Pretty Pills? I knew it!

Some light relief for the pill munchers amongst us…Pills like we have never seen them before, honest!

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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

Ibogaine update

Well readers, I have a treat for you!

Ten years ago David Graham Scott (whom we have written about and written with on this website) screened a very personal documentary on channel

Documentary filmmaker David Graham Scott on his journey to rid himself of heroin and methadone addiction. David during the dream phase of the Ibogaine drug. Copyright david gillanders_photography 2003 Not to be reproduced, printed or published without prior consent from David Gillanders. m_ + 44 (0)7974 920 189 e_ david@davidgillanders.com

Documentary filmmaker David Graham Scott on his journey to rid himself of heroin and methadone addiction. Above: David during the dream phase of the Ibogaine drug in the film Detox or Die. Copyright 

4, about his own experience as a person struggling to finally quit using methadone -by using ibogaine. The film Detox or Die has since been viewed many, many thousands of times on the web and at film festivals and conferences. It is a really interesting, personal and thoughtful film about his attempt to embrace the spirit of Iboga, by using a guide, who stayed with him throughout the entire two day ordeal, something he filmed entirely.

Well, my treat for you in David’s follow up film made 10 years later. David not only talks about his own experience of staying drug free since then but he looks at Ibogaine in other treatment settings -one persons actual DIY treatment to cure their heroin addiction, another couple of guys who embarked on a ‘journey with ‘a guide’ whom they paid a couple of thousand pounds, someone who bailed halfway through the treatment, as well as talking to some other dependent drug users about kicking their habit and their hopes for ibogaine working for them.

Portrait of filmmaker David Graham Scott today

Portrait of filmmaker David Graham Scott today

It is a classic piece of work, expertly made by a pro, we are dead proud of him here at BP and happily I can provide you with the link to watch not just Detox or Die but the more recent Iboga Nites -which came out in 2013. David has already won numerous awards for the film and it should spark interest and debate for some time to come. Well worth a watch for anyone remotely interested in detoxing or the subject of drugs.

This comes from David’s website detailing information on the film Iboga Nites

“The psychedelic plant root hails from Africa where it has been used in religious ceremonies through countless generations. A burgeoning movement in the west has promoted iboga as a quick fix route to painless withdrawal.

Now David wants to find out how truly effective iboga is. In a Dutch suburb several addicts embark on the long night of psychedelic detox under the watchful eye of an experienced Iboga practitioner. One client collapses and ends up on life-support, the provider is jailed and David starts to question the safety of iboga treatment.

 The film culminates with a nerve-wracking iboga session in London where the director himself administers the treatment. How does the filmmaker weigh up the ethics of involving himself so deeply in this controversial detox option and what will be his final resolve on the efficacy of it?”

IBOGA NIGHTS from David Graham Scott on Vimeo.

Drug Consumption Rooms

Here is a video I just wanted to share with you all, it was made in the UK by one of our treasured harm reduction /drug workers Phillipe Bonnet in Birmingham and he presents a very honest (and difficult to watch at times) account of why we need drug consumption rooms all across the world – particularly in the UK today. We have yet to open such a facility in the UK -it makes no sense to shy away from such a simple, straightforward solution. Our pal Neil Hunt talks about cost and why DCR’s are not that expensive and that they could hook onto needle exchanges as they already appear. Why not? How much longer can we look the other way when we have the solution in our very hands -solutions with the evidence base to back it up. As Dr Judith Yates in the film says “A simple intervention like this early on, can prevent all this damage later on”.

A word from the film-makers – Published on 23 Oct 2012

This Documentary invites the audience to see the harsh reality of ‘street injecting’ drug users in the UK’s second city Birmingham. The presenter Philippe Bonnet explores this subject by interviewing outreach workers, health care professionals and current and ex drug-users. The film shows how other countries around the world have found a solution to this and as a result have reduced harms and costs associated with this phenomenon and ultimately helped drug users access treatment and begin their recovery.

 

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.

 

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.

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?

 

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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.

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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

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