Archive for May, 2013

The War on Drugs versus livers

Thursday, May 30th, 2013

Kofi Annan has been reading my blog again. Last week I again raised my concerns about the spread of Hepatitis C, and this week he and his Global Commission on Drugs Policy have concluded that current drugs policy has resulted in a Hep C pandemic. I’m impressed he managed to pull a paper together so quickly – but then he’s probably been a follower of mine for a while if his opinions on the futility on the War on Drugs are anything to go by.

He and his posse of world leaders have this week published a report stating that current drugs policy is “repressive” and “ineffective”. Claiming that, by treating drug use as a criminal justice issue instead of a health issue, governments are breaching human rights and putting their communities at unnecessary risk, their argument about the spread of Hep C is conclusive and damning.

The report claims that those countries with the harshest drug policies, including the USA, provide the biggest deterrent to accessing health services which would reduce the chance of contracting the virus. This has led the commission to conclude that “The war on drugs is a war on common sense”.

There are some positives though (and not just the Hep C type), with Scotland being hailed as a model of good practice. Having learned about blood-bourne virus (BBV) transmission the hard way with the HIV outbreak of the 80s, Scotland’s Hepatitis C Action Plan has succeeded in reducing the numbers of those infected, both by increasing preventative measures, such as hugely increasing access to clean injecting equipment to reduce new infections, and by improving access to treatment for those who already have the virus.

The biggest win, for me, is Scotland’s eight-fold increase in Hep C treatment in prisons. Working with the War on Drugs policies, rather than against them, this idea uses the revolving door of incarceration as an intervention opportunity. Whereas, in England, it’s still nigh on impossible to even get liver function tests done for someone in prison (to enable quicker prescribing of an opiate blocker to encourage no ongoing use on release – common bloody sense, but seemingly too much trouble for prison healthcare teams, whose responsibilities end the second the individual walks out of their door), Scotland are now offering full Hep C treatment in prisons.

This is refreshing – treatment services in England are notoriously out-dated and a nightmare to negotiate. I have taken clients to appointment after appointment at hospitals, only to be told that six months drug-free is not a long enough period of stability to ensure treatment success and reduce risk of reinfection (“because drug addiction is a relapsing condition” – thanks for the positivity, guys), or that reducing alcohol use from nine cans of Special Brew a day to two cans of Carling is still not enough of a reduction in consumption. There is no evidence-base to support their criteria – in fact some Hep C services go and dish out treatment on the streets to current drinkers and injectors – but the liver specialists in big hospitals do not particularly relish being forced into changing their treatment population. They’d much rather work with people with hereditary liver conditions, or even drinkers, than IV drug users, and they gate-keep their services accordingly.

Because of the potential and significant mental health impacts of the intense treatment, reported low mood is another classic reason for being deemed ‘not appropriate for treatment’. This seems to miss that point that, for someone whose existence is miserable, repetitive and cut-throat, and who may not have anywhere to live or food in their belly, low mood is kind of a must-have. So no drug or alcohol use, never feeling down, and a stable living environment – it makes you wonder who amongst us would actually qualify for Hep C treatment. (I would fail on all counts.)

But if this public health disaster isn’t bad enough, there is a hidden population who do not seek testing or treatment, because they perceive their injecting behaviour to be healthy. Steroid users are increasing in numbers, with little or no access to safer injecting information or blood-bourne virus prevention advice. I have heard many reports of one needle being passed around four or five men in a gym toilet, meaning a high risk for all of BBV infection and bacterial infection. And given that drug users generally spend their time working out and bulking up whilst in prison – and Hep C rates amongst IV drug users are estimated at 80% in the county I work in – it doesn’t bode well for the beefcakes, who may not know that the healthy-looking, fake-tanned meathead in front of them was once a pale, scrawny smackhead.

Whilst working in a busy city-centre needle exchange several years ago, one canny gym owner used to come and get boxes of needles to distribute to his customers. Most gym owners aren’t so conscientious – they will happily sell steroids to their members, but these come without injecting advice or equipment. One gym owner in the whole of one of the biggest cities in the country. That’s a whole lot of new livers required in twenty years’ time – for those whose hearts last that long.

Anyway, for the rest of you, some quick advice – don’t share toothbrushes or razors, and use a clean piece of paper or a straw each instead of sharing a grimy twenty pound note when you’re banging cocaine up your noses in pub toilets. Hep C can be transmitted by a single invisible drop of blood, and, unlike HIV, can live outside the body for up to four weeks. It’s a feisty little beast. And livers are quite handy.

Also here’s a shout-out to the big man, KA, and all his homeboys and girls. Good work on the report, guys, and let me know if you want me to join your little commission thing – and in the meantime, peace.

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Austerity gives it Greek-style

Tuesday, May 21st, 2013

As most, I fear the fate of our beloved NHS under the Shithead Coalition. I have previously suggested that current Government policy (punish the poor for the mistakes of the minted) may well be leaving the door wide open to another heroin epidemic, and we already see the country flooded with novel psychoactive substances such as MCat. Well it seems that the nightmarish repeat of the 80s unravelling before our eyes in Britain is already taking place in Greece.

A new ‘cocaine of the poor’ is sweeping the poverty-stricken country. At €2 a hit, and reportedly a variant of crystal meth, ‘shisha’ sounds likely to me to be MCat by another name. Similarly, it brings aggression, violence, mental health problems, and burns users from the inside out. And as with MCat, it is cheap, easily accessible, and currently has ripe pickings of the desperate poor.

And who can blame people for wanting some escapism. With Greek youth unemployment apparently at 64% and a total of 400,000 families without any income at all (not to mention those who have jobs but aren’t getting paid, or are earning so little that they are unable to sustain their families), it is no surprise that suicides have increased by over 60%. Prostitution and homelessness have also massively increased – and I don’t know about you, but if I was reduced to living a brutal life on the streets, I think I’d prefer to be the nutter than the nutted, battered than the battered. Shisha use could be seen as a strategic line of defence.

In terms of the back-drop to the growing drug problem in Greece, I have been dipping in and out of an amazing blog (a really excellent example of why the Internet and its self-publishing is a wonderful thing) which challenges pretty much everything written in the mainstream media, and uncovers some fairly scary truths about the state of the world and those running it. The author, John Ward, writes about the ‘Troika’ – European Commission, International Monetary Fund, and European Central Bank – crippling Greece’s economy by forcing austerity measures. His comparisons between the Troika’s policies and those of the Fascists during the Second World War are genuinely frightening. John has exposed the corruption within the capitalist structures of Europe, and warns that, as in the past, ‘austerity’ can be a label given to international looting by those in power. And last time round, he says, when the Nazis stole Greek resources as part of ‘German reconstruction costs’, 40,000 Greeks starved to death.

So what does this mean for the Greek people now, and are there lessons we can learn? A new book, as reported in the Guardian this week, looks specifically at the health impact of austerity measures, and brings the tag line “Recessions can hurt, but austerity kills”. Strong words – but they are backed up with hard facts by this Yale, Oxford and Cambridge-educated expert in health economics, David Stuckler, who says that Greece is facing a public health disaster. With a reduction to the health budget of 40%, he quotes the Greek health minister, “These aren’t cuts with a scalpel, they’re cuts with a butcher’s knife”. And the cuts weren’t made under the guidance of the medical profession but by the financially-motivated Troika. They are not even representative of financial requirements being met by other countries, but are in fact much harsher than the cuts being imposed in other areas of Europe. It seems that John Ward’s shocking comparisons may be more accurate than is comfortable to acknowledge – and that the concepts of public health and indeed humanity appear to have been lost in a calculated move for money and power.

And the results for Greek health provision so far? Hospitals without surgical gloves, pharmacies without necessary medication, and seriously diminished resources to support the ever-increasing population of substance users. Stuckler has spoken to drug services in Athens to see how close they are to meeting World Health Organisation guidance that 200 clean needles should be made available for each IV drug user every year – and the current availability per person is 3. No wonder then that cases of HIV have shown a 200% increase (which is probably a conservative estimate given that testing is no doubt harder to access, and will not be helped by the increasingly desperate prostitution trade), and I dread to think of the rates of hepatitis C, venous damage and bacterial infections as people continue to use drugs without access to harm reduction advice and clean equipment.

As Professor Stuckler points out using multiple examples from history, destroying welfare, healthcare and employment programmes is never a positive move for the economy, aside from the human cost. A country that fails to invest in its people has not the strength to recover – very much like a person, there needs to be belief, hope and investment for recovery to take place. And if austerity was a treatment programme being clinically trialled, “It would have been discontinued” says Stuckler. “The evidence of its deadly side-effects – of the profound effects on economic choices on health – is overwhelming”.

So, just to bring it back home.. Cuts to public services: check. Increase in unemployment: check. Money being taken from the poor and disabled to pay for the rich: check. Increase of depression presentations (especially in the north of England where unemployment is highest and suicide is on the rise): check. Easy access to dangerous, damaging new drugs and a bumper opium crop due in from Afghanistan: check. Right then, we’re all set! Addiction is the new black, I’d get taxing the stuff if I were you, David.

Addiction is sooooo passé, darling

Thursday, May 9th, 2013

Two substantial pieces of research have recently considered people’s perceptions about drug use and how this might influence their choices. Unlike the usual, predictable drugs research, these consider two pretty interesting variables – pleasure and social class.

The first, carried out in Australia, used some fairly complex formulas to grade respondents’ socio-economic status (I’d imagine things like ‘How many kangaroos do you own?’, ‘How big is your beer fridge?’, ‘What do you throw on your barbie?’), and then correlated this with their opinions about which substances they associated with drug problems. The results were compiled into this rather lovely diagram (apologies to email subscribers if this doesn’t come through as intended, it’s worth having a look on my actual blog by clicking on the link at the bottom):

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As you can (hopefully) see, heroin, considered more of a problem by those further up the social ladder, has become less of a perceived problem over the last few years. Conversely, and unsurprisingly given the massive ‘P’ problem in Australia, methamphetamine has become more of a concern over the years, regardless of social class – although wierdly is still less of a worry than heroin. Concern around cannabis use seems bizarrely high, but has remained fairly stable over the whole research period, and those in higher social classes feel cannabis is significantly less problematic than those further down the scale. And alcohol and tobacco, the substances most associated with addiction and serious health problems, seem to be seen as largely unproblematic by the people questioned. But then they are Australian.

I’d love to see this piece of research replicated in Britain. I think the boundaries of socio-economic status would be more blurred here, with our very old and complex social structures, but I think we could all help the process by thinking of some potential questions: Staffie, rescue mongrel, or labrador? Aldi, Tesco, or Waitrose? Jeremy Kyle, Jeremy Clarkson or Jeremy Vine?

The second piece of research is grandly titled The Global Drugs Survey – although it’s UK data was collected from readers of Mixmag and The Guardian, so The White Middle Class Survey might have been more accurate. However, the concept was novel – using an (unvalidated) scale called the Net Pleasure Index, it looked at positive and negative experiences of each substance and how they impacted on an individual’s ability to function.

Mephedrone and ‘unknown white powders’ caused the most concern in terms of after-effects, with psychadelics and ecstacy coming out the most pleasurable overall. Those who had been caught in possession of small amounts of illicit substances had a good chance of not facing criminal charges. The role of Silk Road in shifting drug purchase trends was acknowledged.

Old Nuttbag got involved, of course, to point out that alcohol and tobacco were perceived as the most problematic by respondents. Banging the pro-drugs drum with his headline ‘The real driver behind most drug use is pleasure, not dependence’, he seemed to be missing the point that sample was biased, being a cohort of reportedly happy, healthy, educated and employed Mixmag and Guardian readers. Obviously most of them are still able to work and function, otherwise they wouldn’t be buying publications about spending all your money having fun, either wearing designer garns and sunglasses in a warehouse at midnight, or carbon-neutral eco-camping in France. And clearly, therefore, their experiences of drug use are bound to be more positive than if they had asked the same questions at a Jobcentre or a needle exchange – where the focus might have been less “hey life’s great, I’m financially stable, confident, and fulfilled in my working week, so drugs are about weekend pleasure” and more “I am dragging myself through yet another degrading fucking groundhog day and cannot wait to smash something into to me to block out the banality and misery of my own existence”.

Or had the research population been Sun readers, I would imagine the results would have been skewed somewhat differently. But then the questions might have been a bit too hard for them to understand. And it’s difficult to find time to do surveys when you’ve got to sign on, get the transit ready for the scrap run, sign bail and make it in time for Wetherspoon’s happy hour (every hour’s a happy hour at Wetherspoon’s).

So there we go – my conclusion is that both pieces of research told us more about socio-economic status than they did anything else, and that in fact problematic drug using behaviours may well be symptomatic of poverty, poor education and lack of aspiration. And if you’re white and middle-class, you will probably get off a possession charge without so much as a caution. Ground-breaking stuff.

Heroin for the poor, cannabis for the sick, and the death of an anti-capitalist dream

Friday, May 3rd, 2013

There have been some interesting additions to our previous ponderings in the news this week.

Drugs in medicine

A US collaboration between a medical research team and a centre for substance misuse research have found that cannabanoids can reduce the replication of the HIV virus in white blood cells. This may also relieve inflammation of the central nervous system, reducing symptoms of HIV-related neurocognitive disorders. The broader applications of these findings to other disorders are now being considered.

If we think back to Cancer Patients With Acid Smiles, here is another example of the US striding ahead because they are changing their angle on substances. Cannabis is no longer illegal in some American states, making it free game for medical research, and, as Professor Nutt pointed out, we are slowing down progress in tackling some of our worst illnesses by limiting the substances we consider for treatment.

By way of comparison, a prescribable Naloxone injection becomes available in the UK this week. I have been reading recent discussions on American websites about the huge problem that opiate (illicit and prescribed) overdose is causing over there, as I waved the British flag with news of the work being done in Wales where heroin users and their families have been trained to administer Naloxone. It seems, given the market launch of the product, that this life-saving product is now available to anyone over here. Hooray for harm reduction.

Afghan heroin trade continues to boom

The United Nations has apparently released data suggesting an eighteen percent growth in Afghanistan’s opium trade in the last year. As I suggested in Smacktastic Britian, this correlates nicely with the Government’s poor-battering, and we are bound to see a new wave of heroin use across the country. Maybe David Cameron should read Cameron Does Cocaine and get the bloody stuff taxable sharpish. It would certainly fit in with his other policies if he could provide an actual opiate for the (poor) people. Make it half-price on election day to keep the buggers at home. Although given that the CIA have reportedly been sending over suitcases stuffed with cash for eleven years now, maybe that trade route has already been baggsied. After all, the Americans are the originals (and the best) when it comes to using substances for social control.

Silk Road taken down by hacker

And finally, the website Silk Road was briefly closed down by hackers this week. It is thought the anonymity software Tor, which became known as ‘the dark web’ because of its uses for the grimier side of the net, is to blame for the problem, and that vulnerabilities in the system may have been exposed. This has come in the same week that the Bitcoin system has also been breached, as a software specialist illegally ‘mined’ an amount of the currency for himself. Unsurprisingly, the virtual currency continues to drop in value.

All of which is proof that, if someone is clever enough to develop a system, there will always be someone clever enough to cheat it. It saddens my socialist ideals that the person who tried to take on the banking system wasn’t superiorly intelligent (in my mind he is a masked hero called Merchant Wanker – make love, not profit), but, as we have to accept, there are vultures everywhere, and nobody likes a clever clogs.

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