Home This Time, It's Personal Outcasts Among Outcasts: Injection Drug-Using Sex Workers in the Sex Workers’ Rights...

Outcasts Among Outcasts: Injection Drug-Using Sex Workers in the Sex Workers’ Rights Movement, Part 1

Myrna Loy wants to know if you're one of us (Gif from "Double Wedding" (1937))
Myrna Loy wants to know if you’re one of us (Gif from “Double Wedding” (1937))

For a long time, I’ve wanted to talk to other former and current injection drug-using sex workers about our experience of sex work and the sex workers’ rights movement. With every other statement from other sex workers seeming to be a disclaimer about how, “we’re not all junkies!”, pushing drug using sex workers in front of the bus in the name of respectability politics, a girl can get lonely out there. My most cherished dream is true, consistent collaboration between the sex workers’ rights movement and harm reduction organizations and drug users’ unions. Until that dream is realized, there’s always this roundtable. Material for the roundtable was gathered over e-mail dialogue throughout the month. Some of us wrote more than others, just as some of us have chosen to be pseudonymous while some of us are out. The participants are Inane Moniker 3, Lily Fury, Andrew Hunter 4, The Specialist 5, and me, Caty Simon. Part two will be posted tomorrow.

What are your experiences with stigma against injection drug use in the sex workers’ rights movement?

Lily Fury:  I feel like it’s hard enough to be an out sex worker but because, in general, sex workers experience so much stigma they feel like they need to separate themselves from “other” sex workers, especially injection drug using sex workers. I can’t count how many times I’ve heard or read a sex worker saying, “I wasn’t molested, I came from a good home, I don’t use drugs” in an attempt to bust stereotypes. But what about the girls who were molested or who came from poor shitty homes or who do use drugs? I feel like many times our stories and voices are muted just to make certain people more comfortable and I especially feel like this speaks to the divide among sex workers. It’s like because there’s so much stigma in just being a sex worker it’s triple hard for an IDU sex worker to be open about drug use and gain acceptance among her sex worker peers. Being outcast from a group that is already outcast from society can be really shitty and I just idealistically wish we could all have each other’s backs regardless of things like class, working conditions, and whether or not we decide to use drugs, because our voices and experiences are equally important.

Caty Simon: I feel all these conflicting impulses all the time about whether to be closeted or not about my IV drug use. I assume that the mainstream world will think that it’s connected to my sex work, and yet, I started working LONG before I ever started doing drugs seriously. Nor did the social circles escorting introduced me to have anything to do with the people I did drugs with. But I still sometimes feel this responsibility to the movement to look like a fine, upstanding whore and not talk about my IV drug use, and instead highlight my activism and how literate I am, etc (sort of the same way I play up my middle class background and education in order to manipulate classist clients into treating me well.)

I find that even though there’s some overlap between sex workers’ rights groups and the harm reduction movement, sometimes movement sex workers can be some of the most puritanical, retrogressive people when it comes to drug use, adhering tightly to the AA/NA line as the only model with which to understand drug use. It depresses the hell out of me.

Andrew Hunter: I think adherence to the AA/NA line on drug use as THE truth about drug taking/addiction is pretty much confined to North America and to drug treatment workers in the UK. I think most of the world doesn’t see drug use through that lens, which is good for most of the world, I guess—but not so good for drug using sex workers in the US…..

When I was in Australia helping to organize early sex worker groups like the Prostitutes Collective of Victoria, in Melbourne, most of the people involved in setting it up were injecting drug users. We also set up one of the first, and most successful needle exchange programs—which included outreach needle exchange to street workers. Our main thing then was hiding our use from our government funders, not each other.

But outside of Australia, when I began organizing work in in Asia there was a strong line that sex worker groups shouldn’t be involved in issues around drug use. That it would ‘give a bad name’ to the sex workers movement and increase stigma against sex workers in general. That’s changing now—but it’s been a long time coming.

19th century French postcard depicting an unidentified nude woman smoking opium—one of our hard drug using, sex working foremothers. (Courtesy of peachridgeglass.com)
19th century French postcard depicting an unidentified nude woman smoking opium—one of our hard drug using, sex working foremothers. (Courtesy of peachridgeglass.com)

What, if anything, does your injection drug use have to do with sex work, and vice versa?

The Specialist: For me, sex work and drug use are both related and not. I started using at 15, which was well before I got into sex work. I actually spent seven years sober when I started dancing. I picked up again when I moved back to my old home town. Around that time I realized I was burned out on stripping and didn’t want to live with my parents, so I looked into finding an incall. Most people misunderstand my reasons for using IV drugs. My mom (and others) assume that I use because I feel bad about sex work. I feel fine about sex work. The truth is that I use in order to make a good living while managing my social anxiety/agoraphobia and bipolar disorder. The drugs help me immensely by regulating moods and chasing away anxiety, thus enabling me to function. My family doesn’t acknowledge my mental illness. My criminal record also prevents me from getting a “regular” job. Of course, the addictive nature of heroin throws my life into a repeating loop of work to use, use to work. But for me it’s better than the alternatives. I have been on Subutex maintenance for over a year now and I’ve managed to stay sober, but that’s because I’m a stay-at-home wife. This weekend I’m going job hunting (I’m also a licensed bartender) and I’m having a ton of anxiety about it. I don’t think I’ll be able to function unless I go back on psych meds. If I weren’t pregnant I’d go back to using (and escorting!) in a heart beat.

Inane Moniker: I used heroin from 16 to 26 years old (IV), and I have been sober for 8 years. I practice abstinence, and abstinence is harm reduction, but that I choose abstinence can make people uncomfortable even though I am comfortable around (95% of) drug use. Being sober feels alienating to some people, and I often feel like people project their own conception of what that means in order to convince me of their own politics, and honestly, I could not give a shit about any of it. The fact is, the only people I want to be around are drunks and addicts, because I these are the only people in the world I like and feel like I can trust.

I don’t do well in sober communities because I don’t believe AA is the end-all be-all. I am an out sex worker in AA and buck the shame and pathologization of 12 step recovery, particularly attitudes about sex. I advocate harm reduction over abstinence (disclaimer: historical exceptions are people experiencing extreme symptoms of drug-induced psychosis). Still, I use the 12 step model and that has worked for me where other methods did not. For me, it’s not a perfect fit, but it works. This choice creates friction for me in sex work and harm reduction circles, so I don’t volunteer my drug use, nor my sobriety in AA. But I don’t deny it either. People want me to be on their board of directors so they can have a junkie hooker for cred, but because I am sober I am “not representative,” and on and on…I just don’t talk about it anymore because it doesn’t feel (emotionally) safe for me to do so.

I have also been a sex worker for 15 years. I have been a sex worker through seriously dark times, and it has also been my lifeline to normalcy. I have been sex working strung-out and sober—both have their own highs and lows. In total, sex work has been one of the best things that has ever happened to me.

GPOY (Courtesy of Matthew’s Island of Misfit Toys)

I often feel like the sex workers’ rights movement is deeply naive about serious drugs and at the same time wants to respond to the junkie hooker stigma (that all sex workers feel regardless of drug use) but really has no clue what that means. The sex workers’ rights movement has serious issues around talking about drug use, because people are usually too a) politically correct, b) are horrified to be stigmatized as junkies and “othered”, or c) think the fact they like to smoke pot means they have a seat at the junkie hooker table. IMO, they don’t. These conversations usually end with me feeling invalidated, which is head space I do not want to be in, so I don’t talk about it (see? harm reduction! lol). I really like the parallel of patriarchy here, Kitty. For both citizens and sex workers, my story can evoke horror or people think it’s so great (because I go to college now or something), but in the end it always makes everyone feel like shit because I can’t give them either the happy hooker or the junkie whore narrative that feels settling to them. My life is extremely messy, even without the drugs.

 How do you feel about the common cultural trope that sex workers do hard drugs to “numb themselves” from the “pain” of doing their work?

Caty: I prefer to work straight, because besides the obvious benefits of being alert and concentrated on the job, especially in the case of new clients, why the hell would I want to waste a high on a call? I also feel no need to numb myself from the mundanities of escorting, though I might occasionally feel the need to put a damper on the whorephobia being blasted at me from all sides.

Lily: I was already using heroin to numb the pain of my past so it wasn’t a sex work-specific  thing. I think it’s not so much numbing the pain but passing the time, especially in an atmosphere where you’re able to or where it’s even encouraged. I remember when I first started stripping, most of the other girls hated me (mostly because I was their main competitor) and one girl tried to get me fired when she saw me apply cover up over a track mark in the dressing room. Let me be clear: this was the most lax on drugs white trash strip club I had ever worked in, and the girl who tried to fire me had no problem sniffing coke or drinking herself into oblivion every night, but still, injection drug use almost got me fired. I find it ludicrous and so hypocritical that for many people cocaine and alcohol is completely socially acceptable but God help you if you are an IDU.

You can find part two of this discussion here.

3. Inane Moniker was an injection drug user for over ten years. She’s done every type of sex work under the sun.

4. Andrew Hunter works as the Program Manager of the Asia Pacific Network of Sex Workers. Andrew was involved in setting up sex worker rights organizations and drug user groups in Australia in the 1980s and has been working on sex workers rights issues in Asia and globally for over ten years.

5. The Specialist has been working in the sex industry for 15 years, as an escort and former dancer. She is living proof that you can, in fact, turn a ho into a housewife.



  1. Oh my god, there is so much excellent, insightful, quotable stuff in here. I’m going to be referring people to this for a long, long time. You are all freaking brilliant.

    (Sorry, I’m still a little too excited about this piece.)

    • Thank you SO much for this. I have been dancing on the ceiling all night reading this, and reposting it all over the place. This is honestly the first time I have heard this topic discussed so openly and honestly, and I hope this is just the beginning.

  2. Excellent article – very honest and insightful. It’s encouraging to read articles that go beyond the happy hooker, life-is-beautiful-for-everyone trope; it’s pretty unrealistic to think those of us who have worked in the sex business are in lockstep. We come from a variety of different backgrounds, different journeys – and for some of us, the journey has been very difficult, not all sugary sweetness and light, with gauzy pink butterflies and golden castles. (I was a user of cocaine when I was a hooker – sniffing it, not injecting it – but I knew other women who were IV addicts.)

    • I also wouldn’t say that all injection drug using sex workers’ experiences are quite so dire. I’m an IDU sex worker but sometimes I blush to think about how easily I’d fit into the happy hooker trope if not for that. I mean, my experience of sex work has been really damn positive, and besides brushes with the drug war, my life has been pretty good in general.

        • I’m not saying there haven’t been struggles in my life, or times when getting out of bed felt like an enormous accomplishment. Just that, all in all, I don’t see my life as a tragedy, or even significantly worse than non drug using sworkers’ lives.

  3. Seeing as how I don’t believe it’s possible to casually use meth, heroin, cocaine or any combination thereof, and that I’ve had people around me die, I found this post and its bashing of 12-step programs really irresponsible.

    • Have you seen the stats on the success of 12 step programs?
      And it’s also really kinda messed up for you to assume I and the other participants of this round table haven’t had the people around us die. My ex-girlfriend who overdosed went to her share of NA meetings. What killed her wasn’t the fact that she didn’t stick to them, it was because of a) the problems of using in the context of the drug war and b) a lack of harm reduction education.
      I think this is a prime example of how drug users are silenced when they talk about their lived experiences. Not only do you disagree, you think that our saying what we think is “irresponsible.”

      • “I think this is a prime example of how drug users are silenced when they talk about their lived experiences. Not only do you disagree, you think that our saying what we think is “irresponsible.””

        YES. I could not agree more. Furthermore, Twelve Step programs are faith-based, and there is no scientific evidence whatsoever that they work. Quite the opposite, in fact. Only in America are these programs considered the be-all end-all for addiction treatment; in Europe and elsewhere, they are viewed as the hoodoo nonsense that they are.

    • Also, no one here said that 12 step programs weren’t great for the people they worked for. It’s just they don’t work for everyone, not even most people, and the way they and other abstinence based models dominate all discourse in the US around treatment and drugs is criminal. No one was bashing 12 step programs, we were bashing 12 step programs excluding anything else.

    • Also, research has shown that there are MANY casual users of meth, heroin and cocaine. There’d be no way for the amount of those substances that are sold to be bought only by the population of daily/addicted users.

    • I’ve tried meth on several occasions (5?) and snorted cocaine maybe 40-50. I did special K a handful of times at the tail end of when it was popular (or at least, what someone was passing off as Special K) and smoked crack once—that did seem scarily addictive, to me anyway. So the one time was it.

      I’ve never been an addict. I’ve not even come close. Of the few friends I know who do sporadically indulge, their paranoia at being labeled an addict seems more unhealthy than their occasional usage. Like sex work, the stigma around drug use can makes them less honest, more secretive, and more anxious, even around people they love and generally trust. It makes me mad that a reasonable response to public disapprobation and shaming (i.e. selective secrecy) is then used against them as evidence that they’re sick. It’s irresponsible to claim that anyone who tries* any of those drugs more than once automatically has a problem.

      *or “uses” if that’s a better verb, though I only ever feel like I’m sampling something, not “using” it. Like trying food off someone else’s plate and then going back to a life of not regularly eating that particular dish.

      • Casual cocaine user here. And as Charlotte noted above, I’m actually more worried about the stigma of being labeled a “cokehead” than becoming addicted.

    • Disclosure (offered not to reinforce or to undermine anyone’s reductive ideas about anything but simply in the interests of honesty and to introduce myself a bit): I am neither a SW nor an IDU. I don’t do non-injectable drugs, either. I quit cigarette smoking in ’99. I drink very lightly and only occasionally. I’m a Registered Nurse. Personally and professionally I’ve witnessed enormous harms including deaths from drug use. I recognize criminalization and stigma as powerful drivers of harm, but I also have no rose-tinted illusions about addiction. I’m a strong believer in harm reduction, good science, open discussions and safe spaces.

      Kat, the information you convey simply isn’t accurate. Most drug use is casual, and only a percentage of dabblers go on to regular use, dependence or addiction. No one bashed 12-Step programs; in fact, participants shared complex, nuanced views about the programs. That you missed this suggests to me you weren’t actually listening.

      Even more troubling to me than the content of your remarks is your tone. You aren’t here in good faith offering an exchange of ideas. You’re attacking and hijacking, reinforcing stigma and silencing, and that’s not okay.

      I’m sorry for the pain you’ve experienced in losing people around you to drugs. But it’s not acceptable to let that become an excuse for choosing to remain ignorant in order to lash out. There are better ways to contribute, but I think you should do some honest self-evaluation first.

    • Skramamme left this reply several times and it didn’t post, so she asked me to post it for her:
      Seeing as how I don’t believe it’s possible to casually use meth, heroin, cocaine or any combination thereof, and that I’ve had people around me die, I found this post and its bashing of 12-step programs really irresponsible.”

      Well, alcohol kills more people than illicit drug use, so I guess it’s impossible to drink responsibly too if you apply your argument to booze, or does it only count with illicit drugs?
      I’m also living proof that your statement isn’t accurate- I’m a 42 year old woman who has been using IV drugs since I was around 20 (started using speed at university). I have been on and off methadone and suboxone for well over 15 years and have reached a point in my life where I *can* use heroin occasionally without relapsing into a full blown habit.
      That’s not to say that I don’t understand how dangerous illicit drug use can be under our current system. I have unfortunately lost people to drugs- in fact, my partner and soul mate killed himself because he couldn’t face going back to prison after failing to get clean on the court’s schedule. The idea of being stuck in the revolving door of our punitive justice system was just too much for him to bear and he hadn’t reached the point in his personal development where he could kick it and stay clean.
      But if you cut through the hype and misinformation surrounding most drugs you will see that it’s actually criminalisation that accounts for the majority of the terrible problems associated with drugs and not the drugs themselves.
      Now I have written plenty of posts about the problems with prohibition (it doesn’t work, for one) and I’m not going to go into exhaustive detail here, but I think people need to understand prohibition’s role in the issues associated with drug use- heroin (and to a lesser extent, cocaine) in particular- and how the social ills pinned on using are actually a direct result of its criminality.
      If you look at some of the more science based pharmacotherapy programmes in places such as Switzerland you will see that the majority of the issues faced by addicts in places like the States no longer apply- homelessness, poor health, unemployment, crime, overdoses, dealing, antisocial behaviour and the like drop dramatically. In fact, heroin based pharmacotherapy doesn’t result in OD’s *because* the drugs are quality controlled and dispensed safely.
      It is the black market, the illegal drug trade, the inherently hidden nature of addiction in countries that criminalise drug use that results in death and incarceration, not the drug itself.
      A quick bit of history here;
      Several years ago there was a movement by scientists, lawyers, doctors and the like to urge the U.N to rethink its stance on ~the war on drugs~ and the treatment of addicts and drug users. It called for a science based approach rather than a moral one (The Vienna Declaration). These experts had found after years of research and time in the field that criminalising drug use and addiction didn’t work, it actually contributed to greater levels of recidivism, disease, death and so on. They also found that addicts had their basic human rights breached repeatedly, in part because of the moral based approach to addiction that most U.N countries take, and the Vienna Declaration was a way for these experts to pool together and let it be known that there needed to be a new way of dealing with all of this. Unfortunately, while the evidence is there to support decriminalisation, politicians are simply too scared of the potential backlash and refuse to address the situation.
      You see, in a similar way to how many people used to view mental illness, addiction is widely seen as a moral failing, a character flaw, and that results in dehumanising laws, unrealistic “treatments” and punitive approaches that work on the assumption that the addict should not only want to get clean, but that to do so all they need to do is pull on those bootstraps! And if they “refuse” to get clean when the court orders them to, well, then maybe jail will scare them straight!
      But addiction is a complex issue, and all the threats and prison terms in the world won’t “cure” an addict.
      Now, as an addict myself (although I am not addicted to illicit drugs at this time) I have ~a lot of feels~ about this subject and I’d like to touch on a couple of topics, especially the whole issue of how we refuse to accept the idea of the functioning addict;
      In our society an addict must always be in pursuit of recovery if they are to be accepted. An addict who does not want to get clean is either a hopeless case to be scorned, or maybe they still have potential, they just need the right motivation to ~want~ to get clean! We are unable to accept the idea of a functioning addict because in our society that’s a contradiction in terms, we see addiction as an inherently negative thing with no possible alternative.
      However, I personally find heroin addresses my anxiety far better than other medications and it also helps to smooth out my cyclical depression/hypomania (plus it’s fantastic for my ongoing nuerological pain) and, if it weren’t for the issues created by prohibition, I would gladly use it daily to treat my various health needs- I would definitely accept physical addiction for the benefits I would receive.
      But instead I have to rely on drugs like Seroquel and Tramadol and methadone every day and be dependent on those, even though they are not as effective, because…because…?
      If you take away the criminal aspect, what exactly makes taking heroin worse than fentanyl or seroquel or lithium?
      If you remove the criminality of the situation why is heroin inherently bad and wrong to take but other medications that improve my moods and manage my pain are ok?
      We are caught up in a moral battle where we see the addict as bad, yet we don’t chastise a diabetic for being insulin dependent. We say “using heroin is just running away from your problems”, but using seroquel and other psych drugs to manage moods is ok.
      We turn around and cry “But you’ll never get off it!” and I just have to sigh. I’m on medication for life as it is, why should a drug that is extremely effective and that poses no long term health problems, aside from physical dependency, be illegal when I am prescribed things like methadone, of all drugs. Talk about addictive! Of course, it’s not nearly as good in helping manage my pain. And it doesn’t help alleviate my anxiety. But at least it’s not the Big H.
      We have demonised illicit drugs while encouraging the use of others and most of that is down to our archaic view of what an addict, and what addiction, is.
      When you get right down to it almost all arguments against drugs like heroin are either to do with being morally “right” or they are focused on the harm that is, ironically, a direct result of the drug’s criminalisation, and when you put it into a pharmacotherapy based scenario all of those arguments become null and void.
      Is a model similar to Switzerland going to solve all drug related problems? Of course not. But it has better outcomes for both the addict and the community than our current method.
      And that’s the kicker- what we’re doing doesn’t work.
      Since Nixon declared a war on drugs they have become cheaper, more potent and more easily available than ever before. We have allowed violent drug cartels to flourish by providing the very black market that they need to survive. We are locking up people for drug related crime at historic rates. We are spending billions of dollars on drug related law enforcement while we cut funding to health and education.
      We are losing lives every. single. day. on an unwinnable war, yet we are so determined to prove a point that we are willing to count those casualties as necessary sacrifices. And we have done all of this because we can’t let an addict think taking drugs is acceptable.
      So lets start looking at this issue from a research based, scientific stand point and get rid of the moral hand wringing. Addiction is always going to be around, but it’s how we deal with it that will have the greatest impact on our communities- whether it be positive and progressive or the same old same old that tears lives apart.
      Also, if you want to hear from those on the other side of the law who are now calling for an end to prohibition, check out L.E.A.P (law enforcement against prohibition).
      I know there’s more I would love to say, but I’m seriously exhausted. Hopefully this is enough to get some people looking at this subject from a new perspective.

  4. And yet, sex work is judged on the same basis of “choice” and “lifestyle.” Also, the fact that your example of a hard drug user is someone who doesn’t take care of their children–not even considering that many of us work hard and make ethical decisions–is telling. Wouldn’t it be more effective if both sex workers AND drug users weren’t all seen as shitty, irresponsible people, and drugs and sex work were both decriminalized?

    Just because I use drugs doesn’t mean I’m reinforcing the stereotypes about sex work or drug users. And just because I use drugs, doesn’t mean I don’t do sex work because I like it too–and if you’d read the round table more closely, I think you’d see that most of us most of the time aren’t just out there to support our habits.

    • It’s really telling how much you’re reading into this article. No one’s asking you to not identify as a sex worker who doesn’t use drugs or make no distinction between yourself and other sex workers. You are reacting *exactly* how ‘progressive’ civilians react to sex workers. Bully for you for being respectable in every other possible way, but playing the respectability politics game isn’t going to help you or anyone else. And I certainly hope you never fall down among the ‘disrespectable’ and, god forbid, have to do something identified as stereotypical, like continue with sex work if you’re diagnosed with a mental illness that prevents you from holding down a full-time job. It’s gonna be really lonely for you.

      • Mental illness is not a choice. Drug use is a choice. And the line I was referencing was “I saw other workers say things like, “it’s not like we’re street-walking crack addicts”, which is blatantly whorephobic as well as discriminatory to drug users.”

        I’m not a crack addict. And I don’t feel that I’m being “discriminatory” by identifying that way, and taking responsibility for my own choices and the stigmatized behaviors I choose to associate with, and not those that I don’t.

      • Past a certain point, drug use may not be a choice anymore, but that’s kind of a different discussion. And sex work is also a choice. Do you not see the parallels?

        There are ways to talk about your experiences with sex work without implying that certain sex workers aren’t worthy of respect or rights or a voice in the movement. “That’s not true for me or a lot of other workers I know. It’s true for some other people, though. What’s your point?” And the point is always something related to criminalization. THOSE people deserve to be criminalized. THOSE people deserve whatever they get. No, no one who isn’t hurting anyone else deserves anything.

    • “I do sex work both because I like it, and to make a living, give my kids a backyard and a full-time, hands-on parent who can be there more than a traditionally-employed single parent, but it’s somehow “discrimination” to see a difference between myself and someone who gives their kids away blah blah blah…”

      That’s a totally bullshit dichotomy. Just because someone used or uses drugs doesn’t mean that they also are not *also* doing sex work to be a full-time hands-on parent. Me, for example.

      “the “I-gave-my-kids-up-to-support-my-junkie-boyfriend” stereotype”

      And maybe you noticed that I am the exact opposite of that stereotype. I have a stable marriage, a nice home, and I work hard to support my family. I also happen to be an addict. And I’m not unique in these things.

      “Being judged based on lifestyle choices is not the same as being judged based on race, gender, class, or sexual orientation.”

      That’s exactly what you’re doing, though. Do unto others, et cetera.

      “Drug use is a choice.”

      After a certain point, no, it isn’t. Your brain chemistry is permanently changed. Addiction is a disease, not a “choice.” That basic fact is accepted by the established medical community.

      You strike me as a total hypocrite.

      • Perhaps I’ve misunderstood then. This roundtable seemed to be proposing that a) there’s not really a link between drug use and sex work, and yet that b) it’s somehow “bad” to be a sex worker who wants to distance herself from the junkie stereotype, because sex worker rights and being pro-IV-drug-use are linked. Further, it seems to propose that a) drug use is a personal choice that should be respected because it’s not that bad, really, and then you say that b) drug use is not always a choice, and therefore people who aren’t choosing it should not be forced to endure judgement or consequences for not choosing treatment, either, because they can’t.

        Everyone has the right to live their own lives as they see fit. I’m not saying that they don’t. Everyone should have equal protection under the law, and equal access to medical treatment, which I said earlier on my Twitter timeline. I don’t think that one sex worker–or many sex workers–using drugs has anything to do with me, and that’s what I object to. I don’t agree with compulsory solidarity, or that defending a person’s right to make a living should also entail advocating for a person’s right to any particular leisure.

        I have had friends in the past who got caught up in drugs, and doing sex work gave them little enough accountability that they really got in trouble with it, and eventually it became a horrible cycle. One ultimately tried to kill herself over it, and very nearly succeeded. I don’t have a lot of positive feelings for IV drug use, or glamorizing it as a personal choice whose main drawbacks are stigma and judginess. It’s dangerous, it often changes a person’s personality, impairs their ability to make good choices, and by the time it becomes a problem, whole lives are ruined around it.

        My whole point was that I don’t want to advocate or be associated with that, BECAUSE it has cost me friends, and I don’t want my sex work advocacy to be conflated with being pro-drug use. If it’s a disease, why aren’t we talking about treating it? If it’s a disease, why are you fighting for how perfect it would be to live with that disease if only everyone would stop judging and stigmatizing you? If you’re so happy with where your life choices have gotten you, then why do you need my advocacy and support?

        The fight for sex worker decriminalization is difficult enough, and there are enough other contributing factors to survival-based sex work–like race, disability, poverty, and on and on–that I don’t feel a responsibility to be like “fuck yes, go shoot up, that sounds awesome and I completely support you in that.” They’re two different fights. There are contributing factors in common, but I don’t want the association, and resent that I have to correct the stereotype every time I choose to out myself as a sex worker.

        Basically: do what you want, live with your choices, like we all do, but if your choice to do drugs and your choice to do sex work are really so un-linked, then leave drug-free sex workers out of it, and quit acting like I have to be pro-junkie to be pro-hooker, or need to proudly embrace my profession’s association with a culture I don’t want to be a part of.

        • We often forget that the “war on trafficking” that affects so many sex workers is in many ways based on the War on Drugs. We need to fight both if we are to defeat the anti-sex work anti-traffickers and get real liberation for drug using sex workers, who in many cases are the most oppressed and disadvantaged among us all. The new informal alliance between INPUD (global drug users network) and NSWP, our global sex workers network is a great start to the global political fight we need against the drug was and the antitrafficking treaties and rescue industry.

    • I’m not saying it’s not okay to exercise your bodily autonomy. I’m saying it’s not okay to insist that we share this cause just because we share a job title.

      It’s not “shaming” to want to distance myself from the stigma for a behavior I think is inherently problematic, and it’s hypocritical to demand the autonomy to make the choice (which is fine), exempt yourself from any accountability (earlier comments re: actually it isn’t a choice I guess?), and then also insist upon the support and advocacy of those who neither make that choice nor think it’s a good one–which is the piece I really have a problem with.

      • We’re not asking you to tell us it’s a good choice, we’re asking for the right to not be criminalized. Just as the sex workers’ rights movement isn’t asking for approbation, just for labor rights.

  5. All other nastiness and astounding hypocrisy aside, victim-blaming a woman who was in an abusive relationship for not leaving sooner is an especially loathsome touch.

  6. I casually used meth a month ago, and 5 or 6 months before that. I think we need to look at what is being found to have been propaganda about crack from ten years back (crack babies etc) to realize that meth is just the latest casualty in drug war propaganda…

  7. Whoa. I didn’t understand you were talking about Olive–who made it CLEAR that she gave her kids to her parents b/c her ex was abusive, NOT b/c of drugs. She wasn’t even using drugs at that point yet, and only started when her kids were away. As Lori notes, the level of victim blaming here is atrocious. From everything I hear, Olive is a great mom.

  8. Like Caty, I agree that it is telling that you attribute unethical choices to IDUs (as mentioned in the roundtable, IDUs often do sex work so *as to be* ethical). You should probably know that sex workers and drug users and people who are just simply poor and/or non-white lose their children all the time to the state, and it’s not a choice and it is very often unconnected to how the children are actually being cared for. So that really seems like a straw-situation, or even victim-blaming. Whereas middle and upper class families can often invisibilize even serious sexual and/or physical abuse. Someone has mental health issues? Someone runs away or gets kicked out? They were definitely the problem there. (TRIGGER WARNING) Boys in daycare were sticking sticks in your vagina? We’ll issue them a warning that they need to have better supervision. No we won’t get you therapy until later when you start having behavioral issues in school, why would we do that, and we won’t even consider there might be abuse in the home.

    I have, for instance, experienced very little discrimination for being queer and mostly oriented toward women (not zero, and I’ve known people who suffered a lot), somewhat more at various points in my life for gender and class. Not just discrimination. Like have you ever known a homeless or brink-of-homeless woman who wasn’t being raped? A large and significant amount of discrimination over disability – in life, in academic settings starting in elementary school, in the family, in activism, everywhere. Discrimination related to sex work DWARFS all of that except disability. There were choices involved, and lack of choices involved. But you know, like Caty said, that is just as much considered a lifestyle. And there is still discrimination. And you know, I think you feel that too, or you wouldn’t feel the need to throw your sisters and brothers under the bus to try to escape it.

    I am not an IDU. But I have friends who were or are, and you know, I kind of doubt based on your comment that you do. You don’t have a lot of sympathy, and you do have a lot of misconceptions.

    So, why do you think sex work is associated with hard drug use and life instability? Sure it is criminalized and stigmatized and so most people who fancy themselves “respectable” avoid it. It also has low barriers to entry and a ready customer base. As long as these latter features are true, sex work will be the province of people with mental health issues, of drug users (keeping in mind there are plenty of white-collar IDUs too, and some pretty classic “happy hookers,” but again they can invisibilize it and do not suffer these things to the same degree, Caty as one who might be described this way, you know I <3 you and please let me know if you disagree), of poor and homeless people, of runaways, of ex-felons considered unemployable – oh hi drug war (or people otherwise discriminated against in employment, like trans women), and other people you probably see as disposable and brush past as you go about your day. This is a good thing, because last resorts are better than no resorts. And if you do not feel solidarity with any of these people, that is frankly pretty awful, and breathtakingly selfish. I can't see anyone with that attitude as being interested in sex worker rights, and if you are actively working against these features of sex work, then you actively working against any sort of remotely just or ethical form of sex worker rights.

    Like, you don't deserve to get arrested or suffer other legal or social consequences for sex work, I mean you have a house with a nice backyard, but screw those little people. You know, the ones already seeing the brunt of the criminalization, the brunt of the stigmatization, and all the rest. They can continue to be vulnerable, to arrest and to violence and to pimps and to the challenges of poverty. Maybe you believe in outreach. But it doesn't sound like you believe in systematic change.

    That people feel like you do is probably the biggest barrier to making change for sex workers. You think you are being "respectable." All this "respectability politics." But they will never see you as respectable – you are throwing people down in order to grasp at something which is not even there. Which is one why that whole way of thinking about "respectability" needs to be challenged in society, and why it is better to chip away at criminalization from the bottom up rather than from the top down. The other, bigger reason is that it is the right thing to do. Try having some sympathy and empathy for others, try putting yourself in their shoes. Consider, even, just what you said above, and how it might make people feel other than yourself. People who shared their insights in this roundtable, and the many, many others out there. Beyond yourself and beyond your own experience.

    • I guess I call myself a happy hooker b/c I sincerely do love my experience of sex work. (Not that I don’t have bad days, but that’s how I feel for the most part.) And yeah, I’ve been criminalized and busted for both sex work and drug use throughout my decade or so both working and using, but I think, yes, I got through those things relatively unscathed–I got off without any extended stays in jail–b/c I’m white, and come from a mixed class background but have an upper class education. (And also b/c I have an amazing, dedicated ex-client for a lawyer.) (Though, hey, we’ll see what happens to me with my record if/whenever I have to transiton into straight world employment.) I still have suffered–my friends and lovers have died b/c of the drug war, I almost lost my beloved partner to a lengthy prison sentence, etc etc etc But not as much as people who are more marginalized.

  9. KC: ‘I would like it recognized in general that sex workers’ and drug users’ rights both center around bodily autonomy and that we are marginalized in similar ways, except that it is more intense for drug users’. Absolutely!… I was working/using speed and heroin thru the 80s in Australia and Indonesia and when I became aware of sex workers’ groups and drug users’ groups after 1990, it was in the context of HIV, and it was the workers who were open about using, like Andrew, driving the ‘movement’. At that time, I felt it to be more a celebration of our misfit status than a demand for acceptance. Personally I find heroin inspiring rather than ‘numbing’ but it’s certainly a lifestyle that brings stigma, drama and sometimes self-loathing. I think the experience of marginalization is a key point, and it is those sex workers [and queers] who are concerned with joining the ‘mainstream’ who play down drug use [a bit like the parlour owners I’ve worked for, who claim to run a clean house when the reality is more like ‘don’t ask don’t tell’]. I’ve written about this in a book, Pink Fits, I might dig it up for my blog…. meanwhile thanks for this, really excellent, I’m looking forward to part 2!

  10. Kudos and thanks to the participants of the roundtable for an incredibly thoughtful & insightful discussion. And to those engaging the hateful, reactionary comments here. You’re navigating some fraught territory (and apparently hitting some buttons). Please keep on keepin’ on. You’re awesome, and you and your work are so valuable.

  11. Huh. I’m honestly confused by how it seems that sexworkers doing too much sexy stuff in a strip club is open to question and critique, but sexworkers doing IV drugs is not. I don’t think anyone should be shamed or stigmatized. There are a lot of harmful myths about drug use just as there are with sex work, and both are used to criminalize private behavior in a way I find cruel and unacceptable.
    But overall, does the sex workers rights movement accept or reject the idea that one sex worker’s behavior affects other sex workers, and that they will have responses to that? How does that work? I am sincerely confused by this and would like to be clearer.

    • How is sex workers use of IV drugs not open to question? Several people have already raised objections here. And it’s not like they received nothing but praise and support publicly.

      Asking somebody to definitively say a movement accepts or rejects anything is unreasonable, and a disingenuous request—and I wouldn’t trust anyone who took you up on that. Since when does any movement speak with a single voice? Did we come to a collective conclusion about extras in the strip club? If so, I missed that press release.

      Moreover, where did any of these participants claim their behavior doesn’t impact others? And (perhaps more relevantly) in what ways to you want them to respond to the supposed effects on others, which have also not been defined? I imagine those who weighed in in the original post will be better able to answer your questions if they have more information.

    • “But overall, does the sex workers rights movement accept or reject the idea that one sex worker’s behavior affects other sex workers, and that they will have responses to that? How does that work? I am sincerely confused by this and would like to be clearer.”

      I know I for one certainly accept that, which is exactly why I told Beatrice she was being breathtakingly selfish above. I don’t think sex workers using drugs and being out about it affects other sex workers much, though.

  12. Through a combination of the gendered, classed and racialized effects of the drug war, bad public health policy with regard to harm reduction, and NIMBY-style urban policy and social behaviours, sex work and drug use are absolutely *already* connected. For some sex workers to pretend that this is an example of “those other people” hijacking “our” labour rights discourse is ridiculous.

    Much like the gay rights movement, we seem so determined to forget whose labour our movement is founded on. Street-working, drug-using, poor, racialized, disabled and trans women have been the backbone of some of the most solid, most protective and most targeted sex workers’ communities, especially in poor urban areas undergoing gentrification (see, for example, Canadian scholar Becki Ross’ research on the expulsion of trans sex workers from Vancouver in the 70s and 80s). In Canada, advocacy for decriminalization (which on its own and as the courts so far have offered it will most benefit the most privileged workers) has used violence against drug-using and street-working sex workers as evidence of the harms we “all” face. These are the histories to which we owe the very existence of the notion of sex worker solidarity and rights.

    Speaking of which, standing with other workers and advocating for their issues, even if you are not directly affected by the exact same issues right now, is *by definition* solidarity. If your solidarity is contingent, if you feel like somehow drug users haven’t earned it by “sharing a job title” with you, you are missing the point of collective organizing. We have more power together – even when we are together on issues that only affect some of us.

  13. In terms of both drugs and sexwork, I fall on the side of “you should be able to do whatever you wish with your body”. I have both seen and experienced a lot of pushback against that position in regards to the extras issue, both on this site and elsewhere. This discussion seems like it has similarities, yet it feels different. So I’m wondering if there’s a larger formula for this that I’m not understanding.

  14. I do not use illegal or injection drugs, but I fail to see how another woman’s personal bodily choices affect me as a sex-worker – it’s not my business unless we are working together. As an atheist I also am very critical of the predominance of AA/NA as the only form of “effective” treatment.

    I will say that drinking and taking pills make sex work much more bearable for me personally and I see that as sort of a red flag. I don’t want my livelihood to be dependent on a type of work that is only tolerable when I alter my mood/mind/consciousness – and for me, this would apply to all service industry jobs including sex work, food service, and retail. I am not an addict by any stretch of the imagination, but the fact that I have to take something in order to get through a session/shift without wanting to die is not a good thing for me.

  15. I don’t think this is too much of a tangent. As was mentioned in the round table, plenty of rich professionals use drugs, and they’re just able to hide their use a lot better than sex workers can.

  16. Benjamin Rozensweig on the Scarlet Alliance Facebook page just left this amazing comment on my link to this piece there, and gave me permission to repost it here:

    There is a lot to like in this piece. But even here, where people are so open to talking about things that are so rarely discussed in public in this way – and as is not infrequently the case in sex-worker rights scenes – I sense a kind of resistance: people don’t really want to talk about the degree to which, in particular times and places, the intersection of drug-dependence, drug illegality and (expensive) commodification does actually act to form and reproduce the bulk of labour markets in sex-work economies, while playing a significant role in forming the conditions of labour, for good and ill. When I started my involvement with sex-work economies, decades ago in Melbourne, at the ‘lower’, disreputable end of such economies, this was most certainly the case, and a lot of what happened would really be incomprehensible unless one was able to acknowledge this reality. In fact, so much were significant sections of the labour market made up of drug-users at that time that workers were subject to sometimes bizarrely excessive surveillance and policing, because of a (not entirely false) perception of ‘unreliability’ – e.g. brothels with policies against workers leaving the building even for five minutes during a shift, even to go to their car, because of assumptions both that they would use drugs but also that they might not come back. But at the same time, the threat that one would be denied future shifts on the basis of such ‘unreliability’/being a ‘bad worker’ was used much less than one might imagine, precisely because there weren’t many people workers could be replaced with who were not also, themselves, drug-dependent probably-‘unreliable’ workers. I’m not saying that this description effectively characterises the whole of the industry in Melbourne at the time, but for a not trivial part of it, the less ‘respectable’ part to a large extent, management would develop a host of strategies to deal with the reality that this was the bulk of the available labour force. Even respectability was in part just a description of how obviously stoned one was able to be without disapproval. And when these things started to shift, it was in part because other people were found – again because of social conditions that formed people as a potential labour force – and junkie workers were rendered more dispensable. The historical phenomenon of the disempowerment and even exclusion of junkie workers from parts of the industry. So when people talk about how junkies are not representative, or relegated to particular small parts of the economies, or no more likely to be working in brothels than anyone else, I often feel that the people saying this stuff are ignoring the fact that those truths, if they are true, are things that became true because of a whole process of individual and collective struggle by workers, and the significant defeat of such struggles by owners and managers i.e. relations of power, the results of which are then ideologically ratified as the respectability of our marginality or absence.

    • This is a really valuable contribution to the discussion, especially in Benjamin’s focus on (1) how the working conditions of sex workers who use drugs are often “incomprehensible” if the conditions surrounding drug use are ignored as context and (2) his reminder that where sex work has become a gig for non-drug-using workers as well, this is often because worsening conditions in other industries have made more workers available and willing to do stigmatized work, and their entrance into the sex industry is often at the expense of displacing more marginalized workers.

      Both of these points are key, for me, in situating sex workers’ rights in larger labour and anti-poverty struggles.

  17. I have tried to approach activists working on decriminalization of drug use and also anti-prison organizations. From my experience, they still hold terrible stigma towards sex workers and conclude that victims needs to be rescued.

    Even in drug world- the psychedelic movement feels superior to prescription drug or “harder” drug users.

    I am adamant to not fall into this kind of monkey behavior of but then I find myself descending towards having less privilege because I refuse to act and behave like the ” upper class” people.Even within the sex work communities. It’s a losing game .

  18. This is probably the most enlightening piece I’ve seen here, a topic I never considered and I’m glad I got to read these 2 pieces.

    Something I never thought of was the concept of wasting a high on a client. It amuses me and speaks to how well the sex workers in this roundtable function. It also speaks to their drug use as deeply personal. I can relate as it plays into the whole boundary discussion I was just a part of on here. The personal remains personal.

    OTH, I’ve unfortunately gotten to see sex workers who couldn’t function at work unless their minds were altered (and this includes alcohol abuse and this includes me during my burnout days of stripping). I know I offended the Scarlett Alliance once by saying I did not want to work with anyone whose mind was altered and this is true: I do not, it imperils my safety. Off-hours though, your body is your own and if I don’t want to hang around for it, I won’t.

    Do I contribute to the anti-drug stigma in the conversation around sex workers? Likely and inadvertently. Though there is no point to me hinting or pretending that using substances is intertwined with my sex work because it isn’t. This series does give me pause on how to best present the spectrum that is the experiences of sex workers and I’m grateful for the insight.

    • Yes! Ditto to much of this, especially the part about wasting a high on a client. I loved that.

      When clients ask me to do some type of drugs with them (it doesn’t happen often, but the most common are pot, coke, and molly) I always say no—or say yes, and fake it—but I’ve never thought much about why I refuse. Reading this helped me realize that it’s less about me being worried I’ll be so out of it I’ll do something unsafe or unprofessional, and more about the fact that this is *work* and I don’t expect it to be fun. Of course I often have fun while working, and enjoy the person’s company, but it’s not like I’m trying to invent ways to enjoy it more than I would… I’m ok with it being work: a little boring, a little irritating, a little tedious and effortful. Blurring the lines between “whee, this is a party!” and “ok, this is a job” makes me uncomfortable. And often clients who want me to use some type of drug with them are also clients who explicitly ask to hang out as friends, without paying me, or who offer that I could spend the night—unpaid of course–if that’s “more convenient” for me.

    • Different people are different while high on different drugs. I’d hate for someone to have to work with me when I’m dopesick, though I also don’t put people into situations in which they have to work with me when I’m actively high. I’d take it on an individual, case by case basis. In terms of things like pro-domme work in which drugs that affect coordination or judgement might imperil the client or other workers, there’d have to be heightened consideration in pre-scene negotiation about that sort of thing.

    • As a porn performer I have experience working with other performers who were using during our shoots.

      Like Amanda wrote above some couldn’t work unless their minds were altered and performed very poorly because of it (falling down, passing out, spacing out and losing track of what we were doing). This was difficult for me to deal with on a personal and professional level. Having some needing to be that high to have sex with me was troubling and in terms of professionalism them being high affected the production of the content and was often a waste of time and money because we could not use it in the end.

      I just wanted to share a bit from the porn world (two sex workers working together versus a client & worker interaction) to this conversation.

      I appreciate the insight I have received from sharing their experiences. There is a lot of diversity when it comes to our experiences as sex workers and our other choices/behaviours/etc and I am not confident we can speak with one voice but sharing our stories is still so important.

    • The litmus test is, are you ok being around other people at work who are using prescription drugs? If so, you’re a hypocrite with regards to mind alteration.

      And your use of the phraseology “function well” is patronizing (“speaks to how well the sex workers in this roundtable function”).

  19. Thank you for this really thoughtful and thought provoking discussion and blog. The interface between drug use, and particularly injecting drug use, and sex work is of course challenging given the multiplying stigmas. There is a mistaken view that we each have enough battles to fight in both the drug using or sex work communities to support each others’ struggles or to address the multiple challenges faced by drug using sex workers.

    The political agendas and nuances in each community are also complex and this can make advocates stand back for fear of getting it wrong. However, through debates like this one and shared advocacy and collaboration, these challenges can be overcome and mistakes become chances for learning among friends.

    So as a drug user activist, who is not a sex worker (a fact not a judgement), I am happy to see my community and its networks starting to publicly embrace and understand better the issues faced by our allies and friends in the sex work community. I am also pleased to see how this public solidarity has given permission to sex workers in drug user networks to speak out with greater confidence, helping us become more accepting and understanding, and making us realise that a failure to be publicly acknowledging leaves our peers fearful about talking about sex work which undermines all our struggles and means that our networks inadvertently are not as welcoming as we want and need them to be.

    The challenge for non-drug using sex workers is not whether to embrace or endorse drug use, it is instead to understand that demanding human rights for oneself without respecting and supporting the human rights struggles of others, shows a complete lack understanding of the fundamental premise of human rights. To defend this oxymoron is moronic unlike this blog which is an education. Thank you!

  20. “I also feel no need to numb myself from the mundanities of escorting, though I might occasionally feel the need to put a damper on the whorephobia being blasted at me from all sides.”

    I’m not currently using anything really except alcohol, but when I get the urge to go back to familiar friends / chemicals, it’s def coz of the whorephobia. It makes me feel like I’m fucking crazy, and all the psych shit about “well no wonder you’re nuts you’re a worker” doesn’t help. It makes me feel so incredibly hopeless, and makes me wonder if I’ll ever get adequate mental health care. It’s that which calls me to use again, not the work per se.

  21. Wow. And that’s why I will forever fight for the rights of *every* sex worker, and apparently whenever I say I’m a sex worker I’ll have to add “but not a sex worker who believes in hierarchies” O.o

    I have a lot of privilege but I never ever ever forget that my privilege is what keeps me from getting arrested and allows me to work indoors. It’s what kept me from being arrested on CL. It probably helped keep me from being abused on CL. Had I less privilege maybe I’d need more coping mechanisms. Who knows?

  22. Not the point of this post but there is a difference between drug use and drug addiction. Drug addiction IS a medical diagnosis for a medical condition that needs a medical intervention and treatment-like hypertension, diabetes or major depressive disorder. This is what medical science tells us and this is what we use to defend access and funding to standard of care drug treatment such as methadone or suboxone. This of course is not the AA/NA position. AA/NA call alcohol/addiction a “disease” but are against the use of medical intervention to treat it. This position has taken the lives of many people, who could not stay alive simply clutching their NA chair.
    Important topic, thanks for firing it up. Had to chime in on the “addiction is a choice issue” because whoa, it just ain’t that simple and this post was all over my facebook page.
    P.S. Decriminalizing sex work, drugs and migration would be a very good start to a healthier, happier and more just society.

    • As someone whose teeth have been completely destroyed by methadone–I have to get dentures from my top jaw in the next few months, and I’m only thirty two–I can attest to this. Also, the horror stories from other users about detoxing from methadone in prison are just terrifying.

      • Kitty and Caty, it’s a sticky one and probably for another board but people are reading this and I want to contribute to shutting down the stigma of methadone. I have over a 33 year relationship with heroin, methadone and suboxone. Fact of the matter is that many of us who are heroin addicts could not stop using heroin without methadone. If you could or can, good on you. Yes, methadone is the longest hardest detox on the planet (done it too many times-locked up too and yes, it is horrific. That is why we fight for methadone access in all institutions), we are all missing our teeth probably because it reduces our salivary production and the methadone clinic system, which is the only way to get methadone in the U.S. for addiction treatment, is wrought with huge problems, BUT: Fifty percent of heroin addicts die from heroin addiction before they are 50 years old. That’s a huge percentage of our population. Of course, these numbers could also be greatly reduced if heroin was decriminalized but it is not the system we currently live under. I am going to be 50 in a few months and as much as I have suffered and I have suffered long and hard from jumping off, getting locked up or fee “detoxing” while on methadone maintenance, I also attribute the fact that I am going to be 50 years old in a few months to the other fact that for many of those years, I was able to walk into a methadone clinic and get my dose of methadone. Like hundreds of thousands of people currently on methadone maintenance, I could not have done it any other way. I am quite certain that people who have to take daily medications for hypertension, HIV, HCV, diabetes etc. wish they didn’t have those diseases and have to deal with the consequences of those medications either. Many of us got hit with a few on this list because of our injection drug use. And that really sucks.
        Here is where the stigma part comes in. I know you didn’t mean this but ironically, the same arguements you have made against methadone are the same ones used by those who further the law enforcement model of treatment, as opposed to addiction is a medical condition that requires a medical model of treatment. They were also the same arguements used to further stigmatize the methadone population. All your agruements we had to fight to the ground, when methadone treatment funding was going to be cut in the state of California. Drug treatment is always underfunded and cut while plenty of money is always in the budget for police, jails and prisons-which we all know and abhor.
        Harm reduction, that’s what methadone is for the vast majority of us under our current system. I think we can all agree that the whole system of criminalizing drug use and drug addiction and sex work needs to be overthrown. I guess that is how we all found our way here.
        Max Southwell, what you said, right on.

    • Lisa, just want to reply to your other comment, b/c it doesn’t seem like it has a reply option for some reason. While I’m dissatisfied with methadone and suboxone as the only opiate substitution drugs available in the US–people do really well with prescription diamorphine in Britain, for one–I’d defend people’s right to take them to the death, and furthermore, their right to continue to be provided with methadone and suboxone in jail. I wasn’t saying that methadone isn’t an important harm reduction option, just that there are obvious problems with it, as well. I myself am on methadone now, though I still use a lot, also, and it’s made my life easier in some ways.

      • What we need everywhere, now, is what the Dutch call Low threshold methadone. It’s for people who don’t want to stop using and don’t want to be on methadone everyday. In short you register for the program (yes that’s a problem, but…) and on a day where you can’t afford your smack, or the dealer didn’t turn up, or you don’t feel like wasting your little bit of cash on a hot you won’t feel, you just rock up and get a single dose of methadone so you don’t have withdrawals. It’s often sold to communities as crime (burglary and mugging) prevention cause (mostly) straight guys don’t have to rob a house or mug someone to get cash when their usual earner hasn’t worked.
        Of course what we need everywhere also is decriminalisation but this sort of programme would have made my life so much better as I was on methadone for 15 years but only really needed it a few days a month…..

          • We nearly got it in Australia in the early 90s but the ‘drugs are bad, that’s not real treatment’ people won out. I’m not even sure they still have it in the Netherlands but I’ll try and find out. I mean compared to daily methadone or the pie in th sky of legal heroin it’s the most user friendly and useful model I’ve heard of.

    • It’s really an aside here relative to the larger issues & processes going on, but I just wanted to pick up on the language issue raised. To me, it’s important to recognize that terms like “addict” and “addiction” have meanings that are contextual. Different people are going to use them in different ways, and I think it’s important to be clear on that, so there isn’t miscommunication, while also still allowing each other space to use the same terms in different ways. I don’t think it’s a great idea always to “correct” use of language because I think the same term can have different value and utility when it’s used in different ways in different contexts.

      In providers’ work, addiction is by definition something that’s causing a problem(s) for someone, and that’s distinct from dependence or other using behaviors. For example, if a dependent client/patient chooses a baseline substitute therapy but adds supplements, there’s a lot more info I need to tease out to determine what, if anything, is needed at that point. Is she telling me this just as a matter of honesty, or is she sharing because she needs help with something? Are the supplements being used the same way someone else might use an evening cocktail (dependence + recreational use)? Then making sure she’s aware of safety measures & has access to materials & knows how to use them would be the intervention. Is she telling me because her maintenance therapy is inadequate & needs adjustment (still just dealing with dependence management)? Or is she telling me because there’s an addiction (something she defines as a problem for herself) issue or relapse on top of the dependence issue? Are there other things going on (coping with grief, trauma, depression, psychosis, etc.), and if so, what does she need and want to do about those? So, for a provider, it’s important to hang onto those conceptual distinctions between use, dependence and addiction (it can help to remember that apart from substances, something like gambling can be a powerful and destructive addiction/compulsion, for example).

      When I read “addict” or “addiction” here, I’m often inferring some political and social associations that people probably (or at least might) want to hang onto. From a harm-reduction provider perspective, I use language a little differently, in ways that are not only essential for ease of communication among providers, but also that (I hope) are ultimately useful to users as well within that context. But I also recognize that users may find value in using language differently in their/your spheres.

      In general, I think there’s value to letting marginalized populations determine language usage, but “addiction” with its specific meaning within harm reduction is well-entrenched, fairly well-understood, pretty consistently used, and certainly rolls off the tongue a whole lot easier than “the-phenomenon-in-which-drug-using-behaviors-cause-problems-which-the-user-chooses-assistance-with-and-which-are-above-and-beyond-dependence-whether-only-because-of-war-on-drugs-and-stigma-and-criminalization-context-or-because-of-other-factors-in-addition-to-war-on-drugs-and-stigma-and-criminalization-context.” At the same time, I think for users, “addict” can be a powerful reclamation of language and a means of connecting with one another… and it certainly is more recognizable and rolls of the tongue more easily than a different long string of words attached by hyphens to show that they’re intended to remain together conceptually. So, there’s no way I’d want to take away any users’ preferred usages, just as I hope no one tries to take away mine unless it’s perceived as offensive in context. To me, the important things are to understand what we each mean when we communicate with each other and to interact in a way that’s mutually respectful.

  23. This conversation is blowing my mind. I’ve often justified working as a stripper with, “Well, I dance so I can pay for school and it’s not like I use drugs or anything like that.” There’s a huge stigma associated with drug use + sex work, and I’ve never recognized it as such. My personal politics have advocated decriminalizing both for a long time, although I haven’t connected the two until now.

    I use alcohol to get through my shifts, but never anything harder; I’m afraid of becoming addicted or losing control of my boundaries, and I really hate coming down. Other women at my club use pills and cocaine, which has made me uncomfortable, probably due to the stigma discussed above. Thanks for this! I hope everyone is safe and well.

    • Thank YOU. I appreciate your being open to this!
      I find the interesting thing about alcohol is how people don’t class it as a hard drug. It’s actually the most destructive drug in terms of one’s health, causing organ damage and cognitive damage in a way that most class A substances don’t come near to doing, one can die withdrawing from it, and it’s the only drug causatively correlated with violence in studies.

  24. Many of the comments show a misunderstanding of how drug users are treated in both drug treatment services and mental health services. How can we as a movement be against mandated things like ‘John Schools,’ but accept its ok for sex workers who use drugs to be sent to mandated programmes to get on methadone, get a reduced sentence or stay out of jail? A discussion on this in particular issue might be a good part three Caty if you’re up to doing it….. (Ie forcing us to discuss and contribute)

  25. right and I guess you better also qualify that with “but not and hiv+ sex worker” etc, do you see where i’m going with this? the list will go on and on to separate yourself from the “other” or marginalized sex workers. We are here, Beatrice, and we aren’t going anywhere.

  26. I have mixed feelings about this post. I appreciate everyone telling their stories and expressing their feelings. I have the odd experience of being both a sex worker and a healthcare professional. I had a patient who was my age, a sex worker, and a IV drug abuser. Initially we thought she was detoxing but she ended up having a vegetation on one of her heart valves from the IV drug abuse. She had to have open heart surgery. Our cardiothoracic surgeon wouldn’t touch her. I spent a night calling every favor in and finally was able to get her transferred to a larger hospital that would take a chance on her. Now she lives with her mom and is able to take of her daughter again.

    I think it’s easy for drug users to say “oh, I’m just going to do this for fun” but soon it changes. It’s no longer something you use, it uses you. Not to mention it impairs mentation and can cause a host of terrible effects from cardiomyopathy to rotting teeth. You cannot be a sound businesswoman/man if you are impaired. One might extrapolate that behaviors on drugs would be different than sober and this could put the person at an increased risk of harm. I know sometimes drugs are used to treat psychiatric issues but that’s only a band-aid, it’s not going to fix the problem.

    • But don’t you agree that decriminalization would reduce a lot of these harms? Sounds like it was *stigma* against drug users that made it difficult for your patient to access care, and plus, cardiac problems for injection drug users would not be as common if they didn’t have to buy adulterated black market drugs and if they weren’t often forced to inject in unhygienic conditions because of the drug war and lack of harm reduction education. Also, all the sex workers involved in this round table made it very clear that they didn’t work high. Many drugs–such as opiates–have been proven not to affect people cognitively in the long run the way that legal drugs like alcohol do. Also, casual use is the most common form of use. Finally, legal psychiatric drugs are themselves a “band-aid,” and are often more harmful in terms of side-effects than many illicit drugs. I wouldn’t disparage people’s coping mechanisms.

      • I object to the notion that psychiatric drugs (or any drugs– but I don’t know enough about most drugs to comment on that, really) are a ‘band-aid’. SSRI’s work for my OCD the way insulin works for diabetes; just because it’s an on-going thing doesn’t mean it’s a temporary solution or somehow doesn’t address the root of the problem.

        • I have a lot of problems with the whole insulin/diabetes metaphor when talking about psych drugs, which is not to say I have a problem with the people they do work for, or that they can’t be a solution for some people–you’re right, I should’ve been clearer with my language there. But this is a whole ‘nother conversation.

          • I don’t disagree that prostitution should be legalized. I wish it were. As for why she was initially denied surgery, it had nothing to do with her being a sex worker. The vegetation made her septic and you should not do surgery on someone who has a raging infection. It was a huge risk for anyone to take her. Anyway, there was a multitude of dynamics involved.

            As for psychiatric illnesses, I don’t suggest people use drugs or alcohol as their medicine. I have done this before, somewhat unknowingly at the beginning. During grad school, I felt like I couldn’t concentrate so at night when I was studying, I’d drink. I ended up later having a full blown panic attack and knew I needed medical help, not alcohol. And yes, there is scientific fact that mental illnesses do exist and there is an imbalance of neurochemicals.

          • Um, it’s not as clear cut as all that: “there is scientific fact that mental illnesses do exist and there is an imbalance of neurochemicals.” Neuroscience really knows very little about how the brain works. Even the rationale for SSRIs–that people with the mental illness called “depression” don’t reuptake seratonin efficiently–has been questioned in studies not funded by pharmaceutical companies, in which they found that people labeled with depression varied from reuptaking seratonin MORE efficiently, to doing so at a normal rate, to yes, doing so less efficiently, but they didn’t do so more often than people in the control group.
            This isn’t a fringe movement–there are plenty of respectable sources that hold this belief, scholars, award winning journalists, neuroscientists, and psychiatrists:

            Which is not to say that intense mental suffering doesn’t exist, nor that sometimes the biomedical model can help. But it also often doesn’t, or harms people further. It should not be the dominant and only discourse.

            As for self-medication with drugs and alcohol, alcohol is perhaps the most dangerous and damaging drug out there, so I don’t think its use is representative. Plus, people use drugs for a wide variety of reasons, only one of which is self-medication.

          • AGREED Caty, right on. And as you know I’ve been forcibly injected around this stuff. It’s not about what’s good for the “patient” – it’s about society’s comfort level.

            Neuroscience absolutely does not know very much about how the brain works, this is so freaking true. At the point at which you are talking about individual neurotransmitters, you are basically at the point of discovering the electron (1897), and acting like you can describe the functioning of a computer (note that the human brain is considerably more complicated though), on the level of the functioning and mechanisms/algorithms performed by the software. At the point that you are looking at pretty pictures of electrical activity in the brain, you’re looking maybe at a general level at the read-write patterns on the disk (or SSD). You can see how both of these are “missing the point” in a huge way. The reason, IMO, is that neuroscience hasn’t really had any significant breakthroughs yet, not on the level of patterns of communication among neurons giving rise to functions of the brain. Until it does, most of the experiments that are performed are more or less trivial. Kind of like the experiments done by working ecologists – trivial, foreseeable results – and if you disagree, think about how scifi shows depict people being able to come in and alter ecological systems in ways that will FIX them. Imagine if we could do that!!

          • I really didn’t want to have this conversation (like, at all, but especially in this thread), but I’m shocked at how much ableism is coming out here. You don’t have to agree with or ‘believe in’ psychiatry or science as a whole (and as someone who’s been mentally ill nearly my entire life and is capable of critical thinking, I have entertained the same ideas as you, believe it or not, and come to different conclusions), but you don’t get to decide what mental illness is and isn’t for everyone else. Mental illness is a physical illness for me, in that it is based in part in my biology and affects my physical functioning. It literally affects my ability to move my body (http://en.wikipedia.org/wiki/Psychomotor_retardation).

            I use ‘legitimate’ physical illness as a comparison point because explaining my experiences with mental illness to everyone all the time gets tiresome, and they’re dismissed anyway, and people seem to have an easier time accepting that diabetes isn’t an idea you need to get over or a motivation issue or a character flaw. My mental illness is like diabetes in that going without my medication nearly killed me, I have to take my medication regularly in order not to have a crisis, and my medication fixes a chemical imbalance I have. That could kill me. So, you know, in the big ways it is very much similar, and I dare you to try to tell me that I don’t know my own body well enough to know that this isn’t some hype I bought into. And if more people thought of mental illness as being like diabetes, I wouldn’t have had my basic human rights taken away half a dozen times in institutionalized settings.

            You can argue all you want that mental illness in general is just a bad thought pattern or a social construct or thetans, but you don’t know my body and my life better than I do (does this sound familiar?), so you don’t get to tell me what MY mental illness is. My life and experiences are not unproven. I am examining my own experiences, my own body, the research I’ve participated in, and all the research I’ve read about and telling you that you are wrong. I do not ‘feel’ helped by meds; I am helped. And I’m shocked that I have to have this conversation here of all fucking places.

          • I am truly sorry that I tried to tell you how to run your own wellness and your body. That wasn’t my intent, but intent is for the birds, if you heard it that way. Your body and your own way of managing your mental health are just that, yours.

            I just still have a problem with the universal comparison between psychiatric drugs and insulin. I do feel those suffering from mental illness are disabled, I just don’t agree with the standard definition of mental illness.

          • That was mostly a response to Kitty, actually, at #comment-11809. I probably should have been clearer.

            And, sure, the psychiatric drugs – insulin comparison isn’t perfect, but it’s pretty damn accurate. Not everyone with diabetes needs insulin, but for those who do need it, it’s not just a placebo, and not taking it can have devastating effects. The reason the comparison is used is because it helps legitimize mental illness as a real disability, not because mental illness is always biochemical in cause like diabetes.

            I also don’t agree that the biochemical + medical models of mental illness apply to everyone, and I know firsthand that psychiatry is massively flawed and fucked-up. But that doesn’t make them totally illegitimate, especially for those of us for whom they do work. Kitty’s comment implied that they don’t work at all, except because we ‘believe’ they work, but that just isn’t true.

          • I’m not sure if you’re responding to my comments or those of others? Anyway, in the mad movement, we’re kinda agnostic about what mental illness is. We totally respect those who feel the biomedical model works for them, and those who don’t. I’m sorry if anything I’ve said implied otherwise. I don’t like the insulin/diabetes model used for EVERYONE, as someone who was diagnosed with a shitload of pejorative diagnoses (bipolar, boderline personality disorder) when I was a teenager, force medicated, and psychiatrically incarcerated, I also get to say what my “mental illness” is or isn’t. But by saying that I’m not trying to deny you the right to interpret yours in a different manner, or saying I know what it’s like to live in your body, and I’m very sorry if anything I wrote implied otherwise. I’m NOT with people who want to convert everyone to one discourse about what mental illness is, whether that discourse is the biomedical model or an irresponsible Adbusters DAMN THE MAN DON’T TAKE YR MEDS NOTHING’S WRONG WITH YOU WHAT ARE YOU COMPLAINING ABOUT approach.

  27. I think adherence to the AA/NA line on drug use as THE truth about drug taking/addiction is pretty much confined to North America and to drug treatment workers in the UK.

    That’s certainly not my experience Andrew.

    I’ve run across several drug treatment workers around Sydney who are doctrinaire NA folk (I’ve worked with NUAA and the Hep C Council, so I’ve met quite a few in that line of work).

    Then about fifteen years ago I needed help with my own major depression. When I told the nurse at the Ashfield Community Health Centre I had been a heroin user who had cleaned himself up about twenty years earlier she insisted on marking me down as ‘dual-diagnosis’ and refused to refer me to depression counselling until I’d completed an NA twelve step program. Ultimately I had to overcome my own depression just as I had overcome my own heroin addiction in the early 80s because I couldn’t get into any non-cultist rehab programs.

    The black dog came closer to killing me than the dragon ever did too.


Please enter your comment!
Please enter your name here

This site uses Akismet to reduce spam. Learn how your comment data is processed.