My boyfriend, John, wordlessly handed me two and a half pills, 25 milligrams of street-bought methadone. I’d been huddled dopesick under the blankets all morning, waiting for him to return to our tiny room in the SRO housing unit, knowing we were broke and hoping he could work some of his resourceful magic to get us something to feed both our habits.

This article was originally published by The Influence, a news site that covers the full spectrum of human relationships with drugs. Follow The Influence on Facebook or Twitter.

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This is what he’d come up with. It was all we had, and he gave it to me, because I was the one who had to go to a session with a client in an hour and so I was the one who needed it more. As an ex-street sex worker himself in his younger days, he knew that. So he didn’t begrudge the couple of hours of sickness he’d still have to withstand, waiting for me to bring home cash we could convert to enough heroin to actually get us both well.

I took the chalky pills dry. Even the sensation of swallowing hurt. Everything did. I knew that this dose of methadone wouldn’t beat back the withdrawal all together, not with the enormous habit I’d cultivated. John, with his old school Vietnam-vet-dopefiend lingo, called it an “oil burner.” But the pills would get me well enough to move, to function.

As I waited for them to kick in, I shuffled off to the grimy communal bathroom downstairs to wash off that goat-like smell of sick. The shower brought a brief respite—all those endorphins from the hot water momentarily filling in for a brain that’d gotten too used to dope doing the work of producing those feel-good chemicals—but convincing myself to get out of it was a struggle.

I slathered on deodorant. The cheap smell of it overpowered my irritable senses until, for a moment, it felt like the only thing in the world. I shivered and shook off the sensation, plastering on a layer of foundation across the track marks on my arms. I contorted myself into my stockings—always put them on over wet legs, I remembered a whore mentor saying,they’re less likely to run that way. These stockings already had a few tears in them, but luckily, they were all situated on the inside-facing sides of my legs. Then I threw on my work outfit, some thrift shop’s version of the Little Black Dress. Even my own touch made goose pimples crawl up my skin.

I put on chapstick and lipgloss on, mascara, eye shadow. Then I dipped my finger into the tub of mentholated chapstick and put some on the inside of my nostrils, to keep me from sniffling and to try to stave off the stink of, well, everything. Struggling to open a blister pack of store brand antihistamines seemed like an impossible challenge until, finally, I fished the tab out and swallowed that too, to ensure my nose didn’t run during the appointment. The last touch was a pair of plastic sunglasses, to hide the dilation of my pupils and keep my eyes from watering until I was safely inside the dimly lit motel room.

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I was ready. Staring at my reflection in the bathroom mirror, the performance of sex work felt like a particularly shoddy thing right at that moment. How do men buy this? I thought, examining my hag-ish face. But I was still sufficiently young and lithesome, and that was apparently enough. After all, I’d gotten away with this enough times before that I knew this transformation from loathsome, detoxing wraith to bargain-basement sexpot could and did work.

***

The junkie-in-withdrawal is the distillation of all the worst stereotypes of heroin users. Think of movie depictions of the whining, sniveling dopefiend in duress, willing to do anything and fuck over anyone to get well. Though these are images that come from people driven to desperation by the economic and legal constraints of an unjust drug war, they’ve still come to represent us in many people’s minds. And the position of the detoxing, opioid-using sex worker in particular lays the capitalist transaction of sex work bare: The dopesick whore isn’t with you because she truly likes you, with the money you give her simply serving as a pleasant afterthought, to pay for her cab fare, perhaps. No: She needs your cash, now.

So it’s no wonder many sex workers hide their withdrawal from clients in order to keep up the middle-class pretense of prostitution, the emotional labor for which many men are truly paying.

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“I’d jump in for extra showers—’this is a work out, getting sweaty’—to hide the clammy sweats and give myself little breaks on longer shifts [at the brothel],” recalls Briana, an Australian worker. “If I suspected they noticed the sniffling, I said allergies and made a story up, spun something.”

“Obsessive cleaning and heavy makeup, to take away the sweat and filth of a detox and cover the bags under my eyes, gave me enough cushion on a few occasions to get through a session before looking too sick,” recounts Fae, a trans West Coast escort. “Imodium (loperamide) in high doses helps with the nausea and diarrhea well enough for me to receive anal.”

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Luckily, despite the current heroin and prescription opioid epidemic, our bourgeois clientele often has no idea what dopesickness looks like.

“I feel like most people who don’t do heroin don’t really know the symptoms of withdrawal,” explains Lilyana, a New York State street worker. “I’ve told clients that I had a cold or even the flu once, when I actually threw up at a session, and they literally seemed to believe me.”

“Most white upper-class clients were too detached from the realities of addiction,” echoes Fae. “[They] frequently accepted such diversions as, ‘Oh, I have the flu, but I’ve been on antibiotics for 48 hours, so I’m no longer at risk to infect you.’”

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“Those sort of guys aren’t imaginative—they didn’t seem to pick me for a junkie because they expect stereotypes and exaggeration,” Brianna scoffs.

There are, of course, also predatory clients out there who count on the added vulnerability of withdrawal exacerbating the already criminalized and stigmatized nature of sex work in order to exploit us.

“Some of them had a fetish for it,” ex-street worker Connor remembers. “It was heroin chic…tall, skinny, gaunt even, loose clothes, and a habit. On top of that, I have deep blue eyes and shaggy brown hair. It was a common look among males in that particular scene and a lot of johns (particularly repressed […] dealers) really liked guys like that. I tried to avoid really manipulative people. I knew kids who practically became sex slaves for heroin because of certain pieces of garbage.”

“Some of us are pretty sure some of our former friends and acquaintances were abducted and killed because of those type of people,” he continues, “though that’s just speculation.”

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But you don’t have to run the risk of being abducted or murdered to feel subtly used by a client when you’re dopesick.

“I had an anesthesiologist customer [at the club], who found out about my addiction and would give me two or three Percs for free,” recounts Sydney, a pill using stripper, “but he deftly got more out of me than he should of.”

“I’ve had clients who’d only book me if I missed their call by a few hours and sounded less than exuberant on the phone,” Fae remembers. “Some would offer me to see them for shorts if I ever ‘needed it.’”

“I had one photographer that would shoot me for Barely Legal who knew of my situation because he was an ex-addict,” Lilyana tells me. “I definitely agreed to do some ridiculous photoshoots that in retrospect I feel were seriously exploitative of my circumstance—I was 19 and homeless.”

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“Even though I would argue with him about my limits,” she relates, “I feel like he knew I was homeless and that I had an expensive habit, and so he exploited that factor in getting me agree to do stuff I was uncomfortable with. It’s a terrible feeling to know someone has that sort of advantage over you and makes you feel incredibly powerless.”

Clients aren’t the only ones that take advantage. Brianna tells me there’s management in Australia who center their scheme entirely around profiting off opioid-using workers in need: “I worked one night in the parlor that will pay you gear, [though] I was given cash. They are sneaky, manipulate it so girls owe when they would not have scoring the same amount. Now, in that place, the guys coming in expected way more and would take advantage because it was common knowledge a lot of junkie girls worked there…the clients were awful, expecting desperation and degrading you.”

“I was well dosed that night so told them where to go and made less money than I usually did,” she continues. “But enough to score!”

Often, though, simply enduring sex and conversation with an oblivious man while detoxing can be torturous enough, without any malign intentions on the client’s part. Imagine every sensation you have translated by your nervous system as pain. (I have to laugh when people compare opioid withdrawal to bad flu symptoms without including this detail.) Now imagine being the brightest, perkiest version of yourself while expertly providing someone with a memorable sexual experience, all while experiencing this pain.

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It’s an ordeal that’s so bad that one opioid using sex worker I interviewed for this article, Callie, had to bow out.

“I’m trying to remember a specific incident where I worked dopesick—I know there have been a ton—and I’m drawing a total blank,” she tells me apologetically. “Which I guess means I blocked it out.”

“There was a few times when I was so scared I would shit myself while the client was thrusting,” Brianna reflects. “Especially because when I had eyes watering and nose running I would get them to do me doggy style so I could surreptitiously wipe my nose, but doggy style can be the hardest to control how hard they thrust. [A few times I] had to run off to the toilet very quickly [and get] a drink for the client on the way back to sweeten how long I was gone for.”

But sex workers are resourceful. For every opioid-using sex worker, there are a thousand methods of avoiding work while detoxing, or at least making the experience bearable.

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Sometimes stage-managing a session is the best option when detoxing makes almost all prolonged sexual activity uncomfortable.

“I’d change my head style, more licking than having the cock deep in my mouth, then do [a] vibrator show for free, or touch myself to distract them from getting less head than they expected,” Brianna confides. “I [w]ould switch things up, can’t stand this, switch to that! Then when that is getting gross, switch again! You come quickly from withdrawals so often the clients were pretty distracted by that, thinking I was having a great time.”

Fae agrees, explaining, “Bottoming, as opposed to my usual versatility, required less effort. Laying on my back and taking it is much easier than having to top.”

She also has some more general tips for detox contingency plans: “I’d always keep an extra couple bags when I ran out. Even when I was two days in[to withdrawing], I had the integrity to not use it—until I got a call,” she details. “I knew it was worth it and it saved me tens of times. If I didn’t have any extra bags, there were always cottons [used to strain previous injections]…or a Suboxone strip waiting for the moment I got the call.”

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“As a junkie, you learn every trick in the book eventually, from hanging out with dealers to faking prescriptions,” Connor explains. “Sometimes, if there wasn’t any dope in town, we’d just go to the local Winco and buy a few pounds of unwashed poppy seeds. Called it ‘shake.’ You basically just shook water and the seeds together, strained the water, and drank it. Like liquid opium, if you got a good batch. Kept me going through some rough times.”

“Then again,” he adds ruefully, “sometimes, you really can’t prevent something like your dope dealers getting raided or a bust at the border fucking up a shipment to your area.”

Often, when worst comes to worst, it’s only other opioid-using sex workers who will help you out.

“Finding the other junkies when I started [at a new brothel was always a good idea], because chances are they had a delivering dealer if I hadn’t organized [one] yet,” Brianna says. “They’d understand. Had a nice older worker give me half a bottle of methadone once. And later she hooked me up with two long-time dealers.”

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“Another time,” she continues, “a fellow worker gave me an Oxy—she worked with a cracked back, used heaps of heroin, and was prescribed OxyContin.”

“I had a clique that stuck together,” Connor tells me, “and we were some pretty tough people, so [the] type of people [who liked to take advantage of sick sex workers] weren’t interested in trying to wrestle bulls.”

Eventually, though, no matter what safeguards one builds into one’s routine of use, the pain of episodic withdrawal coupled with the desperate financial need to work become too much. Two of the sex workers I interviewed for this piece eventually kicked the habit all together. Two of them got on MAT (Medication-Assisted Treatment) for harm reduction purposes, if not for abstinence. Suboxone and methadone programs at least guarantee that you don’t wake up nightmarishly sick every morning, looking forward to having to work in that condition if you haven’t been able to plan ahead.

“When I got on methadone, I thought, ‘Why the fuck didn’t I do this sooner?’” Brianna exclaims.

I’ve been on methadone myself on-and-off for the better part of a decade. But MAT is not a comprehensive solution to the lows that opioid-using sex workers face. There aren’t enough treatment centers or enough slots in those treatment centers to offer a place in a program for everyone. And there isn’t enough funding to expand treatment access, because although MAT is demonstrably more effective than other forms of treatment, the old myths about methadone being a crutch for those who lack willpower linger. And criminalized sex workers who can access the treatment then have to worry about that horrendously more painful detox from a long-acting opioid like methadone or Suboxone they’ll suffer in jail, should they be arrested—since MAT is not offered in the vast majority of US prisons and lockups.

MAT also does nothing to address the power and class imbalance between marginalized opioid-using sex workers and their clients. As drug users and sex workers have been saying for decades, the only way for us to begin to ameliorate conditions for both groups is to end the War on Drugs and decriminalize prostitution. Only then can we also address the unique vulnerability of those who belong to both stigmatized populations.

This article was originally published by The Influence, a news site that covers the full spectrum of human relationships with drugs. Follow The Influence on Facebook or Twitter.