combination with other stimulants, like cocaine, you can potentiate the negative effects of cocaine that can cause permanent harm or injury. So those are reasons why you should be careful with that.
Sam: When using cocaine, avoid stacking the effects with other stimulant drugs. Which is relatively straightforward. But less straightforward, is mixing uppers with downers, specifically cocaine and alcohol.
Dr Darien: As scientists, we understand cocaine and alcohol creates a substance called cocaethanol, which can last in your system for even longer. And unfortunately, potentiate those risks that you see with cocaine, more so in that patient than the person who chose one substance. You're spending the effort and the time and trying to get that high. And it's not doing anything in, terms of giving you more effect, it's simply leaving cocaine in your system longer so that when you're not even feeling the stimulant, it's still affecting your body negatively.
Sam: So mixing downers and mixing uppers is maybe a little bit, you know, college 101 level for some folks.
Gaby: Okay, so let's move into 201 and talk about some other more advanced combos that may also not mix.
Brad: Like I guarantee you when they made Viagra, they didn't test it against poppers. We found out that Viagra and poppers can kill you because gay men ended up in the ER, having just done Viagra and poppers and were perfectly healthy and suddenly had a giant blood pressure drop.
Dr Darien: They're actually the same mechanism. So it can dangerously drop your blood pressure and cause you to faint, hit your head. And so you really gotta be careful if you're using these two medications together and I know that they are often used together.
Gaby: So we don't have data on how long after using poppers it would be safe to use Viagra, just keep in mind that you may not feel the side effects of a drug like poppers, but it still could be active in your system.
Richard: I mean, and we can also counsel people, you know, many people have used Viagra and poppers together. It's not that every time you do that, it's instantly fatal. Some people have more experience than others, but you take these things slowly and understand what the consequences could be. So you can take precautions against them.
Sam: Brad was very clear that he has often seen sleeping drugs, mixed in folks who are coming down from things like cocaine or ecstasy, cuz the high is over, but they still feel too stimulated to sleep.
Brad: So Ambien is a very strong drug and all, and all of those kinds of sleep, all of those kind of forced sleep. I consider them kind of anesthesia sleep pills. They’re really kind of forcing you into an anesthetic form of sleep. When you start mixing them with varying forms of narcotics, of varying quantities, you see, in, in my circle of friends, you've seen it in a lot of the overdoses and a lot of the comas and a lot of the unexpected deaths. And I think because it's a prescribed drug, once your doctor decides you should be on that drug, you know, you're just like, oh, I take this the same way. I take blood pressure medication in the same way I take, you know, my migraine medication or something like that. And they are very different and they are very strong.
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Richard: Okay too much to summarize. So please just rewind if you wanna hear it again, but in short for the safest drug experience…
Gaby: Don't mix.
Sam: Don't overdose. Remember to get medical attention, if it's needed or use a narcan kit
Gaby: Don't chug excessive amounts of water. Get electrolytes in there, but do stay hydrated.
Sam: And hashtag goop.
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Richard: Before we wrap up, which we promise we're gonna do soon, we just wanna make one last point about why we think club drugs is an important topic for queer folks.
Gaby: Being queer can be fucking stressful.
Sam: And drugs can relieve stress.
Richard: Many folks just use drugs for fun, full stop, but everyone we spoke to made it clear that a little self-reflection on what drugs are doing for you and your mental health can hurt.
Sam: Here's Brad.
Brad: So yes, drugs are not healthy for you. But yeah, be honest with your doctor and how honest you are with your doctor. In my opinion will always tell you how much you can trust your doctor by the response.
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Richard: QHP is a power sharing podcast that puts community stories and conversation with healthcare expertise to expand autonomy for sexual and gender minority folks.
Sam: Thank you to our community, voice Brad Loekle, and our healthcare experts. Perry Halkitis and Dr. Darien Sutton. We would also like to thank our community reviewer, who helped do these interviews and come up with the design for this episode, Eric Kutcher.
Gaby: For more information on this episode's topic, or other episodes and other topics, check out our website, www.queerhealthpod.com.
Richard: Help others find this information by leaving a review in subscribing on Spotify or Apple.
Sam: And despite that I've been called an awkward dad on social media, follow us @QueerHealthPod on both Twitter and Instagram.
Gaby: I think it's more like confused grandpa.
Sam: Don't kink shame me again, please.
Gaby: And thank you to Lonnie Ginsburg who composed our theme music.
Richard: As always, opinions in this podcast are our own and do not represent the opinions of any of our affiliated institutions. And even though we're doctors do not use this podcast alone as medical advice instead, please consult with your own healthcare provider.
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Gaby: Wait, khakis are straight. I have a lot of internal reflection to do.
Richard: On cis men khakis straight, especially if they have pleats.
Gaby: Oh, God.
Richard: Former gap girl here.
Gaby: There's a whole story in here about how I auditioned to be the Gap baby, but that's for another time.
Sam: scoff.
Gaby: It's true.