Adapted from a talk given at Mind States VI, Palace of Fine Arts--San Francisco, CA May 29, 2005

Recently, while preparing a presentation for the Mind States conference, I plugged the words "harm reduction" into an anagram generator (software that helps find new meaningful arrangements of the letters from a word or phrase) to stimulate my imagination. "Rumor and Ethic" was one of the results that caught my attention.

While the best known examples of harm reduction include things like needle exchange and pill testing programs, peer-to-peer communication is also an important component. The anagram "Rumor and Ethic" struck me because "Rumor" hints at how harm reduction messages are often exchanged person-to-person. "Ethic" suggests the value of using care and accuracy when crafting messages that will become part of these peer-transferred messages. The specific language used to describe psychoactive drugs and experiences can deeply imprint on the thoughts and actions of others. The crafting of ideas, words, and styles to communicate a particular set of ideas and behaviors, a practice we call "meme cultivation", can have a significant impact on not only individual, but societal understandings of psychoactive drugs. Memes are about memory and interest. If a message reaches people in the right easy-to-remember form, they are more likely to pay attention, yet harm reduction messages must be designed to be carried peer-to-peer without dangerous information loss.

One of the problems with peer-based information distribution is highlighted in the classic "telephone game", where errors may be introduced into a message with each transmission. A person in the communication chain can degrade the message or potentially transform and improve it. By proactively quashing rumors and errors before they become seen as "truth", knowledgeable and careful members of the network can help correct and reduce the damage done by the media and government. Some of the most common problems that occur in peer-transmitted information can be reduced with a little care on the part of better-informed peers. Using precise language, avoiding the unqualified use of the word "drug", being wary of oversimplified messages, and being willing to say "I don't know" are just a few examples.

The use of precise and careful language can help entrain people to be more careful with their actions. Questioning and clarifying ambiguous terminology used by others can raise awareness of substance-related health and safety issues. Consider "speed", a term that is used for everything from street methamphetamine and 4-methylaminorex, to pharmaceutical products like Adderall or methylphenidate (Ritalin), and even ephedrine. All of these have been referred to as "speed", yet each has unique issues that could impact harm reduction. Informed peers can qualify the term by using phrases like "some kind of speed" or "speed, probably methamphetamine" which may both help clarify dangerous misunderstandings and point out that the term, by itself, does not have a single meaning.

The term "Ecstasy", while probably sufficient when referring to "a random pill we know very little about that someone got at a rave", is also used for everything from pure MDMA to other MD* compounds and even for GHB (sometimes called "liquid ecstasy"). In cases where confusion is possible, it can be useful to ask specifically what substance is being referred to.

Similar considerations exist when describing dosages. Because of the nature of the underground market, people often don't know the exact dose they are taking, yet dosage is a primary safety consideration. It's easy for people to become careless about the words they use. Ask what someone means when they say they took "one dose". Ask if they know how many milligrams or micrograms, and if they do, how do they know? Was the dose measured or eyeballed? How was it measured and with what equipment? This can open conversation about the importance of dosage considerations. Such discussions can point out that, even with illicitly-manufactured materials, dosage is still under the control of the individual: pills or capsules do not have to be taken whole, rather than taking a larger dose one can start low and take more later if necessary, and doses measured by someone else can be verified with a scale.

Adding precision to casual speech can sound awkward at first--you may get some funny looks if you refer to MDMA instead of Ecstasy, or "a half milligram of alprazolam" instead of "one Xanax"--but it can introduce the concept of accuracy among those with whom you interact.

Highlighting issues of dosage can point out how differently each person can be affected and how different body weights and sizes can impact dosage and effect levels. If someone is told by their peers to simply "take one pill", they have little to go on and may run into unintended consequences. Increased precision and detail in language is essential to improving the culture of psychoactive drug use.

Definitions

Rumor: talk or opinion widely disseminated with no discernible source. a statement or report currently without known authority for its truth. Ethic: the discipline dealing with what is good and bad and with moral duty and obligation a theory or set of moral principles or values the principles of conduct governing an individual or a group a guiding philosophy Harm Reduction: a set of practical strategies that reduce negative consequences, specifically of drug use. Merriam-Webster, Webster.com Harm Reduction Coalition, harmreduction.org

Erowid tends to avoid the use of the word "drug" alone when something more specific is meant because the word is so often used to obscure the important distinctions that are key to harm reduction and education. Harm reduction is often about helping people differentiate between choices that carry different levels of risk. Making good choices regarding psychoactives without distinguishing carefully between substances is nearly impossible. There is a big difference between psychedelics and antibiotics, stimulants and depressants, prescription pharmaceuticals and street methamphetamine, yet all are covered indiscriminately by the term "drugs".

If a woman seems to be having problems and all we know is "she's on drugs", we have nowhere near enough information to make useful decisions about how to help her. Is she nodding off, having taken too much heroin? Is she twitchy and paranoid, having taken some sort of stimulant? Is she on LSD, or perhaps a regimen of Prozac, or having a bad reaction to antibiotics? In this area, meaningful distinctions are critical.

When the term "drugs" is allowed to stand alone to mean "that poorly-defined group of bad drugs or pharmaceuticals used in disapproved ways", we lose an important harm reduction battle--getting people to think carefully and with nuance about psychoactives. We also lose an opportunity to make people aware that powerful psychoactives surround them. Knowledgeable community members can help by asking more questions about the types and identities of drugs that are meant when the unqualified term "drugs" is used in place of more appropriate specific terms.

Clearly, the descriptions we use can program people's expectations. Simple changes in word choice and framing can have a significant impact on how other people will interpret what we say. Consider the following three examples, which describe briefly what eating psilocybin mushrooms is like:

1. Eating mushrooms makes you trip out and see weird shit!
2. When I ate mushrooms the first time, I saw a strange vision of an alien circus.
3. After eating psilocybin mushrooms, some people report visual changes or even full-blown hallucinations.

These three ways of describing the same phenomena can have very different meanings to someone who has never taken mushrooms. The first example implies that this single experience is what will result from ingesting mushrooms; it does nothing to prepare a novice for the variety of fundamentally different experiences they may actually have. The second example also describes a specific experience, but it clearly presents one possible outcome for one person on one occasion, rather than implying that there's a quintessential mushroom experience. The third example states that different people will experience different things, but that hallucinations are one thing that at least some people report.

Each of these descriptions may have its place in different contexts. The choice of which voice to use can influence not only expectations, but also the way listeners make choices that could impact their physical and mental health.

Although the second person "you" is commonly used during casual speech, in statements like "Ecstasy makes you feel love for everyone", it should be avoided whenever possible. Phrases such as "you should" or "you will" neither communicate a personal experience (better conveyed with "I") nor really make a statement about the range of responses that may occur. Using "you" can be dismissive of someone else's experience and choices, and may obscure or ignore that a range of factors such as body type, set and setting, interactions with medications, allergies, or other mitigating circumstances can lead to dramatically different reactions. Becoming aware of how often the second person "you" is used by people who actually mean "I" (especially when describing personal experiences) can help improve how we communicate with others about what is unique and individual, and what is shared and common.

When discussing psychoactives or their use, extreme modifiers such as "always" or "never" are best avoided. Absolute language is often just plain wrong since exceptions are easy to find: when people are in a mood to disagree, absolute language increases resistance. In the interest of promoting accuracy, we need to build and spread memes that are not easily falsified.

Perhaps the classic problem with exaggerated assertions is that if they are seen to be wrong, other messages that accompany them may also be discounted. For example, even if people commonly think that mixing substance A and substance B "always" results in a bad reaction, there are many factors (such as dosage) that could keep a bad reaction from occurring. If someone mixes them and doesn't have a bad reaction, it may lead them or their friends to dismiss other risk-reducing measures.

This is similar to the problems with sensational government messages that complicate harm reduction efforts. One of the most common criticisms of the anti-cannabis campaigns is that they exaggerate deleterious effects in hopes of keeping people away from trying cannabis. These exaggerations may work in the short term, but often end up causing the most important points of the message to be ignored when parts of it are later found to be exaggerated.

Language that allows for nuance, like "sometimes", "often", "in many cases", "you may want to" or "you might consider", suggests that listeners should weigh the issues themselves, take responsibility for their choices, and then make decisions. Careful phrasing also gives other people more room for their own experiences and for all the scenarios they may face when taking psychoactives, including no effects or unexpected effects. There may be exceptions when exaggerations are appropriate (like when dealing with a psychedelic crisis, where a person may wish for the reassurance of an ultimate truth), but in most cases, nuanced messages promote self-responsibility and informed decision-making.

People naturally tend to want to speak with authority, yet this impulse often results in an impression of the speaker as the source of the information they're conveying. Knowing the source of the data, or having the ability to cite specific sources, demonstrates that awareness of where information comes from can be as important as the information itself.

Asking people for the source of their information helps spread the idea that researching and supporting claims that affect health is important, although questioning may need to be done carefully, since it can be seen as insulting. If someone uses Erowid as a reference, it is prudent to consider whether they read an experience report, a peer-reviewed article, a well-researched independent paper, an entry in the Guestbook, or data from some other part of the site. Maybe they read an archived FAQ from 1997 that no one has updated in eight years!

This brings up the three important words: "I don't know." There is often pressure to offer simple answers to complex questions. But when it comes to information about psychoactives, everyone is better off if people just admit to not having information rather than making something up. For example: "Is MDMA neurotoxic?" There is no pat answer, and anyone providing one is likely to be simply wrong.

Acknowledging ignorance about something can spur others to research the answer, lead to fruitful discussions about why the answer is not known, and motivate people to put more thought and care into their actions as they realize the complexity and unknown risks of their activities. Answering "I don't know" can also open the door to other people admitting the edges of their knowledge and promote further dialogue.

Harm Reduction Memes and Slogans

"Clean needles save lives" "Know your body, know your mind, know your substance, know your source" "Less is more" "Don't drink and drive" "Drink water" "Fuck safe, shoot clean" "Use condoms"

Unfortunately, as we become more aware of how the words we use impact others and shape their choices, the messages can get longer and more complex. That is why slogans and simple messages are popular: they stick with us. Being memorable, they can serve as useful reminders to be safe.

One of the difficulties of harm reduction is that complex issues often have to be distilled down into simple language: easily-remembered phrases are forced into the role of carrying harm reduction messages. This is a double-edged sword as people come to rely on the slogan at the expense of more detailed knowledge. Sometimes the simplest memes are the most likely to be misinterpreted.

One common example from the electronic dance culture illustrates how dangers can hide in a simplistic message. The harm reduction message "drink water" began as a useful reminder to stay hydrated when taking MDMA at a club or party, where attendees are more likely to get dehydrated or, in an extreme case, develop hyperthermia (unusually high body temperature). Even those who are under the influence of a drug can generally understand and remember this two-word message.

Unfortunately, there have been some incidents where people have died of hyponatremia (a deficiency of sodium in the blood) because they were encouraged to "drink more water" when they started to feel sick after taking Ecstasy. While the meme probably helps more people than it hurts, "according to C. Haller, MD from the California Poison Control Center in San Francisco, hyponatremia (although actually rare among users) is one of the most common causes of ecstasy deaths or serious injuries."1 In the 1990s, the "drink water" meme was usually missing the critical and unspoken "but not too much" modifier. A more accurate rendition would be, "Drink water, but not too much. Drink around one pint per hour or one glass for every serving of alcohol, especially if it's really hot". But this wording lacks the immediate impact of "Drink water!" The longer version might become garbled and dangerously inaccurate as it passes from person to person; yet the appropriate water dosage and context are medically important nuances. So, although simpler messages are easier to remember, they also have a greater chance of being misinterpreted and perhaps even causing harm.

This tension between memorable and complete is at the heart of the meme cultivation challenge, yet all too often it seems to be resolved in favor of incomplete information. Memes are the memorable hooks that lead to the more complex message. But the complex message is often what we are trying to communicate. Educators, informed peers, harm reduction workers, and writers can help limit the spread of incomplete or inaccurate rumors by promoting an ethic that encourages careful communication. The problems with psychoactive drug use are diminished as better-informed members of peer networks step up and not only correct errors but also help people evolve the way in which they share information.

Those who read articles like this or attend harm reduction talks at related conferences are people who have the knowledge and interest to make a difference in their communities by raising the general level of awareness about these complex issues.