Another place that thinks its fine to kidnap users…

Just thought I would put in a story i saw on the BBC website today. It has left me cold and angry. I get so sick and tired of people who just think it is ok to come and take someone away, lock them up, beat them if necessary, maybe if your lucky your parents know where you are but you don’t get out until they let you…Guatemala, ok so it is having problems with a crack surge, but for Goddsake, this is a money making scam and a human rights violation. Why do we think its ok to just take a person who uses drugs, and think that there life is so worthless, that no one really cares enough to save them, that they actually need to be kidnapped, locked up and never let out. That it is ok to ‘treat’ them psychologically with any sort of unproven bullshit  for hours and days or months at a time. That they need to be made into slaves to work scrubbing floors or cleaning toilets…It is a disgrace and a scam and we need to keep the UN, who it says, said in 2012 that these places must be shut down (enforced treatment centres)…is there something the using community can do to speed this up? 

The rehab centres that lock up addicts against their will

A man behind bars

In Guatemala, behind barred and locked doors, thousands of drug addicts are offered treatment by Protestant churches. Christianity offers salvation for some but many are held against their will, and some are swept off the street by “hunting” parties.

“They grabbed me. They found me completely out of it on the streets, and they just grabbed me.”

Marcos is a big guy. With closely cropped hair, and a huge expanse of chest, he is not the kind of man to tackle lightly. But Marcos was accosted by a group of men in Guatemala City and forcibly taken to a private, Christian rehabilitation centre.

“I was there for about a month and a half, and nobody knew anything about me. People thought I was killed or something, because that’s what happens in Guatemala.”

“I saw terrible things in that rehab – the owner used to beat up the girls. He would tie up the guys and roll them up like a taco in a piece of carpet, and leave them there for hours,” he says.

Listen to Linda Pressly’s report from Guatemala City on Crossing Continents on BBC Radio 4 on Thursday at 11:00 BST – or find it soon after on BBC iPlayer

Marcos was freed when a friend came looking for him, and demanded his release. He doesn’t think enforced rehab is the right approach and says it did nothing to help him quit his alcohol and drug habit.

“People came out madder and more furious. Instead of being rehabilitated, you just went out to get high again.”

Marcos grew up in the United States – a refugee from Guatemala’s civil war in the 1980s – but was deported back to his parents’ homeland after serving a prison sentence. With family in California, the owner of the rehab centre saw Marcos as a money-making proposition – he tried, and failed, to get contact details for Marcos’ family to ask them for money for Marcos’ keep.

All that is behind him now – Marcos is clean, and is dedicated to mentoring young people.

As there is no residential, state provision for addicts in Guatemala, private rehabilitation facilities have filled the vacuum. There may be as many as 200 Christian centres in Guatemala, possibly holding 6,000 people, estimates Dr Kevin O’Neill, from the University of Toronto, who has made an anthropological study of the centres. It is not known how many of them practice the aggressive “hunting” Marcos experienced.

A rehab centre with metal bars on the outsideOne of the private rehabilitation centres that have sprung up in Guatemala City

O’Neill believes Guatemala is confronting a surge of addiction. Its strategic location in Central America means the majority of illicit narcotics moving from South America to the United States make landfall here. And the fallout is a growing local market for highly addictive drugs like crack cocaine.

“It’s increased the number of centres in the capital city. But it’s also changed the culture inside the centres – the internal dynamics have become much more aggressive, and much more discipline-driven because of the rise of crack cocaine,” he says.

The founder and director of the Rescatados del Abismo, Rescued from the Abyss, centre is Pablo Marroquin, a born-again Christian and former drug addict.

Pablo Marroquin at his rehab centre

“I’d been in other rehabilitation centres, but I wanted to make mine more personal. I put it in the hands of God – he’s the only one who can rescue us from drug addiction,” he says.

Marroquin lives on the ground floor of an unremarkable building in Guatemala City with his family, his budgerigars, and a pack of small, snappy dogs.

On the first floor, behind a locked, barred door, 54 addicts mill around. Many of them will not be allowed to leave for at least three months – but it could be years. Only the addicts’ families or the director himself sanction the release of those interned here.

It is a confined space for so many people – the size of a large, three-bedroom flat. Off a common area, there is a bathroom, a room stacked with roughly-constructed bunks for those with privileges -most inmates sleep on the floor – and a bedroom for the six women internees.

A man sits on the floor against the wall, eating out of a bowl

Currently, the smooth running of the centre is down to Carlos – an internee who has been into rehab more than 30 times to try to overcome his addiction to crack cocaine and alcohol. Carlos imposes discipline and punishment at Rescatados del Abismo.

“When people arrive they can be very violent, and the only way to respond to that is with violence. It makes me uncomfortable, but it’s extremely important to maintain discipline here,” he says.

CarlosCarlos, an internee himself, maintains order at Rescatados del Abismo

Forcing an internee to clean the floors or to work at night are other forms of punishment.

Internees are partly controlled by compulsory attendance at meetings. They spend seven hours a day telling and re-telling each other their stories, charting their descent into addiction. These meetings are the only “therapy”.

They are not structured, there is no psychologist or doctor involved, and no one is allowed to leave the room without permission. While listening to the testimony, the residents sit in shadow – the barred windows of the meeting room are covered with thick yellow corrugated plastic.

Freddie speaking to other internees

It is impossible to see the street from anywhere inside the centre.

“The vast majority, I would say 95% of the internees are here against their will,” says Carlos.

“Now he’s there, we have a bit more peace of mind – if he were in the street, anything could happen here in Guatemala”

Carlos Ruiz

Carlos Ruiz, brother of Victor, an internee

When desperate families call the centre asking for help with a substance-abusing loved one, he often accompanies the director to go and pick an addict up.

“It’s our role to bring them here, and that can mean using handcuffs like the police. Sometimes a family will say their son is very violent and has a knife or machete. In those cases we tie him up before bringing him here.”

Carlos believes this is legal in Guatemala. A ministerial accord of 2006 states that an addict can be interned when they are not in a fit state, but once they have recovered sufficiently, they must give consent. By all accounts, this rarely happens.

At the Ministry of Health, the regulation and co-ordination of the centres comes in the shape of just one man – Hector Hernandez has worked for the last 14 years to try to improve the centres and make them more humane. He has closed some, but he says forced detention has never been proven.

“Not even the attorney for the defence of human rights has been able to establish there are people detained against their will – there’s been no confirmation of any allegations made,” he says.

During the compulsory meetings at Rescatados del Abismo, Victor Ruiz reads his well-thumbed bible. An abuser of crack cocaine and alcohol, he has been here for three months. Victor believes only God and Jesus Christ will rescue him from addiction.

Victor Ruiz reading his bible

“I think I’ll be here for another five months, it all depends what my brothers decide,” he says.

Before he came to the centre, Victor was living on the streets. One day when the family could not find him anywhere, his older brother, Carlos Ruiz went to look for Victor at the morgue.

“I was looking at the photos of dead people to see if one of them was him. It’s really shocking. These things stay with you, it’s like you die a bit too,” he says.

After Victor was attacked in the street by someone with a machete, the family had him interned in Rescatados del Abismo.

“Now he’s there, we have a bit more peace of mind – if he were in the street, anything could happen here in Guatemala.”

The director of Rescatados del Abismo, Pablo Marroquin, has little patience with arguments about whether the regime he runs violates the rights of internees, especially when they are held involuntarily.

“What about families? What we do is give families peace, so their loved one doesn’t get himself into trouble. And so that he won’t kill them,” he counters.

Adverts for other rehab centresAdverts for other rehabilitation centres in Guatemala City, with the left one titled “Warriors of Christ”

There is no data about how successful the rehabilitation of addicts is in Guatemala. In 2012, the United Nations called on all member states to close compulsory drug detention and rehabilitation centres.

“There is no evidence that these centres represent a favourable or effective environment for the treatment of drug dependence,” declared the UN statement.

Many experts believe addicts can never be forced to change – they have to want to stop. And in Guatemala there are many Christian establishments that will only take addicts on a voluntary basis.

But Pablo Marroquin, clean now for 22 years, is a testament to his own approach to rehabilitation.

“I experienced God’s mercy – he rescued me. He brought me to a rehabilitation centre where I met myself, and I met God. And these days, I’m a happy man.”

Listen to Linda Pressly’s report from Guatemala City on Crossing Continents on BBC Radio 4 on Thursday at 11:00 BST – or find it soon

Australia’s hidden gem: A Tradition of Exceptional Drug User Orgs

Terrific examples of Drug User Run Organisations

Here is something you will rarely hear about emanating from Australia, or mooted by its politicians. Yet it is worth shouting about -and worth emulating — and demanding more recognition for its many excellent years of work outside the drugs field! In Australia, the user run, federally funded AIVL (Australian Injecting & Illicit drug users League) is an incredible, national organisation that is at the centre of the some of the best harm reduction initiatives in OZ and in the world.  Extremely well versed in drug policy and politics, AIVL  and its team of extremely able people who use/d drugs (many at the top are women!) have been tireless in their innovation, research and developments to help empower the drug using community in ways to look after themselves, each other and their communities. The publish a National user magazine called Junkmail (like our BP blog,by coincidence -(we called it Junkmail after BP’s letters page although Junkmail has been the Aussie national mag for many years)). Many states like NSW, Queensland and Victoria also have their own excellent magazines by and for users – with NSW probably having the longest running user mag in the world in Users Voice by NUAA.

Positioned as the national drug user organsiation, AIVL members stretch across Australia, and in each state there is another State ‘user run’ organisation, which has just as much oomph, savvy, and articulateness as their ‘mothership’ AIVL. Organisations like QuIVAA (Queensland Intravenous AIDS assoc) which aims to “represent the diversity of interests of injectors and illicit drug users, through systemic advocacy aimed at addressing issues affecting users in Queensland” (Fantastic!) -along with other groups in what can sometimes really seem like a police state -Northern territory for example, or where in Western Australia they lock up more indiginous folk per head of population than anywhere in the world, targeting plenty of drug users and throwing them in the lock up in the process, over and over again…Shameful.

But you really can count on the user activists in OZ to be fighting the good fight, and if you are ever searching for good quality info on harm reduction and user rights in English – here is a good place to start. BP will be adding more reviews about user orgs as we go. (Sweden next)

AIVL gives you the list of contacts for all states in Australia – great orgs to seek out should you ever be travelling there and need advice or help with scripts, legal issues, the low down on the local scene etc.

AIVL, is Australia’s national org (click here) but here is a list of Australia’s State Organisations run by and for people who use drugs.

Canberra – CAHMA  (Canberra Alliance for Harm Minimisation and Advocay)

QueenslandQUIVAA   (Queensland Intravenous AIDS Assoc) and

NSW – NUAA (NSW Users AIDS Assoc)

What packets of cocaine look like in your stomach

 

cocaine inside the stomach looked at via at CT scan

 

Radiograph of the abdominal area of a drug cou...X-Ray of the intestines with 38 packets of coke.

Just for our amusement..If you have ever wanted to have a closer look at what cocaine packets look like in the stomach, here it is.

The image comes via University of Bern, which did a study that found CT scans detected cocaine better than X-rays.

To the right we have the CT scan, and below right we have the x-ray…

The one below is a radiograph of the abdominal area of a drug courier. Multiple capsules of drugs are visible in the stomach (yellow markers **) and the intestines (*). The man swallowed 38 capsules of cocaine. (2007)

Peering at Peer Work from Prague…

Hiya,

Sending an update from Prague, having been attending a Correllation event based around peer work and peer support. A great focus for an event, and one that promised to include a deeper look into what peer work is, what makes it successful, the obstacles, why its important etc, with the aim of boosting it and outreach work in Europe. The title was ‘Stimulating Inclusion, Participation and Meaningful Involvement’ (European Seminar on Peer and Outreach Work).

The Czech Drug Situation…(A quick glance)

Anyway, having a quick squiz at the drug situation in Czech Republic on the way over, I was interested to learn a bit more about the Czech peoples relationship with amphetamines, which are apparently the drug of choice over here.  In fact, according to the EMCDDA’s 2010 report on drug use in Europe, the Czech Republic has the highest prevalence of amphetamine use in Europe at 3.2%, (Denmark comes a very close 2nd at 3.1% and then Estonia 2.5%…Ok ok, us Brits are in 4th place with 2.3%!!).

In any case, what is interesting is that its use has risen markedly since data started being collated in 2002. Most of it is methamphetamine in powder form, therefore it’s primarily injected in 90% of cases.  Many eastern and central European countries have seen recent surges in problematic amphetamine use and have been caught unprepared in how they should deal with it, with treatment systems largely organised to deal with opiate users.

It was kinda interesting also to note the Czech relationship with speed

Amphetamine, the prototypical releasing agent,...

Image via Wikipedia

going back to the 1950’s with a few pharmaceutical amphet based preparations proving the drugs of choice. Consumption greatly increased through the 60’s and 70’s until the ol’ meth labs appeared and took the place of the, now banned pharmy meds.

The 1980’s saw the expansion of meth users, mainly quite closed groups that grew up around meth dealers and production areas and by the end of the 80’s an estimated 25-30000 users were dependant on non alcohol drugs – principally pervitin (which is the name used for methamphetamine in Czech Republic and Eastern Europe).

Since 2000, pervitin use has grown beyond these small groups into the wider popluation and is now quite extensive in Slovakia as well. Just to round up, the EMCDDA report mentioned that the surge in pervitin use in Slovakia corrosponded with a drop in retention rates at methadone clinics from 77% in 1999 to 46%  in 2003 (quite a drop). This seem to show that opiate users were using pervitin as well, and were either getting chucked off the methadone clinics or leaving themselves. A change in the philosophy of the clinics whereby meth clients were not excluded from clinics but were given a low-ish dose of methadone (a max of 40mg) and were not required to become abstinent. This appeared to stop the drop in retention rates which, in 2008 improved to about 58%. (Perhaps something for the conservatives abstinence evangelists  to think about!)

Finally on the drugs front, just to throw in that methamphet is reported as the primary drug of choice by around 70% of those entering treatment and is also reported by opiate users as their secondary drug of choice – especially by those in methadone programmes. Searching for, no doubt, something to break the monotonous dullness of long term methadone use!

Back to the Seminar then!

We heard that the Czechs have around 10,000 problematic drug users in Prague, one of the lowest rates of HIV in Europe (although they have low rates of testing), approx 50% of opiate users are in treatment but they don’t have much involvement from drug users themselves in services, as peer workers etc (nothing new there then).

John Peter Kools, one of the conference organisers, urged us over the days ahead to find the similarities that bind peer workers and professionals, rather than the differences. He said he had seen the biggest changes happen when people have started to relate to others and searched for that common ground, finding that ‘win-win’ position. He assured us that it is an uphill battle and that wont change i soon; the political climate around Europe for small government (in other words – do it yourself!) is spreading fast and he mentioned specifically the situation in the UK where a new government policy document had just been written (The Coalitions new drug strategy) and the words harm reduction weren’t mentioned even once. Shocking, to be sure. He urged us to keep engaged because we could, indeed we have in some instances, lose precious hard won ground.

Rhythm and Pace.

Just a highlight from the first day, a speaker (actually from the UK) named Graeme Tiffany, who talked very eloquently about outreach work with young people about successful outreach being the matching up of the Romantic (of the era) and the scientific. He was very clear about such ‘hard to reach’ groups – are not at all that; in fact it is services that raise the threshold too high. So true! When you think about teenagers (and i was a drug using youngster!) – regulations are not of your language then – you need a service that keeps the bar low – that allows you to retain your identity, not one that trys to lift you out of your scene and strip you of what you feel is what protects you: your youth culture, your mates, your sense of belonging, all I think are felt so much stronger when your a teenager. He talked about the directives he gives when training youth workers now, after learning some fascinating work of an agency in Pamplona Spain that insisted its workers go out, and sit on the wall in the street (where the kids hang about) for 6 hours. It was called feeling the ‘rhythm and pace‘ of the community. That you need to stop and ‘feel’ the pace of things, the movement, you have to listen to the street. So often people sit in offices and very rarely go out and see and really feel the local street scene, or as is the case with outreach – rushing out of the office to hurry around the area doing ones ‘work’.

Then it is about ‘proximitie’ the french meaning – to be close enough to ‘hear the request’, hear what is being asked of you – not to think you know what someone needs and lumber in with ideas of what you think is important for them – you need to hear the request; when you have taken the time to tune into their space you will be asked and you will understand what they need from you. Then he talked of ‘accompagne‘ also in the french sense, which means unity and solidarity – to stand by and be with. It really was a wonderful ‘code’ by which to help outreach workers tune into their local youth scene.

Macedonia Rules!

A wonderful woman from Macedonia named Maria Tosheva from the Healthy Options Project in Skopje gave us some truly inspiring news about real peer involvement.

HOPs began as a user led initiative doing syringe exchange out on the streets of Skopje, despite harassment and suspicion from the local police and community. Hops has expanded enormously and become a service in its own right but it has retained its community members as being the most important part of the Hops team.

21 out of the 52 paid workers are drug users – a truly remarkable achievement we just done see replicated enough. Maria said that there is no real meaningful involvement of community members unless they are part of challenging the laws and creating the policies that affect them; changing the main obstacles that they face. She recommended that in order to support and foster this we have to invest in community groups, pay as equals, respect individual ambitions and preferences of those involved, and respect the need for members natural group development and structures; it is not always about the structures that you think will be most effective – you must listen and allow space for the natural development of user groups. Brilliant stuff – and what we KNOW to be true words spoken. Nice one Maria!

Ill end here and try and give an update on day 2, which had me a bit teary at one stage! I always write my blogs too long, hope you’ll forgive me readers. Until later,

Erinx

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