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

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

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

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

Forced Treatment for Brazil Crack Addicts

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

By Lucy Jordan, Senior Contributing Reporter

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

END

 

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

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

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

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

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

 

 

 

 

RECOVERING FROM RECOVERY RANT

…Help, someone, anyone, gimme something to get that taste out of my mouth!

I’ve just been mooching around the British recovery policy arrow . That all want us to RECOVER. They all want us to hurry along off that awful substitute drug methadone or whatever dulls your senses, and step into real life, the good life, the real shiny happy coloured world.

I’m seeing David Cameron, sitting there in his living room, talking intensly about ‘how to deal with this country’s drug problem’ about how Labour just left us all sitting on methadone by a policy drafted and financially driven ‘bums on clinic seats’ kinda approach (amongst other things).

In a way, it worked. EVERYONE got a ‘script. EVERYONE who went near heroin got a methadone or Suboxone (in fashion pharmaceutically with the Gov these days) prescription and got off the crazy merry go round of hunting for dope 24-7.

But I could go on and on about what I thought of the last governments policies and where we went wrong and right – and we definitely did – for the first time ever – make some right decisions with the drug users welfare in mind -and occasionally involved in that as well! Movement!

But my RANT for today……

I am soooooo sick of the way we are supposed to go to ‘health professionals’ for ‘recovery’. More money thrown at them (for us you understand).

They pull out their research statistics -most of which are dubious (we could tell you that if we were ar these meetings or were there designing the research with you).

RECOVERY has become religious. Like a light we have to follow to ‘come and accept the truth and waljk through the recovery door into the light…..’

STOP! WE are making a mistake! support us if you must -but support us to be a community – to support each other, to decide for ourselves what kinda warm and fuzzy workshops we want to attend on the way to our new life….I mean please! We are all individuals. WE need what everyone needs to make it;

We need a purpose.

We need love and support

We need community, family, bridges healed, bridges left behind.

We need to be able to deal with anxiety, pressure, deadlines, responsibility without always using drugs. Sometimes it might be appropriate but we need to know when that is and when that isnt. A joint in bed after a mental nites work -what the fuck is wrong with that?

We need to feel like we are contributing to something useful, that we are giving something useful to our community. We need to focus on these things – not be held up like a ‘recovery champion’.

Its embarrassing, its patronising, it is demeaning; it makes the service feel good. Especcially when they have their big ‘event day’.

‘Here we are, look commissioner, look at our guy/girl -and hear their story of where they have come from (the gutter of course) to how, with the help of their drug service, they are a new person, they have their lives back and even their children. We all well up, stuff a chip in our mouths, drink the free wine (oops, no alcohol at these kind of events), network, and everyone feels good and wants to know how they too can replicate this service.

Why dont we ever learn? Why dont we acknowledge those who really need some serious support, practical and emotional and help them to help themselves. Support them to support each other. Peer support works well — but not run like a church with a bloody door and light at the end of the tunnel and youve never really made until you get there. drug free.

Im so sick of it all. And now london is haveing the biggest ‘RECOVERY EVENT’ in the world in January????!!! Please god!

The Meaning of Recovery Has Changed, You Just Don’t Know It | Psychology Today

Stanton Peele writes refreshingly once again in Psychology Today this month, about a remarkable development from SAMHSA (Substance Abuse and Mental Health Services Administration), in the States. This government agency is charged with “formulating drug and alcohol abuse treatment policy, [and] after surveying the leading specialists in the mainstream of the field, has created “Recovery Defined— A Unified Working Definition and Set of Principles.”” Peele goes on to enjoy the fact that SAMHSA actually ends up at his view of recovery — not AA’s and the 12 Steppers– as “A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.”

Quoting the article “The definition [of recovery] is the product of a year-long effort by SAMHSA and a wide range of partners in the behavioral health care community and other fields to develop a working definition of recovery that captures the essential, common experiences of those recovering from mental disorders and substance use disorders, along with major guiding principles that support the recovery definition”

Please do click the link at the bottom of this blogs section to find the article in its entirety, but just to summarise things here -and I have to add, I feel this is a very well good definition of recovery and alludes to what many of us have been saying for a long time. That it benefits to shift the focus off drug use per say and embrace the fact that it is about positive, meaningful change, wherever that may take you and whatever that may look like.

But back to the SAHMSA definition – Here is the resulting formulation:

Working Definition of Recovery

Recovery is a process of change whereby individuals work to improve their own health and wellness and to live a meaningful life in a community of their choice while striving to achieve their full potential.

Principles of Recovery

Person-driven;
Occurs via many pathways;
Is holistic;
Is supported by peers;
Is supported through relationships;
Is culturally-based and influenced;
Is supported by addressing trauma;
Involves individual, family, and community strengths and responsibility;
Is based on respect; and
Emerges from hope.

Furthermore SAMHSA’s Recovery Support Initiative identifies four major domains that support recovery:

Health: overcoming or managing one’s disease(s) as well as living in a physically and emotionally healthy way;
Home: a stable and safe place to live that supports recovery;
Purpose: meaningful daily activities, such as a job, school, volunteerism, family caretaking, or creative endeavors, and the independence, income and resources to participate in society; and
Community: relationships and social networks that provide support, friendship, love, and hope.

Click below for the rest of the article and hear more from Stanton’s engaging summary.

The Meaning of Recovery Has Changed, You Just Don’t Know It | Psychology Today.

Different perspectives on the Political Declaration on HIVAIDS 2011

Estimated number of people in the world living...

Numbers of people living with HIV in 2008

New York’s user led Harm Reduction Coalition runs a weekly podcast on a range of interesting subjects and during the High Level Meeting in HIV/AIDs that occurred in New York early June, Allan interviews several people (including myself) and gains a few different perspectives on just how people felt about the declaration and their input into it. Over to you Allan (text taken from the HRC podcast website)

High Level Meeting on AIDS: A report back from New York. A new Political Declaration emerged from the recent United Nations High Level Meeting on AIDS. This week’s podcast features interviews with participants in the meeting – Erin O’Mara from the International Network of People Who Use Drugs, Pablo Cymerman of Intercambios and Rick Lines from Harm Reduction International. The final Political Declaration is available here
Click here for the Podcast – no 33 

(The Harm Reduction Coalition has an excellent website, highly recommended and with good activist roots and the organisation is a definate contact point for any person who uses drugs when looking for drug related support in New York)

A young Russian and a message you can’t forget.

The Red ribbon is a symbol for solidarity with...

Russia’s Aleksey Kurmanaevskiy speech delivered at the UN High Level Meeting on HIV and AIDS in New York – June 9 2011 by INPUD on Thursday, 09 June 2011 at 18:33:

INPUD is a global peer-based organisation that seeks to promote the health and defend the rights of people who use drugs. We will expose and challenge stigma, discrimination and the criminalisation of people who use drugs and its impact on our community’s health and rights. We will achieve this through processes of empowerment and international advocacy. Find us at: http://www.inpud.net, Facebook/INPUD, Twitter/INPUD. Blog at: http://www.inpud.wordpress.comThe following speech was delivered by Aleksey Kurmanaevskiy at A dialogue on HIV and Human Rights at: Universal Access for Key Affected Populations. This event was hosted by the United Kingdom and the Republic of South Africa together with the International HIV/AIDS Alliance and the International Federation of the Red Cross and Red Crescent Societies. This session took place at the High Level Meeting on HIV and AIDS at the United Nations in New York City.

Aleksey is from Russia and is 30 years old. He has been dependent on drugs for 15 years, and has been living with HIV for 11 years. He is a member of the International Network of People who Use Drugs (INPUD) and will speak with you today for people who inject drugs, those who are living with HIV\AIDS, and for the members of the drug using community who are no longer with us because of HIV\AIDS, Tuberculosis, Hepatitis, and drug Overdoses.

Text of Aleksey’s speech:

Q1 – Highlight key challenge or obstacle & successful action or approach:

I would like to call to attention the laws and practices that are based on the criminalization of people who use drugs and the consequences of these measures. In our opinion, the practice of imprisoning people who use drugs in order to deny them their freedom or subjecting them to coerced treatment for the personal use of drugs should be ended. Imprisonment and coerced treatment are clear breaches of human rights that undermine the public health of people who use drugs and the wider community.

The criminalisation of people who use drugs and the widespread stigma and discrimination against our community results in people hiding and living in fear and secrecy. This can cut people off from family support and drives people further into problem drug use. As such, punitive laws can dramatically reduce the effectiveness of HIV prevention strategies with my community and undermine access to and retention in services. As a result, punitive laws are costly and ineffective.

The introduction of science-based harm reduction interventions like needle and syringe programmes, opioid substitution therapy (OST), and overdose management programmes is saving the lives of my community in many countries in the world. We have the experience, the evidence and tools to end concentrated epidemics of HIV among people who inject drugs. 30 years of evidence demonstrates that OST radically improves the health and wellbeing of people who take drugs and supports our engagement in HIV and TB treatment. Significantly OST gives people who are dependent on heroin and other opiate drugs an alternative to crime and allows us to fully participate in and contribute to society. History has shown that when people who use drugs are involved in the design, development and delivery of HIV prevention interventions, the reach is greater, the quality is higher and there is better value for money.

Q2 – 1 or 2 key recommendations to HLM on practical way forward:

I am a husband and father of two sons and very much want peace and mutual understanding within my family. I learned that it is absolutely critical to listen to my loved ones. Before agreeing on a solution, we consider all of the possible alternatives. The very welfare of our family depends upon this process of open dialogue.

I have drawn this analogy deliberately. The family can be viewed as a microcosm of society. We are all members of one global family. Though we all have unique worldviews, customs, and ways of life, there is no doubt that we have to deal with the HIV epidemic together. The foundation of such mutual understanding through dialogue is the first step in this process.

Around the world people who inject drugs are giving sterile injecting equipment to their friends, are sharing education and knowledge and supporting service access. At a global and regional level drug user organisations are supporting consultation and contributing to policy development. At a country level we can provide a community watch dog function helping donors to spend money wisely and programmers to deliver services effectively.

Our challenge to all countries is meaningfully involve people who use drugs in the design, implementation and monitoring of the HIV response. If you are serious about engaging us as true partners then this has include the resourcing of our organisations and the meaningful participation of our representatives. This is key to reversing the trajectory of the HIV epidemic and bringing under control the spiraling costs of HIV. It is time to stop framing my community always as the problem and instead to recognise that we are a key part of the solution to HIV.

Naltrexone

Advertisement for curing morphine addictions f...

There's been a lot of 'cures' advertised over the years...

(Updated in 2011 from an article in BP issue 2)

There has been quite a lot of developments in the uses for naltrexone, not just in the UK but around the world -and it is clearly not just a single treatment option. There are various ways of using naltrexone – and this update, taken from issue 2 and added too, looks at Naltrexone’s origins, its uses and its future.

What is Naltrexone and How Does it Work?

For heroin, (and other opiates such as methadone, morphine, palfium, codeine etc), to produce their effects – and get you stoned – they need to be able to attach themselves to small areas in the brain and nervous system called receptor sites. Naltrexone not only blocks these receptor sites, which prevents any opiates from working, but also displaces or removes any existing opiates that currently occupy those sites. Such drugs are called ‘opiate antagonists’ – they antagonise (to put it mildly!) any opiate. This means that if you take naltrexone when you have an opiate ‘habit’, you will find yourself withdrawing quickly and intensely as the opiates are rapidly (rather than slowly) removed from your receptor sites, and your body reacts to their absence. However, if you’ve already detoxed, taking naltrexone may help keep you abstinent as using heroin simply will not work. Naltrexone is sometimes referred to as a ‘non-drug’ because it doesn’t really have any effect other than blocking the effects of opiates. Naltrexone is long lasting – from 24 to 72 hours depending on the dose, and it comes as a tablet, or as an implant. It is closely related- but not the same – as Naloxone (or Narcan), the ‘pure’ opiate antagonist which doctors use for opiate overdoses; but naloxone only works when injected and lasts for only a short time – less than an hour, which is why people need to be monitored and can ‘fall back’ into overdose.

To read the rest of what is an interesting insight into Naltrexone, click here.

Methadone – The History of Juice

Chemical structure of methadone.

Methadone's chemical structure

The Methadone Myths…

Methadone was first synthesised in Germany in 1938 by chemists working for IG Farbenindustrie. There are several widely-circulated stories about the birth of methadone which are of doubtful veracity. It is often said, for example, that the new pharmaceutical was dubbed Dolophine in honour of Adolf Hitler. In fact, it was originally tagged with the unimaginative name of Hochst-10820 (Hochst being the name of the factory where it was invented), and later named Palamidon. Another widely-circulated story has it that the chemical was synthesised for use as an analgesic, eliminating Nazi Germany’s dependence on Turkish opium for morphine, or that it was created on the personal orders of Reich Marshal and Luftwaffe commander Hermann Goering, a heroin addict, to ensure that cold turkey could be kept at bay if supplies of morphine were cut off. Attractive as this last story is, and while it is true that Goering was a junkie, it is probably apocryphal.

Methadone was not brought into wide production during the war at all, and its properties were only studied later. After the war the Hochst factory fell into American hands and as a part of the wholesale plundering of German scientific and technical knowledge (which saw V2 rocket technology and Nazi advanced weapons and intelligence expertise appropriated by the US military-scientific establishment under Operation Paperclip) the methadone molecule too, ended up as loot of war.

More Than Morphine?

It was the American pharmaceutical company Eli-Lilly who began the first clinical trials in 1947 and it was here that it was first christened Dolophine, probably derived from “douleur” and “fin”, the French words for, respectively, “pain” and “end”. The chemical was found to have a similar pharmacological action to morphine, despite its very different chemical structure, and it was much longer-acting. Once these facts were established, methadone disappeared into obscurity in the USA for over a decade. While its chemical cousin pethidine – which, incidentally, was produced in bulk in Nazi Germany as a morphine substitute -and is still used today to ease women’s labour pains, methadone never really caught on as a narcotic analgesic in America.

The earliest accounts of methadone use in the UK are from 1947, when a paper published in the medical journal Lancet described it as “at least as powerful as morphine, and ten times more powerful than pethidine”.

Methadone Treatment

By the end of 1968, the year when the Home Office notification/registration system of addicts was introduced, 297 people had been notified as being addicted to methadone. Doctors who thought it less addictive than other opiates had begun prescribing them the drug however, through the 1960s, patterns of drug use were changing; Opiate addiction, which had until then, primarily been an indulgence of the wealthy (or medical professionals themselves), was now being picked up by younger people, taking opiates for pleasure rather than for pain.

1968 also saw the introduction of drug treatment clinics and the abolition of free prescribing. The clinic system effectively removed the GP’s discretion in the prescribing of controlled drugs and specialist centres took over the treatment of the majority of dependent drug users, a practice that continues today. In the first years of the clinics, doctors freely prescribed pure pharmaceutical heroin and methadone in injectable form for addicts. The introduction in the mid 70s of smokable Middle Eastern brown heroin resulted in many users arriving for treatment not expecting to inject their drugs, encouraging the clinics to move towards using oral methadone for treatment.

Methadone Maintenance – The Minimum Vs the Maximum

Methadone maintenance treatment, as we recognise it now, was pioneered in the USA in the early 60s. In 1963, two New York doctors by the names of Marie Nyswander and Vincent Dole began exploring methadone as a possible treatment for opiate addiction. There was a screaming need for it – by the end of the decade, heroin-related mortality had become the leading cause of death in New York for young adults aged between 15 and 35. Dole and Nyswander identified the features of methadone that made it a suitable maintenance drug. At doses beginning at 80mg per day, it effectively blocks the euphoric effects of all opiate drugs. Patients stabilised on methadone do not experience euphoric effects and tolerance does not develop like many other opiates, necessitating ever-increasing doses. Tolerance to methadone’s pain-killing effects does develop however, meaning patients experience pain normally although trying to explain this to a nurse or doctor when you’re in A & E is another matter entirely. As it is a long-acting drug, it can be administered once a day, enabling a greater level of stabilisation as compared to shorter-acting opiates.

Nyswander and Dole operated on the premise that heroin addiction is in effect a metabolic disorder, comparable perhaps to diabetes. Large doses of methadone – 80 to 150mg – were used to normalise the disorder, as insulin is used for diabetes. They combined this theory of treatment with efforts at psychological counselling and social rehabilitation, including help and encouragement in finding work. Many of their patients benefited greatly from the treatment and were successfully re-integrated into “normal society”, such as it is. The use of the treatment spread, but was not necessarily implemented with the innovation displayed in the work of Nyswander and Dole. For example, more than half of the USA’s 120,000 methadone patients today are treated with dosages well below those recommended by their research.

To read the rest of this article and find out about methadone’s pros and cons and the trials of treatment, click here.

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