Archive for the ‘heroin’ Tag

Legal drug-pushers and the US smack boom

Monday, March 3rd, 2014

It’s nearly a year since I warned about bumper heroin crops in Afghanistan, and months since raising the issue of soaring opiate painkiller abuse in the US. Yet the debate is still fresh, it seems, after reporting this week about the speed with which heroin use continues to increase in America.

Using stats from the substance misuse treatment centres in a sample district, heroin use increased 425% between 1996 and 2011. Four out of every five people presenting for treatment for their heroin use reported first becoming addicted to opiate painkillers. Use of these painkillers, in the same sample, had increased 1,136%.

But the really interesting part is how and why this happened.

On one side, there is the argument that this epidemic rise in opiate use is due to the drug companies. Marketing techniques for OxyContin, for example, were apparently so aggressive that doctors were ‘convinced’ (by what means, I am unsure, but we can imagine) that the tablets were completely safe to prescribe long-term. (Now I haven’t got a degree in medicine, but it would take more than a marketing campaign to persuade me that making an opiate slow-release stopped it from being addictive..)

Whatever methods the drug company used, they worked, and as sales soared, so did the deaths. In 2009, more than fifteen and a half thousand people died of opiate painkiller overdoses in the US – more than double the numbers in 2002.

The manufacturers were later fined over six hundred millions dollars for misleading doctors and patients about the addictive nature of the pills.

But there is another perspective – that the War On Drugs is to blame for the over-prescribing and addiction problems. The DEA, according to some, have turned decisions that should remain in the medical domain into legal issues – by scapegoating legitimate prescribers.

The case of pain specialist William Hurwitz is a poignant one. Of the hundreds of patients under his care, fifteen were found to be selling their medication. This was without Hurwitz’s knowledge. However, he received a custodial sentence of fifty-seven months for distributing narcotics.

As someone who has worked in drug treatment for many years, this is a chilling tale. There is no way of ensuring that meds are not diverted – even on daily supervised consumption, where pharmacists are paid to watch people take their medication every day, people will hide meds in their cheeks, sneak them out and sell them on in the spat-out form. And people will buy them. Such is the desperate nature of opiate addiction. But if I were held responsible for my patients making these choices, would I continue to provide prescriptions? Unlikely. And then, for the majority taking their meds as prescribed, where would they turn when the script stopped and the withdrawal symptoms and agonising pain set in?

Unsurprisingly, this type of prosecution discouraged doctors from signing legitimate prescriptions for people with genuine chronic pain, raising human rights issues for sufferers. In response, unscrupulous, or humane (depending which stance you take), doctors set up ‘pill mills’ – centres where prescriptions for opiate painkillers were provided more freely than was medically advised, both to pain sufferers and to addicts. The black market became flooded and, conversely to DEA intentions, that meant that the tighter legislation in fact enabled the boom in opiate dependence.

Whatever your beliefs about opiate prescribing, there is no doubt that America is facing a top-down public health crisis. And now, here we are – 2014. Poverty, depression and opiate addiction. Just in time for the heroin mega-crop. Yeehaa, as the they say in the States.

Ooo, doesn’t it make you nostalgic…

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An acceptable overdose

Tuesday, February 4th, 2014

Another prominent drugs death, that of Philip Seymour Hoffman, has again exposed society’s moral judgements about drug users. Reports of the ‘tragedy’ of his death portray Hoffman as a victim, a tortured soul, an artist battling inner demons. I feel for the poor guy, even more so for his three kids – but I am also left questioning the discrepancy in reporting between his death and the reports in my local paper about comparable situations. I wonder why the kid who spent his childhood watching his dad kick his mum’s head in, being raped by his uncle, then living an adult life of deprivation and misery before overdosing in a skip, only gets three lines on page 15.

You could say it is because the local lad never made a dint on the world. He didn’t offer art, beauty and insight to the masses. The difference in media representation reflects the size of the social impact each man had.

You could also say it is a class issue – a rich death is mourned, whilst a poor death is ignored. Maybe human value is just measured in wealth.

But why is it that Philip Seymour Hoffman, a man of considerable intelligence and opportunity, is considered a victim? Where is his agency in this situation?

It goes back to the same moral position I recognised in myself many months ago, this presumption so unwittingly common, that using drugs is bad. And, as with all immoral activity, for those who we choose not to perceive as bad – possibly because we relate to them, or respect them, and struggle to look at them without also seeing a reflection of ourself – we must instead formulate them as either mad or sad. So they become ‘tortured’, a victim of their ailment, circumstance or art. With such brilliance, it could happen to anyone.

Of course, your average die-in-an-alley heroin user does not evoke this sense of admiration. He would have lacked eloquence, instead conveying his pain through aggressive expletives, and probably smelled a bit. We would have tried our best not to identify with him – to imagine how we would have coped with the hand life had dealt him, how he might feel as door after door shut in his face, his options reduced to their basest – to live or to die.

And yet whose death really is tragic? A man whose life embodied success and choice, whose demise resulted from an informed choice?

It is sad, as almost every death is. I do not feel, however, that Hoffman deserves our pity. He made his choices. And when he chose to inject himself, he had a number of other options available to him that day, chances most only ever dream of.

For those who stand in Daily Mail judgement of the drug users in their community – not the professionals who have the odd line or the students using MCat, I mean the drug users who with pasty, clammy skin and homemade tattoos – I recommend you watch “Stuart – a life backwards”. I had no idea it was possible to fit twelve years of drugs work into one film. And, as with many of my clients, the main character is mad, sad and bad all at the same time – as well as being a man worthy of admiration and bloody hilarious.

I just wonder, without presupposed moral judgements about drug users, how much more we would learn about the human experience. Hoffman must have had reasons for choosing to take the risks he did, not because he wanted the deification his death seems to have provoked. But no doubt any realism of his motivations will be media-ised into a preformed box to prove he was mad or sad. Whilst the local lad will be remembered for his convictions.

America, Land of the Brown

Wednesday, August 21st, 2013

I warned about a resurgence of heroin use, following this year’s bumper opium crop in Afghanistan, in Smacktastic Britain, and unfortunately this may be already starting to come true, with reports of presentations of new heroin users at services (too young to remember the stigma of the last wave) and increased purity levels of the drug. But, given that there has been an international drought for the last three years, I guess this could just be business getting back to normal. And it will be another few months, possibly into early next year, before that crop reaches our shores and heroin use becomes a tempting prospect again – and people like the drug so much they start dying all over the place.

There has, however, been somewhat more of a significant increase in America. Fox News report that heroin use is “on the rise: cheap, available and out of control”, and the Wall Street Journal state that “heroin use in the U.S. is soaring, especially in rural areas”.

Fox’s Dr Manny Alvarez makes the claim that this increase is due to the last decade of prescription drug abuse, as painkillers such as Vicodin and oxycodone have been dished out like sweets and created large numbers of opiate addicts. The report also spells heroin with an ‘e’ on the end, claims that it causes miscarriage, and demands that America starts another War On Drugs – so I’m guessing we can take its contents with a pinch of salt – but it remains however an interesting suggestion that America’s increase is heroin use may be self-created. This claim is supported by other reports, which claim that OxyContin (the market name for oxycodone) has been refomulated to make it less abusable (by making it harder to crush and pastey, so that snorting or injecting is more difficult), and that, compared to the price of buying prescription meds, heroin is by far the cheaper option for those who find themselves dependent.

The Wall Street Journal, who also support the idea of a vast shift from prescribed opiates to painkillers, give some insightful and scary facts on the country’s growing heroin problem – seizures from the Mexico border have quadrupled between 2008 and 2012, and overdoses are going through the roof. Some of the rural communities are heroin-naive, most of them have no service provision, and heroin purity is at its highest in years, making overdose an inevitable consequence. Even more headline-grabbing – these medicated kids are white and middle-class.

So maybe we haven’t got as much to worry about in the UK as we first thought. The US market is prepped, desperate, and think that heroin is a bargain. If I was a drugs baron, I know where I’d be taking my bumper crop. Something tells me that the horrendous US drug overdose death rate of someone every nineteen minutes might be about to get a lot, lot worse…

Baby wants a double vodka

Saturday, July 20th, 2013

Pregnant women who use methadone are likely to under-report their alcohol and drug use, a piece of research published this month has found. The admittedly small sample of fifty-six opioid-dependent women, prescribed methadone as a substitute for heroin, were found to continue taking illicit drugs and alcohol during their pregnancy, as discovered by testing mothers’ and babies’ urine, and meconium (first stools). The study showed that 91% of women taking part in the study had used illicit drugs – 73% had continued taking opiates, and 70% had used benzodiazepines (which are thought to be linked to birth defects). 47% of the babies had also been exposed to alcohol use at levels of at least 2 units a day or 5 units at once, despite only 5% of the women disclosing this level of alcohol use. The most common combination (drug workers won’t be surprised to hear) was heroin, cannabis and alcohol.

Now this is clearly a highly-contentious area to discuss. On one side of the debate, there are people who acknowledge that women become pregnant for a variety of reasons, not necessarily through choice, and that the lifestyle that comes with heroin addiction may not be the most happy or meaningful existence, or borne from the most stable of upbringings. Once pregnant, drug users typically face extreme feelings of guilt – feelings which they have historically used drugs and alcohol to manage. And then the judgements and processes they are subjected to during pregnancy – safeguarding procedures and meetings, constant monitoring, reports written weekly about them and their parenting capacity, every bad decision they have ever made dragged up and pored over – make pregnancy not a joyful but a very stressful experience.

And then, on the other side of the debate, there are the tabloid readers – and there is so much meat on this bone for them to chew. First of all, of course, all drug users should die. They sacrificed their right to be on this planet the first time they smoked a spliff. Then – it gets worse – they are mothers. Should a woman not cease to exist in her own right the instant she conceives? She is, after all, a vessel. She should be pure and demure and fit all the glowing, maternal images we associate with motherhood. So the lifetime of misery, abuse, ill-treatment and self-deprecation should end the second that sperm hits that egg.

Now, don’t get me wrong, I find it very hard not to judge drug-using mothers-to-be. The unborn child is helpless and dependent on her to meet its every need, and it is heart-wrenching to think that it is disadvantaged before it has even left her womb. I do read the riot-act to these women, making it very clear that they are putting their baby’s welfare at risk, and increasing the chance that, once born, their baby will suffer painful and distressing withdrawal symptoms. What a sad and sorry start to life.

However, one thing is for sure – guilt does not perpetuate healthy behaviour. The fact these women are under-reporting their substance use is a sure sign that they already know all of this. You can bet your bottom dollar that they are beating themselves up more than anyone else ever could. And it is the discrepancy between what is expected of them and what they believe themselves to be capable of that makes burying one’s head in the sand the most realistic option.

I would imagine that most women who have had children would find this research both sickening and saddening. Whilst the idea of doing anything that may put their babies at risk may repulse them, I bet most of them have also felt judged, squeezed by other people’s expectations, desperate not to stand outside the prescriptive maternal mould that is dictated to them. Surely there is no worse judgement than being a bad mother. And not breast-feeding…?!

In the late stages of her pregnancy, I took a good friend of mine out for a drink. She was a single mum with two other kids at home, and she was desperate, for one last time before her baby was born, to just be herself for a night. She hadn’t drunk at all throughout her pregnancy, but on this occasion, I bought her a bottle of Corona, and she savoured it as we sat talking for an hour. We were in Wetherspoon’s – not an establishment known for its distinguished clientele with high moral values – but you should have seen the looks she got that evening. People gathered to bitch and point; judgements were formed, comments were made. At the time, she was drinking within the acceptable limits in pregnancy (guidance has since changed to ‘no alcohol during pregnancy’, although I believe this was mainly due to the fact that people struggle to quantify a unit), and she certainly wasn’t putting her late-stage pregnancy at any risk by her action. But as she sat there, gorgeous and bulbous, trying to enjoy her one night of being a person before months of being a multi-tasking milk machine, she was deemed by the other drinkers gathered that evening as the scourge of the earth.

So I suppose, in conclusion, I just want to say – this piece of research is sad. It is sad for the babies, it is sad for the mothers, it is sad for society. But maybe, maybe, if we saw pregnant women as people first and mothers second, the gap between expectation and reality might not be so great, and the image of the happy, stable, glowing mum-to-be might change into something more achievable for all pregnant women.

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.

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.

Smacktastic Britain

Monday, April 15th, 2013

A report today indicates a record opium crop in Afghanistan this year. The farming of poppies is seeing a resurgence, particularly in areas where violence is rife and agricultural aid is sparse. It seems that large-scale producers will not only provide all the necessary ingredients, but also pay in advance. This is in addition to reports that cannabis cultivation is also seeing a dramatic rise in the country.

And who can blame them. In a country where Western interventions have caused political instability and war, why would anyone, including the UN who are tasked to monitor and reduce drug production in the country, expect the Afghani people to give a toss about what rich white people on the other side of the world choose to spend their money on? I see no lack of morality in the trade myself – they are producing a crop to meet a demand, they are earning a decent living for them and their families, in circumstances most of us can’t even imagine. The fact that other people may then choose, under their own free will, to use that crop in way a manner which may be harmful to themselves, is no concern of the farmers.

Yet the War On Drugs prohibits it, and no doubt Afghanistan will come under further fire for failing to control its most lucrative exports.

Now this year’s bumper crop, partly due to poor weather for two previous years, partly due to more farmers choosing this crop above less well-paid alternatives, is coming at a time when, as a country, we probably need it most. Britian’s poorest are being targeted by benefit cuts and room taxes; budgets for social and health care are being reduced; politicians are diverting our eyes from their significant fuck-ups and self-serving financial scams by blaming the state of the country’s finances on the poor by likening them all to Mick Philpott; the impact of Margaret Thatcher’s policies still resonating across the country following her death, the anger no less fierce than the day she lost power. It does not surprise me that there were two incidents of football violence at prominent matches over the weekend – I think the current feelings of distrust and unfairness are rising in much the same as they did in the 80s.

And, in the 80s, at a time where everyone but those at the top of the social strata battled against the system and lost, and feelings of disempowerment and displacement engulfed the country, which market flourished? Here’s a clue – it blocks out physical and emotional pain, it provides a sense of social identity, and maintaining its demands is equivalent to a full-time job. That’s right guys, strap in – heroin’s sure to make a come-back!

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