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.

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.

Constipation (Drug/Diet Induced)

Stomach colon rectum diagram.

Image via Wikipedia

The longer lasting Life Of A Constipated Tom Tit – What Can You Do About Drug/Diet Induced Constipation

It’s a scary feeling…….That large plate of spaghetti bolognese from 5 days ago is swimming around in your bowels, fighting for space alongside 7 bowls of cornflakes, a packet of custard creams, 60 vinegar-soaked chips, 2 cheeseburgers, various chocolate bars and a massive Indian curry. Your stomach’s swelling by the hour and you feel like you’re just about to give birth-but you’ve swallowed 5 laxatives and plugged in a suppository and still nothing. What do you do?

Those of us who have taken a bite out of the ‘drug misuse’ apple know that it doesn’t always come out at the other end in a quiet or comfortable fashion. Some heavy users can go 2-3 even 4 weeks without a trip to the loo and if you’re a working girl (or boy) having sex with a chock-a-block bowel can be most unpleasant. We’ve all heard of the advice, ‘fresh air, plenty of exercise and lots of fresh fruit an’ veg’. Well you might get the exercise running around chasing your gear (- it’s still exercise), but the fresh air – fruit an’ veg stuff isn’t always so easy and besides, a big enough smack or methadone habit can constipate the healthiest person.

Prevention really is the best cure, particularly for those who are susceptible to bowel troubles. Using the odd laxative or suppository is okay, just don’t go mad doing it. Using them over a long period of time is seriously bad news, eventually your sewage system will pack up altogether. It helps to know a bit about your bodily functions in order for it to receive the right attention. (There are no particularly palatable words for faeces, shit, excreta, pooh, stools, waste, pony, tom tit etc so we will mix and match, okay? )

The Journey Traveled…..

When your food reaches its final stage of digestion in the small intestine, it has become a thick, watery liquid. It is moved along its way by the continuous contraction and relaxation of the intestinal muscles (peristalsis). The surrounding large intestine or colon absorbs this liquid into its walls, feeding blood vessels and maintaining peristalsis. Whatever waste remains will then become your shit. For various reasons, the drugs we take, stress, vitamin and mineral deficiencies, the intestinal muscles slow down and bacteria from the waste gets absorbed into the bloodstream leaving your system toxic.

The degree of firmness of your faeces depends on its length of time passing though the gut – the longer the journey, the more water is absorbed back into the bloodstream, leaving your stools dried out. You end up which a pooh that takes longer to move along its passage – becoming constipating. (Charming!!)

The more sluggish the gut, the firmer the stools. Headaches, oily skin and hair, bloating and congestion of the nose, throat and lungs result as well as dried out stools. Methadone user’s will know all about dried up, sheep style pooh! Although constipation may be considered trivial, each year around one tenth of the population of the UK take laxatives regularly with over 7 million visiting their GPs.

Tried and Tested Tips (for moving that tom tit!)

When your food reaches its final stage of digestion in the small intestine, it has become a thick, watery liquid. It is moved along its way by the continuous contraction and relaxation of the intestinal muscles (peristalsis). The surrounding large intestine or colon absorbs this liquid into its walls, feeding blood vessels and maintaining peristalsis. Whatever waste remains will then become your shit. For various reasons, the drugs we take, stress, vitamin and mineral deficiencies, the intestinal muscles slow down and bacteria from the waste gets absorbed into the bloodstream leaving your system toxic.

To read the rest of this article which appeared in Black Poppy,Magazine, click here.

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