"One and done is the rule for using needles," Nicole*, an 18-year-old from Long Island, New York, writes on her Tumblr, nicolethedopefiendqueen. "After you use it once, dispose of it (capped, in a sharps or other container); you really shouldn't be reusing needles if you can help it. A fresh, new needle is always better than a used one, even if it's been sterilized."
Nicole is an active heroin user. In an email interview, she said she began using at 14 after coming across her terminally ill father's OxyContin prescription, which eventually evolved into heroin use. On her Tumblr, she posts selfies and re-blogs moody screengrabs from drug movies like Trainspotting, as well as close-up shots of spoons, lighters and syringes.
But to hear Nicole tell it, she doesn't just use Tumblr as a platform for blogging about her heroin use. She also teaches other users how to do heroin safely. Her blog contains information about what to do if an overdose occurs, as well as how to administer Narcan (naloxone), an emergency antidote to treat opiate overdose.
"I decided that if I'm going to have a drug addiction blog with lots of followers, I must spread harm reduction information, because addicts deserve to be healthy and to live," Nicole said in an email interview. "I advocate for safe intravenous drug use, especially to help prevent infection and overdoses."
Heroin addiction is a rapidly growing epidemic in the United States. The Harm Reduction Coalition reports that overdose is the leading cause of preventable accidental death in the United States, second only to car accidents. Since 2000, opiate overdoses have increased by 200%, in large part as a result of an increase of pain medication prescription, the Centers for Disease Control and Prevention reports. Because pills and heroin are sold on the black market, opiate use can be difficult to track, but a 2014 report estimates there are 1.5 million "chronic" heroin users in the United States.
Nicole's blog is one of many on Tumblr that track the lives of regular opiate users. Many of such blogs' posts feature the hashtag #nodsquad, a community that curates images of drug paraphernalia as well as information and resources promoting safe drug use.
Such blogs are based on the principles of harm reduction, which aims to reduce harm associated with drug use, such as overdose and spread of diseases like hepatitis C or HIV, through counseling, opiate substitution programs like methadone and safer injection facilities, or legal, supervised injection facilities where people can use heroin under medical supervision. (There are currently no supervised injection sites in the United States, but some cities and states like New York have toyed with the idea of introducing them.)
As Nicole explains it, "harm reduction is about reducing the damage and harm done from using. It's not about stopping use, it's about safety, which is the realistic approach to saving addicts in this epidemic."
It's a strategy distinct from abstinence-only programs such as traditional 12-step recovery methods, as harm reduction psychotherapist Eddie Einbinder said in a phone interview. "Harm reduction is not anti-abstinence," Einbinder stressed. "Harm reduction is pro-choice."
Susan E. Collins, co-director of the Harm Reduction Research and Treatment Center, thinks Tumblr blogs like Nicole's can help to reduce harm caused by heroin use.
"[Nicole] is a person who appears to really care about her community, and is trying to help people use safer," Collins said in a phone interview. "She is trying to reduce harm, and is being honest about where she's at and her recovery. Personally, I think all of that is really admirable."
Social media has created a space that didn't previously exist for active users to connect with others and share information about how to use drugs safely, such as how to sterilize a needle after use.
"A core concept of harm reduction is meeting people where they are, and I feel like most people don't spend their spare time reading up on harm reduction techniques. But people spend time on social media like Tumblr," Caroline, who keeps her own harm reduction blog, fuckyeah-harmreduction, told Mic in an email.
"Having a resource for harm reduction information on a platform that people are already using is a great idea."
Caroline is not a user, but she became involved in the movement through a harm reduction organization she volunteers at in Washington, D.C., most often doing needle exchange or distributing safer sex supplies.
That said, some of the information being shared on Tumblr, such as user videos on how to shoot up safely, can be shocking to watch for those unfamiliar with intravenous drug use. Such videos, as well as artily lit images of spoons and stashes, has prompted debate as to whether such blogs glamorize drug use. It's also worth noting that some users visit the blogs as a way to find drugs, if asks from users looking to score in a new town or city are any indication.
"Could it glamorize the use? I think yes," Einbinder said in a phone interview. "It is hard to create a completely objective vision when you're creating different forms of reality."
"Could it glamorize the use? I think yes."
Other professionals agree that the Tumblr community has potential for both help and harm.
"On the one hand, users are often the experts of their experiences and their own needs. If a user is generating content which is informed, safe, promotes hygiene, and teaches people how to reduce risks, then it can be powerful and helpful in a way that resonates with other users," Sheila Vakharia, a coordinator of a substance abuse counseling concentration for students at Long Island University, Brooklyn, said via email interview.
"However, if user-generated content is full of people doing things in risky, unhygienic ways or if they are sharing false, mixed, or un-researched information, it can be just as harmful as any other problematic content on the web."
The blogs also raise the question as to whether Tumblr has any obligation to monitor content that promotes drug use on the platform. (Mic has reached out to Tumblr for comment, and have not received a response at the time of publication.)
"I don't necessarily think that platforms have a responsibility to monitor drug use content because it seems like a slippery slope," Vakharia said. "I also understand that sales or advertisements of illicit drugs are in violation of laws. However, instructional videos from the health professions show doctors/nurses injecting patients all the time. Should a video of a person doing it to themselves be censored because the vial is filled with a substance that we think is illegal?"
Bloggers like Nicole are aware that not everyone is pleased with their message.
"People argue with me and say I'm enabling users by providing them with resources to avoid disease, but it's not, because if all harm reduction measures were taken away addicts would still use resort to unhygienic, unsafe practices in order to get high," Nicole said. "I wish the myth that harm reduction is enabling would disappear. It is so ignorant and spreads misinformation that is contributing to the stigma that surrounds addiction." This same stigma also translates into the everyday world, preventing users from gaining access to harm reduction services.
Yet aside from sharing information on opiate overdose prevention and reversal, some of the most frequent ways bloggers like Nicole help others are from intimate one-on-one interactions, such as reminding others not to mix OxyContin and Xanax, because she cares about them.
"I've been ridiculed, judged and talked bad about on Tumblr for my passion on harm reduction," Nicole said. "I've been told to give it up, that it's not important and not worth it, but I say every time addicts are very important and worth it. I do this [despite] all the hate I receive because these addicts' lives matter to me."
*Last names have been withheld to allow subjects to speak freely on private matters.