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. 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
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.
“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?”
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.
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.
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
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.
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.
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 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
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
Hi guys, now you know we are always the first to understand that things are complicated and never just black and white and that a junkies relationship with their doctor/s is something pretty unique (we could all write a book right?) and we are not saying we want all prescribing doctors arrested – that is not the point here, and its a very long way from it.
But just like when you scratch at the ugly scab that is the war on drugs and you find governments’ lying, scheming for their own economic ends, even wheeling and dealing in the very drugs they lock thousands of their citizens up for..and you scratch deeper still and you see the roots of these global drug laws rooted in fear and racism, xenophobia and cultural ignorance, economies and GDP’s, total monopolies by companies and the ever larger monolithic pharmaceutical industrys’ that orchestrate and lobby for the very laws they securely tie up ever tighter still, seeking global domination and a pill for everything we could never even imagine we needed one for….- there is certainly no concern for our youth or environment, – …..Well, I thought you might like to read this article that gives some background into the explosion in Oxycontin in the USA today. How big pharma is raking it in, how the doctors are earning billions as well, how USA overdose rates continue to rise and rise year on year, how prisons keep increasing their numbers of paid lobbyists at Capitol Hill to make sure that, although violent crime is, and has gone down (yes that’s right) in the USA for many years now, more and more laws keep getting introduced to ensnare the illegal immigrant, the petty criminal etc, so society can pay for these ‘Titan prisons’ and maintain the jobs within them, in the cities that the bureaucrats would flourish because of these disgusting, concrete jungles of inhumanity..
But let’s just get a glimpse of how big pharma do things – or rather – how little pharma can grow into HUGE pharma, courtesy of the American taxpayer, and another drug dependent generation – paying the ‘Right Man’ this time, not the junkie down the street….
PS – Remember, we don’t always dig the journo’s language when describing people who use drugs, but we will overlook that somewhat for the sake of the piece. Always write in to the editor to challenge their language if you see or feel that oit is inaccurate, sweeping, or causes offence.
(The link to complete article above and at the end of this text – thanks in advance to Mike Mariani – Here is an extract)
The state of Kentucky may finally get its deliverance. After more than seven years of battling the evasive legal tactics of Purdue Pharma, 2015 may be the year that Kentucky and its attorney general, Jack Conway, are able to move forward with a civil lawsuit alleging that the drug maker misled doctors and patients about their blockbuster pain pill OxyContin, leading to a vicious addiction epidemic across large swaths of the state.
On December 12, 1995, the Food and Drug Administration approved the opioid analgesic OxyContin. It hit the market in 1996. In its first year, OxyContin accounted for $45 million in sales for its manufacturer, Stamford, Connecticut-based pharmaceutical company Purdue Pharma. By 2000 that number would balloon to $1.1 billion, an increase of well over 2,000 percent in a span of just four years. Ten years later, the profits would inflate still further, to $3.1 billion. By then the potent opioid accounted for about 30 percent of the painkiller market. What’s more, Purdue Pharma’s patent for the original OxyContin formula didn’t expire until 2013. This meant that a single private, family owned pharmaceutical company with non-descript headquarters in the Northeast controlled nearly a third of the entire United States market for pain pills.
OxyContin’s ball-of-lightning emergence in the health care marketplace was close to unprecedented for a new painkiller in an age where synthetic opiates like Vicodin, Percocet, and Fentanyl had already been competing for decades in doctors’ offices and pharmacies for their piece of the market share of pain-relieving drugs. In retrospect, it almost didn’t make sense. Why was OxyContin so much more popular? Had it been approved for a wider range of ailments than its opioid cousins? Did doctors prefer prescribing it to their patients?
Because there was simply so much OxyContin available for over a decade, it trickled down from pharmacies and hospitals and became a street drug, coveted by teens and fiends and sold by dealers at a premium
During its rise in popularity, there was a suspicious undercurrent to the drug’s spectrum of approved uses and Purdue Pharma’s relationship to the physicians that were suddenly privileging OxyContin over other meds to combat everything from back pain to arthritis to post-operative discomfort. It would take years to discover that there was much more to the story than the benign introduction of a new, highly effective painkiller.
In 1952, brothers Arthur, Raymond, and Mortimer Sackler purchased Purdue Pharma, then called Purdue Frederick Co. All three men were psychiatrists by trade, working at a mental facility in Queens in the 1940s.
The eldest brother, Arthur, was a brilliant polymath, contributing not only to psychiatric research but also thriving in the fledgling field of pharmaceutical advertising. It was here that he would leave his greatest mark. As a member of William Douglas McAdams, a small New York-based advertising firm, Sackler expanded the possibilities of medical advertising by promoting products in medical journals and experimenting with television and radio marketing. Perhaps his greatest achievement, detailed in his biography in the Medical Advertising Hall of Fame, was finding enough different uses for Valium to turn it into the first drug to hit $100 million in revenue.
The Medical Advertising Hall of Fame website’s euphemistic argot for this accomplishment states that Sackler’s experience in the fields of psychiatry and experimental medicine “enabled him to position different indications for Roche’s Librium and Valium.”
Sackler was also among the first medical advertisers to foster relationships with doctors in the hopes of earning extra points for his company’s drugs, according to a 2011 exposé in Fortune. Such backscratching in the hopes of reciprocity is now the model for the whole drug marketing industry. Arthur Sackler’s pioneering methods would be cultivated by his younger brothers Raymond and Mortimer in the decades to come, as they grew their small pharmaceutical firm.
Starting in 1996, Purdue Pharma expanded its sales department to coincide with the debut of its new drug. According to an article published in The American Journal of Public Health, “The Promotion and Marketing of OxyContin: Commercial Triumph, Public Health Tragedy,” Purdue increased its number of sales representatives from 318 in 1996 to 671 in 2000. By 2001, when OxyContin was hitting its stride, these sales reps received annual bonuses averaging over $70,000, with some bonuses nearing a quarter of a million dollars. In that year Purdue Pharma spent $200 million marketing its golden goose. Pouring money into marketing is not uncommon for Big Pharma, but proportionate to the size of the company, Purdue’s OxyContin push was substantial.
Boots on the ground was not the only stratagem employed by Purdue to increase sales for OxyContin. Long before the rise of big data, Purdue was compiling profiles of doctors and their prescribing habits into databases. These databases then organized the information based on location to indicate the spectrum of prescribing patterns in a given state or county. The idea was to pinpoint the doctors prescribing the most pain medication and target them for the company’s marketing onslaught.
That the databases couldn’t distinguish between doctors who were prescribing more pain meds because they were seeing more patients with chronic pain or were simply looser with their signatures didn’t matter to Purdue. The Los Angeles Times reported that by 2002 Purdue Pharma had identified hundreds of doctors who were prescribing OxyContin recklessly, yet they did little about it. The same article notes that it wasn’t until June of 2013, at a drug dependency conference in San Diego, that the database was ever even discussed in public.
purdue_reformulated_oxy_Pic – crushed by a mortar n pestle: reformulated to deter injecting…
Combining the physician database with its expanded marketing, it would become one of Purdue’s preeminent missions to make primary care doctors less judicious when it came to handing out OxyContin prescriptions.
Beginning around 1980, one of the more significant trends in pain pharmacology was the increased use of opioids for chronic non-cancer pain. Like other pharmaceutical companies, Purdue likely sought to capitalize on the abundant financial opportunities of this trend. The logic was simple: While the number of cancer patients was not likely to increase drastically from one year to the next, if a company could expand the indications for use of a particular drug, then it could boost sales exponentially without any real change in the country’s health demography.
Id like to discuss a campaign involving many members of the drug using community across the world. As far as campaigns go, this one should be a done deal. In fact it should of been snapped up as a central component in all our national and community drugs strategies years ago. The benefits and results to be reaped from rolling out similar campaigns is nothing less than saving life itself and the prevention of repeated tragedy, trauma, gut-wrenching grief and endless pain and loss. What is the campaign? To get Naloxone, the drug that instantly brings a fully overdosed and dying person back to life in seconds, into the hands of every single heroin user and ideally, into the hands of their family and partners.
The reasons to implement and progress this campaigns’ agenda are, at first glance so crystal clear, so straightforward, so blindingly obvious that the average person could be forgiven for asking, “Just what is taking so long? – We need to empower people to save lives, naloxone works, its cheap and simple to use, so let’s do this!”
But, after we remove the blindingly obvious common sense and our societies desperate need to rollout these programmes in the face of rising overdose figures, we must question why we still have unacceptable dithering by authorities and a worrying lack of will to progress the agenda.
It must be considered that such delays carry the familiar hallmarks of the common ‘junkie stain’ or rather, the agenda that is stained or dismantled or even left to rot, simply through its association with drug users. However, this particular campaign, which has come in all sorts of shapes and guises, is gaining traction in areas all over the world and recently, finally, here in the UK too. It has the fangs of drug user activists in it all over the place, with programmes that are getting naloxone into the trained hands of policemen and women, family members and partners, pushing forward the idea of Naloxone as a free item or a purchase from a pharmacy by people, even bringing a used one back to get a new one etc.
There is bound to be something you can do in your own community to help push this agenda forward and to get Naloxone into the trained hands of at least every single heroin user in your neck of the woods, in the rollout towards Naloxone being in every hand, in every city across the world.
What do we do with a medicine that prevents certain death for people with a particular condition—and is safe, cheap, and easy to administer?
Immediately make it accessible to those who can administer it when such a life-or-death situation arises.
Make it available to no one except doctors and emergency room workers.
Endlessly debate the particulars of how and when it should be widely introduced.
If you picked number one, that would seem to be a reasonable choice. Unfortunately, it would also be incorrect. With few exceptions, answers two or three apply in the vast majority of the world when it comes to the medicine naloxone.
Overdose remains a leading cause of death among people who use drugs, particularly those who inject. Increasing the availability and accessibility of naloxone would reduce these deaths overnight.
Naloxone is an effective opioid antagonist used to reverse the effects of opioid overdose. On a global scale, however, exactly how and where naloxone is used remains unclear. International Doctors for Healthier Drug Policies (IDHDP) is seeking to learn why this is and what can be done to change it.
Some form of community-based distribution programs for naloxone exist in over a dozen countries. But the quality of data pertaining to how naloxone is used is highly variable. Enhancing our knowledge about the use of naloxone will help us to better reap its benefits.
What we do know is that the availability of naloxone is growing in several countries. Scotland implemented a national program in 2010, and outcomes there have demonstrated its effectiveness in reducing drug overdose deaths. In China, it is available in an increasing number of hospitals. Canada and Estonia have pioneered programs on take-home naloxone.
And in the United States, policymakers called for greater availability and accessibility of naloxone after opioid overdose deaths more than tripled between 2000 and 2010. In some states, distribution expanded from emergency rooms, paramedic services, and needle-exchange programs to police stations. In Quincy, Massachusetts, all police began carrying naloxone [PDF] in 2010, leading to a 70 percent decrease in overdose deaths.
The role of naloxone in addressing opioid overdose was recognized for the first time in a high-level international resolution in March 2012. Members at the UN’s 55th commission on Narcotic Drugs unanimously endorsed a resolution promoting evidence-based strategies to address opioid overdose. Recently, the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) published a very useful literature review of the effectiveness of take-home naloxone.
To build on these gains, we need more data. IDHDP wants to find more out about the availability and accessibility of this life-saving intervention. To that end, we’ve created the Global Naloxone Survey, an attempt to compile information about where naloxone is available, who can use it, and where it can be accessed with or without a prescription.
We then will analyze the results with the short-term goal of obtaining as much information as possible on how widely and readily available naloxone is. Subsequently, we intend to work to maximize both the availability and the accessibility of naloxone, particularly to those who are most likely to be present where and when an opioid overdose takes place.
This talk on Naloxone was given at a local TEDx event, produced independently at one of the TED Conferences. In 2011, fatal drug overdoses in the UK (3,338) exceeded the number of road accident deaths (1,960). These deaths are preventable. Jamie Bridge talks here about how rethinking both product design and service design have the potential to save lives in the administration of overdose medication. Naloxone was developed in the 1960s to counter the effects of heroin overdose. It’s a staple part of ambulance crew kits, but those who need it face barriers to the drug at the point at which it could save their lives. Recently, there has been a shift in focus and design to ensure that naloxone is available to those likeliest to witness an overdose – drug users, their families and friends. The evidence shows that naloxone works, and that drug users can be empowered to save the lives of their friends.
Jamie Bridge is a passionate advocate for drug services and drug policy reform in order to protect the rights, health and well-being of vulnerable people around the world.
* Naloxone is the generic term, it is also known by its brand name which is Narcan.
Wow, great question huh? And one that Max Daly from VICE Magazine has just answered in its January 13th Edition. I was really pleased to see an articulation of how I have been feeling about set ups like Silk Road and the Dark Web as well as the hype around NPS’s – New Psychoactive Substances, or research chemicals to you and me.
I couldn’t help shake the feeling that many of these new research chemicals sound like (and feel like) a bad day in your drugged out teenage bedroom. Chemicals that are – well, just too chemically, with spiky, wired kind of edges, insomnia rather than stimulation, and a strange collection of side effects like twitches, memory loss, anxiety or nausea or even seizures, arrhythmias, panic attacks and collapsing/black outs. You’re sensing the picture. You’ve probably had experience of the ‘almost’ drugs; ephedrine trying to be amphetamine, (no good) pheniramine trying to pose as LSD (a trip for sure but…) The old school big sellers are out there as big sellers for a reason.They have risen above the throng. Surely we would know by now if these new drugs were consistently more like diamonds than mud to experience? But I fear we do know, for the most part. Most of the newbies, 98% of them, aren’t really very pleasant. Now of course there has been fatalities, but what do we expect when we really dont know shit about where these chemicals are coming from, the lab conditions, the chemists making it up, let alone whats REALLY in a particular substance.
15 minutes of Fame, NPS Style
A look on YouTube into NPS /research chemicals/bath salts and overdoses, and you get our wonderful society out there filming their buddy’s or a strangers weird drug overdose. This was when I saw some very disturbing but similar overdose reactions of a type Id never seen before from any other drug. These weren’t seizures of any kind currently understood, they were some kind of altered state where the person (and their were many sharing the same kind of symptoms) was unable to master any lower limb movements -in other words their arms and legs were completely all over the place and they were often unable to walk at all. Not only that, but movement came from a kind of seal like or fish like, flapping, rolling, careering along the pavement. Vocal sounds became an awful guttural kind of noise or a choked up screaming. apparently something does actually happen to the vocal chords so the person cannot use it for normal communication. There has also been videos of police getting out taser and repeatedly, and I mean REPEATEDLY, tasering a person 2,3,4 even 5 times and the person is still able to excitedly respond or get up and still freak out etc. Body temperature supposedly heats up so clothes come off, which again gets all the home grown film makers out, filming another persons terrifying psychosis of some sort for all their workmates and neighbours to see.
(Note: This is a very disturbing video (think Ill remove it afterwards) of what appears to be the kind of ‘bathsalts’ type of overdose -NOT Krokodil as the heading describes. There are many of chemicals possibly derived from the cathinones that seem to be responsible for some of these responses, in particular MDVP which may be the culprit. People often use way over the tiny dose that is advised of 5-10mg. There are quite a lot of youtube videos like this where people are having some kind of episode but all show strikingly similar side effects, side effects that I for one, in over 30 years on the scene, have never seen before. It isn’t to be hyped, but there is something weird and a bit scary about the effects of some of these unknown new chemicals).
Click to KFX.org.uk, a really comprehensive website on all drugs but esp NPS, updated regularly.
So yeah, its scary but, to go back to the future of drugs and the Vice article, it was good to hear someone agreeing that the NPS’s wont really take off, that they will remain a teenagers fallback, or for the person that has not yet properly developed real drug taste. That only the good old troopers will remain the most used and the quality will; just get better as more and more people use the Dark Web and networks like Silk Road 3, to really flesh out a safe place to buy quality drugs and, yes ok, hellishly over inflated prices. But, if your anything like me and, dare I say, a drug connoisseur, you will be happy to pay an inflated fee if the drugs are going to be exactamundo – quality high, packaging clever, weight bang on. Here is a quote from the article:
” Yet the future will not be about the endless procession of legal highs. A smattering of new psychoactive substances (or NPS) will always be around, and to an extent always have been, but they have had their day in the sun. An interesting sideshow, they have served a purpose. Yes,mephedrone is here to stay and maybe 2C-B will hang around too, but now that the ecstasy and cocaine markets have righted themselves, with the purity of both drugs up considerably, the old school drugs are back. Clones of stimulants and other chemicals will still have an appeal to those who are skint, or are unable to get hold of decent drugs or who want to avoid getting caught out in piss tests, but the imminent clampdown on head shops will stifle supply to teenagers and the homeless – two of the keenest buyers of NPS products.
The online drug trade, however, will be blazing a trail into the next decade and beyond, whether the world’s police like it or not.”
Finally a Market to Dream About?
The Future of Drugs: Vice Magazine Issue 531: Written by Max Daly
Max Daly then relays his meeting with Mike Power, author of what looks to be a great read, called Drugs 2.0: The Web Revolution That’s Changing How the World Gets High. Max asks himabout how the online drug trade might fare over the next decade or two. “At the moment, the online trade in drugs is a minority sport, a good way of buying high quality drugs,” he told me. “Even now it’s tipping over from early adopters into the mainstream. It will get bigger, easier to use and more widespread. There will be more sites and more people using them because it is the perfect business model: anonymous, commission-based, peer-reviewed, postal drug dealing. Online dealing is not a replacement for trafficking cartels, it’s never going to work on that level, but if you’ve got a kilo of MDMA it’s the way to go.”
I would actually add to that, having just a bit of this and that, it can still be a way to go. Sharing in a solid community where a forum is tightly connected to the site itself, so people regularly post about who they bought off and what it was like, along with who to avoid like the plague, all overseen by the sites moderator ensuring there is no bullshit being allowed to fester or take off, its really effective. It has a terrific potential for the future to be a real by the people for the people, kind of drug market, one where quality triumphs! What, what, no I’m not dreaming! This could slowly start to formulate around us. Oh sure I think people will continue to invent chemicals to take, although it does seem like they’ve already exhausted the best feeling drugs from a few main families of drugs: cathinones / phenethylamines, and amphetamines and are already on the dregs of these. Surely there has to be another surprise like a synthetic ‘opioid’ family to discover??
In the meantime, it could well be as VICE, and Max state. That NPS’s will die a slow death or remain in relatively low numbers as adults go old school and teens grow out of it, and bans catch up and overdoses get publicised. Mephedrone and a few relatives are here to stay of course, and although I think Spice and the synthetic cannabinoids are a bit creepy, even scary, that will always attract some who think it’s a cheap and easy cannabis alternative (just buy real pot and avoid the brain damage!).
All those goodies to buy! The old silk road online shop. It seems the FBI busts only served to force the dodgier online set ups out of business and tightened up safety protocols for the remainders.
I saw the wonderful JP Grund so a recent presentation on NPS’s at a conference in Amsterdam and he talked about the 3 D printer and that we will, one day in the near future, have drug recipes that are made for our genetic makeup and they will be sent to you with the computer programme and I presume the associated chemicals, that you administer to your 3D printer and it makes you your own, personal drug of choice. Now how nice could that be friends?
Black Poppy and INPUD, are more than pleased to report on THRWU, the world’s first ever harm reduction workers’ union which went public on 11 November 2014. Members of INPUD have been involved in this campaign, with a major shout out going to Torontonian Raffi Balian – (a long time friend of both Black Poppy and member of INPUD since its beginnings). Raffi has been a serious mover and shaker on the East Side of Canada for about 20 years now, setting up CounterFIT, which has consistently brought us all innovative, user led and drug user centric projects while inspiring people from all over the world that there is a time to stop thinking and just do it! So it was no surprise to see Raffi, (the guy kneeling down with the green jacket on the left in the picture below) at it again, enthusing, organising, promoting and supporting his fellow junkies, workers, and of course the community.
Toronto Harm Reduction Workers Union -What are you waiting for -give your local union leader (IWW) a call and start talking!
The Toronto Harm Reduction Workers Union is a city-wide organization, representing over 50 employed, unemployed, and student workers. At the launch workers at two of the city’s largest harm reduction programs went public with their affiliation to the Union which is a part of the Industrial Workers of the World (IWW). The IWW is a fighting union for all workers that organizes workers regardless of skill or trade and it is member (not staff) run, with a long history of fighting for the most oppressed and marginalized workers in society
The majority of these workers have been hired for their lived experience of using drugs, incarceration and homelessness and are continuing to organize with the goal of unionizing all of the city’s harm reduction workers.
THRWU speak about the need to organise around many of the issues affecting the industry – of which many harm reduction workers who come from a drug using background, will know a lot about. THRWU point to some of the main areas on their website:
Discrepancies in wages, with workers doing similar work taking home vastly different pay.
People work for years without raises, and have limited to no access to benefits, vacation and sick days.
Management depends on social assistance to provide the basic benefits that workers need (such as emergency dental and drug benefits). This is especially detrimental for those of us hired because we live with HIV and/or Hep C, or use opiode substitution therapy.
Workers are discriminated against based on the lived experience they are hired for.
Many positions are extremely precarious, with grants and funding threatened by conservative and anti-science ideology, and austerity budgets that endanger public health.
These are very real issues affecting the daily lives of people who’s work is not just a job, but a ’cause’, a life, based on their lived experience and a way to put their heart and soul back into their communities, funneling years and years of privileged insight into their work, which has gone such a long way towards stemming the HIV epidemic in the drug injecting community. And damn right they deserve paid work or a raise along with everyone else! Damn right their should be the chance of promotion from volunteer to worker, to team leader to manager. Let’s all be clear here, harm reduction would not work saving the lives it does, reducing the harm it does, stemming the tide of infectious diseases that it does, without the world’s harm reduction workers and many of these are our peers. People who use drugs, used drugs, are on prescriptions etc. The majority of work is unsung, underpaid and under acknowledged for the real impact it has on the community.
So who are we talking about exactly? Well, let’s let THRWU speak for themselves!
“We are the workers that make harm reduction work. We are the kit makers, outreach workers, community workers, and coordinators that reduce the harms associated with bad drug laws, poverty and capitalism. As working class people, our communities have been hard hit by the War on Drugs, the epidemics of HIV, Hepatitis C and overdose deaths. We are organizing to better our working conditions and improve the services we provide. And we are organizing to fight for a society free of oppression and injustice.”
Below is THRWU’s mandate and definition of harm reduction:
“THRWU is an organization of Harm Reduction Workers who are united together in solidarity, to improve our working conditions and to strengthen equality in the workplace for the betterment of the workers and those who access the services. We are a union of employed and unemployed workers committed to harm reduction with a range of skills, education and lived experience. We have come together in our common concerns to form a non-hierarchical democratic labour union with a commitment to mutual aid, social justice and the principles of harm reduction.”
“Harm reduction is an evidence-based and practical approach to dealing with the harms associated with drug use…Harm reduction also aims to respond to harm experienced on a structural or societal level (such as stigma, discrimination and criminalization). This work should be grounded in the values of respect, non-judgment, and in the promotion of self-determination and self-empowerment for folks involved!
We recognize that many healthcare and social service providers endorse a ‘harm reduction framework’ in name only. Our union will prioritize those workers who are actively engaged in harm reduction work, as defined above!”
INPUD, the International Network of People who use Drugs are positive about the future as more drug users self organise. In a statement of support INPUD said, “In the context of the War on Drugs, in which our fellow workers are the casualties, an organizing campaign of this nature is exciting. The THRWU is setting itself up to be a powerful voice for harm reduction workers in the workplaces as well as in broader political struggles”. Last word to THRWU: “We need to organize ourselves to demand an improvement in wages and in workplace conditions. We love the work we do but we also know we need to be treated more equitably. There are many of us working in harm reduction and we can work in solidarity with each other to improve this.”
Boy oh boy, lets wish them luck with their new unionised labour force and their further organizing efforts!
How do I organize a Harm Reduction Workers Union in my city?
If you are interested in building a Harm Reduction Workers Union in your city, get in touch! email@example.com
International Drug User Day 2014 – Let’s hear 3 cheers for that activists
activist -Theo Van Dam, the beautiful Dutchman who came up with the
brilliant idea of a day in the calendar to celebrate the existence, the
achievements, the lives and the work of people who use drugs and their
brave and courageous direct actions that have been challenging wrongs
and fighting injustice, wherever it lies in the world.
Drug User’s must always be part of the solution and never framed only as the problem. Our lived, perceptive and insightful lives will always provide our communities with the insight and language to tackle the issues that black markets have left us; society must work with the drug using community to end the crippling discrimination, criminalization, marginalization and isolation felt by too many – generation to generation; and for what? So some could drink beer while others could not smoke dope? So some could arrest an entire people of colour while others could put on the guards hat and boots while swinging the keys in the lock, stops the clock….IDUD is our day friends -walk tall, believe in yourself not based on your drug or the frequency you use it, but based on the person you really are deep down. Drug users will not be defined by their substance or by societys ignorance; only by the quality of their soul at the gates. Yessirree! November 1st – celebrate it all day friends!
Here are the final 2 blogs in the series of 4, from Igor Kuzmenko’s personal blogs of Crimea, in particular, life for those who once lived under Ukraine law and received Opiate Substitution Treatment (OST) such as methadone only to lose their new found stability after the region’s Referendum when the majority voted to go back to Russian governance. This effectively closed the doors for good on OST leaving over 800 people in shock and despair. So what is a person withdrawing from treatment supposed to do? What would you do if your access to methadone or buprenorphine was cut off almost overnight…? Igor gives us a frighteningly honest account of what happened to the OST community in Crimea..Here is part 3 and part 4.
NOTE: Part one and two are a bit further down this blog and the whole series has been reprinted here courtesy of INPUD’s blog and you can also read them in Russian at ENPUD’s website /blog. Thanks to Igor for a fascinating insight into Crimea for the drug using community, and INPUD for reprinting.
RIP Crimean OST Program, 2006
Meanwhile life in the Crimea went on. As spring approached, people continued to go to work, and students proceeded to attend their studies. Very few inhabitants of the Crimea understood that 806 people of the region’s population, were literally on the way out.
Death From Abstinence
As I wrote previously, the first patient in Simferopol died around the beginning of April. He was about 50, was seriously ill and couldn’t move at all. Everything was good with him before the March events; the doctor wrote a prescription for him so he could get liquid methadone and he continued to use Opiate Substitution Therapy without leaving the apartment. But after March 16, everything changed and the prescription form of OST was suspended in Crimea. It goes without saying that any coroner wouldn’t determine a cause of death as ‘death from abstinency’. But something tells me that if he continued to have the opportunity to receive methadone, he would be still alive.
“But after March 16, everything changed and the prescription form of OST was suspended in Crimea.“
Bupe Not Methadone
Actually, there were not so many people receiving OST on a prescription basis in the Crimea. And there were a few reasons for that. First, the prescription form is possible only for those people who receive buprenorphine in Ukraine. There are cities where all clients of the buprenorphine program constantly receive it using a prescription. But everything is much more difficult when dealing with methadone.
The medicine used in a Ukrainian methadone OST program – known as ‘Metadict’ and ‘Metadole’ – are both made in Germany or Canada. Both of them are in the form of tablets, not syrup. They come in blister packs of 10 tablets: 25 mg each, (total 250mg) or in bottles of 500 mg. But it is impossible to get it using a prescription because according to the laws of Ukraine a single prescription dose of any narcotic substance mustn’t exceed 112 mg. The blister packs are not allowed to be cut up or tablets prescribed separately from the packaging. There were individual cases when patients could receive a liquid methadone on prescription, but only on a commercial basis and it is very expensive.
Methadone Not Bupe
In the Crimea, it is different. Slightly more than 50 people out of 806 patients received buprenorphine, the others got methadone. About 10 people out of those 50 had the opportunity to receive buprenorphine on prescription though not on a constant basis. They got it occasionally – because of a business trip, illness or going on a holiday.
Ukrainian methadone; Metadol
There is also one more reason for prescriptions being shut down in the Crimea after “the referendum”. Doctors were afraid to write out prescriptions on both of these substances because they are actually illegal in Russia and so employees of drugstores in turn, were afraid to sell the medications and fill these prescriptions.
May 20th – D Day
May 20 was the last day when people could use the OST program in the Crimea, so after that each of the 806 person’s who were prescribed had to make one’s own choices of what to do. There were only four options:
String oneself up to stop using drugs forever
Go to Russian local rehabilitation centers praised by numerous Russian “guests”;
Continue using OST by moving to Ukraine;
Go back to using “street” drugs.
According to my knowledge, no more than 20-30 people went to Russia for rehab. Many of them couldn’t undergo an entire “rehabilitation course” till the end and ran away. However, some stayed in rehab for the whole term. One OST client from Simferopol died in St. Petersburg during the rehabilitation process. He died of an overdose.
Slightly less than 60 people risked going to Ukraine. This option was, undoubtedly, the most realistic of all. For example, in many cases it was necessary to buy tickets at ones’ own expense to go to Russia, but in Ukraine both tickets, accommodation and food were paid for you.
Should I Stay or Should I Go?
Nevertheless, as you can see by the number of people who went to Ukraine, it didn’t become a mass phenomenon. Partly, this was due to mass media propaganda which colourfully described the various ‘atrocities’ of Ukrainians in relation to the inhabitants of the Crimea who risked leaving and facing the ‘mockeries’ of the Ukrainian border guards who were taking away passports on the border and other nonsense. The other reason that many of inhabitants of the Crimea never left for Ukraine, was they had neither friends, nor relatives there and simply couldn’t imagine where they were supposed to go.
Now many of the clients of OST who had gone to Ukraine, already found a job there, and all without exception found rented accommodation and received some financial support from the project MBF “Renaissance”.
“It turns out that more than 600 people started taking street drugs again.”
From those people with whom I was in contact no more than 10 people could finally stop taking drugs of any kind. If you make simple arithmetic operation, it turns out the following:
806 (total number of clients in the Crimea OST program) minus 20 (number of those who undergone “rehabilitation” in Russia), minus 60 (left to Ukraine), minus 50 (suppose not 10, but 50 people stopped taking drugs) = 676.
About 30 already died out of that number of people. It turns out that more than 600 people started taking street drugs again. And many of them during many years of using the OST program found work, started a family and gave birth to children. Now it’s all over.
Below is the final part of Igor Kuzmenko’s series on Crimea. Please feel free to add your thoughts and comments and let us know if you have a story to tell from your country.
RIP Crimean OST Program, 2006
How to reach those people who made decisions on the issues of Opiate Substitution Therapy (OST) in the Crimea? Which words should be found to explain to them that situation where 800 drug users under constant medical and psychological control, employed and reintegrated, is much better than 800 people coming back to being criminalised in the drug trade? How could one explain what the blue sky is to the person born blind? How it is possible to explain to a mother, whose son quietly had been using OST for several years, stopped breaking the law, started a family and found a job, why he has died of an overdose during the rehabilitation? Who benefits from it?
“What we had been created for several years was destroyed in two and a half months.”
Probably, for those people who have nothing to do with OST and don’t have the slightest idea of what this therapy actually is, it is only a “change of the dealer” – earlier I bought drugs on the street and now I get them free of charge from the doctor. But actually OST is a difficult system in which the process of taking methadone or buprenorphine is only a small part of the whole process. OST is a complex of actions that allow the person to live a more or less productive life. Many elements of this scheme, such as the ART (Anti Retroviral Therapy*), anti-tubercular therapy, are strongly connected with OST. There is no point in pretending otherwise, many people started to use ART and to look after their health only after they visited the OST site.
Irina, a client from the OST program
Stability and the Street
What we had been created for several years was destroyed in two and a half months.
So, more than 600 former people from the OST programs have taken part in the illicit drug scene again since May. What do our people use to medicate themselves with now?
Lyrica. This beautiful and romantic word is actually the name for one of the biggest problems of the Crimean drug scene nowadays. Lyrica (active agent – Pregabalin). An antiepileptic and anticonvulsive medical product made by Pfizer Company. Many ex-OST patients are suffering from its over-use today. It has excellent medical qualities if you take it on prescription, but it causes terrible side effects and dependence for those people who try to combat withdrawal syndrome with its help. It is sold freely in any drugstore in the Crimea and costs not so much.
Only a total deficiency of any medical products in local drugstores is saving others from the serious consequences of pharmaceutical drug dependence in the Crimea.
“Now I hear from people who were full of vim and vigor, who had plans for the future just two months ago, that they want to die.”
Checks. “Checks” is how people name portions of raw opium from which it is possible to extract heroin, if you add acetic anhydride to it.
“Checks” existed in the Crimea as far back as I can remember. It is a good reliable way to quickly recover from withdrawal syndrome. You could get “checks” quite easily at any time. But after the OST programs were closed, hundreds of drug users suddenly entered the market (more than 200 people just in Simferopol! ) and devastated all the opium reserves in the Crimea. Moreover, new anti-narcotic structures represented by the Russian police (all police officers came to the Crimea from the Russian cities – Perm, Kazan, Moscow, there are not any local representatives in police) and by Federal Service on Control of the Drug trafficking (FDCS) – the nightmare of the Russian drug users. The increase in number of “checks” users led to a decrease in its supply and importing from Ukraine became a big problem.
By hearsay, so as not to suddenly miss an opportunity to increase profits, dealers began to add foreign substances to their product, it could be harmless substances or hard shit like home-made methadone. New police forces and new circumstances around buying drugs has led to the situation where purchasing “checks” poses a big problem now.
Heroin. I often hear from people in the Crimea that there is lot of cheap heroin here now. But I couldn’t find even one person who saw or tried that heroin. So I can draw a conclusion that there is not and there was not any heroin in the Crimea.
Krokodil. I assure you that if it wasn’t for a deficiency of medical products in drugstores, including codeine-containing ones, “krokodil” would now be problem No. 1 in the Crimea. But every cloud has a silver lining. People just can’t find the substance that you should use to make this poison, and that’s why krokodil isn’t present in the Crimean drug scene.
“Well, this is how it goes.”
Well, this is how it goes.
Now I hear from people who were full of vim and vigor, who had plans for the future just two months ago that they want to die. Former patients aren’t able to go to work because they suffer from never-ending withdrawal syndrome. Their families suffer as much as they do.
I am an optimist. My glass is always half full. But I can’t see anything optimistic in the future of those from the last OST programme in Crimea.
Well, who knows, maybe I’m mistaken.
Written by Igor Kuzmenko
*ART: Anti Retroviral Therapy is a medical treatment for HIV/AIDS
All 4 parts in the Crimean OST series has been written by Igor Kuzmenko and here’s a massive public thank you to him for his really honest and personal insights into what it has been like for our peers in the region, and answering many of our questions too, I’m sure. The blogs were translated from Russian into English by the very professional Daria Mighty, and we are indebted to her speed and accuracy, thank you Daria! (The Russian version is available atENPUD) If you want to find out more about the drug using community and its issues in the region of Eurasia, or you are living in that part of the world, check out INPUD’s sister organisation on their website ENPUD (The Eurasian Network of People who Use Drugs). You can become a member, read other blogs from Igor and others and find out the news and views on drug issues and politics.