Trafficking in Drug Users

Hi friends,

I just came across this old article/ presentation I wrote some years back about my own treatment journey (nightmare might be a better word!) and how so much idiocy, money, misguided support and policies, ignorance, do-gooders, moralising shits, and the whole web of the incredibly resourced, career inflating, gravy train that is the current drug and alcohol treatment /criminal justice interwoven system, is stitched up so tight across the globe, that it is going to take a hell of a lot of strategising for us to get out from under the intensity and chains of the current goal of ‘managing and controlling’ people who use drugs, in any way possible -and how carreers and reputations ride on this these days – the research, the papers, the positions in clinics and academy’s, the psychology and the ‘experts’ draining cash from everyone hand over fist with the misguided or embossed descriptions that they will ‘fix’ and cure your loved one, yourself, your child before it has even smoked a cigarette!  We are taught year by year, harder, longer and stronger – that we are weak, we have no control over our desires anymore, that we cannot do it ourselves – we HAVE to have professional help….Yet what of the professional help? The basic, colourless, inflexible, unchangeable, plain and homogenous, evidenceless help….my God, what a load of crock so much of it all is – and still – they never seem to ask us what we need. What would help. We just get encouraged to join into more peer pressure and trot out the same old slogans that we believe are right coz our old peers say so (12 steps etc). 

When is it EVER the right way to provide one solution for everyone no matter what where how when why they use drugs? in 2016, we are still one leg firmly in the dark friends….Sad alright. But it just shows – the only way is to get active – get politicised, get smart.

Hope you like it (bit dated now!)

Here – One of the BEST sites for resources on progressive ideas about drug use / treatment -based in UK – The SMMGP (includes forum, resources, GP chatter and much more).

RCGP Special Interest Masterclass Presentation

Originally entitled ‘Don’t Give Them What They Want’.

EO;  Editor Black Poppy Magazine, Written /presented July 2003

I left my home of Australia 10 years ago trying to find a way to get off heroin. I thought the beautiful scenery in Europe might inspire me, I thought London might show me a new way of looking at life. I thought I might find something that would interest me more than heroin. But I should have known that doing what many of my peers call a ‘geographical’ is very rarely the answer.

I had already been to a variety of treatment clinics and surgeries in Australia. I had hadpoppies_final_black5.jpg habits on heroin, cocaine, benzo’s, and a few other pharmaceuticals, but my treatment options, no matter where I went, were methadone, methadone and more methadone. I felt screwed by the time I came to England. I felt numb and I wasn’t well either. By the time I arrived, I was hanging out, sick, extremely tired and depressed and went to a hospital looking for some relief. I was offered a two week blind detox on methadone. Suffice to say, I remained sick. I felt like I was trapped and my head just kept wanting to be well. I was in a new city and hoping to find a bit of peace of mind, I had to begin to learn the ropes of the British prescribing system. Suffice to say, it has taken me another 10 years to finally land on my feet, with a script that suits me, Erin O’Mara, an individual with individual needs. After almost 20 years I can now look to a future – that’s what a tailored prescription has really meant.

To get to this point, I have attended around 10 different methadone programmes, 2 heroin prescribing programmes, seen numerous GP’s (both private and NHS), and sat with plenty of psych nurses, key workers, social workers, psychiatrists and counselors. I’ve been to rehabs in the country and detoxs in the city, made plenty of attempts at stabilizing and fought to come off completely with concoctions of pills gathered from anyone who would give them too me or suing acupuncture, massages and herbal teas. It wasn’t that I didn’t try. I really did. Everything was riding on it. My life, my health, my liberty. But I just kept coming back to the same old blanket prescribing of methadone linctus – a drug that, while I know it helps many people, it isn’t for all of us. Drug users are not born from the same mold, we all use for different reasons, we all take different drugs, we take differing amounts of different drugs and offering us variations on the same methadone theme, while helping many, is still going to leave thousands of us out in the cold. And how long can we afford to stay frozen out?

For many drug users, getting on the treatment rollercoaster means you are certainly in for a ride and a half. I have learnt that the right prescription is only half of the equation – the other half is the treatment and understanding you receive from your prescriber. It can be so hard to explain to some prescribers that it is the creation of the types of prescribing systems -that can cause so much difficulty in adhering to it. The clinics that offer only a 2 week break or holiday a year (no opportunities to mend familial bridges there then), the confusion or distrust around your intentions, the reducing of your script every time you take something else or have a need to top up your dose, having to turn up for dosing at inflexible times -whether you have to pick up your kids or go to work or uni or like being closely watched as you sit for 3 hours on a toilet to give a urine sample before you’re allowed to get your dose. I’ve been to a clinic where a girl burnt off her tracks with a cigarette because she was afraid the doctor would cut down their methadone if they found out she was still using on top. And, at that particular clinic, sadly she would have been right. Getting the treatment dose right is essential, finding the drug that suits that individual is critical, allowing room for maneuver or looking for other drug treatment alternatives is the most important of all.

chrispolice

Your nicked!

Since leaving Australia where we were all prescribed methadone – no options, no alternatives to coming to the UK where there was some room for maneuver with prescribing has been an interesting experience. Heroin has always been my drug of choice and for me, methadone linctus just didn’t work. It didn’t work for me in Australia and it wasn’t working for me here. I looked everywhere for a more suitable script. I’ve tried morphine, slow release tablets and ampoules – which, while being a welcome relief from methadone, I found it incredibly constipating and uncomfortable and found myself again, unhappy, not wanting to take it and looking for something else. I will never forget that particular doctor who was then the first one to actually sit down with me and talk to me about what it was I felt I needed. But while we both knew it was probably a diamorphine script, he was powerless to offer me it. Thus he offered me what we thought was the next best thing. Morphine. It wasn’t that I didn’t want it to work, I did, more than anything else in the world, but it just wasn’t suitable for me.

It is so important to be able to offer alternatives to drug users when they come in looking for treatment. Generalisations about drugs and drug users are made without considering how cultural differences mediate and transform both the reality and meaning of a persons drug use. Younger users, older users, women, men, mothers, those on parole or probation, those with HIV and or Hep C, injectors, smokers, pill takers and snorters – how can we expect to support an individual with a chemical dependence if we are only prepared to offer them methadone?

It has taken years for methadone to be accepted by doctors, and still it is only by a minority. Without question it clearly works for some people and it certainly has a place in prescribing options. But there are other alternatives. At Black poppy we are receiving many letters about how helpful Subutex has been (mainly for detoxing) but many more letters from people wanting to know how they can encourage their doctor to prescribe it. We all know its out there but where? How can one be prescribed it or is it too a lottery depending on your area or GP?

Morphine also holds an important place but is usually prescribed by private doctors and is prohibitively expensive. I have a good friend who has tried methadone unsuccessfully many times and finally went to a private doctor to try and get MST’s or slow release morphine sulphate tablets. Because he can’t stomach methadone linctus and doesn’t want to inject methadone ampoules, his morphine script has meant every fortnight he has to resort to spending literally his entire benefit cheque on paying his chemist and his doctor and is still fifteen pounds short. His clothes are old, his cupboards are empty and he is fighting off a depression that threatens to jeopardize his whole stability. This is because he cannot find a single NHS doctor in his area to prescribe him morphine tablets – despite his private doctor offering support. The last time I saw him he was eating the only thing he had in his cupboard – tomato paste. Why?

There are many people who have either dropped out of the prescribing system altogether or regularly have to top up with additional drugs because the system just isn’t geared for those with poly drug dependencies. While years ago many people just seemed to stick to using one or two drugs at a time, these days poly drug use has become the norm. How are doctors going to help support people if they can’t or won’t take on anyone who was multiple drug problems. This is 2003 and this is the way drugs are now taken. Both patients and doctors must be prepared to be open and have the courage to admit when something isn’t working and be flexible when considering alternatives. It isn’t easy. I know drug users can be difficult patients. When that doctor sitting opposite you seems to have the power to change your life – things do and can get emotional. For treatments to work we all have to be open and honest. The system has to let you be open and not punish you for what it sees as ‘not conforming to the treatment’. Relapsing is part of stabilizing as well as part of ‘the cure’.

For me, after years of searching for some stability – I was finally offered the chance to try diamorphine – or heroin on a script. It is extremely rare to get this chance and I believe the deciding factor was because I had recently contracted HIV.

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

Now I’ve had the opportunity to participate in 2 very different approaches to heroin prescribing – and it has taught me a great deal about how the differing structures, regulations and nuances behind the way heroin is administered to users, is critical to the success of the programme. For example: The first heroin script I received was back in 98, through a pilot project in London, whose aim it was to study the effectiveness of prescribing either pharmaceutical heroin, or methadone in injectable form to drug users.

The first error and one eventually admitted, was to limit the amount of diamorphine prescribed, to an unmanageably low 200mg. (The Swiss, The Dutch and others, myself included, have found 400 – 1000mg much more suitable). Pharmaceutical heroin does not have a long half life and to seriously underestimate the dosages required was to become a momentous error and one that would seriously jeopardise a person’s ability to adhere to their prescription. With a median age range of 38 and an average injecting career of 19 years, many clients at this project had other drug problems, such as crack, benzodiazepines, alcohol or cocaine which I don’t fully believe were taken on board at the time. The severely punitive clinic regulations or ‘protocols’, would bear this out. i.e. anyone caught using any other drugs or ‘topping up’ their rather limited dose, would immediately be ‘sanctioned’ by way of a 30mg reduction in ones daily prescription, reducing even further ones ability to adhere to the programme. Once ones prescription began to lower, it was practically impossible not to ‘top up’ with something else, and so clients, myself included, were locked in a constant spiral of script alterations.

A stifling clinic environment would be the clinics 2nd fundamental error, where people would be unable to talk about their other drug issues for fear of a variety of repercussions. This would lead to an even more alarming situation where clients hid serious medical issues for fear of their prescription being stopped or being transferred back to methadone linctus.

The importance of maintaining an environment where users can talk openly and honestly to their keyworkers and consultants is a crucial element in a person’s success on any drug treatment programme and this was no exception. A deeply unhappy client group had nowhere to go to complain about their treatment and having to attend to such a stressful and demoralising project promptly each morning in order to receive ones medication only exacerbated people’s and my own depression and did little if nothing to improve the spirits of those attending.

Two years later, after a desperately unsuccessful period trying an injectable methadone prescription, I had developed a dire crack problem, was drinking alcohol regularly for the first time in my life, and began having regular seizures from increased benzodiazepine use.

It was at this time that, after an enormous effort and support from my GP Chris Ford, my mum, my local MP, (and bailing up the prescribing doctor at a conference I attended), I managed to secure a place at London’s Maudsley hospital, where there was a doctor prescribing heroin to a small group of patients. I clearly remember my sense of complete and total desperation. I felt I could not go on any longer, that if they didn’t help me I would be – I didn’t know where I would be and that was the trouble. I felt that this was my last hope, that I’d tried everything. And I begged…. Most drug users know well the feeling of someone else, a doctor, having the power of your life in their hands, every single day. A script started or terminated making the difference between life and death, or misery and hope. Sometimes you end up having to beg…

I have now been on my heroin script for 2_ years. My health has improved substantially and my HIV doctor is delighted – as is my mum and I. My moods and energy levels have improved considerably and so has my ability to contribute to life and my community. I founded and continue to work on what has become a National drug users’ magazine called Black Poppy, and I am actively involved in drug user politics, journalism and harm reduction issues. It has been a difficult journey, but thanks to my mum, my mates and the open-mindedness of my doctor, who fully engages me in my treatment decisions and doesn’t wave punishments in my face, I have stabilized and am well, for the first time in 18years of using opiates.

Now, I have somewhat of a vested interest in the campaign towards prescribing heroin – both here and overseas. Last year, my mum returned to Australia to live and while I would have liked to go with her, the thought of losing my heroin script after fighting so hard to get it, felt more than I could bear. I am HIV positive. There are going to be times when I will want to be near my family. Yet archaic laws in Australia forbid me from even entering the country with my prescription. How can this be legal? Anyone, on any other medication, would be permitted to continue that medication in another country but these basic human rights do not extend to drug users. The intense and totally unfounded hysteria that surrounds the prescribing of heroin to drug users sadly endures and has made the campaign to prescribe heroin in Australia a momentous task. Yet while campaigners look to the British System for guidance, it would be a mistake not to closely examine both its failings and successes. The potential for problems in importing a system that hasn’t been culturally fine tuned for the British using community are great because to get it wrong, Britain may lose the chance to ever attempt it on a large scale again. The Swiss users have to return to their heroin prescribing clinic 3 times a day to receive their heroin, watched over as they inject by a clinic nurse. Although the Swiss programme has had incredibly positive results, would English users blossom under such a severe restriction of an individual’s freedom? Or if the dosage is not allowed to be adjusted to suit each individual, as occurred before at the London clinic, what chance is there of success?

While there is undoubtedly a role for the prescribing of heroin to heroin users, it is important to remember how crucial the role of the heroin user is in the planning, implementation and evolution of a heroin programme – or any drug treatment programme for that matter. Users must be involved every step of the way and accepted, as other users of health services are, as an integral part of a treatment programmes development, with rights, responsibilities and a mutual respect for experience.

I know I’m fortunate. As an Aussie living in London, there are times when I have to pinch myself that this is real – I have a diamorphine prescription!. That the long and often harrowing road of ‘substitute prescribing’ has finally come to an end – and now I’m free to think about my future. But in the small silences that fall between me counting my blessings, I can’t help but wonder whether it’s all just been a bit to little, a bit too late. I question why it has taken 18 long years to get here? Why did I have to wait until I’d been chewed up and spat out of over 10 different treatment programmes and Dr’s surgeries, of at least 4 rehabs and an uncountable number of detox attempts? Why did I have to wait until I’d ‘finished’ selling my young body to men, til I’d got sick and deeply depressed, til I’d used every vein in my body from my neck to my feet, til I’d contracted both HIV and Hep C? Yet doctors can prescribe heroin to people who are opiate dependent in the UK and indeed they have recently been encouraged to by our current Home secretary, David Blunkett. Are doctors prepared to start looking at other alternatives? Is the government going to stand behind them? Support each other – doctors who are prepared to look at other options – keep each other updated. As a drug user, I know what its like to be on the other side of the fence – and as a drug user, I also know there are courageous doctors out there who are trying to do their best but are often working in isolation, with little support.

bppicnunsmall1.jpgMeanwhile, 96% of all opiate based prescriptions given out to British users, remains methadone and only 449 people currently receive a heroin prescription for opiate dependence. And I am one of them.

Unfortunately, I still hear the saying, ‘Don’t give them what they want’. But it’s not about want anymore. It’s about need and it’s about our lives. I would just like to take this opportunity to thank those doctors who did go that little bit further and treated me and my needs individually. Their support has got me the prescription I needed and has allowed me to be here today.One day we might have a system that doesn’t insist on me being sick and dysfunctional from the get-go and asks the big questions like ‘Why do we have a society / laws, that push substance users to the brink of insanity and outside the margins of society just because they prefer opiates instead of whiskey, a little stimulation from khat chewing instead of 20 cups of ‘legal’ coffee.

 

Addendum: The drug conventions are based on a lot of hot air and bullshit friends, the more you look back into history and the closer you inspect the world of economics, society, and criminal justice today, the more you unravel a mish-mash of men in suits making decisions decided by money, history, fear and racism, certainly not strong evidence, humanity and common sense.

– Erin

Editor Black poppy Magazine

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.

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….

Last Train to Woking

I just came across this story on an old blog of ours, written by BP Magazine’s co-founder Chris Drouet. Its hysterical, and a nod back to the old days of Diconal which were so popular in the UK during the 1980’s. Chris of course, overdosed in 2009, a huge loss -but it has made me start thinking about logging all the material from the back issues on this site, as there is some really classic stuff there. Anyway, over to Chris…

Train

Train Trip...

I had just picked up my script of Ritalin and physeptone amps and from somewhere I’d got five Diconal so I was looking forward to having a nice hit. I was standing on the platform on Waterloo Station looking up at the departure board for the next train to Woking in order to go and sign on for bail at the Police Station. There’s a train leaving in 15 minutes. Perfect! I can get on it and have a hit in the toilet before it leaves because I don’t really like trying to do it on a moving train. I go into the toilet and get my usual fix together, 5 Rit and 5 Diconal.

Just as the buzz is coming on me I hear a woman’s voice outside say, 

‘ Here, John, there’s someone in there having a fix. Get the guard’.

Then I hear someone, obviously John say, ‘Fuck the guard . I’ll get the police’.

Oh no. The police is the last thing I need, I was already on three lots of bail and another nicking I can do without.

A couple of minutes later the train starts moving out of the station. Relief sweeps over me. Plod couldn’t have had time to get on yet. Just then there’s a banging on the door and a voice saying,

‘Come on out Chris. We know it’s you in there and when you do come out, you’re nicked’.

Like fuck I am’. I reply, ‘I’m not coming out. If you wanna nick me you’re gonna have to come in here and do it. All you cunts can fuck off’.

A wave of panic engulfs me. I’ve got two 5ml works to get rid of plus the Rit blister packs. Then I hear plod say, ‘Can you turn the water off in there’?

They must be talking to the guard, I think. ‘Yes’, another voice retorts. I try the taps-nothing. There’s no water in the toilet bowl and there aren’t any windows to throw anything out of. What the fuck am I gonna do now? I really don’t wanna get nicked again. Not for something as trivial as this, anyway.

One of the cops says, ‘Can you undo the lock or get it off from out here’?

‘Yes.’ came the reply.

I look at the bolt and sure enough, it’s slowly being worked back so I jump to the door and slam the bolt back home. What am I gonna do? It’s only a matter of time till they come in. Suddenly, like a light being switched on, an idea comes to me. I pull the plungers out of both the syringes, pull off the little rubber things and swallow them and crush all the rest under the heel of my shoe. Thank God I wasn’t wearing trainers. I crush them till the plastic bits are reduced to tiny slivers.

Then I have to push the bolt home again and when I do I hear from outside,

‘You bastard, we’ll get you.’

‘No you fucking won’t, you cunts. Have it up a tree all of you, you fuckers.’

I lay down on the floor on my stomach in the piss and dirt and filth with my feet jammed against the door so they can’t get in and I poked all the little bits of plastic through the ventilation grill one by one as the holes were so small. Every so often I had to jump up and push the bolt back home again. each time I did the police outside gave me a volley of abuse which I answered in spades

‘Why don’t you cunts fuck off and leave me alone. Haven’t you got anything better to do. Why don’t you go and nick a few nonces instead of hassling me, you fucking wankers?’ Fuck off. Fuck off. Fuck off!!!

Screaming and shouting I was getting really worked up.

Eventually I managed to push everything, syringes, spikes and even the little bits of silver foil from the Ritalin through the ventilation grill so there was nothing in my possession to be nicked for and I began to relax a little.

I can still hear the police outside the door talking. I can’t hear what they’re saying as they’re now keeping their voices down. I try and clean myself up as best I can in the circumstances. I’ve still got to sign on for bail and I’ve got all these dirty pissy marks down the front of my shirt as a result of lying on the toilet floor and I look a mess. I stand with my back to the window facing the door waiting for the police to come in and arrest me.

Nothing.

The train starts slowing down as it’s pulling into Woking station. It stops and I don’t have any choice’ I’ve got to get off the train to go and sign on. I gather myself together the best I can knowing that they’re out there just waiting for me to get off the train. They know who I am and, I guess, where I’m going.

I open the door and walk out into the corridor and there was no-one there. Fuck! I’d imagined the bloody whole episode.
By C.D sadly missed.

Drug Induced Seizures

IMG_5570_1

know your seizure 'triggers'

Many drug users may have experienced a seizure at one time or another –and you don’t have to be an epileptic to have a seizure.

[Epileptic] seizures can be very frightening to experience and to witness and although many ‘committed’ drug users/drinkers will have experienced a seizure at some point in our lives, there are still many myths that concern how to deal with a person who is fitting and a general lack of understanding as to what triggers ones seizure, or how to deal with it when it occurs. (look at OD Myths’ in Black Poppy 2).

There are two main types of epileptic seizures; petit mal (minor epilepsy where a person may momentarily lapse into inattention/ daydreaming without losing consciousness) and Grand Mal ( Major epilepsy) which is more serious with muscular spasms and convulsions and a short loss of consciousness. People who are epileptic may often carry an orange ID card or wear a warning bracelet. With drug use, it is the major type of seizure that occurs most often. This is usually from long term (or heavy bingeing) benzo or barbiturate use; A person may miss taking their pills for a day and find themselves fitting. However, seizures can occur alongside an overdose on most drugs, indeed they occur from too much alcohol, heroin, cocaine, ecstasy, antidepressants and many others.  Interestingly, everyone has what is known as a ‘seizure threshold’ meaning that anyone can experience one given the right conditions. (BP has an indepth article on seizures, see Issue 11 for our drug induced seizure update.)

It is certain that stress increases the possibility of seizures, as does menstrual changes, vitamin or mineral deficiencies, metabolic changes (including blood pressure that is too low or drug/alcohol use), virus activity and other things, such as trauma to the head area, with seizures more likely to  re-occur if someone has had them in the past.

It is important to get to know what ‘trigger’ your seizures as it appears that the more you get them, the more susceptible you become to getting them. Thus if you can find ways to reduce the likelihood of getting a seizure, either through using certain neuroleptic drugs and improving your lifestyle, you have more chance of getting rid of them. Most people do stop or ‘grow out’ of seizures, but they can come back when your body is struggling from one thing or another.

Many of us have experienced seizures starting through too much benzodiazepines use (or from stopping them too quickly). Seizures can still happen up to a few years after benzo/barbiturate use has stopped. (see warning signs).

For the rest of the article, click here.

Dealers Certificate of Standards

A Dealer’s Certificate of Standards

I, [who cannot be named for legal reasons] hereby declare to adhere to certain standards within my trade and promise to do what is

right and fair inasmuch that is permitted by my [ i l l e g a l] profession.

I hereby swear to the following:

Hygiene

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

If your gonna do it - pass dem drugs on in the safest way possible -save face, save mates.

When mixing up any powder or liquids/ I promise do it on a clean surface, with a clean blade/card/ in as clean wraps/bags as I can manage. If I must keep my wares hidden in socks/pants/pockets/mouth/arse/ I shall be especially vigilant as to how they are wrapped and ensure they are covered at least 3 times and sealed properly, and shall work to find the most robust method of wrapping to avoid contamination by bacterium. I shall always try and use a  cool/ dark and dry place to store/hide my wares to avoid any contamination and moisture.

Timekeeping

I promise to not lie about the time I will take to deliver my wares to my customers/ or to leave my customers standing on street corners for ridiculous lengths of time/ especially in winter.

Respect

I promise to treat my customers with dignity and respect whenever possible. I will not fall prey to the traps of ‘powder power’ and will never lord my wares over customers less fortunate than myself. I will never take advantage of women or men for drugs. If customers are straight-up with me, (possibly leaving some room for small abberations when junksick) I will always try and be reasonable in return. I do however, always reserve the right to ditch a grass no matter how long I’ve known them…

Ethics

I will abide by the knowledge that overdoses occur more frequently for those just out of prison or rehab and will always endeavour to tell such customers the risks involved. I shall never sell a person their first ‘hit’ and will do what I can to dissuade the young and inexperienced.

Adulterants

I will never cut any powders or liquids with anything I believe to be harmful or unclean. I will always use the safest cuts on the market and will keep abreast of developments regarding the safest cuts available/ only if cutting is necessary.

Credit

I promise not to be overly tight about giving credit to regular customers and if I know they are sick or desperate/ 1 promise to afford regular customers at least one bag on tick.

(print out and…) Sign or stamp here

(from BP issue 10)

Osteomyelitis

Note: To read the complete article and not this abstract, please click here

Big Name, Big Infection

After noticing an increase in the numbers of IV drug users who have been diagnosed with osteomyelitis, BP thought some investigation was needed as it appears to be an infection most of us know very little about, but which can have some extremely serious consequences if left untreated. Osteomyelitis is a serious bone infection which can occur in virtually any bone in the body although it usually crops up in the spine, foot or in long tubular bones such as those in the arm or leg, even fingers.

osteomyelitis – an extremely painful infection inside the bone, and one that can affect injectors.

While quite rare in many countries, there has recently been a rise in the numbers of intravenous drug users (IVDUs) becoming infected and this is particularly disturbing considering its often vague initial signs and symptoms which can mean diagnosis is often delayed. This, coupled with the problems IVDUs often encounter when accessing health care can mean that many users are suffering unnecessarily through late diagnosis.

This is a particular concern as some forms of the disease, such as vertebral (spinal) osteomyelitis can, if left untreated, lead to permanent paralysis, significant spinal deformity or even death. It can be an extremely painful infection of the bone and can take some time to heal so it is important for all of us to be aware of osteomyelitis and its symptoms so we know what to look out for. People with compromised immune systems such as cancer or HIV/AIDS, need also be very aware of this debilitating condition as it is often more likely to appear in people whose immune systems are not functioning well.

What is it?

Osteomyelitis is usually a secondary infection that follows an infection borne elsewhere in the body – perhaps caused by a wound, (such as an infected abscess), surgery, bone fracture, or a foreign body such as a surgical plate. IV line, urinary catheter or bullet. Once started, the infection can then spread to the bone via the blood and when the bone is infected, pus is produced within the bone. This can result in an abscess, depriving the bone of its blood supply. Early treatment can save the bone from destruction but as bone is hard tissue it is often resistant to antibodies and this can be difficult to treat.

Similar to infective endocarditis (BP issue 7 and BP’s A-Z of Health), osteomyelitis is usually caused by the same bacteria: Staphylococcus aureus (Staph. a). This bacterium can be introduced into the body in a variety of ways. Staph a. live intermittently on the skin in more than 70% of the population at any one time and the other 14 are colonized persistently. Those who use injecting equipment on a regular basis and inject in sites that are potentially Staph A colonized such as the feet, hands, groin etc can be at greater risk of attracting infection (see prevention). Again, this is why a hygienic injecting regime is essential for all IV users to help reduce as many factors as possible that could encourage an infection, (see overleaf & BP no. 7).

To read the rest of this important article on osteomyelitis and catch up on the symptoms, treatment, its relation to intravenous drug use and more, click here (from BP issue 8)

Naltrexone

Advertisement for curing morphine addictions f...

There's been a lot of 'cures' advertised over the years...

(Updated in 2011 from an article in BP issue 2)

There has been quite a lot of developments in the uses for naltrexone, not just in the UK but around the world -and it is clearly not just a single treatment option. There are various ways of using naltrexone – and this update, taken from issue 2 and added too, looks at Naltrexone’s origins, its uses and its future.

What is Naltrexone and How Does it Work?

For heroin, (and other opiates such as methadone, morphine, palfium, codeine etc), to produce their effects – and get you stoned – they need to be able to attach themselves to small areas in the brain and nervous system called receptor sites. Naltrexone not only blocks these receptor sites, which prevents any opiates from working, but also displaces or removes any existing opiates that currently occupy those sites. Such drugs are called ‘opiate antagonists’ – they antagonise (to put it mildly!) any opiate. This means that if you take naltrexone when you have an opiate ‘habit’, you will find yourself withdrawing quickly and intensely as the opiates are rapidly (rather than slowly) removed from your receptor sites, and your body reacts to their absence. However, if you’ve already detoxed, taking naltrexone may help keep you abstinent as using heroin simply will not work. Naltrexone is sometimes referred to as a ‘non-drug’ because it doesn’t really have any effect other than blocking the effects of opiates. Naltrexone is long lasting – from 24 to 72 hours depending on the dose, and it comes as a tablet, or as an implant. It is closely related- but not the same – as Naloxone (or Narcan), the ‘pure’ opiate antagonist which doctors use for opiate overdoses; but naloxone only works when injected and lasts for only a short time – less than an hour, which is why people need to be monitored and can ‘fall back’ into overdose.

To read the rest of what is an interesting insight into Naltrexone, click here.

Methamphetamine

Crystal methamphetamine

A nice pic of crystal meth!

Methamphetamine

From BP issue 11. Written by M.M (additional text and research E O’Mara)

Recently making a re-appearance in the UK, methamphetamine is starting to make itself known. BP investigates the drug – its effects – and the hype that surrounds its use.

If you were a heroin addict in London during 1967/68 it was likely you were either a doctor or someone in the medical profession with easy access to prescription drugs. Or, you were one of the small clique of several hundred addicts who frequented the West End, many being prescribed ‘jacks’ (diamorphine in soluble pill form), cocaine and a plethora of drugs we might only dream about today (e.g Mandrax, Drinamyl, Seconal, Dexedrine etc). These drugs were prescribed to users by a handful of well meaning, sympathetic -although some might say misguided, doctors, many of whom were based in the West End. One such doctor, now mythologized in British drug culture was Dr. John Petro. Dr Petro was the first G.P to switch his clients from cocaine to Methedrine, (the brand name for methamphetamine) as a result of a clinical preference for the latter. His colleague, Dr Christopher Swann, also switched his cocaine using patients to Methedrine, but for very different reasons. The rules governing the dispensing of cocaine to addicts were, during the late 1960′s, being tightened and this was to affect the way other doctors would prescribe at the time.

There is little doubt that some of those who were switched to Methedrine were drastically over prescribed with some patients receiving as many as 20 to 50, 25mg ampoules per day (1/2g -1 gram). It’s not hard to foresee that the massive over prescribing of amphetamines would cause problems within the drug using community and in retrospect, one can only stagger back in disbelief at the naivete or inexperience of the few doctors involved in this practice. One must remember however, that the treatment of ’addicts’ was still in its infancy and a good deal less was known about methamphetamine, which of course was liberally used by medical students under the recommendation of doctors – as they crammed for exams while working extremely long hours.

The ramifications of the sudden introduction of Methedrine ampoules were twofold. One consequence of the availability of injectable speed was that it caused a significant number of current ‘pill taking’ amphetamine users to begin injecting Methedrine ampoules, the injecting of which didn’t have the same connotations as injecting heroin. Once familiar with a needle and the injecting process, barriers to trying other drugs IV were effectively overcome, making methedrine a more realistic ‘gateway’ drug than the contentions around cannabis. While many of these IV speed users soon came to rely on barbiturates in order to come down after a binge on Methedrine, it was soon discovered that barbs could also be injected although this was a far more dangerous practice and overdose became endemic amongst the drug using population of the time, particularly in the West End. Many users were known on a first name basis by the doctors in the A&E department at Charing Cross hospital, sometimes presenting as many as 2 to 3 times a day. Barbiturates on the whole, were not made for injection and caused horrific abscesses known amongst users as ‘barb burns’.

In Soho and the West End a new ‘type of addict’ started to emerge who had never taken heroin but were experiencing very real problems with Methedrine and barbiturate dependence. The physical health of London’s users deteriorated rapidly coinciding with the increase of methamphetamine and barbiturate prescribing and the subsequent leakage onto the black market. These new drug users were more visible and a good deal harder to treat than their heroin/cocaine predecessors. Methedrine when taken in large doses and administered frequently, does little to improve the mental health of users and when combined with the disinhibiting effects of barbs, many of these patients became unruly and occasionally violent, suffering from varying degrees of drug induced psychosis. In 1968 pharmacists themselves voluntarily agreed to desist in the practice of dispensing Methedrine ampoules.

That was then, the first time that methamphetamine had darkened the doorstep of our green and pleasant land to any significant degree. It seems likely however, that it won’t be the last as anyone with their ear to the ground will no doubt be aware. Methamphetamine has reemerged, but this time entirely through the black market…In simple terms, methamphetamine is the granddaddy of the amphetamine family, being twice as strong as dextroamphetamine (e.g dexedrine), and four times the strength of ordinary amphetamine i.e Benzedrine.

If you would like to read the rest of this terrific article, click here.

Methadone – The History of Juice

Chemical structure of methadone.

Methadone's chemical structure

The Methadone Myths…

Methadone was first synthesised in Germany in 1938 by chemists working for IG Farbenindustrie. There are several widely-circulated stories about the birth of methadone which are of doubtful veracity. It is often said, for example, that the new pharmaceutical was dubbed Dolophine in honour of Adolf Hitler. In fact, it was originally tagged with the unimaginative name of Hochst-10820 (Hochst being the name of the factory where it was invented), and later named Palamidon. Another widely-circulated story has it that the chemical was synthesised for use as an analgesic, eliminating Nazi Germany’s dependence on Turkish opium for morphine, or that it was created on the personal orders of Reich Marshal and Luftwaffe commander Hermann Goering, a heroin addict, to ensure that cold turkey could be kept at bay if supplies of morphine were cut off. Attractive as this last story is, and while it is true that Goering was a junkie, it is probably apocryphal.

Methadone was not brought into wide production during the war at all, and its properties were only studied later. After the war the Hochst factory fell into American hands and as a part of the wholesale plundering of German scientific and technical knowledge (which saw V2 rocket technology and Nazi advanced weapons and intelligence expertise appropriated by the US military-scientific establishment under Operation Paperclip) the methadone molecule too, ended up as loot of war.

More Than Morphine?

It was the American pharmaceutical company Eli-Lilly who began the first clinical trials in 1947 and it was here that it was first christened Dolophine, probably derived from “douleur” and “fin”, the French words for, respectively, “pain” and “end”. The chemical was found to have a similar pharmacological action to morphine, despite its very different chemical structure, and it was much longer-acting. Once these facts were established, methadone disappeared into obscurity in the USA for over a decade. While its chemical cousin pethidine – which, incidentally, was produced in bulk in Nazi Germany as a morphine substitute -and is still used today to ease women’s labour pains, methadone never really caught on as a narcotic analgesic in America.

The earliest accounts of methadone use in the UK are from 1947, when a paper published in the medical journal Lancet described it as “at least as powerful as morphine, and ten times more powerful than pethidine”.

Methadone Treatment

By the end of 1968, the year when the Home Office notification/registration system of addicts was introduced, 297 people had been notified as being addicted to methadone. Doctors who thought it less addictive than other opiates had begun prescribing them the drug however, through the 1960s, patterns of drug use were changing; Opiate addiction, which had until then, primarily been an indulgence of the wealthy (or medical professionals themselves), was now being picked up by younger people, taking opiates for pleasure rather than for pain.

1968 also saw the introduction of drug treatment clinics and the abolition of free prescribing. The clinic system effectively removed the GP’s discretion in the prescribing of controlled drugs and specialist centres took over the treatment of the majority of dependent drug users, a practice that continues today. In the first years of the clinics, doctors freely prescribed pure pharmaceutical heroin and methadone in injectable form for addicts. The introduction in the mid 70s of smokable Middle Eastern brown heroin resulted in many users arriving for treatment not expecting to inject their drugs, encouraging the clinics to move towards using oral methadone for treatment.

Methadone Maintenance – The Minimum Vs the Maximum

Methadone maintenance treatment, as we recognise it now, was pioneered in the USA in the early 60s. In 1963, two New York doctors by the names of Marie Nyswander and Vincent Dole began exploring methadone as a possible treatment for opiate addiction. There was a screaming need for it – by the end of the decade, heroin-related mortality had become the leading cause of death in New York for young adults aged between 15 and 35. Dole and Nyswander identified the features of methadone that made it a suitable maintenance drug. At doses beginning at 80mg per day, it effectively blocks the euphoric effects of all opiate drugs. Patients stabilised on methadone do not experience euphoric effects and tolerance does not develop like many other opiates, necessitating ever-increasing doses. Tolerance to methadone’s pain-killing effects does develop however, meaning patients experience pain normally although trying to explain this to a nurse or doctor when you’re in A & E is another matter entirely. As it is a long-acting drug, it can be administered once a day, enabling a greater level of stabilisation as compared to shorter-acting opiates.

Nyswander and Dole operated on the premise that heroin addiction is in effect a metabolic disorder, comparable perhaps to diabetes. Large doses of methadone – 80 to 150mg – were used to normalise the disorder, as insulin is used for diabetes. They combined this theory of treatment with efforts at psychological counselling and social rehabilitation, including help and encouragement in finding work. Many of their patients benefited greatly from the treatment and were successfully re-integrated into “normal society”, such as it is. The use of the treatment spread, but was not necessarily implemented with the innovation displayed in the work of Nyswander and Dole. For example, more than half of the USA’s 120,000 methadone patients today are treated with dosages well below those recommended by their research.

To read the rest of this article and find out about methadone’s pros and cons and the trials of treatment, click here.

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