Substance Use: The Basics

Substance use involves ingesting different types of drugs in different ways. It can include caffeine, alcohol or medications. It also includes other drugs like nicotine, cocaine, meth, cannabis, fentanyl, and heroin. Some are legal drugs and some aren’t. Some come in the form of medication given to us by a doctor to help us feel better (prescription medication). And some are over the counter or available without a prescription, such as cough syrup or Tylenol^TM . Some you consume orally, others you smoke or vape. Some you inject and others you bump (sniff or snort).

Substances can have some short-term effects like lifting your mood, making you feel relaxed, or even making you feel more energized. They can also have effects that make you feel anxious or depressed. They may put you at risk of an overdose or drug poisoning (when a toxic amount of a drug, or combination of drugs, overwhelms the body and can cause death), or cause damage to your health.

It is not unusual for people to experiment with substances such as cannabis, alcohol and other drugs. Many people may try substances only once or use them rarely. Most young people who drink or use other substances do not go on to develop regular substance use. But for some, regular use can lead to mild, moderate or severe substance use disorders.

People use different substances in different amounts for different reasons. It can be helpful to learn about the continuum (or range) of substance use to better understand your own use. You can then figure out if you might need to ask for help with changing your relationship with your substance of choice (the substance you use the most or like the most).

Our substance use is on a continuum that can change from day to day, week to week, and year to year depending on what is happening in our lives. Our mental health is also on a continuum. We can have a mental health diagnosis and still feel happy. Or we may not have a diagnosis but struggle emotionally. Depending on what is happening in our lives, our mood can shift and our substance use may shift with it.

A substance use continuum talks about the different stages of use. These stages are listed from not using to higher risk of use. But that doesn’t mean you will go through all stages or go from one to the next. You might start using and stop. You could use one substance with a greater potential for harm and another one casually. You could start using for one reason, and then continue for another. Maybe you start because it seems fun, and then continue because you feel like you can’t stop or because you go through withdrawal if you do stop. A substance that seems beneficial may also have harmful effects, with unintended consequences or side effects.

• Not using means not drinking alcohol, smoking tobacco or using any other substances for a period of time. This can change at any time.

• Beneficial use is when you take a substance, such as medication, that is prescribed for you. The drug benefits you overall and it makes you better. Examples of this could be a prescription you take that is prescribed to you. It could also be medicinal tobacco you use as part of cultural healing practices.

• Casual or lower-risk use refers to using substances without the drugs having any major effects on your health or social life. You are probably not using often, and are using in low amounts. You are not using substances that have higher risks and harms.

• Regular or higher-risk use is when your substance use starts to have a negative effect for you, your friends and family, or others. Here are a few examples:
  • losing your licence because you are drinking and driving
  • missing a shift at work or an exam because you are high or hung over
  • binge drinking or combining different substances
  • using substances more often or in larger amounts to achieve the same effect

• Substance use disorder can range from mild to severe. Severe is commonly known as addiction. It is when you’re using a lot, as if your body needs the drug to feel normal (physical dependence) or help you function normally. You may think or feel like you can’t stop, even when you know that the drug is having a bad effect. You may be giving up important social or recreational activities to use substances instead.

Physical dependence is when you get used to a drug as a result of regular use, and you have withdrawal symptoms if you stop using the drug. It is often related to increased tolerance (a higher dose is needed to get the same effect as before).

Substance use disorder, or addiction, usually refers to the compulsive use of substances even if they are having harmful effects. A person may not be able to follow through on their responsibilities at school or work, with family and socially. Instead, they are totally focused on the substance. They crave it and keep using it even when they know it is not good for them. Even drugs that are prescribed can become addictive. But whether or not someone gets addicted depends on many things, like their genetics, their lifestyle, and if they can change their life and do things differently. For more information on addiction, you can read more here or watch this video.

Substance use can become harmful if:

• you start using substances at an early age and continue to use frequently
• you struggle with mental health challenges
• you use more than one substance at a time
• you do not realize the impact of substances on your life (for example, friends telling you to cut down on your use)
• you feel you cannot stop on your own
• you use as much as you can (binge use) when you use
• you can’t have fun without it or must be high to deal with difficult situations

Substance use can cause health damage that is sometimes short-term — it goes out of your system and doesn’t last long. Other times the damage can be long-term and can affect your overall health as you age. We do not yet know the long-term health effects of some of the newer synthetic substances.

You may be using medication that has been prescribed for you by your doctor or another health professional to prevent or treat sickness. However, you may be using prescription medication recreationally, for reasons such as:

• it feels good
• it alters your state of consciousness
• it makes you lose weight
• it helps you to concentrate better at school
• it makes you feel like you fit in better with friends
• you are just curious to try it

Many people assume that all medicine is safe, but that’s not necessarily true. For example, it can be dangerous to use a drug that has been prescribed to a friend or family member, in the same way that buying a prescription drug off the street is. That’s because the doctor has prescribed the medication in a dose or amount that is right for that specific person. The doctor has likely examined the person and knows about their overall health. They were given information about how to take the drug, and things to avoid while they’re on it. When buying a prescription drug off the street, it’s important to consider it may not be the drug that you think it is.

Make sure to store prescription meds like opioids safely in their original packaging. Keep them out of reach of children or pets. Avoid leaving them on a kitchen counter or in the bathroom cupboard. You could lock them in a cabinet or safe. If you don’t have something secure like that, buy an inexpensive lockbox that comes with a key or digital code. If you are using pills, count them regularly to make sure that none are disappearing without your knowledge.

Harm reduction for substance use is about reducing the harmful effects of using drugs without stopping use completely. It means using in a way that is safer, or in a way that causes less physical or emotional damage. It may mean reducing use for a while, even if you start back. There are many different ways to practice harm reduction.

Natural tobacco has been an integral part of Indigenous culture in many parts of British Columbia and Canada and is still used in ritual, ceremony and prayer today. Tobacco is considered a sacred plant with great healing and spiritual benefits that should be treated with respect in traditional situations. But, if you smoke tobacco in non-traditional ways, cutting back on the number of cigarettes can be a great start. Smoking is still harmful, but smoking less reduces some of those harmful effects.

One way to reduce harm if you inject opioids or other street drugs is by going to safe injection sites (also called supervised consumption sites). This is where you can get your drugs tested, a potential overdose can be responded to, where you can get basic wound care, and be connected to community services. Supervised consumption sites provide access to clean equipment (such as needles, filters, water) that helps to prevent diseases such as HIV, hepatitis and other infections that are transmitted by blood. If an overdose does occur in a supervised facility, a trained professional can administer naloxone and provide first aid, reducing the chance of a fatal overdose. No overdose deaths have been recorded at a supervised consumption site anywhere in the world. At these sites, you can also find out about other services like withdrawal management and addiction counselling. You can get information without feeling judged.

Here are some tips to lower the risk of harm if you use substances:

Before using:

• Don’t be alone. Plan to use with others you trust and who will look out for you, and you for them. Then take turns using or plan for one person to not use at all, so if someone overdoses, someone will be able to help. Discuss what you are willing or not willing to do when using and make sure you agree. Or, you could tell someone where you are, and ask them to call or text you every few minutes to check in on you. If you don’t have someone you trust, use the Lifeguard App or visit a safe injection site instead of using alone. You can also call or chat online with the Never Use Alone Hotline, open 24/7 at 1-800-484-3731.

• Know the signs of an overdose (drug poisoning). Be able to recognize signs of an overdose and call 9-1-1 if you need help.

• Signs of an overdose include:
  • loss of consciousness
  • being awake but unable to talk
  • very slow or uneven, erratic breathing or breathing that has stopped
  • a change in skin tone
  • choking or snore-like gurgling noise
  • vomiting
  • a slowed, erratic or absent heartbeat

• Get your drugs tested. You can bring your drugs to free anonymous drug-checking services that will tell you how pure they are, or if they are “unclean” or mixed with other chemicals. They will take a sample of your drug and give you a report of what’s in it. You can also get fentanyl test strips that will show if fentanyl is present. Fentanyl is a drug that can cause an overdose and is found in many different substances. These test strips can show if fentanyl is present in drugs in many forms, including pills, powders and drugs that are injected. For more information about where to get your drugs checked and how it works, check out drugcheckingbc.ca.

• Pick up Naloxone, learn how to use it and carry it with you always. You can use Naloxone if someone overdoses on drugs like fentanyl and codeine. Naloxone can reverse the effects of opioids if someone overdoses on drugs like fentanyl and codeine. You can pick up a Naloxone kit at most pharmacies. Watch the video to see how to use Naloxone at towardtheheart.com.

• Plan where you will spend the night and how you will get home. Plan to use at home or in a familiar place. If you are using somewhere else, plan how you will get home or find a safe place to stay. Know where the phone is and where to get water and food. That will help to reduce anxiety and other symptoms that may come with using substances in a new place.

• Have new gear (supplies) on hand. Keep supplies such as clean needles, condoms and other items on hand to reduce harm. You can get new equipment for free at sexual health and youth clinics. Check out a supervised consumption site near you for new supplies.

• If you are pregnant or breastfeeding, talk with your health care provider about ways to reduce harm for you and your baby. Substances can pass to a developing fetus or to a baby through breastmilk.

If you’re using:

• Start low and go slow. If you haven’t used in a while, use less than you did before. Using the same amount can increase your risk of overdose if you haven’t built up a tolerance to the drug. Tolerance is when you need more and more of the drug to feel the same effect. You lose tolerance during times of non-use, so use less than you used to and build up from there. Someone else may have a different drug tolerance and experience than you. For more information about where to get your drugs checked and how it works, check out drugcheckingbc.ca.
  If it’s your first time using, start with a method that takes longer to get to your brain. Drinking or eating a substance is considered a “slower” method because it takes time for the drug to be digested and then reach your brain. On the other hand, smoking, snorting, sniffing or injecting brings the substance to your brain in seconds. They can increase the risk of overdose.

• Eat and drink water before and while you drink alcohol.

• Don’t drive or use any machinery while you use or are “under the influence” – and don’t get into a car with someone else who is! Take a Taxi, Uber, the bus, or ask for a sober friend to pick you up.

• Don’t mix. Try one drug at a time – you may not know how your body will react, and if you combine substances, it can cause dangerous interactions. Some substances that are known to have harmful interactions when taken together include:
  • antidepressants and Ecstasy
  • Valium and opioids, like Oxycontin or Vicodin
  • prescription medication when using another drug
  • drinking alcohol when using another drug

  If you do choose to mix drugs and alcohol, remember it’s best to use drugs before you drink alcohol. When you’ve had a few drinks, your judgment about how much is safe to use may be impaired, which can lead to all sorts of potential harms. For more information on mixing medicine, alcohol and drugs check out drugcocktails.ca.

• Use in a place that is comfortable and familiar. You’re more likely to make decisions calmly, and to feel less rushed or pressured.

• Get rest. If you aren’t getting enough sleep, you may experience hallucinations or feelings of distress while using substances. You may end up in the hospital. Even if you are unable to sleep, getting rest is important.

After using:

• Check in with friends who you have used with. Send a text or call and ask if they are okay. It’s a good idea to check in to make sure they’re safe.

• Safely dispose of used gear (supplies), such as needles by placing them in a container with a lid. You can find safe disposal bins at safe consumption sites or in most healthcare settings.