Trafficking in Drug Users

Hi friends,

I just came across this old article/ presentation I wrote some years back about my own treatment journey (nightmare might be a better word!) and how so much idiocy, money, misguided support and policies, ignorance, do-gooders, moralising shits, and the whole web of the incredibly resourced, career inflating, gravy train that is the current drug and alcohol treatment /criminal justice interwoven system, is stitched up so tight across the globe, that it is going to take a hell of a lot of strategising for us to get out from under the intensity and chains of the current goal of ‘managing and controlling’ people who use drugs, in any way possible -and how carreers and reputations ride on this these days – the research, the papers, the positions in clinics and academy’s, the psychology and the ‘experts’ draining cash from everyone hand over fist with the misguided or embossed descriptions that they will ‘fix’ and cure your loved one, yourself, your child before it has even smoked a cigarette!  We are taught year by year, harder, longer and stronger – that we are weak, we have no control over our desires anymore, that we cannot do it ourselves – we HAVE to have professional help….Yet what of the professional help? The basic, colourless, inflexible, unchangeable, plain and homogenous, evidenceless help….my God, what a load of crock so much of it all is – and still – they never seem to ask us what we need. What would help. We just get encouraged to join into more peer pressure and trot out the same old slogans that we believe are right coz our old peers say so (12 steps etc). 

When is it EVER the right way to provide one solution for everyone no matter what where how when why they use drugs? in 2016, we are still one leg firmly in the dark friends….Sad alright. But it just shows – the only way is to get active – get politicised, get smart.

Hope you like it (bit dated now!)

Here – One of the BEST sites for resources on progressive ideas about drug use / treatment -based in UK – The SMMGP (includes forum, resources, GP chatter and much more).

RCGP Special Interest Masterclass Presentation

Originally entitled ‘Don’t Give Them What They Want’.

EO;  Editor Black Poppy Magazine, Written /presented July 2003

I left my home of Australia 10 years ago trying to find a way to get off heroin. I thought the beautiful scenery in Europe might inspire me, I thought London might show me a new way of looking at life. I thought I might find something that would interest me more than heroin. But I should have known that doing what many of my peers call a ‘geographical’ is very rarely the answer.

I had already been to a variety of treatment clinics and surgeries in Australia. I had hadpoppies_final_black5.jpg habits on heroin, cocaine, benzo’s, and a few other pharmaceuticals, but my treatment options, no matter where I went, were methadone, methadone and more methadone. I felt screwed by the time I came to England. I felt numb and I wasn’t well either. By the time I arrived, I was hanging out, sick, extremely tired and depressed and went to a hospital looking for some relief. I was offered a two week blind detox on methadone. Suffice to say, I remained sick. I felt like I was trapped and my head just kept wanting to be well. I was in a new city and hoping to find a bit of peace of mind, I had to begin to learn the ropes of the British prescribing system. Suffice to say, it has taken me another 10 years to finally land on my feet, with a script that suits me, Erin O’Mara, an individual with individual needs. After almost 20 years I can now look to a future – that’s what a tailored prescription has really meant.

To get to this point, I have attended around 10 different methadone programmes, 2 heroin prescribing programmes, seen numerous GP’s (both private and NHS), and sat with plenty of psych nurses, key workers, social workers, psychiatrists and counselors. I’ve been to rehabs in the country and detoxs in the city, made plenty of attempts at stabilizing and fought to come off completely with concoctions of pills gathered from anyone who would give them too me or suing acupuncture, massages and herbal teas. It wasn’t that I didn’t try. I really did. Everything was riding on it. My life, my health, my liberty. But I just kept coming back to the same old blanket prescribing of methadone linctus – a drug that, while I know it helps many people, it isn’t for all of us. Drug users are not born from the same mold, we all use for different reasons, we all take different drugs, we take differing amounts of different drugs and offering us variations on the same methadone theme, while helping many, is still going to leave thousands of us out in the cold. And how long can we afford to stay frozen out?

For many drug users, getting on the treatment rollercoaster means you are certainly in for a ride and a half. I have learnt that the right prescription is only half of the equation – the other half is the treatment and understanding you receive from your prescriber. It can be so hard to explain to some prescribers that it is the creation of the types of prescribing systems -that can cause so much difficulty in adhering to it. The clinics that offer only a 2 week break or holiday a year (no opportunities to mend familial bridges there then), the confusion or distrust around your intentions, the reducing of your script every time you take something else or have a need to top up your dose, having to turn up for dosing at inflexible times -whether you have to pick up your kids or go to work or uni or like being closely watched as you sit for 3 hours on a toilet to give a urine sample before you’re allowed to get your dose. I’ve been to a clinic where a girl burnt off her tracks with a cigarette because she was afraid the doctor would cut down their methadone if they found out she was still using on top. And, at that particular clinic, sadly she would have been right. Getting the treatment dose right is essential, finding the drug that suits that individual is critical, allowing room for maneuver or looking for other drug treatment alternatives is the most important of all.

chrispolice

Your nicked!

Since leaving Australia where we were all prescribed methadone – no options, no alternatives to coming to the UK where there was some room for maneuver with prescribing has been an interesting experience. Heroin has always been my drug of choice and for me, methadone linctus just didn’t work. It didn’t work for me in Australia and it wasn’t working for me here. I looked everywhere for a more suitable script. I’ve tried morphine, slow release tablets and ampoules – which, while being a welcome relief from methadone, I found it incredibly constipating and uncomfortable and found myself again, unhappy, not wanting to take it and looking for something else. I will never forget that particular doctor who was then the first one to actually sit down with me and talk to me about what it was I felt I needed. But while we both knew it was probably a diamorphine script, he was powerless to offer me it. Thus he offered me what we thought was the next best thing. Morphine. It wasn’t that I didn’t want it to work, I did, more than anything else in the world, but it just wasn’t suitable for me.

It is so important to be able to offer alternatives to drug users when they come in looking for treatment. Generalisations about drugs and drug users are made without considering how cultural differences mediate and transform both the reality and meaning of a persons drug use. Younger users, older users, women, men, mothers, those on parole or probation, those with HIV and or Hep C, injectors, smokers, pill takers and snorters – how can we expect to support an individual with a chemical dependence if we are only prepared to offer them methadone?

It has taken years for methadone to be accepted by doctors, and still it is only by a minority. Without question it clearly works for some people and it certainly has a place in prescribing options. But there are other alternatives. At Black poppy we are receiving many letters about how helpful Subutex has been (mainly for detoxing) but many more letters from people wanting to know how they can encourage their doctor to prescribe it. We all know its out there but where? How can one be prescribed it or is it too a lottery depending on your area or GP?

Morphine also holds an important place but is usually prescribed by private doctors and is prohibitively expensive. I have a good friend who has tried methadone unsuccessfully many times and finally went to a private doctor to try and get MST’s or slow release morphine sulphate tablets. Because he can’t stomach methadone linctus and doesn’t want to inject methadone ampoules, his morphine script has meant every fortnight he has to resort to spending literally his entire benefit cheque on paying his chemist and his doctor and is still fifteen pounds short. His clothes are old, his cupboards are empty and he is fighting off a depression that threatens to jeopardize his whole stability. This is because he cannot find a single NHS doctor in his area to prescribe him morphine tablets – despite his private doctor offering support. The last time I saw him he was eating the only thing he had in his cupboard – tomato paste. Why?

There are many people who have either dropped out of the prescribing system altogether or regularly have to top up with additional drugs because the system just isn’t geared for those with poly drug dependencies. While years ago many people just seemed to stick to using one or two drugs at a time, these days poly drug use has become the norm. How are doctors going to help support people if they can’t or won’t take on anyone who was multiple drug problems. This is 2003 and this is the way drugs are now taken. Both patients and doctors must be prepared to be open and have the courage to admit when something isn’t working and be flexible when considering alternatives. It isn’t easy. I know drug users can be difficult patients. When that doctor sitting opposite you seems to have the power to change your life – things do and can get emotional. For treatments to work we all have to be open and honest. The system has to let you be open and not punish you for what it sees as ‘not conforming to the treatment’. Relapsing is part of stabilizing as well as part of ‘the cure’.

For me, after years of searching for some stability – I was finally offered the chance to try diamorphine – or heroin on a script. It is extremely rare to get this chance and I believe the deciding factor was because I had recently contracted HIV.

Heroin is provided on prescription in what was known as 'The British System'

Now I’ve had the opportunity to participate in 2 very different approaches to heroin prescribing – and it has taught me a great deal about how the differing structures, regulations and nuances behind the way heroin is administered to users, is critical to the success of the programme. For example: The first heroin script I received was back in 98, through a pilot project in London, whose aim it was to study the effectiveness of prescribing either pharmaceutical heroin, or methadone in injectable form to drug users.

The first error and one eventually admitted, was to limit the amount of diamorphine prescribed, to an unmanageably low 200mg. (The Swiss, The Dutch and others, myself included, have found 400 – 1000mg much more suitable). Pharmaceutical heroin does not have a long half life and to seriously underestimate the dosages required was to become a momentous error and one that would seriously jeopardise a person’s ability to adhere to their prescription. With a median age range of 38 and an average injecting career of 19 years, many clients at this project had other drug problems, such as crack, benzodiazepines, alcohol or cocaine which I don’t fully believe were taken on board at the time. The severely punitive clinic regulations or ‘protocols’, would bear this out. i.e. anyone caught using any other drugs or ‘topping up’ their rather limited dose, would immediately be ‘sanctioned’ by way of a 30mg reduction in ones daily prescription, reducing even further ones ability to adhere to the programme. Once ones prescription began to lower, it was practically impossible not to ‘top up’ with something else, and so clients, myself included, were locked in a constant spiral of script alterations.

A stifling clinic environment would be the clinics 2nd fundamental error, where people would be unable to talk about their other drug issues for fear of a variety of repercussions. This would lead to an even more alarming situation where clients hid serious medical issues for fear of their prescription being stopped or being transferred back to methadone linctus.

The importance of maintaining an environment where users can talk openly and honestly to their keyworkers and consultants is a crucial element in a person’s success on any drug treatment programme and this was no exception. A deeply unhappy client group had nowhere to go to complain about their treatment and having to attend to such a stressful and demoralising project promptly each morning in order to receive ones medication only exacerbated people’s and my own depression and did little if nothing to improve the spirits of those attending.

Two years later, after a desperately unsuccessful period trying an injectable methadone prescription, I had developed a dire crack problem, was drinking alcohol regularly for the first time in my life, and began having regular seizures from increased benzodiazepine use.

It was at this time that, after an enormous effort and support from my GP Chris Ford, my mum, my local MP, (and bailing up the prescribing doctor at a conference I attended), I managed to secure a place at London’s Maudsley hospital, where there was a doctor prescribing heroin to a small group of patients. I clearly remember my sense of complete and total desperation. I felt I could not go on any longer, that if they didn’t help me I would be – I didn’t know where I would be and that was the trouble. I felt that this was my last hope, that I’d tried everything. And I begged…. Most drug users know well the feeling of someone else, a doctor, having the power of your life in their hands, every single day. A script started or terminated making the difference between life and death, or misery and hope. Sometimes you end up having to beg…

I have now been on my heroin script for 2_ years. My health has improved substantially and my HIV doctor is delighted – as is my mum and I. My moods and energy levels have improved considerably and so has my ability to contribute to life and my community. I founded and continue to work on what has become a National drug users’ magazine called Black Poppy, and I am actively involved in drug user politics, journalism and harm reduction issues. It has been a difficult journey, but thanks to my mum, my mates and the open-mindedness of my doctor, who fully engages me in my treatment decisions and doesn’t wave punishments in my face, I have stabilized and am well, for the first time in 18years of using opiates.

Now, I have somewhat of a vested interest in the campaign towards prescribing heroin – both here and overseas. Last year, my mum returned to Australia to live and while I would have liked to go with her, the thought of losing my heroin script after fighting so hard to get it, felt more than I could bear. I am HIV positive. There are going to be times when I will want to be near my family. Yet archaic laws in Australia forbid me from even entering the country with my prescription. How can this be legal? Anyone, on any other medication, would be permitted to continue that medication in another country but these basic human rights do not extend to drug users. The intense and totally unfounded hysteria that surrounds the prescribing of heroin to drug users sadly endures and has made the campaign to prescribe heroin in Australia a momentous task. Yet while campaigners look to the British System for guidance, it would be a mistake not to closely examine both its failings and successes. The potential for problems in importing a system that hasn’t been culturally fine tuned for the British using community are great because to get it wrong, Britain may lose the chance to ever attempt it on a large scale again. The Swiss users have to return to their heroin prescribing clinic 3 times a day to receive their heroin, watched over as they inject by a clinic nurse. Although the Swiss programme has had incredibly positive results, would English users blossom under such a severe restriction of an individual’s freedom? Or if the dosage is not allowed to be adjusted to suit each individual, as occurred before at the London clinic, what chance is there of success?

While there is undoubtedly a role for the prescribing of heroin to heroin users, it is important to remember how crucial the role of the heroin user is in the planning, implementation and evolution of a heroin programme – or any drug treatment programme for that matter. Users must be involved every step of the way and accepted, as other users of health services are, as an integral part of a treatment programmes development, with rights, responsibilities and a mutual respect for experience.

I know I’m fortunate. As an Aussie living in London, there are times when I have to pinch myself that this is real – I have a diamorphine prescription!. That the long and often harrowing road of ‘substitute prescribing’ has finally come to an end – and now I’m free to think about my future. But in the small silences that fall between me counting my blessings, I can’t help but wonder whether it’s all just been a bit to little, a bit too late. I question why it has taken 18 long years to get here? Why did I have to wait until I’d been chewed up and spat out of over 10 different treatment programmes and Dr’s surgeries, of at least 4 rehabs and an uncountable number of detox attempts? Why did I have to wait until I’d ‘finished’ selling my young body to men, til I’d got sick and deeply depressed, til I’d used every vein in my body from my neck to my feet, til I’d contracted both HIV and Hep C? Yet doctors can prescribe heroin to people who are opiate dependent in the UK and indeed they have recently been encouraged to by our current Home secretary, David Blunkett. Are doctors prepared to start looking at other alternatives? Is the government going to stand behind them? Support each other – doctors who are prepared to look at other options – keep each other updated. As a drug user, I know what its like to be on the other side of the fence – and as a drug user, I also know there are courageous doctors out there who are trying to do their best but are often working in isolation, with little support.

bppicnunsmall1.jpgMeanwhile, 96% of all opiate based prescriptions given out to British users, remains methadone and only 449 people currently receive a heroin prescription for opiate dependence. And I am one of them.

Unfortunately, I still hear the saying, ‘Don’t give them what they want’. But it’s not about want anymore. It’s about need and it’s about our lives. I would just like to take this opportunity to thank those doctors who did go that little bit further and treated me and my needs individually. Their support has got me the prescription I needed and has allowed me to be here today.One day we might have a system that doesn’t insist on me being sick and dysfunctional from the get-go and asks the big questions like ‘Why do we have a society / laws, that push substance users to the brink of insanity and outside the margins of society just because they prefer opiates instead of whiskey, a little stimulation from khat chewing instead of 20 cups of ‘legal’ coffee.

 

Addendum: The drug conventions are based on a lot of hot air and bullshit friends, the more you look back into history and the closer you inspect the world of economics, society, and criminal justice today, the more you unravel a mish-mash of men in suits making decisions decided by money, history, fear and racism, certainly not strong evidence, humanity and common sense.

– Erin

Editor Black poppy Magazine

Ibogaine update

Well readers, I have a treat for you!

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

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

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

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

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

Portrait of filmmaker David Graham Scott today

Portrait of filmmaker David Graham Scott today

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

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

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

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

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

IBOGA NIGHTS from David Graham Scott on Vimeo.

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

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.

                                              ****************************************************************

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

Does England Need a Drug User Union?

IDUD_2014Hi, I received a comment from Joe (hi Joe!) who said he was writing an aricle on why Britain needs a drug user union and could we help? Well, it happens to be good timing Joe, because it is a discussion on many peoples lips – how to unify and strength the voice of the drug user in the UK enabling it to become more effective addressing issues that routinely affect the lives of drug users. For England however, it is even more pertinent as we are currently adrift  in what might be a diverse and eclectic drug user movement, but it is one without a unified voice, or indeed a mechanism to sift and reflect back through the real concerns of the drug using community at large. So what do we do? Well, we can start by answering Joe’s question. Do we need a drug user union in the UK? (Note: this is pitched at a newcomers look into the drug user union movement so does not go in depth into some of the issues that are bubbling away for the movement).


Union2_Hi Joe,
We do need a drug user union in the UK, just like they do in many other parts of the world. Whilst a trade union’s primary role is to represent their members on employment issues, a drug user union has often emerged in a country to focus on issues affecting drug users in treatment. And just like a workers union would fight for better pay and working conditions, a drug users union focuses at least half of their energy on ensuring drug users in treatment get treated fairly, humanely, and equally – like anyone else who is a consumer of a health service.

union5Historically and no different from many other countries,  drug treatment in the UK has varied widely in its ability to reflect the needs of its client group and has often been modelled on extremely punitive, isolating and demoralising approaches to treating drug use. The most widely used approach has always been the ‘Carrot and Stick’ model, where users are rewarded with privileges for compliance. This often means permitting take home doses of methadone if users choose to ‘get with the programme’ and show it by presenting no positive urine samples. The Carrot.

The stick happens when users are punished punitively when they ‘fail’. This has varied from the inexplicable; a reduction in ones prescription (just when they are showing they perhaps need an increase) to the common; drink your methadone supervised -which can mean rather humiliatingly drinking it at the chemist in front of everybody (including your children’s friends parents). But anyone who fully understands drug dependence in all its complexity, will know that punishments make no hay when it comes to the decision, or the overwhelming need to use drugs. In fact punishments often simply isolate the person further and drive them deeper into their dependence/addiction. People become resentful, unable to confide in the people who are supposed to be supporting them, and simply lose the resources, the motivation and the knowledge about how to make the changes they wanted to when they started the programme.

Tunion3wenty years ago when ‘user involvement started in the UK, we were coming out of the dark ages in terms of drug treatment. Today, with a high degree of user involvement around the country, things have been much better for the average drug user in treatment. But success in the UK has been patchy to say the least, and todays political ideology that directs the funding wand has caused not only cut backs in drug treatment but has created a whole series of new problems, problems which are ripe for a drug user union to tackle.

The UK needs independent union/s for drug users simply because they must have an independent voice in their treatment which affects, like a work union1or a trade union, a huge part of ones daily life. Much of todays user involvement is now suffering from the left turn it took many years ago to follow the money (and sometimes the support as well, both are understandable to some degree) and get into bed with the same health authorities they needed to have clear heads about. This has not only influenced some of the decisions such groups have made, sometimes at the expense of their communities, but has now left them defenseless to big budget cuts in the health service, money which is no longer ring-fenced to protect drug treatment. Drug User Groups that have spent years working, often for no pay, sometimes doing or supporting much of the work of professionals, have, at the stroke of a pen, been vanquished. Thanks for all the work mate, but seeya later.

Perhaps if we had set up as unions, even to the extent where users who wanted to join could pay their dues with the knowledge that they were getting something for their money; positive change, we would have a strong lead and vision for the way we want drug treatment to go in this country, a direction which is centred around the needs of the client, not the government, and not the key-worker or consultant. The client who is, after all supporting a massive industry of jobs, careers and reputations.

But drug user unions have a much bigger part to play in civil society. Unions can offer educational, lifelong learning and training opportunities to their members, just like real unions.

But drug user unions have a much bigger part to play in civil society. Unions can offer educational, lifelong learning and training opportunities to their members, just like real unions. Historically, unions have not only negotiated for and championed better workplace rights with employers but for a better deal for working people in the wider world. Having battled to extend the right to vote, it was the unions that created a political party that working people could vote for – the Labour Party. It is perfectly possible, as is reflected in perhaps one of the world’s most brilliant Drug User Unions, The Swedish User Union, for drug users to become directly influential in a country’s national politics; becoming to Go To organisation on drug related issues: Nothing About Us Without Us – the slogan for the drug user movement.

union4So yes, the collected strength and political ability of the English user movement is perhaps at a bit of a crossroads, or on a cliff edge, or even a sinking boat. It has only to look to its brethren in Scotland and Ireland (north and south) to see shining examples of cohesive and effective partnership working and union values, forging better and more humane drug policies in various sectors like health, criminal justice, treatment etc. But the space is empty for a unified user voice in England, the seat is up, the pantry littered with almosts and nearlies. Yet the values of a drug user union are urgently needed today. For those drug users still struggling with substandard or punitive treatment, poor engagement opportunities, or one size fits all care, it is just as much-needed for the society we live in, the drug policies that desperately need our thoughts, creativity and input, the solutions to community drug issues that only we as drug users can really pinpoint and tackle effectively. But that’s not all. What about unions at work?

All the unpaid hours we do to better our communities as harm reduction and recovery workers, all the glass ceilings we encounter despite our enormous skill and ability. Indeed Canada has recently ensured its harm reduction workers have been able to come together under a union banner as the Harm Reduction Workers Union, a really marvellous idea that is also primed as a template for other countries to adopt. And while history tells us that England, indeed Britain, has always been a rather tribal country, with tribal interests and cultures that still affect the way shires and counties do things, it will be basic union values that are able to touch a common core through all that diversity, and hopefully, bring us home to a unified drug user movement. A movement that is solid and secure with our UK brethren, allied in defence of ever more humane drug policies for our societies. And a vision of innovative and responsive drug treatment that is driven forward by equally by ex/current drug users and a diverse orchestra of dedicated others forever fine tuning our treatment and information response. All leading our communities down the right road ahead, across the changing landscape of drug using Britain today. Erin O’Mara

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.

Life Goes on In Crimea, (unless your on methadone…)

Life Goes On in Russia’s Crimea

Here are the final 2 blogs in the series of 4, from Igor Kuzmenko’s personal blogs of Crimea, in particular, life for those who once lived under Ukraine law and received Opiate Substitution Treatment (OST) such as methadone only to lose their new found stability after the region’s Referendum when the majority voted to go back to Russian governance. This effectively closed the doors for good on OST leaving over 800 people in shock and despair. So what is a person withdrawing from treatment supposed to do? What would you do if your access to methadone or buprenorphine was cut off almost overnight…? Igor gives us a frighteningly honest account of what happened to the OST community in Crimea..Here is part 3 and part 4.

NOTE: Part one and two are a bit further down this blog and the whole series has been reprinted here courtesy of INPUD’s blog and you can also read them in Russian at ENPUD’s website /blog. Thanks to Igor for a fascinating insight into Crimea for the drug using community, and INPUD for reprinting.

 

RIP Crimean OST Program, 2006

small_igor (1)

Igor Kuzmenko

Part 3

Meanwhile life in the Crimea went on. As spring approached, people continued to go to work, and students proceeded to attend their studies. Very few inhabitants of the Crimea understood that 806 people of the region’s  population, were literally on the way out.

 

Death From Abstinence

As I  wrote previously, the first patient in Simferopol died around the beginning of April. He was about 50, was seriously ill and couldn’t move at all. Everything was good with him before the March events; the doctor wrote a prescription for him so he could get liquid methadone and he continued to use Opiate Substitution Therapy without leaving the apartment. But after March 16, everything changed and the prescription form of OST was suspended in Crimea. It goes without saying that any coroner wouldn’t determine a cause of death as ‘death from abstinency’. But something tells me that if he continued to have the opportunity to receive methadone, he would be still alive.

 

 But after March 16, everything changed and the prescription form of OST was suspended in Crimea.

 

Bupe Not Methadone

Actually,  there were not so many people receiving OST on a prescription basis in the Crimea. And there were a few reasons for that. First,  the prescription form is possible only for those people who receive buprenorphine in Ukraine. There are cities where all clients of the buprenorphine program constantly receive it using a prescription. But everything is much more difficult when dealing with methadone.

ukrainianmethadone

The medicine used in a Ukrainian methadone OST program – known as ‘Metadict’ and ‘Metadole’ – are both made in Germany or Canada. Both of them are in the form of tablets, not syrup. They come in blister packs of 10 tablets: 25 mg each, (total 250mg)  or in bottles of 500 mg. But it is impossible to get it using a prescription because according to the laws of Ukraine a single prescription dose of any narcotic substance mustn’t exceed 112 mg. The blister packs are not allowed to be cut up or tablets prescribed separately from the packaging. There were individual cases when patients could receive a liquid methadone on prescription, but only on a commercial basis and it is very expensive.

 

Methadone Not Bupe

In the Crimea, it is different. Slightly more than 50 people out of 806 patients received buprenorphine, the others got methadone. About 10 people out of those 50 had the opportunity to receive buprenorphine on prescription though not on a constant basis. They got it occasionally – because of a business trip, illness or going on a holiday.

ukrainian-methadone-metadol

Ukrainian methadone; Metadol

 

There is also one more reason for prescriptions being shut down in the Crimea after “the referendum”. Doctors were afraid to write out prescriptions on both of these substances because they are actually illegal in Russia and so employees of drugstores in turn, were afraid to sell the medications and fill  these prescriptions.

 

May 20th – D Day

May 20 was the last day when people could use the OST program in the Crimea, so after that each of the 806 person’s who were prescribed had to make one’s own choices of what to do. There were only four options:

  1. String oneself up to stop using drugs forever
  2. Go to Russian local rehabilitation centers praised by numerous Russian “guests”;
  3. Continue using OST by moving to Ukraine;
  4. Go back to using “street” drugs.

According to my knowledge, no more than 20-30 people went to Russia for rehab. Many of them couldn’t undergo an entire “rehabilitation course” till the end and ran away. However, some stayed in rehab for the whole term. One OST client from Simferopol died in St. Petersburg during the rehabilitation process. He died of an overdose.

Slightly less than 60 people risked going to Ukraine. This option was, undoubtedly, the most realistic of all. For example, in many cases it was necessary to buy tickets at ones’ own expense to go to Russia, but in Ukraine both tickets, accommodation and food were paid for you.

 

Should I Stay or Should I Go?

Nevertheless, as you can see by the number of people who went to Ukraine, it didn’t become a mass phenomenon. Partly, this was due to mass media propaganda which colourfully described the various ‘atrocities’ of Ukrainians in relation to the inhabitants of the Crimea who risked leaving and facing the ‘mockeries’ of the Ukrainian border guards who were taking away passports on the border and other nonsense. The other reason that many of inhabitants of the Crimea never left for Ukraine, was they had neither friends, nor relatives there and simply couldn’t imagine where they were supposed to go.

Now many of the clients of OST who had gone to Ukraine, already found a job there, and all without exception found rented accommodation and received some financial support from the project MBF “Renaissance”.

 

“It turns out that more than 600 people started taking street drugs again.”

 

From those people with whom I was in contact no more than 10 people could finally stop taking drugs of any kind.    If you make simple arithmetic operation, it turns out the following:

806 (total number of clients in the Crimea OST program) minus 20 (number of those who undergone “rehabilitation” in Russia), minus 60 (left to Ukraine), minus 50 (suppose not 10, but 50 people stopped taking drugs) = 676.

About 30 already died out of that number of people. It turns out that more than 600 people started taking street drugs again. And many of them during many years of using the OST program found work, started a family and gave birth to children.  Now it’s all over.

 Igor Kuzmenko

Below is the final part of Igor Kuzmenko’s series on Crimea. Please feel free to add your thoughts and comments and let us know if you have a story to tell from your country.

 RIP Crimean OST Program, 2006

 

Igor Kuzmenko

Igor Kuzmenko

Part 4

How to reach those people who made decisions on the issues of Opiate Substitution Therapy (OST)  in the Crimea? Which words should be found to explain to them that situation where 800 drug users under constant medical and psychological control, employed and reintegrated, is much better than 800 people coming back to being criminalised in the drug trade? How could one explain what the blue sky is to the person born blind? How it is possible to explain to a mother, whose son quietly had been using OST for several years, stopped breaking the law, started a family and found a job, why he has died of an overdose during the rehabilitation? Who benefits from it?

“What we had been created for several years was destroyed in two and a half months.”

Probably, for those people who have nothing to do with OST and don’t have the slightest idea of what this therapy actually is, it is only a “change of the dealer” – earlier I bought drugs on the street and now I get them free of charge from the doctor. But actually OST is a difficult system in which the process of taking methadone or buprenorphine is only a small part of the whole process. OST is a complex of actions that allow the person to live a more or less productive life. Many elements of this scheme, such as the ART (Anti Retroviral Therapy*), anti-tubercular therapy, are strongly connected with OST. There is no point in pretending otherwise, many people started to use ART and to look after their health only after they visited the OST site.

 

Irina, a client from the OST program

Irina, a client from the OST program

Stability and the Street

What we had been created for several years was destroyed in two and a half months.

So, more than 600 former people from the OST programs have taken part in the illicit drug scene again since May. What do our people use to medicate themselves with now?

Lyrica. This beautiful and romantic word is actually the name for one of the biggest problems of the Crimean drug scene nowadays. Lyrica (active agent – Pregabalin). An antiepileptic and anticonvulsive medical product made by Pfizer Company. Many ex-OST patients are suffering from its over-use today. It has excellent medical qualities if you take it on prescription, but it causes terrible side effects and dependence for those people who try to combat withdrawal syndrome with its help. It is sold freely in any drugstore in the Crimea and costs not so much.

Only a total deficiency of any medical products in local drugstores is saving others from the serious consequences of pharmaceutical drug dependence in the Crimea.

“Now I hear from people who were full of vim and vigor, who had plans for the future just two months ago, that they want to die.”

Checks. “Checks” is how people name portions of raw opium from which it is possible to extract heroin, if you add acetic anhydride to it.

“Checks” existed in the Crimea as far back as I can remember. It is a good reliable way to quickly recover from withdrawal syndrome. You could get “checks” quite easily at any time. But after the OST programs were closed, hundreds of drug users suddenly entered the market (more than 200 people just in Simferopol! ) and devastated all the opium reserves in the Crimea. Moreover, new anti-narcotic structures represented by the Russian police (all police officers came to the Crimea from the Russian cities – Perm, Kazan, Moscow, there are not any local representatives in police) and by Federal Service on Control of the Drug trafficking (FDCS) – the nightmare of the Russian drug users. The increase in number of “checks” users led to a decrease in its supply and importing from Ukraine became a big problem.

By hearsay, so as not to suddenly miss an opportunity to increase profits, dealers began to add foreign substances to their product, it could be harmless substances or hard shit like home-made methadone. New police forces and new circumstances around buying drugs has led to the situation where purchasing “checks” poses a big problem now.

Heroin. I often hear from people in the Crimea that there is lot of cheap heroin here now. But I couldn’t find even one person who saw or tried that heroin. So I can draw a conclusion that there is not and there was not any heroin in the Crimea.

Krokodil. I assure you that if it wasn’t for a deficiency of medical products in drugstores, including codeine-containing ones, “krokodil” would now be problem No. 1 in the Crimea. But every cloud has a silver lining.  People just can’t find the substance that you should use to make this poison, and that’s why krokodil isn’t present in the Crimean drug scene.

“Well, this is how it goes.”

Well, this is how it goes.

Now I hear from people who were full of vim and vigor, who had plans for the future just two months ago that they want to die. Former patients aren’t able to go to work because they suffer from never-ending withdrawal syndrome. Their families suffer as much as they do.

I am an optimist.  My glass is always half full. But I can’t see anything optimistic in the future of those from the last OST programme in Crimea.

Well, who knows, maybe I’m mistaken.

Written by Igor Kuzmenko

*ART: Anti Retroviral Therapy is a medical treatment for HIV/AIDS

 

All 4 parts in the Crimean OST series has been written by Igor Kuzmenko and here’s a massive public thank you to him for his really honest and personal insights into what it has been like for our peers in the region, and answering many of our questions too, I’m sure. The blogs were translated from Russian into English by the very professional Daria Mighty, and we are indebted to her speed and accuracy, thank you Daria! (The Russian version is available atENPUD)
If you want to find out more about the drug using community and its issues in the region of Eurasia, or you are living in that part of the world, check out INPUD’s sister organisation on their website ENPUD (The Eurasian Network of People who Use Drugs). You can become a member, read other blogs from Igor and others and find out the news and views on drug issues and politics.

Last Calls on Methadone, Russia’s in Charge

A  fascinating insight into what can happen to the drug using community after a  government is deposed and a region splits borders. Igor Kuzmenko, a member of Eurasian Network of People who Use Drugs, wrote this insightful article for sister organisation INPUD (International Network of People Who Use Drugs).

The recent events in Ukraine were watched by us all over the world. A president is deposed, and civil unrest spreads throughout the region. The Ukraine loses control of its western front in Crimea and by way of a rushed referendum supported by the people, has to hand the region back to Russia.  Military personal appear in the streets and laws change overnight. But what happens to the drug users? At INPUD, our members know very well that while the Ukraine recently started giving methadone and buprenorphine (mainly buprenorphine) to its users, Russia on the other hand, deems both drugs illegal and will not entertain OST (Opiate Substitution Therapy) for any reasons whatsoever. So, to the Crimean drug users who had once been lining up outside the methadone clinic, what was going to happen? Igor Kuzmenko was there and has written a series of blogs for us to give readers an insight into life after The Russian Referendum. 

Note: Igor Kuzmenko is an active member of INPUD’s sister organisation ENPUD, the Eurasian Network of People who Use Drugs / Click the link to find out about what is going on in the region (pages are translatable with Chrome) and if interested, if you can fill in their membership form.

 

RI.P. Crimean OST program, 2006  

By Igor Kuzmenko

Part 1 (of 4)   It just so happened that when that a life changing referendum was being held in March in the Crimea this year, the one which asked all Crimean citizens about whether our region should stay with the current government of Ukraine or return again to Russia, I was participating in the annual commission of Narcotic Drugs in Vienna.  This meant  I could only receive news from the Crimea via Skype or by phone. And the news was bad. For my own work as a social worker dispensing Opiate Substitution Treatment (OST),  it really was bad news; a sharp decrease in dosages was followed by panic among the patients and  low spirits of the medical personnel on the OST site. And then there was the strange armed people and large numbers of ‘unknown’ military equipment now appearing in the Crimea…

Igor Kuzmenko outside the Commission for Narcotic Drugs In Vienna this year. He would return to quite a different Crimea…

Igor Kuzmenko outside the Commission for Narcotic Drugs In Vienna this year. He would return to quite a different Crimea…

 

Almost nothing has changed in the Crimea on the surface. Except that instead of usual Ukrainian flags there are now Russian ones, and instead of traffic cops there are notorious “green little men” at the junctions. And at night you can sometimes hear the roar of military machines crossing the city.

 

“If, at the beginning buprenorphine was reduced by 2 mg a week, at the end of April and in May it was being reduced by 2 mg every other day. It was a very painful process.”

 

The OST site changed externally even less – the same people, the same fuss. But it was only externally. The fear started to grow. The doctors and nurses were afraid because legally, if the Crimea belongs to Russia and obeys Russian laws and they continue with methadone distribution on the site, they could be arrested for “distribution of drugs in especially large amounts performed in collusion by a group of people”. And you should agree, that’s no laughing matter.

OST clients were terrified because changes to prescriptions are always frightening. Their families were terrified too, because years of quiet living came to an end after the termination of OST.

Dosages decreased more and more. If, at the beginning buprenorphine was reduced by 2 mg a week, at the end of April and in May it was being reduced by 2 mg every other day. It was a very painful process. Of course, many patients tried to compensate for a lack drugs by using a large amount of barbiturates and those who could, also used street drugs. Thus the condition of patients constantly worsened: barbiturates helped to numb unpleasant feelings a little but not the pain, which was enfeebling you at the same time. I still remember people wandering about the site yard like ghosts, patients who had grown old in just a few days.

OST Patients walking away having consumed their last dose of methadone…

OST Patients walking away having consumed their last dose of methadone…

 

How OST Died

I want everyone to have a clear idea of how exactly OST died in the Crimea. There weren’t any documents issued by local authorities or from the Ukrainian or Russian side which could forbid, limit or in any other way have an effect on the situation with substitution therapy on the Crimean sites.

The reasons for the decrease in dosages were a limited quantity of pharmaceuticals in the Crimean warehouses and an impossibility to import methadone and buprenorphine from Ukraine to the Crimea.

It was difficult to import enough methadone and buprenorphine for a month into the Crimea even before the referendum because there wasn’t calm in Ukraine due to the Maiden* and, after March 16, all these difficulties were multiplied by the issues of state affiliation. We just weren’t allowed to import a new consignment of medicine. OST wasn’t banned in the Crimea, it was strangled.

 

“OST wasn’t banned in the Crimea, it was strangled”

 

OST wasn’t banned in the Crimea, it was strangled. Whose fault is this? It is difficult to tell. It seems to me that happiness of the patients wasn’t important for both sides. A patient on pills is a medical issue, and a suffering patient is political issue. We live in politically charged times and in my opinion, a political outcome was favorable to both parties: beneficial for Russia because methadone is not legal there, and Ukraine got its’ chance to once again confirm the inhumane actions of Russia.

 

In Simferopol there were rumours of drug users being severely beaten by ‘groups of sporty looking people’. However, Igor says; “There was the death of a patient in Simferopol that was for real during that period. He just didn’t have any energy left to live with a daily decreasing dose…”

 

In the meantime there were a lot of rumors spreading around. Rumors of absolutely fanatical methods of counter-drug operations by FDCS,  (The Federal Drug Control Service of the Russian Federation) such as shooting out the wheels of suspected cars. Rumors about groups of young sporty looking people who had recently appeared in Simferopol to attack drug addicts and beat them almost to death in places where it is possible to buy drugs. Rumors about  a shipload of heroin delivered to the Crimea from Russia. But there wasn’t any real confirmation of these rumors either.

But there was the death of a patient in Simferopol that was for real during that period. He just didn’t have any energy left to live with daily decreasing dose…. The fear of the future was for real too. And at the same time, there were high hopes. At that time very few people believed that OST, which everyone had gotten used to and without which nobody could imagine one’s life, would be banned and services closed all of the sudden.

The hope helps us to live.

Igor Kuzmenko

* Maiden: The name of the city Square in Kiev. It has been the site of many important protests including The Orange Revolution but for many months in 2014 it became the place where Euro-centric activists protested, camping out and fighting back against authorities. After bloody battles, people power reigned and the Ukrainian president fled into Russia. The protest gained the name The EuroMaiden Revolution.

 

RI.P. Crimean OST program, 2006

Part 2         Igor Kuzmenko

Around April, during the period of intensive decreases in methadone and buprenorphine doses, one of the patients approached me in the OST site in Simferopol. He was an adult man, slightly over 50 years old. He had multiple diagnoses, including  active form of tuberculosis (before the referendum he was admitted to the tuberculosis dispensary where he could get methadone, but after the referendum this opportunity didn’t exist anymore and he had to go the remaining OST site to get his methadone among healthy patients). He also suffered from Hepatitis C and HIV. He is an artist and looks like a true artist – he wears a raincoat and a long scarf. It was notable that he was extremely worried. Nervously taking a puff, he said:

“Igor, if sometimes you need my help, you can count on me. I have only one wish right now – to douse myself in gasoline and set myself on fire. If only it could do any good!”

Many of us didn’t want to sit back and do nothing. We organized a group. We didn’t set a task to change the political reality, obviously we were unable to do it, and we simply wanted to draw as much attention as possible to the stopping of the importation of OST medicine to the Crimea. So three of us paid a visit to the Ministry of Health of Ukraine, in Kiev.

 

The Opiate Substitution Programme In Simferopol closes its doors for the forseeable future…

The Opiate Substitution Programme In Simferopol closes its doors for the forseeable future…

 

Besides us, inhabitants of the Crimea, there was a large number of local activists and representatives of The Alliance Ukraine (an HIV/AIDS organisation) participating in a protest action. Unfortunately, we couldn’t meet the minister, but some officials from the civil service on HIV issues found a little bit of time for us.

…It became absolutely clear to me that there will be no importation of OST medicines to the Crimea at all.”

I must admit that after this meeting in the Ministry of Health, it became absolutely clear to me that there will be no importation of OST medicines to the Crimea at all. Nobody was interested in that..

 

No Discontent Allowed

 

Meanwhile in Simferopol in the Crimea, our people tried to make a protest action near the headquarters of the Crimean government. And there we ran into surprise: all of us had gotten used to our liberal Ukrainian system regarding protest actions and meetings. It was rather simple to inform the city authorities of the time and place of a meeting in Ukraine. But as it became clear, in Russia, (and now in Crimea)  it is impossible for more than two people to gather together to show any discontent. Therefore we had to drop any idea of setting a protest action in the center of Simferopol.

 

Almost nothing changed in Crimea on the surface…(pic: Sevestapol)

Almost nothing changed in Crimea on the surface…(pic: Sevestapol)

 

Parental support is also very effective in context of raising the profile of OST, not least for the reason that parents are not drug-dependent and the stigmatizing that is usual in such cases, doesn’t apply to them. Unfortunately however, we also failed to attract a lot of parents to our movement.

I have to admit that the OST patient community couldn’t find complete consensus either. Some of us considered the proximity of Russia as being a benefit, others rejoiced at the sudden opportunity to quit methadone, and someone didn’t care at all. Some patients even participated in the referendum and the self-defense groups (groups which promoted pro-Russian forces in the Crimea). Nevertheless the majority of us wanted the same: at the maximum – the resumption of Opiate Substitution Treatment, and at the minimum – importation of a monthly stock of methadone and buprenorphine.

I am very grateful to the medical personnel of OST sites in the Crimea. Not their chiefs but the ordinary physicians and nurses. All of them are courageous people. Just think of it: according to Russian laws every day they went to work to give out methadone to the patients, they were making criminal acts. Acts that can be characterized as “distribution of drugs in especially large amounts performed in collusion by a group of people“. It was a very courageous especially as all of them without exception knew perfectly well how it could turn out for them.

And there were some things and some people to be afraid of. Both the administration and numerous “guests” put unbearable pressure on them. But I will tell you about that and many other things next time…

Stay tuned for part 3 and 4 in Igor Kuzmenko’s personal story of his community after Crimea becomes Russian again, first posted at INPUD’s International Diaries or read it all in Russian at ENPUD

Norway’s’ Drug Users’ Inject Some Common Sense into Parliament!

Norway’s Drug User’s Day has been arranged every year on November 18 but this year it seemed quite special. Arranged by Arild Knutsen and his companions in The Association for Humane Drug Policies to raise awareness about the issues facing people who use drugs in Norway, this year would see a contingent of passionate drug user activists face their country’s politicians across the table in Parliament – offering opinions and answering questions – all upon invitation by the current Labour Government.

The film shows how drug users in Norway effectively banded together to ask their government to implement heroin prescribing for many of its country’s  10,000  users.

Fully subtitled, the film follows a large group of Norway’s drug users as they put their thoughts and views across to their country’s politicians in an articulate, direct and heartfelt way way, asking simply for the considered implementation of more progressive drug policies that would permit many  the chance to live a more dignified life; for is that not their right like any other?

They ask why, when the results from heroin prescribing in neighboring Denmark is so encouraging as to now be expanded, can’t Norway consider a heroin (diamorphine) trial or programme? Why, when more and more European countries continue to collate positive and encouraging data on the outcomes from heroin prescribing clinics does Norway continue to hold back a tool that could provide so many heroin users with stability, dignity, and well being?

Quoted here, Arild Knutsen  Norway’s Association for Humane Drug Policies (fabulous name!) gives a short introduction to their film (edited)…”There’s around 10,000 injecting drug users in Norway and we want more harm reduction measures for them. Stop the criminalization of drug users! We also want the politicians to try implementing heroin assisted rehabilitation, like Denmark, The Netherlands and Switzerland (among others) have successfully done.”

He continues to describe the film…”Drug users are rallying to be treated with dignity. The group is invited in to The Parliament. This year by The Labour Party. There, drug users’ show the short movie: “Magnus, a Spring Day” which is heroin user Magnus Lilleberg documenting his life, through Munin Films.  Magnus, an Academy Award winner and heroin user, screened his short documentary for politicians in the Norwegian Parliament. Like many others, he tells how Methadone and Subutex haven’t worked for him and he asks the politicians to implement heroin assisted treatment.”

“Then Winnie Jørgensen (Drug User Union, Denmark) appears on a Skype Feed, answering questions about her life now that she gets heroin legally in Copenhagen.”

Amongst others in this film were: Geir Hjelmerud, Torstein Bjordal, Line Huldra Pedersen and Arild Knutsen from The Association for Humane Drug Policies. http://www.fhn.no

facebook.com/pages/Foreningen-for-human-­narkotikapolitikk

Ronnie Bjørnestad from proLAR and Borge Andersen are also profiled as fighting for drug users rights.
A film by Chistoffer Næss and Per Kristian Lomsdalen, Munin Film.

John Cale talks about the heroin scene in Wales

An interesting programme from the former Velvet Underground bassist/viola player, John Cale takes a searching inventory of the treatment drug users experience in Wales. Of particular interest are the massive discrepancies in service availability/accessibility between North Wales and urban South Wales. Mr Cale handles the subject compassionately, probably stemming from his own difficulties with overcoming opiate dependence. This is definitely worth a look for an honest and sobering update on the drug and treatment situation in Wales, which we -in the rest of Britain -rarely hear much about.

http://youtu.be/SbIDJ7lNHik

%d bloggers like this: