Harm Reduction for Stimulants

[Nicaine]

Part 1 - Prescription Medications for Stimulant Harm Reduction

Since these prescription drugs are quite potent, often they will not be used unless there's a need. However, some of them can safely be taken in lower doses as a protective measure. Some of them can and will interfere with the stimulant "high" in various ways.

Everything discussed herein is based on SWIM's personal experience and research, and should never substitute for medical advice. SWIM cannot advise where/how to acquire any of the medications listed here, but he recommends consulting directly with your physician and being honest about your drug use and desire to acquire medication(s) for the purpose of harm reduction.

Unless advised directly by a physician, SWIM suggests a starting "harm reduction dosage" of exactly 50% (half) of the lowest doctor-prescribed dose for any given medication. Such a dosage will tend to have some positive effects, while minimizing potential negatives. This is especially important before you know how a drug will affect you.

Beta Blockers -- example of generic drug names are propranolol (http://www.rxlist.com/cgi/generic/propran.htm) and atenolol (http://www.rxlist.com/cgi/generic/atenolol.htm). This class of medication blocks adrenaline from affecting certain types of receptors in the body (beta-adrenergic), but not other types. Its most obvious effect is to slow the heartbeat down, and it also lowers blood pressure when used under normal conditions.

This may sound really useful in conjunction with stimulants, but there's a risk involved. Because it only blocks a certain type of adrenaline receptor, the effects of stimulants on the other type (alpha-adrenergic) can be increased. This often results in vasoconstriction (constricted blood vessels) and paradoxically *increased* blood pressure. For this reason, beta blockers should normally be used only with extreme caution while high on cocaine or amphetamines. Blood pressure should be monitored! They may be used in combination with a vasodilating drug such as enalapril maleate (http://www.rxlist.com/cgi/generic/enalap.htm), but it usually isn't advised. Rapid heart rate is usually not dangerous, therefore you should generally avoid beta blockers while on coke or speed.

One exception is a beta blocker called labetalol (http://www.rxlist.com/cgi/generic2/labet.htm), which has both alpha- and beta-adrenergic blocking properties. This drug has been used in emergency cardiac conditions involving cocaine (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8124849&dopt=Abstract) and/or amphetamines. It will definitely "kill the high" a lot, and should not be used unless there's a heart problem occurring.

Verapamil - also known as COVERA-HS, CALAN, ISOPTIN, and VERELAN. Verapamil is a "calcium channel blocker" that dilates both cardiac and peripheral blood vessels, resulting in a drop in blood pressure. It can also result in warming/flushing of the skin. Verapamil is used to treat high blood pressure, angina (heart pain) and certain arrythmias. Thus, it's a very useful medication for stimulant harm reduction, and one of the safer ones as well. The side effect profile is excellent compared to most other cardiac drugs.

Here are some links to further info:

http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a684030.html

http://www.patient.co.uk/leaflets/verapamil.htm

http://www.rxlist.com/cgi/generic/verapsr_pi.htm

SWIM recommends stimulant users acquire and have some verapamil on standby, for use if (A) blood pressure gets too high, (B) the heart starts beating irregularly, or (C) chest pain is encountered.

Benzodiazepines - Valium (http://www.rxlist.com/cgi/generic/diazepam.htm), Ativan (http://www.rxlist.com/cgi/generic/loraz.htm), Klonopin (http://www.rxlist.com/cgi/generic/clonaz.htm), Xanax (http://www.rxlist.com/cgi/generic/alpraz.htm) and other drugs in this family. These are sedatives that can help "bring down" a person if they get agitated or anxious or "too high" on stimulants.

Every stimulant user should probably have these around in case of emergency. Xanax (alprazolam) is probably the fastest-acting, thus best for emergencies. However, it can also be one of the most addictive of the benzos. Ativan (lorazepam) is another excellent choice, as is Klonopin (clonazepam). The latter has a long half life and tends to be one of the least addictive.

Caution should be used with benzodiazepines, as they are highly addictive. However, there's really no substitute. Due to brain biochemistry, the benzo will always "win" if given along with a stimulant, helping to bring the user down.

Flonase (http://www.rxlist.com/cgi/generic/flutic_cp.htm), Beconase AQ (http://www.rxlist.com/cgi/generic/beclo1.htm) - These drugs come in the form of nasal sprays and are primarily for cocaine users who insufflate (snort) their drug of choice. This may of course also be applicable to amphetamines and such. Steroidal nasal sprays decrease nasal congestion over time, and are a much better choice than 12-hour or 24-hour over-the-counter nasal sprays, which can cause severe problems in combination with cocaine use (including profuse bleeding, severe rebound congestion and accelerated tissue death in the nose). Regular cocaine users should strongly consider getting one of these drugs prescribed.

Part 2 - Food and Fluid Intake

Proper stimulant harm reduction involves (A) constant/steady intake of fluids, but not insane or outrageous levels of intake. Water or diet soft drinks are preferred over sugary soft drinks which may rot the teeth. (B) Easy-to-take high protein/carbohydrate foods such as chocolate milk, yoghurt, plain deli luncheon meats, protein bars and meal replacement shakes. Bananas can be eaten pretty easily. Simple carbs are fine for quick energy (i.e. corn syrup, sugars), as complex carbs/fibers will be difficult to choke down for most people who are high on stimulants. Remember that energy has to come from somewhere. If it isn't being generously supplied during stimulant use, it's being depleted from muscle tissue and fat stores. If one's body fat index is low, they are literally wasting away as the body digests muscle tissue for energy.

Emergency Electrolyte Balancing -- note that Gatorade does NOT contain the right balance of fluids/electrolytes to resupply your body if you're dehydrated from sweating or have been drinking large amounts of water or other "plain" fluids all night. If you don't have any electrolyte tablets available (you should get some!), consume the following: (1) 1/4 banana for Potassium, (2) ~50mg Magnesium (possibly from multivitamin), (3) 1/8 teaspoon salt for sodium and chloride, and (4) Yogurt or milk for calcium. If possible, add sources for vitamin C and Zinc. This combination will at least keep you from keeling over or dying if you've been sweating out electrolytes all night, and may help prevent painful muscle cramps.

(To Be Continued...)

[toe]

Reduced-sodium V-8. (That's mixed vegetable juice, for the international crew).


Apologies. Will return to complete sentences as soon as capable.

[Laudaphun]

First off, this is a great thread and SWIM thinks it should be stickied. After all, safety is our #1 concern right? Well, some of us anyways. A question SWIM has regarding the original post is that it was stated that (alprazolam) is probably the fastest-acting, thus best for emergencies. , however would it be fair to say that temazepam would be a bit more effective? While temazepam is not nearly as abundant for most as alprazolam would likely be, if SWIM is in a situation where she has an intense panic reaction whether it be to a drug, or more likely just a life situation, she goes for the temazepam everytime. Alprazolam would be her #2 choice, but for this simple reason, and even though they are technically prescribed as sleeping pills, SWIM keeps some temazepam with her at all times. SWIM's emergency kit that goes with her everywhere consists of methylphenidate, clonazepam, alprazolam, temazepam. Sorry, not trying to argue, just giving SWIM's opinion.

Anyways, how do people feel about the safety of benzos (at therapeutic doses) along with a stimulant like methylphenidate on a regular basis or semi-regular basis. For some reason SWIM always tried to wait until methylphenidate had worn off before consuming any benzo except in emergency situations. But for example, SWIM works in a laboratory sometimes which is fairly crowded. This creates panic in SWIM, eventually one day SWIM broke down and consumed a 1mg clonazepam tablet before going into the laboratory, while being under the influence of methylphenidate at the same time. Now before you say anything about safety and taking a benzo before going into a lab, SWIM is very tolerant of benzos and 1mg clonazepam is a small dose for SWIM. It does not make him a saftey risk.

SWIM can't find anything in pharmacology texts stating that there is any kind of interaction, but is this healthy? SWIM does not take alprazolam or temazepam while under the effects of methylphenidate unless emergency, which has not happened yet. Methylphenidate dosages are 10mg as needed (typically per 4-5 hours). Is it safe to consume benzos at the same time as stimulants like methylphenidate? Obviously it would have to be a small enough dose so that it wouldn't cancel out the methylphenidate, but large enough that it deals with the anxiety/panic. SWIM sticks with clonazepam as it seems the mildest of the benzos SWIM regularly consumes and 1mg clonazepam seems to have a positive effect along side of 10mg methylphenidate when necessary. But is this a health risk? Opposing forces.

Keep in mind that SWIM's use of stimulants are strictly at prescribed doses and for therapeutical reasons. As a matter of fact, SWIM does not particularly like stimulants in a recreational context... However SWIM does find stimulants such as methylphenidate very useful in treating whatever it is that is wrong with SWIM, ADD or whatnot. SWIM has never felt real comfortable about the use of stimulants, but is becoming more and more convinced that when used properly, under the care of a dr. they are safer and more useful than she'd previously given them credit for. SWIM does not use benzos to "come down" from stimulant use as there is no "come down" to come down from... Her focus just simpily begins to drift.

[jazzmetalguitar]

A great start, other than the fact that SWIM would never call use of benzos for a come-down "harm reduction" unless amphetamine psychosis has set it. Otherwise, SWIM feels it could potentiate the already inevitable rebound of the dopaminergic system. For example, without benzos, SWIM's body once rebounded much too hard and sent him into a hypoxic attack (lack of oxygen in the blood; explained likely by counteractive breathing retardation and vasoconstriction while the body's system was attempting to reset to normal).