She Used Meth Daily for Three Years and Says It Helped. Harm Reduction Never Built Anything for Her.

Kastalia Medrano, a deputy editor at Filter, writes that she used methamphetamine daily for three or four years and that it helped her manage hard circumstances. She says it also helped keep her husband alive for about a decade. She is not writing a redemption story. She is writing about what the movement that is supposed to protect people like her built, and what it didn’t.

Harm reduction was designed around opioids, and the people who use stimulants got a tool kit written for someone else.

Her argument, published August 12, is that the movement has not built services around the people who actually use meth: queer and trans people, sex workers, people living with HIV or without housing, people already inside the criminal legal system. The drug gets treated as a chemistry problem to be managed. The people get treated as a policing problem.

The policing part has a number attached. Federal sentencing for methamphetamine is set by purity, not by weight like most other drugs. Medrano’s line for what that does: “Meth users are punished because the supply is pure.” Medrano reports that the National Association of Criminal Defense Lawyers told the Sentencing Commission in 2025 that methamphetamine “is now punished more severely than any other drug.” In its own July 2025 comments, the group called the 10-to-1 sentencing gap between “actual” meth and meth in a mixture empirically unjustifiable. The Commission spent the 2025-2026 cycle studying whether to erase that distinction. How that review ended is not confirmed here; the Commission’s 2026 amendments are the place to check.

The psychology underneath her essay is the part clinicians skip. If you have used a stimulant to get through a day that would otherwise have flattened you, you know the drug was doing a job. Medrano names that job in plain terms. Treatment that starts by denying the drug ever had a job loses the person in the first five minutes. The only stimulant-specific treatment with real evidence is contingency management, gift cards for drug-free urine tests, which she describes as the one intervention aimed squarely at this problem, and which is still not available in most places.

If you use, or love someone who does, the practical part: naloxone is cheap, harmless if you didn’t need it, and still yours to carry, whatever you take and whoever is in the room.

She wrote it from inside, and that is the only way it was going to get written.