Employing People Who Use Drugs

And why it is a good idea!

Introducing a Good practice guide for employing people who use drugs .

A truly indispensable toolkit.
PWUD (People Who Use Drugs) have insights and expertise that can help inform the planning, delivery, monitoring and review of harm reduction and many other drug related services. When we involve PWUD in the design and delivery of services for our community, the overall work becomes more relevant, targeted and accessible. Working in partnership with PWUD helps services to reach and connect with other PWUD more effectively, and importantly, to understand and meet their needs.

A really powerful way of involving PWUD is to employ them as staff.

EmployingPWUDs_guide1

Employing PWUD sends out a clear message that they are valued partners and are welcome at all levels of service delivery. It also has a very practical set of benefits, helping services to better understand the needs and lived experience of PWUD. PWUD have the right to be employed. Policies that routinely exclude PWUD from the workplace are discriminatory.
This guide has been carefully and thoughtfully written and involved the community of people who use drugs in its design and execution.  It provides really excellent information in the form of a practical toolkit that services themselves can and should use when it comes to considering the employment of PWUD’s in services.

It is true, there are unique issues that PWUDs may bring to the workplace if / when employed. However, the really interesting insights,  ideas, and approaches a service will experience from engaging PWUDs is sure to make the extra effort of learning how to structure the work environment, all the more worthwhile.

This guide also has really well thought out and evidenced based information for ensuring that PWUDs who are engaged as volunteers or mentors in any service, are able to deliver their very best, and are properly supported and compensated by the service they work hard for.

It is essential that people who are still actively using drugs, and those who are relatively stable in treatment  -are recognised as able to make a valuable contribution to the development of our communities drug and alcohol services! It is a field that should not be exclusively for people ‘in recovery’, and as this guide will show, there are many valid reasons why the entire community of people who use drugs all have valuable roles to play in giving us better quality drug and alcohol services.

Here are just some of the topics discussed in this excellent guide. Make sure every drug service is aware of its existence.

2.2. When drug use is a problem (and when it is not)
2.4. Employing ex-drug users and people in recovery
2.4.1. Employing people who are engaged in OST and drug treatment
2.4.2. Employing people who are active drug users
2.4.3. Employing people who are active stimulant users
2.5. The value of staff who use drugs

4.2. Problem drug use and work
4.3. Imposing personal models and philosophies of drug use
4.5. Moving from being a peer to working in a harm reduction organisation
4.6. Inappropriate relationships with clients
4.7. Supplying, or soliciting the supply of, illicit drugs
4.8. When peer support groups become unhealthy
4.9. Managing staff with health conditions that impact on performance
4.10. Managing a death in the workforce or among the client group

Appendix 3: Risk assessment circle
Appendix 5: Examples of job advertisements for staff who use drugs and peer outreach workers
Appendix 6: Model questions for peer interviewers
Appendix 7: Conducting a review meeting
Appendix 8: Developing a self-control programme
Appendix 9: Checklist for managing staff with problem drug use at work
Appendix 10: Training exercises from the Bangkok workshop
Appendix 11: Normal and complex grief reactions

Save yourself a copy and spread it around the staff in the drug services you know -you never know -you might get a job there one day!

NOTE: This guide came out at the end of 2016 and I have written about it before however it was hidden on our website so I thought it should be pulled out again and given a front page showing. I hope you will agree it will be a useful guide for some years to come.

Good Practice Guide for Employing People who Use Drugs

Good practice guide for employing people who use drugs  – An indispensable toolkit (click link)

PWUD (People Who Use Drugs) have insights and expertise that can help inform the planning, delivery and review of harm reduction and HIV services. When we involve PWUD in the design and delivery of services, our work becomes more relevant, targeted and accessible. Working in partnership with PWUD helps our services to reach and connect with other PWUD more effectively, and to understand and meet their needs. A really powerful way of involving PWUD is to employ them as staff.

Employing PWUD sends out a clear message that they are valued partners and are welcome at all levels of service delivery. It also has a very practical set of benefits, helping services to better understand the needs and lived experience of PWUD. PWUD have the right to be employed. Policies that routinely exclude PWUD from the workplace are discriminatory.

When drug use is a problem (and when it is not)

Drug use is complex, and debate on the rights and wrongs of it can become easily polarised. In this context, the medical (disease) model of drug use tends to dominate. This emphasises the problems of dependence as an inevitable consequence of using heroin and other drugs. As a result, the response to drug use is often described as a treatment or cure for a medical illness. The medical model also dominates many 12-step programmes, such as Narcotics Anonymous (NA). It also influences the way many health professionals, academics, politicians and members of the public understand drug use. They share a belief that PWUD quickly lose the ability to control their drug use, and make conscious, autonomous or rational decisions about it. However, the United Nations Office on Drugs and Crime (UNODC) acknowledged in the World drug report 2014 that only 10% of PWUD will experience problems arising from their drug use.

This implies that many people’s experience of drug use can be non-problematic and often pleasurable. Similarly, some of our staff will have experiences with drugs that are non-problematic and recreational. Although in the alcohol field the concept of controlled drinking is now widely accepted, for many years the possibility of non-dependent and controlled heroin use has been largely ignored, despite evidence that such patterns exist.

This research demonstrates that some people are able to use heroin in a non-dependent or controlled manner. Studies of people using cocaine have also shown well-established patterns and strategies for self-control. These studies highlight the importance of the social context in which drugs are used and its impact on an individual’s experience of drugs and their effects.

We learn from these studies about the importance of context when trying to understand drug use patterns, and question the value of framing drug use as an individual failing or illness. (text taken from the guide itself. To receive a copy of the guide click the link at the top of this page)

Also read:

International HIV/AIDS Alliance (2010), Good Practice Guide. HIV and drug use: community responses to injecting drug use and HIV. Available at: www.aidsalliance.org/assets/000/000/383/454-G ood-practice-guide-HIV-and-druguse_original.pdf?1405520 726

This guide has been developed by the International HIV/AIDS Alliance (the Alliance) as part of the CAHR project, supported by the Netherlands’ Ministry of Foreign Affairs. The International HIV/AIDS Alliance in Ukraine (Alliance Ukraine) led this work, supported by the programme “Building a sustainable system of comprehensive services on HIV prevention, treatment, care and support for MARPs and PLWH in Ukraine”, funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund).

 

Citric Acid in Heroin: How Much is too Much?

Hi again,

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

 

Citric_sachets_small

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

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

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

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

 

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

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

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

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

Naloxone – the big hit with the long wait

Id like to discuss a campaign involving many members of the drug using community across the world. As far as campaigns go, this one should be a done deal. In fact it should of been snapped up as a central component in all our national and community drugs strategies years ago.  The benefits and results to be reaped from rolling out similar campaigns is nothing less than saving life itself and the prevention of repeated tragedy, trauma, gut-wrenching grief and endless pain and loss. What is the campaign? To get Naloxone, the drug that instantly brings a fully overdosed and dying person back to life in seconds, into the hands of every single heroin user and ideally, into the hands of their family and partners.

The reasons to implement and progress this campaigns’ agenda are, at first glance so crystal clear, so straightforward, so blindingly obvious that the average person could be forgiven for asking, “Just what is taking so long? – We need to empower people to save lives, naloxone works, its cheap and simple to use, so let’s do this!”

But, after we remove the blindingly obvious common sense and our societies desperate need to rollout these programmes in the face of rising overdose figures, we must question why we still have unacceptable dithering by authorities and a worrying lack of will to progress the agenda.

It must be considered that such delays carry the familiar hallmarks of the common ‘junkie stain’ or rather, the agenda that is stained or dismantled or even left to rot, simply through its association with drug users. However, this particular campaign, which has come in all sorts of shapes and guises, is gaining traction in areas all over the world and recently, finally, here in the UK too. It has the fangs of drug user activists in it all over the place, with programmes that are getting naloxone into the trained hands of policemen and women, family members and partners, pushing forward the idea of Naloxone as a free item or a purchase from a pharmacy by people, even bringing a used one back to get a new one etc.

There is bound to be something you can do in your own community to help push this agenda forward and to get Naloxone into the trained hands of at least every single heroin user in your neck of the woods, in the rollout towards Naloxone being in every hand, in every city across the world.

The International Doctors for Healthier Drug Policies is also taking up the mantel to push the Naloxone agenda, this article appeared the other day and gave a useful global overview. 

Naloxone*

Naloxone_banner

 

WE COULD INSTANTLY REDUCE THE NUMBER OF

OVERDOSE DEATHS IF THIS MEDICINE

WERE MORE WIDELY AVAILABLE

 

What do we do with a medicine that prevents certain death for people with a particular condition—and is safe, cheap, and easy to administer?

  1. Immediately make it accessible to those who can administer it when such a life-or-death situation arises.
  2. Make it available to no one except doctors and emergency room workers.
  3. Endlessly debate the particulars of how and when it should be widely introduced.

If you picked number one, that would seem to be a reasonable choice. Unfortunately, it would also be incorrect. With few exceptions, answers two or three apply in the vast majority of the world when it comes to the medicine naloxone.

Overdose remains a leading cause of death among people who use drugs, particularly those who inject. Increasing the availability and accessibility of naloxone would reduce these deaths overnight.

Naloxone is an effective opioid antagonist used to reverse the effects of opioid overdose. On a global scale, however, exactly how and where naloxone is used remains unclear. International Doctors for Healthier Drug Policies (IDHDP) is seeking to learn why this is and what can be done to change it.

Some form of community-based distribution programs for naloxone exist in over a dozen countries. But the quality of data pertaining to how naloxone is used is highly variable. Enhancing our knowledge about the use of naloxone will help us to better reap its benefits.

What we do know is that the availability of naloxone is growing in several countries. Scotland implemented a national program in 2010, and outcomes there have demonstrated its effectiveness in reducing drug overdose deaths. In China, it is available in an increasing number of hospitals. Canada and Estonia have pioneered programs on take-home naloxone.

And in the United States, policymakers called for greater availability and accessibility of naloxone after opioid overdose deaths more than tripled between 2000 and 2010. In some states, distribution expanded from emergency rooms, paramedic services, and needle-exchange programs to police stations. In Quincy, Massachusetts, all police began carrying naloxone [PDF] in 2010, leading to a 70 percent decrease in overdose deaths.

Last November, guidance from the World Health Organization recommended increased access to naloxone for people who use opioids themselves, as well as for their families and friends. Naloxone is also included on the WHO’sEssential Medicines List.

The role of naloxone in addressing opioid overdose was recognized for the first time in a high-level international resolution in March 2012. Members at the UN’s 55th commission on Narcotic Drugs unanimously endorsed a resolution promoting evidence-based strategies to address opioid overdose. Recently, the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) published a very useful literature review of the effectiveness of take-home naloxone.

To build on these gains, we need more data. IDHDP wants to find more out about the availability and accessibility of this life-saving intervention. To that end, we’ve created the Global Naloxone Survey, an attempt to compile information about where naloxone is available, who can use it, and where it can be accessed with or without a prescription.

We then will analyze the results with the short-term goal of obtaining as much information as possible on how widely and readily available naloxone is. Subsequently, we intend to work to maximize both the availability and the accessibility of naloxone, particularly to those who are most likely to be present where and when an opioid overdose takes place.

This post first appeared on the website of International Doctors for Healthier Drug Policies

This talk on Naloxone was given at a local TEDx event, produced independently at one of the TED Conferences. In 2011, fatal drug overdoses in the UK (3,338) exceeded the number of road accident deaths (1,960). These deaths are preventable. Jamie Bridge talks here about how rethinking both product design and service design have the potential to save lives in the administration of overdose medication. Naloxone was developed in the 1960s to counter the effects of heroin overdose. It’s a staple part of ambulance crew kits, but those who need it face barriers to the drug at the point at which it could save their lives. Recently, there has been a shift in focus and design to ensure that naloxone is available to those likeliest to witness an overdose – drug users, their families and friends. The evidence shows that naloxone works, and that drug users can be empowered to save the lives of their friends.

Jamie Bridge is a passionate advocate for drug services and drug policy reform in order to protect the rights, health and well-being of vulnerable people around the world.

* Naloxone is the generic term, it is also known by its brand name which is Narcan.

 

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…)

New Research: former users may be a LOWER risk of developing new ‘addictions’

Excuse the language in the title  -and in some of the article – but here’s an interesting news item about some new research that came out at the end of September 2014 about testing the hypothesis about whether drug users ‘switch’ to another 2nd drug after they detox or give up their 1st drug of choice; very interesting answer- original source is below the piece (Reuters Health) –

some injecting environments

Hmm, more drugs anyone?

People who manage to get clean after being addicted to drugs are at lower risk of becoming addicted to something else in the future than people who never overcame the first substance use disorder, according to a new study.“The results are surprising, they cut against conventional clinical lore which holds that people who stop one addiction are at increased risk of picking up a new one,” said senior author Dr. Mark Olfson, a professor of clinical psychiatry at Columbia University Medical Center in New York. “The results challenge the old stereotype that people switch or substitute addictions but never truly overcome them,” Olfson told Reuters Health by email.

Getting over substance addiction reduces criminal activity, improves health and social functioning, as well as overall quality of life, Olfson’s team writes in JAMA Psychiatry.

But research into the assumption that former addicts are vulnerable to becoming addicted again has produced mixed results, they point out.

Using nationally representative data from surveys in 2001 and 2004, the researchers compared the occurrence of a new substance addiction among adults who started out with at least one substance addiction.

Nearly 35,000 people were asked about their use of sedatives, tranquilizers, painkillers, stimulants, cannabis, cocaine or crack, hallucinogens, inhalants, heroin, alcohol and nicotine dependence.

Participants were interviewed once at the beginning of the study and again three years later, with their responses either qualifying or not qualifying them for a diagnosis of substance use disorder.

At the time of the second survey, 3,275 people who had at least one addiction at the time of the first survey still qualified for a diagnosis of substance use disorder, and 2,741 people had overcome their original addiction and no longer qualified.

About 20 percent of participants developed a new substance addiction by year three. That included 27 percent of those who had not gotten clean from the original addiction and 13 percent of those who had gotten clean.

Based on those results, and after adjusting for other factors, the researchers calculated that people who overcame a substance use disorder had less than half the risk of people who didn’t overcome it of developing a new addiction.

“While it would be foolish to assume that people who quit one drug have no risk of becoming addicted to another drug, the new results should give encouragement to people who succeed in overcoming an addiction,” Olfson said.

Young, unmarried men with psychiatric problems in addition to substance abuse were most likely to develop a new substance use disorder during the study.

Though many people believe that conquering one addiction leaves you vulnerable to substituting another substance, that hypothesis actually has little support to-date, said Olaya García-Rodríguez, of the department of Psychology at the University of Oviedo in Spain.

“The ‘Substitution’ hypothesis is mainly based in clinical lore that may be biased with clinicians’ subjective perceptions of specific patients’ progression,” Garcia-Rodriguez told Reuters Heath by email.

This study is the first to test the concept with a large and representative sample in the general population, she said.

The results indicate that remission from addiction is possible, and we should rethink the common perception that substance use disorders are chronic illnesses, she said.

In the new results, only 13 percent of former addicts replaced the first substance with a new one, which is lower than usually thought, said Garcia-Rodriguez, who was not part of the new study.

“To achieve remission, most individuals need to make changes in their lifestyle and learn strategies to avoid substance use that will eventually protect against the onset of new addictions,” she said.

They may learn to avoid substance-related situations and peers, expand their behavioral repertory with coping strategies, and improved family relations, health, financial stability may contribute to maintain abstinence, she said.

The results indicate that remission from addiction is possible, and we should rethink the common perception that substance use disorders are chronic illnesses, she said.

“I hope that these results contribute to lessening the stigma and discrimination that many adults and young people with a history of substance abuse face when they seek employment,” Olfson said.

SOURCE: bit.ly/1svcvPa JAMA Psychiatry, online September 10, 2014.

Succinct Explanation about the Many Misconceptions About ‘Addiction’

Check out another neatly defined, succinct and straightforward explanation of the roots of ‘addiction’ and just how society became laden with so many misconceptions about drug dependence or ‘addiction’. Dr Cart Hart has a new book out called High Price. Just 20 minutes long, this is a very useful listen for people wanting to know a bit of history around how we came to view ‘out of control drug addicts’ as the norm. He also mentions his fascinating research delivered over a few years around crack and crack users, which challenged many of our most deeply ingrained ideas about crack users. Get your facts up to date and have a listen..

Thanks to Vox.com for the article and video, though I think it originally appeared on TedsTalk.

Carl Hart is a neuroscientist and drug addiction expert at Columbia University. In a recent TEDMED talk, Hart spoke about drug addiction and the many misconceptions surrounding the topic — and how those misconceptions can mislead drug policy.

Hart went into neuroscience to cure the drug addiction he blamed for causing crime and poverty in his old Miami neighborhood. But when he began to work on the issue, he learned that his assumptions were wrong.

About 80 to 90 percent of the people who use illegal drugs don’t turn out addicts, Hart explained. As an example, Hart pointed to the three previous presidents, all of whom used drugs when they were younger. “Their drug use did not result in an inevitable downward spiral leading to debauchery and addiction,” Hart said. “And the experience of these men is the rule, not the exception.”

THE FINDINGS SHOW THE PROBLEMS ARE MUCH MORE COMPLICATED THAN SOME BELIEVE

As Hart explained, many of the current assumptions about drug addiction are based on old animal experiments from the 1960s and 1970s. In these tests, animals were put in a cage with a lever that they could pull for a shot of a drug. Researchers found the animals would pull the lever until they died from an overdose.

Hart said these animals were never presented with an alternative, though. In other experiments, animals were given another option: a mate or a sweet treat. At that point, the animals began choosing the non-drug alternative, and they didn’t take the drug until they died.

Hart followed up on these experiments with human participants in 2000 and 2012. His lab recruited meth and crack cocaine addicts, and the addicts were given the option to choose between a small amount of money or their drug of choice. When the money option was $5, they chose the money about half the time. When the money option was $20, they chose the money about eight out of 10 times.

The results, of course, don’t diminish the real problems of crime, poverty, and drug addiction in some of America’s communities. But the findings show the problems are much more complicated than some, including a younger Hart, believe.

 

Check out the useful flip cards and the rest of the article here.  Listen to Dr Carl Hart give a clear account of the many misconceptions around drug use and where they sprang from. 

 

Methamphetamine – A document well worth a read

Hi,

Many of you will recognise the writings of US psychologist Carl Hart, having had many interesting things to say about crack, and now methamphetamine. Yes there have been many books on the subject but this is different and you can read it all here right now! It is a fascinating read on meth, the facts and the hype. If the subject interests you, and I reckon it probably does, give it a read. Love to hear your comments.

Report cover

Text From Open Society Institute: The rise in methamphetamine use has provoked a barrage of misinformation and reckless policies, such as mandatory minimum sentences, increased penalties for minor offenders and major restrictions against certain medicines.

This new report, titled Methamphetamine: Fact vs. Fiction and Lessons from the Crack Hysteria, reveals the extreme stigmatization of users and dangerous policy responses that are reminiscent of the crack hysteria in the 1980s and 1990s, which led to grossly misguided laws that accelerated mass incarceration in the United States.

The report recommends that national and international policymakers review laws that harshly punish methamphetamine possession or use, invest in treatment rather than punishment, restudy the restriction of access to amphetamines for legitimate medical purposes, and stop supporting wasteful and ineffective campaigns of misinformation on methamphetamine use.

Go straight to the 36 page report here 

The Incredible Story behind ‘The Frozen Addicts’

English: MPPP; 1-methyl-4-phenyl-4-propionoxyp...

MPPP; 1-methyl-4-phenyl-4-propionoxypiperidine, desmethylprodine Deutsch: 1-Methyl-4-phenyl-4-propion-oxy-piperidin; 3-Desmethylprodin or synthetic heroin -however one mistake in the lab and it becomes an injectable nightmare.  (Photo credit: Wikipedia)

A nightmare of immense proportions for any opiate user watching this film. Watch the simply mindblowing film about a handful of opiate users in California in the early 1980’s who, after injecting what they thought was heroin, woke up completely frozen – in body and voice – but not mind. Locked into a prison of their own bodies, their stories confounded doctors until bit by bit they managed to unravel what had happened to them and so began the long, long road as they endeavored to cure them of their condition, despite at times creating other situations that were as bad if not worse than the original Parkinson-like condition they initially faced.

Crucially, I think it is worth mentioning that the underground chemist who was trying to manufactuer a synthetic form of heroin known as MPPP, rushed the process and came up with something called MPTP, a drug that destroyed peoples dopamine receptors, leaving them unable to produce dopamine and thus leaving them frozen in their bodies. See text below the video for link to information on MPTP and MPPP. This is yet another byproduct of prohibition, where the law allows underground labs to flourish and horrendous mistakes like this to occur. This is not to say mistakes don’t occur in big pharma although in general, research techniques ensure such enormous problems are found before such drugs find their way to market. You can also follow up the stories of these amazing individuals whom our hearts go out to, on google etc.

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NOTE on MPPP and MTPT: While MPTP itself has no psychoactive effects, the compound may be accidentally produced during the manufacture ofMPPP, a synthetic opioid drug with effects similar to those of morphine and pethidine (meperidine). The Parkinson-inducing effects of MPTP were first discovered following accidental ingestion as a result of contaminated MPPP. For more info on MPTP and MPPP, click here.

Here we go again; sweeping up the junkie mess in time for the glowingly healthy & happy Olympics; Brazilian Stylee

Hey readers, just check out this news article from Brazil. Enforced treatment not only goes against every tenet of the therapeutic relationship which has at its crux that one can’t force change on anyone who isn’t a willing, consenting partner -let alone the ethical issues at the heart of this. Enforced treatment rears its ugly head over and over again, emerging often in all manner of forms from the mildly menacing “‘we’re not forcing you exactly but if you don’t do xyz you won’t get help/housing/support/treatment etc” to the outright being kidnapped in the middle of the night and locked up in a ‘treatment facility’ with no recourse or redress. Yes, this all happens -but it is yet another story. This one is about Rio in Brazil, which has followed a programme first implemented in Brazil in Sao Paulo -and although there is clearly no evidence base for this kind of incarceration as a ‘treatment’, Rio nevertheless rolls out the rehab carpet. Go directly to rehab. Do not pass go. Do not collect $200. Being brought by ones parent’s or family members, which is often offered up to us as reasonable force or ‘encouragement’ can also be highly dubious, more realistically occurring as a punishment for the wayward child, who attends as a display of remorse or guilt to the family rather than a real desire or ability to get off drugs at what is often a crisis in that persons life that precipitates the heated fights and tears of the ‘pre rehab familial tsunami’. Breaking point for one side or the other ensues and rehab is raised, the bags packed. Of course as the article states, there is NO evidence for this kind of treatment approach, which isn’t to say it is all about baby steps and lots of cuddles (although that would be more effective than the former, I’m sure).  It is a convoluted mixture of approaches, which need to be guided by the individual who needs to believe in their own power to create the changes that lead to a better life; but to have some options of a better life being a possibility. And some support if needed to get there. After all, as one junkie I know said, “When you’re on the bottom rung of the ladder, everything is above you”. Firstly though – we have to stop treating drug users like they can be just swept away when the Olympics or some such event passes by our cities. Treated like they are the dirt on the new shoes of the up and coming new city suburbs. To believe in themselves, we have to believe in them. They are, after all -our sons, our daughters, mums, dads, grandpas and grandmas, our cousins and our husbands and wives. A selfish society or an impatient one, is destined to fall on its face in the muddy streets of its crime filled cities. No help to anybody. Yes it gets messy, yes there are countries, cities and towns where the picture is more harrowing than one could ever imagine. But our old approaches just arent working anymore. How many times must we throw money and our heads against brick walls? Involve people who use drugs to find out new answers, ask them their thoughts and opinions, provide the mechanisms to get their voices heard and their ideas developed. Engage the community you are targeting, it works – don’t just lock them up out of sight.

Issue CCXII – Weekly Edition: April 3 – April 9, 2013

Forced Treatment for Brazil Crack Addicts

February 26, 2013 | Filed underFront Page,Politics | Posted by 

By Lucy Jordan, Senior Contributing Reporter

BRASÍLIA, BRAZIL – In an attempt to tackle Brazil’s growing crack epidemic, the city of Rio de Janeiro has begun a program of involuntary hospitalization for users, one month after Brazil’s biggest city São Paulo began a similar program. At least 99 addicts have been hospitalized, 29 involuntarily, since the program launched one week ago, according to local media tallies.

Officials say that most of those hospitalized for crack addiction in São Paulo since involuntary treatment was introduced have come voluntarily, or been brought by family members, photo by Marcelo Camargo/ABr.

With its long, porous border adjoining the world’s top three drug producers – Bolivia, Peru and Colombia – Brazil has historically been a transit country for drug trafficking to the U.S. and Europe.

Yet increasingly, Brazil has become a drug destination, with a Federal University of São Paulo study released last year showing that Brazil is now possibly the world’s largest market for crack-cocaine, with as many as one million users.

Some feel it it the approaching 2014 World Cup and 2016 Olympics that has prompted officials to ramp up efforts to present a clean, safe, tourist-friendly image.

Critics say that forcing addicts into rehabilitation treatment is ineffective, as the vast majority of users will quickly start using drugs again once discharged.

“When an addict is interned unwillingly, he can remain abstinent as long as he remains hospitalized,” Psychiatrist Dartiu Xavier da Silveira, who coordinates the renowned Guidance and Treatment of Addiction program of the Federal University of São Paulo (Unifesp), told The Rio Times.

“When he returns to his normal life (and his usual problems), the vast majority of users go back to using the drug as before,” Professor Silveira added. “Proposals for compulsory hospitalization as a measure of public health has no support in scientific evidence.”

Ronaldo Laranjeira, who heads up Unifesp’s Research Unit on Alcohol and Drugs and is a leading authority on the subject, said that the nature of crack addiction is so extreme that ordinary addiction treatment is inappropriate, and patients should be treated as psychiatric patients.

Critics of involuntary hospitalization say that without adequate treatment following detox, most addicts will begin using again, photo by Tânia Rêgo/ABr.

“In terms of crack users, the cases are so severe, people are so aggressive, so impulsive, sometimes psychotic, for me they are [not just addicts but] severe cases of psychiatric diseases,” he told The Rio Times. “That’s why for many people we have to use involuntary admission.”

“The clinical structure we have is basically only outpatients’ clinics and they cannot cope with these more severe cases,” he added. Long-term, Professor Laranjeira says that more specialized clinics for chemical dependency are required.

Professor Silveira agrees that involuntary hospitalization is appropriate for some patients who present psychiatric problems, but says these patients make up less than fifteen percent of crack addicts.

Brazil is by no means the first country to try coercive treatment for drug addiction. It is particularly common in Asia, and in the United States, some studies have shown that as much as fifty percent of publicly funded drug treatment referrals come from the criminal justice system. Coercive treatment for psychiatric treatment is common in much of Europe and the U.S.

In Dec 2011, the federal government launched a R$4 billion program to tackle the spread of crack-cocaine, focusing on prevention, care and policing. Health Minister Alexandre Padilha called the problem an “epidemic” and said drug addiction in Brazil had increased ten-fold between 2003 and 2011.

However, Professor Laranjeira said that very little of that money has actually reached state governments, and that this could adversely affect Rio’s ability to cope with demand for beds. “São Paulo has nearly a thousand beds for chemical dependency treatment; Rio doesn’t have even fifty,” he said.

“The huge contrast between Rio and São Paulo is that in São Paulo they are using state money to finance this service while in Rio they are relying too much on the federal government, and the money the federal government is putting on this treatment of crack is very small.”

Since São Paulo started its program in mid-January, 223 people have been admitted to hospital, but only seventeen of the admissions were involuntary.

END

 

Note: here are a few snippets from the recent Sao Paulo Study;

Altogether, more than six million Brazilians have tried cocaine or its derivatives at any point during their life, research by the Instituto Nacional de Pesquisa de Políticas Públicas do Álcool e Outras Drogas (National Institute for Public Policy Research on Alcohol and Other Drugs, INPAD) at the Federal University of São Paulo showed.

Of this group, two million have at some point usedcrackoxi or merla – two other highly destructive derivatives of cocaine, usually cut with gasoline or other household solvents – while one million had used at least one of these three drugs during the past year.

The research also showed that in the past twelve months to between January and March 2012….2.6 million adults and 244,000 young Brazilians consumed cocaine in some form.

Of these, 78 percent sniffed powdered cocaine, five percent smoked derivatives, and seventeen percent used the drug in both these ways. Some 27 percent of these used daily or more than twice a week and fourteen percent said that at some point they had used the drug intravenously

 

 

 

 

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