The Joys of Being in Recovery

On rolls another year. And like each year "in recovery", life goes on with an array of challenges, changes and temptations. 

I have not touched anything now for many, many years with the exception of a beer about a year ago, an occasional glass of red wine with dinner and I smoked a bit of ice one sunny day. I have an excellent work contract, a steady relationship and an above average health. But something is missing and I still feel like my life is on hold.

Each year my life gets better in some aspects but worse in others. Well, not actually worse but more complex and frustrating. It's often said that issues that affect our lives are relative to our current situation. What stresses us out today might be minor compared to a decade ago. And the problems we may see as insurmountable to us are just minute compared to what others have to contend with. I'm sure that even if I was stinking rich, married to the Minogue sisters and healthier than Chuck Norris, I would still be worried out of my mind. Like I said, our problems are relative.

My daily dose of Slow Release Oral Morphine (SROM) has halved since this time last year. SROM is the magical medication that keeps me away from heroin. It's been a hell ride but overall, I am in a much better position now than anytime since my headlong dive into junkism. But there is a problem and one that is more frustrating than heroin addiction itself … the mess they call recovery.

Recovery is subjective and depending on who you talk to, it must be done a certain way. Some people insist that cold turkey is the only way out while most recommend substitution treatment like methadone. Others swear by the 12 steps program while a lucky few like myself receive something more practical. And then there's the naltrexone cheer squad who have their own ideas. So who is right? 

Forget the multitude of research showing that each person has unique needs. Forget the constant stories of users relapsing. In fact forget it all. If you're in the system, you are at the mercy of whoever you get burdened with regardless of their knowledge and success rate. For all the talk and money spent on recovery, it seems that our medical system is just not geared up to deal with individual needs. Not once have I been asked what I think is best (for me) or if I feel comfortable proceeding with a particular course. If my doctor and the specialist had it their way, I would be totally clean in a just few short months. Who cares if I relapse or my life becomes unbearable?

When I first approached the specialist pharmacotherapist to cut my dose nearly two years ago, he came up with a simple plan. Drop 50mgs every two weeks and soon I would be magically opiate free. Even I knew that was a big ask. And after voicing my dismay at such a rapid tapering he told me it would be fine. Of course it wasn't. 

Dropping 50mg every two weeks is just ridiculous. I have been on some form of opioids for nearly 20 years and every forced attempt to drop my dose just resulted in chaos. The upside is that when I initiate the reduction, it works.

It was me who suggested an initial drop of 100mg then maybe 50mg every month. I knew I was ready to start this long, painful journey and reducing my dose by a whopping 100mgs was a show of good faith that I was serious. Silly me! This enthusiasm was quickly exploited and the "maybe" drop of 50mgs each month became fortnightly. Of course it was a massive failure and after several pleading emails it was changed to monthly reductions.

I stop exercising and put on weight. I smoke more. I stop interacting with my family and hide myself away in my office. I stop contributing to the household (cooking/cleaning/caring for the pets etc.). I neglect family and friends. My focus on work deteriorates which costs me my income and the bills pile up. Even simple tasks such as showering becomes a drag.

-Extract from a letter to my specialist

Eventually, the monthly reductions started taking their toll. Dropping my dosage was causing too many problems and heroin was again becoming an attractive alternative.

The pressure to keep lowering my dose by my largely ignorant doctor and the specialist has been intense. It takes several long winded emails and some major pleading just to keep my dose fixed for another month. Sometimes I wonder if they actually understand that I am on a maintenance dose to keep me stable. If it was methadone, there would be no pressure whatsoever. 

It is a medical fact that forced recovery simply does not work. For some folks the idea of forcing junkies to rapidly drop their maintenance dose is appropriate punishment for being an evil druggy but for doctors it is just not good enough. There is ample research readily available and anyone, including a doctor, can just Google it. So why does my doctor and pharmacotherapist keep insisting that I constantly drop my dose?

It gets really tiring trying to explain the affects of lowering my dose when I am not ready. I have repeatedly explained to them that just prior to my dose dropping my clinical depression gets worse, I become very anxious and it causes me incredible stress. This falls on deaf ears. Even saying that I fear I may return to heroin isn't enough to reassess my situation. What is that about? You would think this would send off alarm bells. You would think…

The last 12 months have been pretty scary at times but I have somehow managed to get through. But as I have mention many times, each reduction causes incredible stress and distress. I manage to get through it but now it's proving to be counter-productive.

Each month as it comes time for my dose to drop and for weeks afterwards, I become extremely apprehensive and anxious. I feel that every everything is just too daunting and I loose any motivation I may have. It also makes me depressed. Naturally, I want this to stop. When I loose my motivation and feel depressed, everything suffers. At my age, this is not an acceptable situation especially after putting in so much hard work to get this far.

-Extract from a letter to my specialist

I can't help but question the reasoning behind the current policies for prescribing opiates. There are no major physical health problems with long term opiate use which only leaves the problem of dependance and any psychological issues. If SROM improves my ability to lead a normal productive life without causing any physical problems then why are the so called experts hell bent on dropping my dosage when I'm not ready? The physical health advantages from having a steady supply of SROM are glaringly obvious; 20-30kgs lighter, a regimented exercise plan, a healthier diet, a massive reduction in smoking and much less back pain. These benefits alone should justify my monthly script. Then, of course there's the huge benefits to my mental health; participating in work, socialising, integrating into the local community, reduced depression and anxiety, increased mental aptitude.

I wonder why diabetics are not forced to reduce their insulin? What about those on Ritalin or other medications to deal with specific mental health issues? Why are opioids singled out? If these medications help benefit our lives then they should be readily available for recovery as well.

We all know what causes the extreme paranoia around prescribing opiates and it should not exist in our advanced, modern society. The war on drugs -encouraged by sleazy politicians, the trash media and the anti-drug nutters- is probably the single most destructive policy in modern history. And when it affects the process of recovery you know it has really just gone too far.

Living life whilst in recovery is not pleasant although it's better than the constant cycle of heroin addiction. I suppose I shouldn't complain but it's hard when I know there's an easier route. I just want to know why those people and governments departments who are supposedly experts in addiction and recovery seem to know so little about addiction and recovery.

Giving Free Drugs to Addicts

What is more important? Stopping; violent crime, theft, robberies, drug overdoses, thousands being murdered in drug wars, the spread of HIV and HCV etc. or trying to stop drug addicts getting high? History has revealed 2 things - you can’t have both and trying to stop society from using drugs simply does not work. So, which would you choose? ... stopping associated crime and violence or stopping users getting high?

I’m sure most rational people would prefer to cut out nasty social ills like robberies, HIV, HCV, violence and murder but I am just as sure that some muffins would be so anti-drug that they would refuse to answer or try to change the question. 

Most informed people already know that prohibition causes crime and violence whilst not having much success at lowering drug use but how about the public? Do they know this or do they simply find it difficult to acknowledge due to decades of misinformation from the authorities? Is legalisation or handing out free drugs to addicts just too radical for the everyday citizen even if it cut crime rates by half and changes society dramatically for the better? According to a recent survey by McNair Ingenuity Research, 66% of Australians think people would be more likely to try or use drugs if legalised but only 5% confess that they would indulge. 

One of the survey’s most interesting results concerned what people thought would happen if illegal drugs were decriminalized. Although only 3% of people said they would personally use drugs more often, 62% said they thought other people would. The results were similar when we asked whether you’d be more likely to try drugs at all (only 5% said they would, but 66% thought others would).

It seems we define the people who can’t be trusted with drugs as everyone but ourselves.

-Kirsten Drysdale - Hungry Beast. ABC TV

Giving drugs to drug addicts is not new. Most western countries supply highly addictive opioids like methadone, buprenorphine and suboxone to heroin addicts. Other countries give out Slow Release Oral Morphine (SROM) and even free heroin. These programs are heavily regulated and restricted to opiate abuse like heroin because opioids are basically non toxic. The most success has come from supplying heroin to long term addicts who have failed repeatedly in other treatment programs. The success or prescription heroin has prompted a growing trend for drug experts to push this strategy. 

The main problem is that many addicts don’t qualify for the program because of the strict guidelines and heroin is the only targeted drug (a limited number of cocaine addicts were also given their drug of choice in the latest UK scientific trial). What about those who missed out on the trials or those who are just not “hard core” enough to make it to a permanent program? What about users of cocaine, methamphetamines and prescription medications? Once again it seems that politics and ideology are robbing addicts of valuable treatment options. 

As an addict in Vancouver for 38 years I was certain I would have no problem attending the program. It seems they only took Downtown addicts which gave them a very limited demographic and my calls went from wait to forget it. You could contact the NAOMI people if you want info but you'll be searching through an unpublished project.I hope you discuss parameters as most trials make getting off of heroin a prerequisite, which kills the project as you may well imagine. Harm reduction and working and happy clients should be the goal.Don't let them set you up to fail. 

-Comment by Terry McKinney. Vancouver BC (28/05/2008) - The Australian Heroin Diaries

How imbecilic can we be when we know that most established addicts will use street drugs everyday but the idea of government supplying safe and free drugs is simply out of the question. Up will come that old argument that dishing out illicit drugs is dangerous to their health and we should be trying to get people off drugs, not encouraging them. These reasons might be fine in prohibition utopia where drugs can be eliminated but not in the harsh realms of reality. And that’s the problem. The people who make these important decisions aspire to a “Drug-Free World” which has more chance of being a Disneyland theme park than materialising on planet earth.

I was in Canberra when the trial was set to happen. Now a decade later, failed relationships, failed uni attempt, lost employment and still raging habit, i often wonder where i'd be now if it had've gone ahead. damn howard! i wrote to chief minister stanhope last year at 3am, hanging out, begging for him to think about another try. 6 wks later he replied (shock horror) and said he was 100% behind it, but couldnt do anything til howard was gone. well hes gone.......Methinks its time i start emailing again :) 

-Comment by plzHoldSteady (22/01/2008) - The Australian Heroin Diaries

I always wonder how many lives we could have saved and how many addicts would now be clean if the proposed ACT heroin trials weren’t poo-pooed by Howard. Given the success from every heroin trial overseas, it must be quite a few. Imagine how many lives we could save or change for the better if skipped the strict criteria for candidates of prescription heroin. What if we simply opened it up to anyone who has been on methadone for more than a year or had attended a rehabilitation program and failed? And what if we supplied all dangerous drugs like ice, cocaine, heroin etc. and even ecstasy and other drugs that can be contaminated with filler products? What is the real downfall of this idea compared to the benefits? The same groups would continue to use the same drugs and those who don’t use drugs would continue to abstain. The sky would not fall in and societal chaos would not engulf mankind. Some dedicated users might increase their intake but many more will take advantage of extra treatment options and quit using drugs. 

I don’t think the public has correctly been told what would happen to their surroundings if illicit drugs were distributed by the government or legalised. The most obvious effect is that crime would drop by about half and several billion dollars would be saved every year. This are not just a slight decrease in costs or small improvements but massive, unparalleled changes to crime rates and government spending. Whole police departments used to fighting drug crimes would be relocated to other, understaffed divisions ... including more cops on the street. The back log in courts would eliminated. Huge percentage drops in overdoses and deaths. Organised crime losing their most profitable source of illegal income. Prison populations dropping so much that not only won’t new jails be required in the near future but some actually might shut down. Dangerous meth labs would almost cease to exist. You would be able to buy flu tablets with pseudoephedrine again without having to produce your passport, a personal reference from an astronaut or leaving your first born as collateral. Convenience store workers, pharmacy staff and train travellers  won’t have to worry about desperate junkies robbing them anymore as they will cease to exist. The CourierMail, Adelaide Advertiser, Daily Telegraph etc. will have to expand their subject matter or lose 8-10 pages. The quality of drug education will improve ten fold. Young adults will no longer be so susceptible to a permanent criminal record. Teen drug use will drop as the mystique of drugs will be gone as well as unscrupulous drug dealers who don’t ask for age ID. The problem of alcohol will be addressed more rigourously and classed as a dangerous drug. And so on...

Ironically, easier access to drugs will improve life for users and addicts. Their health will greatly improve and many of them will be able to work once again. They will be able to re-establish relationships with their families and no longer run the risk of being imprisoned. Many of the health issues for drug addicts are the result of prohibition, especially for heroin users. Opiates including heroin are basically non toxic and can taken for decades with very few physical problems. Haven’t you ever wondered why street junkies on heroin look sick but those on pain medication look normal? They are both taking the same sort of drug but the most visible heroin addicts in society often don’t eat very healthily, sleep where ever they can, have very few clean clothes and are more focussed on dodging the police and paying for their next hit. Take away the high cost and the stigma attached to drug addiction and they get to live much more productive lives. In the countries where heroin is prescribed to addicts, there has been substantial improvements in their health and personal lives. Most of them cease any criminal activities and many find work. 

The big question is - why are other countries looking into evidence based strategies like heroin assisted treatment and related programs while Australia keeps regurgitating tired, old drug policies that fail every year?

New Approach To Drugs Seeks Footing In Costa Rica

Tico Times

By Mike McDonald 

April 2010

The drug debate in Latin America has started to shift.

For decades, possession and addiction in the Americas have been treated with a zero tolerance policy. Efforts to slow drug use have largely centered on arresting and punishing users.

But packed jails, overburdened court systems, and a growing consensus that the war on drugs is failing are transforming the discussion.

In August, 2009, Argentina's Supreme Court ruled that it was unconstitutional to prosecute people for possession of drugs for personal use. One month later, Colombia's high court issued a similar ruling.

In Peru and Bolivia, there are now small clinics that give cocoa leaves to crack addicts in order to manage and lessen their addiction. Bolivia's President, Evo Morales, has asked the United Nations to eliminate the narcotics label on the coca plant.

Now, in Costa Rica, high-ranking officials are joining the tolerance dialogue.

In March, Costa Rica's Chief Prosecutor, Francisco Dall'Anese, proposed offering free drugs to addicts as a way to compete with dealers. Squeezing in between the addict and the supplier to offer a cheap alternative would “break” the finances of drug pushers and “reduce demand,” he told the Spanish–language daily La Nación.

“Here, what we would do is preempt the business of drug dealing,” he said.

The reasoning behind the proposal is fairly simple. By stopping the flow of income to drug dealers and eradicating the addict's need to steal in order to buy another fix, crime rates should drop.

This idea is not revolutionary. Countries in North America and Europe have used harm reduction techniques such as methadone clinics for years to treat heroin addiction.

These efforts have been regarded as successful in reducing crime and curving addiction by medical journals.

Dall'Anese's proposal, though, does represent a fundamental shift in Costa Rican drug policy, as providing addicts with free, chemical substitutes would take the drug addiction problem out of the hands of law enforcement and place it at the doorstep of public health officials.

Related Articles

Who Supports a Heroin Trial?

What Does Prescription Heroin Really Mean for Junkies?

The Start of Prescription Heroin in Australia?

Would You Give Heroin to Addicts ... Why Not?

Heroin Assisted Treatment Winning Approval in Europe

Cannabis - Another Possible Fix for Opiate Addiction

Sorry about posting another research related item but I couldn’t help it. Look at the headline of the article below from ScienceDaily and you might start to forgive me. Even though the headline is an eye catcher, there are no human trials yet and any real results are years away. Still, the study is strangely compelling. The premise is straight forward enough but the irony is priceless ... smoking dope to stop being a smack junkie. I can see the anti-drug nuts having a mild seizure and the pro-cannabis supporters drooling with anticipation. Is cannabis going to be the wonder drug that even cures opiate addiction? Maybe ... maybe not, but there’s enough here for the weed worshippers to be optimistic. Unfortunately it’s too early to be excited for those on the receiving end of this potential treatment, the opiate addicts themselves. Sadly, the future for this type of treatment in Australia looks grim. We don’t even have provisions for medical marijuana yet and with the current trend of conservative politics, I can’t see a radical change anytime soon. There is already plenty of opposition to any form of medical treatment with cannabis but using pot to treat heroin addicts would create a sensation. Can you imagine the war cries from moral crusaders in the media like Miranda Devine, Piers Akerman and Andrew Bolt? What about political screwballs like Fred Nile, Chris Pyne and Tony Abbott? Even if the federal government gives it the okay, would the states support it? Can you imagine SA giving it the nod with Attorney General, Michael Atkinson and indpendant Anne Bressington being so anti-drugs. Would WA Premier, Colin Barnett have a change of heart regarding pot? What about the hysterical NSW government? Or the redneck wonderland, Qld? You get my point. Anyway, it’s early days and there’s plenty of rats yet to become martyrs. Maybe by the time it comes to phase III human trials, there might be more support for evidence based drug policy? Maybe, some new, fresh blood in politics has initiated change? Maybe a new wave of fact driven journalism has replaced the old, stale, self righteous opinion based dribble? Maybe....

Active Ingredient In Cannabis Eliminates Morphine Dependence In Rats ScienceDaily July 2009 Injections of THC, the active principle of cannabis, eliminate dependence on opiates (morphine, heroin) in rats deprived of their mothers at birth. The findings could lead to therapeutic alternatives to existing substitution treatments. In order to study psychiatric disorders, neurobiologists use animal models, especially maternal deprivation models. Depriving rats of their mothers for several hours a day after their birth leads to a lack of care and to early stress. The lack of care, which takes place during a period of intense neuronal development, is liable to cause lasting brain dysfunction. The study was carried out by Valérie Daugé and her team at the Laboratory for Physiopathology of Diseases of the Central Nervous System (UPMC / CNRS / INSERM). Valérie Daugé's team at the Laboratory for Physiopathology of Diseases of the Central Nervous System (UPMC / CNRS / Inserm) analyzed the effects of maternal deprivation combined with injections of tetrahydrocannabinol, or THC, the main active principle in cannabis, on behavior with regard to opiates. Previously, Daugé and her colleagues had shown that rats deprived of their mothers at birth become hypersensitive to the rewarding effect of morphine and heroin (substances belonging to the opiate family), and rapidly become dependent. In addition, there is a correlation between such behavioral disturbances linked to dependence, and hypoactivity of the enkephalinergic system, the endogenous opioid system. To these rats, placed under stress from birth, the researchers intermittently administered increasingly high doses of THC (5 or 10 mg/kg) during the period corresponding to their adolescence (between 35 and 48 days after birth). By measuring their consumption of morphine in adulthood, they observed that, unlike results previously obtained, the rats no longer developed typical morphine-dependent behavior. Moreover, biochemical and molecular biological data corroborate these findings. In the striatum, a region of the brain involved in drug dependence, the production of endogenous enkephalins was restored under THC, whereas it diminished in rats stressed from birth which had not received THC. Such animal models are validated for understanding the neurobiological and behavioral effects of postnatal conditions in humans. In this context, the findings point to the development of new treatments that could relieve withdrawal effects and suppress drug dependence. The enkephalinergic system produces endogenous enkephalins, which are neurotransmitters that bind to the same receptors as opiates and inhibit pain messages to the brain.

Indonesian Disgrace

Indonesia, like most Asian countries have harsh drug laws which can include long jail terms and the death penalty. While the more spectacular busts might attract attention here, what we don’t hear much about are the many Aussies being jailed in these countries for months or even years for possessing just a small amount of illicit drugs. The Bali 9 and Schapelle Corby are household names for their drug smuggling charges in Indonesia and the media made sure they would all be remembered. But what about Jason McIntyre who faces 10 years in jail for 5 grams of hash or Shane Demos who got 8 months for having 5.9g of dried hash and 0.3g of heroin? In Australia, these charges would not lead to jail time and that’s if they made it to court at all. Maybe we should look at the strange circumstances and possible corruption involving drug arrests in Indonesia. Why would Jason McIntyre be facing 10 years jail when he had fewer drugs than Shane Demos? Neither had a criminal record and the drugs they had were for personal use but Shane Demos was given (only) 8 months. Why wouldn’t the Indonesian court accept certain requests for forensic evidence from Schapelle Corby’s legal team? Why did the Australian Federal Police (AFP) feel obliged to tip off the Indonesian authorities about the Bali 9 rather than making the arrest themselves. Especially considering that the AFP’s decision was most certainly condemning the Bali 9 to the death penalty. Why was a request by Schapelle Corby’s legal team for important CCTV footage from Qantas denied? Where was the the Australian government on this? The addition of shifty behaviour from Australia must also raise some questions.

Australian Foreign Minister Alexander Downer, when questioned on ABC radio, arrogantly declared that he had no control over such issues, stating: “I’m not the minister for tapes.” He also made clear that, apart from some limited assistance to Corby’s lawyers and private talks with Indonesian foreign affairs officials, there would be no political intervention by Canberra.
-Muted response by Canberra as Australian woman faces death penalty in Indonesia - wsws.org

We all know that Alexander Downer is a lying, poncy sleaze but the whole government clammed up. When Schapelle Corby’s legal team requested finger prints from the inner bag containing the cannabis, the Indonesian court denied the request and then allowed the bag to be handled without gloves by anyone. It was an obvious flaw in the investigation but neither the AFP nor the Australian government said a word. Barbaric Drug Laws What is interesting to know is that extreme drug laws have been proven not to significantly deter drug use but many countries still continue with their draconian drug laws. The US is a classic example where harsh laws have done nothing to halt the uptake of drugs and ironically they have the world’s highest rate of drug use. Some countries like Indonesia are actually proud of catching and executing drug related criminals and are not afraid to say so.

To give them a lesson, drug traffickers must be executed immediately
-General Sutanto. Indonesian National Police Chief and Chairman of the National Anti-Narcotic Body

Indonesia isn’t alone when it comes to barbaric drug policies. Thailand, Malaysia, United Arab Emirates, Singapore, China etc. are all guilty of human rights violations where it’s not only their drug laws but their so called rehabilitation for drug addicts. The latest International Harm Reduction Conference (IHRA) held in Bangkok last week exposed the shameful behaviour of these countries and called on the world to enforce human rights and harm reduction procedures. Under the guise of drug addiction treatment, these countries are complicit in torture and abuse for those detained in “work camps” or compulsory treatment centres. The spread of HIV/AIDS and Hep C is epidemic, methadone is rare, addicts are beaten, tortured and forced to live in sub-human conditions. When released, they are often abandoned by their families and seen as outcasts which inevitably leads back to drug abuse. Below is an article from the Drink and Drug News newsletter reporting on the IHRA conference.

Describing experiences that spanned 30 years in Malaysian drug dependence treatment centres, Shaharudin bin Ali Umar showed photographs of weapons used to discipline him and the scars he had suffered from repeated beatings. 'If you are suspected as a drug user you are given compulsory treatment and kept under observation. If you relapse you get more jail sentences and lashes,' he explained. 'But the result is not effective – there is a 70 to 90 per cent rate of return to drug use.' The military style discipline and abuse included beatings with baseball bats and bricks and being burned on his genitals with a lighter. 'The scars may finally have healed, but the bad memories remain forever,' he said. 'I was humiliated and beaten until I forgot what pain is.' Interrogation began at the admission process. Then detoxification took between two weeks and a month,during which 'when the guard changed they started torturing us – humiliating torture I feel too shy to tell you'. A medical check-up and 'orientation process' were followed by a phasing system,which involved 'being beaten by a religious teacher and treated as animals'. While hopeful that changes were on the horizon,he said progress was hampered by the impossibly large size of the rehab centres, lack of methadone for detox and constant beatings. 'Harm reduction in Malaysia is like a sandcastle – built up by community organisations and then torn down by enforcement activities,' he said. Srey Mao from Cambodia – whose colleague took over her conference presentation when she became too traumatised to speak about her experiences in a detention centre – told of 'a place where living conditions are not for humans'. Packed into one room 'where they don't care what age or sex you are', and where there was no toilet, food,water,nor mosquito nets,she had seen her friend die from a beating,another drown trying to escape,and a fellow inmate electrocuted. The backdrop to her presentation showed Srey Mao reaching through bars of a crowded cage. 'Srey Mao would like this facility closed,' said her colleague. 'She would like the Cambodian government or anyone who can help,to close this down.'
-Harm Reduction ‘Torn Down By Enforcement’ - Drink and Drug News

Corruption
One of the major problems with extreme drug laws is the ingrained corruption. Even without the harsh punitive laws, the immense profits from the illegal drug trade is probably the single largest cause of corruption we know of. Although most dependant drug users rarely consider the legal consequences when desperate for their next dose, once caught, it all changes if they are facing a firing squad or decades in prison. This gives incredible power to low ranking police officers who often earn very little and have absolute contempt for drug users.

Indonesia is one of the world's most corrupt countries
-Wiki Travel

Is Indonesia corrupt when it comes to drug arrests? The readers forums in our major newspapers are full of criticism for Indonesia’s legal system since the Bali bombings in 2002. The criticism continued to grow when Schapelle Corby made headlines in 2004 and the Bali 9 in 2005. But not all of the comments were anti-Indonesian as many readers declared Corby and the Bali 9 should be executed because they were drug dealers and should be subject to Indonesian laws. Were the comments made by readers just pure speculation and emotional outpouring or were they based on real life experience? The fact is, Indonesia has a long history of corruption and and bribes are deeply rooted in the legal system. Add into the mix, extremely harsh drug laws with an underpaid police force and you have opened the gates of hell for Indonesia’s drug addicts and their families. For a more detailed look, read the brilliant article below by Nick Perry.

Winning A Battle, Losing The War
Drug users in Indonesia are made vulnerable by current drug laws
Inside Indonesia
By Nick Perry
May 2009

Merry Christina was 26 years old when she and her boyfriend were arrested by police while injecting heroin in a South Jakarta slum. Taken to the district police station, the officers cut Merry a deal: she could have her drugs back and leave the prison without charge if she agreed to ‘service them sexually’. Facing a serious prison sentence if she refused, and struggling with her decade-long heroin addiction, Merry was left with little choice. She agreed to their proposition and the officers returned her drugs. She was then blindfolded and repeatedly raped and physically abused by several officers over a five day period at the station. At the same time, her boyfriend was beaten and tortured in a separate cell. When the ordeal was over Merry and her boyfriend were released without charge. ‘It is widely known among drug-using communities that if you are caught by police and are a woman,’ said Merry, now an NGO worker staying clean through a methadone program, ‘you can just sexually satisfy the officers and there is no need for you to seek legal counsel or face punishment.’ Merry’s experience is one shared by many drug users in Indonesia. Organisations advocating on behalf of drug users in Indonesia have been lobbying for the laws about drug use to be changed; however, they have faced a government that is reluctant to see drug users as victims who need help.

Torture and extortion
The Indonesian government has long claimed to be fighting a ‘war on drugs’. However, since 2006 the number of people abusing substances in Indonesia has risen almost six-fold to 3.2 million. According to a report presented by the Indonesian Coalition for Drug Policy Reform (ICDPR) there has been a correlating spike in human rights abuse cases and social discrimination against drug users nationwide. The ICDPR report draws together years of research conducted across drug-using communities in nine major cities in Indonesia. The research was carried out by the NGO Stigma Foundation (Stigma) and the Law Faculty and HIV/AIDS Research Centre at Atma Jaya University, as well as by the Community Legal Aid Institute. Alarmingly, it found that almost all respondents claimed to have been extorted for money, physically or sexually abused, or tortured by police officers while being detained on drug offences. ‘Even though Indonesia has signed an international ratification against torture, the practice among the police force against drug users is very common, and on the rise,’ said Asmin Fransiska, lecturer on International Human Rights and Law at Atma Jaya University and co-founder of the ICDPR. ‘Women in particular face sexual abuse at the hands of police officers. When they are taken to the police station, they are often forced to strip naked in front of other officers or are simply raped with the threat of imprisonment if they do not agree.’ Testimonies from hundreds of drug users interviewed for the report paint a similarly horrific picture: blindfolded beatings, cigarettes put out on bare flesh, electrocutions and threats of murder. The penalty for possession of a single gram of heroin is currently 15 years which makes extortion another common practice used by police. ‘The common custom is for police to ask how much money you are willing to pay, or what you are willing to do, in order for them to change the offence they arrested you for,’ Fransiska said.


Police blackmail users for information about other users and dealers and reward them with high-quality heroin

Jarot, a former long term heroin user, has been imprisoned three times in the past for heroin possession. After serving time in an overcrowded Jakarta prison, where more than half the inmates are drug addicts and almost ten per cent leave having been infected with HIV, he was willing to do anything to avoid another prison sentence. ‘Police blackmail users for information about other users and dealers and reward them with high-quality heroin,’ Jarot said. ‘They then become cepu [spy].’ Many of the most impoverished drug users are vulnerable to this informal - and highly illegal - relationship with police officers. They lack the cash to bribe themselves out of their convictions and they have an overwhelming addiction to feed. According to Anto Suwanto, Field Coordinator at Stigma, cepu are often the target of reprisal attacks from dealers and other users, and are sometimes even murdered for their apparent betrayals. When asked if he had ever worked as a cepu for the police, Jarot turned away, looking down. After a few moments, he quietly answered, ‘Yes’.

Self-inflicted criminals
The current laws controlling illicit drugs in Indonesia are Law No. 5/1997 on Psychotropics and Law No. 22/1997 on Narcotics. Both laws were introduced under the dictatorial New Order regime but were not repealed or even altered until very recently. The meanings embedded in these laws and the ways they have been implemented have created problems for drug users. There is little distinction made between a drug user and a drug dealer under article 78 of the Narcotics Law. The article makes both criminals deserving severe punishment. According to legal principles there must be a victim and an offender in a crime. However, in this situation, the drug user plays both roles in the offense. This presents something of a conundrum to lawyers fighting for drug users to be treated as addicts who require help, rather than as prisoners requiring lengthy prison terms. The fact that the World Health Organization considers drug use a ‘chronic relapsing brain disease’ is not taken into consideration by judges and lawmakers, explained Professor Irwanto, Chair of the Institute for Research and Community Services at Atma Jaya University. ‘The strange thing is, the law is written as such that the crime has no victim, except oneself. It is like a self-inflicted crime,’ Irwanto said. While Indonesia has taken a hardline stance on drugs for some time, often punishing traffickers with death, a sudden surge in funding for law enforcement in recent years has seen drug users facing an increasing threat of abuse and discrimination. Between 2000 and 2004, drugs were not listed by the government as a major issue to be dealt with, and were discussed in terms of welfare and protecting the youth. However, since 2005, President Susilo Bambang Yudhoyono has deemed narcotic abuse a serious national problem that threatens security as well as religious and moral values. ‘Since 2006, the government has allocated 200 billion rupiah to enforcing the Narcotics Law, which has only resulted in an increase in the deaths of drug users, the number of HIV/AIDS cases and the arrests of drug users,’ said Rido Triawan, a Stigma advocate heavily involved with ICDPR. ‘Data shows that last year, many more people were arrested for using drugs, but only two per cent of the total figure were actually arrested for dealing.’

Reform on the horizon, for better or for worse
Indonesia is currently at a crossroads with its domestic drug policy. With parliament having resumed following the legislative elections on 9 April 2009, soon the newly-elected People’s Representative Council will recommence deliberating an amendment to the National Narcotics Law. This amendment was first submitted for consideration in 2005 by the Department of Law and Human Rights. Groups such as the ICDPR initially thought that this amendment would follow global trends by softening the ‘war on drugs’ ideology and shifting toward a more humane approach toward drug users. In actual fact, if this amendment is passed the situation for drug users and the state of human rights in Indonesia will almost certainly become worse. Ending the criminalisation of drug use is the linchpin of the ICDPR’s alternative approach to drug policy in Indonesia. To ICDPR members’ dismay, neither decriminalisation nor a raft of other crucial reforms were addressed in the proposed amendment to the Narcotics Law. If anything, this amendment will upgrade the criminal status of drug users and equip police with new powers to deal with them. Currently, a user can be legally detained for a maximum 24 hours, whereas the amendment will extend that detention to 72 hours. This not only increases the likelihood and opportunity for abuse to occur, it also throws potentially vulnerable addicts into an already overcrowded prison system rife with drug abuse, HIV/AIDS and violence. Another issue in prison is intimidation, explained Fransiska. Human rights lawyers are finding it increasingly difficult to defend users accused of possession because police pressure them into believing that if they fight the charges, they will receive a harsher sentence. ‘Sometimes they [drug users] will express interest in seeing a lawyer, but then after a night in prison, they suddenly change their mind. They claim they never wanted a lawyer, or they don’t know you, or that you are lying,’ Fransiska said. ‘Police are intimidating users and interfering with their proper legal rights.’ ‘Women are particularly reluctant to discuss their abuse, because they are afraid both society and their families will stigmatise them and be ashamed of the sexual abuse they have suffered,’ Fransiska said. After Sekar Wulan Sari was arrested for heroin possession, police officers threatened to sexually assault her if her boyfriend did not return with a bribe of several million rupiah for her release. After being exiled from her family, and following a lengthy rehabilitation process, Wulan helped form the Stigma Foundation. She understands first hand the risks posed by harsh articles in the amendment, particularly those that encourage the public to identify drug users in their neighbourhoods and families. ‘Not only are drug users being criminalised by the state, but now families and society are being threatened. Under the amendment, if you are aware of a drug user in your area or in your family and don’t report them to police, you could face court or prison,’ Wulan said. According to Fransiska, the responsibility for resolving drug issues should not be forced upon the community, particularly when law enforcement agencies are simply ‘incapable of carrying out their duties'.

After Sekar Wulan Sari was arrested for heroin possession, police officers threatened to sexually assault her if her boyfriend did not return with a bribe of several million rupiah for her release

The planned reform has thrust the death penalty for drug offences back into the limelight. If passed, the maximum penalty for possession of one gram of heroin will be increased from 15 years prison to death, providing police with even greater ammunition to leverage drug users for money and gratification.

Lobbying for a black campaign
ICDPR members admit that tackling law reform in Indonesia is complicated and overwhelming, but they do not ‘view laws as being almost untouchable’, as Fransiska claims many organisations continue to do. The ICDPR have lobbied the government through international mechanisms as well as by directly targeting politicians with mixed results. The United Nations Commission on Narcotic Drugs met in Vienna on 11 March 2008 to review the effectiveness of the last decade of international drug policy. The Indonesian government sent a delegation of Health, Education, Security and National Narcotic Agency (BNN) representatives who signed an international ‘Political Declaration’ on narcotics. The ICDPR sent its report to Vienna as a means of lobbying international states, particularly progressive European countries which provide funding to Indonesia, to encourage the government to change its human rights and drugs policy. The UN system tends not to cast judgements on particular governments, so the Indonesian delegation essentially signed the agreement without ever being directly addressed about its own domestic policy. ‘It seems the meeting [in Vienna] was fairly non-transparent,’ said Professor Irwanto, ‘with Indonesia being represented by people who may not have necessarily understood the real issue of drug abuse.’ When coalition members met with parliamentarians on 10 December last year for International Human Rights Day, they were surprised to learn that many politicians believed drug users were victims and supported, in theory, a shift toward drug policies that focused on decriminalising drug use. But lobbying for support from legislative candidates in the lead up to the general elections was virtually impossible as being seen as being soft on drugs remains a potential source of ‘black campaigns against their re-election efforts’, Fransiska said. Even though the amendment has not yet been passed, the ICDPR is pessimistic about its chances of being rejected by the incoming parliament. Stigma is focusing its attention on younger candidates linked to NGOs in the hope that future legislators will have a fresh perspective about the current perpetual cycle of targeting drug users and ignoring human rights abuses. ‘After we know who the legislative members are, we will approach them in order to get support for our work,’ said Ricky Gunawan, program director at the Community Legal Aid Institute, after the recent elections. With newly-elected legislators to take their seats in the coming months, and with the ICDPR planning to meet once again with representatives from the Indonesian Human Rights Commission, National AIDS Commission, Supreme Court and Ministry of Health, their overarching concern now is that many of the steps toward reform made in past months by advocates may have been in vain.

Nick Perry is currently living in Indonesia where he is the subeditor on the national news desk at the Jakarta Post newspaper. Nick holds a Bachelor in Communications (Journalism) degree from the University of Technology, Sydney, and regularly submits articles for publications both in Indonesia and abroad.

Smoking Ban - Putting the Boot into Mental Health Patients

Anti-Smoking groups are applauding the NSW government's decision to remove a smoking exemption for mental health facilities. The obvious question is, will it help patients? A third of mental health sufferers and two thirds of schizophrenics smoke but under the government plan, they have to quit or abstain while they are being treated. Is it really a good idea to put this extra unnecessary stress on people already confronting intense personal issues? Although nicotine is physically addictive, it also has a huge psychological dependancy that can make it extremely stressful to quit.

As a smoker I know about the compulsory need to reach for a cigarette regardless of the harms. Kicking nicotine addiction is simply not possible for many including myself especially during a time of stress. I don’t care how many anti-smoking groups or loud vocal nay-sayers harp on, I find it virtually impossible to quit. The idea of quitting whilst dealing with a major issue in my life is even more distant and I am sure this is the same for most long term smokers. And what bigger issue could one have to deal with than going to a psychiatric centre for a mental health problem? I could only imagine one worse scenario than having to deal with a mental health issue at a psychiatric hospital ... having to quit smoking as well.

Like most people, I understand the need for smoke free environments and designated outdoor smoking areas meet this need. But in a mindless and stupid attempt to appease anti-smoking groups, the NSW government has taken a Zero Tolerance approach and banned all smoking in mental health facilities. The alternatives ... quit smoking. This is just what someone needs whilst dealing with probably the biggest issue in their life. What a bunch of shit-for-brains.

It has been found, rather surprisingly, that nicotine has beneficial effects on brain function in schizophrenia (American Journal of Psychiatry, 1993;150(12):1856-61). Normally, people are able to adapt to background noise and disregard it, for example while having a conversation in a busy street. Recordings of brain activity show that this ability is impaired in people with schizophrenia, so they are more distracted by the surrounding environment. When they smoke, or use nicotine gum or patches, brain function normalises and they are less reactive to irrelevant sounds around them. When the nicotine is taken away, the problems return. -The Australian: Mentally Ill Smoke More And Quit Less.

Has anti-smoking hysteria gone too far? I remember when the idea of banning smoking in pubs was so far fetched, I just knew it couldn’t happen. It was the same when they first touted the idea of banning smoking in restaurants ... and offices ... and public transport ... and ... etc. So times change and we get used to it. I just want to know where the line is. 

In The Netherlands where you can buy and smoke cannabis in licensed coffee shops, they have banned tobacco smoking. Is this just anti-smoking fever gone mad or does it make sense? I’m still thinking about that one but what doesn’t make sense is removing designated outdoor smoking areas. Considering smoking is highly addictive, you would think the authorities would be more realistic. So what’s their solution ... more smoking bans. 

It’s obvious that the balance between the rights of a smoker being able to light up and the need to keep everyone else free from smoke is failing. This is especially true when anti-smoking zealots start to threaten the well being of people like they have with mental health patients. Can you see a pattern here? A group of fundamentalists with certain beliefs, forcing their views on the public through manipulation of the government. A group that is so desperate, they will ignore any harm caused by their suggestions and continue to ruthlessly push their agenda. A group that brushes off expert opinion and ignores the people they are supposed to be helping in favour of their own unqualified views. 

The common denominator is drugs and this time it’s nicotine. And their target is the patient being treated for mental health problems. The fundies just cannot let an opportunity pass to force some poor unwilling sucker to suffer like hell. The patient be damned. Who cares if they are treated successfully? Who cares if they check out because they can’t quit smoking? Who cares if it discourages patients from seeking medical help? At least they won’t smoke for a few days.

Tobacco Ban Leaves Mental Health Groups Fuming
Sydney Morning Herald
By Louise Hall - Health Reporter
March 2009

A BAN on smoking in all psychiatric facilities will go ahead despite vehement opposition from some members of the mental health community, who argue that strict anti-smoking rules will destabilise acutely ill patients and put staff at risk of violence.

NSW Health has ordered all facilities, including emergency psychiatric centres, to close designated outdoor smoking areas, confiscate tobacco products and supply free nicotine replacement therapy to staff and patients.

Anti-smoking groups say the department's decision to enforce its longstanding smoke-free policy in wards that had been granted an exemption will help to break down the "deep-rooted smoking culture" among mental health staff and patients.

The new guidelines will be implemented over at least six months to give workers, patients and visitors time to adjust and, ideally, to quit their habit, with the help of counselling and anti-smoking aids such as patches and pharmacotherapy. The director of NSW Health's Centre for Health Advancement, Liz Develin, acknowledged there was widespread hostility to the ban but said research in Britain, Canada and other Australian states showed careful planning and education can lower levels of patient distress.

About one-third of people with a mental illness smoke, rising to two-thirds for people with schizophrenia, compared to about 17 per cent of the general population.

"Some consumer groups see it as taking away a person's right but everyone has the right to be in a smoke-free environment," Ms Develin said.

The chief executive of the Cancer Council NSW, Andrew Penman, said arguments that people with psychiatric disorders smoke to self-medicate or relieve symptoms, stress and anxiety "are too easily used as excuses to justify inaction about smoking".

There was weak evidence that smoking improves the neurological functioning of people with schizophrenia, he said. But many of these patients want to quit and can quit to improve their overall wellbeing.

A spokesman for the Mental Health Council of Australia, Simon Tatz, said forcing a nicotine addict to endure withdrawal symptoms while battling an acute episode of mental illness may impose a disproportionate level of suffering on people who were already suffering enough.

"No one wants to defend smoking, but when you're dealing with people in extreme crisis, their mental health and wellbeing has to be the priority, not quitting smoking," Mr Tatz said.

Desley Casey, who has worked in the mental health field for 15 years and has been an acute psychiatric inpatient several times, said forcing people to quit when they are acutely unwell is inhumane and "goes against a patient's human rights".

She is concerned that some patients will not seek help or admit themselves to hospital if they know tobacco is banned.

Ms Casey disagreed that NSW Health had a duty of care to break the cycle of smoking and disadvantage. "Is it their duty of care to put someone through terrible nicotine withdrawal symptoms during psychosis?

"I'm a smoker and I would prefer to risk the dangers to my physical health than risk my mental health, which is far more precious to me."

Internal NSW Health documents show hospital administrators have expressed concerns that patients may abscond or become increasingly agitated or violent if not allowed to smoke.

But "in some circumstances smoking may be permitted on a case-by-case basis" if nicotine replacement therapy does not work or where "refusal may pose a significant risk of violence to a staff member, patient or another person", the draft guidelines outline.

The chief executive of the Richmond Fellowship of NSW, Fred Kong, said mental health workers often used tobacco to bond or develop relationships with patients, which could help their recovery. "I'm fearful that applying this sanction will interfere with the therapeutic relationship between staff and patients," Mr Kong said.

A review of 26 bans in psychiatric settings worldwide published in the Australian And New Zealand Journal Of Psychiatry in 2005 found there was "no increase in aggression, discharge against medical advice or increased use of as needed medication" linked to smoke-free policies.

Although there has recently been a big push to help psychiatric patients quit smoking whilst in medical care, searching through the internet I have found plenty of criticism of forced smoking bans. Most of it comes from doctors and those involved in the day-to-day operations who’s only concern is the well being of the patient. Being medical professionals, they obviously understand the danger of smoking but pragmatism wins out over the rigid dichotomy between anti-smoking rhetoric and the real world of mental health services. 

Although there is growing evidence that patients can quit smoking whilst keeping their place in treatment, there is equal opposition from those who work on the ground, doing the actual work. Treating a mental health patient is already extremely complex and unless we have perfected it recently then introducing additional, non related and non critical goals, cannot make the task easier. The losers are the patients and as usual, those who don’t easily adapt to a new system are merely statistics and left to fend for themselves.

Stopping Mentally Ill People From Smoking Is Cruel
Sydney Morning Herald - Opinion: Letters
By Dr Alvaro Manovel Randwick
March 2009

As a doctor I strongly support anti-smoking policies. But there are specific issues relating to mental health patients that make the move against smokers by NSW Health deplorable ("Tobacco ban leaves mental health groups fuming", March 19).

Mental health patients may be voluntary or involuntary. Voluntary patients may simply stroll off the hospital grounds to smoke. But involuntary patients are detained against their will in hospital under the Mental Health Act and are not allowed that liberty.

They are by definition so mentally disordered that the last resort of the act has been invoked because they may be a risk to themselves or others. These patients are frequently agitated and smoking is one method they use to calm down. In this state they lack the capacity to consider the benefit of stopping smoking, and this is clearly not the time in their lives to introduce intransigent non-smoking rules that only escalate their agitation.

In the past these patients were allowed to go outside to smoke escorted by security staff, but since the introduction of smoking bans they may no longer do so. In hospitals all over NSW these poor individuals are being physically restrained and given sedative drugs when their agitation escalates. This infringes the spirit of the Mental Health Act, which stipulates that it may be invoked to detain a person only when there is no less restrictive means of doing so. Clearly allowing them to smoke is far less restrictive than physical restraint and sedation.

We already make these patients suffer protracted stays in crowded emergency departments, due to the failure of NSW Health to provide beds for them. It is easy to imagine what effect this has on individuals who are at the lowest ebb of mental wellbeing. To add insult to injury they are now told that their last vestige of self control - to seek solace with a smoke - is being withheld, in what must seem an arbitrary and cruel act by their carers.

Doctors are placed in the unenviable position of choosing to restrain the individual or to let them out on their own, with the risk they may abscond and harm themselves. What a sad state we have sunk to.

Related articles: Mentally Ill Smoke More And Quit Less

What Does Prescription Heroin Really Mean for Junkies?

Switzerland has just become the first country to include prescription heroin as part of official government policy after a referendum voted 2 to 1 in favour of it. Although the 1300 patients who already receive prescription heroin in Switzerland are breathing a sigh of relief, what does it mean to addicts worldwide? Will other countries follow suit and if so, what will be the criteria to be accepted into the program? 


Also heroin trials to date have focussed on one or maybe two cities in each country so that leaves the vast majority of addicts not able to participate until the trial is either extended to cover other locations or it becomes government policy like Switzerland.

Swiss Approve Prescription Heroin BBC 

 

(mmmmm . . . look at all that heroin!)

Swiss voters have backed a change in health policy that would provide prescription heroin to addicts. 

Final results from the national referendum showed 68% of voters supported the plan. The scheme, where addicts inject the drug under medical supervision at a clinic, began in Zurich 14 years ago before spreading across the country. But in another referendum, the Swiss appear to have rejected the decriminalisation of cannabis. 

The heroin vote was one of a series of referendums held to decide policy on illegal drugs. The policy is described as one of last resort - prescribing addicts with the very drug that caused their problems in the first place - but supporters say it works, and Swiss voters appear to have agreed, the BBC's Imogen Foulkes in Berne says. Switzerland would be the first country to include it in government policy. 

Supporters say it has had positive results - getting long-term addicts out of Switzerland's once notorious "needle parks" and reducing drug-related crime. 

Opponents say heroin prescription sends the wrong message to young people and harms the addicts themselves.

Firstly though, congratulations to the Swiss for leading the world in common sense and pragmatic health policies. The world owes a lot to the Swiss (and the Dutch) for having the courage to care more for their people than pleasing the United States or hysterical religious groups. 


Secondly, we shouldn’t forget that this is the second attempt at trying something new. The first project, dubbed Needle Park was a failed experiment but it was still recognition that treating addiction with strict law enforcement wasn’t working. 


There have been several heroin trials now and all with very positive results. Even though they have all been successful, only 2 trials have developed into more permanent programs. One in Switzerland and the other in The Netherlands. Spain, Germany, Belgium and recently Canada have all held heroin trials with the UK’s trial finishing shortly. Also Denmark has announced they will be commencing a 2 year trial with a few other countries toying with the idea. 


Whilst many heroin addicts must be relieved to hear the good news of an ever expanding prescription heroin trend, the reality is not as rosy as it seems. Geographically, it is impossible to include everyone in a trial which is not the objective anyway. Most trials last about 2-3 years and for a program to be approved and operated in other cities, it may be 4 or more years away. Then you have to qualify them. At the moment, trials are for hard core, long term addicts who have failed other treatments and continue to participate in risky behaviour. I think the general consensus is that only the homeless or really desperate addicts will get in on the trials but established heroin assisted treatment (HAT) programs encompass other long term users more readily. But what about those functioning heroin addicts with jobs who appear to live a relatively stable life? Are they eligible? 


This site has shown many functioning addicts who remain outside the law by using and/or selling an illegal substance and are kept in a world of shame by hiding profound issues from their families. The binding thread is that they have all failed repeated attempts at treatment. Will they ever be included in a program for prescription heroin or are they not considered ‘desperate’ enough. A cynic could argue that these addicts might be excluded because they won’t contribute to the success statistics of such a program when there’s no room for improving key issues like homelessness, employment and health. A slap in the face really for those addicts who have been strong enough to stay employed or healthy whilst living with the nightmare of addiction.

As an addict in Vancouver for 38 years I was certain I would have no problem attending the program. It seems they only took Downtown addicts which gave them a very limited demographic and my calls went from wait to forget it. You could contact the NAOMI people if you want info but you'll be searching through an unpublished project.I hope you discuss parameters as most trials make getting off of heroin a prerequisite, which kills the project as you may well imagine. Harm reduction and working and happy clients should be the goal.Don't let them set you up to fail. [...] In my case I offered to move to the moon if transport was available. They seemed to have some issue with my actually having a roof over my head. They seemed to think that if you had it together enough to actually pay rent you didn't need a maintenance program. 
-Terry McKinney. Vancouver BC

I imagine some addicts would consider changing their lives dramatically if prescription heroin was available but not where they live. The opportunity to receive clinical grade heroin as part of their treatment is a huge temptation which I can testify to. Although prescription heroin may have been perfect for myself a few years ago, I am happy on my current treatment. The idea of injecting daily again or having to visit a clinic twice a day doesn’t appeal to me currently and it’s bound to be the same for other recovering addicts on substitution treatment. That’s if we were eligible at all.

HAT will expand over the next decade as it’s success becomes more accepted by governments frustrated over current drug policies and so will the requirements for entry into the programs.

Heroin is basically non toxic and users are able to lead relatively normal lives if they don’t have to deal with the consequences of it’s illegality. Most of the problems associated with heroin addiction are purely because of man made laws and not the drug itself. Issues like the spread of blood borne disease (Hep C, HIV/AIDS etc.), crime, health, employment and social exclusion are recent problems caused solely by treating this medical condition as a law and order issue.

Before the 1960s, some countries already treated opiate addiction with either morphine or heroin and there were very few problems. Back then, a great proportion of addicts eventually weaned themselves off opiates and went back to their normal lives, often over a 5-7 year period which is sometimes called the natural addiction cycle. It’s ironic that in this age of advanced technology and medicine, we are starting to revert to treatments from over 50 years ago.

On a sad note, there are many who criticise HAT for all sorts of reasons except those that count. There’s the “sending the wrong message” argument and the “we should be getting them off drugs” excuse. These are all just philosophical opinions that have no bearing in the real world and are just placing the morals of drug use above the health and well being of someone with a medical issue. Associated Press reported that one opponent of the Swiss decision, Sabine Geissbuhler from Parents against Drugs was so adamantly opposed to the program that she publicly stated:

I would never, never, put my children into a heroin prescription programme. What kind of freedom is that? I'd rather they were dead -Sabine Geissbuhler - Parents against Drugs

Releated Links: 
Swiss vote on radical heroin rules 
Swiss likely to approve prescription heroin

Methadone Saves More Lives Than Abstinence / Detox.

People who are opiate dependent like heroin addicts, will die at a rate of 13 -1 compared to non addicts of the same age/sex. Mind blowing stuff. But there are still many out there who object to substitution treatment despite it being the single most effective treatment for opiate addiction. What would happen though if abstinence based treatment like detox was found to have a higher mortality rate than opioid maintenance treatment (OMT)?

The Boston University has recently released several reports that should make many anti-methadone proponents reassess their ignorant and often arrogant views. Not only do they indicate that methadone and buprenorphine save lives but choosing abstinence/detox over OMT increases the chance of patients dying. The anti Harm Minimisation stooges will undoubtedly still push their naive, ‘drug free’ ideology but the fact is, those on methadone or buprenorphine have a hugely reduced risk of being a mortality statistic. 

Isn’t this the goal, to save lives? It’s becoming increasingly obvious that’s not the case for some of the so-called “Tough Love” advocates. Extremist, Salvation Army Major and INCB member, Brian Watters suggested that heroin addiction was a fate worse then death. He also said that addiction was a sin. For the record, Watters is also a DFA director, ex chairman of the Australian National Council on Drugs (ANCD) and one of the 12 members of the UN’s International Narcotics Control Board (INCB) which has come into major criticism for breaching human rights and being a stooge for US drug policy. Many opponents of methadone use Sweden as an example of a successful drug policy which includes a strong preference for abstinence based programs and severe restrictions on how long someone can stay on methadone. What they leave out is the high mortality rate in Sweden compared to countries that endorse methadone.

This report is very specific about what needs to be done to prevent harm—not just to reduce it or minimise it but to prevent it, with the ultimate aim of always making the individual drug free and not sentenced to a lifetime of methadone, which will probably take 46 years off your life expectancy, and not turned into a hag with their teeth falling out. If you think the mouth of a tobacco-smoking person is hideous, look at the mouth of a methadone user.

Bronwyn Bishop - Inquiry Chair: The impact of illicit drug use on families. The winnable war on drugs.

There are many who object to substitution treatment as being a ‘cop out’ for addicts or as a grand plan of industry ‘elitists’ who want full drug legalisation. The claims are varied from an ‘Orwellian addiction swap’ to ‘the federal government trades places with the street dealer, swapping heroin for methadone and feeding the addiction with taxpayer dollars’. Even politicians who have access to vast amounts of research either choose to ignore the evidence and lie to the public or are incapable of separating their personal views from facts. What is worse ... an elected official blatantly deceiving us or an elected official being so obviously clueless and incapable yet still left to manage important issues for us?

Do we want to follow the example of the many US OMT clinics that place restrictions on the period of treatment or set unrealistic dosage levels out of misconceived ideas on how OMT works? OMT was never meant to be a short term treatment but through a haze of Zero Tolerance claptrap, the guidelines have been misinterpreted by many health care providers. It seems logical to end OMT as quickly as possible because of the temptation to have a cured addict, free of physical addiction. Unfortunately, it’s not that simple and the usual consequences are the unnecessary deaths of addicts pushed into a dangerous treatment plan by ignorant and self righteous care providers.

Opioid Maintenance Therapy Saves Lives

http://www.bu.edu/aodhealth/issues/issue_may08/friedmann_gibson.html

Opioid-dependent patients are 13 times more likely to die than their age- and sex-matched peers in the general population. To examine predictors of long-term mortality, Australian researchers conducted a 10-year follow-up study of 405 heroin-dependent patients who had participated in a randomized trial comparing methadone and buprenorphine.

Overall mortality was 8.8 deaths per 1000 person-years of follow-up (0.66 during opioid maintenance treatment and 14.3 while out of treatment).

Each additional opioid maintenance treatment episode lasting more than 7 days decreased mortality by 28%.

Subjects who were using more heroin at baseline had a 12% lower mortality rate overall, likely because they spent more time in opioid maintenance treatment.

Comments:

Often overlooked in the controversy over opioid substitution therapy is the reality that opioid dependence has a high fatality rate. The current study highlights that opioid maintenance treatment saves lives. The selection of the treatment episode as greater than 7 days strongly suggests that opioid maintenance, not detoxification, reduces mortality. The time is right to promulgate opioid maintenance therapy with either buprenorphine or methadone as the standard-of-care, first-line treatment for opioid dependence.

Peter D. Friedmann, MD, MPH

Reference: Gibson A, Degenhardt L, Mattick RP, et al. Exposure to opioid maintenance treatment reduces long-term mortality. Addiction. 2008;103(3):462–468.

Death Before, During, and After Opioid Maintenance Treatment

http://www.bu.edu/aodhealth/issues/issue_apr08/samet_clausen.html

To what extent does opioid maintenance therapy (OMT) reduce mortality in patients with dependence? To answer this question, Norwegian researchers linked data from a national death registry to a national database of people who were on a waiting list for OMT, receiving OMT (predominantly methadone), or discontinued OMT. Researchers then compared the risk of death during treatment with the risk before and after treatment among 3789 patients. In some cases, data from the death registry were confirmed with death certificates and autopsy results.

Over 7 years, 213 patients died.

Seventy-nine percent of deaths in the waiting-list group, 27% of deaths in the treatment group, and 61% of deaths in the discontinued-treatment group were attributed to overdose.

Mortality risk (from overdose and other causes) was significantly lower in patients receiving treatment than in patients on the waiting list (relative risk [RR], 0.5; death rates of 1.4 versus 2.4 per 100 person years, respectively).

Risk was highest among men who discontinued treatment (RR, 1.8 compared with men on the waiting list).

Comments:

With impressive methodological rigor, these investigators provide further strong evidence that OMT lowers the risk of death. Because of the increasing cases of overdose death attributed to physician-prescribed methadone for pain and the potential negative public backlash towards this treatment, these data may play an important role in policy efforts that support the continued use of OMT to reduce mortality risk in people with opioid dependence.

Jeffrey A. Samet, MD, MA, MPH

Reference: Clausen T, Anchersen K, Waal H. Mortality prior to, during, and after opioid maintenance treatment (OMT): a national prospective cross-registry study. Drug Alcohol Depend. 2008;94(1-3):151-157.

Related Links:

What are the benefits of Methadone Maintenance Treatment

Advocates For Recovery Through Medicine

Ideological Influence in Addiction Treatment

Naltrexone Implant Data: Dangerous - MJA