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Citric Acid in Heroin: How Much is too Much?

Hi again,

Now many of you will know about this video -and the information that came out a few years back on citric acid and heroin -regarding ‘How Much is Too Much?’. But there are still many people who didnt see it and many people who are still using too much citric acid, not realising that not only are they damaging their veins more, but they are actually damaging / reducing the quality of their heroin! Yes, it is true readers! If you use citric or vit C (which is the same but slightly less acidic thus you need a bit more when mixing up) when mixing up your brown, black or beige heroin (this does not affect white heroin which should dissolve without heat or citric), and you haven’t heard about this issue or seen the video -then you MUST take 10minutes out of your day and listen up!

 

Citric_sachets_small

Order your sterile Citric sachets to your home in discreet wrapping, from Exchange Supplies, the good guys in business http://www.exchangesupplies.org/shop.php

So, this is a really good video from Exchange Supplies, every users favourite organisation and at the forefront of developing really useful user friendly, health and harm reduction information and equipment for the drug using community and needle exhanges and drug services across the UK and worldwide.

They have made numerous videos but this is one of their most popular. It is a clear video shown in under 10 minutes,  that discusses the issue of citric acid (or vitamin C) -the powder many of us have to add to brown heroin in order to ‘break it down’ and make it work as an injectable solution. Now, we don’t of course need to do this with white heroin, but dark beige, brown or black heroin made up for injecting, will need citric acid or vitamin C added to it.

Now ok, we all know that. But what this video (and the research done at Exchange Supplies), they wanted to look into just HOW MUCH citric was enough.

 

It turns out that we all learnt 2 valuable lessons from ES working in the laboratory! Too much citric over the years -will fuck up your veins -and also your heroin – so there are 2 very good reasons to use less citric:

  1. to save your veins over the short and long term

  2.  To avoid destroying or reducing the quality of your heroin from over acidification

For further reading and to see the famous How Much is Too Much, Citic Video, click here.

Be Wary of the New Stylee Drug Rip Off

Something to spread among our community friends -a new style of rip off affecting drug users on the internet.

If your gonna do it - pass it on in the safest way possible.

If your gonna do it -be careful out there!

The other day while helping out on the Release Drugs Helpline (Release has THE BEST team of assembled minds to solely eat, sleep, think, create and research ‘drug use by the common dude’ -in ALL its incredible shapes and sizes. A knowledge that is only attainable by a  ferocious interest and total  immersion in the ‘Good the Bad and the Ugliest of every corner of the biggest dark room of synthetic and organic drug use and its role in our society today. We can’t advertise about it too much because we don’t have the resources to do the work that we know is out there and will flood our way should people find out we exist.

Anyway, I was answering a call on the helpline, which covers every kind of drug related call from worried mums and partners, to drug tests at work, to bullying or coercion to detox etc, from staff at methadone clinics,  to ‘what drug is this’ to ‘help I think I am in a mess -am I?’ and everything in between, before and after, when I got an interesting call.

For info on the RELEASE Helpline -click here

A very worried guy started telling me this story. He said his boss was a recreational drug user, who was using too much of everything and was spiralling out of control a bit. One night, his boss and a few other workmates were at his house (the phone guy) when the boss says ‘Hey, lets order some drugs on the internet -I know where and what to ask for’.

Everyone was drunk so agreed without thinking too much about it. The boss needed to use his employees computer right there, and his email -and sent off an order using – FIRST WARNING SIGN – a Moneygram money order – for mephedrone. It was to the USA.

48 hours later, the phone guy (the employee) starts getting emails -loads of them -and then phone calls -constantly. The people on the end of the phone said to him “I know what you did -those drugs are illegal. We are in Ghana and our company have intercepted your illegal shipment of drugs -destined for you in the UK. We want you to send $2000 immediately by way of a Moneygram order to a bank account we will name shortly – OR we will contact British Police and tell them everything and send them the drugs for your prosecution.

The poor employee was completely freaking out -his saw his entire ‘straight’ life crumbling around him in a mess of lies and police raids. He had not told his wife and was trying to hide everything. His boss had no real sympathy and told him to ignore it.

Unfortunately, the dude had to hang up fast as his wife came home and he didn’t ring back. However, he did say that the phone calls had stopped during the last 24 hours and so had the emails. So I am hoping things went quiet and the shitfuckers with the rather clever scam, went elsewhere.

In any case, our advice would have been to ignore it completely. A complete chancers scam, one should just call their bluff, maybe get ready with a story to tell your wife or boss if an email goes around from them with your order on it (which is probably not likely -but possible) -and say you were just curious but didn’t do anything -etc. I am sure you could think of something decent to explain your out of character behaviour.

Of course one must be very careful re buying internet drugs – always do your research -always read between the lines re-reviews, only buy via recent recommendation from a previous purchaser. And don’t inject anything you get through the internet re research chemicals. By the look of the very odd occurrences that happen to people who overdose on cathinones, (it looks like no other kind of overdose -and closer to poisonings from chemical gases or nervous system toxicity like chemical weapons exposure etc. Very disturbing so tread super careful with chemistry and what you dont expect… Google ‘frozen addicts’ on our website and see what one small mistake in the lab -one wrong molecule -can create in the average heroin user.

click this link to see it -its unmissable.

 

Junkie Literature

BP is starting a new segment on our site -something we think you will enjoy. The good ol’ internet has thrown up some real gems in the world of the arts; old videos and films we all thought lost forever, wonderful artistic surprises we never believed we would even see let alone to be able to keep a copy safe on our own laptops. For this new BP segment, we hope to collect writers /poets and authors from our own drug culture in the best format possible, and preferably recorded reading their work, in their own voice. What a treat! The chance to share some of our old favourites and inform a new generation of listeners, or just to warm the fuzzy hearts of us oldies.

The first 2 we have for you are pretty special, whether you are a fan or not; both ground-breakers for the invention of the stream of consciousness style of writing, the subject matter raw, real and like nothing before it, they both managed to put  their pens straight onto the pulse of a new generation.

And finally, these guys discussed drugs and philosophy with such relish, such passion, such singularity -it managed to expel upon an era of incredible conservatism,  a spiky new vocabulary for an entire generation, fortunately somewhat protected by the elite position of the untouchable befalling the avante-garde. These guys could take drugs, write books, and tell the world to fuck off and still be considered an artist. It should shame us today; when our society is now so quick to judge, to exclude, to label, to diminish those who seek an alternative road. When one’s art forces one to take the big risks in the search of furthering answers, in search of surfaces real and unreal looming to carry you on ahead, despite the deep fissues always risking to drive apart the roads you thought would lead you back home…
Why must we denigrate those who don’t / can’t choose ‘this life’ this lie we all know is on offer to the democratic masses? We all smell a rat, don’t we?

So, back to our 1st two contenders…

William Burroughs reads his first novel, Junky, to you

 

Jack Kerouac On the Road – The complete audiobook

When the book was originally released, The New York Times hailed it as “the most beautifully executed, the clearest and the most important utterance yet made by the generation Kerouac himself named years ago as ‘beat,’ and whose principal avatar he is.”[1] In 1998, the Modern Library ranked On the Road 55th on its list of the 100 best English-language novels of the 20th century. The novel was chosen by Time magazine as one of the 100 best English-language novels from 1923 to 2005. That’s quite something, is it not? Pick your spot, sit back and get ready -for you are finally going on the road with Jack…

Click here for the rest…

The State We’re In; Heroin Prescribing in the UK

Here is the unedited version of an article I wrote for the Drug Fields’ trade magazine, DDN (Drink and Drug News), which was published yesterday. The link to DDN website is here, and they publish both free online versions and hard copy mail-outs. It is an excellent way of keeping bang up to date with what is happening in the UK drug treatment system. Here is the link to the article as appeared and the issue of the DDN magazine.

Heroin is provided on prescription in what was known as 'The British System'

Heroin is still (rarely) provided on prescription in what was known as ‘The British System’

 

The average diamorphine prescription: A long way from street smack.

The average diamorphine prescription: A long way from street smack.

 

 

 

 

 

 

 

 

 

The State We’re In

‘The game of history is usually played by the best and the worst over the heads

of the majority in the middle.’ – Eric Hoffer

“I feel like they are waiting for the last handful of us to die off and that will be the end of heroin prescribing in Britain, as we know it”, I said miserably.

Gary turned and looked at me seriously through his spectacles, “If we don’t try and do something now there will be no diamorphine prescribing left anywhere in the UK”.

Gary Sutton (head of the Drug Team at Release)  tapped away on the computer in front of me, putting the last few lines on a letter to yet another treatment service who had been forcibly extracting a long term client off his diamorphine ampoules and onto an oral medication. It was proving to be a painful and destructive decision for the client, who was experiencing a new daily torment as his once stable life began to unravel around him.

The drug team and its helpline (known affectionately as ‘Narco’), all part of the UK charity Release, receives phone calls from people in drug treatment from all over UK. By doing so it serves as the proverbial stethoscope clamped to the arrhythmic heart of our nation’s drug politik and bears a chronological witness to the fallout from Number 10 affecting the individual, on the street and in treatment. In other words we witness the consequences of policy and treatment decisions, and try and support or advocate for the caller.

 

“...But as winter draws the shades on yet another year in

the drugs field, we find we are bearing witness to a tragedy,  

one of small proportions but with huge implications…”

 

But as winter draws the shades on yet another year in the drugs field, we find we are bearing witness to a tragedy, one of small proportions but with huge implications. It involves the last vestiges of the British System of drug treatment, the ‘jewel in its crown’ – heroin prescribing – and the decline of the NHS, under assault from a mercilessly competitive tendering process and the crude procurement that is defining its replacement. Is that where we are really heading?

It may be true to say that to try and define the old ‘British System’ is to trap its wings under a microscope and allow for a possibly contentious dissection; the late ‘Bing’ Spear, formerly Chief Inspector of the Home Office Drugs Branch, might be the first in line by reminding us that the implications of “’system’ and ‘programme’ suggests a coordination, order and an element of (state) planning and direction, all totally alien to the fundamental ethos of the British approach”. His point being that the essence of the ‘British System’ was that it “allows the individual doctor total clinical freedom to decide how to treat an addict patient”.

John Strang and Michael Gossop, in their thoroughly researched double volume book on ‘Heroin Addiction and the British System’, stated in the epilogue of volume 2, that ‘Amongst the (probably unintended) benefits of [this] approach may be the avoidance of the pursuit of extreme solutions and hence an ability to tolerate imperfection, alongside a greater freedom, and hence a particular capacity for evolution.’

 

“…‘Amongst the (probably unintended) benefits of [this] approach

may be the avoidance of the pursuit of extreme solutions

and hence an ability to tolerate imperfection, alongside a greater freedom,

and hence a particular capacity for evolution.’…Strang/Gossop..”

 

The average diamorphine prescription: A long way from street smack.

The average diamorphine prescription: A long way from street smack.

The British ‘Approach’ (arguably are more appropriate phrase) had once allowed for a level of evolution, of experimentation and pharmaceutical flexibility; three characteristics that are glaringly missing from front line drug treatment today. Although we have no room to discuss clinical guidance here, it is often the case that when presenting services with complex individual cases at Release, we are rebuffed by the response ‘it’s not in the guidelines’, ‘it’s not licensed’, or even, as if drug workers are loyal party backbenchers, ’it’s not government policy’!

Hindsight is a gift, and although many of us could while away the hours pontificating about just how and why it all went so publicly wrong for our ‘unhindered prescribers’ back in the day (think Drs Petro, (Lady) Frankau, and a handful of others), that would be to miss the point. The reality is, once we pick up and examine the pieces of the last 100 years, there are shining areas of light in our British Approach. Marked by both a simple humanity and a brilliant audacity, it permitted a private and dignified discussion between both doctor and patient to find the drug that created the preconditions for the ‘patient’ (today the ‘client’) to find the necessary balance in life.

Are we really back to the days of having to ask to be treated as an individual? Policy in treatment is today interfering to such an extent that the formulation that the patient feels works best for them (physeptone tablets, heroin, morphine, oxycodone, DF118’s etc.) may no longer fit into today’s homogenous and fixated theme of methadone or buprenorphine, one part of a backwards step.

Although the days of unhindered diamorphine prescribing are almost gone, thankfully, there is still a small group of well informed and supportive doctors, some of whom hold the rarefied Home Office licence to prescribe diamorphine (to people who are opiate dependent.) Regrettably,  there appear to be a good number of licensees who don’t use their license to treat opiate users at all possibly having never to have had the good fortune to encounter a suitably needy client in their catchment area.  Is it possible that they remain content to absorb the kudos and ‘super specialist status’ that the licence conveys without doing any of the work?

 

Prohibition, fear

“…Prohibition, politics and the soundbite media means we are doomed to discuss [heroin prescribing] under the umbrella of ‘treating the most intractable…”

 Fear and public ignorance has forced us to collapse any new diamorphine prescribing into a tight wad of supervision, medicalisation and regulation while prohibition, politics and the soundbite media has meant that we have been doomed to discuss this subject under the umbrella of ‘treating the most intractable, the most damaged, the treatment failures, the failures of treatment’.

Why must a treatment that has proven to be the optimum for so many, be left until people have been forced to suffer through a series of personal disasters and treatment failures? Did this narrative help to diminish the intervention? One of the benefits of the ‘old style’ of heroin prescribing has been the ability to take it home and use it like one might use insulin, which permits a level of independence central to any functioning life of work and leisure.  This small although hugely significant freedom can still fit comfortably as part of a transitional route for people progressing through more heavily supervised heroin programmes towards less supervision and as such needs to be retained, and even embraced.

The last few dozen people left on take home diamorphine prescriptions in the UK today, seem to be stable, functioning, often working people who no longer have so much as a ‘drug problem’ but a manageable drug dependence. This last group of diamorphine clients are remnants of the old system with, it appears, no new people taking their places once they leave. Today these are some of the very people who are now ringing the Release helpline to try and save their prescriptions altogether. They are frightened, most of them are in their fifties and having qualified for diamorphine many years ago because ‘nothing else worked’, what now are they to do?

 

In Switzerland, diamorphine prescribing has been so successful; they even have two programmes in prisons. (Now there is a ‘Sun’ headline, if I’ve ever seen one!). Clients in their community programmes pay around 45 Euros (£32) a month for their ‘scripts, something most British heroin users/OST clients would probably agree to in an instant if it meant diamorphine was offered.

In Britain, diamorphine prescribing has been ensconced in a political and clinical debate about the expense and fears of an imaginary tsunami of diversion. Yet what of today’s financial wastage? We have ways to deal with diversion, yet poor and frequent commissioning has a number of serious consequences, including a lack of continuity of care, a slide back to postcode variance, and not least, cost. An exercise to quantify the costs of tendering services over 10 years ago came up with a figure of £300,000 as the sum expended by all bidders and the commissioner, per tender. Money that could be better spent, surely?

A few weeks ago the LSE put on a mini-symposium on diamorphine with a panel of international clinicians, academics and research experts. Everyone present agreed that prescribing diamorphine, albeit in a very controlled supervised manner, had tremendous merit. Taking the idea from the success in Britain (e.g. Dr John Marks), today we see a method that has evolved across Europe; the Swiss, the Dutch, the Germans and the Danes, amongst others, are all doing it, treating thousands of clients, with great results. So it was more than frustrating to hear that our own diamorphine clinical trials had been closed this year with no plans to re-start them

 

“…Diamorphine should not end up marginalised and discarded because a

controversial new ‘system’ finds it far harder to tolerate than the patients

who receive it do…”

 

Diamorphine should not end up marginalised and discarded because a controversial new ‘system’ finds it far harder to tolerate than the patients who receive it do. The benefit is proven. It’s not a choice between maintenance and abstinence, addiction is not reductive to either/or and as treatment is neither just a science nor an art, and our clinicians should not be restricted to methadone or Subutex, or our clients subjected to a binary ‘take it or leave it’ choice in services.

by Erin O’Mara with massive thanks to Release and its intrepid Drug Team: published in Dec 2015 issue of Drink and Drug News

New York City; Drug Use in the Belly of the Beast

Here is a story from an incredible activist from back in the day called Peter VanDerKloot. Peter actually fought to keep open one of NYC’s main methadone clinics from closing, by agreeing to put his entire face (and his boyish all-American good looks) onto a FULL PAGE advert in a NYC newspaper, telling people that methadone had saved his life and was saving the lives of hundreds of others and that it just must not be closed down! It wasn’t, and Pete went on to do some fabulous work in the field and, though I don’t know where he is now, we are lucky to have had a few articles from him. Here is one. From issue 2.

 

Pic by photographer L. Bobbe 1970's NYC

When the Black Poppy crew asked me to do a column on the dope scene in the States, it got me thinking about all that’s changed in my time as a dopefiend here in the Belly of the Beast. It’s hard to believe it’s been 15 years since Ron and Nancy Reagan cranked up the heat on the War on [Some] Drugs and sold folks on the idea that invasion of ones home by a SWAT team was something that all Americans had a right to expect. Not that this was the first time our fearless leaders had declared war on a molecule. We’ve been through plenty of chemical warfare in this country, from turn of the century campaigns against cocaine-crazed Black men visually raping Southern belles with  their dilated pupils, to drives in the 70s to save pot-head teenage boys from the shame of Dolly Parton-esque breast growth. All along though, it’s been us dopefiends who’ve made up most of the casualties. Hell, we started the century able to buy pure heroin via mail order and now we end it unable to buy dried decorative poppies in the florist’s.

 

Still, the last two decades have been rougher yet. The powers that be seem to have decided that the solution to unemployment in our post-industrial

https://vimeo.com/106919970

The typical sort of NYC_heroin-baggies_ From Graham MacIndoe’s collection, see more in his photographic book, wraps he collected throughout his using days. Fascinating!

economy is to imprison half the population and hire the other half to guard them. At the rate we’re going, we’ll meet that goal soon – as it is, nearly 1% of our adult male population is currently behind bars.  No other Western democracy comes close, and when you factor in the effects of spiraling mandatory drug testing, increased police powers, and ever-decreasing privacy, you can bet that that lead will remain unchallenged – even if our right to call ourselves a “democracy” does not.
Here in my hometown of New York City, the dogs have really been loosed on us. The tanks are filled with public beer drinkers and subway fare-beaters, and you can catch a six month bit just for looking cross-eyed at a cop. And yet when it comes down to copping and getting off, the War on Drugs hasn’t made much headway.economy is to imprison half the population and hire the other half to guard them. At the rate we’re going, we’ll meet that goal soon – as it is, nearly 1% of our adult male population is currently behind bars.  No other Western democracy comes close, and when you factor in the effects of spiraling mandatory drug testing, increased police powers, and ever-decreasing privacy, you can bet that that lead will remain unchallenged – even if our right to call ourselves a “democracy” does not.

 

When I first got turned on to heroin, New York was still the dope capital of the world, and “Alphabet City” was still the capital of New York dope neighborhoods. In the days before the real estate interests moved in and the area was declared an extension of the “East Village” and hence suitable for yuppie inhabitation, the streets belonged to us, and you best believe we made the most of it. Block after block of abandoned buildings and vacant lots were commandeered by major dealing organizations. The streets echoed with the cries of the steerers touting the brand names of different bags: “Red Tape!… Seven-Up…ET!!”  We’d line up to cop in queues stretching around the corner, kept in place by enforcers with golf-clubs in their fists or pistols in their waistbands who’d order us to have our money ready and fanned out just so — reminding us not to linger post-purchase with chants of  “Cop and bop!” Street traffic was heavy too, as the narrow streets were choked with cars with out of state plates down either to supply the driver’s habit or to run a few bundles back for resale.

For the rest of this excellent article, click here.

Cocaine -How Do You Take Yours?

This was no. 2 in our series; How Do You Take Yours? We looked at Cocaine, and asked the people that used it, how they preferred taking it and why, and gave some useful harm reduction tips for everyone!

This BP article was brought to you by A&E Lifestyles, a BP partnership in drug taking & drug investigating!

While the BP ‘knowledge’ tends to come from hundreds of combined years of experience of opiate, coca use and loads of pharmaceuticals (and that’s just the crew!), these days, drug taking for the enthusiast is changing. It’s broadening out, it’s becoming consumer savvy, it’s becoming mainstream. Nowadays, we aren’t so attached to one drug anymore, it’s a pill for this, then a smoke for that, then a whole pharmacopoeia of drugs for the come downs. We are learning how to use our drugs, we want to know more about them and what they do and what are the safest ways of taking them. The West has created a pill culture – and drugs are out there by the bucket load. This issue, BP looks at cocaine – and A&E are asking you “How do you take your coke?”

Freebase Cocaine

freebase -not the same as crack…

Cocaine is used by such a diverse group of people, probably because it lends itself to being snorted, smoked, injected, freebased, chased,  chipped, drunk, or blown up an orifice somewhere,  and as such, many of us will have a preference of our own. A (of A&E Lifestyles prefers to have it via injection and mixed with brown in a speedball, while E prefers to have the coke first, then the brown!). The emergence of crack has added more dimensions to what the phrase ‘using coke’ actually means. But as anyone who’s had a coke habit will tell you, no matter which way you take it, consistent, regular use of coke/crack can lead to a whole host of problems – the combo of no food, sleep, come down drugs and paranoia  can lead to some serious shit , compounded by the potential health problems due to the method by which it’s administered. A&E spoke to a few coke fiends to get their views on using it their way and have collected some good harm reduction tips to remember – whichever way you use it.  (This focuses on cocaine in all its guises except crack -although we do look at freebase and smoking tips -crack kinda needs its own article these days!

To see the rest of the article, click here…

Dealer’s Discuss

Articles from BP’s back catalogue….

Here’s a chat with a few of the people doing the biz, day in and day out, they haggle and hassle (and we cough up and complain)…But by and large, dealer’s are just like us, most are just trying to keep their own habits going without resorting to ‘other methods’. Can’t blame them. Dealer’s don’t sit out the front of schools tempting kiddies, they rarely want to sell to a newbie. In today’s world of prohibition and drug habits, dealing to keep your own head above water, is a way of managing day to day. It is the result of drug laws that leave all our drugs to the influences of the black-market. Some dealer’s are a nightmare, some violent, some a complete rip-off. BP says; if you are going to deal drugs -have compassion, take pride, do your best to give a clean product and treat your customers with respect. It shouldn’t have to get down and dirty. See our ‘Dealers Certificate’ and sign up to it. Let’s make the best of it and treat each other well; we are all struggling out there.

 

Martin (does heroin & crack):

“I wouldn’t call myself a dealer personally, and this very important to me; whether it’s the profiteering aspect or the pushy aspect, to me it makes a difference. I feel I am providing a service – most of my clients are middle class,  I see them twice a day, the same faces; My employers you could call business men or drug dealers, but again, its supply and demand. We don’t push drugs onto other people, we don’t go looking for new converts.

I guess I do it out of choice – it suits my lifestyle,  I’m paid a salary – I see the guy at the end of the day and get paid up. It doesn’t work on a commission basis like some setups. I use drugs myself so naturally it keeps my habit looked after. I look at it as a proper job, one has to be professional, it entails a hell of a lot from you and the law aspect is also on your mind. Yet sometimes one reaps the benefits and hits the highs, and meets some amazing people along the way. The myth of the user / dealer’s relationship is complex – discovering all the layers within each customer as you get to see them day after day in all manner of situations…It can be tough job.”

To see the rest of the article click here….

World -Take Note! The story of one country unafraid to take risks to better the lives of its citizens-despite overwhelming opposition and ridicule. So who’s laughing now?

 

health-logo

Switzerland, courageous, progressive, humane – junkies around the world thank you!

Dudes and Dudettes, around the globe; As I was just about to write an article for the British press on the demise of the much respected ‘British System’ and the diminishing role of the prescribing of legal, pharmaceutical heroin to opiate-dependent people, I came across this article. Published just last year it gives a brief but interesting look at Switzerland’s incredible journey as an innovator and leader in the field of drug treatment. I hope you may find this as interesting as I have.

Many of us will know something of the Swiss Story, but it is never more pertinent than today, to renew these very important discussions about heroin prescribing, standing up loud and proud and  showing off the very real successes this approach has decades on, across Europe today. We must take a leaf out of Swiss’s History book and, while fanning the flames of the decriminalization and regulation discourse, we can burn a clear and wide road ahead, devoid of the forest and the trees – out of our dangerously out of control illicit drugs market, and hopefully towards sowing some damn busting seeds at UNGASS 2016, in New York City. Once home to the archetypal junkie!!

Switzerland’s fascinating journey from the experimental Needle Park to the development of the most innovative, effective and publicly supported heroin prescribing clinics now available across the country and even in (2) prisons.

Friends, it is time we celebrated and thanked our Swiss comrades in arms -for their bravery in going it alone for so many years; their refusal to condemn junkies to the gutters and prisons of society, for standing so far out in the crowd in the search for humane and pragmatic solutions to the fallout from prohibition, and all at a time when all around was calling for blood; incarceration, isolation and discrimination.

A street heroin epidemic that was to sweep through Europe and the rest of the world during the 70’s and 80’s, while nations governments used tactics and policies that were brutal at worst -and misguided at best – psychiatrists and medical professionals began years of postulating and aggrandising their professions and their careers.

                                              ****************************************************************

PRESCRIPTION FOR SUCCESS?

Article by By Gabriele Ochsenbein

Article reprinted as it appeared on the online newspaper SWISSINFO.CH

At the beginning of the 1990s, pictures of the open drug scene at the so-called “Needle Park” in Zürich went around the world, leading to the introduction of legal heroin prescribing. Strongly criticized at first, it has since been hailed as an example.

The old Needle Park in Zurich, Switzerland; the experiment that led the way to one of the world's most successful drug policies -heroin prescribing.

The old Needle Park in Zurich, Switzerland; the experiment that paved the way towards one of the world’s most successful drug policies -heroin prescribing. Click the image to see more pictures of the era in Needle Park.

Doctor André Seidenberg, who has treated 3,500 patients suffering from addictions in his career, was one of the first to provide emergency help in Needle Park and to call for clean syringes to be given out to addicts. Police and the justice authorities tried to deal with the problem with repressive measures that failed to work. The crackdown even encouraged drug addiction and the drug trade, Seidenberg claims.

swissinfo.ch: Twenty years ago Switzerland became the first country to prescribe heroin to therapy-resistant addicts. Has it been a success story?

André Seidenberg: Yes, although you have to bear in mind that the heroin programme has been marginal and to my knowledge never reached more than 5% of the affected people. It is a kind of show project, a prestige project.

It is however a success because in Switzerland, the majority of people dependent on opioids are in treatment, mostly with methadone, and a small proportion, particularly those who respond poorly to therapy, with heroin. It would be preferable if the proportion of addicts in treatment could be increased. I wish we could have gone further with the medicalisation and legalisation of the market.

Needle Park in Zurich today -heroin use is very clearly on the decline

Needle Park in Zurich today,  heroin use is very clearly on the decline

swissinfo.ch: Would that have had an effect on the black market?

A.S.: Of course. The black market is a market that is encouraged by repressive measures and ultimately produces poor products that are harmful to people. I wish we could have a less hypocritical approach to drugs.

swissinfo.ch: Then you are in favour of a general legalisation of drugs?

A.S.: I am in favour of better market control. It is an international problem, because we still have a very active drug wars in many regions.

Appropriate control of the drug market is not a trivial matter either. One cannot for example just legalise cocaine and think that all problems will be swept away. It would have to be introduced very carefully.

swissinfo.ch: How is life different for a person who doesn’t have to seek out heroin in the back streets anymore but receives it regularly as a medicine?

A.S.: A person who receives their fix twice a day is in psychologically better condition, is more stable in every way. Of course there are side effects and even lasting impairments. Those who take this substance daily suffer from decreased libido, sleep problems or a limited capacity to experience emotional states in between euphoria and sadness.

People who take part in a heroin programme are also freed from the necessity to finance their existence through illegal activities. Delinquency, prostitution and social deviance of all kinds have decreased.

swissinfo.ch: So they can lead a normal life?

A.S.: The possibility of procuring drugs in this [legal] way makes a big difference, because in illegally procured drugs tend to be consumed in more dangerous ways. Most addicts are not in a position to always inject themselves carefully, which can lead to infections and infectious diseases. Overdoses also happen much more easily with drugs bought on the street.

When we are able to look after people medically, these risks are avoided to a larger extent. With controlled distribution people are able to lead a mostly normal life, although there are more people getting disability benefit among those taking part in the heroin programme, compared to the methadone programme.

swissinfo.ch: So from a medical point of view the focus is on limiting harm and stability rather than abstinence?

A.S.: The priority for doctors is to avoid serious harm to the body and death. Healing the soul comes, in medical terms, just after the body.

swissinfo.ch: Should abstinence not be the goal of a state drugs policy?

A.S.: That was the goal of politicians and society, and many doctors still nurture this illusion. But it’s a very dangerous strategy. Heroin addiction is a chronic illness. Only a small, shrinking minority of opioid addicts will become abstinent long-term. And most of them suffer during their abstinence.

With heroin – as opposed to alcohol – abstinence doesn’t improve well-being and health. The death rate is three to four times higher for abstinent patients, compared to those prescribed heroin or methadone. Repeated attempts to come off the drugs can trigger psychological difficulties, that can then lead to self-harm.

swissinfo.ch: Is heroin still an issue today?

A.S.: Thankfully we rarely see young people taking up heroin. Consumption has fallen massively. One per cent of those born in 1968, the Needle Park generation, became addicted and many of them died because of their addiction or are largely still dependent.

The average age of a heroin addict in Switzerland is now around 40. If we hadn’t stopped this development at the beginning of the 1990s, young people born in the following years would have been affected to the same extent. There are societies, for example the countries of the former Soviet Union or Iran, where a significant percentage of the population is dependent on opioids.

swissinfo.ch: You tried out various drugs, including heroin. Why didn’t you become addicted?

A.S.: Maybe I was just lucky. When I was young I tried out almost all kinds of drugs. I was able to satisfy my curiosity and maybe also learnt certain things that could be useful for my patients. I also got to know the danger of drugs: I lost many friends, even before my medical studies began.

swissinfo.ch: Do you have to have taken drugs to be a good drugs doctor?

A.S.: No, I would not recommend that. When dealing with problems that have to do with the psyche, it is definitely helpful to have an open mind. But you don’t have to try out everything for that, because that could be harmful and dangerous.
(Translated from German by Clare O’Dea), swissinfo.ch

Swiss drugs policy -A Timeline

  • Since 1991 Switzerland has implemented the so-called four pillar policy of prevention, therapy, damage limitation and repression.
  • This pragmatic policy was developed largely in response to the extreme drug-related misery in Zurich in the 1980s and 1990s.
  • The controlled prescription of heroin was first introduced in 1994.
  • In 1997, the Zurich Institute for Addiction Research came to the conclusion that the pilot project should be continued because the health and living situation of the patients had improved. There had also been a reduction in crime.
  • In 1997 the people’s initiative ‘Youth without Drugs‘, which called for a restrictive drugs policy, was rejected by 70% of voters.
  • In 1998 74% of voters rejected the ‘Dro-Leg’ initiative for the legalisation of drugs.
  • In 2008 68% of voters accepted revised drugs legislation. Since then controlled heroin distribution has been anchored in law.
  • The new law came into force in 2010.

Further reading; (docs come in German, French, Italian and English

Federal Office of Public Health; Click here for survey loads of interesting information on results of all the Swiss studies going back over a decade

The Challenge of addiction The basics of a sustainable approach for drugs policy in Switzerland

Interesting Doc on how the Needle Park experiment became the road into heroin on prescription -and discusses how the first studies were set up and the results

Drug Induced Seizures -an Update

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(from BP Issue 9 but now with new updates as of Nov 2015)

Many BP readers will have already witnessed the distressing sight of someone having a seizure, or you may have even experienced one yourself. It can be frightening to watch, exhausting to go through and unfortunately, people can often make the situation worse by not knowing how to deal with seizures properly, leaving everyone concerned thoroughly freaked out.

Most people associate seizures with having epilepsy and while it is certainly true to say that seizures (there are over 40 different types) are a symptom of having epilepsy, you don’t have to have epilepsy, to have a seizure. Anyone who has seen someone have a cocaine or alcohol induced seizure can attest to that.

Drug Induced:

For those of us who use drugs, particularly those of us who binge use or use to excess, seizures are known to occur for a few reasons. Sometimes they happen just before or as someone is overdosing, (i.e a seizure occurring just in the minutes before someone actually lapses into an overdose) or through withdrawing from a drug/s (i.e benzos, alcohol) or, they are a (rather intense) way of telling us that we have been pushing our bodies too hard for too long (i.e cocaine/stimulant related) and we can have a seizure which although is not an overdose -it is an overdose in the sense that you have reached the threshold in what your body can tolerate -and it is telling you -“Enough! My body has now gone into toxic overload!”. Basically, seizures occur when our systems have reached this point of toxicity or overload, even if the culprit drug is ecstasy, acid or heroin -when we tend to think of the most common culprits as stimulants and alcohol and benzodiazepines and barbituates.

 Know Your Limit

Everyone however, has what is called a ‘seizure threshold’, a certain sensitivity to seizures which means that anyone can experience one given the right conditions – such as excess use of alcohol, drug withdrawal, toxicity, dramatic metabolism changes etc. With 1 in 20 people having experienced a seizure at some stage in their lives, amongst drug users that rate increases rather dramatically, so its important that we learn something about seizures, their ‘triggers’ as well as their treatment.

It can be all too common to put the odd re-occurring seizure down to ‘the drugs I’m taking’ or to find that our medical investigations have not been followed up due to the pressures of everyday life and the difficulty embarking on consistent/stable medical care when you have other things on your mind like survival. But it’s important to remember that seizures can be very serious, they are hard work for the body and the brain in particular and, depending on where you are when you have your seizure, or if you end up having multiple seizures, you can be left in a dangerous or vulnerable situation.

If you are affected by seizures, if you have had more than 2 at once or 2 or more during the last year, or if it takes you more than a day to recover, or if your seizures start to occur regularly, it is essential you seek medical advice – at least to rule out any underlying causes such as infection, virus’s, tumors etc. You might have developed epilepsy in which you need medication, or there may be an underlying medical condition that has nothing to do with your drug use. You need to know these answers so you can take the right action.

To read the rest of this interesting and updated article, click here. Comments always welcome

https://blackpoppymag.wordpress.com/wp-admin/post.php?post=1166&action=edit

Abscesses – A Major Update

Identification, Treatment and Prevention

Abscesses are something most of us have encountered before and they can be everything from hardly noticeable, to extremely painful. Medical care can be hard to come by for many of us around the world who inject drugs and so some people resort to treating themselves, for reasons of cost, access, stigma or fear. This can lead to some serious complications as the toxicity of an abscess can vary considerably. Here are a few things to remember when it comes to getting to grips with an abscess -and whether you can really treat it yourself.  Yes, you may think you know what to do if you have an abscess, but there is new guidance in terms of treating them these days, to ‘pack or not to pack’ , antibiotics everytime or just some of the time? Yes, this is a big article and has had a major update, and we will edit it down in the coming weeks, but for now here is all the information we have collected to help you make the most important decision -when to get help. Yes, it is worth reading the whole thing if you are concerned about abscesses, or at least read the summary!

A fairly typical large abscess on a heroin user who seemed to have skin popped heroin.

A fairly typical large sized infected abscess on a heroin user who is said to have skin popped heroin recently.

 

here is one where it was recommended to just cut and drain, and not necessarily dispense antibiotics

This is a pic of an infected abscess, but one where it was only recommended to just cut and drain, and not necessarily dispense antibiotics.

A Sterile Abscess is caused by injecting either an irritating or insoluble substance into a vein – and if some of the cut in your drugs are insoluble, a sterile abscess is sometimes formed. It is basically a milder form of the same process of an infected abscess, caused not by germs this time but by nonliving irritants such as drugs. If an injected drug is not absorbed, it stays where it was injected and may cause enough irritation to generate a sterile abscess—sterile because there is no infection involved. Sterile abscesses are quite likely to turn into hard, solid lumps as they scar, rather than remaining pockets of pus. It will not usually show signs of heat although there may be a touch of redness and it can feel like a solid nodule under the skin and isn’t likely to be sore. Soreness will depend on the volume of substance under the skin. Don’t try to squeeze or poke it as it will usually go away in its own time and squeezing it could induce an infection.

A Septic or  an Infected Abscess can occur anywhere in the body. In the injecting community in which we are referring to here, these can be caused by either using non-sterile injecting equipment or by bacteria from your skin entering under the skin via the injecting process. An infected abscess will soon come up as a swollen lump on or near the injection site. Appearing inflamed and red, it feels hot to the touch and soon becomes very painful. The abscess may come to a ‘head’ or ‘point’ and be filled with pus. Sometimes a deep abscess will eat a small channel (sinus) to the surface and begin leaking pus. It can be tempting to squeeze or burst it now – but DON’T! This will only spread the infection, driving it deeper and wider, and it could head for the bloodstream making you very ill by giving you blood poisoning which can be fatal!

For a much more in depth look, click here for the rest of the article which covers topics such as Antibiotics -Yes or No?, Prevention, Treatment, Home Treatment, click here.

For information concerning users of steroids and performance enhancing drugs, and abscess, click here.

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