Ketamine, the antidepressant we always knew it to be…

Spravato; the esketamine nasal spray released for use by the public.

https://www.brainfacts.org/diseases-and-disorders/therapies/2019/listening-to-ketamine-041119#

I wanted to share this very interesting article from last year, which talks about the recent race pharmaceutical companies have been in to get the first ketamine based anti depression product into the market, which many BP readers may already know.

Well, in case you missed the fairly quiet news, which is actually big news, but which you could be forgiven for not seeing as it didn’t make much of a splash – especially considering the rather large fact that many of us are still getting locked up on a regular basis in prisons around the world for using our own Kay for our own self medication and self…exploration…But I digress, I want to pass on this news you just might have missed…

Ketamine, or rather, ‘esketamine in the nasal spray formulation called Spravato’ (‘dig the hipster parlance’ as my buddy used to say!) has finally made it out the door first, as a proper polished big pharma product- via the company Janssen Pharmaceuticals (a subsidiary of Johnson and Johnson). Guess we should say thanks or something…

Anyhoo, that has made ketamine “the first novel depression drug to hit the market in more than 50 years.” Now that IS big news isn’t it? Yay Kay! So it was officially approved by the US FDA in March 2019 and it appears everyone has big hopes for it.

In brief, and from what I can gather, the idea is to prescribe it to those suffering severely with depression and suicide ideations – along with a common antidepressant; being dosed nasally a couple of times a week for 4 weeks, and then being reassessed as to whether your prescription should contine. But it’s expensive…of course. Thanks again guys…we think?

And if you are interested in a little more information on dosing, which to be honest, we DO want to know how much the dose is (and yeh, they are super small) along with prescribing information and stuff like that, I have included a couple of links that shed a bit more light on this fascinating subject, that many BP readers will be very interested in, indeed. One more thing to add, there are also a whole heap of intravenous ketamine clinics popping up throughout the USA, giving teeny tiny doses of Kay, IV, as you lie flat out on a trolley bed in a therapists office for an hour or so, before you feel better and they send you on your way with your next appointment in hand. And what results they have had! Really very good readers, though we might suspect as much. The malleability of ketamine makes it an ideal drug to ‘guide’ and I am certain one could address numerous issues and feelings of depression from using it in a…therapeutic kind of way. Anyway, read on, the article is very interesting and the subject well worth a further bit of study, friends. Adiós til next time. EO.

FDA approval and company expectations for the drug.and how it’s used, with some trial info etc

The situation re medicines approval in the EU and UK

Listening to Ketamine, The terrific article below was written by Emily Underwood, April 2019, updated in 2020, from Knowable Magazine.

At 32, Raquel Bennett was looking for a reason to live. She’d struggled with severe depression for more than a decade, trying multiple antidepressants and years of talk therapy. The treatment helped, but not enough to make it seem worth living with a debilitating mental illness, she says. “I was desperate.”

In 2002, following a friend’s suggestion, Bennett received an injection of ketamine, an anesthetic and psychedelic party drug also known as Special K. During her first ketamine trip, Bennett hallucinated that God inserted a giant golden key into her ear, turning on her brain. “It was as if I was living in a dark house and suddenly the lights came on,” she says. “Suddenly everything seemed illuminated.”

The drug lifted Bennett’s depression and dispelled her thoughts of suicide within minutes. The effect lasted for several months, and, she says, the respite saved her life. She was fascinated by the drug’s rapid effects and went on to earn a doctoral degree in psychology, writing her dissertation about ketamine. Today, she works at a clinic in Berkeley, California, that specializes in using ketamine to treat depression. “This medicine works differently and better than any other medication I’ve tried,” she says.

When Bennett experimented with ketamine, the notion of using a psychedelic rave drug for depression was still decidedly fringe. Since the first clinical trials in the early 2000s, however, dozens of studies have shown that a low dose of ketamine delivered via IV can relieve the symptoms of depression, including thoughts of suicide, within hours.

Even a low dose can have intense side effects, such as the sensation of being outside one’s body, vivid hallucinations, confusion, and nausea. The antidepressant effects of ketamine typically don’t last more than a week or two. But the drug appears to work where no others have — in the roughly 30 percent of people with major depression who, like Bennett, don’t respond to other treatments. It also works fast, a major advantage for suicidal patients who can’t wait weeks for traditional antidepressants to kick in.


“When you prescribe Prozac, you have to convince people that it’s worth taking a medication for several weeks,” says John Krystal, a psychiatrist and neuroscientist at Yale University in New Haven, Connecticut. “With ketamine, patients may feel better that day, or by the next morning.”

The buzz around ketamine can drown out just how little is known about the drug. In the April 2017 JAMA Psychiatry, the American Psychiatric Association published an analysis of the evidence for ketamine treatment noting that there are few published data on the safety of repeated use, although studies of ketamine abusers — who typically use much higher doses — show that the drug can cause memory loss and bladder damage.

Most clinical trials of the low dose used for depression have looked at only a single dose, following up on patients for just a week or two, so scientists don’t know if it’s safe to take the drug repeatedly over long periods. But that’s exactly what might be necessary to keep depression at bay.

The analysis also warned about ketamine’s well-established potential for abuse. Used recreationally, large doses of the drug are known to be addictive — there’s some evidence that ketamine can bind to opioid receptors, raising alarms that even low doses could lead to dependence. (BP Ed – that is interesting.)

Bennett has now been receiving regular ketamine injections for 17 years, with few negative side effects, she says. She doesn’t consider herself addicted to ketamine because she feels no desire to take it between scheduled appointments. But she does feel dependent on the drug, in the same way that a person with high blood pressure takes medication for hypertension, she says.

Still, she acknowledges what most clinicians and researchers contend: There simply aren’t enough data to know what the optimal dose for depression is, who is most likely to benefit from ketamine treatment, and what long-term treatment should look like. “There’s a lot that we don’t know about how to use this tool,” Bennett says. “What’s the best dose? What’s the best route of administration? How frequently do you give ketamine treatment? What does maintenance look like? Is it OK to use this in an ongoing way?”Despite the unknowns, pharmaceutical companies have been racing to bring the first ketamine-based antidepressant to market. In March, the U.S. Food and Drug Administration approved a ketamine-derived nasal spray, esketamine, developed by Janssen Pharmaceuticals, a subsidiary of Johnson & Johnson.

Only two of Janssen’s five phase III trials had shown a benefit greater than taking a placebo. Still, in February an independent panel recommended FDA approval. That makes ketamine the first novel depression drug to hit the market in more than 50 years, notes Carlos Zarate Jr., a psychiatrist who studies mood disorder therapies at the National Institute of Mental Health.


Although clinicians are hopeful that Janssen Pharmaceutical’s newly approved esketamine nasal spray, Spravato, will expand access to treatment, many also worry about the drug’s potential for abuse.


Thousands of people are already flocking to private clinics like Bennett’s, which provide intravenous ketamine infusions. Because the drug was approved in the 1970s as an anesthetic, physicians can legally provide the drug as an “off-label” depression treatment. Many ketamine clinics have long waiting lists or are so swamped that they aren’t accepting new patients, and Janssen’s nasal spray could rapidly expand access to treatment.

But some researchers worry that the nasal spray won’t solve many of ketamine’s problems and could create new ones. Although the FDA is requiring that the nasal spray be administered only in a certified doctor’s office or clinic, esketamine is “every bit as habit forming as regular ketamine,” and will be difficult to keep out of the hands of abusers, says Scott Thompson, a neuroscientist at the University of Maryland and a coauthor with Zarate of a 2019 review on fast-acting antidepressants in the Annual Review of Pharmacology and Toxicology. A nasal spray can’t deliver as precise a dose as an IV infusion, Thompson notes. “If someone has got a cold, they’re not going to get the same dose.”


Scott Thompson of the University of Maryland discusses how ketamine is changing the landscape of the psychiatric treatment of severe depression.
Video Produced by Hunni Media for Knowable
In Thompson’s view, esketamine holds few advantages over generic ketamine, which costs less than a dollar per dose, although the IV infusions in private clinics often cost hundreds of dollars per visit. Janssen has indicated that each esketamine treatment will range from $590 to $885, not including the costs of administration and observation.

Zarate and others are still thrilled to see big pharma investing in ketamine, after decades of stalled efforts to find new psychiatric drugs. “As esketamine hits the market, venture capitalists will come up with better versions and move the field forward,” Zarate says. Several drug companies are now testing other ketamine-like compounds in hopes of developing drugs that have its potent antidepressant potential without its psychedelic and dissociative side effects.

Some researchers are also testing whether ketamine works for conditions beyond depression, such as obsessive-compulsive disorder, as well as in specific subsets of patients, such as severely depressed teenagers. Other scientists are using ketamine to help untangle one of the biggest mysteries in neuroscience: What causes depression?

Seeking Answers in Neural Wiring.

Thirty years ago, the prevailing thought was that low levels of certain brain chemicals, such as serotonin, caused depression. Boosting those could remove symptoms.

“I felt that depression needed months or weeks of treatment — that the plastic changes involved in the healing process would require weeks to reset themselves,” says Todd Gould, a neuropharmacologist at the University of Maryland and a coauthor of the recent review paper. But ketamine’s speed of action casts doubt on that idea.

Newer evidence suggests that depression is caused by problems in the neural circuits that regulate mood, Gould notes. Much of the evidence for this faulty-wiring hypothesis comes from rodents. Starting in the 1990s, scientists began to discover intriguing abnormalities in the brains of mice and rats that had been exposed to certain stressors, such as bullying by a big, aggressive male.

Stress and trauma are strong predictors of depression in people, but scientists can’t ask rats or mice if they are depressed. Instead, they use behavioral tests for classic depression symptoms such as anhedonia, the inability to take joy in pleasurable activities, Thompson says. Depressed animals “give up easily” in experiments that test their willingness to work for rewards like sugar water, or their interest in the intoxicating scent of a potential mate’s urine. “They can’t be bothered to cross the cage,” he says.

Thompson and others have found that there are fewer connections, or synapses, between neurons that communicate reward signals in the brain in depressed animals. Other labs have found shriveled connections in neuronal circuits key to decision-making, attention, and memory. Brain imaging studies in people with depression have also revealed abnormal activity in neural circuits that regulate emotion, suggesting that the findings in rodents may also apply to humans.

If faulty neural connections are to blame for depression, the next question is, “How do we get atrophied neural pathways to regrow?” Krystal says.

Circuit training
The answer, many scientists now believe, is the brain’s most abundant neurotransmitter, glutamate.

Glutamate is the workhorse of the brain. It relays fleeting thoughts and feelings, and enables the formation of memories by strengthening synaptic connections. Glutamate is the reason you can still ride a bike years after you learned, even if you never practiced.

Not all glutamate activity is good. Too much can cause the equivalent of an electrical storm in the brain — a seizure — and chronically high levels may lead to dementia. Abnormalities in glutamate receptors — specialized proteins on the surface of brain cells where glutamate can dock and bind — are linked to a wide array of psychiatric diseases, including depression and schizophrenia.

To maintain balance, cells called inhibitory interneurons act like brakes, releasing a neurotransmitter called GABA that quiets brain activity. Most mind-altering drugs work by changing the balance between GABA and glutamate — amphetamines and PCP enhance glutamate signaling, for example, while alcohol inhibits glutamate and boosts GABA.

By the 1990s, scientists had discovered that ketamine triggers a gush of glutamate in the brain’s prefrontal cortex. This region governs attention and plays an important role in emotional regulation. The out-of-body sensations that some people experience when they take ketamine may occur because this rapid release of glutamate “excites the heck out of a whole bunch of neurons” in the prefrontal cortex, says Bita Moghaddam, a neuroscientist at Oregon Health & Science University who discovered the drug’s glutamate-revving effect on rats while studying schizophrenia.

Scientists aren’t sure yet how ketamine forms stronger neural circuits. But the hypothesis goes roughly like this: When ketamine enters the brain, it causes a short-term burst of neuronal activity that triggers a series of biochemical reactions that create stronger, more plentiful synaptic connections between brain cells.

At first, many researchers thought ketamine’s antidepressant effects relied on a structure located on the surface of neurons, called the NMDA receptor. Like a key that fits into different locks, ketamine can bind to several types of NMDA receptor, making neurons release the excitatory glutamate neurotransmitter.

This hypothesis suffered a blow, however, when several drugs designed to bind to the NMDA receptor (as ketamine does) failed in clinical trials for depression.

Illustration of an NMDA receptor
Central to the controversy over how ketamine works in the brain is the NMDA receptor (illustrated here), which binds to the neurotransmitter glutamate. Some scientists believe ketamine’s antidepressant effects hinge on its ability to block NMDA receptors, but others believe the drug works via other mechanisms. Resolving that mystery is key to developing similar drugs with fewer side effects, scientists say.
Furukawa Lab, CSHL
Esketamine also complicates the story. Ketamine is made up of two molecules that form mirror images of each other, R- and S-ketamine. Esketamine is made up of just the S form and binds roughly four times as effectively as R-ketamine to the NMDA receptor. Despite acting much more powerfully on the NMDA receptor, studies in rodents suggest that S-ketamine is a less potent antidepressant than R-ketamine, although it’s not yet clear whether or not R-ketamine could work better in humans.

Zarate and others now believe ketamine may work through a different receptor that binds glutamate, called AMPA. By pinpointing which receptor ketamine acts on, researchers hope to develop a similar drug with fewer side effects. One hot lead is a compound called hydroxynorketamine (HNK) — a metabolic byproduct of ketamine that does not affect NMDA receptors but still produces rapid antidepressant effects in rodents. The drug appears to lack ketamine’s disorienting side effects, and Zarate and Gould plan to launch the first small clinical trials to establish HNK’s safety in humans this year, likely in around 70 people. “I think we have a very good drug candidate,” Gould says. (Zarate and Gould, among others, have disclosed that they are listed on patents for HNK, so they stand to share in any future royalties received by their employers.)

Plastic synaptic remodelers
To alter how the brain processes mood, scientists believe ketamine must ultimately change synapses. In experiments in rodents, Ron Duman of Yale University has shown that both ketamine and HNK can harness one of the brain’s most important tools for synaptic remodeling: brain-derived neurotrophic factor, or BDNF.

BDNF is a protein intimately involved in shaping synapses during brain development and throughout the lifespan. Healthy brain function depends on having just the right amount of BDNF in the right place at the right time. Many mental illnesses, including depression, are associated with low or abnormal amounts of the protein. For example, samples of brain tissue from people who have died by suicide often contain abnormally low amounts of BDNF.

Duman and colleagues have found that both ketamine and HNK cause a sharp uptick in the amount of BDNF that is released from neurons. This increase is required for the drugs’ antidepressant effects, and for the increase in dendritic spines — the stubby protrusions that form synaptic connections with other neurons. Both ketamine and HNK also seem to reduce inflammation, which has been linked repeatedly to the stress-induced loss of synapses.

Compared with a control, a rat neuron (in red) treated with ketamine has grown more dendritic spines (shown by yellow arrows).
Ketamine strengthens connections between brain cells. Compared with a control (top), a rat neuron (red) treated with ketamine (bottom) has grown more dendritic spines (shown by yellow arrows).
Rong-Jian Liu, George Aghajanian & Ronald S. Duman
Ketamine is not the only compound that can induce rapid synaptic plasticity: Other psychedelics, such as ecstasy (MDMA), acid (LSD), and DMT also trigger similar structural changes in neurons and rapid antidepressant effects in rodents, researchers at the University of California at Davis recently found. The effects don’t hinge on getting high, the team reported in March in ACS Chemical Neuroscience. Even very small doses — too low to cause perceptual distortions — can increase synapse density and lift depression.

Traditional antidepressants such as Prozac also increase BDNF levels in the brain, but not nearly as fast as ketamine does, Duman says. That is why most antidepressants take so long to remodel synapses and relieve depression symptoms, he says.

Dissecting depression
Beyond promising new treatments, Zarate and other researchers see ketamine as a powerful tool for probing depression’s tangled neurobiology. Studies in mice and rats are a good start, but scientists need to study the drug in people to truly understand how ketamine affects the brain. Unlike traditional, slower-acting antidepressants, ketamine lends itself to short-term lab experiments.

Zarate is using neuroimaging tools such as fMRI to study the human brain on ketamine. Past studies have shown that in people with depression, communication among several key brain networks is disrupted. One network, called the default-mode network (DMN), is involved in self-referential thoughts such as ruminating about one’s problems or flaws. This network tends to be hyperactive in people with depression, and less connected to more outwardly attuned brain networks such as the salience network, which helps the brain notice and respond to its surroundings.

Neural activity prior to a ketamine infusion (on the left) and six to nine hours after an infusion (on the right).
Ketamine appears to strengthen connections between neural networks in people with severe depression. In a study comparing neural activity prior to a ketamine infusion (left) and six to nine hours after an infusion (right), a single dose made the brain more responsive to a simple sensory stimulus, the light stroking of a finger.
Carlos Zarate & Jessica Gilbert, Experimental Therapeutics and Pathophysiology Branch (ETPB), National Institute of Mental Health (NIMH)
In one recent study, Zarate and his colleagues found that after receiving an IV dose of ketamine, people with depression had more normal activity in the default mode network, and that it was better connected to the salience network. At least temporarily, the drug seems to help people get unstuck from patterns of brain activity associated with repetitive, negative thoughts. Zarate does caution that the study results need to be replicated.

The team has also used brain imaging to study how ketamine affects suicidal thoughts. About four hours after an infusion of ketamine, a chunk of the prefrontal cortex that is hyperactive in people with depression had calmed down, researchers found, which correlated with people reporting fewer thoughts of suicide.

Ketamine also seems to tune other brain regions that are key to effective treatment. Last year, scientists published a study in mice showing that ketamine quiets abnormal activity in the lateral habenula, a small nodule wedged deep under the cortex. Some researchers have described the lateral habenula as the brain’s “disappointment center.” The region is responsible for learning from negative experiences, and is hyperactive in people with depression, as if “broadcasting negative feelings and thoughts,” Thompson says.

Such studies remain exploratory. As to why ketamine works — and just as important, why its effects are transient — scientists are still speculating. “I think ketamine is resetting neural circuits in a way that improves the symptoms of depression, but the risk factors — whether genetic, environmental, or other risk factors — are still present,” Gould says. “It seems to help reset things temporarily, but the underlying cause is not necessarily resolved.”

Helen Mayberg, a neurologist at Mount Sinai Hospital in New York who specializes in using an experimental procedure called deep brain stimulation to treat depression, suggests that ketamine may be like using a defibrillator on someone experiencing cardiac arrhythmia. “I am not addressing the fact that you have underlying heart disease, but now that your arrhythmia is gone, I can concentrate on other treatments.”

It’s important to put the potential risks of ketamine into perspective, particularly for people contemplating suicide, researchers emphasize. Most people are willing to tolerate severe side effects for other life-saving treatments, such as cancer drugs, Mayberg points out. “If you can interrupt an extreme suicidal plan and ideation, I’ll take that.”

Ketamine in teens?
For Krystal, weighing ketamine’s still largely uncharted risks and potential rewards ultimately comes down to a deeply personal question: “What would we want for ourselves? For our families? Do we want them to have to go through several failed trials over several months, or even a year, before taking a medication that might make their depression better in 24 hours?”

Some of the hardest decisions are likely to involve children and adolescents. Hospitalization for youth suicide attempts and ideation nearly doubled between 2008 and 2015, leaving many clinicians — and parents — desperate for more effective and rapid treatments. Left untreated, depression is “really bad for the brain” and can cause serious, long-term cognitive and developmental problems when it starts young, Zarate says. “The question is, is that going to be better than the long-term side effects of ketamine?”

Untreated depression is really bad for the brain, especially in the young. The question is, is that going to be better than the long-term side effects of ketamine?

Scientists don’t yet know. Ketamine has been deemed safe to use as an anesthetic in children, but there aren’t yet sufficient clinical data to show how low, repeated doses of ketamine used for depression could affect the developing brain.

On a more fundamental level, scientists don’t fully understand the neurobiology of adolescent depression, notes psychiatrist Kathryn Cullen of the University of Minnesota. It may involve abnormalities in brain development, such as the way the prefrontal cortex connects to brain regions that process emotion, but “we don’t know if the brain connection abnormalities emerge because of toxic stress induced by depression, or if these abnormalities predispose people to develop depression, or if depression itself reflects abnormal development,” Cullen says. “It’s critical to figure out how to alleviate the biological changes that are associated with [teen] depression so that the brain can get back on a healthy trajectory.”

Two recent clinical trials — one at Yale and another at Minnesota run by Cullen — have found that ketamine can lower symptoms in severely depressed teenagers, but neither study was set up to follow the teenagers long-term, says Cullen. Janssen is currently running a trial of its esketamine nasal spray with 145 youths who are suicidal, but the results of that study have not been published yet. Cullen thinks ketamine has potential for use in teens, particularly to avoid suicide, but “there are still a lot of unknowns.”

Not just a quick fix
Worldwide, depression afflicts more than 300 million people, making it the leading global cause of disability. When contemplating such overwhelming misery, the vision of a world in which depression can be cured with a single injection or squirt of nasal spray holds obvious appeal.

But — despite the hype — that is not what ketamine offers, Bennett says. Based on her own experience as a patient, and her clinical work, she is troubled by the framing of ketamine as a “rapid” depression treatment if that precludes the slower, more effortful process of psychotherapy. Without psychotherapy, she says, “you’re not giving patients any tools to help themselves, just making them dependent on a molecule that has temporary effects. When the effect wears off, they have to go back for more medicine. This is going to be lucrative for the pharmaceutical company but probably not in the patient’s best interest.”

In Bennett’s clinic, ketamine is administered only alongside talk therapy, which she uses to prepare patients before they take ketamine, and afterward to help them process the experience. “I think this is the only ethical way” to administer a drug that can trigger disorienting psychedelic experiences, she says. “This isn’t a ‘take two and call me in the morning’ situation.”

There’s growing scientific interest in whether ketamine can enhance the effectiveness of therapy by increasing the brain’s ability to remodel circuits through experience, Krystal notes. And in 2017 a small Yale study found that providing cognitive behavioral therapy in tandem with ketamine can extend the drug’s antidepressant effects.

Unlike some researchers and pharmaceutical companies, which consider ketamine’s and esketamine’s hallucinogenic side effects inherently negative, Bennett thinks that for some people the visions can be positive — particularly in the context of therapy. There’s scant scientific evidence to support the idea that such hallucinations are therapeutic, and they can be deeply disturbing for some people. (If people who experience hallucinations do better, it may simply be because they have received a higher dose of ketamine, Krystal points out.)

Still, Bennett thinks researchers and clinicians need to stay open-minded about why ketamine is helping people — and be more attentive to the settings in which ketamine and esketamine are administered. “People consistently report that they experience the presence of God, or their own sacredness,” she says. “When someone comes to my office wanting to kill themselves, ready to die — and then they have a transformational moment where they believe their life is sacred — it’s indescribable how exciting that is as a clinician.”

Editor’s note: This story was updated March 29, 2019, to correct the affiliation of neuroscientist Bita Moghaddam. She is a professor at Oregon Health & Science University.

ABOUT THE AUTHOR
Emily Underwood
Emily Underwood

Emily Underwood is a freelance science writer and contributing correspondent for Science magazine. She is based in Coloma, California.

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Knowable Magazine
Knowable Magazine

Knowable Magazine is an independent journalistic endeavor from Annual Reviews.

Possessing heroin, cocaine, methamphetamine and other drugs for personal use is no longer a criminal offense in Oregon.

Some good news to emerge from the States…

This article was written in entirety by Scott Aikins and Clay Mosser, from The Conversation in The Contributor and all links belong to them. All credit to them.

Note; This law passed at the end of November, 2020, but we thought we should put it up here as it’s such a major bit of groundbreaking legislation that who knows what might come next – An American state doing narcotic decrim? Who would have thought?!

An assortment of pill bottles set against the backdrop of the American flag, 1982. (Photo by Alfred Gescheidt/Getty Images)
Oregon became the first state in the United States to decriminalize the possession of all drugs on Nov. 3, 2020.

Oregon’s move is radical for the United States, but several European countries have decriminalized drugs to some extent.GETTY IMAGES

Oregon became the first state in the United States to decriminalize the possession of all drugs on Nov. 3, 2020.

Measure 110, a ballot initiative funded by the Drug Policy Alliance, a nonprofit advocacy group backed in part by Facebook’s Mark Zuckerberg, passed with more than 58% of the vote. Possessing heroin, cocaine, methamphetamine and other drugs for personal use is no longer a criminal offense in Oregon.[ 

READ: Where Is Marijuana Legal? A Guide to Marijuana Legalization ]

Those drugs are still against the law, as is selling them. But possession is now a civil – not criminal – violation that may result in a fine or court-ordered therapy, not jail. Marijuana, which Oregon legalized in 2014, remains fully legal.

Oregon’s move is radical for the United States, but several European countries have decriminalized drugs to some extent. There are three main arguments for this major drug policy reform.

1. Drug prohibition has failed

In 1971, President Richard Nixon declared drugs to be “public enemy number one” and launched a “war on drugs” that continues today.

The ostensible rationale for harshly punishing drug users is to deter drug use. But decades of research – including our own on marijuana and drugs generally – has found the deterrent effect of strict criminal punishment to be small, if it exists at all. This is especially true among young people, who are the majority of drug users.

This is partly due to the nature of addiction, and also because there are simply limits to how much punishment can deter crime. As a result, the U.S. has both the world’s highest incarceration rate and among the highest rates of illegal drug use. Roughly 1 in 5 incarcerated people in the United States is in for a drug offense.

Criminologists find that other consequences of problematic drug use – such as harm to health, reduced quality of life and strained personal relationships – are more effective deterrents than criminal sanctions.null

Because criminalizing drugs does not really prevent drug use, decriminalizing does not really increase it. Portugal, which decriminalized the personal possession of all drugs in 2001 in response to high illicit drug use, has much lower rates of drug use than the European average. Use of cocaine among young adults age 15 to 34, for example, is 0.3% in Portugal, compared to 2.1% across the EU. Amphetamine and MDMA consumption is likewise lower in Portugal.

2. Decriminalization puts money to better use

Arresting, prosecuting and imprisoning people for drug-related crimes is expensive.

The Harvard economist Jeffrey Miron estimates that all government drug prohibition-related expenditures were US$47.8 billion nationally in 2016. Oregon spent about $375 million on drug prohibition in that year.

Oregon will now divert some the money previously used on drug enforcement to pay for about a dozen new drug prevention and treatment centers statewide, which has been found to be a significantly more cost-effective strategy. Some tax revenue from recreational marijuana sales, which exceeded $100 million in 2019, will also go to addiction and recovery services.

Oregon spent about $470 million on substance abuse treatment between 2017 and 2019.

Not everyone who uses drugs needs treatment. Decriminalization makes help accessible to those who do need it – and keeps both those users and recreational users out of jail.

3. The drug war targets people of color

Another aim of decriminalization is to mitigate the significant racial and ethnic disparities associated with drug enforcement.

Illegal drug use is roughly comparable across race in the U.S. But people of color are significantly more likely to be searchedarrested and imprisoned for a drug-related offense. Drug crimes can incur long prison sentences.

Discretion in drug enforcement and sentencing means prohibition is among the leading causes of incarceration of people of color in the United States – an injustice many Americans on both sides of the aisle increasingly recognize.

Freed up from policing drug use, departments may redirect their resources toward crime prevention and solving violent crimes like homicide and robbery, which are time-consuming to investigate. That could help restore some trust between law enforcement and Oregon’s communities of color.

Risks of decriminalization

One common concern among Oregonians who voted against decriminalization was that lessening criminal penalties would endanger children.

“I think it sends a really bad message to them, and influences their perception of the risks,” James O’Rourke, a defense attorney who helped organize the opposition to measure 110, told the news site OPB in October.

But U.S. states that legalized marijuana haven’t seen adolescent use rise significantly. In fact, marijuana consumption among teens – though not among college-aged Americans – actually declined in some states with legal marijuana. This may be because legal, regulated marijuana is more difficult for minors to get than black-market drugs.

Research also shows that for some people, particularly the young, banning a behavior makes it more alluring. So defining drugs as a health concern rather than a crime could actually make them less appealing to young Oregonians.States Where Marijuana Is LegalView All 18 Slides

Another worry about decriminalization is that it will attract people looking to use drugs.

So-called “drug tourism” hasn’t really been a problem for Portugal, but it happened in Switzerland after officials in the 1980s and 1990s began officially “ignoring” heroin in Zurich’s Platzspitz Park. People came from across the country to inject heroin in public, leaving discarded needles on the ground.

The local government shut down Platzspitz Park. But rather than chase off or arrest those who frequented it, it began offering methadone and prescription heroin to help people with opioid use disorder. Public injection, HIV rates and overdoses – which had all become a problem in Zurich – plummeted.

Certain parts of Oregon already have higher rates of public drug consumption, namely Portland and Eugene. Because public drug use is still illegal in Oregon, however, we don’t expect a Platzspitz Park-style open drug scene to emerge. These places should benefit from the expansion of methadone programs and other medication-assisted treatment, which is endorsed by the American Medical Association.

If neighboring Washington state decriminalizes drugs, which it is considering, the chances of drug tourism would drop further.

Upside – and downside

There are risks with any major policy change. The question is whether the new policy results in a net benefit.

In Portugal, full decriminalization has proven more humane and effective than criminalization. Because drug users don’t worry about facing criminal charges, those who need help are more likely to seek it – and get it.

Portugal’s overdose death rate is five times lower than the EU average – which is itself far lower than the United States’. HIV infection rates among injection drug users also dropped massively since 2001.

These policies show that problem drug use is a public health challenge to be managed, not a war that can be won.

This article was written by Scott Akins, professor in the Sociology department at Oregon State University, and Clayton Mosher, professor in the Sociology department at Washington State University, for The Conversation. It is republished here with permission.

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

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

Dealer’s Discuss

Articles from BP’s back catalogue….

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

 

Martin (does heroin & crack):

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

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

To see the rest of the article click here….

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

 

health-logo

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

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

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

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

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

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

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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

How to build support: influencing politicians /policymakers

Hi again, For all you activists out there, check out this really terrific piece of work from some really interesting collaborators  – and all their materials are available for others to use. Really useful stuff on how to explain the issues affecting people with multiple needs  so that politicians and policymakers can understand the issues and the people better and thus, should be more able and willing to really listen.

Thanks to Opportunity Nottingham and Voices from the Frontline:

Voices from the Frontline is an “exciting new project to bring the voices of people with multiple needs and those who support them to the heart of the policy debate.” Click here for more info. I love their thinking! Opportunity Nottingham exist to help people fighting at least three of the following: Reoffending, substance misuse, homelessness and mental ill health. “In achieving our primary goal of helping people we are also going to change the way the existing system of support works.” Bloody fantastic! I love this new way people are starting to think regarding issues of homelessness and incarceration, mental health problems and drug use etc; we have developed certain tools of empowerment -now we need to cross that divide, find out how we can make politicians really, but really understand our issues. Places where we can find the common ground, the language; As they say in the notes of what came out of their collaboration, “We need to move away from defensive practice.  Services can help people raise their voice, but they’re not really listening if they’re only defending their own position”. So true, so  true. Visit these sites my friends, for some really useful tips.

Bye for now – and thanks to the people working so hard to develop these amazing organisations and work towards changing the minds of some of the stubbonist in society – the politicians and policymakers!!

Here is the piece below…

How to build support: frontline tips for influencing politicians and policymakers

See entire article on the website by clicking here: 

Last Wednesday, a number of participants in Voices from the Frontline traveled to the Multiple Needs Summit in London. Over the last few months, all of them have been involved in a conversation about what the next government should do to improve support for people with multiple needs.

A big part of this conversation has been about how to explain the issues affecting them so that politicians and policymakers can understand and will listen. For that reason, we held a joint workshop with Opportunity Nottingham (an organisation improving services for people with complex needs in the city) to explore this.

One thing was clear: there’s a huge amount of knowledge out there about how to put the case across. Here are some of the best tips that people had.

  1. Get the right people in the room, and you’ll get the right answers. Go into a room feeling confident. Get people to listen to what you say (even if they roll their eyes.)
  2. Bring people together and get them to talk about a real case study. Then they’ll realise that languages are different, and there are other worlds they very rarely think about.
  3. Beware of ‘innovation fatigue’. For instance, someone explaining Fulfilling Lives (a major programme to help local areas improve how they work with complex needs) met with people saying “you’re just another person coming to my meetings – we’ll never see you again”.
  4. Sometimes the bad news and bad stereotypes that exist can make it really difficult. It can help to capitalise on them, though. “If I don’t address those stereotypes, we haven’t had a conversation.”
  5. The higher people are up, the less they know about what’s happening down below. Build relationships based on helping them see what’s happening. How do you bring things that don’t work to their attention?
  6. We need to move away from defensive practice.  Services can help people raise their voice, but they’re not really listening if they’re only defending their own position.
  7. Be a critical friend.  Or, as one person put it, “don’t throw a strop.”
  8. Finally, don’t assume a divide between policy people and lived experience.  There can be more overlap in their knowledge and interests than we sometimes assume.

(Should you be interested, you can read all the notes from the workshop here.)

If you want to think about how your own organisation could do more to influence decision-makers, Opportunity Nottingham have produced a brilliant handout summarising some of the things they’ve learned. Feel free to share it with others who you think might find it helpful.

Making Every Adult Matter

Making Every Adult Matter (MEAM) is a coalition of four national charities – Clinks, DrugScope, Homeless Link and Mind – formed to influence policy and services for adults facing multiple needs and exclusions. Together the charities represent over 1600 frontline organisations working in the criminal justice, drug and alcohol treatment, homelessness and mental health sectors.

For more information, click here.

And for the conference called

MultipleNeeds Summit 27th April 2015

MultipleNeeds Summit 27th April 2015

MEAM Coalition

@MEAMcoalition

Making Every Adult Matter (MEAM) – A coalition of     and  dedicated to tackling multiple needs and exclusions.

Thanks for the chance for credited reprinting everyone. BP xx

 

 

 

 

 

 

 

The Incidious Spread of Big Pharma

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.

Poison Pill:  How the American opiate

epidemic was started by one

pharmaceutical company 

Written by MIKE MARIANI FEB 23, 2015

(The link to complete article above and at the end of this text – thanks in advance to Mike Mariani – Here is an extract)

PURDUE_oxyThe 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.

A pernicious distinction of the first decade of the 21st century was the rise in painkiller abuse, which ultimately led to a catastrophic increase in addicts, fatal overdoses, and blighted communities. But the story of the painkiller epidemic can really be reduced to the story of one powerful, highly addictive drug and its small but ruthlessly enterprising manufacturer.

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

_oxycontin_600During 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.

oxycodone-oxycontinStarting 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's Oxycontin - reformulated: Pic - Oxy's crushed by a mortar and pestle: reformulated to deter injecting...

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.

Read the rest of the fascinating article here – Poison Pill:  How the American opiate epidemic was started by one pharmaceutical companyMIKE MARIANI FEB 23, 2015

(more…)

What Will the Future Look Like for Drug Users?

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.

colouredbrain

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.

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

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 him about 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!).

goodies to buy. But there are no new vendors on SR2 these days, only old vendors from Silk Road are permitted to sell these days, seems it is safer that way...

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?

Read the full Vice article here (more…)

The History of Drug User Activism in Australia; by an Aussie Activist Superstar

Dont Miss this!!! If you want to find out the story of drug user activism in Australia by a woman who was not only there but integral to the very essence of active drug users doin’ it for themselves, setting limits in the sky and rockin right up to parliament house itself to get the job done – then you cannot miss this production!! From WHACK; Victorias Drug User Magazine; Annie Madden, the firebrand of an Aussie cog in the Aussie activist wheel, was asked to write about he years of experience and knowledge around the evolution of the Australian drug user history movement – and it is compulsory reading my friends! The History of Drug User Activism in Australia by AIVL’s Chief Exec and Superwoman incarnate, Annie Madden – get out your reading specs, sit back with your favourite tipple, and IV the contents of this fabulous issue….

Please click this link for the easy to read online magazine, which you can print out.

http://hrvic.org.au/docs/historyofIDUactivism/index.html

A Word About Ms Annie Madden…

Annie Madden, Chief Exec, AIVL Australia; Australia's Own Superstar Activist!

Annie Madden, Chief Exec, AIVL Australia; Australia’s Own Superstar Activist!

Australian Injecting & Illicit Drug Users League (AIVL)

Annie Madden is currently the Executive Officer of the Australian Injecting & Illicit Drug Users League (AIVL) which is the national peak body representing state and territory drug user organisations and illicit drug users at the national level. Prior to her current role, Annie was the Co-ordinator of the NSW Users & AIDS Association (NUAA) for six years. She has an honours degree in Social and Political Sciences. She is on numerous national, Commonwealth Government and research committees including the recently appointed Ministerial Advisory Committee on AIDS, Sexual Health and Hepatitis C and regularly takes extremely effective roles in global United Nation and WHO reviews, committees, global guidance publications and drug related recommendations. She has been working in the areas of illicit drug use, HIV/AIDS and hepatitis for over 14 years, has been an injecting drug user for over 18 years and on methadone for many years also. Annie is one of the world’s most inspiring women user activists who has worked tirelessly day in and day out to challenge the discrimination and human rights violations occurring to people who use drugs. And not just in Australia where she works at the top of her game, going head to head with politicians and Charity heads, doctors and do-gooders, parents and always her peers – drug users, but around the world, wherever she gets the chance to fight against ignorance and discrimination, for women who use drugs, for all of us, of any colour. Annie Madden is a woman we should all be proud of, especially, as drug users, we are lucky enough to have her on our side. Coz she is a truly kind and caring person, humble, hard working, smart and emphatic. Thanks for all you’ve done Annie Madden, and all your future will bring. We send you thanks, light and love.

Your friends at BP and around the world, those who know you, love you, and those who haven’t yet had the pleasure, thank you.

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