Mic

Heroin Addicts Are Turning to Tumblr to Tell Their Stories — And Save Lives

Originally published in Mic.

“One and done is the rule for using needles,” Nicole*, an 18-year-old from Long Island, New York, writes on her Tumblr, nicolethedopefiendqueen. “After you use it once, dispose of it (capped, in a sharps or other container); you really shouldn’t be reusing needles if you can help it. A fresh, new needle is always better than a used one, even if it’s been sterilized.”

Nicole is an active heroin user. In an email interview, she said she began using at 14 after coming across her terminally ill father’s OxyContin prescription, which eventually evolved into heroin use. On her Tumblr, she posts selfies and re-blogs moody screengrabs from drug movies like Trainspotting, as well as close-up shots of spoons, lighters and syringes.

But to hear Nicole tell it, she doesn’t just use Tumblr as a platform for blogging about her heroin use. She also teaches other users how to do heroin safely. Her blog contains information about what to do if an overdose occurs, as well as how to administer Narcan (naloxone), an emergency antidote to treat opiate overdose.

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“I decided that if I’m going to have a drug addiction blog with lots of followers, I must spread harm reduction information, because addicts deserve to be healthy and to live,” Nicole said in an email interview. “I advocate for safe intravenous drug use, especially to help prevent infection and overdoses.”

Heroin addiction is a rapidly growing epidemic in the United States. The Harm Reduction Coalition reports that overdose is the leading cause of preventable accidental death in the United States, second only to car accidents. Since 2000, opiate overdoses have increased by 200%, in large part as a result of an increase of pain medication prescription, the Centers for Disease Control and Prevention reports. Because pills and heroin are sold on the black market, opiate use can be difficult to track, but a 2014 report estimates there are 1.5 million “chronic” heroin users in the United States.

Nicole’s blog is one of many on Tumblr that track the lives of regular opiate users. Many of such blogs’ posts feature the hashtag #nodsquad, a community that curates images of drug paraphernalia as well as information and resources promoting safe drug use.

Such blogs are based on the principles of harm reduction, which aims to reduce harm associated with drug use, such as overdose and spread of diseases like hepatitis C or HIV, through counseling, opiate substitution programs like methadone and safer injection facilities, or legal, supervised injection facilities where people can use heroin under medical supervision. (There are currently no supervised injection sites in the United States, but some cities and states like New York have toyed with the idea of introducing them.)

As Nicole explains it, “harm reduction is about reducing the damage and harm done from using. It’s not about stopping use, it’s about safety, which is the realistic approach to saving addicts in this epidemic.”

It’s a strategy distinct from abstinence-only programs such as traditional 12-step recovery methods, as harm reduction psychotherapist Eddie Einbinder said in a phone interview. “Harm reduction is not anti-abstinence,” Einbinder stressed. “Harm reduction is pro-choice.”

Susan E. Collins, co-director of the Harm Reduction Research and Treatment Center, thinks Tumblr blogs like Nicole’s can help to reduce harm caused by heroin use.

“[Nicole] is a person who appears to really care about her community, and is trying to help people use safer,” Collins said in a phone interview. “She is trying to reduce harm, and is being honest about where she’s at and her recovery. Personally, I think all of that is really admirable.”

Social media has created a space that didn’t previously exist for active users to connect with others and share information about how to use drugs safely, such as how to sterilize a needleafter use.

“A core concept of harm reduction is meeting people where they are, and I feel like most people don’t spend their spare time reading up on harm reduction techniques. But people spend time on social media like Tumblr,” Caroline, who keeps her own harm reduction blog, fuckyeah-harmreduction, told Mic in an email.

“Having a resource for harm reduction information on a platform that people are already using is a great idea.”

Caroline is not a user, but she became involved in the movement through a harm reduction organization she volunteers at in Washington, D.C., most often doing needle exchange or distributing safer sex supplies.

That said, some of the information being shared on Tumblr, such as user videos on how to shoot up safely, can be shocking to watch for those unfamiliar with intravenous drug use. Such videos, as well as artily lit images of spoons and stashes, has prompted debate as to whether such blogs glamorize drug use. It’s also worth noting that some users visit the blogs as a way to find drugs, if asks from users looking to score in a new town or city are any indication.

“Could it glamorize the use? I think yes,” Einbinder said in a phone interview. “It is hard to create a completely objective vision when you’re creating different forms of reality.”

Other professionals agree that the Tumblr community has potential for both help and harm.

“On the one hand, users are often the experts of their experiences and their own needs. If a user is generating content which is informed, safe, promotes hygiene, and teaches people how to reduce risks, then it can be powerful and helpful in a way that resonates with other users,” Sheila Vakharia, a coordinator of a substance abuse counseling concentration for students at Long Island University, Brooklyn, said via email interview.

“However, if user-generated content is full of people doing things in risky, unhygienic ways or if they are sharing false, mixed, or un-researched information, it can be just as harmful as any other problematic content on the web.”

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The blogs also raise the question as to whether Tumblr has any obligation to monitor content that promotes drug use on the platform.  (Mic has reached out to Tumblr for comment, and have not received a response at the time of publication.)

“I don’t necessarily think that platforms have a responsibility to monitor drug use content because it seems like a slippery slope,” Vakharia said. “I also understand that sales or advertisements of illicit drugs are in violation of laws. However, instructional videos from the health professions show doctors/nurses injecting patients all the time. Should a video of a person doing it to themselves be censored because the vial is filled with a substance that we think is illegal?”

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The Tough Choice Pregnant Women With Depression Have to Make

I wrote a new article for Mic. Image Mic/Getty.

Amy* is a blogger and teacher who lives in Ohio. She was also diagnosed with bipolar disorder in 2003. Since her diagnosis, she has become the mother of three children.

“[During] my second pregnancy I didn’t really have any problems, but when I got pregnant the third time … it wasn’t planned, [and] I was on Lamictal,” she told Mic. Lamictal is an anticonvulsant often used to treat epilepsy which has proven effective in treating bipolar.

During the first trimester of her third pregnancy, Amy was told to go off her medication. “Everyone [was] like, ‘Oh if you stay on it they’ll be hurt for life!'” she told Mic. She looked up Lamictal and found out it was a Category C drug, meaning the FDA determined that animal reproduction studies “have shown an adverse effect on the fetus,” causing potential health risks for pregnant women.

Amy wanted to stop taking the drug, but she wasn’t able to get in touch with her doctors. “My mood pretty much just plummeted,” she told Mic. Three weeks later and still in a state of despair, she finally got in touch with her psychiatrist’s office. “They said, ‘Well, you shouldn’t have gone off of that,'” she recounted, with palpable frustration.

Later in her pregnancy, Amy said she struggled with some of the more severe symptoms of her mental illness. “I was doing a lot of self injury, cutting,” she told Mic. After being turned away from one mental health facility, she ended up in the medical side of a psychiatric ward. “I still wasn’t good, but I was more stable,” she said.

Pregnant women living with mental illness face monumental struggles. According to the World Health Organization, approximately 10% of pregnant women experience a mental disorder during pregnancy, primarily depression. (In developing countries, that number is higher: about 15.6%.) For Amy and other mothers who fall in this category, pregnancy isn’t a picture-perfect experience of satiating ice cream cravings and emitting a radiant glow.

Although the symptoms of postpartum depression are well-understood, as the New York Times reported in May, “far less recognized is an equally troubling condition: antenatal depression, or depression suffered during pregnancy.” In addition to depression, researchers have found that 5 to 16% of women struggle with an anxiety disorder during their pregnancy.

Traditionally, many doctors have warned against patients taking antidepressants while pregnant. But the truth about whether it’s OK to take such medication during pregnancy is more complicated than we think. Pregnant women with mental illnesses must make critical decisions about treatment — not just for their own health but for their baby’s.

“I took fluoxetine for the whole pregnancy,” Jess*, a mom blogger living in New Zealand who has been diagnosed with panic disorder, told Mic. “I was very concerned about it and was willing to stop taking [the meds], but at the same time, the risks of me becoming extremely unwell were far too high. You need to weigh the risks and benefits.” Jess’ daughter was born healthy in 2013.

rappling with stigma: Women struggling with mental illness often experience extreme guilt and fear if they choose to take a medication during their pregnancy. And unfortunately, there aren’t many reproductive psychiatrists to help them make decisions about their treatment.

“It’s challenging because there are a lot of psychiatrists who are very uncomfortable treating pregnant patients, just because there isn’t a lot of training on that. And then there’s a lot of [obstetricians] who aren’t as comfortable treating mental health issues,” Dr. Anna Glezer, a psychiatrist in San Francisco who specializes in reproductive psychiatry, told Mic.

Glazer told Mic that the answer to whether a woman should take medication during pregnancy largely depends on the medication and the woman taking it. “I think it will be really hard for anyone to say that a particular medication, treatment, supplement, anything, is ‘absolutely safe’ in pregnancy. But there are definitely some that are safer than others,” she said.

Some medications, such as the selective serotonin reuptake inhibitor (SSRI) antidepressant Paxil, are shown to cause harm to a fetus. (That said, other SSRIs, such as Prozac and Celexa, are generally considered to be OK to take during pregnancy.) Other types of antidepressants, such as tricyclic antidepressants like Tofranil and serotonin-norepinephrine reuptake inhibitors like Cymbalta, have been determined to not have any serious effects on a fetus and can be safely used during pregnancy.

Yet, as Glezer explained, deciding which meds to take during pregnancy isn’t as simple as finding out what’s OK and what isn’t via a Google search. “I would say that apart from a couple of select medications, I don’t say that you absolutely can’t be on something. Otherwise, it’s absolutely a risk-benefit [analysis],” Glezer said.

This decision-making process is more complicated than people might think. In some instances, the mental illness itself poses more risks to a fetus’s health than the medication the mother might be taking.

“Depression in and of itself has consequences during pregnancy,” Glezer told Mic, citing increased risk of self-harm, as well as less serious conditions like sleep loss, as examples. “Furthermore, if you’re depressed and unmotivated while pregnant, you might not have the energy to do some of the things your doctors are recommending. Then there’s the illness of depression itself, and studies have found that[‘s] associated with things like smaller babies [low birth weight] or preterm deliveries.”

These days Amy is doing well, as is her daughter, who was born healthy in 2011. But the lack of information on psychiatric disorders and pregnancy is prompting professionals like Glezer and women like Amy and Jess to work to spread awareness.

“That was a big factor in me starting my blog,” Jess said. “I was so sick of having to act like nothing was wrong. I really hope that by sharing my experiences, maybe one person will benefit. Then it would all be worth it.”

Ultimately, some women with mental illness are going to want to live as pharma-free as possible during their pregnancies. But others are going to find that they benefit from medication, even in small doses. “I’ve actually found that pregnancy-related depression responds really well to even really low doses of medication,” Glezer said.

If taking even small doses seems too risky, Glezer recommends purely non-pharmaceutical approaches are available, such as psychotherapy, massage, light therapy, acupuncture and exercise. Prenatal yoga has been shown to help with anxiety and depression.

“Women who do yoga during pregnancy and postpartum are better able to fight anxiety and depression because yoga lowers the stress hormone cortisol and helps develops a stronger relaxation response,” Dr. Marlynn Wei — author of The Harvard Medical School Guide to Yogapsychiatrist and certified yoga teacher — told Mic.

Why Do So Many Women Feel Sad After Sex?

Repost of an article I originally wrote for Mic Connections. Photo courtesy of Mic/Getty Images.

The last time I cried after sex was during a summer fling I wasn’t totally into, about a year and a half ago. The sex was consensual, but all of a sudden, while he was on top of me, my flight-or-flight instinct kicked in. I had to ask him to stop before tears came.

This wasn’t a first-time experience. I live with post-traumatic stress disorder brought on by sexual assault, which means I sometimes have panic attacks during sex, which can sometimes end in tears. But according to a paper recently published in the journal Sexual Medicine, I’m not alone.

According to the study, nearly 46% of the more than 230 women polled have felt depressed after sex at some point during their lives. These women reported feeling symptoms of PCD, or postcoital dysphoria, which is marked by “tearfulness, anxiety, agitation, a sense of melancholy or depression or aggression,” according to the Independent. Of those women, 2% said they felt that way after every time they had sex. And although 20% of the women polled said they had experienced sexual abuse in the past, which led to them developing mental health issues down the road, many of those surveyed didn’t report having a preexisting condition like PTSD to explain their symptoms. 

Why the hell are so many women feeling sad after sex? The PCD study had some obvious flaws. For instance, the results were collected through an online survey, and the sample size included predominantly heterosexual women. But this is not the first time researchers have tried to link sex to sadness in women. A 2011 study published in the International Journal of Sexual Health found one-third of women said they felt depressed even after satisfactory sex.

Jerilyn, 27, is one of them. “Even when I was single, the post-sex depression morphed into a different shade of empty. I always attributed it to the fear of being abandoned,” she told Mic. “I started to wonder if something was being taken from me every time I had sex, even though I enjoyed the act itself.”

Researchers theorized this post-sex dysphoria was caused by hormonal shifts after orgasm. But according to sex and relationship expert Logan Levkoff, the reason might have less to do with biology and more to do with how women’s sexuality is viewed in modern society.

“I think it’s important to remember that if you grow up not feeling empowered by your body, if you feel guilt and shame about sex, if you’ve been taught that your needs are less important than a man’s needs … [it’s not a] surprise that some people wouldn’t feel great after sex,” Levkoff told Mic.

According to Levkoff, part of why women might feel down after getting laid is that their needs weren’t met in bed, a phenomenon linked to how our culture teaches women about their sexual desires. While many men believe that women can achieve orgasm via penetration alone, according to one study, about 75% of women need some form of clitoral stimulation to achieve orgasm.

If their partners aren’t interested in paying attention to their desires, it’s no surprise that women would feel frustrated or emotionally drained after sex. “I think that the take-home message has a lot to do with how we learned about sex [and] how we feel about our bodies,” Levkoff said.

Playing into stereotypes: Possible causes of PCD aside, it’s worth noting that the study could be interpreted as perpetuating the idea that women are more biologically predisposed than men to becoming emotionally attachedto their partners after sex. (That notion was quickly debunked by a study from Concordia University, which found men and women process both love and sexual attraction in pretty much the same way.)

The idea that women are more likely than men to become sad or depressed after sex also inherently endorses the stereotype that women just aren’t really into sex at all. While numerous publications have said otherwise — in fact, a fertility app survey from earlier this year determined that many women would prefer to be having more sex than they’re currently having — the stereotype of the sexless housewife in a frumpy nightgown snapping, “Not tonight, honey,” at her poor, neglected husband still persists.

For this reason, many women don’t buy into the PCD study, insisting that they feel just fine after sex. “The only time I ever feel negative emotions after sex is if it was a one-night stand and I didn’t practice safe sex,” Meredith*, 24, explained. “Maybe guilt the next day, but no, I’m never sad. I love sex.”

Ehris, 22, is also skeptical that women have a biological predisposition toward post-sex depression. “I’ve experienced [sadness after sex] before. But I don’t think that it needs to be pathologized as a problem experienced predominantly by women,” she explained. “I’ve had and heard of partners of both sexes and a variety of genders who have felt melancholic after sex.”

Ehris brings up an important point: PCD isn’t exclusive to women. Men too don’t always feel awesome after sex. “We certainly don’t talk about it as much,” Levkoff said of PCD in men. “And that’s the one thing — this study sort of stereotypes, ‘Yeah, women really aren’t interested in sex.’ I don’t want this to become a self-fulfilling prophecy. I think that’s a bad paradigm to put out there.”

hormonal quirk or a sign that something’s not quite right: An orgasm can be one of nature’s most powerful drugs. When you have sex, the release of hormones in your brain can cause some funny reactions, from making you want to snuggle into your partner’s armpit to making you cry uncontrollably for no apparent reason. The occasional bout of post-sex sadness might be a sign that something isn’t right in the relationship, but it might also just be an odd quirk of nature and nothing more than that.

That said, if you consistently feel sad and depressed after having sex, it’s worth asking yourself why and reevaluating your partner selection. While it might sound obvious, who you’re having sex with plays a major role in how you feel about it afterward. Levkoff said it’s wise to check in with yourself and make sure you are comfortable with your partner and that there are no unaddressed, underlying issues preventing you from enjoying the encounter to the fullest, even if you’re just looking for a one-night stand.

Ultimately, it’s important to have sex with someone with whom you feel safe, “and by safe I mean respected, trusted, cared for,” Levkoff said. “It might not even be a monogamous romantic relationship. If you feel like this is someone you are connected to and who respects you, that certainly impacts [your feelings afterward].”

Jerilyn experienced PCD for years before she started dating her current partner, a longtime friend of hers. They’ve been together five months, and Jerilyn said she is finally enjoying sex in the way she thought she was meant to.

“This is the first time in my life that I have not had some form of postcoital depression. The only reason I get sad is if he falls asleep and I want more,” she explained. “Sex is finally what it should be for me, which is primal and passionate, and no longer something that provokes that overhanging, ambiguous sensation that something isn’t right.”

I’ve dealt with a lot of my PTSD-related issues, and like Jerilyn, I am now with a partner with whom I feel safe. I no longer feel sadness or anxiety after sex. Instead, I feel a lovely, Ativan-esque sense of calmness.

*Some names have been changed and last names have been withheld to allow subjects to speak freely on private matters.