Drogenabhängige sind gegen kostenloses Heroin“, berichtet Politiken. Wie die dänische Tageszeitung erklärt, können sich Süchtige seit zehn Monaten in öffentlichen Hilfseinrichtungen kostenlos rezeptpflichtige Heroin-Dosen verabreichen lassen. Es handelt sich um reines Heroin, dass ohne jede strafrechtliche Verfolgung konsumiert werden kann. Dennoch haben nur 80 Menschen dieses Angebot in Anspruch genommen, an das ebenfalls eine Behandlung gebunden ist. Insgesamt verfügen die Einrichtungen über 300 Plätze. „Die Behandlung schränkt den Patienten sehr ein, wird streng überwacht und kontrolliert“, erklärt der leitende Sozialmediziner der dänischen Hauptstadt. Die Drogenabhängigen müssen ein oder zwei Mal täglich in die Einrichtung kommen und jede einzelne Dosis muss unter medizinischer Aufsicht eingenommen werden. „Wenn die Junkies das vom Staat bezahlte Heroin ablehnen, ist klar, dass das Programm überarbeitet werden muss“ und die betroffenen Personen vielmehr angehört werden müssen, meint Politiken.
Tag Archive: Heroin
Bonn/Rheinbach. Dass in vielen Gefängnissen nicht nur Handys und Alkohol, sondern auch Drogen unter den Gefangenen gehandelt werden, ist ein offenes Geheimnis. In der Justizvollzugsanstalt (JVA) Rheinbach sollen sich jetzt sogar zwei Beamte mit sechs Gefangenen und zwei externen Dealern zusammengetan haben, um den Handel mit Heroin und Cannabis professionell zu organisieren.
Foto: Saxler-Schmidt
Wie Oberstaatsanwalt Robin Faßbender am Mittwoch mitteilte, wurden die zehn Männer im Alter zwischen 27 und 52 Jahren jetzt wegen bandenmäßigen Drogenhandels sowie Bestechlichkeit und Bestechung im besonders schweren Fall angeklagt. Voraussichtlich müssen sie sich demnächst vor der 3. Großen Strafkammer des Bonner Landgerichts verantworten.
„Ein derartiger Fall ist im hiesigen Bereich noch nicht bekannt geworden“, so Faßbender zu der Dimension des Drogenhandels hinter Gittern. Bei 13 Taten, die in den Augen der Staatsanwaltschaft nachgewiesen werden können, sollen 635 Gramm Heroin und 800 Gramm Cannabis in das Gefängnis eingeschleust worden sein.
Der Verkauf der Drogen brachte anscheinend mehr als 100 000 Euro ein. Die Initiative soll im März 2008 von zwei Insassen der JVA ausgegangen sein: Offenbar wussten sie, dass ein 52 Jahre alter Bediensteter in finanziellen Schwierigkeiten steckte.
Der Vollzugsbeamte ließ sich schließlich laut Anklage auf den Plan der Männer ein: Von zwei Dealern bekam er die in Päckchen verpackten Drogen nach Hause in seinen Briefkasten geliefert, so der Oberstaatsanwalt. Anschließend soll er die Päckchen in die JVA geschleust haben.
Dort hatten die beteiligten Gefangenen, die allesamt mehrjährige Haftstrafen absitzen, anscheinend ein regelrechtes Handelsnetz aufgebaut: Neben den Drogen sollen auch eingeschleuste Waren wie Mobiltelefone und Sonnenbrillen an die Mithäftlinge verkauft worden sein.
Wenn Gefangene Bestellungen aufgaben, sollen sich die Bandenmitglieder bei einem mitangeklagten 36 Jahre alten Beamten – der Einblick in die Gefangenenkonten hatte – erst einmal über deren finanzielle Verhältnisse Klarheit verschafft haben.
Doch im November 2008 bekamen die Ermittler Wind von dem Treiben: Ein 43 Jahre alter Häftling, der an den Bestellungen und dem Verkauf der Drogen beteiligt gewesen sein soll, packte aus. Es folgten verdeckte Ermittlungen, bei denen vor allem etliche Handys überwacht wurden.
Im März 2009 schlugen die Fahnder der Ermittlungsgruppe „Briefkasten“ dann zu: Sie durchsuchten unter anderem bei dem 52-Jährigen und nahmen den Vollzugsbeamten in Untersuchungshaft. Nach fünf Monaten wurde er gegen Auflagen wieder auf freien Fuß gesetzt.
Dass erst jetzt Anklage erhoben wurde, lag laut Faßbender an den langwierigen Ermittlungen – insgesamt wurden Verfahren gegen mehr als 100 Personen eingeleitet – und der sich nur nach und nach entwickelnden Aussagebereitschaft der inzwischen teilgeständigen Angeklagten. Das Fall wird in Kürze am Bonner Landgericht verhandelt.
Artikel vom 10.03.2011 http://www.general-anzeiger-bonn.de/index.php?k=loka&itemid=10001&detailid=860047
DOCTORS are writing thousands of suspect prescriptions for a pharmaceutical variation of heroin, much of it destined for the black market, forcing the federal government to investigate the actions of 50 medical practitioners.
More than 580,000 taxpayer-funded scripts were approved in NSW in the past two years for OxyContin and similar opiate painkillers, such as OxyNorm and MS-Contin, dubbed “hillbilly heroin“.
For every $34 script of OxyContin, users are obtaining a box of 20, 80 milligram tablets. Each tablet can then sell on the black market for as much as $50. With further subsidies to pensioners, the box can be bought for as little as $6 – and its contents might be sold on the street for $1000.
While the medication has revolutionised care for chronic pain sufferers, it is leaking out of the health system to such an extent that police and health experts warn it could soon surpass street heroin and ice as the needle addict’s drug of choice.
The prescription opioids are obtained unlawfully by dealers and addicts who “doctor shop“ for multiple prescriptions. One patient visited 46 doctors in three months and obtained 119 scripts, primarily for OxyContin, the government has confirmed.
Sydney doctor Alan Saunders, who has been targeted by doctor shoppers, warned: „It’s not just OxyContin – it’s valium and all the other drugs. The government is subsidising the drug trade.“
Pharmacists say they are confronted with stolen and fake scripts, while legitimate pain sufferers are obtaining the drug and then selling it.
The government acknowledges the problem. Federal Minister for Human Services Tanya Plibersek confirmed to The Sun-Herald that Medicare had identified 50 doctors for “unusually high levels of prescription writing for drugs such as OxyContin and OxyNorm“.
„The misuse of prescription narcotics is a growing problem which destroys lives and tears communities apart. Doctors suspected of making these drugs available to patients who do not require them for clinical purposes will be put on notice.“
With a slow-release formula, OxyContin capsules are designed to work through the day. Illicit users, however, discard the other binding agents and extract the drug in its purest form so, when injected, it delivers an instant hit.
According to new state government statistics released to The Sun-Herald, more than $557 million worth of illegal drugs were seized in the state last year – more than double the street value of the previous year’s tally of $260 million. The haul included $185.2 million worth of cannabis, $126 million of cocaine, $195 million of amphetamines and $28 million of MDMA/ecstasy. NSW Police Minister Michael Daley said the figures showed police were doing “a fantastic job keeping our streets safe“, adding: “It’s millions of doses of deadly substances that have been kept out of the veins of would-be drug users.“
Significantly, NSW police also seized more than $25 million worth of heroin. At the same time, a taxpayer-funded version of the drug is infiltrating the black market. The commander of the NSW drug squad, Nick Bingham, said: “We’re talking pharmaceutical-grade heroin. It’s highly sought after in the drug-using community and, unfortunately, it is finding its way [onto the streets]. To be honest, police don’t particularly want to have to target prescription opiates when there are other important things to tackle, such as organised crime.“
Inspector Bingham is part of the recently formed National Pharmaceutical Misuse Strategy Committee and said prescription opiates were “high on the agenda … One of the discussion points is educating doctors in regards to prescriptions … there needs to be tighter scrutiny.“ The director of the Alcohol and Drug Service at St Vincent’s Hospital, Alex Wodak, agrees major reforms are needed to improve the way opiates are prescribed by the medical profession: “The process needs to be far more discriminating, more realistic, more careful.
“GPs do the bulk of this work. They’re under tremendous pressure and could do with better assistance from the whole system, whether it be from medicine doctors, psychiatrists, pain doctors or better guidelines tailored to them.“
Dr Wodak also referred to the “long overdue“ national real-time database which, if implemented, could alert authorities when “runners“ try to use multiple scripts at different chemists, at different locations.
“The Commonwealth seems interested in trying to get all the states to adopt a similar live system,“ he said. “If we are serious about this issue, we have to form a national response.“
But Richard Mattick, from the National Drug and Alcohol Research Centre, fears a crackdown could hit genuine pain sufferers.
“Let’s not forget these medications are terribly important to the community,“ he said. “If you have a loved one affected by cancer or serious pain, you want them to receive the best possible care and these medications are much better, much safer than anything previously available. The community is better served and, in a way, that has allowed prescribing to be more generous.
“The danger here is that we see the bad side but don’t balance that against the need.“
Gideon Warhaft, of the NSW Users & AIDS Association, argues: “There will always be people who inject drugs and there will always be people with narcotics dependencies. The positive advantage with OxyContin is that users know exactly what they’re getting, whereas with heroin, they don’t. Many now prefer OxyContin because it’s clean and it’s safer.“
Patients ’sell drugs to help families‘
„Better than heroin“ … Stephen buys Oxycontin from people who are terminally ill. Photo: Jacky Ghossein
FORMER heroin user Stephen* has been using Oxycontin for six years but has a better alternative than doctor shopping. He buys the drug from terminally ill people who use the funds as a legacy for their families.
“I got introduced to Oxycontin by a sick friend who was being prescribed it. They were receiving roughly 30 per cent more than they needed so I took it off their hands.
“There are a lot of terminally ill people out there who get so much of this stuff, they’re selling it and making a fortune. It’s their legacy, for their kids … it’s a far better option than doctor shopping, taking risks and ending up in jail. They’re helping you and you feel as though you’re helping them.“
He said the Oxycontin rush wasn’t as intense as heroin and it wore off more quickly but the feeling was “extremely similar“ to heroin and many users preferred it.
“Heroin can be dangerous, particularly if you don’t know where it’s come from … I have overdosed twice. But with Oxycontin, you know exactly what dose you’re getting and at $30-$40 for an 80 milligram tablet, it’s far better value for money.“
He said if politicians came down on Oxycontin, users would “revert … to heroin – which can mean stealing, armed robberies and doing absolutely anything to fund it“.
source: http://www.smh.com.au/nsw/legal-heroin-sold-to-addicts-20110305-1bipy.html
More young people are becoming addicted to heroin in Burma’s northernmost Kachin state as authorities fail to clamp down on dealers, sources in several towns have warned.
Males between the ages of 17 and 40 were among the most affected,s aid a resident of Mogaung town, which lies just west of the Kachin capital, Myitkyina. Other towns suffering rising rates of addiction were Mohnyin, Myitkyina and Hpakant, he added.
“The kids are so ruined,” the man said. “Everyone, from students aged around 18 to even farmers, are addicted to heroin. They were only trying it out at the beginning but now are addicted.”
He continued that most addicts were injecting the drug, a cheaper method despite the health risks. One intra-venous hit, he said, cost around 1000 kyat ($US1), while smoking through a pipe costs up to 4000 kyat ($US4.50).
A group of heroin dealers were reportedly arrested last month in Mohnyin by the government’s Anti-Drugs Task Force (ADTF) but later released on bail. The man said they had quickly got back to dealing.
Burma
Assertions by the Burmese government that it is stamping out the country’s lucrative drugs trade have been widely doubted: the US released a report last week saying that Burma had “demonstrably failed” to halt the trade of heroin and its derivative, opium, whilst statistics showed that in-country production of methamphetamine continues to rise.
The report was followed by an announcement in the state-run New Light of Myanmar newspaper that 15,021 acres of poppy fields were destroyed in 2010-2011, 411 of which were in Kachin state. Regardless, however, criticism continues to abound.
“The government is the main culprit for this,” said the Mogaung resident. “The government is the first to blame and the dealers the second. They are openly selling drugs on a tray.”
He claimed that dealers paid monthly bribes of up to 400,000 kyat ($US450) to government officials, including the ANTF.
Two years ago the Kachin News Group released an alarming report claiming that a significant number of students at the once prestigious Myitkyina University in Kachin state had fallen victim to drug addiction, notably heroin, with dealers initially luring students in with free samples.
Until the late 1990s and the explosion in Afghan heroin, Burma had held the distinction of being the world’s leading source of the narcotic, with the ethnic United Wa State Army producing hundreds of thousands of tonnes each year.
A report released last year by the Thailand-based Shan Drug Watch claimed that junta-backed militias had taken over ethnic armies as Burma’s main drugs’ producers, with the product finding its way to neighbouring Thailand and China.
source:http://www.eurasiareview.com/world-news/asia/burma-heroin-use-up-as-supply-goes-unchecked-08032011/
During her last stay in jail, which ended in 2007, her HIV transitioned into full-blown Aids. Her life could have been very different, she says, if people had treated her drug addiction as an illness rather than a crime.
„The answer for me and for millions of others is simple,“ says Ms Teplinskaya, 44, who now works for an organisation advocating a more humane drug policy in Russia – substitution therapy. Almost every country in Europe allows treatment using methadone. Like heroin, it is an opiate, but is administered orally, meaning no risk of HIV transmission through needles.
Russia is the world’s largest heroin consumer and, to add to that, risky injecting practices have fuelled one of the world’s fastest-growing HIV epidemics. With tens of thousands of people dying every year, in a country where the population is shrinking, the twin epidemics are a catastrophe.
Campaigners say methadone would help tame both the heroin and HIV epidemics. As well as preventing HIV transmission, giving addicts methadone also brings them into the medical system, help steer them away from committing crimes to fund their habit and takes trade away from illegal dealers. Even China uses the technique to treat drug addicts. But Russian officials will have none of it. Government figures say it is perverse to treat drug addiction with other drugs and favour methods based on full withdrawal, sometimes against an addict’s will. It’s risky even to discuss methadone – advocates can be accused of „pro-drugs propaganda“ and taken to court.
„There is no logical reason behind Russia’s opposition to substitution therapy,“ says Anya Sarang, a campaigner who advocates the introduction of methadone. „I’ve been fighting this battle for 12 years and I don’t understand the mentality at all. The scientific evidence is all there to prove that it works.“
Ms Sarang and a group of Western academics published a study in the British Medical Journal last year which found that the widespread introduction of substitution therapy could cut rates of HIV transmission in Russia by up to 55 per cent. Estimates vary, but it’s thought that more than two million Russians inject heroin and the drug causes 30,000 deaths per years, as well as tens of thousands of new HIV cases. Russia is located on the transit route for drugs from Afghanistan to Europe and cheap heroin is readily available – a dose of heroin on the streets costs about 600 roubles (£12). If methadone therapy is not available, activists say programmes that offer addicts clean needles and syringes to avoid HIV transmission are essential.
The government, however, is adamant that only aggressive punitive measures can work to tackle drug use. Needle-exchange programmes funded by foreign donors have been discontinued in recent years, leading many addicts to share injecting equipment.
While there is some discussion about whether needle exchanges should be reintroduced, methadone is completely taboo. Leading Russian drugs specialists denounce substitution therapy as a failed Western imposition and see it as a „legalisation“ of drug use.
„We have no evidence from the international community that methadone is effective,“ said the Health minister, Tatyana Golikova, this week, reiterating a long-held government policy.
Others go further. Evgeny Roizman is a former Russian MP from the city of Yekaterinburg in the Ural mountains. He runs a series of clinics there where drug addicts go cold turkey, without methadone or any other drugs to ease the withdrawal symptoms.
He insists that methadone advocates are simply being disingenuous. „These people will say anything to get Western funding,“ says Mr Roizman. „I have worked with drug addicts for years, and I can tell you: methadone doesn’t work.“
He wants to bring in a range of policies, including harsher penalties for drug dealers and compulsory drugs testing in all Russian schools and colleges. „We need forced treatment for drug addicts,“ he says. „We need to force them into special institutions where there are no drugs and where they can be treated. This is the answer, not methadone.“
Last year, a disciple of Mr Roizman was sentenced to three-and-a-half years in prison for kidnapping drug addicts. Yegor Bychkov said addicts‘ parents had given him permission to „cure“ their children. „Patients were tortured, chained up to steel beds, starved,“ says Ms Sarang. „It was absolutely outrageous and when the court case against him started, we thought there would be a scandal.“
But a huge wave of support for Mr Bychkov swept through the country. Even many from Russia’s beleaguered human rights community joined with church figures and government officials to condemn his trial and in the end the court suspended his sentence and he was released. Mr Bychkov was „overenthusiastic“, said Mr Roizman, but his heart was in the right place.
Ms Teplinskaya, who is still a heroin user, travelled to Moscow last week to meet Navi Pillay, the UN High Commissioner for Human Rights, and ask her to press the Russian government on substation therapy. „I think I could have done a lot of good things for my country,“ she said. „But instead, I’ve lost my home, my health and my family. Methadone could have helped me lead a normal life.“
But her opponents are confident their views will prevail. Mr Roizman says: „They can shout as much as they want with their Western money. Methadone will never be legal in Russia.“
(Reuters) – In her one-room flat, as a small shelf of porcelain cats looks on and the smell of mold hangs in the air, Zoya pulls down the left shoulder of her black blouse and readies herself for her next hit.
A friend and ex-addict uses a lighter to heat a dark, pebble-like lump of Afghan heroin in a tiny glass jar, mixes it with filtered water and injects it into Zoya’s shoulder. The 44-year-old widow is a wreck: HIV-positive, overweight and diabetic. After 12 years of dealing and drug abuse, the veins in her forearms and feet are covered in bloody scabs and abscesses, too weak and sore to take fresh injections.
Crimson-dyed hair frames her bloated face, which is made up to match a hot pink manicure. As the syrupy brown mixture enters her system, Zoya’s eyes glass over and she ponders her fate and that of her country.
„There are a lot of us. What do they (the government) want to do? Kill us?“ she says. „They want to gather us together and drown us? I worry for tomorrow’s generation.“
If Zoya is anything to go by, today’s Russians are hardly flourishing. Russia has one of the world’s biggest heroin problems, with up to three million addicts according to local non-governmental organizations. Twenty one percent of the 375 tons of heroin produced from Afghanistan’s opium fields now finds its way through central Asia into Russia, according the United Nations. (By contrast, China, with nine times more people, consumes just 13 percent.) The Russian government estimates its citizens bought $17 billion worth of street-traded heroin last year — about seven billion doses. The addiction kills at least 30,000 Russians a year, which is a third of the world’s total heroin-related deaths, adding to pressures on the country’s already shrinking population.
So grave is the problem that President Dmitry Medvedev last year branded heroin a threat to national security.
That’s one reason why last October, 21 years after the end of the decade-long Soviet war in Afghanistan, Russian troops joined forces with U.S. soldiers for a joint drug raid on four Afghan labs. The operation, which destroyed nearly a ton of heroin, was hailed a success and the Cold War foes said they would like to see more such operations in Afghanistan, which is responsible for 90 percent of the world’s heroin production.
At home, though, Russia has been far less active in tackling the problem. Critics go as far as to accuse Moscow of wilfully neglecting its citizens and thereby fuelling what the World Health Organization says is one of the fastest growing HIV/AIDS epidemics in the world.
Unlike most countries around the world, Russia refuses to finance harm reduction programs such as needle exchanges, or to legalize methadone. Over the past few months, Moscow has decided to discontinue the work of foreign donors and NGOs with heroin addicts. It even recently blamed foreign groups for worsening the country’s HIV epidemic.
Health experts and drug addicts alike point to official inaction as the real culprit. It’s as if Moscow has misinterpreted the old U.S. anti-drugs slogan „Just Say No“ and turned its back on the crisis. „My government does nothing for me. I am no longer a person in this society,“ says Zoya, who lives in Tver, a drab city of half a million just off the Moscow-St Petersburg highway, and whose husband, also an addict, died from AIDS several years ago.
Anya Sarang from the Andrey Rylkov Foundation for Health and Social Justice, a small UN-funded Russian organization set up in June 2009, says Russia is failing its people. „For the main groups prone to the disease — drug users, sex workers, migrants — there is absolutely nothing for them,“ says Sarang.
THE PROUD BEAR
Russian officials have a long history of denying crises. From the Soviet government’s refusal to help during the famine of the 1920s to its delay in responding to the 1986 Chernobyl nuclear accident, responses from the top have often mixed disregard and cover-up. During last August’s heat wave, as peat fires and acrid smoke killed hundreds, officials kept silent on the wider health effects of the smoke for weeks.
One of the reasons for the rush to denial lies in the national psyche. Russia is a deeply patriotic country, with a long history of strong governments far removed from the everyday concerns of ordinary citizens. After the humiliating collapse of the Soviet Union 20 years ago and the calamity and poverty that followed, the strongman rule of Vladimir Putin (former president and current Prime Minister) has allowed the Russian bear to flex its muscles on the international stage again.
But while Moscow crows about hosting such high-profile sporting events as the Winter Olympics and soccer World Cup, it ignores daily reality, says health worker Sarang. „Russia is trying to preserve a certain political image, showing that everything is fine,“ she says. „This has shown to be nothing more than a lie.“
Most Russians see the truth all around them. Zoya’s story is repeated so often across the country’s nine time zones that the reality is hard to ignore. Even the government estimates there are 1.8 million heroin users; activists and doctors put the number closer to 3 million, and in a study last June, the United Nations put it at 2.34 million or 1.64 percent of Russia’s population. That’s the world’s third highest heroin abuse rate in per capita terms after Afghanistan and Iran. In absolute numbers, the UN says, Russia is number one.
Heroin was virtually unheard-of during the Soviet era, but is now easy to buy in any city in the country. In Tver, a medium-sized city with relatively little industry and few job prospects for the young, the detritus of addiction — used syringes, needles — litters the streets. Deals are a regular sight on street corners.
Russia’s anti-drugs tsar, Viktor Ivanov, who heads the Federal Drug Control Service — a powerful government body given to U.S.-style rhetoric about the ‚War on Drugs‘– blames the country’s porous Central Asian borders for the heroin hunger.
„Unfortunately, in 1991 we suddenly found ourselves without borders,“ Ivanov told reporters in December, referring to the collapse of the Soviet Union.
Ex-Soviet Tajikistan, which borders Afghanistan and is one of the world’s poorest countries, has long been a haven for drug smuggling out of Afghanistan, where the Tajiks have ethnic ties. From there the heroin flows through Kyrgyzstan and Kazakhstan and into Russia.
INTERTWINED WITH AIDS
The drug problem has now become an AIDS problem. Officially, Russia has 520,000 registered HIV-positive people. The UN and local NGOs say there are probably closer to a million, maybe even more. HIV/AIDS has spread rapidly over the past decade, especially among drug users who regularly share dirty needles. The government estimates around a third of all drug users in Russia are HIV-positive; and international and Russian health experts worry the disease is beginning to spread to the general population through heterosexual sex.
The biggest problem, say health experts, is the government’s refusal to address Russia’s drug addiction. The lack of official intervention is remarkable. There are currently just 70 needle exchange and distribution programs in Russia, reaching a mere 7 percent of heroin addicts according to the London-based International Harm Reduction Association (IHRA). In terms of needle exchanges, „Russia is not even scratching the surface,“ says Rick Lines, executive director of the IHRA.
All the programs are run with foreign funding. Government support: nil. It’s not as if the government is powerless. In the one area of the HIV/AIDS epidemic where it is active — mother-to-child transmission — it has reduced transmission rates to almost zero.
HIGHWAY AIDS TEST
In the face of government inaction, grassroots groups have mushroomed across the country.
Outside Tver, Yuri Suring parks his beat-up black Toyota at a truck stop along the Moscow-Saint Petersburg highway every night. There, between 7 pm and 4 am, he surreptitiously doles out clean needles and condoms to prostitutes, many of whom work to support their drug addictions. „If I were not here, where would these girls go? Who would help them? No one,“ Surin says as a trio of prostitutes in knee-high boots and bomber jackets approaches the car.
Surin’s organization, We And AIDS, consists of himself, a second outreach worker and a driver. The supplies he hands out every night and the kits he uses to test women come, he says, from sympathetic doctors and western groups who want to help.
On a cold night in November, 20-year-old prostitute Olga slips into Surin’s car for an AIDS test. Surin rubs a two-inch indicator on her gums and inserts it into a small plastic tray while Olga nervously smokes a cigarette and shakes her black-bobbed head from side to side in anger at her fate, her gold leaf-shaped earrings swaying.
After studying the result — negative — the prostitute flings the indicator out of the car window and then hops across the gravel into a truck cabin where customers — two large middle-aged truckers — are waiting.
The Health Ministry says it spent 10 billion roubles ($320.5 million) on HIV/AIDS testing and treatment — mostly antiretroviral drugs — in 2010. But activists and health experts say this amount compares badly with other countries in the G20 and sufferers are routinely ignored.
In a 2010 report, the World Health Organization said just a fifth of Russians who needed AIDS drugs were receiving them. South Africa, which has the biggest HIV-positive population in the world — and whose government until recently was criticised as being in denial on AIDS — gives AIDS drugs at almost twice that rate.
„Appeals, trials and public action — nothing works,“ says Alexandra Volgina, head of The Candle Foundation for HIV-positive people, a non-governmental organisationorganization in Saint Petersburg.
When asked why so many sick Russians lack access to AIDS drugs, the health ministry’s spokesman responds: „The amount spent was deemed sufficient.“
POPULATION PROBLEMS
Russians usually blame alcohol for their health problems. Official data shows the average Russian drinks 18 liters (38 pints) of pure alcohol every year, compared with 14 liters in France and eight in the United States.
Official campaigns against drinking have been pursued sporadically since Tsarist times, usually with little success. In September last year Russia banned night-time sales of heavy alcohol, following on from a proposal to double the minimum price of vodka over the next two years in an effort to curb drinking.
„They (the government) are nicer to alcoholics than they are to us,“ says 32-year-old heroin addict and Tver resident Valera, whose scaly hands and face are covered in bright pink scabs from a decade of use. Like many drug addicts, Valera does not work and refuses to say how he funds his $300-a-day habit.
The Geneva-based International Aids Society Aids Society (IAS) warns that if Moscow continues to take no measures, the number of new HIV infections in Russia is likely to grow by 5-10 percent a year, pushing the problem to „an endemic level“, according to IAS president Elly Katabira: the rate will stay constant even without any additional infections from outside the country.
That would hit Russia’s already dwindling population — recently called a „demographic crisis“ by President Medvedev. Heavy smoking, alcoholism, pollution, poverty, low birth rates in the years after the fall of Communism, as well as HIV/AIDS underpin UN projections that the population will shrink to 116 million by 2050 from 142 million now. Moscow — which now gives money to mothers bearing two or more children – targets a population of around 145 million by 2025, but concedes that it could fall to as low as 127 million by 2031.
DESPERATE FOR METHADONE
If one thing appals foreign health officials and activists more than anythappallsing else about Moscow’s response to its heroin problem, it’s the ban on methadone. The WHO regards methadone as essential in combating heroin dependence, but in Russia anyone caught using it or distributing it can face up to 20 years in prison — as harsh a sentence as that for heroin.
Called a replacement drug, methadone is taken by mouth — so reduces the risk of HIV infection by using shared needles — and is used around the world to treat opiate addiction. Russia is one of just three countries in Eastern Europe and Central Asia to ban the drug, alongside Turkmenistan and Uzbekistan, where heroin consumption is relatively low. China, which has over one million registered heroin addicts, with unofficial estimates running several times that, has more than 680 methadone sites.
Methadone is a potent synthetic opiate in its own right, but it can eliminate the agonizing withdrawal symptoms that addicts experience when they quit heroin. Its main advantages are that it has to come from a health-care source, in controlled doses and without needles. That gives addicts some chance, over months or sometimes years, to go clean for good.
In Tver, Yuri Ivanov, a doctor and the deputy head of the state-run Tver Regional Narcology Clinic, is dumbfounded by the ban. „Why do civil servants limit me from doing my work?“ he asks in his dimly lit office in the crumbling grey clinic, which sits off an unpaved muddy lane in the center of the city. „All that they are trying to do is the opposite of what we need. It is hard for me to understand… The situation is going backward. When there is no real medicine, they go right back to drugs.“
Ivanov sometimes resorts to giving his patients tropicamide, a drug used by eye surgeons to dilate the pupils and which has a similar effect to heroin.
Addicts talk of their rare encounters with methadone users with a sense of wonder and even magic. „All of us know about this drug methadone and all of us want it. People come through who have done it and we can instantly see how much brighter and better they live,“ says Tver addict Valera in jittery sentences, high after shooting up twice by midday, in an interview in the back of his tobacco-stained car.
But Moscow won’t be swayed. „The medicine has become more dangerous than the illness. It would be replacing one evil with another,“ said the anti-drugs baron Ivanov. „And why on earth would we do that?“ Gennady Onischenko, the country’s top doctor, repeatedly dismisses methadone as „still a narcotic“.
In a major government anti-drug strategy launched last June, there was no mention of substitution therapy, even though Moscow says it is now focused on reducing the demand for drugs. That means that Russia’s measly four federal and 77 regional rehabilitation centers will continue to treat addicts with psychotherapy, counseling or simple painkillers.
CHAINED TO BED FRAMES
The vacuum created by the lack of effective substitution therapies was highlighted in an incident last October in the Ural Mountains town of Nizhny Tagil. Anti-drugs activist Yegor Bychkov, 23, was sentenced to three and a half years in prison for kidnapping drug addicts. Bychkov said he had received permission from the addicts‘ parents to forcibly take their sons and chain them to steel bed frames while they underwent a painful detox.
Anti-drugs chief Ivanov praised Bychkov, saying he had acted in good will; the head of the parliamentary health committee Olga Borzova said the state was to blame for his arrest as he had become desperate.
The Russian Orthodox Church also weighed in. Though its official stance is against sex education and it regards heroin use as a sin, it has set up its own rehabilitation centers which offer religious guidance. The Church also holds regular discussions with the UN over the HIV/AIDS crisis.
Unfortunately, those sorts of initiatives may be risky. Almost two years ago, the General Prosecutor’s Office was ordered by Russia’s Security Council to beef up prosecutorial measures against non-governmental organizations which advocate substitution therapy. Since then, activists distributing free needles have been detained on charges of aiding illegal drug use.
„Russian government officials consistently promote falsehoods about harm reduction, and deter those who speak in favor of them,“ the IHRA’s Rick Lines says. „Speaking honestly about the vast body of evidence supporting the effectiveness of methadone is a dangerous thing to do (in Russia).“
That may be why relations between the UN’s Global Fund to Fight AIDS, Tuberculosis and Malaria — which has been pushing for methadone legalization — and Russia’s health ministry ruptured at the end of last year. The Global Fund provides the most finance for HIV/AIDS prevention in Russia and granted $351 million to Russia for 2004-11. Now $16 million of that allocation remains, and is at risk of being cut this year.
Worse, say global health experts and local NGOs, is the health ministry’s decision to scrap the Global Fund’s needle distribution, HIV awareness and medication programs. „They proved ineffective and we shall not continue them after 2011,“ said Alexander Vlasov, the ministry’s spokesman.
In October, the health ministry directly accused the Global Fund of making the HIV epidemic worse. „In the regions where these (Global Fund needle) programs were operating, the spread of HIV infection increased three-fold,“ minister Tatyana Golikova told a narcology conference.
The Fund says it is keeping up a dialogue with the Health Ministry. But global health experts warn that the decision to end the Global Fund’s work in Russia will be catastrophic. „Russia will fall behind and lose the achievements made so far,“ warned IAS president Katabira. „We will not be able to recover the situation.“
Cable dated:2006-05-23T11:49:00
C O N F I D E N T I A L SECTION 01 OF 03 PHNOM PENH 000983
SIPDIS
SENSITIVE
SIPDIS
STATE FOR EAP/MLS, INL/AAE–PETER PRAHAR AND YANTI KAPOYOS, INL/C–GREG STANTON
E.O. 12958: DECL: 05/23/2016
TAGS: SNAR, PGOV, CB, TW
SUBJECT: CAMBODIA: DRUG SEIZURES AND ARRESTS UP
1. (U) SUMMARY: May 19 and 20 arrests of two Taiwanese nationals attempting to smuggle a total of nearly 7 kg of heroin to Taiwan highlight increased drug arrests and seizures in Cambodia. The quantity of heroin seized during the weekend airport busts is large by Cambodian standards–authorities seized just 11 kg of heroin in 2005. Seizures of amphetamine-type stimulants are more than double last year’s levels. Police and international observers credit USG and other foreign training with providing skills, motivation, and international pressure for the increase, but say that narcotics trafficking may also be on the rise. END SUMMARY.
Heroin Seizures at Phnom Penh International Airport
——————————————— ——-
2. (U) Police and customs officials seized nearly 7 kg of heroin and arrested three Taiwanese nationals in two separate incidents at Phnom Penh International Airport on May 19 and 20. These two cases represent an impressive intake for one weekend given that in 2005 Cambodian authorities seized just over 11 kg of heroin.
3. (SBU) Chen Hsin Hung, 57, was arrested on May 19 carrying 4.75 kg of heroin with a local street value of USD 95,000 to 133,000. Customs officials became suspicious when they noticed that Hung was carrying several bags of imported Taiwanese foil-wrapped candies back to Taiwan in his hand luggage. The candies turned out to be foil-wrapped packages of heroin. Hung, who was due to travel to Taiwan via Kuala Lumpur on Malaysian Airlines flight 755, had arrived in Phnom Penh the previous day. During his police interrogation, Hung said that he had been picked up at the airport and returned to the airport by a couple, whom the police identified as a Cambodian woman and a mainland Chinese or Taiwanese man. Police are attempting to locate the couple.
4. (SBU) A second Taiwanese man, who was standing near Chen Hsin Hung during the security process, appeared to be quite interested in the proceedings and upset by Hung’s arrest, and had tickets for the same flight as Hung, was also arrested on suspicion of drug trafficking. Moek Dara noted that the investigation had revealed no evidence to indicate that the second individual was also involved in drug smuggling, but that it was the prosecutor’s decision how to proceed in the case.
5. (SBU) On May 20, a 90-year-old Taiwanese national named Huang Sang Hou was arrested at Phnom Penh International Airport with 1.9 kg of heroin, worth USD 38,000 to USD 53,000. Hou reportedly came to Cambodia as a tourist intending to gamble. Over the course of a week, he lost the USD 4,000 he brought with him, borrowed an additional USD 2,000 from a Taiwanese national in Phnom Penh, and then lost that money as well. The Taiwanese lender then persuaded Hou to carry the heroin back to Taiwan. Airport customs officials were tipped off by the sloppy manner in which the heroin was packed on Hou’s body, making him appear bloated. Hou cooperated with the police in identifying the Taiwanese lender, and Cambodian government officials have already passed his name, address, and passport information to the Drug Enforcement Administration (DEA). Hou had been planning to fly Dragon Airlines flight 207 to Hong Kong, and then to continue on to Taiwan.
Amphetamine Seizures, Prices on the Rise
—————————————-
6. (SBU) According to statistics from the Ministry of Interior’s Anti-Drug Police and the National Authority for Combating Drugs (NACD), seizures of amphetamine-type stimulant (ATS) tablets more than doubled when comparing the first four months of 2006 with the first four months of 2005. From January to April 2006, more than 220,000 ATS tablets were seized, whereas from January to April 2005, approximately 87,000 ATS tablets were seized. The number of offenders arrested also rose from 154 from January to April 2005 to 204 during January to April 2006.
7. (U) Both Brigadier General Moek Dara, Director of the Anti-Drugs Department, and World Health Organization XXXXXXXXXXXX noted that prices for ATS tablets have risen in the past few years, with particularly dramatic increases in the past 12 months. One year ago, a single ATS tablet sold for approximately one dollar in Phnom Penh, but now costs two to three dollars. Moek Dara noted that prices rise as the ATS tablets make their way along the drug route, from fifty cents per tablet in Laos, where the
PHNOM PENH 00000983 002 OF 003
majority are produced, to USD 3 in Cambodia, and then even higher prices in two destination countries: USD 4 in Vietnam and USD 7.50 in Thailand. XXXXXXXXXXXX cited anecdotal evidence from NGOs that some ATS users are switching to injecting heroin, currently available for USD 1.50 to 2 in Phnom Penh, as a cheaper alternative to rising ATS prices.
Lower Ecstasy Seizures Likely Point to Disrupted Network ——————————————— ———–
8. (U) In contrast to the dramatic rise in ATS seizures, seizures of ecstasy tablets are down sharply, from 1,900 in January to April 2005 to less than 800 in January to April 2006. Moek Dara and XXXXXXXXXXXX believe that lower levels of ecstasy seizures are a sign that supply has been disrupted following a cooperative DEA/Anti-Drug Police controlled delivery operation against the Peter Brown drug ring in 2004 and continued Anti-Drug Police action against the ring in 2005.
USG Training Provides Needed Skills, International Pressure
——————————————— ————–
9. (SBU) Moek Dara gave much of the credit for the dramatic increase in heroin and ATS seizures and drug arrests to counternarcotics training funded by the State Department’s Bureau of International Narcotics and Law Enforcement Affairs (INL) and conducted by the DEA. Before the training sessions, which were conducted in January and April 2006, police officers along Cambodia’s porous northern border were not very active and would not even conduct foot patrols in the forest, according to Moek Dara. Now, however, the officers have more skills and are more motivated to patrol actively, he said, and have seized drugs and a lot of drug production equipment as well. Customs, immigration, and police officials at the airports are also better trained and more active, and Moek Dara noted that all of the officials involved in the weekend’s airport arrests had completed DEA training.
10. (C) XXXXXXXXXXXX gave partial credit for increased anti-drug activity to counternarcotics training by the US and other foreign donors. Some high-ranking Cambodian police and military officials are rumored to be complicit in narcotics trafficking, he noted. He speculated that the training and pressure on the Cambodian government to clamp down on drug activity has finally made an impression on higher ranking officials, and lower-level officers are „being allowed“ to make more seizures. At the same time, such a dramatic increase is probably also an indication of efforts to traffic increased amounts of ATS through Cambodia, he opined.
Trainees Enthusiastic about INL/DEA Courses
——————————————-
11. (U) Provincial Anti-Drug Police officers who attended the January Basic Counternarcotics course reported uniformly enthusiastic assessments to an embassy follow-up survey. Participating police captains reported an increased awareness of drug smuggling tactics, best practices in seizing and preparing evidence, and how to identify drugs using field test kits. Captain Preap Sovann of the Svay Rieng Anti-Drug Police noted that the training also promoted inter-agency and inter-province cooperation as well. All captains reported training their staffs in the key topics covered by the DEA training, and captains in Koh Kong and Pursat provinces reported conducting anti-drug outreach to primary and secondary school students as well. Trainees suggested that future courses provide written materials in Khmer as well as English, include information on money laundering, have more laboratory equipment available for in-class practice in drug identification, and include more time in simulations.
Police Officer Arrested on Drug Charges
—————————————
11. (C) Nov Sophal, a municipal police officer in the southern city of Kep, was arrested on April 15 and charged with trafficking 1 kg of heroin. Moek Dara was not expansive when asked about the case, noting simply that it is not uncommon for low-ranking police and military officials to be arrested for drug trafficking. In contrast, XXXXXXXXXXXX noted that drug investigations of police or military officials are very rare, and speculated that the individual involved may even have run afoul of rumored higher-level police involvement in narcotics.
12. (SBU) COMMENT: While increased smuggling activity may
PHNOM PENH 00000983 003 OF 003
account for some of the increased seizures and arrests, it is clear that the Cambodian government is turning up the heat on the country’s drug smugglers. Training from the USG and other countries is playing a critical role in supporting this effort–both through the skills and enthusiasm imparted to the participants, and also through the implicit expectations of improved performance on the part of the police and other officials.
STORELLA
source: http://www.guardian.co.uk/world/us-embassy-cables-documents/65065
Russia has one of the fastest spreading HIV epidemics in the world, driven largely by the government’s refusal to institute measures to treat the country’s drug addicts — measures that have dramatically reduced HIV infections in drug addicts in other countries, including the U.S.
The New York Times reported yesterday that 60,000 new cases of HIV were seen in Russia in 2009, up 8% from the prior year. At least 60% of those new cases were spread by intravenous drug use, according to the Times, and a good portion of the rest of the new cases were likely the result of sex with drug addicts. (More on Time.com: Drug Policy Backfires: Controlling Meth Ingredients Fails to Cut Drug Supply)
Writes the Times‘ Michael Schwirtz:
Officials estimate that well over a million people abuse drugs intravenously in Russia, often sharing and infecting one another with tainted needles. They are among Russian society’s most marginalized people, more likely to face a few weeks handcuffed to a clinic bed than to receive basic treatment to break their addictions. Meanwhile, officials have treated sex education and other preventative programs with open hostility.
“Which are the main infected groups? Injecting-drug users and sex workers,” said Lev Zohrabyan, the Europe and Central Asia adviser for Unaids. “It turns out that these are the groups where the money must be directed to change the picture. But if you open the budget, you will see that for prevention work among these groups for the next two years there is nothing.”
According to Schwirtz, Russia blames America’s failure to eradicate Afghanistan’s opium crops for the IV drug problem in Russia. But if the U.K.’s current shortage of heroin, due to Afghan crop failures this year, are any indication, the international heroin supply has actually been significantly reduced. Regardless, changes in the supply side have never had any impact on the HIV epidemic.
So, what’s really driving Russia’s problem? Politics. The country has a long-standing ideological opposition to the use of “substitute” maintenance drugs like methadone and buprenorphine to treat IV drug addicts. Yet methadone is the best known treatment for heroin addiction: according to numerous reviews of the voluminous international data, it reduces relapse and death rates better than any other treatment, including all therapies based on abstinence. The effectiveness of buprenorphine treatment for heroin addiction is also well-supported by research. (More on Time.com: Salvia, a Mexican Hallucinogen Piques Scientists‘ and Regulators‘ Interest)
In all countries that have successfully reduced HIV infection rates among intravenous drug users, health officials have instituted maintenance treatment programs. But they have all also simultaneously increased clean-needle availability — the other public-health measure that undergirds many effective AIDS-prevention programs. In that respect, Russia has not been entirely remiss: it does offer some needle-exchange programs that provide addicts with clean syringes and educate them not to share.
Alone, methadone maintenance programs and legal needle-and-syringe exchanges cannot stop an epidemic. But the evidence is pretty clear that together, they can. Case in point: New York City.
In the not too distant past, New York was the epicenter of the AIDS epidemic among America’s drug addicts. In the early 1990s, at least half of all intravenous drug users in the city were HIV-positive. But a recent study of HIV infection rates among injected-drug users in New York found that while 21% of addicts tested positive for HIV between 1984 and 1994, that figure dropped to just 6% in people who used IV drugs between 1995 and 2008.
What changed? The two groups are distinguished by the prevention measures most available to them. In the 1980s and early ’90s, New York City had a large methadone treatment system, but awareness of the spread of HIV among drug addicts was initially low; at the time, syringe exchange programs were also either illegal or just getting started, and needle possession was illegal. (More on Time.com: The Most Dangerous Drugs? Alcohol, Heroin and Crack — in That Order)
In 1992, needle exchanges were legalized in New York City, and massively expanded by 1995. Over-the-counter sales of syringes in New York became legal in 2001.
Nationally, the AIDS epidemic in addicts has subsided too, with only 12% of new cases linked to IV drug use, down from more than 1 in 3.
Given that the data overwhelmingly show that maintenance programs and needle exchanges, together, can significantly reduce the spread of HIV, Russia’s refusal to treat the country’s million-plus drug users is putting millions more of its citizens — including nonusers who may be partners of drug users or of infected former partners — at deadly risk.
The public policy debate on Afghan opium is filled with simple narratives (i.e., it is mostly opium that fuels the insurgency, poppy farmers are wealthy) justified by simple metrics and responded to with simple solutions. The problem with simplicity, of course, is that it crowds out complexity and propels us toward ineffective and even counterproductive policies.
Much of the counternarcotics debate in Afghanistan focuses obsessively on cultivation numbers produced by the United Nations Office on Drugs and Crime’s (UNODC) annual opium survey, with annual changes in cultivated area used as indicators of policy success or failure. Yet such changes are the result of a range of factors, including price shifts, household perceptions of future food insecurity and larger market forces. They are therefore transient, not necessarily indicative of fundamental changes in the rural economy.
For instance, last year’s 22 percent reduction in national opium acreage was largely attributed to the distribution of wheat seed and fertilizer in Helmand Province, which by itself produces around half of Afghanistan’s opium. But this reduction was less the result of policies and programs than farmers‘ rational response to the changing relative prices of wheat and opium. Memories of high wheat prices and concerns over insecurity in central Helmand continue to shape planting decisions, highlighting the fact that farmers give greater priority to managing the risk of food insecurity than to maximizing profits. After all, one can’t eat opium poppy no matter what its price.
The addiction to annual cultivation numbers has similarly produced praise for the firm commitment and strong hand of the provincial governors in Balkh and Nangarhar, the two provinces most lauded for success in becoming „poppy free“ in 2008 (in 2009, some poppy cultivation resumed in Nangarhar). Yet short-term reductions brought about by coercion may not be sustainable, and the side effects include migration to Pakistan (with attendant risk of radicalization), increasing enlistment in the Afghan National Security Forces under duress, sales of household assets and incurring of debt—as well as the potential undermining of support for the national government, which was seen as the driving force behind the coercion.
Fieldwork done in the areas hardest hit by the opium ban in these two provinces reveals a widespread perception that the economic impact on the general population has been too severe and that the social „contract“ under which reductions have been made is breaking down. In fact, one could argue that coercive suppression of cultivation in areas where there are no other viable sources of income is leading to greater instability—and thereby establishing preconditions for increased cultivation. One needs only to look at recent insurgency penetration in a number of districts in Nangarhar to see what appears to be the failure of success.
Some of the narratives analysts use to justify an aggressive approach to opium poppy reduction, including the „nuclear option“ of aerial chemical spraying, are built on „faith-based“ policy and questionable data. Several years ago, for instance, a US military commander mentioned that the percentage of the insurgency funded by the opium trade was likely between 20 and 40 percent, although an „international expert“ had said that the percentage could reach 60 percent; within weeks, much of the media had discarded the caveats so that 60 percent became the number of record. In some counterinsurgency circles, the belief that only 10 percent of the population is directly engaged in cultivation legitimates coercive measures on the grounds that even the harshest approach will not alienate the majority of the population. Yet the figure is based on a flawed methodology, and it ignores both the multiplier effect of the created wealth as well as bonds of solidarity, by which communities will band together to resist outside threats to life and livelihoods.
Such arguments also tend to shift from year to year. In 2007, UNODC proclaimed that „opium cultivation is no longer associated with poverty—quite the opposite.“ But by 2009 it was saying that „opium remains a major source of income in one of the world’s poorest and most unstable countries. Farmers may grow it to stave off poverty…. Eradicate poverty, not just poppies.“
The past two years have brought a welcome respite from the eradication debate, in part because of the Obama administration’s focus on the interdiction of traffickers rather than the destruction of crops, and in part because the military has sensibly recognized that obliterating Afghan rural livelihoods does not win hearts and minds. Still, there are forces that remain committed to a more aggressive eradication strategy, and they may be revived if the number of hectares heads upward in key provinces. If this year’s opium figures show an increase in cultivation, brace yourself for lurid headlines, Congressional delegations and calls to abandon a failed policy.
Rather than constantly alternating between back-slapping and hand-wringing, in the discussion over counternarcotics we should keep in mind that the transition away from opium is a long-term process and that the annual ups and downs are somewhat irrelevant. We must recognize that one size will not fit all areas, and that we can’t simply view drugs as a „bad“ to be stomped out while ignoring the role they play at all levels of the political economy. Ironically, aspects of the opium economy have contributed to stability and development by generating financial flows that have, in turn, been used to fund other licit economic activities, while counternarcotics policies have destabilized areas by forcing households deeper into poverty and by undermining political arrangements.
Above all else, acknowledging that drugs are a part of the rural economy and social structure in the distressed environment of a country wracked by decades of war and violence will allow us to focus on governance, security and economic growth—which will facilitate a slow but steady transition out of opium rather than spending on stovepiped, single-season interventions.
Source: http://www.thenation.com/article/157630/addicted-numbers
SHAN STATE, 13 January 2011 (IRIN) – Poverty and lucrative profits make poppy cultivation increasingly attractive to farmers who would otherwise produce legal crops to feed their families and make a living, say experts.
„More of the rural poor continue to be drawn into participating in the illicit drug trade as a last means of finding money to feed their families,“ Jason Eligh, Country Representative for the UN Office on Drugs and Crime (UNODC) Myanmar, told IRIN.
Shan State, 400km north of the capital, Yangon, between Myanmar, Laos and Thailand, produces more than 90 percent of all opium in Myanmar, an estimated 35,000 tons in 2010, according to UNODC.
UNODC is the only international agency directly involved in supporting different crops in poppy cultivation areas, with three agriculture projects in southern Shan State trying to reach 100,000 people. However, much more needs to be done to stop farmers from reverting to opium production, said Eligh.
„UNODC wants to see a strong alternative development response, one that includes market access, community mobilization, access to credit, improved technology and better overall infrastructure in rural areas.“
Cash crop
In 2010, a higher proportion of farmers‘ income came from poppies than in previous years, reversing a trend of steady decline in the past six years.
Between 2003 and 2009, the proportion of total household income from poppies fell from 70 to 20 percent, according to a December 2010 UNODC report.
In 2010, however, high prices paid for poppy in Myanmar and low food security throughout the country meant income from the seed contributed to 43 percent of total household income in Shan State, the report stated. About a quarter of the state’s population was involved, estimate aid agencies.
Though prices at source (farm-gate) for poppy fell marginally in 2010 from 2009, opium overall remained lucrative at US$305 per kilo. Poppy farmers can earn 13 times more money cultivating poppies than rice, making poppies the cash crop of choice for most, based on the UNODC report.
Farmers forced out of poppy cultivation are having problems growing other food to survive. „I grow enough vegetables to keep my family going, but that is all,“ U Tin Kyi told IRIN.
U Tin Kyi grew poppy seeds to supplement his income until authorities destroyed his fields two years ago. Like many of his neighbours in this hilltop village, U Tin Kyi has little extra income. „The fuel cost to get to the market outweighs any profit I would make from selling vegetables,“ he told IRIN.
Eradication efforts
Poppy cultivation continued to rise in Myanmar in 2010, despite an official 15-year drug elimination plan developed in the late 1990s. In 2009, the authorities initiated the final five-year phase of this plan.
Government figures claim 8,268 hectares of poppy-cultivating land were eradicated in 2010, a 102 percent increase on the previous year.
But other groups calculate that Myanmar’s poppy cultivation area and yield actually increased during this period.
„In 2010 we estimate that there [was] 20 percent more area under opium poppy cultivation, a 46 percent increase in average opium yield, and a 17 percent increase in the number of households involved in domestic opium poppy cultivation,“ said Eligh of UNODC.
In northern Shan State, in 2008, government figures showed 25 percent of poppy fields were destroyed, but a 2010 report by Palaung Women’s Organization (PWO), an NGO based in Mae Sot along the Thai-Myanmar border, stated only 11 percent of poppy fields had been eradicated.
Government anti-drug teams were only destroying easily visible poppy fields and filing false eradication data to the police headquarters, the report said. At the same time, farmers were forced to pay taxes to continue growing poppies.
In Mantong village in northern Shan State, PWO estimated the government collected approximately $37,000 in poppy taxes in 2008.
(lsw) Künstliches Heroin auf Rezept ist für viele Schwerstabhängige der letzte Weg aus dem Sumpf. Doch wann es eine flächendeckende Versorgung gibt, ist unklarer denn je. Nicht selten fehlt es einfach an Patienten mit den notwendigen Voraussetzungen.
Bund und Land sind mittlerweile willig, die Krankenkassen signalisieren Einverständnis – und doch läuft die Diamorphin-Abgabe für Schwerstabhängige in Baden-Württemberg nur schleppend an. Das unternehmerische Risiko, das eine neue Abgabestelle für künstliches Heroin birgt, ist oft zu groß. Nach Angaben des Gesundheitsministeriums steht die Stadt Stuttgart in den Startlöchern. Der Gemeinderat hat sich Ende November berichten lassen, wie die gesetzlichen Voraussetzungen für eine Abgabestelle sind. Doch: „Vor 2012 wird es sicher nichts“, schätzt Hans Gros, Suchthilfeplaner der Landeshauptstadt.
Hohe Auflagen
Bevor der Gemeinderat grünes Licht geben könne, müsse die Finanzierung stehen. Und danach dauere es sicher noch ein Jahr. Dabei würde Suchtmediziner Andreas Zsolnai, der die Anlaufstelle betreiben soll, am liebsten bald loslegen. Die rechtlichen Vorgaben seien erfüllt, auch Kooperationspartner habe er schon. „Doch wegen der Auflagen und des hohen Personalschlüssels ist das betriebswirtschaftliche Risiko so hoch, dass ein einzelner Arzt wie ich das nicht schultern kann.“
Bis sich die Abgabestelle trägt, braucht es nach Schätzung der Fachleute rund 50 Patienten. Sie müssen unter anderem mindestens 23 Jahre alt und seit fünf Jahren abhängig sein. Voraussetzung sind zudem zwei gescheiterte Therapieversuche, etwa mit Methadon. Die hohen Hürden führen dazu, dass laut Gesundheitsministerium von den rund 9000 Schwerstabhängigen im Land nur etwa 200 bis 300 die Voraussetzungen für die Diamorphin-Behandlung erfüllen.
Modellprojekt
Eine Anlaufstelle in Stuttgart könne sich durchaus tragen, sagt Zsolnai. Wie lange es aber dauere, bis die notwendigen Patienten auch in die Praxis kommen, könne er nicht schätzen. „Irgendjemand müsste für die Anfangszeit grade stehen. Es bräuchte vielleicht ein fünfjähriges Modellprojekt.“ Für die Räume gibt es ebenfalls enge Vorgaben – aus Sicherheitsgründen. Zsolnais derzeitige Praxis im Gesundheitsamt wäre zu klein. In seinen Augen drängt die Zeit, weil jederzeit Kooperationspartner abspringen könnten. „Wenn es nicht innerhalb des nächsten Jahres festgezurrt wird, besteht die Gefahr, dass es im Sande verläuft.“
Als mögliche Standorte für die Diamorphin-Zentren waren im Sommer auch noch Mannheim, Freiburg, Heilbronn, Tübingen, Singen, Ulm und Ravensburg im Spiel. Doch sieht es vielerorts nicht rosig aus. „Viele dieser Anlaufstellen werden sich wohl nicht realisieren lassen“, sagt Joachim Holzapfel, Leiter des Suchthilfezentrums in Karlsruhe. Meist fehlten Patienten.
quelle: http://www.mainpost.de/regional/main-tauber/Kuenstliches-Heroin-auf-Rezept;art21526,5904860
Hundreds of drug users from Iran are turning up in Afghanistan’s western Nimroz province, with some claiming they were dumped there as undesirables by police from their own country.
Afghan officials worry that Tehran is exporting its social problems, although Iranian diplomats say there is no such policy. Others say that at least some drug users congregate in Afghanistan because narcotics are so freely available there and there are none of the draconian punishments meted out by the Iranian authorities.
Reza, 27, told how he was detained as a drug user in his home city of Zahedan in Iran’s Sistan-Baluchestan province, and was then included among a group of Afghan refugees who were being deported.
“I have documents showing I’m an Iranian national,” he told IWPR. “When I apply to government offices in Nimroz, they tell me to go to the border and ask the Iranian frontier officers to let me cross over. But when I go there, Iranian border officials abuse me and refuse to let me enter my own country.”
Reza says he sleeps in religious shrines in Zaranj, the main provincial town in Nimroz, and survives on the food he gathers from rubbish piles. He recently helped bury a friend. aged 40 and like him from Zahedan, who he says died “for lack of drugs”.
“Other addicts buried him between two graves,” he said.
Another man, Hossein, 38, said he was detained after family members in Iran’s Zabol province went to the police to complain about his chronic addiction problem.
He too said he was packed off across the border as part of a group of deported Afghan nationals. When he showed Afghan police his Iranian ID, they made efforts to send him home, but guards on the other side of the border would not admit him.
Mohammad Anwar Muradi, the head of the provincial counter-narcotics department, said ten to 15 Iranian drug users were entering Nimroz every week.
“There are currently about 2,000 drug addicts in Nimroz province, 80 per cent of them Afghans and Iranians deported from Iran,” he said. “It isn’t yet clear why Iranian border officials are deporting their own nationals to Afghanistan.”
The provincial police chief Hajji Musa Rasuli says his men have detained around 40 Iranian nationals in the region in the past two months, but have yet to pinpoint those living in Zaranj. His officers have tried to send ten drug users back home in recent weeks but Iranian frontier guards would not let them in.
Hajji Najibullah Alami, chief of staff in the provincial governor’s office, said the matter had been raised with Iranian officials, but no satisfactory response had been received.
An Iranian diplomat at the consulate in Herat, speaking on condition of anonymity, flatly denied that his country was expelling its own citizens. He suggested that individuals claiming to be Iranian nationals were in fact Afghans who had been properly deported, and were now seeking a way back into Iran.
“Anyone who has documents can enter Iran and will be assisted by Iranian border officers,” he said.
Residents of Nimroz province say many Iranians come and go voluntarily to enjoy the free market in heroin and other drugs.
“There’s no rigorous control in border areas, so Iranians come over from the other side, buy drugs and go back,” restaurant owner Hajji Sultan said.
He went on to voice a belief that appears to be widespread and was even articulated by some of the officials interviewed for this article, “Iran is deliberately deporting its addicts to Afghanistan in order to spread lethal diseases among Afghans.”
The Afghan government is struggling to provide drug treatment centres for the expanding number of users, and health officials in Nimroz say they do not have the resources to admit Iranian nationals as well. The country’s counter-narcotics minister, Zarar Ahmad Moqbel, recently said there was capacity to treat just one per cent of the estimated one million addicts.
Dr Nur Ahmad, the provincial health chief for Nimroz province, said no clinics existed to run medical checks on individuals – whether returning Afghan refugees or Iranians – as they entered the country.
“Initial assessments indicate that 50 per cent of addicts in Nimroz province are using needles, which increases the incidence of diseases like HIV/AIDS and hepatitis,” he said.
Zia Ahmadi is an IWPR-trained journalist reporting from western Afghanistan.
Source: http://iwpr.net/report-news/iranian-drug-users-%E2%80%9Cdumped%E2%80%9D-afghanistan
Hamburg. Bernd ist heroinabhängig und nimmt das Medikament Methadon, das ihm als Ersatz für den Drogenkonsum dient. Er ist seit Jahren Schmerzpatient. Seine Füße brennen, er kann nicht lange stehen, und er hat starke Spannungen in den Beinen. Bernd ist 47 und Rentner. Er sieht nicht aus wie ein alter Mann, aber seine langjährige Drogensucht, seine Schmerzen sind ihm anzusehen. 47 Jahre, das ist für einen Drogenabhängigen schon ein hohes Alter. Die meisten sterben vorher. Wenn diese Menschen alt- und pflegebedürftig werden, gibt es in Hamburg für sie keine entsprechenden Einrichtungen. Noch nicht. Die zuständige Behörde für Soziales, Familie, Gesundheit und Verbraucherschutz (BSG) hat vor diesem Hintergrund bei der Hamburgischen Landesstelle für Suchtfragen eine Studie in Auftrag gegeben. Diese befasst sich mit der Situation älterer Konsumenten illegaler Drogen und den zukünftigen Anforderungen an Versorgungskonzepte in der Sucht- und Altenhilfe. Die Ergebnisse liegen dem Abendblatt exklusiv vor.
In den 70er- und 80er-Jahren starben die Drogenkonsumenten zu 90 Prozent an Überdosen. Heute überleben viele mit Drogenersatzmitteln wie Methadon. „Dank besserer Medikamente und einem besseren Drogenhilfesystem wird die Lebenserwartung von Drogenabhängigen immer höher“, sagt Theo Baumgärtner, verantwortlich für die Studie. Die Abhängigkeit lässt die Betroffenen aber „biologisch voraltern“. Gesundheitliche Probleme, die sonst mit 70 Jahren auftreten, haben diese Menschen schon mit 40. Hamburgweit gibt es um die 1900 Opiatabhängige (zum Beispiel Heroin), die in ambulanter Betreuung und älter sind als 45 Jahre. Für das Jahr 2018 sagen die Autoren der Studie voraus, dass es fast 14 000 drogenabhängige Menschen geben wird, die älter sind als 45.
Das hört sich so jung an. Aber: „Drogenkonsumenten brauchen oft schon mit Mitte 40 Pflege“, sagt Waltraut Campen vom Malteser Nordlicht, einer Übergangseinrichtung für drogenabhängige, obdachlose Männer. „Wir haben viele Klienten, die ohne Hilfe in einer Wohnung nicht zurechtkommen. Die brauchen Unterstützung.“ Im vergangenen Jahr haben in ihrer Einrichtung 58 Klienten im Alter zwischen 40 und 59 Jahren Hilfe in Anspruch genommen. Wie stark ein Abhängiger voraltert, hänge mit dem Konsum unterschiedlicher Substanzen und mit dem stressigen Leben auf der Straße und in der Drogenszene zusammen.
Bernd übernachtet beim Malteser Nordlicht in Bahrenfeld zunächst für drei Monate in einem Zwei-Bett-Zimmer. Auf der Straße könnte er nicht mehr leben. „Ich brauche wegen meiner schmerzenden Beine spezielle Matratzen. Eine Nacht auf dem Boden, und ich würde auf der Intensivstation landen“, sagt er. Seine Drogengeschichte begann mit 17 Jahren. Erst konsumierte er Cannabis. Mit 19 Jahren begann Bernd eine Ausbildung zum Krankenpfleger. Zu dieser Zeit kam er mit Heroin in Berührung: „Viele Krankenhausmitarbeiter von damals, die Schichtdienst hatten, haben Heroin genommen, um das durchzustehen“, sagt er. Drei Jahre lang ging das gut: „Wir waren ja die Schlauen, dachten das im Griff zu haben.“ Er hatte es nicht im Griff. Auf die psychische Abhängigkeit folgte die körperliche. Er ging mehrmals auf Entzug, aber Bernd wurde immer wieder rückfällig. Fünf Jahre schaffte er es, zwischendurch clean zu bleiben. Die Folgen seiner Sucht, sie schlagen jetzt im Alter richtig durch: Viele Drogenabhängige wie er haben laut der aktuellen Studie Hepatitis und HIV. Hinzu kommen häufig Probleme mit den Lungen oder mit dem Herz-Kreislauf-System, Zahnprobleme, manchen müssen Gliedmaßen abgenommen werden.
Ältere Menschen mit Drogenproblemen sind unter anderem oftmals in Substitution und medizinischer Versorgung, sie konsumieren häufig zusätzlich Alkohol und Beruhigungsmittel, leiden unter gravierenden körperlichen Problemen. Häufig sind sie schwerbehindert und haben mit erheblichen psychischen Belastungen zu tun.
Waltraut Campen: „Diese Menschen brauchen eine besondere Pflege. Die jetzigen Hilfsangebote für Drogenkonsumenten in diesem Alter sind nicht ausreichend.“
Bisher sind die bestehenden Alten- und Pflegeheime nicht auf Junkies eingestellt. Pflegen und Wohnen betreibt das Haus Öjendorf, eine Einrichtung speziell für ältere Alkohol- oder Medikamentenabhängige, aber nicht für Abhängige illegaler Drogen. Bei Pflegen und Wohnen heißt es: „Solange Drogen konsumiert werden, haben wir keinen Platz. Meistens werden diese Drogen ja auch illegal beschafft.“ Genau dort liegt die Schwierigkeit: „Das Problem ist, dass die Pflegeheime den Drogenkonsum akzeptieren müssen“, sagt Rainer Schmidt von der Palette-Drogeneinrichtung. Wer 20 oder 30 Jahre lang Drogen nimmt, komme davon nicht mehr los. „Die Frage ist: Wie kriegt man Pflegeeinrichtungen dazu, mit Suchtgeschichten umzugehen.“
Nun in Aktionismus zu verfallen und neue Einrichtungen für ältere Drogenabhängige aufzubauen sei nicht der richtige Weg, meint Theo Baumgärtner: „Man muss schauen, wie und an welchen Stellen die Angebote der bestehenden Systeme bedarfsgerecht aufeinander abgestimmt werden können.“ Alten- und Drogenhilfeeinrichtungen sollten enger miteinander kooperieren. „Die Fachkräfte aus beiden Bereichen müssen in Zukunft stärker für die Probleme der jeweils anderen Klientel sensibilisiert und qualifiziert werden.“
Das Thema Altern wird von den in der Studie befragten Abhängigen meistens tabuisiert. „Auffallend viele der älteren Drogenabhängigen äußerten ihre Überzeugung, lieber Selbstmord zu begehen als in einem Pflegeheim zu enden“, heißt es in der Studie.
Anthrax confirmed in an injecting drug user in Kent
3 November 2010
The Health Protection Agency (HPA) can confirm that it is investigating a case of anthrax infection in a drug injecting heroin user, who is critically ill in Kent.
Dr Mathi Chandrakumar, Director of Kent Health Protection Unit said: „We are working closely with NHS and police colleagues to monitor the situation. I’d like to reassure people that there is no risk to the general population, including close family members of the patient. It is extremely unlikely that this form of anthrax can spread from person to person.
„We continue to see occasional cases of this serious infection among injecting drug users, following a cluster of cases earlier this year. Exposure to anthrax is now one of a number of risks that drug users are exposed to. All heroin users should seek urgent medical advice if they experience signs of infection such as redness or excessive swelling at or near an injection site, or other symptoms of general illness such a high temperature, chills or a severe headache or breathing difficulties, as early antibiotic treatment can be lifesaving.“
This is the fifth case of anthrax seen in an injecting drug user in England, the first being in London in February this year. Similar cases have been seen in Scotland since December 2009 with 47 cases confirmed and one in Germany. Similarities to the cases in Scotland suggest that the heroin, or a contaminated cutting agent mixed with the heroin, is the likely source of infection.
Dr Chandrakumar added: „If friends and family are concerned about a family member or friend and their drug use there are a number of services, including their GP, Social Services and local drug teams who can help advise about where the most appropriate help can be found.“
ENDS
Summary of recent advice on infections due to spore-forming bacteria in drug users:
anthrax, botulism & tetanus
The Health Protection Agency (HPA) has confirmed that a heroin injector who was being treated for anthrax infection died on 3rd November 2010 in a Kent hospital. The HPA has issued a local press release in Kent.
Since December 2009, there have been a number of anthrax cases, including some deaths, among heroin users in Scotland and, to a much lesser extent, in England. There continue to be occasional cases of wound botulism among injecting drug users. In addition, injecting drug users are vulnerable to tetanus if they have not been appropriately vaccinated. Heroin – or perhaps a contaminated agent mixed with it – is the most likely source of these infections among English injectors.
We are drawing together, in this summary, the key sources of recent authoritative advice and information on infections due to spore-forming bacteria. This is to remind partnerships that, while there is no immediate increased cause for concern, the provision of relevant health advice to drug users continues to be an important activity for drug services.
Key points:
- It is important that all heroin users, and professionals working with heroin users, are familiar with the HPA’s advice about the risks of anthrax, wound botulism and tetanus. It is important that a person who is thought to have one of these infections or an unusual illness seeks urgent medical treatment. To help communicate these messages, the HPA and NTA developed specialist materials about anthrax in the form of detailed poster and leaflets designed so local areas can add the details of their treatment services. These, and information for healthcare professionals, are available from the HPA website. The HPA website also has information about wound botulism for both healthcare professionals and drug users. Information for healthcare professionals about tetanus immunisation can be found on the DH website.
- Local media campaigns are not recommended for raising awareness. Instead, effective local responses will involve targeted awareness-raising that is aimed at the key ‘at-risk’ group – heroin users. This will involve services and professionals using authoritative information and advice materials to inform their clients. Distribution should reach a wide range of organisations in touch with drug users including those focusing on those not in contact with drug treatment services, such as homeless hostels/housing departments, needle exchanges, and community pharmacies.
More information and links on the HPA website.
Notes to Editors
1. Heroin users in Kent are strongly encouraged to find out more about the support services in their area. They can find drug services or seek advice from Talk to Frank: 24-hour helpline: 0800 77 66 00 / website: www.talktofrank.com
2. For local drug treatment services visit DAAT website local services section at www.kdaat.co.uk
3. The Health Protection Agency has produced advice for injecting drug users and guidelines on the clinical evaluation and management of people with possible anthrax in England. These are available at: http://www.hpa.org.uk/HPA/Topics/InfectiousDiseases/InfectionsAZ/1191942145749/
Contact: SE Region Comms Manager Teresa Cash 07789 295454
Million plus in Europe’s 60s generation of ageing drug addicts, report finds
122,000 heroin and crack users aged 35-64 in Britain
Keith Richards and Ozzy Osbourne may now be clean, but there are a hidden generation of ageing heroin users in their 50s and 60s who have not been able to kick the habit.
The European drugs agency say there are more than a million problem drug users aged over 40 across the EU, including 122,000 in Britain, who dent the widely held perception that drug use is a youth phenomenon.
„In reality, more older people than ever are reporting experience with drugs at some point in their lives and drug problems have no age limits,“ said the annual report of the European monitoring centre for drugs and drug addiction, published today.
The agency says about a million people across Europe aged 45 to 64 have used cannabis alone in the last year. While they have not „matured out“ of drug use, this is far below levels in the US where nearly 10% of the 50 to 59 age group — the 60s generation — regularly use cannabis.
There is a further group of nearly a million older problem drug users, including 122,000 in Britain aged between 35 and 64 who use heroin and crack, who first became dependent in the 1980s and 1990s. Many have tried detox and methadone substitution but have not managed to stop.
Wolfgang Götz, director of the agency, said that while the Rolling Stone, Keith Richards, says he is clean, many older drug users face a life of repeated overdoses with chronic health implications. They are prematurely experiencing the health problems faced by people 20 years older. Denmark and Germany are among countries developing specialist nursing or retirement homes for older drug users .
source: http://www.guardian.co.uk/society/2010/nov/10/europe-heroin-users-ageing
The International Campaign for Human Rights in Iran (ICHRI), an NGO based in New York and the Netherlands, sounded alarm bells over undeclared executions, many taking place in groups, carried out at the Vakilabad Prison in the eastern city of Mashhad, the UAE daily The National reported Sunday.
According to the ICHRI’s statement, based on the testimony of former prison inmates, prisoners are in many cases executed in groups and the last mass execution took place on October 12 when ten prisoners were executed together. A former inmate told the ICHRI that he was witness to 46 executions in one day in October 2009.
According to Ahmad Ghabel, a religious scholar who spent three months at Vakilabad Prison earlier this year, at least 50 executions took place during his detention.
Ghabel, who was released on bail then detained again for speaking about Vakilabad executions in public, said the government does not release accurate figures of hangings and never acknowledges secret executions to avoid international outrage.
More than 600 inmates are currently awaiting execution in various Iranian prisons mainly for drug trafficking. The city of Mashhad is a major smuggling hub for heroin coming from Afghanistan.
Executions on the rise
We are concerned that if these executions are, in fact, taking place in Mashad, then are other prisons executing in secret also 
Testimonies by former inmates indicate that the numbers of executions in Iran double from last year’s figure, said ICHRI spokesman Aaron Rhodes.
“We are concerned that if these executions are, in fact, taking place in Mashad, then are other prisons executing in secrecy also?” he said in a phone interview from Hamburg, Germany.
“The authorities are trying to curb these problems by using extreme punishments, which violate Iranian and international law, in an increasingly brutal policy of intimidation.”
Similar testimonies by Iran former Vakilabad prisoners and their families have been investigated by Amnesty International (AI). Although the findings are not yet completed, AI experts argue that reports of secret executions are true.
“We regard these allegations as credible,” said Drewery Dyke, a London-based expert on Iran in an interview.
According to analysts, the surge in execution rates reflects hardliners’ dominance in Iran’s judiciary. Imposing the capital punishment has also been recently accompanied by a rise in the use of torture in Iran’s prisons.
Statements by Iranian judges serve to highlight the growing tendency towards violent punishments. A few days ago, Ebrahim Raisi, Iran’s deputy judiciary chief praised the recent amputation of a thief’s hand as a “divine punishment” and “source of pride.”
A senior analyst in Tehran, who spoke on condition of anonymity, said that new judiciary chief Sadegh Larijani, contrary to his predecessor, does not promote the reduction of executions especially in drug offences.
Secretive procedures
According to the ICHRI report, executions are carried out in the most secretive manner. The majority of prisoners get to know they would be executed only a few hours before. Neither their families nor their lawyers are notified and prison phone lines are disconnected in order to avoid leaks.
Under Iranian law, families of prisoners are to be informed of the time of the execution in order to visit the prisoner or be present at the hanging.
Names of the condemned are announced over a microphone after making sure prisoners are inside their cells then prisoners to be executed are taken from their cells to write their wills and undergo a religious cleansing ritual.
After the execution, the prison notifies the deceased’s family and they are allowed to retrieve the body after paying for the rope used in the hanging, a former prisoner told ICHRI.
The stance of the Iranian authorities towards secret executions, observers argue, is quite ambivalent. While information about executions is treated as highly confidential, the regime does not mind occasional leaks that they believe have a deterring effect.
Death penalty and drugs
According to multiple accounts, the majority of inmates on death row were convicted for narcotics-related crimes
In Iran, offences punishable by death include murder, rape, drug trafficking, armed robbery, adultery, treason, and espionage and the capital punishment is seen by the authorities as essential for preserving national security.
“According to multiple accounts, the majority of inmates on death row were convicted for narcotics-related crimes,” said the ICHRI. “Some reported that they were tortured and forced to make confessions, but that trial judges ignored their claims of physical coercion.”
Despite government claims to the contrary, human rights groups say that prisoners accused of drug offences are detained for a long time before the trial, allowed limited access to lawyers, and subjected to physical abuse.
Drug trafficking ranks first amongst Iran’s capital offences and clashes between security officers and more than 3,500 officers were killed in the past two decades in clashes with drug smugglers on the border with Afghanistan.
Iran is believed to have the world’s highest addiction to opium and heroin, which are usually available in cheap prices after failing to reach Europe from Afghanistan. Analysts argue that unemployment and social problems contribute to the rise in addiction rates.
At least 388 were executed last year, which makes Iran the world’s second in executions after China. In 2005, the year President Mahmoud Ahmadinejad assumed power, the number did not exceed 85.
Multi-National Operation Nets $55.9 Million Heroin Seizure in Afghanistan
First-ever joint mission for DEA, Afghan, and Russian drug agents nets nearly one metric ton of drugs
OCT 29 — A multinational DEA operation led to the seizure of $55.9 million in heroin at four clandestine laboratories located in Nangarhar Province, Afghanistan. The nearly one metric ton of narcotics was seized as a result of a large-scale joint narcotics enforcement operation by DEA, Afghan, and Russian anti-drug agents in Afghanistan.
Members of the U.S. military’s 101st Airborne Division, along with ISAF, took part in “Operation Tar Pit.”
Acting on DEA intelligence, the multinational task force was able to identify a major clandestine heroin laboratory in the Zerasari Village of the Achin District. Upon arrival at the site, agents discovered three additional labs hidden by vegetation. Evidence collected confirmed that all of the labs were actively producing heroin and morphine.
“Thanks to the close cooperation among DEA, Afghan, and Russian anti-drug personnel as well as U.S. Military and ISAF in Afghanistan, one metric ton of heroin was seized from four clandestine laboratories along with various precursor chemicals. Operation Tar Pit was a significant enforcement success due to the fearsome force multiplier arrayed against the narco-traffickers and insurgents,” said DEA Acting Administrator Michele M. Leonhart. “This nearly $60 million worth of heroin seized in Afghanistan will never find its way to vulnerable communities around the world.”
In addition to 932 kilograms of heroin and 156 kilograms of opium seized, the following precursor chemicals and materials were also confiscated: 10 liters of acetic anhydride, 15 kilograms of ammonium chloride, 10 kilograms of soda ash, 40 kilograms of charcoal, two mechanical heroin presses, three metal industrial cooking vats, and 500 feet of plastic irrigation equipment.
An investigation into the drug trafficking organization responsible for operating the clandestine heroin labs is ongoing.
Summary
The present review aims to clear up the issue of the neurological processes underlying the personality changes induced by chronic opioid use. The effects of methadone treatment on brain functions have been analyzed, too. Brain disintegration becomes evident very soon after an onset of chronic heroin abuse and continues throughout the period of drug consumption. A considerable proportion of opioid addicts are characterized by conspicuous neuropsychological deficits, which preclude the maintenance of complete opioid abstinence in this patient subgroup. At present, there are no data to testify that the effects of methadone maintenance on brain functions exceed the adverse neurological effects of chronic heroin use.
Progressive personality changes in opioid addicts are a considerable burden for their families and for the community. Opioid addiction is associated with a high risk of death. Only about 50% of these patients live longer than 20 years after an onset of
opioid use [6], and about 10% of them try to commit suicide over a 12-month period [11].
It is also appropriate to stress the contribution of heroin addiction to the prevalence of HIV infection and other morbid conditions. Hence, the progressive personality changes seen in opioid addicts represent the core and most serious complication of
chronic opioid use. Unfortunately, all existing treatment approaches, including complete opioid abstinence, do no more than partly alleviate these personality changes in
a proportion of addicts.
The present review aims to clear up the issue of neurological processes underlying the personality changes induced by chronic opioid use. The effects of methadone treatment on brain functions in this patient population have been analyzed, too.
Progressive brain disintegration in heroin abusers
Abnormal electric activity in central brain regions in heroin addicts.
There is growing evidence that electric activity in central brain regions is radically altered in heroin addicts, and that these alterations emerge very soon after an onset of chronic opioid use.
In the late ’90s heroin addiction spread all over Russia on the scale of an epidemic. In that period, street heroin was relatively pure and in most cases it did not contain contaminants. The duration of daily heroin use ranged from several months to 3.5 years in the addict population of Moscow.
Besides this, a considerable proportion of Russian heroin abusers were very young (mean age about 23 years) and otherwise psychiatrically healthy people coming from well-educated and socially integrated families.
This gave us the opportunity to evaluate the early effects of daily heroin use on the electric activity of the brain in young patients with a relatively normal psychiatric premorbid history.
We found that the mean frequency of alpha2 band electric activity in heroin addicts was significantly above normal throuhout the brain, as assessed by comparison with controls, and that this electroencephalographic (EEG) phenomenon was significantly correlated with the duration of chronic heroin use in our patient cohort [34].
The most important finding in this study referred to relationships between changes in brain electric activity and selective cognitive dysfunctions in the early stages of heroin addiction.
Planning deficits (the Tower of London test) was strongly associated with alpha2 mean frequency increases in central derivations (C3, Cz and C4) in our patients [13].
This association was mediated by the length of chronic heroin use in the right hemisphere (C4), whereas it was not related to chronic heroin use at the left central lead (C3). These data gave grounds for hypothesizing that the functioning of central brain structures is
affected very soon after an onset of chronic heroin use, and that these alterations first arise in the left hemisphere and a little later spread to the central region of the right hemisphere in heroin addicts.
At least four other research groups similarly recordedelectric activity abnormalities in central brain regions in patients with a mean duration of chronic heroin use ranging from 3.5 to 15 years; all of these findings refer to slow wave activity in central structures.
Shufman and colleagues [39] reported an excessive intensity of delta activity at Cz in abstinent patients with a mean length of chronic heroin use of 3.5 years, but in no case did these authors find any similar electric abnormality in current heroin users
with a mean duration of opioid use of 4.5 years. Papageorgiou and colleagues [31] also found an abnormal spread of slow wave electric signals from C3 to right hemisphere central and frontal regions during the performance of a cognitive test by heroin addicts who had been abstinent for at least 6 months. The most important findings on electric activity in central brain structures in heroin addicts were reported by Franken and colleagues
[16, 17].
This research group found that heroin cues elicited slow wave-evoked potentials with the largest amplitude at central leads (C3, Cz and C4) in heroin addicts who were compared with normal controls, and that the amplitude of these potentials was significantly correlated with the severity of craving for heroin.
These authors also reported a significant correlation between craving severity and the coherence of delta activity at central temporal derivations in the same patient cohort.
It should be noted that in our patient cohort we recorded significant correlation between the intensity of delta activity at Cz and C4 and the amounts of heroin which patients used per day before their admission to the in-hospital unit. Following a different
line of inquiry, Greenwald & Roehrs [20] found increased delta activity in central derivations in addicts who self-administered fentanil, in comparison with patients who received the drug passively. Both findings may be interpreted as an indirect confirmation of causal association between delta activity in central brain structures and craving processes.
These contemporary EEG studies go to show that central brain structures are radically altered in heroin addicts at an early stage. This functional brain system is involved in incentive sensitization and craving processes, and is unable to adequately support
cognitive operations which do not relate to heroin use in this patient population. The severity of the dysfunction of central brain structures seems to be directly related to the severity of addiction behavior.
All the characteristics of the central brain electric system mentioned above closely resemble the abnormalities of the mesocorticolimbic dopamine system in opioid-abusing
subjects. Animal and human studies have shown that the structures of mesocorticolimbic system (dopamine neurons of the ventral tegmental area, the nucleus accumbens and anterior cingulate gyrus) are highly sensitized to opioids and neuroplastically altered in addicts [35, 36].
The baseline activity in these structures is abnormal in abstinent heroin abusers [18]. These structures are involved in incentive sensitization and craving processes [8, 9, 38], and are unable to adequately support cognitive operations which are not related
to drug addiction behavior in opioid addicts [14, 15, 26]. Hence, EEG studies confirm the findings of human neuroimaging and animal experimental studies on the quickly initiated, inevitable long-term reorganization of the dopamine mesocorticolimbic system in heroin abusers.
Frontal dysfunction in heroin addicts.
In our study of heroin abusers, a subgroup of patients with a duration of chronic heroin use of under 18 months did not differ from healthy controls in their performance on two cognitive tests evaluating prefrontal functions (Delayed Alternation Test and
Wisconsin Card Sorting Test) [4].
Even so, individual variations in cognitive performance
were significantly associated with the amount of heroin which patients self-administered each day before their admission to the in-patient unit [5]. Patients who performed poorly on both prefrontal tests self-administered about 0.7 gram of heroin per day, whereas patients who performed ‘ideally’ on prefrontal tests used only 0.18 gram per day. The subgroup of patients with a selective deficit on Delayed Alteration Test self-administered
0.4 gram per day. Three subgroups did not differ in the duration of chronic heroin use.
We concluded that premorbid prefrontal dysfunctions significantly affect patterns of daily heroin use in subjects with a relatively short drug use history.
Four other research groups reported significant clinical effects of prefrontal dysfunctions in opioid addicts. Gerra and colleagues [19] observed right prefrontal hypoactivation in heroin addicts with antisocial and/or depressive personality characteristics, i.e. a
subgroup of patients with especially severe addictive behavior. Similar findings were reported by Bauer [3], who found significant correlation between childhood conduct disorder and amplitude of the P300 component of EEG evoked potential which was
recorded during a continuous performance test in adult drug-abusing patients.
Besides this, Pezawas and colleagues [32] observed a significant effect of the frontal lobe volume on the longest periods of abstinence in methadone-maintained patients, and Lyvers &
Yakimoff [29] found a correlation between the severity of opioid dependence and the number of perseverative errors made in performing the Wisconsin Card Sorting Test in
their similar patient cohort.
Hence, prefrontal dysfunction is an individual characteristic of heroin abusers, and it underlies the prominent severity of drug abuse patterns in a proportion of opioid addicts.
Although patients with a short duration of chronic heroin did not differ from normal controls on their performance on the Delayed Alternation Test in our study, patients with a longer heroin abuse history (18 months to 3.5 years) gave a significantly poorer
performance on this orbito-frontal neuropsychological task compared with normal subjects (p=.04). Moreover, we found a significant association between performance on Tower of London test (medial prefrontal cortex) and the duration of chronic heroin
use [4]. These data gave grounds for concluding that dysfunctions in the orbito-frontal and medial frontal cortex progress in subjects sowing a chronic use of heroin.
Two other research groups reported a similar association between frontal cortex deficits and chronic opioid use history. Liu and colleagues [27] found significant and negative correlation between bilateral white matter volume and length of chronic heroin
usage in addicts with a drug abuse history of 2 – 15 years. Franken and colleagues [17] reported significant negative correlation between frontal interhemispheric coherence and chronic heroin history duration. It should be noted that, along with neuropsychological deficits, brain electric activity in frontal regions was also significantly correlated with heroin abuse history in our patient cohort [34]. Overall, these findings provide
evidence that prefrontal dysfunction progresses in opioid users during their period of drug consumption.
Concomitant brain damage in opioid addicts.
Concomitant brain damage is common in opioid addicts. About 70% of opioid users report non-fatal overdoses and mild to moderate head injuries, which significantly affect cognitive performance in this patient population [10].
Concomitant alcohol and cocaine abuse also significantly contribute to brain damage in chronic opioid users [10, 28].
Ischaemic-hypoxic brain lesions are commonly found in long-term heroin addicts, and these brain alterations develop at significantly earlier age than in non-drug abusing controls [1, 28].
Concomitant adverse factors probably underlie the posterior brain disintegration which was reported in addicts with a long-term heroin history (about 15 – 20 years), but not in patients with a shorter duration of chronic heroin use [2].
The course of brain disintegration in chronic heroin users.
The findings of neuroimaging, EEG and neuropsychological studies cited above may be summarized as follows. Brain disintegration becomes apparent very soon after an onset of chronic heroin abuse. First, opioids inevitably reorganize the dopamine
mesocorticolimbic system, which begins to implement addictive behaviour and is ineffective in other domains in chronic heroin users. Second, prefrontal dysfunction progresses in opioid addicts, and its severity is associated with especially prominent
patterns of addictive behaviour. Third, concomitant brain damage is another common feature in heroin addicts, and may contribute to cognitive dysfunctions in this patient population!
Physiological correlates of complete opioid abstinence.
Gritz and colleagues [21] registered significant elevation of heart rate with the same trend for arterial blood pressure in opioid addicts who had been completely abstinent for two months. At the same time methadone-maintained patients demonstrated normal
haemodynamics, along with a somewhat depressed respiration rate. This study therefore confirmed clinical observations concerning persistent sympathetic hyperactivation
in abstinent opioid addicts [33], whereas methadone treatment normalized autonomic dysfunctions in this patient cohort.
Shufman and colleagues [39] demonstrated that both abstinent and methadone-maintained patients were characterized by abnormalities in brain electric activity not found in healthy controls. The two groups demonstrated similar significant deficits of alpha2 band power, but differed in delta and alpha1 power displayed. Delta activity was significantly higher in abstinent subjects, whereas the intensity of alpha1 activity
was higher in methadone-maintained patients. Similar data were reported by Gritz and
colleagues [21], who recorded significant slower alpha rhythms in methadone-maintained patients than in normal controls, with intermediate alpha peak frequencies in abstinent subjects.
Cognitive dysfunctiona are also commonly reported in both methadone-maintained and abstinent patient populations.
Two neuropsychological studies found cognitive deficits
to be more frequent and more conspicuous in methadone-maintained patients than in abstinent addicts [12, 21].
However, methadone-maintained subjects were characterized
by considerably longer histories of street opioid use compared with abstinent controls in both reports. Bauer [2] too observed significantly more radical changes in visually evoked potentials in methadone-maintained subgroups compared with abstinent ones.
Even so, statistical procedures showed that these differences were mediated by the
length of chronic heroin use, but not by the effects of methadone treatment.
Methadone-maintained patients and abstinent former addicts with an equal length of chronic heroin use were compared in the study of Mintzer and colleagues [30].
Psychomotor speed was slower in both patient groups than in normal controls, while this deficit was even more marked in former addicts than in the methadone group. However, methadone-maintained patients demonstrated additional cognitive impairment while performing the Gambling Task, which measures orbito-frontal cortex functions.
In our opinion, these data provided evidence that the orbito-frontal dysfunction underlies the inability of methadone patients to maintain complete opioid abstinence, whereas addicts
showing a normal orbito-frontal performance entered the abstinent subgroup.
Overall, the studies just cited can be summarized as follows. Both methadone- maintained and abstinent addicts display cognitive impairment when compared with
healthy controls. At the same time, patients entering methadone maintenance treatment are characterized by more comspicuous cognitive deficits than patients who are able to maintain complete opioid abstinence.
Correlates of cognitive dysfunction in methadone-maintained patients.
At least 4 neuropsychological studies failed to find any significant association between methadone dosage regimen and cognitive performance [10, 21, 37, 40].
Moreover, Gruber and colleagues [22] demonstrated an improvement in cognitive functions as little as two months after the beginning of methadone treatment in opioid addicts. At the same time, cognitive deficits in methadone-maintained patients was significantly correlated with the number of non-fatal overdoses, mild to moderate head injuries, severity of
alcohol dependency and global health in the study of Darke and colleagues [10].
These data all provide evidence that methadone maintenance per se does not seem to radically affect cognitive functions in chronic opioid abusers. However, mildly sedative effects
attributable to methadone may not be completely excluded by the data just quoted.
Conclusion
From the neurological point of view, populations of opioid addicts are not homogeneous.
A considerable proportion of opioid addicts are characterized by conspicuous neuropsychological deficits, which preclude the continuation of complete opioid abstinence by this patient subgroup. So far, no data have been found to testify that the
effects of methadone maintenance on brain functions exceed the adverse neurological effects of chronic heroin use.
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The southern Kyrgyz city of Osh saw violent ethnic clashes in June. But the city has other problems – it is also a major hub for Afghan heroin on its way to Europe. Rayhan Demytrie has been investigating the impact of drug trafficking on the region.
A group of volunteers are smoking cigarettes outside a needle distribution centre in Osh.
Most of them are former drug addicts.
„When we started taking drugs, we watched films, saw people snorting drugs through dollar bills and we thought it looked so cool,“ says Oleg.
„We did not know what it might lead to. But now those who are starting up can see what it leads to and yet they still do it.“
Yulia, standing nearby, blames a lack of jobs.
„There is nothing to do, there is no work. Young people don’t have anything to do,“ she says. „They will try it once, twice and then the third time they are already hooked.“
Osh – the centre of ethnic fighting in June between the Kyrgyz and Uzbek communities – is one of the drug capitals of Central Asia.
A quarter of the world’s heroin is believed to travel through Central Asia on its way to Russia and Europe. Osh is a key hub along the route.
Mamasabir Burhanov, who set up the needle distribution project, says the growth in heroin users is linked to the collapse of the Soviet Union.
„In Soviet times the borders were strong and drugs didn’t get through. With the collapse of the Union, the borders got much weaker. Drugs offered such good profits, and lots of people got involved in trafficking,“ he said.
„The resources we have to fight against the drug traffickers here are like a sling against a tank. We don’t have enough resources to stop the drugs that come through our country.“
Most who know the region well believe that serious money is generated in the south through criminal activity, especially the drug trade.
„There is no other business here,“ says Radmir, a local journalist.
Red town
Driving through town on the way to distribute clean syringes, Oleg points to the home of a drug dealer.
„Everybody in Osh knows who he is. He’s been selling hashish, opium and heroin since the early days. And what’s most important is that he will keep selling it,“ he says.
At the syringe collection point, heroin addicts were quick to condemn local police.
„They detain us for carrying small amounts of drugs even though we have ID showing that we are heroin addicts. Why don’t they detain drug dealers?“ said one.
„They bring drugs to drug dealers and profit from sales, it’s a red town. It means it is controlled by the police,“ said another.
At the city’s Ministry of Internal Affairs, the deputy head of the anti-narcotics department played down the corruption allegations.
Melis Mamasaliyev said there had not been any such cases this year. But he was willing to talk about successes.
„Our biggest seizure was in May – over 100kg, more than half of it was heroin,“ he said
„Immediately after that we had the inter-ethnic conflict in June. Since then we haven’t been able to concentrate on drugs – because we’ve been involved in dealing with the conflict.“
‚Tears of Allah‘
It is true that it has been a year of political and social unrest in Kyrgyzstan.
President Kurmanbek Bakiyev was ousted in popular protests in April, leaving an interim government in charge of a fragile nation.
A struggle developed in the south – Mr Bakiyev’s home region – between the former president’s supporters and new political leaders in Bishkek.
Old ethnic tensions between Kyrgyz residents and ethnic Uzbeks were exploited. Organised crime, corrupt politicians and those who benefited from drug money are suspected of having played a hand in the violence.
Criminal gangs who thrive on the heroin trade are believed to have influence and protection among government officials.
In 2009 after noted successes, Mr Bakiyev’s decision to shut down Kyrgyzstan’s Drug Control Agency (DCA) strengthened the widespread suspicion that gangs enjoyed the patronage of powerful government figures.
Vitaliy Orzaliyev, who was the deputy head of the DCA, says his agency was becoming too successful and independent.
„Just a few months before the closure there were a few successful seizures, including liquid heroin called the Tears of Allah which fetches 45,000 euros ($63,000) per kg,“ he said.
„Another 200kg of heroin that we tracked was seized in Russia with a street value of around 6 million euros, huge money.“
The Drug Control Service has since been reinstated by current Kyrgyz leader Roza Otunbayeva. Mr Orzaliyev is now heading the unit.
„Ms Otunbayeva said at the UN General Assembly in September that one of the reasons for the disorders in June was the fight against the drug channels, the transit, and fighting between drug clans,“ he said.
„When the Bakiyevs were overthrown and the authorities were weakened, no-one was monitoring organised crime. They were left to their own devices, and different interests were in play. They had money to support one side or the other.“
New patrons
Regional observers say the trend in which drug gangs seek protection from figures in the government may continue.
According to Paul Quinn-Judge, the Central Asia director for International Crisis Group, organised crime and narcotic groups may already be looking for a new set of patrons.
„They have to make sure that drugs continue to flow through here in the way they had in the past. Having very high-level protection as they had here in Kyrgyzstan, they were probably feeling rather spoiled. So we assume that the narcotics dealers are looking for a similar deal in the future,“ he said.
In Kyrgyzstan’s recent parliamentary elections many of Mr Bakiyev’s allies from the south were re-elected. They are now seeking office in a possible coalition government.
It is not clear yet how high the fight against organised crime or drug trafficking will be on the new government’s list of priorities.
Listen to Rayhan Demytrie’s Assignment documentary: ‚Drugs and Power in Kyrgyzstan‘
BANGKOK, Sep 29, 2010 (IPS) – Dustbins in a university toilet rarely elicit a second look, but those at one of the oldest universities in Burma’s Kachin State do offer reason to pause. The bins, after all, collect a special form of garbage disposed of by students – hypodermic needles and syringes they have used to inject themselves with heroin.
The special bins were introduced to Myitkyina University as part of a humanitarian gesture by two non-government organisations – the French-based Medecins Du Monde (MDM) and Holland-based Artsen Zonder Grenzen (AZG) – with the aim of reducing injuries that students often get from stepping on used needles and syringes strewn around the campus.
It is normal to find „discarded bloody syringes, needles, and syringe packets (that) are littered in latrines, under stairwells and bushes, and even scattered on the football field“, according to the Kachin News Group.
It is these details, which expose the alarming level of heroin addiction in the university of some 3,000 students, that Nawdin Lahpai of the Kachin News Group cites when painting a grim picture of „the future leaders of the Kachins being destroyed by drugs“.
„The drug addiction was not as high as it is now in the university, which is located in the capital of the Kachin State,“ the editor of the news organisation, based in Thailand’s northern city of Chiang Mai, told IPS. „It has changed since 2004. Now heroin is easily accessible everywhere.“
Some estimate that over 50 percent of the male and female students seek a narcotic fix. „Students can be seen openly purchasing drugs in shops, cafes, billiard centres and houses near the university,“ with sales beginning as early as 8 a.m. in some places, states a brief study released Wednesday by Nawdin’s media group.
The leaders of the Kachin, an ethnic minority that has, like other ethnic groups, been persecuted by the Burmese military, place the blame for this situation of drug abuse squarely on the country’s junta.
They accuse the regime of promoting the narcotics trade to further torment the country’s beleaguered minorities – and weaken their social fabric.
„The military government must bear responsibility for this spread of drugs into the communities,“ Col James Lum Dau, deputy chief of foreign affairs of the Kachin Independence Organisation, said in an interview. „But the students being addicted to drugs also need to discipline themselves.“
Such concern about heroin use in Burma, also known as Myanmar, is shared in both the Kachin and the neighbouring Shan State, home to the ethnic Shan, near the Chinese border. Both provinces are where most of the opium – a thick paste extracted from poppy to make heroin – is grown in the country.
The Kachin and the Shan are among the 130 ethnic communities in Burma, majority of whose more than 55 million people are with the Burman ethnic group.
Currently, 46 of the Shan State’s 55 townships are growing poppy, Khuensai Jaiyen of the Shan Drug Watch told a press conference here on Sep. 29 to launch the Chiang Mai- based organisation’s 2010 report. „This is attributed to the Burma Army’s reliance on taxation of opium, and its policy to allow numerous proxy militia to deal in drugs.“
„Most of the poppy-growing areas are under control of the Burmese army and the Burmese army’s local militia,“ he added. „The Burmese army needs the drug trade to feed its own troops.“
The continuing presence of poppy fields in the rugged, mountainous corner of Burma over a decade after the regime announced it was determined to eradicate the drug trade by 2014 troubles the United Nations Office on Drugs and Crime (UNODC).
In a December 2009 report, the U.N. agency revealed that the area under poppy cultivation had increased 50 percent since 2006 to 31,700 hectares. „More than one million people are now involved in opium cultivation in Myanmar, most of them in Shan State, where 95 percent of Myanmar’s poppy is grown.“
In fact, „2009 saw the third successive annual increase in cultivation,“ said Gary Lewis, head of the UNODC’s East Asia and Pacific office, in an interview. „Our assessment convinces us that we need to remain very concerned about the extent of opium cultivation in Myanmar.“
This trend marks a reversal of the dramatic drop in Burma’s opium production in the mid-1990s, when it enjoyed the notoriety of being the world’s leading opium producer. The 1995-96 harvest season saw poppy cultivation peak at an estimated 163,000 hectares, producing 1,760 metric tonnes of opium, says the UNODC.
„At that time these figures were the highest in the world,“ said Lewis. „By 2001-2002 however, domestic cultivation had declined to 81,400 hectares and estimated opium production had decreased to 828 metric tonnes.“
The Burmese regime’s 1999 announcement that it would eradicate the drug trade in 15 years saw the country give way, in 2000, to Afghanistan as the world’s largest heroin supplier.
But the junta’s continued support of opium production convinces the likes of Khuensai that the regime’s ‘war on drugs’ is a „charade“. „This is evident from the junta’s local militias emerging as the new drug lords in Burma.“
The easy access to drugs in Kachin State exposes the junta’s plans „to profit at the expense of the ethnic groups,“ adds Nawdin. „It is almost like a Cold War to destroy the young.“
source is: http://www.ipsnews.net/news.asp?idnews=53002
- Disease keeps prices high despite drop in production
- Number of households involved in farming drug on rise
- Industry supports Taliban insurgency against 150,000 troops
The Taliban made £65million last year from Afghanistan’s opium trade despite the presence of thousands of British troops, a damning UN report has found.
In a startling indication that the war on poppy growing is having little effect, insurgents are still reaping the benefits despite the loss of life and huge amounts of money being thrown at the problem.
The report for the United Nations ominously warns that the illegal trade will grow even more.
Helmand province, where 9,500 British soldiers are battling the Taliban, produced 53 per cent of the country’s opium, the raw ingredient to make heroin.
The insurgents receive about $100million (£65million) a year from Afghanistan’s illegal opium trade. the report said.
The cash bonanza will continue to fund their fight against British and NATO troops. In the last 12 months, 92 UK servicemen have lost their lives in the country.
This is despite the U.S. and its coalition allies spending more than $250million (£190million) on counter-narcotics programmes in the war-ravaged nation.
In total the amount of poppy cultivated last year was 304,000 acres – the same as in 2009.
The figures are a damaging blow for Britain, whose deployment to the Taliban heartland of Helmand in 2006 intended to smash poppy cultivation and production.
Since then the UK death toll has risen to 337 since military action began in 2001.
Afghanistan produces 90 per cent of the world’s opium, said the UN’s Office on Drugs and Crime.
Before the 2001 invasion, the Taliban had managed to drastically reduce the poppy crop.
But since being toppled it has backed poppy growing to finance its insurgency.
Cultivation of the multibillion-dollar crop in 2010 was the same as in 2009 after falling in the previous two years.
Opium production dropped 48 per cent to 3,600 metric tons, mainly due to the spread of a disease that damaged poppy plants.
But low harvest yields caused by blight is likely to lead to an increase in poppy prices – encouraging more poverty-stricken farmers to plant the crop.
In 2009, the average price per kilogram of dry opium at harvest was $64 (£41) per kilogram. It is now about $169 (£114) per kilogram.
UN officials warned three years ago that ‘frightening levels’ of poppy production was threatening the very survival of Afghanistan.
The coalition has poured money into the country to try to stem opium production as part of an effort to undercut funding for insurgent groups fighting the 150,000 coalition forces in the country.
The disappointing figures come despite years of programmes aimed at reducing the poppy crop, by giving farmers subsidised seeds for other crops and vouchers for farmers.
The wheat-distribution programme, where famers receive bags of cereal seeds to persuade them to quit growing narcotics, will begin shortly.
Experts said that if Afghanistan’s discredited government can provide security there would be less incentive for farmers to plant opium to survive.
Robert Watkins, the deputy UN envoy in Afghanistan, said: ‘If there is not going to be security in Afghanistan across the entire country, we are not going to be able to eliminate this problem.’
This is despite the U.S. and its coalition allies spending more than $250million (£190million) on counter-narcotics programmes in the war-ravaged nation.
In total the amount of poppy cultivated last year was 304,000 acres – the same as in 2009.
The figures are a damaging blow for Britain, whose deployment to the Taliban heartland of Helmand in 2006 intended to smash poppy cultivation and production.
Since then the UK death toll has risen to 337 since military action began in 2001.
Afghanistan produces 90 per cent of the world’s opium, said the UN’s Office on Drugs and Crime.
Before the 2001 invasion, the Taliban had managed to drastically reduce the poppy crop.
But since being toppled it has backed poppy growing to finance its insurgency.
Cultivation of the multibillion-dollar crop in 2010 was the same as in 2009 after falling in the previous two years.
Opium production dropped 48 per cent to 3,600 metric tons, mainly due to the spread of a disease that damaged poppy plants.
But low harvest yields caused by blight is likely to lead to an increase in poppy prices – encouraging more poverty-stricken farmers to plant the crop.
In 2009, the average price per kilogram of dry opium at harvest was $64 (£41) per kilogram. It is now about $169 (£114) per kilogram.
UN officials warned three years ago that ‘frightening levels’ of poppy production was threatening the very survival of Afghanistan.
The coalition has poured money into the country to try to stem opium production as part of an effort to undercut funding for insurgent groups fighting the 150,000 coalition forces in the country.
The disappointing figures come despite years of programmes aimed at reducing the poppy crop, by giving farmers subsidised seeds for other crops and vouchers for farmers.
The wheat-distribution programme, where famers receive bags of cereal seeds to persuade them to quit growing narcotics, will begin shortly.
Experts said that if Afghanistan’s discredited government can provide security there would be less incentive for farmers to plant opium to survive.
Robert Watkins, the deputy UN envoy in Afghanistan, said: ‘If there is not going to be security in Afghanistan across the entire country, we are not going to be able to eliminate this problem.’
Stuttgart – Die Versorgung von schwerstabhängigen Drogensüchtigen mit künstlich hergestelltem Heroin wird sich weiter verzögern. Zwar hat nach dem Bund nun auch das Land die rechtlichen Voraussetzungen geschaffen, aber die Kassenärztliche Vereinigung (KV) wird die neun geplanten Schwerpunktpraxen im Land nicht auf einmal ausweisen. „Unser Ziel ist es, noch dieses Jahr oder spätestens Anfang 2011 in Stuttgart eine Praxis zu eröffnen. Danach werden wir sukzessive die anderen Standorte im Land angehen. Alle auf einmal geht nicht“, sagte ein KV-Sprecher am Freitag unserer Zeitung. Man müsse „erst einmal Erfahrungen in Stuttgart“ sammeln.
Jahrelang hatte die Politik darum gerungen, wie man schwerstabhängigen Süchtigen hilft und sie aus der Beschaffungskriminalität holt. Während SPD, Grüne, FDP und Kommunen für die Therapie mit Diamorphin warben, stellte sich die CDU lange quer. Inzwischen hat die Union auf Bundesebene eingelenkt, das baden-württembergische Sozialministerium hat nun die entsprechende Verwaltungsvorschrift erlassen. Damit haben rund 200 bis 300 Schwerstabhängige im Land, bei denen alle anderen Therapien gescheitert waren, das Anrecht auf das sogenannte Heroin auf Krankenschein.
Im Land sollen speziell ausgestattete Schwerpunktpraxen an den Standorten Stuttgart, Mannheim, Freiburg, Heilbronn, Tübingen/Reutlingen, Singen, Ulm und Ravensburg eingerichtet werden; in Karlsruhe gibt es bereits eine Praxis. Die Genehmigung müssen das jeweilige Regierungspräsidium sowie die KV erteilen. Wann die anderen Arztpraxen betriebsbereit sind, ist unklar. „Der Aufwand an Sicherheitsvorkehrungen ist sehr hoch“, so der KV-Sprecher.
Das Land hat für die einzelnen Standorte einen Investitionszuschuss von jeweils 100000 Euro signalisiert. Der Städtetag begrüßte die Verwaltungsvereinbarung des Sozialministeriums. „Land und Kommunen haben ihre Hausaufgaben gemacht. Jetzt ist die kassenärztliche Vereinigung am Zug“, sagte Städtetagssprecher Manfred Stehle unserer Zeitung . Das „jahrelange Bohren eines dicken Brettes“ habe zu einem „letztlich befriedigenden Ergebnis“ geführt, zumal wenn die Therapie in die örtliche Suchtkrankenhilfe integriert werde. Der Städtetag warnte zugleich davor, die Ausweisung der Arztpraxen hinauszuzögern. Nachdem das Gesetz nun in Kraft sei, könnten Drogenabhängige die Therapie einklagen.
Inhaltsverzeichnis……………………………………………………………………………………………….1
Abbildungs- und Tabellenverzeichnis……………………………………………………………………1
1 Einleitung und Fragestellung…………………………………………………………………………3
2 Methodik…………………………………………………………………………………………………….3
2.1 Durchführung………………………………………………………………………………………4
2.2 Auswertung………………………………………………………………………………………….4
3 Ergebnisse…………………………………………………………………………………………………..4
3.1 Die Untersuchungsgruppe……………………………………………………………………..5
3.2 Gesundheit…………………………………………………………………………………………..9
3.3 Konsummuster……………………………………………………………………………………12
3.3.1 Prävalenz des Drogenkonsums………………………………………………………13
3.3.2 Applikationsformen……………………………………………………………………..15
3.3.3 Konsumentengruppen…………………………………………………………………..16
3.4 Risikoverhalten………………………………………………………………………………………..19
3.5 Hilfebedarf und Hilfenutzung……………………………………………………………….22
3.6 Konsum in Haft………………………………………………………………………………….31
4 Fazit…………………………………………………………………………………………………………32
Literatur………………………………………………………………………………………………………….36
Abbildungs- und Tabellenverzeichnis
Abbildung 1: Anzahl der Befragten pro Stadt…………………………………………………………5
Abbildung 2: Durchschnittalter nach Stadt…………………………………………………………….6
Abbildung 3: Migrationshintergrund nach Stadt……………………………………………………..6
Tabelle 1: Schulabschluss…………………………………………………………………………………….7
Abbildung 4: Arbeitssituation………………………………………………………………………………7
Tabelle 2: Wohnsituation…………………………………………………………………………………….7
Abbildung 5: Substituierte nach Stadt……………………………………………………………………8
Abbildung 6: HIV-Infektion nach Stadt…………………………………………………………………9
Abbildung 7: HCV-Infektion nach Stadt………………………………………………………………10
Tabelle 3: Körperlicher und psychischer Zustand………………………………………………….10
Abbildung 8: Einschätzung des körperlichen Zustands nach Stadt…………………………..10
Abbildung 9: Einschätzung des psychischen Zustands nach Stadt…………………………..11
1
Abbildung 10: Anzahl Krankheitssymptome nach Stadt………………………………………..11
Tabelle 4: Körperliche und psychische Probleme………………………………………………….12
Abbildung 11: Prävalenz Drogenkonsum…………………………………………………………….13
Abbildung 12: Konsummuster von Männern und Frauen……………………………………….14
Abbildung 13: Heroin-, Kokain- und Crackkonsum nach Städten……………………………14
Abbildung 14: Prävalenzen nicht-verschriebener Substitutionsmittel nach Städten……15
Abbildung 15: Konsumformen……………………………………………………………………………15
Abbildung 16: Konsumgruppen nach Clusteranalyse…………………………………………….16
Abbildung 17: Konsummustergruppen nach Stadt…………………………………………………17
Abbildung 18: Wichtigkeit der Hilfsangebote nach Konsumgruppen………………………18
Abbildung 19: Spritzen- oder Utensilien-Teilen nach Konsumgruppe……………………..19
Abbildung 20: Risikoverhalten……………………………………………………………………………20
Abbildung 21: Verwendungshäufigkeit von Spritzen nach Städten………………………….20
Abbildung 22: Gemeinsames Nutzen von Spritzen oder Utensilien…………………………21
Abbildung 23: Drogen aus einer Spritze mit anderen geteilt…………………………………..21
Abbildung 24: Gemeinsame Nutzung der Crackpfeife…………………………………………..22
Tabelle 5: Gründe für den Aufenthalt auf der Szene………………………………………………22
Abbildung 25: Gründe für Szeneaufenthalt nach Stadt…………………………………………..23
Abbildung 26: Wichtigkeit von Hilfeangeboten……………………………………………………24
Abbildung 27: Wichtigkeit von Hilfeangeboten nach Stadt…………………………………….24
Abbildung 28: Häufigkeit des Besuchs der Einrichtung…………………………………………25
Abbildung 29: Häufigkeit des Besuchs der Einrichtung nach Stadt…………………………25
Abbildung 30: Besuch anderer Einrichtungen………………………………………………………26
Abbildung 31: Nutzung der Hilfsangebote……………………………………………………………26
Abbildung 32: Nutzung von Beratung…………………………………………………………………27
Abbildung 33: Nutzung des Konsumraumes…………………………………………………………28
Abbildung 34: Besuch anderer Konsumräume nach Stadt………………………………………28
Abbildung 35: Nutzung von Konsumräumen durch Substituierte……………………………29
Abbildung 36: Orte des Konsums……………………………………………………………………….29
Abbildung 37: Gründe für öffentlichen Konsum…………………………………………………..30
Abbildung 38: Grund für öffentlichen Konsum nach Stadt…………………………………….31
Abbildung 39: Drogenkonsum in Haft…………………………………………………………………32
Meine geliebten Statistiken:AbschlussberichtSzenebefragung
quelle: INSTITUT FÜR INTERDISZIPLINÄRE SUCHT- UND DROGENFORSCHUNG – ISD, HAMBURG Träger: Förderverein interdisziplinärer Sucht-
und Drogenforschung (FISD) e.V.
http://www.isd-hamburg.de
WASHINGTON — The FDA has approved a new sublingual film formulation of the opioid dependence treatment combination buprenorphrine/naloxone (Suboxone).
The new formulation will be released in the same 2 mg buprenorphrine/0.5 mg naloxone and 8 mg buprenorphrine/2 mg naloxone doses as the drug’s sublingual tablet form.
„During clinical tests, Suboxone sublingual film was shown to be faster dissolving than Suboxone sublingual tablets,“ Shaun Thaxter, president of manufacturer Reckitt Benckiser Pharmaceuticals, said in a prepared statement.
Drug approval included a risk evaluation and mitigation strategy program, which requires the company to monitor patients to determine whether potential treatment benefits outweigh potential risks, especially with accidental overdose, misuse, and abuse of the film, the brief said.
The drug can be abused in ways similar to other opioids. Healthcare professionals should monitor patients for proper use, the company said in the statement.
Buprenorphrine reduces patient opioid cravings and withdrawal symptoms, and also blocks the effects of other opioids. Naloxone triggers withdrawal symptoms in patients who crush and inject the drug, but has limited bioavailability when taken sublingually, and should cause no adverse events.
Chronic use of the drug may result in physical dependence and a sudden or rapid decrease in dose may result in withdrawal symptoms, though the symptoms are milder and more delayed than those occurring with full opioid agonists, the brief said.
Patients taking the film, particularly if injected or through other improper means and with central nervous system depressants, may experience life-threatening respiratory depression or death. Healthcare professionals should consider a reduced dose of the central nervous system depressant, the combination, or both when prescribing buprenophrine/naloxone, the statement said.
Pediatric patients taking the drug may have severe, potentially fatal respiratory depression.
Those taking the film should have liver function monitored before and during drug treatment.
Patients who take the drug prior to use or abuse of other full agonists, such as heroin or oxycodone, may experience withdrawal symptoms due to interactions with the drug’s naloxone.
Healthcare professionals should only prescribe pregnant or nursing patients the drug combination if potential gain outweighs potential risk, due to possible neonatal withdrawal symptoms associated with the drug, according to the manufacturer.
The drug is contraindicated in patients hypersensitive to buprenophrine or naloxone.
Adverse events associated with the film include numb mouth, sore tongue, mouth redness, headache, nausea, vomiting, sweating, constipation, insomnia, pain, swelling of limbs, attention disturbance, palpitations, blurred vision, cytolytic hepatitis, jaundice, and anaphylactic shock.
Abstract
This retrospective study aims to determine whether
there is a difference in the additional consumption of
alcohol between addicts treated with methadone or dihydrocodeine
(DHC) and untreated addicts injecting heroin.
1,685 patients admitted for opioid withdrawal between
1991 and 1997 were reviewed. Cross-reference tables
and multiple logistic regression analyses were carried
out. 28% of patients take more than 40 g of alcohol daily
(on average 176 g). We found that patients who are
treated with methadone or DHC drink alcohol significantly
more often daily than the heroin-dependent patients
(p ! 0.01). Using multiple regression analyses, the results
were confirmed. Additionally, we found that co-abuse of
alcohol was predicted by male gender, longer duration
of drug use, additional daily consumption of tetrahydrocannabinol
and daily consumption of benzodiazepines.
Alcohol consumption by opioid-addicted patients
treated with methadone or DHC presents a serious medical
problem. Co-abuse of alcohol will receive more attention.
Introduction
Consumption of other psychotropic substances during
substitution treatment of opioid addicts with methadone
and dihydrocodeine (DHC) may have a substantial impact
on morbidity, mortality and clinical course. While
consumption of illegal drugs is usually reduced during
substitution treatment, additional consumption of legal
psychotropic substances, especially of alcohol, has not
been examined in such detail. Chronic alcohol consumption
leads to a variety of somatic effects and diseases.
Therefore, where a high prevalence of regular or severe
alcohol consumption exists among patients in substitution
programs, the advantages and risks should be carefully
weighed up. Further, to the consumption of respirantdepressive
opioids, additional complications and dangers
are involved when taking other psychotropic substances
with respiration-depressive effects, such as alcohol, benzodiazepines
or barbiturates. 62–72% of the patients, who
had been treated for overdosing, had consumed various
substances [1, 2], of which 23–35% comprised alcohol. In
cases of fatal overdosing, abuse with multiple substances
was reported in 71–92% of patients [3–7]. In 41–51% of
these deaths, alcohol was identified. In addition to the
acute risk of an overdose from combined consumption of
a number of psychotropic substances, the consumption of
alcohol, in contrast to opioids, leads to chronic permanent
damage and disease concerning almost all aspects of medicine
[8–11].
On the one hand, a number of studies have ascertained
that the supplementary consumption of illegal drugs such
as heroin and cocaine may be reduced by methadone
maintenance treatment programs [12–15] and codeine
maintenance programs [16]. On the other hand, it has
often been reported that about 30% of the patients in
methadone maintenance treatment programs have an
alcohol problem or are even alcoholics [17–19]. It is not
clear, however, whether the patients already had alcohol
problems before their entry into the methadone maintenance
treatment. The North Rhine Westphalia study on
the efficacy of outpatient medical rehabilitation with
methadone maintenance indicated that over time the
number of patients being abstinent of alcohol increased
during treatment [20].
In Germany, the critical dose is often stated as 60 g for
men and 40 g for women [21]. More than 8,000 deaths of
people aged 15–29 years in Europe in 1999 were attributable
to alcohol [22].
In addition to the risk of overdosing, alcoholism for
example leads to an increased risk of long-term secondary
physical sicknesses [8, 9]. With regard to narcotics fatalities,
toxicological data from southern Bavaria – the same
area as in our study – indicate that alcohol is a frequent
covariant in drug-related deaths and in patients treated
with codeine (27% each) and that it is less frequent in
methadone patients (16%) [23].
Those studies concerned with supplementary consumption
within methadone and codeine maintenance
treatment programs have mainly focused on the supplementary
consumption of illegal drugs. We further consider
that in Germany, and especially Bavaria, where alcohol
is everywhere easily available and where alcohol consumption
is well established (e.g. the ‘Oktoberfest’), heroin
addicts consider alcohol consumption analogous to a
‘normal’ individual’s regular consumption of alcohol, and
more so when heroin becomes more difficult to obtain.
We thus present our hypothesis that those patients treated
with methadone or DHC drink less alcohol than the
untreated patients injecting illegal heroin.
Subjects and Methods
Sample
All drug-addicted patients voluntarily admitted to inpatient detoxification
treatment between April 1991 and December 1996, in
whom, according to ICD-10 criteria, an opioid or multiple-substance
addiction had been diagnosed, were included in the study. Of all
patients enrolled in the treatment program between April 1991 and
December 1996, those subjects coming for a second or third detoxification
visit within this time period had to be excluded, except for the
first visit, otherwise the assumption of independent observations
would have been violated. Patients could come in of their own volition,
and previous contact with a counsellor or physician was not
necessary. The treatment strategy called ‘qualified detoxification’ has
been described elsewhere [24].
Measures
On the day of admission, the daily intake of psychotropic substances
over the preceding 6 months was established. The patients
were questioned individually regarding their intake of opioids, especially
heroin, codeine/DHC and methadone (D, L-methadone, levomethadone),
and of other psychotropic substances such as nicotine,
benzodiazepines, barbiturates, cocaine, cannabis, amphetamines/
amphetamine derivatives and alcohol. The alcohol intake
was noted in grams of alcohol per day. 500 ml beer was calculated as
20 g alcohol, 500 ml cognac (40%) or vodka (40%) as 160 g alcohol
[21]. The declarations were verified by an immunoassay urine test
(Triage®) and a KIMS test (kinetic interaction of microparticles in a
solution).
The patients were divided into 3 groups according to the preferred
opioid of each individual. Those who daily received methadone
or levomethadone (summarized as methadone) were included
in group 1, those who took codeine or DHC daily (summarized as
DHC) in group 2 and those daily consuming heroin in group 3. If
primarily two opioids were taken daily, then the priority sequence of
heroin before methadone before DHC was decisive. If none of the
opioids were taken daily, but rather several of them alternatively,
then these patients were not introduced into any of the 3 groups.
Data concerning the daily intake of other psychotropic substances
were collected for each group, as well as the gender of the patient,
duration of addiction, age at first opioid use, age, marital status, history
of imprisonment, history of suicide attempts and employment.
Alcohol was separated and selected as a dependent variable (co-abuse
of alcohol). Co-abuse of alcohol was defined as consumption of more
than 40 g alcohol per day. The 40-gram value was chosen since it is
the stated critical dose of alcohol per day in most other published
reports [21, 22, 25, 26].
Statistics
After cross-tabulation and bivariate analysis, a logistic regression
model was established. Bivariate analyses were performed for the
variable of interest and all further potentially relevant variables.
Since preliminary analysis indicated nonlinear associations involving
type of opioid dependency, age, duration of drug use, age at first
opioid use, marital status and history of imprisonment, these variables
were transformed from ordinal to categorical variables. Results
are summarized by reporting a ‘full model’ that includes all investigated
variables regardless of their statistical significance. Tests for
interactions were used as a check on the uniformity assumption
under which multiple regression estimates are derived.
Results
During the observation period from April 1991 to
December 1996, 1,656 patients were voluntarily admitted
to stationary qualified withdrawal treatment, 36% women
and 64% men. 537 of these were patients readmitted
within the given time frame. Of these patients only the
first admission was included in the study in order not to
violate the assumption of independent observations. 49
patients were not included since they had daily consumed
several different opioids. 137 patients, 36% women and
64% men, who daily received methadone, were included
in group 1. 658 patients, 34% women and 66% men, due
to their daily intake of codeine/DHC were placed into
group 2. 275 patients, 39% women and 61% men, daily
consuming heroin formed group 3. The average age was
30.7 years in group 1, 28.9 years in group 2 and 28.3 years
in group 3. The average duration of addiction to opioids
was substantiated as 10.5 years in group 1, 8.9 years in
group 2 and 8.2 years in group 3.
301 patients consumed more than 40 g alcohol per day.
These were evaluated as positive for the dependent variable
‘co-abuse of alcohol’. On average, alcohol consumption
was 176 g/day (table 1).
Contrary to our hypothesis, the bivariate analysis indicated
that patients who are in a methadone or DHC maintenance
treatment program daily drink alcohol significantly
more often than the heroin-dependent patients (p !
0.01). Fewer patients who were treated with DHC
(31.3%) drink alcohol than patients who were treated with
methadone (36.5%). Table 2 presents bivariate analyses
on the key variable and possible confounding variables
predicting co-abuse of alcohol. As shown, co-abuse of
alcohol was predicted by male gender, older age, longer
duration of drug use, additional daily consumption of
tetrahydrocannabinol (THC), daily consumption of barbiturates
and daily consumption of benzodiazepines.
Table 3 shows the results of a multiple logistic regression
analysis. The key finding that patients consuming
heroin drink less alcohol than patients who were treated
with DHC or methadone persists even when all investigated
variables regardless of their statistical significance
were included in the model. Age and daily consumption
of barbiturates turned out not to be a significant predictor
of co-abuse of alcohol. None of the other previously
entered significant variables like gender (odds ratio, OR,
0.61, 95% confidence interval, CI, 0.44–0.84, p ! 0.01),
duration of drug use (OR 0.19, 95% CI 0.05–0.74, p !
0.05), daily consumption of benzodiazepines (OR 0.52,
95% CI 0.38–0.71, p ! 0.001) and daily consumption of
Table 1. Consumption of alcohol by opioid patients consuming
more than 40 g of alcohol per day (defining ‘co-abuse of alcohol’)
Quantity of alcohol
g/day
Patients (n = 301)
%
40–60 12.0
61–120 23.9
121–180 27.2
181–240 13.3
More than 240 23.6
Total 100
THC (OR 0.67, 95% CI 0.47–0.95, p ! 0.05) became
insignificant, even though our variable of interest ‘type of
opioid dependency’ remained only marginally significant
(OR 2.38, 95% CI 1.42–4.00, p ! 0.001; table 3).
Discussion
The aim of this study was to investigate the association
between the consumption of alcohol and the daily preferred
opioid (methadone, DHC or heroin). The results
indicate that patients consuming heroin drink less alcohol
on a regular basis. In comparison to the patients who consume
DHC, patients in a methadone maintenance program
drink alcohol more often (36.5% of the methadone
patients vs. 31.3% of the DHC patients). The hypothesis
had therefore to be rejected. One explanation might be
due to the effect of the substance, i.e. that heroin is the one
substance with which the desired effect according to the
addicts may best be attained. Other opioids such as methadone
and DHC do not completely produce the desired
effect so that other additional substances, e.g. alcohol, are
consumed. In published reports, problematic alcohol consumption
by opiate users is given as varying between 12%
[27], 32% [18, 28] and 42% [27]. In this spectrum, the
individual subgroups of our study are found, with 16%
problem drinkers in the heroin group, 31.3% in the
codeine group and 36.5% in the methadone group. It is
becoming increasingly possible in Europe to use various
opioids as substitutes. This is understandable when one
considers the high mortality rate of drug addicts, which,
in a meta-analysis, was found to be more than 13 times
greater than in the average populations’ equivalent age
group [29]. Researchers and practitioners are therefore
required to re-evaluate indication positions and to annotate
advantages and disadvantages of each substance. An
important target criterion should be the parallel consumption
of further psychotropic substances, especially alcohol.
It is known that alcohol has a toxic effect on all
organic systems and that therefore chronic consumption
of alcohol causes many severe illnesses. If the patients
now begin to drink alcohol during the methadone or DHC
substitution treatment, then a serious responsibility falls
upon the physicians to recognize, and where necessary to
prevent, the injurious alcohol consumption being caused
perhaps partly by the substitution treatment itself. Further
studies had to be conducted to prove the association
between methadone or other substitutes and drinking
alcohol, and to investigate how long patients can be
treated with methadone before the risk of excessive alcohol
consumption increases significantly. A previous study
showed that 29% of the patients initially began to drink
during the course of methadone maintenance treatment
programs and that they are younger in comparison to nonopioid-
addicted alcoholics [30]. Numerous studies continue
to substantiate that patients during substitution
treatment with methadone consume fewer illegal drugs,
that the risk of HIV infection is reduced and that drugrelated
crime rates fall [20, 31–33]. DHC, which is frequently
prescribed in Germany, appears to improve the
addicts’ situation just as well as methadone [16]. In all
these studies, the illicit drug co-abuse but not alcohol was
a target criterion. In a new study, it was reported that only
one third of the patients in methadone maintenance treatment
abstained from alcohol at the intake and follow-up
[34]. It is known that with a lower dosage of methadone,
co-abuse is higher [35]. Apparently, patients who discover
they are hepatitis C positive, reduce their alcohol con
sumption considerably [28]. In principle it should be taken
into consideration that in Germany alcohol is culturally
accepted. Possibly the results would be somewhat different
in a more abstinence-oriented culture.
Independently of the preferred daily opioid the following
variables were associated with co-abuse of alcohol:
(1) in the total population, males more often have an alcohol
problem than females [36–38] – so it was not surprising
that male opioid addicts more often had drunk alcohol
daily than female opioid addicts; (2) that older patients,
consuming drugs over a longer period, drink more alcohol
seems realistic since the drug alone no longer appears to
have the desired effect; (3) this would be an analogous
explanation of the significantly higher benzodiazepine
and cannabis consumption. Barbiturates are consumed
(in total) in such small quantities that its use is difficult to
assess with certainty. The subgroup of cocaine users is
also so small that an assessment here appears to be of little
practical value.
The multiple logistic regression analysis result proves
that patients who have been treated with methadone or
have taken DHC drink quite significantly more than
patients who have injected heroin intravenously. To our
knowledge this has not yet been described thus in any other
literature. It is nevertheless necessary to consider that
this concerns a retrospective study. Being male, additional
consumption of benzodiazepines and THC was also
confirmed as independent predictor for alcohol co-abuse.
Increased age was not asserted as an independent predictor,
but duration of drug use was. This may be explained
by the fact that increased age implies a longer period of
drug use, since drug addicts in this study on average first
began injecting heroin at 20 years of age. In the first year
of opioid consumption, it appeared that the opioid itself
achieved the desired effect. Not quite every sixteenth
patient drinks alcohol additionally. Already from the second
year onward every fourth patient drinks alcohol daily.
From the sixth to the tenth year, the proportion was
30%, from the eleventh to the fifteenth year 40%. The
effect of the opioid itself no longer appears to be sufficient.
With an opioid consumption of more than 15 years,
slightly fewer patients drank alcohol daily (32.4%). This is
comparable to a British study in which a 32% harmful
daily alcohol consumption has been diagnosed, where the
average duration of opioid dependence was 17 years and
the average age was 39 [28].
The results of this study suggest that co-abuse of alcohol
should receive more attention in further studies of the
effectiveness of substitution treatment programs with various
substitution drugs. Particularly, a comparison between
heroin and methadone should prove very interesting.
More longitudinal studies are still needed.
Acknowledgements
This study was supported by the ‘Modellprogramm Kompakttherapie
im Verbund der Drogenhilfe 1990–1995’ from the Department
of Health of the Federal Republic of Germany. The authors
would like to thank the staff of the detoxification unit ‘villa’ for their
help with data collection and entry.
Read the whole Material here: alcoholConsumption.in.methadone
The haul of 5.7tonnes was seized with 11.3tonnes of opium, worth £141million, and 841kg of hashish valued at £3.3million.
During the operation last month, 63 terrorists were killed, ten armed insurgents and drug traffickers of national and foreign citizenship arrested, and 14 Afghan hostages released.
The raids took place with Afghan police in the Bahramcha and Haji Wakil areas of Helmand province, where British forces are based.
It was aimed at seizing drugs before they are exported and possibly make their way on to the streets of Europe.
Bomb and weapon making materials were also taken in the operation.
The drugs, along with 4.5tonnes of ammonium chloride used to turn opium into heroin, were burnt and two processing factories destroyed.
The heroin seizure alone was more than the entire amount seized during the first three months of this year.
Afghan interior minister Bismillah Khan Mohammadi said: ‘Our special counter-narcotics forces have brought a fantastic achievement to the people of Afghanistan.
‘The seizure of heroin represents the largest single seizure of heroin not only in Afghanistan but the world.’
Helmand’s former head of counter-narcotics Philippa Brown said the amount of the seized drug represented 25-30 per cent of Britain’s annual consumption of heroin.
‘We are making these seizures in conjunction with giving out alternative crops including wheat, grape and fruit trees to show that there is an
alternative to poppy cultivation,’ said Mrs Brown.
Opium seizures in Helmand are significantly higher than levels last year but prices for the drug have also risen sharply, British officials warned.
Bad weather, disease and insect damage have resulted in the cost of a kilogramme of raw opium rocketing from £29 to £142.
Drug economics in Burma’s new political order
The regime’s biggest threat for the past half-century, besides Aung San Suu Kyi, has been rebel armies from various ethnic groups. For decades the regime has worked to increase its presence in these rural areas by building paramilitary allies in hostile regions. The local militias suppress rebel activities in exchange for the freedom to produce and transport drugs with full military co-operation. As the military brokered more deals, its obsession with power quickly took precedence over its war on drugs. Now the regime is more powerful than ever, due to a survival strategy that is largely subsidised by Burma’s multi-billion-dollar drug trade. Perry Santanachote examines that trade, the people who benefit from it and cover it up, the victims and those caught in between.
Welcome to Shan State: land of the drug lords
Aung Min, like many in Rangoon, grew up poor. He enlisted in the Burmese army in 1999 at the age of 18 with ambitions that he would one day join the ranks of his commanding officers. By 2003 he was a second lieutenant stationed in Laukkaing Township in Shan State and led a group of 20 men – his pockets filled reliably with drug money.
Opium production has been an economical lynchpin in eastern Shan State since the late 1940s when military leaders refused to honour the Panglong Agreement that granted autonomy to ethnic states. Rebel armies grew as their drug trade took over the region, and then the world. Shan warlord Khun Sa dominated Southeast Asia’s infamous Golden Triangle with his heroin enterprise through the 1980s and 1990s. By 1995, the Golden Triangle, the mountainous region where Burma, Laos and Thailand meet, became the world’s leader in opium production. His 30-year revolutionary war ended in 1996 but heroin continues to flow out of the state, albeit at a lower rate, with a new breed of drug lords.
Despite acknowledgement by the US State Department that poppy cultivation in Burma today is less than 20 per cent of what it was in the mid-1990s, it’s still an annual multi-billion-dollar business. Burma remains the world’s second-largest opium producer after Afghanistan, and processed 330 metric tonnes, or 17 per cent, of last year’s world supply, according to the UN Office on Drugs and Crime (UNODC) 2010 World Drug Report. Poppy cultivation has also been on a steady incline for the past three years.
Other pages in the report show that Burma is also Asia’s largest producer of amphetamine-type stimulants (ATS), which include methamphetamine, distributed in the form of the cheap and chemically dirty pills, most commonly known in Thailand and the region as ya baa (crazy drug); and the more expensive and cleaner crystalline form known as Ice. Burmese production of methamphetamine coincided with reduced opium production, but producers did not necessarily switch over.
“There has been more production last year when it comes to stimulants because of the increased involvement by the junta-backed militia groups,” Khun Seng, an editor at the independent media and research group Shan Herald Agency for News (SHAN), said. “When the militia groups support the political aspirations of the junta they are also supported by the junta in their drug activities.”
“And if you’re the drug boss,” he added. “You’ll do anything that’ll bring in money. If I’m producing more meth it is because of the market – the buyers. Right now, for two years in a row, opium production has been down so there is less production of heroin than in other years, that’s all. They are not intentionally switching from heroin production to meth production.”
Pornthep Eamprapai, director of the Office of the Narcotics Control Board in Chiang Mai, said heroin and opium production was down because of climatic conditions and drought, not because of eradication. “Meth” quickly filled that gap in recent years, he said, because consumer demand in Thailand is high due to economic and social instability. Thais are becoming addicted to ya baa at an alarming rate, while they were never too keen on heroin.
“Making meth is so much easier too,” Pornthep said. “Cooking up meth or Ice doesn’t require any crop.”
Another big difference between today’s drug trade and that of the Khun Sa era, is that it is now increasingly controlled by the government. Former Prime Minister Khin Nyunt engineered a series of ceasefires with major drug-producing militias in 2003-2004 and incorporated them into the economy and constitutional process, creating an environment conducive to drug production and collusion between military personnel and drug traffickers. The regime has been suspected of involvement in the drug trade in the past but never at the level seen today.
In the past decade, the military regime has prioritised keeping it under wraps and making it appear as though it has waged a war on drugs. In 1999 the military inducted a 15-year drug-eradication programme, made lofty promises to the international community to crack down on trafficking, publicised some token drug busts and even opened an anti-drug museum. But these acts were all sleight of hand – an illusion to placate the international community. Although, they may have worked.
The UNODC commended the junta for its “considerable decrease in the area under cultivation and a strong decline in potential opium production” in its Opium Poppy Cultivation Report last year and budgeted US$7.7 million for the eradication programme between 2004 to 2007.
“It’s just another attempt to get the international community to pay for ordinary development programmes instead of using the state budget for that purpose,” said Chiang Mai-based author Bertil Lintner, who chronicled the history of Burma’s heroin warlords in his book, Burma In Revolt, and more recently the multi-billion-dollar methamphetamine trade in Merchants of Madness: The Methamphetamine Explosion in the Golden Triangle.
“And most of the UNODC’s programmes are just that – ordinary development programmes that have little or nothing to do with drug eradication,” Lintner said.
Pornthep says the Thai government gives Burma 20 million baht (US$625,000) annually every year for opium eradication.
“Their [Burma’s] government isn’t doing enough because they don’t have the resources,” he said. “Therefore they need co-operation and aid from other countries.”
Eleven years later, drug lords continue to operate with impunity and the Burmese Army remains closely involved in the lucrative opium economy, using it as leverage against ceasefire armies. As its deadline approaches, Burma is nowhere near being a drug-free nation. Only 13 townships of the targeted 51 can claim to be poppy-free, while the others are still growing, according to the 2009 Shan Drug Watch Report.
Military culture: a paradigm shift
In 2003 Aung Min was riding high on drug “taxes” collected from traffickers that crossed into his command area, but one day he arrested and executed 15 traffickers, seized their heroin and sold it on the Chinese black market for 200 million Kyats (US $200,000), 20 times more than he would make in a year of tax collecting.
Military intelligence investigated Aung Min shortly after the incident when his foot soldiers were seen suddenly adorned in gold jewellery and he had made a considerable transaction to his mother in the middle of Burma’s banking crisis that had left several banks bankrupt and the Kyat inflated beyond repair. That red flag landed him 15 years in prison. However, the crime he committed was not really the problem; it was the spectacle that got him in trouble.
“Military officers’ involvement in drug trafficking is very common, particularly in Shan State. Even the killing,” said an ex-army captain and friend of Aung Min. “It’s rare that they are arrested. Aung Min was inexperienced so he didn’t know how to be low-profile.”
The former officer divulged Aung Min’s story on condition of anonymity. He left the army last year after 10 years of service and now lives across the border in northern Thailand. He went through three years of officer intake with Aung Min and said they were close friends. The last time they saw each other was on October 7, 2002.
“He was very honest – a simple man,” he said. “I was surprised when I found out. I think it was due to the environment because he was assigned to this area and this kind of bribing, taking money, dealing drugs – this might have changed him.”
Many Burmese soldiers survive on revenues collected from extortion fees because their salaries are meagre and the government has cut off their rations. Today, a private earns about 16,000 Kyats a month, a sergeant earns 35,000 to 40,000 Kyats, while a major general earns 800,000 Kyats.
“The army capacity is also declining: the fighting capacity, military capacity, administration capacity, organising capacity. It’s all due to mismanagement,” he said. “While at the top level they’re getting more benefits and becoming wealthier.”
The ex-army captain explained that battalions had been cut down, but they still had the same amount of work. Faced with the challenge, they had to get creative and make deals with traffickers instead of trying to fight them.
“We can’t fight Karen rebels with 120 soldiers. It’s like 120 people with the duties of 500,” he said.
In 2005, headquarters ordered him to set fire to 180 homes in a Karen village in Kanasoepin Village, Thandaung Township.
“My superiors asked the villagers to forcibly relocate to a designated area. They wanted to control them and destroy the village so they couldn’t communicate with rebels,” he said. “I had to get an agreement with the village head to set up three houses only, document and report to regional command. This way it’d be win-win.”
In this incidence, “win-win” was not bribery, it was security. He only had 18 soldiers with him that day, in an area he referred to as “the black area” where Karen rebels are active.
“If we burned down the village, the Karen rebels would have attacked us,” he said. At that point, he realised he wanted out of the army. “I didn’t want to live with that stress anymore – to deal with that anymore.”
He said there were no official orders to bribe opium farmers or traffickers, but that it had become a major component of military culture. Everyone takes bribes and the money goes all the way up the chain until it eventually reaches Senior General Than Shwe. Officers stress that discretion is key because of the military’s appearance of reform. If a soldier’s actions threaten to expose their role in the drug trade, he will suffer the same fate as Aung Min.
Aung Min’s story illustrates the military’s deep involvement in the drug trade – a complete contradiction to the image it has projected to the world.
Appearances deceptive
A favoured tactic of the regime in its delusive fight against drugs is the highly publicised heroin eradication programme, which the ex-officer explained is set up.
There would be orders from the regional command centre to cut off poppy at a plantation, he said. The authorities would call the farmers and village leader before heading out and telling them to prepare the crop. Upon arrival the farmers would show the soldiers the unusable poppy plants, made so by the plants’ inability to produce the seeds required to make heroin. The soldiers would slash these and leave the good ones intact. Then they would document the eradication with photographs and bonfires. Afterwards, the soldiers collect 10 million Kyats from the village head. This process is repeated every three months.
The Palaung Women’s Organisation (PWO), an NGO based in Mae Sot, Thailand, found in its 2009 report, Poisoned Hills, that only 11 per cent of poppy fields had been destroyed the previous season, mostly in areas visible to the UN’s satellite monitors. The police reports they obtained claimed that 25 per cent of fields were destroyed.
More “taxes” are collected in the trafficking process too. The ex-army captain explained that regional commanders communicate with ceasefire group leaders and issue passes to place on the narcotics cargo trucks so that they are exempt from searches at checkpoints. There are 13 regional commanders throughout the state. About three of them: the Eastern, the Northeastern and Triangle commanders are active in the drug trade. Prime Minister Thein Sein is a prime example of the power these regional commanders hold, as he was the Triangle Regional Commander in 2001 and dealt with Shan warlords on a regular basis before his promotion in 2007.
‘Politically correct’ drug trade
“In my 10 years in the army there’s been an increase in drugs, trafficking, bribes and this kind of involvement,” said the ex-army captain.
The escalation in drug activities is partly caused by the growing number of militia and ceasefire groups.
“Before the army got an agreement with the ceasefire groups they fought against the rebels and weren’t involved in drug trafficking because they were not friends, they were enemies,” said the former captain. “After the ceasefire they had to get money from them for sustainability.”
Today there is an estimated 17 ceasefire agreements with the country’s ethnic rebel groups. The number of active militia groups is unknown, but the SHAN received junta documents that revealed 396 in the Northeastern command alone. In the run up to this year’s election, the military has increased pressure on ceasefire groups to join its Border Guard Force. Those that concede and support the junta’s political ambitions are awarded with military support in their drug activities. SHAN editor Khun Seng said that the junta party needs canvassers that have influence in their respective communities.
“Those who are most influential are involved in the drug trade, especially the militia leaders,” he said. “These people will take advantage of the situation.”
Khun Seng said that as an extra incentive, each militia group was now assigned an operational area where they could do whatever they want without disruption.
“If you are ‘politically correct’, you can do anything in Burma,” he said.
As an example he described this year’s Armed Forces Day in Burma.
“The commander [Colonel Khin Maung Soe] in Tachilek spoke on the sidelines to the militia leaders, ‘This is your golden opportunity. My only advice is that you send your products across the border, but not on this [Burma’s] side’,” Khun Seng said.
PWO’s investigation corroborated SHAN’s accounts that more drugs were indeed coming out of militia-run areas. It reported that opium cultivation increased over 200 per cent in Mantong and Namkham townships in Shan State, both areas controlled by the government. During the 2008-2009 season, the acreage found by PWO for only these two townships, out of the total 23 townships in Northern Shan State, was nearly three times (4,545 hectares) the total recorded by UNODC for all 23 townships combined. The UNODC reported a 100 per cent increase in that same time period in all of Northern Shan State, from 800 hectares to 1,600 hectares.
Both SHAN and PWO have criticised the UNODC’s methodology, which relies on data reported by the junta’s (State Peace and Development Council, SPDC) eradication reports and satellite imagery without proper verification.
The ONCB in Thailand also acquires its Burma drug data from the SPDC.
“For the most part we exchange data with them with good communication and understanding,” Pornthep said. “There has been no lying on their part and their data can be backed up. For instance, the figures for poppy cultivation are the same as the UNODC, the US and China.
“We never meet with the NGOs in Burma,” he added. “We only communicate with the government and narcotic police.”
Seizures mean little
Khun Seng also disputed a statement in the UNODC World Drug Report that attributed the increase in methamphetimine production to ethnic insurgencies in Shan State readying to fight the SPDC by selling more drugs to purchase arms.
“The Kokang and Wa are producing at the normal rate, no more, no less. The increase is due to the involvement of the militia groups, he said. “Now with the Wa and Kokang, these people can produce but they can’t transport without the co-operation of the militia groups. If they do it by themselves they are caught.”
Which explains the number of seized drugs in Burma. UNODC Regional Representative Gary Lewis stated at the release of the 2010 World Drug Report in Bangkok, that 23 million methamphetamine pills were seized in Burma last year, from one million in 2008. Lewis said the numbers likely reflect a surge in production, rather than crime prevention.
Khun Seng agreed that more seizures meant more production, but said that was only part of the picture. The military was particular about where the seizures came from. That is, when the seizures were not fabricated. Militia-produced drugs almost always made it across the border, he said.
The Kokang, a ceasefire group well known for drug production and trafficking along the Sino-Burmese border, were recently attacked by the SPDC for their refusal to join the Border Guard Force and all their drugs were seized. The regime long turned a blind eye to the Kokang’s drug operations and even publicised the area as a “drug-free zone” after its eradication campaign, but in August last year, this all changed and the regime announced a massive seizure of drugs in the Kokang area, while driving more than 37,000 refugees into China.
Several large shipments of methamphetamine, believed to have originated from the United Wa State Army (UWSA), were also recently seized in Tachilek near the Thailand border.
“Seizures are irrelevant and are made only when the authorities want to put pressure on, for instance, the UWSA, for political and security reasons,” Lintner said.
The UWSA, armed with 30,000 soldiers, is the largest ceasefire group to reject the junta’s proposal to become part of the Border Guard Force and the military has turned up the heat as the election approaches. Much of the seized drugs last year are believed to have come from the Kokang and Wa – seizures that would never have happened in the past.
“Proceeds from the drug trade were always a major source of income for several rebel armies in Burma, before and after the ceasefires,” Lintner said. “But the Burmese government and the UNODC chose to turn a blind eye to the traffic as long as the ceasefire groups were on good terms with the government. Now, when some of the ceasefire armies are resisting the government’s demands that they transform their respective armies into Border Guard Forces, they are suddenly being accused of trading in drugs, which they have always done.”
Even with the drastic surge in methamphetamine seizures, the World Drug Report noted that seizures continued to remain very low in Burma. Despite being the second-largest producer of heroin in the world, only one per cent of worldwide heroin interception was seized in Burma in 2008. Similarly, of the 32 million tablets seized in East and Southeast Asia in 2008, only about three per cent, or 1.1 million, were seized in Burma.
The report also states that the number of tablets and the amount precursor chemicals seized in Burma jumped last year, when the SPDC entered by force parts of north and eastern Shan State not under their control.
The new political order
The new drug economy that the SPDC has built in Burma will only worsen as the regime’s crusade for power and control intensifies in the run-up to the election. Lintner anticipates the drug trade will eclipse what was seen in the 1990s.
“In 1990, only opium was produced, and the derivative heroin,” he said. “The production increased dramatically in the 1990s, and now is back to what it was 20 years ago. Plus methamphetamines, which were unknown in the Burmese sector of the Golden Triangle 20 years ago.”
In 1997, then US Secretary of State Madeleine Albright knew all too well where Burma’s drug trade would lead when she aptly stated, “Drug traffickers who once spent their days leading mule trains down jungle tracks are now leading lights in Burma’s new market economy and leading figures in its new political order.”
source: http://www.mizzima.com/news/inside-burma/4218-drug-economics-in-burmas-new-political-order.html
INHALTSVERZEICHNIS
PRÄAMBEL _____________________________________________________________________________ 6
1. Die Substanz Diazetylmorphin______________________________________________________________ 8
1.1. Pharmakologie_______________________________________________________________________ 8
1.2. Medizinische Verwendung _____________________________________________________________ 8
1.3. Pharmakokinetik _____________________________________________________________________ 8
1.4. Wirkungen und Nebenwirkungen von Diacetylmorphin ______________________________________ 10
1.4.1. Wirkungen ______________________________________________________________________ 10
1.4.2. Nebenwirkungen / Unerwünschte Wirkungen___________________________________________ 10
1.4.3. Interaktionen ____________________________________________________________________ 11
1.4.4. Intoxikation _____________________________________________________________________ 11
1.4.5. Entzugssymptomatik ______________________________________________________________ 11
1.4.6. Anwendungseinschränkungen und Vorsichtsmaßnahmen – EXKURS: Heroin und
Verkehrstüchtigkeit ________________________________________________________________ 11
1.5. DAM-Zubereitungen und Einnahmeformen _______________________________________________ 12
1.6. Heroinabhängigkeit __________________________________________________________________ 15
2. EXKURS über Heroinmythologie und Heroinkontrolle _________________________________________ 16
2.1. Der Mechanismus der Drogenkontrolle – Die Entwicklung der Internationalen Kontrolle der Narkotika 16
2.2. Der historische Hintergrund der Heroinkontrolle ___________________________________________ 16
2.3. Heroin als Problemdroge ______________________________________________________________ 16
2.4. Die Heroinmythologie ________________________________________________________________ 18
2.4.1. Die Ebenen der Dämonisierung des Heroins in den USA __________________________________ 18
2.4.2. Heroin in Europa _________________________________________________________________ 21
2.4.3. Ergebnisse der Literaturanalyse 1920-1945_____________________________________________ 22
2.4.3.1. Außermedizinische Literaturquellen _______________________________________________ 23
2.4.3.1.1. Heroin in Frankreich ________________________________________________________ 24
2.4.3.1.2. Heroin und Okkultismus _____________________________________________________ 25
2.5. Kontrolle und Mythologie 1923-1931 ____________________________________________________ 25
2.6. Die Auswirkungen der amerikanischen Heroinmythologie auf die europäische Einstellung in der
Zwischenkriegszeit __________________________________________________________________ 26
2.7. Die Situation nach dem Zweiten Weltkrieg________________________________________________ 27
3. Heroin in der Behandlung der Heroinabhängigkeit _____________________________________________ 28
3.1. Überblick über grundsätzliche Positionierungen in den verschiedenen Heroinstudien _______________ 29
3.1.1. Das Ungenügen der Methadonsubstitution _____________________________________________ 29
3.1.2. Ärztliche Heroinverschreibung als schadensbegrenzende Maßnahme ________________________ 30
3.1.3. Die Kontroverse um die Heroinverschreibung __________________________________________ 32
4. Heroinprojekte international_______________________________________________________________ 33
4.1. SCHWEIZ _________________________________________________________________________ 33
4.1.1. Entwicklung und rechtliche Grundlage der HeGeBe______________________________________ 33
4.1.1.1. Die legistischen Rahmenbedingungen______________________________________________ 34
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4.1.1.1.1. Drogenpolitik als Aufgabe des öffentlichen Gesundheitswesens ______________________ 34
4.1.1.1.2. Die katalysatorische Wirkung von AIDS ________________________________________ 35
4.1.2. Überprüfbare Zielsetzungen der schweizerischen Drogenpolitik seit 1991_____________________ 37
4.1.3. Die Schweizer Studie zur medizinischen Opiatvergabe (PROVE) ___________________________ 38
4.1.3.1. Supervisionsorgane, Expertengremien und Begleitgruppen _____________________________ 40
4.1.3.2. Praktische Umsetzung __________________________________________________________ 41
4.1.3.3. Begleitforschung ______________________________________________________________ 43
4.1.3.3.1. Substanzforschung _________________________________________________________ 43
4.1.3.3.2. Medizinische Forschung _____________________________________________________ 43
4.1.3.3.3. Sozialwissenschaftliche und ökonomische Forschungsthemen________________________ 45
4.1.3.4. Die Ergebnisse der Versuchsphase ________________________________________________ 47
4.1.3.4.1. Der Schweizer Synthesebericht________________________________________________ 47
4.1.3.4.2. Bericht der externen Expertenkommission zur Beurteilung der schweizerischen
wissenschaftlichen Studien über die ärztliche Verschreibung von Betäubungsmitteln
an Drogenabhängige ________________________________________________________ 50
4.1.4. Zusammenfassende Darstellung des Ablaufes der Entwicklung der kontrollierten
Heroinverschreibung – eine Chronik __________________________________________________ 65
4.1.5. Die Entwicklung der Schweizer Versuche nach der Versuchsphase __________________________ 68
4.1.5.1. Die legislative Regulierung – die drogenpolitische Auseinandersetzung ___________________ 68
4.1.5.2. Der drogenpolitische Diskurs ____________________________________________________ 68
4.1.5.2.1. Die Befürworter der HeGeBe _________________________________________________ 70
4.1.5.2.2. Verbände und Initiativen, die gegen die HeGeBe auftraten __________________________ 71
4.1.5.2.3. Das Referendum gegen den dringlichen Bundesbeschluss zur ärztlichen
Heroinverschreibung vom 9.10.1998 – Argumentarium_____________________________ 75
4.1.6. Die Entwicklung der Projekte zur HeGeBe _____________________________________________ 78
4.1.7. Situation 2001 ___________________________________________________________________ 80
4.1.8. Bislang vorliegende Ergebnisse der ersten Routinephase __________________________________ 81
4.1.9. Abschließende Bewertung des Schweizer Modells der heroingestützten Behandlung ____________ 83
4.1.10. Best Practice – Best Control? Das Schweizer Handbuch HeGeBe 2000, herausgegeben vom BAG 86
4.2. NIEDERLANDE___________________________________________________________________ 122
4.2.1. Die Niederländischen Studien und ihre Ergebnisse ______________________________________ 124
4.2.1.1. Ergebnisse __________________________________________________________________ 127
4.2.1.2. Die Kosten der HeGeBe im Niederländischen Modell ________________________________ 129
4.2.1.3. Schlussfolgerungen ___________________________________________________________ 129
4.2.1.4. Empfehlungen _______________________________________________________________ 130
4.3. DEUTSCHLAND __________________________________________________________________ 130
4.3.1. Der Entwicklungsprozess der deutschen Projekte _______________________________________ 130
4.3.2. Struktur, Dauer, Kosten und Rahmenbedingungen des deutschen Modellprojekts ______________ 133
4.3.3. Methode und Design _____________________________________________________________ 134
4.3.3.1. Studienaufbau _______________________________________________________________ 137
4.3.3.2. Zeitplan ____________________________________________________________________ 138
4.3.3.3. Voraussetzungen _____________________________________________________________ 138
4
4.3.3.4. Der aktuelle Stand des Projektes _________________________________________________ 138
4.3.3.5. Der bisherige Verlauf der Studie in Bonn __________________________________________ 138
4.3.3.6. Die deutsche und die niederländische Heroinstudie im Vergleich _______________________ 141
4.4. ENGLAND _______________________________________________________________________ 142
4.4.1. Drogenpolitischer Hintergrund _____________________________________________________ 142
4.4.2. Die Veränderungen in den sechziger Jahren des 20. Jahrhunderts __________________________ 144
4.4.3. Der Einsatz injizierbarer Zubereitungen in der Behandlung Abhängiger _____________________ 146
4.4.3.1. Das Ausmaß der Verschreibung von injizierbarem Methadon und injizierbarem DAM_______ 146
4.4.3.1.1. Aktuelle Situation _________________________________________________________ 149
4.4.4. John Marks: ein Traditionalist des „Britischen Systems“ _________________________________ 154
4.4.4.1. Bericht über die Behandlungsmethode von John Marks _______________________________ 156
4.4.4.1.1. Die abgegebenen Substanzen und ihre Darreichungsformen ________________________ 157
4.4.4.2. Arbeitsweise bis 1995 _________________________________________________________ 157
4.4.4.2.1. Die Arbeit der „drug dependency clinic“ von John Marks im Spiegel der Statistik _______ 159
4.4.4.3. Die Arbeitsweise nach 1995 ____________________________________________________ 160
4.4.4.4. Bewertung durch die örtlichen Strafverfolgungsbehörden _____________________________ 161
4.4.5. Die Verwissenschaftlichung der Opiatverschreibung an Abhängige in England________________ 161
4.4.5.1. Die Untersuchung von HARTNOLL 1980 _________________________________________ 161
4.4.5.2. Die Untersuchung von METREBIAN 1998 ________________________________________ 162
4.5. KANADA ________________________________________________________________________ 163
4.5.1. Drogenpolitischer Hintergrund _____________________________________________________ 163
4.5.2. Opiatgestützte Behandlung Abhängigkeitskranker ______________________________________ 164
4.5.3. Die Entwicklung des Heroinproblems ________________________________________________ 165
4.5.4. Die Entwicklung der Behandlung Opiatabhängiger______________________________________ 166
4.5.5. Die NAOMI – Initiative___________________________________________________________ 167
4.5.5.1. Das Konzept der NAOMI ______________________________________________________ 169
4.5.6. Laufende Heroinprojekte in Kanada _________________________________________________ 171
4.6. SPANIEN ________________________________________________________________________ 172
4.7. AUSTRALIEN ____________________________________________________________________ 173
4.7.1. Drogenpolitischer Hintergrund _____________________________________________________ 173
4.7.2. Der Entwurf des ACT ____________________________________________________________ 174
4.7.2.1. Zielvorstellungen und erwartete Ergebnisse ________________________________________ 174
4.7.2.2. Pilot-Studien ________________________________________________________________ 175
4.7.3. Australien 1997-2002 ____________________________________________________________ 176
4.7.3.1. Die drogenpolitische Diskussion _________________________________________________ 176
4.8. DÄNEMARK _____________________________________________________________________ 178
5. ZUSAMMENFASSENDE DARSTELLUNG________________________________________________ 179
5.1. Überblick über den internationalen Stand der heroingestützten Behandlung _____________________ 179
5.2. Die wissenschaftliche Ausrichtung der internationalen Experimente ___________________________ 179
5.2.1. Methodische Probleme der wissenschaftlichen Designs __________________________________ 180
5
5.2.2. Die Bedeutung der Projekte zur HeGeBe für die Forschung und die Bedeutung der Forschung
für die Praxis der HeGeBe _________________________________________________________ 184
5.2.2.1. Die problematischen Nebeneffekte der Forschungsauflagen für die Praxis ________________ 184
5.2.2.2. Beurteilung der Kritik _________________________________________________________ 185
5.3. Zusammenfassung der bisher vorliegenden Ergebnisse _____________________________________ 185
5.4. Die europäischen Studien im Überblick _________________________________________________ 187
5.4.1. Ergebnisse hinsichtlich der Zielvorgaben der Studien____________________________________ 187
5.5. Diskussion der Ergebnisse und Einschränkungen hinsichtlich ihrer Validität und Generalisierbarkeit _ 191
5.5.1. Bemerkungen zur Frage der „Haltekraft“ der Programme_________________________________ 191
5.5.2. Weiterhin offene Fragen __________________________________________________________ 192
5.6. Ein Zukunfts-Szenarium _____________________________________________________________ 194
5.6.1. Die Registrierung des DAM als Arzneimittel __________________________________________ 195
5.6.2. Die Position der Internationalen Suchtmittelkontrolle____________________________________ 196
5.7. Ausblick: Vorstellungen über die notwendige Differenzierung der heroingestützten Behandlung_____ 197
5.8. Schlussfolgerung und Empfehlung _____________________________________________________ 199
6. LITERATURVERZEICHNIS ____________________________________________________________ 203
Ein dicker Brocken, wie immer sehr interessant meiner wirklich ganz bescheidenen Meinung nach:
PORTO, Portugal—This country’s move to decriminalize illicit substances—Europe’s most liberal drug legislation—turns 10 years old this month amid new scrutiny and plaudits.
Portugal’s decriminalization regime has caught the eye of regulators in Europe and beyond since it was implemented in 2001. Proponents credit the program for stanching one of Europe’s worst drug epidemics. Critics associate it with higher crime and murder rates. Approaching a decade in force, it is providing a real-world model of one way to address an issue that is a social and economic drag on countries world-wide.
Norway’s government formed a committee to look at better strategies for dealing with drug abuse and sent two delegates to Portugal in early May. Danish politicians have also talked of moving toward full decriminalization. In March, Danish parliamentarian Mette Frederiksen of the opposition Social Democrats praised the Portuguese model.
„For us, this is about the addicts leading a more dignified life,“ she told Danish daily Berlingske. „We want to lower the death rates, the secondary symptoms and the criminality, so we look keenly to Portugal.“
Markel Redondo for The Wall Street JournalA patient takes her methadone dose at a Porto rebab center that is part of Portugal’s decadelong experiment with drug decriminalization.
Decriminalization has been criticized by United Nations bodies. In its 2009 annual report, the International Narcotics Control Board expressed „concern“ over approaches that decriminalize drugs or introduce alternative treatments. „The movement poses a threat to the coherence and effectiveness of the international drug-control system and sends the wrong message to the general public,“ the board wrote.
In July 2000, Portugal moved beyond previous liberalization regimes in places like the Netherlands by passing a law that transformed drug possession from a matter for the courts to one of public and community health. Trafficking remained a criminal offense but the government did away with arrests, courts and jail time for people carrying a personal supply of anything from marijuana to cocaine to heroin. It established a commission to encourage casual users to quit and backed 78 treatment centers where addicts could seek help.
Portugal’s Fight Against Drugs
In 2008, the last year for which figures are available, more than 40,000 people used the rehab centers and other treatment programs, according to the Institute for Drugs and Drug Addiction, a branch of Portugal’s Ministry of Health. The ministry says it spends about €50 million ($64.5 million) a year on the treatment programs, with €20 million more provided through a charity funded by Portugal’s national lotteries.
Before decriminalization, Portugal was home to an estimated 100,000 problem heroin users, or 1% of the country’s population, says João Goulão, director of the Institute for Drugs and Drug Addiction. By 2008, chronic users for all substances had dropped to about 55,000, he says. The rate of HIV and hepatitis infection among drug users—common health issues associated with needle-sharing—has also fallen since the law’s 2001 rollout.
Portuguese and European Union officials are loath to give publicly funded treatment centers sole credit. They say the drop in problematic drug users could also be attributed to heroin’s declining popularity in Portugal and the rising popularity of cocaine and synthetic drugs among young people.
At the same time, Portugal’s drug-mortality rate, among Europe’s lowest, has risen. Mr. Goulão says this is due in part to improved methods of collecting statistics, but the number of drug-related fatalities can also be traced to mortality among those who became addicted to heroin during the country’s 1980s and 1990s epidemic.
Violent crime, too, has risen since the law’s passage. According to a 2009 report by the U.N. Office on Drugs and Crime, Portugal’s drug-use and murder rates rose in the years after decriminalization. The general rise in drug use was in keeping with European trends, but the U.N. noted with some alarm that cocaine use doubled and cocaine seizures jumped sevenfold from 2001 to 2006.
Murders rose 40% in the period. The report tentatively links that with drug trafficking, but points out overall murder rates in Portugal remain low.
Pedro do Carmo, deputy national director of Portugal’s judiciary police, says he doesn’t see link the rise in violent crime with decriminalization. Instead, he praises the program for reducing the fear and stigma attached with drug use. „Now, when we pick up an addict, we’re not picking up a criminal,“ he says. „They are more like victims.“
The Portuguese began considering drug decriminalization following a leap in heroin addiction decades ago in the country, a major entry point for drug trafficking from Latin America and North Africa.
The then-ruling Socialist Party government of Prime Minister António Guterres launched a political debate to discuss how to resolve the problem. Members of the right-wing People’s Party decried any tolerance for drug use, saying it would invite drug tourism.
Mr. Guterres’s government pushed through a full decriminalization law. A subsequent center-right coalition led by José Manuel Barroso, now president of the European Commission, didn’t repeal it.
The legislation was the first in a series of liberal policy shifts in this predominantly Roman Catholic country. In May, President Aníbal Cavaco Silva ratified a law allowing same-sex marriage, making it the sixth European country to do so. In 2007, Portugal went from having among the toughest restrictions on abortion to among the most liberal.
Portugal’s focus on close-knit community and protecting the family may be at the heart of many of these reforms, say some observers. In a 1999 report that paved the way for new drug legislation, current Portuguese Prime Minister José Sócrates implored that „drugs are not a problem for other people, for other families, for other people’s children.“
Portugal’s rehab clinics, called Centros de Atendimento de Toxicodependentes, are central to the strategy. In the lively northern port city of Porto, dozens of patients pop in daily to the Cedofeita rehab center to pick up free doses of methadone. Others have scheduled therapy or family counseling sessions, also free.
„The more they can be integrated in their families and their jobs, the better their chances of success,“ says José González, a psychiatrist at Cedofeita. Mr. González says that about half of his 1,500 patients are in substitution treatment, 500 of which take methadone daily. He says there is no defined model or timeline for treatment.
The European Monitoring Centre for Drugs and Drug Addiction, a Lisbon-based European Union agency, says methadone or other substance-substitution programs are generally viewed as successful but has observed that some Portuguese are beginning to question long-term methadone therapy.
„Now that the epidemic is under control for the most part, people start asking questions,“ says Dagmar Hedrich, a senior scientific analyst with the EMCDDA. „The question now is what is going to happen next? There is a part of the population who do not have the possibility of leaving the treatment.“
In a haunted world of heroin and hurt and heartless hustles, located between a dusty brickyard and rusty railroad tracks along the border of Chicago and blue-collar Cicero, Steve Kamenicky is the go-to guy.
Longtime addicts and novice users seek out Mr. Kamenicky, known as Pony Tail Steve, sometimes in the middle of the day, other times deep into the night. They go to him, usually in a panic, desperate for an injection for a fallen buddy or lover of what some call a miracle drug. They hurry over the paving bricks that Mr. Kamenicky neatly laid to lead the way to his tent, pitched among the tall weeds and trees in one of a string of small encampments of the homeless on the edge of the brickyard.
Mr. Kamenicky, 52, is not a dealer. His own heroin addiction is much too strong. He shoots every $10 bag of heroin he can.
But his fellow addicts consider Mr. Kamenicky a savior.
“I’ve saved more people than the paramedics,” he boasted the other evening as he sat in a Cicero parking lot, his long, salt-and-pepper ponytail snaking down his back.
The drug he administers to fellow heroin users is called Naloxone or Narcan, its brand name. Mr. Kamenicky estimated that in the last few years he had brought back from the deadly depths of heroin overdose at least 35 addicts — in abandoned buildings, crack houses and around kitchen tables.
Naloxone, which is injected, reverses the effects of an opiate overdose. A drug that was a few years ago given by doctors and paramedics, Naloxone is now directly dispensed to drug users like Mr. Kamenicky, who are trained by the Chicago Recovery Alliance and receive Naloxone through a doctor-supervised program. The effort is part of an up-from-the bottom movement in the struggle to rescue those addicted to heroin and other opiates.
“It saves lives,” said Dr. Virgilio Arenas, who leads the addiction division at Northwestern Memorial Hospital. “Naloxone is an effective antidote. It works within minutes once administered.”
Mr. Kamenicky receives Naloxone free, as do drug users across the city, from the alliance, a nonprofit needle-exchange and H.I.V.-prevention program. The alliance also dispenses fresh syringes, condoms and other paraphernalia to users in the hope that they will stay alive long enough to make “any positive change,” the group’s mantra.
Dr. Arenas said there were similar “harm-reduction” projects in Milwaukee, New York and other cities where needles and Naloxone were distributed.
Not everyone endorses the effort. “Some people in the addiction field feel it might foster more drug use,” Dr. Arenas said, adding, “but I don’t think people will use more because they have the antidote. I favor the harm-reduction approach.”
Anecdotal evidence suggests that the Naloxone campaign is saving lives in the Chicago metropolitan area, which led the nation in heroin-related hospital emergency-room visits from 2004 to 2008, according to a recent study. The Illinois Consortium on Drug Policy at Roosevelt University found that there were 23,931 such cases during that period, 50 percent more than were reported in New York City, which ranked second.
Dan Bigg, director and co-founder of the Chicago Recovery Alliance, said the group had collected about 2,000 reports of overdose reversals since 2001 when it began widely dispensing Naloxone to addicts — and even to family members, including one Lake Forest mother, who keeps a vial in her home in case her heroin-addicted daughter has another overdose.
“She wants a living daughter,” Mr. Bigg said, “despite whatever potential challenges she might bring in terms of struggling with drugs or education or marriage or anything else.”
Mr. Bigg said he had used Naloxone to reverse five overdoses. Greg Scott, a sociology professor at DePaul University and the recovery alliance’s research director, said he had reversed 24 overdoses, including a case two years ago when he used Naloxone on Mr. Kamenicky.
For years, Professor Scott has been documenting life in the “Brickyard,” Mr. Kamenicky’s encampment. In the last three years, he said, he has interviewed up to 300 suburban residents who come to the Brickyard to use the heroin they buy in surrounding neighborhoods before slipping back into mainstream society.
Mr. Scott said he had interviewed suburban housewives, hard-driving commodities traders and “weekend warriors,” who shoot up and get a thrill from hanging out at the Brickyard. He said the traders were the least responsive to his offers of Naloxone.
They don’t want to admit they might have a problem,” he said.
Mr. Scott, 42, has also been on the other end of the needle. He said he was addicted to opiates until a few years ago, overdosing on three occasions. Each time, he said, the overdose was reversed by Naloxone.
“It really is a kind of miracle drug,” he said.
Not everyone is as lucky as Mr. Kamenicky or Mr. Scott. In 2008, the most recent year for which statistics are available, there were 390 opiate-related overdose deaths in Cook County, up from 280 in 2007, said Dr. Nancy Jones, the Cook County medical examiner.
Dr. Jones said it was impossible to say how many might have been saved by Naloxone and not “end up on my table.”
The Chicago Recovery Alliance dispenses Naloxone from a fleet of silver panel trucks, which are parked in designated spots around the city every day. One truck recently sat baking in the sun at 61st Street and Calumet Avenue. Cheryl Hull, an alliance employee, has dispensed syringes, advice and compassion from the trucks for nearly 17 years.
Ms. Hull said she gave addicts a bottle of Naloxone and a DVD instructing them on its use. For those without DVD players or places to watch, Ms. Hull pops a disc into the truck’s portable player. Many people do not take the time to watch the instructions, she said, adding that young suburbanites were the most reluctant to linger and learn because they were afraid of the police and city crime.
On Wednesday night, Mr. Kamenicky sat on a plastic bucket, waiting for the alliance truck at a Cicero parking lot. He said it felt good to save a life, to give someone a second chance.
“I’ve only lost one person,” he said.
The victim, he said, was his boss at a suburban print shop. The man started snorting a $10 bag of heroin and then lost consciousness. Mr. Kamenicky ran to find his miracle drug.
“But somebody took it,” he said. “I tried to get some other people to help me, but they were too busy getting high. They couldn’t be bothered.
“By the time I found some Narcan, it was too late. I gave him a shot, but he was already dead.”
The amphetamines, also called Yama tablets are being produced in the dam construction sites jointly operated by ASW and the Chinese state-owned China Power Investment Corporation (CPI) in Kachin State, since last year, added the sources.
Currently, the Chipwi dam in N’Mai Hka River and Myitsone dam in Irrawaddy River, or Mali Hka River are being constructed by the two companies, where the illegal drugs are produced. The sites are provided security by Burmese security forces, the sources added.
There are several hundred labourers in the two dam sites and all workers are Chinese except those into road construction and the day labourers.
In early July, about 300 Kokang troops led by Peng Daxun, eldest son of absconding Kokang leader Peng Jia-sheng sneaked into areas controlled by former New Democratic Army-Kachin (NDA-K) in eastern Kachin state, bordering Yunnan province, from the Chinese border town Nansan, opposite Kokang territories in Northeast Shan State.
Peng Daxun’s troops were given shelter in the Chinese border city Nansan along with their arms by Chinese authorities in the wake of the fall of Laogai, the capital of the Kokang rebels, or the Myanmar National Democratic Alliance Army (MNDAA) to the Burmese Army in August, last year.
The rebel capital was seized by Burmese troops on the allegation that they were producing illegal drugs and weapons.
Peng Daxun’s troops have been secretly producing amphetamines in the dam construction sites before they entered Kachin State from Nansan, said sources.
Recently, Peng Daxun’s men were said to have explored the illegal drug market on the Burma-Bangladesh border, said sources close to him.
The illegal drug production done in utmost secrecy has the cooperation of the AWC owned by Burmese drug lord Lo Hsing Han and Peng Daxun’s Kokang troops.
Lo Hsing Han and Kokang leader Peng Jia-sheng are close relatives and the sons of the two — U Tun Myint Naing, a.k.a Steven Law, son of Lo Hsing Han and Peng Daxun son of Peng Jia-sheng are also close and have businesses links, said sources close to them.
Peng Daxun has business investments in companies in Singapore through U Tun Myint Naing, who is married to a Singaporean.
A very good read:ChasingthdragonOriginsandHistory
Asthma and Heroin, a maybe lethal combination?
Read more: HeroinInsufflationandasthma
1. Einleitung
Einheimische Deutsche bringen mit Aussiedlern nicht selten exzessiven Alkohol- und illega-len Drogenkonsum sowie Kriminalität in Verbindung. Damit meinen sie oft die jungen Russ-landdeutschen, die immer wieder im Blickpunkt der Medien stehen. Gerade die Medien sind es, die das Bild der Aussiedler in der Öffentlichkeit bestimmen, zumal die große Mehrheit der Bundesbürger über keine persönlichen Kontakte und Erfahrungen verfügt. Da Medien nur Ausschnitte der Realität zeigen und diese entsprechend den Interessen ihres Publikums aufbe-reiten, bleibt die mediale Darstellung des Drogenkonsums junger Aussiedler rudimentär.
Deshalb sind empirische Untersuchungen erforderlich, die Erkenntnisse über die Drogenprob-lematik bei Aussiedlern liefern. Seit einigen Jahren mehren sich Studien zu dieser Bevölke-rungsgruppe, dennoch fehlt es in Bezug auf den Drogenkonsum weiterhin an Daten. Dieser Missstand ist auch darauf zurückzuführen, dass diese Zuwanderer nach der Einreise die deut-sche Staatsangehörigkeit erhalten und deshalb in den meisten Statistiken nicht gesondert er-fasst werden. Ziel des vorliegenden Beitrags ist, die Einflüsse des Substanzgebrauchs im sozi-alen Umfeld der jungen Russlanddeutschen darzustellen. Solche Einflüsse wurden bei Aus-siedlern bislang lediglich ansatzweise (Strobl et al. 1999) untersucht.
Der vorliegenden Beitrag beschränkt sich auf die jungen Russlanddeutschen, da diese seit den 1990er Jahren das Gros der Aussiedler stellen.1 Ferner sind es diese Heranwachsenden, die immer wieder mit Drogen in Verbindung gebracht werden. Die Befragung war auf die Stadt Frankfurt am Main begrenzt.2 Dies hatte forschungsökonomische Gründe, hing aber auch mit der besonderen Situation in dieser Stadt zusammen: Frankfurt zählt neben Hamburg und Ber-lin zu den „Drogenhauptstädten“ der Bundesrepublik (vgl. Stöver 2001: 15)3 und zeichnet sich durch eine vorbildliche Integration von Zuwanderern aus.
Weiter geht es hier: zdun_drogen_russlanddeutsche
Inhalt
1. Einleitung ……………………………………………………………………………………………………………. 3
2. Ablauf und Methode……………………………………………………………………………………………… 4
2.1 Dokumentationssystem ………………………………………………………………………………….4
2.2 Behandlungszentren und Patienten …………………………………………………………………. 5
2.3 Auswertungen……………………………………………………………………………………………….5
3. Ergebnisse …………………………………………………………………………………………………………… 6
3.1 Ausgangssituation der neu aufgenommenen Diamorphinpatienten……………………… 6
3.2 Behandlungsregime und Status der Diamorphinpatienten in 2008…………………….. 10
3.2.1 Behandlungsdauer, Behandlungsregime und Diamorphindosis………………….. 11
3.2.2 Die aktuelle Situation der Diamorphinpatienten………………………………………. 14
3.3 Verlauf langfristiger Diamorphinbehandlung …………………………………………………. 24
3.3.1 Die Entwicklung des Gesundheitszustands unter den Diamorphinpatienten… 25
3.3.2 Die Entwicklung der sozialen Situation und des Legalverhaltens ………………. 27
3.3.3 Die Entwicklung des Konsums von Alkohol und Drogen …………………………. 31
3.3.4 Dosierung ……………………………………………………………………………………………34
4. Bewertung der Ergebnisse……………………………………………………………………………………. 36
5. Literatur……………………………………………………………………………………………………….
Lest den ganzen Bericht, lohnt sich schon allein wegen dem statistischen Material: Verthein_Haasen_2009_QS_Diamor_Zwischenbericht_II
ABSTRACT
Objectives To examine survival and long term cessation of
injecting in a cohort of drug users and to assess the
influence of opiate substitution treatment on these
outcomes.
Design Prospective open cohort study.
Setting A single primary care facility in Edinburgh.
Participants 794 patients with a history of injecting drug
use presenting between 1980 and 2007; 655 (82%) were
followed up by interview or linkage to primary care records
and mortality register, or both, and contributed 10 390
person years at risk; 557 (85%) had received opiate
substitution treatment.
Main outcome measures Duration of injecting: years from
first injection to long term cessation, defined as last
injection before period of five years of non-injecting;
mortality before cessation; overall survival.
Results In the entire cohort 277 participants achieved
long term cessation of injecting, and 228 died. Half of the
survivors had poor health related quality of life. Median
duration from first injection to death was 24 years for
participants with HIV and 41 years for those without HIV.
For each additional year of opiate substitution treatment
the hazard of death before long term cessation fell 13%
(95% confidence interval 17% to 9%) after adjustment for
HIV, sex, calendar period, age at first injection, and
history of prison and overdose. Conversely exposure to
opiate substitution treatment was inversely related to the
chances of achieving long term cessation.
Conclusions Opiate substitution treatment in injecting
drug users in primary care reduces this risk of mortality,
with survival benefits increasing with cumulative
exposure to treatment. Treatment does not reduce the
overall duration of injecting.
INTRODUCTION
Injection drug use is an important public health problem
with a prevalence of around 1-2% among young
adults in the United Kingdom and a standardised mortality
ratio over 10 times that of the general
population.1 Deaths in those who inject opiates are
mainly a consequence of overdose and bloodborne
infection.2 The principal treatment for dependent
users is opiate substitution therapy, commonly oral
methadone,3 which in the UK is mostly delivered in
primary care settings. Opiate substitution treatment
can reduce opiate use, mortality, and transmission of
bloodborne infections, though most evidence comes
from relatively short term studies.4-8
Short periods of cessation from injecting are relatively
common,9 but few studies have long enough follow-
up to observe long term cessation, and the impact
of opiate substitution treatment on the overall duration
of injecting is unclear.10
We report on a follow-up study of the Edinburgh
addiction cohort.11 This study included injecting drug
users, most of whom were using heroin, recruited
through Muirhouse Medical Group, a single primary
care facility in a deprived area of Edinburgh, during a
rapid local HIV epidemic.12 We describe the duration
of injecting and survival and assess the influence of
opiate substitution treatment and other factors on
these outcomes.
METHODS
Data source
Methods are described in detail elsewhere.11 13 Briefly,
between 1980 and 2006 all patients at a large primary
care facility in Edinburgh who reported a history of
injecting drug use were recruited to the study. Opiate
substitution treatment was publicly funded and accessible
to patients throughout the study period, in keeping
with national guidelines. Cohort members were
flagged with the General Register Office for Scotland
to allow for tracing of deaths and changes of general
practitioner. From October 2005 to November 2007
we attempted to contact all surviving cohort members
to conduct a follow-up interview. Information was also
collected from primary care notes when these were
available.
Read the whole study, it is the longest ever:Methadon, scotland
The revelation that the number of opium-addicted Afghan children has reached new highs is a sad unintended consequence of that war. It dramatically illustrates how adult war games can doom generations of children to a miserable life, argues César Chelala. Worse, it is a growing problem in neighboring Iran and Pakistan as well.
A group of researchers hired by the U.S. Department of State found staggering levels of opium in Afghan children, some as young as 14 months old, who had been passively exposed by adult drug users in their homes.
In 25% of homes where adult addicts lived, children tested showed signs of significant drug exposure, according to the researchers.
According to one of the researchers, the children exhibit the typical behavior of opium and heroin addicts. If the drug is withdrawn, they go through a withdrawal process.
The results of the study should sound an alarm. Not only were opium products found in indoor air samples, but their concentrations were also extremely high. This suggests that, as with second-hand cigarette smoke, contaminated indoor air and surfaces pose a serious health risk to women’s and children’s health.
The extent of health problems in children as a result of such exposure is not known. What is known is that the number of Afghan drug users has increased from 920,000 in 2005 to over 1.5 million, according to Zalmai Afzali, the spokesman for the Ministry of Counter-Narcotics (MCN) in Afghanistan.
A quarter of those users are thought to be women and children. Afzali stated that Afghanistan could become the world’s top drug-using nation per capita if current trends continue.
According to the UN Office on Drugs and Crime (UNODC), no other country in the world produces as much heroin, opium and hashish as Afghanistan — a sad distinction for a country already ravaged by war.
This may explain why control efforts so far have been concentrated on poppy eradication and interdiction to stem exports, while less attention was paid to the rising domestic addiction problem, particularly in children.
Both American and Afghan counter narcotic officials have said that such widespread domestic drug addiction is a relatively new problem. Among the factors leading to increased levels of drug use is on a high unemployment rate throughout the country, the social upheaval provoked by this war and those that preceded it, as well as the return of refugees from Iran and Pakistan who became addicts while abroad.
In both those countries, the high number of opium-addicted children is also a serious problem, particularly among street children. In Tehran, although the government has opened several shelters for street children, many more centers are still needed to take care of them.
According to some estimates, there are between 35,000 and 50,000 children in Tehran who are forced by their parents or other adults to live and beg in the streets or to work in sweatshops.
These children are subject to all kinds of abuse, and many among them end up in organized prostitution rings and become part of the sex trade. They are transported to other countries where they are obliged to work as prostitutes, while others simply disappear.
The situation is equally serious in Pakistan, where in Karachi alone there are tens of thousands of children who are addicted, as drug trafficking prevails all over the city. In Karachi, the main addiction is to hashish.
According to Rana Asif Habib, president of the Initiator Human Development Foundation (IHDF), due to the increase in the number of street children, the street crime rate is also on the rise as children get involved in drug trafficking activities in the city.
Injecting drug users face the additional risk of HIV-infection through the sharing of contaminated syringes. “Drug addiction and HIV/AIDS are, together, Afghanistan’s silent tsunami,” declared Tariq Suliman, director of the Nejat’s rehabilitation center to the UN Office for Humanitarian Affairs.
There are about 40 treatment centers for addicts dispersed throughout the country, but most are small, poorly staffed and under-resourced.
For the first time ever, an international team including World Health Organization (WHO) officials and experts from Johns Hopkins University and the Medical University of Vienna have joined efforts to design a treatment regime for young children.
The United States and its allies have the resources to rapidly expand and adequately fund and resource such treatment and rehabilitation centers throughout the country. Anything less will be yet another serious indictment of an occupation gone astray.
In April 2007 Ciudad Juárez—the sprawling Mexican border city girding El Paso, Texas—won a Foreign Direct Investment magazine award for “North American large cities of the future.” With an automotive workforce rivaling Detroit’s and hundreds of export-processing plants, businesses in Juárez employed 250,000 factory workers, and were responsible for nearly one-fifth of the value of U.S.-Mexican trade. The trans-border region of 2.4 million people had one of the hemisphere’s highest growth rates.
Just three years later, as many as 125,000 factory jobs and 400,000 residents have vanished. More than ten thousand small businesses have closed, and vast stretches of residential and commercial areas are abandoned. It is no surprise that the Great Recession temporarily shuttered factories and forced layoffs in a city intimately tied to American consumers. Mexico’s economy contracted by 5.6 percent in 2009, far worse than the United States’s “negative growth” of about 2 percent.
But Juárez has suffered from much more than recession. Its murder rate now makes it the deadliest city in the world, including cities in countries at war with foreign enemies. On average, there are more than seven homicides each day, many in broad daylight. Some 10,000 combat-ready federal forces are now stationed in Juárez; their armored vehicles roll up and down the same arteries as semis tightly packed with HDTVs bound for the United States. Factory managers wake up in El Paso—one of the safest U.S. cities—and go to work in the plants of a city bathed in blood.
To Americans the most notable killing was the March assassination of a U.S. consular employee and her husband on their way home from a child’s birthday party. Witnesses say their car was chased down a boulevard that once symbolized peace between the United States and Mexico and mutual prosperity. It rammed a curb within yards of the bridge to El Paso. Though the killing took place practically under the noses of armed forces stationed in the highly sensitive area, just a few bullet casings were recovered from the scene, indicating that the executioners took their time to clean up and cover their tracks.
Three weeks later the army arrested the alleged killer—a member of a gang aligned with the Juárez Cartel—but almost no one believes this crime will ever be “solved.” And with good reason. In recent years less than 2 percent of Mexican homicide cases have concluded with the sentencing of the perpetrator. In Juárez alone, there are some 200 unidentified corpses dating back to January 2008. As of June 2010 Juárez is in its 30th month of open warfare.
Can Juárez be saved? Will the factories reopen, as they have after past economic downturns, or is the city too dangerous for the business of making legal consumer goods? The economic questions are, perhaps, beside the point. For even if legal manufacturing returns, salvation may remain a distant goal. The economic model—low-wage export-oriented assembly—that investors celebrated also helped Juárez become the illegal narcotics capital of the Western hemisphere, perhaps indelibly.
A tale of two cities
I first got to know Juárez during the 1990s, when I lived and worked there as a graduate student in anthropology. It was exciting then: Juárez was at the heart of debate over the North American Free Trade Agreement (NAFTA). Coming fast on the heels of the Soviet collapse in 1989, NAFTA launched the current era of globalization. In Juárez I had a front-row seat for the unfolding of free trade.
It was a place of head-spinning extremes—gleaming high-tech industrial parks ringed by worker slums. One of the world’s most profitable Walmarts sat within view of settlements without decent water, sewers, or paved roads. Amid the inequalities, however, ordinary, middle-class Juarenses were enthusiastic about their city’s future.
I recently returned to Juárez and was unprepared for the city’s shocking transformation. Friends cautioned against crossing the border. Some had closed their businesses there, or had moved their families north. A few warily ventured into Juárez, but they always hurried back to the United States before dark. For the first time, I heard the once-optimistic Juarenses lament their city.
The economic model that investors celebrated helped Juárez to become the illegal narcotics capital of the Western Hemisphere.
Some see the roots of Juárez’s violence in its recovery from the Mexican Revolution, which ravaged what was in the 1910s and ’20s a frontier town. Certainly part of the city’s personality—and maybe its pathology—can be traced to that period.
Like its booming neighbor to the north, it needed schools, libraries, and hospitals. Instead it got bars and whorehouses. Because of Prohibition, El Pasoans had to find their entertainment across the border, in the richly appointed American-owned casinos and nightclubs. Juárez of the 1920s was like Las Vegas of the 1950s: elegant, exotic, uninhibited.
Older Juarenses speak of the post-Revolution city as if it were two: by day Juárez was a quiet Mexican town modeling itself on the progress it saw in the United States. At night it morphed into a world of exported vice and carnal pleasure. The growth of Fort Bliss during World War II and El Paso’s lingering blue laws reinforced that split personality.
In the late 1960s an experiment in export-oriented manufacturing seemed to give Juárez-by-day the upper hand. Under an agreement between the U.S. and Mexican governments, American firms set up shop across the border and imported materials duty-free from the United States. The companies employed Mexican labor to transform those materials into finished goods for export back, also duty-free. The firms, called maquilas by the locals, found favorable conditions: third-world wages, a government that promoted unionization in name only, and no oversight of the treatment of manufacturing byproducts. Moreover, maquila managers could work “overseas” during the day, and return home at night, thereby avoiding Mexican poverty, environmental problems, and crime. Success begets competition. The trickle of U.S. firms that abandoned their costly Midwestern labor forces became a torrent in the 1980s.
But while Juárez-by-day had triumphed for the time being, Juárez-by-night had not been tamed completely. Factory managers loved their assignments: they enjoyed the comfort and security of their El Paso homes, and, when they wanted, the thrill of Juárez nightlife, including the venues that everyone suspected were fronts for drug money.
Global change comes home
In the summer of 1992, during my first visit to Juárez, a change was snaking its way through the city’s impoverished working-class settlements. Deteriorating rural economic conditions, together with relatively high maquila wages (typically $5-7 a day) prompted a huge immigration to Juárez. The steady stream of potential workers—more than a hundred new residents arrived each day in the 1990s—kept wages down and the costs of housing and services up. Despite their improved conditions, then, workers could enjoy few benefits from their labor. They struggled to meet basic needs, including fees for schooling that would qualify their children for factory work once they were old enough to earn a living.
All the families I met relied on at least one factory salary. But there were plenty of unemployed, too. Mostly young men, these idlers were the right age to be working or in school, but instead they hung around wearing baggy Dickie pants, hair nets, and other insignia of cholo (gang) affiliation. My research assistant, a former Catholic catechist, taught me to recognize and steer clear of the real cholos, who were dangerous, and to salute and acknowledge the others, who were just posing.
The settlements blanketing the steep ravines of the mountains surrounding the city’s center had no infrastructure to speak of, but they did have corners. And boys hung out on those corners day and night. They huddled on their haunches in winter and they lolled in whatever shade they could find in summer. They were guarding turf; they menaced the school kids and factory workers forced to cross their paths, sometimes beating them bloody.
Some idlers were getting high, though not from illegal narcotics. Rather, they mined stolen factory materials—paint thinner, acetone, and buckets of solvent-soaked rags used to wipe down finished televisions. They would distribute “sniffs” to their neighborhood buddies.
But in the mid-1990s life for these young men began to take on another character. A friend who worked in drug treatment told me that she and her co-workers were scrambling to identify new addictions, as banned drugs supplanted the inhalants.
On a 1996 tour of settlements, my friend showed me some of the places where dealers had set up shop. They were not selling injectable narcotics—a syringe was an extravagance in these desperately poor communities—but drugs that could be consumed directly. She spoke of pills, though their identification was elusive. These small retail outlets laid the groundwork for the harder stuff that would soon follow. Over time I realized what the idle kids were up to. They were working, perhaps earning only pennies, for the new dealers.
My observations in Juárez reflected a shift in global drug markets that began far from the city. As globalization of manufacturing ramped up in the 1980s, it did so in parallel with dramatic changes in the production, distribution, and consumption of illegal narcotics. In the early ’90s the global pressures that disrupted the trade routes for cocaine that ran from Andean jungles to U.S. consumer markets converged on Juárez.
This was not obvious then. The local change that seemed most consequential for Mexico’s future was the 1992 election of an opposition party member as mayor of Juárez. Francisco Villarreal Torres, owner of a small chain of house-ware stores and a political outsider, campaigned on promises of good governance and clean conduct. His election proved the viability of the National Action Party (PAN), which went on to win the 2000 presidential election, thereby ending 70 years of one-party rule.
Villarreal’s true rival once he took office was not his political opponent, but Amado Carrillo Fuentes, the subordinate, rival, and successor of famed rural drug lord Pablo Acosta, who died in a 1987 shoot-out with Mexican and U.S. forces. Carillo Fuentes moved operations from the sparsely populated Big Bend region of Texas to Juárez, a relocation that mirrored and exploited the globalization-driven economic success of Juárez.
Acosta’s business had focused on smuggling Mexican pot and heroin across the border to U.S. buyers. Distribution was in the hands of informal dealer networks, from which, reportedly, Acosta only infrequently took a direct cut. With two significant changes to Acosta’s business model, Carrillo Fuentes would turn cocaine into the cornerstone of a multinational, vertically integrated enterprise with diversified products stretching from the Andes (and other source sites) to United States (and other) markets.
In the past, Colombians had used Mexican marijuana smugglers to transport only a small portion of their merchandise; the main trafficking routes wound through the Caribbean. By some estimates, cocaine importation and money laundering accounted for a third of Miami’s economic activity in the 1980s. But the 1993 killing of Pablo Escobar decapitated the Medellín Cartel, and, beginning in 1991, the Cali Cartel was weakened by seizures and arrests (though its leaders remained at large until 1995). When the U.S. Department of Justice began to seize Miami bank assets and prosecute the Colombian traffickers’ lawyers, the Mexican cocaine trade picked up pace and volume.
Trafficking drugs is effectively a licensed affair, the exclusive and protected rights to which are controlled by the military and the police.
Seeing his opening, Carrillo Fuentes shifted from bagman to distributor—the first of his two innovations. He also took advantage of another vacuum: in the years prior to his rise, the prosecutorial assault on crack-cocaine in the United States had jailed and killed thousands of street-level dealers and their bosses. Carrillo Fuentes filled that void with his own retail agents in U.S. cities.
Like any vendor, Carrillo Fuentes looked for new markets and new products. And like transnational firms that sprawled across the city, he saw a business opportunity in the booming factory-worker population of Juárez. His second innovation—perhaps the single action most responsible for the rise in violence—was to call an end to drug traffickers’ long-standing voluntary prohibition against local sales.
Local-market development began modestly enough. Sometime in 1990 or 1991—before the Colombian cartels had ceded their supremacy—residents in a handful of Juárez’s scrappy, tar-paper-and-adobe settlements found their first samples of a narcotic previously limited to export markets: cocaine. It was neither pure nor of high quality—cut several times with talc and baking powder—but it was coke, for the first time, for the Mexican masses.
Gustavo de la Rosa Hickerson, long-time human rights attorney and director of the city’s prison from 1995 until 1998, described to me the explosion of tienditas, retail drug outlets. According to de la Rosa, in 1990 there were fewer than 50 neighborhood dealers. By 1995 the number had climbed to 300. The current estimate exceeds 1,000. Some of these tienditas are distribution centers, employing as many as 50 roving peddlers. And the city is now saturated with dealer-addicts, the “fivers” who sell just enough (about five hits) to cover the costs of their own high. Charles Bowden, in his new book Murder City, estimates that as many as 25,000 Juarenses may be involved in petty drug sales. At the height of the Great Recession, that meant one drug dealer for every four or five employed factory workers.
But this explosion of corner dealers was not responsible for the city’s dramatic transformation. That change came with the system of dealer protection. Each corner dealer works not only under an officer in the cartel, but in tandem with a beat cop. The cop protects the dealer and his gang against encroachments by other neighborhood gangs. The tiendita system is thus a logical extension of the rules of the Mexican drug “plaza,” the long-established formal arrangement between traffickers and security forces.
When foreigners talk about the Mexican drug business and the drug war, they talk about cartels carving up territory among each other and then going after each other’s turf. Mexicans, by contrast, begin with the plaza, a government concession sold to a preferred bidder. Trafficking drugs is effectively a licensed affair, the exclusive and protected rights to which are controlled by the military and the police.
In the tiendita system, it is not only locally “licensed” dealers who send their earnings up the chain of command. Beat cops, too, pay their supervisors and commanders. Hence the Juárez name for what the Drug Enforcement Administration (DEA) calls the “Juárez Cartel”: la línea—“police line.”
Chronically underpaid Mexican police traditionally have made their living livable with bribes—the famous mordita (“bite”). But historically they did not defend violently their right to bite. Street drugs changed that. De la Rosa told me that in the mid-1990s, only two of the city’s then-estimated 500 gangs were known to be armed. Now, 80 percent of them are.
The violence intensifies
This local retail model was highly successful, and it quickly became the industry standard. By 1997 it was dispersed widely across the industrial north. Carrillo Fuentes had risen in seven years to become Mexico’s wealthiest and most powerful drug trafficker, with a fortune estimated at $25 billion. His “assets” included General José de Jesús Gutiérrez Rebollo, the Mexican drug czar. In February 1997, just weeks after his appointment to the job, an investigation revealed that he had been on the Cartel’s payroll. Carrillo Fuentes also bought shares in a Mexican bank, a move that helped simplify his money laundering efforts.
When Carrillo Fuentes died while undergoing plastic surgery that summer, a violent power struggle predictably followed. But by today’s standards it was mild: a mere 72 deaths over eight months. Now, about a hundred are killed every two weeks in Juárez.
The narcoguerra following Carrillo Fuentes’s death introduced Juárez to “message killings”: bodies tortured, dismembered, and stuffed into boxes, car trunks, and barrels. Also new and shocking were the open-air executions: gangland-style killings at jam-packed restaurants. At the time, such crimes were rare enough that the media could follow them up and report on their continued lack of resolution.
The battle for succession remained mostly isolated to the top command in both the Cartel and the police (the probable first victim of that narcoguerra was a high-ranking federal police officer, killed by commandos just four days after Carrillo Fuentes’s botched surgery). With the confirmation of new leadership—Amado Carrillo Fuentes’s younger brother Vicente, according to conventional wisdom—the killing abated. But it never went away. And it never went back underground. Restaurants and bars became safe again, but killings continued in the neighborhoods where tienditas had taken root. There, factory workers lived tensely with the growing groups of tough, largely unemployed men and boys who moved constantly in and out of alliance with the more organized gangs.
There are 6,600 gun shops in the four U.S. border states. Of the 11,000 guns turned over to the ATF in 2009, almost 90 percent were traced to U.S. gun shops.
Meanwhile the city continued to gorge on the profits of local and international narcotics sales. Though few admitted it, everyone knew how the gaudy houses that popped up in the old moneyed enclaves were financed. Ditto the origins of the flashy princesses who began to grace the newspapers’ society pages. City elites chose to overlook the excesses of the trafficking business. “We tolerated the narco,” an upper–middle class friend recently told me. “That was our mistake.” I asked her why conventional, conservative-Catholic Juárez put up with the traffickers. “Look at all those businesses up and down the Avenida de las Americas,” she said, “it’s all money laundering. But it gave us restaurants to enjoy and boutiques to shop in.”
The price of permissiveness grew increasingly steep. In 1993 a no-nonsense retired accountant named Esther Chavez Cano noticed routine newspaper stories on the discovery of female corpses. The details were gruesome: some were found tortured and raped, almost all were tossed to the side of a road, as if they were litter. Chavez Cano began a newspaper column in which she demanded action and accountability. Her writing campaign soon launched a social movement that garnered international attention for the same city that was then proudly boasting of its manufacturing triumphs. She and those she inspired tallied 427 women dead or disappeared between 1993 and 2007, an undeniable symptom of the city’s violent alter ego.
But these horrific killings of young women eclipsed a more prosaic body count: that of the men who turned up dead all over the city with increasing regularity. It is easy enough to see how the murdered girls and women focused the world’s attention on Juárez’s perverse, misogynistic, and violent appetites. Nonetheless, for every publicized female corpse there are ten overlooked male counterparts, according to government data. Whatever the explanation for the high numbers of women killed, the one incontestable fact is that the killing of both women and men began in earnest the very year that the DEA says cocaine trafficking shifted from Miami to Juárez. This was not a coincidence.
The world’s deadliest city
I moved away from the border in 1999 but returned to visit in 2001. I caught up with two friends, also academics, who had been raised in the city’s toughest neighborhoods. We met at a cute bar on the corner of Avenida de las Americas and Avenida Lincoln. It was the kind of place then multiplying around town: refrigerated air, an impressive sound system, and swanky drinks. It shared a parking lot with a California-style sushi bar that in 1997 had been the site of the dinnertime execution of a businessman with suspected drug ties.
We talked about cholos. “Today’s cholo is different,” one of my friends remarked. “Yesterday’s cholo used to compete with merely his attitude, his fashion, and his posture. If the cholos really needed to fight, they fought with what they had available: rocks, stones. And then they got knives. But now some of them have guns.” Today, “some” would be “nearly all,” but as recently as 2001, guns were rare.
That summer I took pictures of a sixteen-year-old boy. He sported a bandana and an oversized tee shirt depicting the Virgin of Guadalupe and his initials in Gothic letters. He smiled so sweetly and eagerly that he hardly looked tough in his portrait. He and his mother beamed when I brought them copies. She surprised me with the pride she took in her son’s apparent cholo ambitions. I had never met such a parent.
That summer I was also surprised by what seemed to me an astronomical increase in the number of kids just hanging out, guarding turf on corners. Neighborhood toughs were now everywhere. And they belonged to a bewildering array of ranked groups, mysteriously nested within hierarchies that most of the teenagers I talked to only vaguely understood.
In 2001 I could see that what was once isolated in the bars and nightclubs and conducted its affairs after hours, had woken up to business in the daytime and set up shop close to home. The gap between Juárez-by-day and Juárez-by-night was narrowing to a sliver.
Today, the sliver has vanished. The Juárez Cartel and its rival, the Sinaloa Cartel, fight each other in the streets, and Mexican federal forces allegedly fight the traffickers. Rumor has it that a third trafficking organization, the Zetas, may have entered the market.
In any case, the violence escalates. There were many milestones along the way: 1993, the year that femicide was first recorded, the year when Amado Carrillo Fuentes reportedly assumed sole leadership of the Juárez Cartel; 1997, the escalation of violence after his death; 2000, when, with considerable fanfare, the FBI announced its mission to Juárez to locate the rumored remains of as many as a hundred victims buried in narcofosas, “drug graves” (only four bodies were found). Also crucial was 2004. That year, the United States lifted its ban on assault weapons, making it that much easier for traffickers to obtain their arms of choice. There are 6,600 gun shops in the four U.S. border states. Of the 11,000 guns turned over to the Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF) by Mexican forces in 2009, almost 90 percent were traced to U.S. gun shops.
Homicides in Juárez nearly doubled from 123 to 234 between 1993 and 1994. The rate stabilized for the next dozen plus years, dipping in some, ranging from a low of 176 in 1999 to a high of 294 in 1995. The 2007 spike to 316 murders generated much year-end hand-wringing, but within a month 2007 appeared to be the calm before the storm. Violence exploded in January of 2008, with 46 killings. The total for February was 49. And in March, when President Felipe Calderón deployed thousands of troops to secure the city, the murder count doubled to 117. Now it rarely dips below those levels. One hundred deaths in a month would be considered a respite. May 2010 saw 253.
Mexicans, schooled in the reality of the drug business, find it hard to believe that security forces can fight traffickers. The two groups are indistinguishable.
The familiar explanation for the spasm of violence that has seized Juárez since January 2008 starts with Calderón’s vow upon taking office two years earlier to rid Mexico of all traffickers and his rapid deployment of troops to cartel hot spots. But almost from the start, skeptical observers have suggested that Calderón’s forces appear to be routing all traffickers but one: the powerful Sinaloa Cartel, headed by Joaquín Guzmán Loera, a.k.a. El Chapo (“shorty”). For Mexicans, schooled in the reality of the plaza, it is hard to believe that security forces can fight traffickers; they are, as one journalist put it to me recently in an email, indistinguishable from each other.
Consider the evidence that Mexicans never forget or overlook: shortly after President Carlos Salinas left office in 1994, his older brother’s wife was caught using a fake passport to withdraw more than $80,000,000 from a Swiss bank, part of the fortune her husband somehow managed to amass while working as a government bureaucrat. The disgraced ex-president fled into self-imposed exile in Ireland, a country that has no extradition treaty with Mexico.
His successor, Ernesto Zedillo, declared a U.S.-style war on drugs and then appointed Gutiérrez Rebollo as his drug czar, only to find that Carrillo Fuentes was paying Gutiérrez Rebollo his monthly rent for a national concession.
Even the first opposition president in Mexico’s modern history is not free of suspicion. Shortly after Vicente Fox’s election in 2000, he spent a weekend at the private Cancun retreat of Roberto Hernández Ramírez, CEO of Banamex (Mexico’s second-largest bank) and alleged drug trafficker.
None of this explains the extent of Juárez’s homicidal violence. One major difference between 1997 and 2008, as Gustavo de la Rosa Hickerson pointed out, is that the current war is being fought at every level of the trade, down to the street-level vendor and his protection and tribute network. As Charles Bowden puts it, this is not a war against drugs, it is a war for drugs. One related theory put forward by veteran observer Bill Conroy of Narco News is that the army moved into Juárez to take the concessionaire role away from the police.
The story of the two cities of Juárez thus applies to the entire country: what started in Juárez has become Mexico. The attempt to cripple the drug business in Juárez has meant crippling the city; doing the same in Mexico at large may mean crippling the nation.
Innocent victims
President Calderón has sought to make his drug war palatable by asserting that the country’s war dead—estimated at 23,000 since January 2006 for the country as a whole—deserved to die: their deaths implicate them in illegal activities.
When he first learned about what Juarenses have come to call the “massacre at Villas de Salvarcar,” Calderón hinted that the thirteen teenagers who died at the hands of professional executioners were common criminals and city low life. He could not have been more wrong. In fact they were honor students and athletes who had gathered to celebrate a friend’s seventeenth birthday. They had the misfortune of belonging to a football club whose initials, “AA,” were mistaken for the initials of the Sinaloa cartel’s local enforcers, the Artistic Assassins. And so, in the middle of the night, while the teens danced in a room cleared of furniture, they were gunned down. Seven hours later, when the first daylight photos were taken, the concrete floor where they died still glistened with their clotting blood.
The escalating war over the Juárez plaza coincided with a particularly unpleasant moment in the global market system—in the midst of massive factory layoffs prompted by the economic downtown beginning in 2007. Locals easily grasp that little of the current day-to-day violence in Juárez has much, directly, to do with any cartel. Look at who dies with grim regularity: a gang of teenage car thieves, a group of former cholos who opened a funeral home, a guy pilfering doors from an abandoned neighboring house. Not all victims are entirely innocent—the city is filled with scrappy, hard-working men and women, some of whom have turned to Juárez-by-night for survival now that Juárez-by-day has so little to offer them—but they are not drug dealers or corrupt police, either.
Accommodating the drug business has become a shockingly ordinary part of life. Working-class parents ask few questions when their studious daughters and sons lose factory jobs while their wayward siblings provide the household’s only income.
In February I spent a day with the director of a nonprofit day-care organization as she visited centers her group helped to launch. The owner of one home-based establishment related with good cheer being confronted by a nicely dressed middle-aged couple and their armed bodyguard. They advised her to start paying a $1,000-per-month protection fee. She and her family went into hiding for a few weeks before they reopened—quietly, and with great trepidation. The director laughed when I asked which cartel the extortionists work for. “People like that don’t work for anybody,” she replied. “They extort for a living because no one stops them!” The couple had shaken down the entire block of small family-owned businesses. Little matter that across the street stretched the vast army encampment, home to troops sent to end the city’s lawlessness.
Later my guide told me that Juarenses even have their own terms to distinguish between organized crime and opportunistic crime. The most common form of the latter is the secuestro express: a kidnapping that lasts no more than a few hours, just long enough to pressure a family to cough up an “affordable” ransom, but not long or expensive enough to attract the interests of enterprises that might want a cut.
Night falls
For decades, the maquilas’ critics longed for border businesses to be in control, rather than simply in service, of multinational capital. This is the irony of Carrillo Fuentes’s innovation: he became the Mexican-border trade baron who accomplished all that and more. His generation of traffickers adapted the maquila model to their own use by taking advantage of its infrastructure to move and market their products. No wonder Forbes recognized their achievements by including El Chapo Guzman in its 2010 list of global billionaires.
And what of the maquilas? The signs are not promising: in mid-January university researchers calculated industrial park vacancies at 14 percent—a historic high, up from an already-alarming 10 percent the year before. That month a Siemens customs manager was gunned down on his way to work. In October his subordinate had met her end after U.S. officials found drugs smuggled in a shipment. Mid-level staff are frequent targets, prompting some companies to consider extending their security measures beyond plant executives. It is probably just a matter of time before manufacturing firms move on.
What will be left of Juárez then? In El Paso, there are nightclubs, boutiques, fancy restaurants, and thriving industries. That city is growing in ways that seemed unimaginable even a decade ago. Even the mayor of Juárez has fled north of the border, and that was before he received a threat to his life in February—a severed pig’s head marked with his name.
Those who haven’t abandoned Juárez may be watching the death of it, both day and night.
For years, there has been much discussion about the best strategy to rid Afghanistan of its poppies. Eradication, said the George W Bush administration. Interdiction and alternative livelihoods, retorted the Barack Obama administration. Licensing and production for medicinal purposes, suggests the influential Senlis Council.
The issues have been fiercely debated: Would there be enough demand for Afghanistan’s legal morphine? Is the government too corrupt to implement this or that scheme? To what extent will eradication alienate farmers? Which crops should we substitute for poppies?
These questions are not unimportant, but fundamentally, they do not address the primary source of Afghan drug production: the
West’s (and Russia’s) insatiable demand for drugs.
Afghanistan accounts for about 90% of global illicit opium production. Western Europe and Russia are its two largest markets in terms of quantities consumed and market value (the United States is not an important market for Afghan opiates, importing the drugs from Latin America instead). Western Europe (26%) and Russia (21%) together consume almost half (47%) the heroin produced in the world, with four countries accounting for 60% of the European market: the United Kingdom, Italy, France and Germany.
In economic terms, the world’s opiates market is valued at $65 billion, of which heroin accounts for $55 billion. Nearly half of the overall opiate market value is accounted for by Europe (some $20 billion) and Russia ($13 billion). Iran is also a large consumer of opium, with smaller amounts of heroin. The situation is similar for cocaine, for which the US and Europe are the two dominant markets (virtually all coca cultivation takes place in Colombia, Peru and Bolivia).
In short, it is the West that has a drug problem, not producer countries like Afghanistan (or Colombia): demand is king and drives the global industry.
How should we reduce opiate consumption and its negative consequences in the West and Russia? Drug policy research has typically offered four methods. There is a wide consensus among researchers that such methods should be ranked as follows, from most to least effective: 1) treatment of addicts, 2) prevention, 3) enforcement, and 4) overseas operations in producer countries. For example, 12 established analysts reached the following conclusions, published a few months ago:
Efforts by wealthy countries to curtail cultivation of drug-producing plants in poor countries have not reduced aggregate drug supply or use in downstream markets, and probably never will … it will fail even if current efforts are multiplied many times over.
A substantial expansion of [treatment] services, particularly for people dependent on opiates, is likely to produce the broadest range of benefits … yet, most societies invest in these services at a low level.
Also, a widely cited 1994 RAND study concluded that targeting “source countries” is 23 times less cost effective than “treatment” for addicts domestically, the most effective method; “interdiction” was estimated to be 11 times less cost effective and “domestic enforcement” seven times. The problem is that the West’s drug policy strategy has for years emphasized enforcement, combined to overseas adventures, to the detriment of treatment and prevention. Also, Russia has been complaining about the suspension of eradication in Afghanistan, but it has a very poor record of offering treatment to its own addicts, rejecting widely accepted scientific evidence. Moscow has chosen a strategy that “serves the end of social control and enforcement,” just like the US: criminalization is emphasized and the largest share of public resources is directed to arrest, prosecute and incarcerate drug users, instead of offering them treatment. This worsens Russia’s HIV epidemic, the fastest growing in the world – with nearly one million HIV infections, some 80% of which related to the sharing of drug needles – while syringe availability remains very limited. For instance, methadone and buprenorphine remain prohibited by law in Russia, even if they are effective in reducing the drug problem by shifting addicts from illegal opiates to safer, legal alternatives. Accordingly, a just released New York University report states that “Nothing that happens in Afghanistan, for good or ill, would affect the Russian drug problem nearly as much as the adoption of methadone” in Russia – which would also help Afghanistan reduce poppy cultivation. Obama announced last year that the US would have access to seven military bases in Colombia under the pretext of fighting a war on terror and a war on drugs. Likewise, Russia recently announced that it would set up a second military base in Kyrgyzstan, to combat drug trafficking. Victor Ivanov, the Director of the Russian Federal Drug Control Service, explained how he was inspired by US drug war tactics in Latin America:
The United States‘ experience is certainly quite effective. The powerful flow of cocaine from Colombia into the United States prompted Washington to set up seven military bases in the Latin American nation in question. The US then used aircraft to destroy some 230,000 hectares of coca plantations … Russia suggests building its military base in Kyrgyzstan since it is the republic’s Osh region that is a center of sorts whence drugs are channeled throughout Central Asia.
Europe’s record on drug policy has improved over the last two decades, important advances having been made to bring harm reduction into the mainstream of drug policy, and rates of drug usage for each category of drugs are lower in the European Union (EU) than in states with a far more criminalized drug policy, such as the US, Canada and Australia. But there is still room for improvement. For example, although opioid substitution treatment and needle and syringe exchange programs now reach more addicts, “important differences between [European] countries continue to exist in scale and coverage”, a recent review of harm reduction policies in Europe concludes. In particular, “Overall provision of substitution treatment in the Baltic States and the central and south-east European regions, except in Slovenia, remains low despite some recent increases. An estimate from Estonia suggests that only 5% of heroin users in the four major urban centers are covered by substitution programs, and that this rate is as low as 1% at national level.“ Lack of funds is no excuse, as there is plenty of money available, for instance, out of the $300 billion Europeans spend every year on their militaries, to maintain among other things their more than 30,000 troops in Afghanistan. The UK was put in charge of counter-narcotics in Afghanistan. However, domestically, leading specialists Peter Reuter and Alex Stevens report that “Despite rhetorical commitments to the rebalancing of drug policy spending towards treatment… the bulk of public expenditure continues to be devoted to criminal justice measures… this emphasis on enforcement in drug control expenditures also holds for the most explicitly harm reduction-oriented country, the Netherlands.“ In the UK, over 1994-2005, “the number of prison cell years handed out in annual sentences has tripled“ (although significant increases have also been made towards treatment). “The prison population has increased rapidly in the past decade [and] the use of imprisonment has increased even more rapidly for drug offenders than other offenders… These increases have contributed significantly to the current prison overcrowding crisis.“ British enforcement costs taxpayers dearly, but the government does not regularly or publicly calculate those costs. Through a Freedom of Information request a document was released that “calculated the annual cost of enforcing drug laws – including police, probation, prison and court costs – at approximately ฃ2.19 billion, of which about ฃ581 million was spent on imprisoning drug offenders.“ All this said, there is one way in which Afghanistan does have a drug problem, namely, its increasing number of addicts. A recent report from the United Nations Office on Drugs and Crime (UNODC) estimated that drug use had increased dramatically over the last few years and that around one million Afghans now suffer from drug addiction, or 8% of the population – twice the global average. Since 2005, the number of regular opium users in Afghanistan has grown from 150,000 to 230,000 (a 53% increase) and for heroin, from 50,000 to 120,000 (a 140% increase). This spreads HIV/AIDS because most injecting drug users share needles. But treatment resources are very deficient. Only about 10% of addicts have ever received treatment, meaning that about 700,000 are left without it, which prompted UNODC chief Antonio Maria Costa to call for much greater resources for drug prevention and treatment in the country. The problem is that the Obama and Bush administrations could not care less: since 2005, the US has allocated less than $18 million to “demand reduction” activities in Afghanistan – less than 1% of the $2 billion they spent on eradication and interdiction. Clearly, US priorities have nothing to do with fighting a war on drugs.
source: http://www.atimes.com/atimes/South_Asia/LG01Df02.html
The war on the Afghan heroin trade is having some success, with opium production down 22 percent last year. There has also been more attention paid to opium smuggling, as this is a major concern for Pakistan (and its several million opium addicts). Iran has put more troops on their border, for the same reason, and made it more difficult to get opium into the country. The drug gangs have responded by converting more of their opium into heroin and morphine. But that requires more imports of industrial chemicals for the conversion.
Heroin is much less bulky than opium, and easier to smuggle. As a more expensive drug, it finds most of its users in more affluent areas (like the Persian Gulf, Europe and North America). If you can get the needed chemicals, the math works in your favor. Ten tons of opium (worth about $45 a pound) can be refined into 1.3 tons of heroin (worth about $1,600 a pound).
This conversion requires 2.6 tons of acetic anhydride, an industrial chemical. This is a clear liquid that is flammable and poisonous if you inhale it. There is no legal use for acetic anhydride inside Afghanistan. With bribes and transportation costs, the drug gangs pay about $2,000 per ton to get it to Pakistan. Then it has to be smuggled into Afghanistan, by truck. There are a limited number of roads, with the border manned by guards who are accustomed to being bribed. There are several other chemicals needed to refine the opium (to morphine, then to heroin), but acetic anhydride is the hardest to get, and the one needed in the largest quantities. Smaller quantities of hydrochloric acid are also needed, but this is a more common industrial chemical.
Pakistan drove the heroin trade out in the 1990s, in part, by interfering with the supply of acetic anhydride. While there was a market for opium, it was mainly local, and the large amount of opium available drove the price down. The real money was in heroin, where smaller, more valuable amounts, were easier to move out of the country to more lucrative foreign markets.
Now, consider how heroin fits into the worldwide drug market. The most widely used drug is actually marijuana (and it’s refined version, hashish). There are about 170 million users of these products worldwide. Many live in rural areas where marijuana grows wild and legal restrictions are not energetically enforced. But in many urban areas, marijuana is a major source of income for gangsters, and some terrorist groups. Not as profitable as cocaine and heroin, and harder to smuggle (because of the bulk), but it is still a major threat because it has such a large market.
More debilitating drugs like heroin and cocaine are more expensive, more potent and have less than 20 percent of the market of marijuana and hashish. Cocaine and heroin are more likely to disable users, including much higher risk of accidental death. The 30 million cocaine or heroin users (about 60 percent of them prefer the less debilitating cocaine) are actually dwarfed by the slightly larger number of addicts for synthetic drugs (everything from methamphetamine to Ecstasy and especially prescription drugs).
But cocaine and heroin come from farm crops (coca for cocaine, poppies for heroin) that are very profitable for poor farmers in places like the South American highlands (coca) or Central Asia (Afghanistan at the moment). In both these places, the illegal crops account for the majority of the supply for that illegal drug on the planet. In the case of cocaine, the drug is largely produced by gangsters, with some help from political outlaws (mostly leftist groups). There is some terrorism, but it is all local.
The big danger is the heroin trade, where Islamic terrorists have partnered with tribe based drug gangs to produce most of the world’s heroin. This sort of thing is nothing new. For decades after World War II, most of the heroin came from the remote Burma (now Myanmar)-China border area, where the drug gangs could afford to raise and equip private armies. But both of those nations eventually cracked down on that business, and it moved to Pakistan for a while, but was forced, by a violent government reaction, across the border into Afghanistan. In both earlier cases, controlling the supply of acetic anhydride played a major role in crushing the heroin trade.
The Afghan government is reluctant to shut down the heroin trade, partly because many senior government officials are being bribed, and partly because it would cause more tribal warfare (most of the tribes oppose the heroin trade, and only a few of the Pushtun tribes in the south control most of the heroin production). Moreover, there is the likelihood that the poppy growing and heroin production would just move to another Central Asian nation. The Islamic terrorists would follow. So the problem really is to crush, or otherwise neutralize, the Taliban, al Qaeda and other Islamic radicals who are sustaining their violence via drug profits. The Taliban earns $50-100 million a year from helping protect the drug gangs.
It is interesting that the two major illegal drugs are both produced in small regions, areas that are dominated by outlaw armies and a general absence of law and order. Cocaine is largely from Colombia, where the drug gangs and their political allies (the leftist FARC) almost brought the government to its knees, before politicians, and most of the population rose up and fought back. In Afghanistan, NATO and U.S. commanders have finally convinced their governments to go after the money; the heroin trade.
That means manufacturers and distributors of acetic anhydride have been under scrutiny, and pressure to control the supply of the chemical entering Afghanistan, for nearly a decade. The smugglers have been very resourceful, using bribes and threats to get past government restrictions. The chemical enters Afghanistan from all neighboring countries, except Iran (which has a small army of incorruptible troops on the border trying to keep out the opium and heroin.) The acetic anhydride is often bought in Europe or Russia, labeled as some other product, and sent on its way to Pakistan or one of the Central Asian neighbors of Afghanistan, where bribes or threats are used to get it into southern Afghanistan, where the processing labs are. This smuggling network is now under major attack. Russia is determined to control their growing addiction problem by keeping the smugglers (who bring drugs out and chemicals out) away from the border. But all this effort is crippled by the corruption and lawless nature of the border area. The example of Colombia shows that you can fight back. But it’s not easy, and progress is slow.
ps. the so called „Islamic Terror Groups“ are founded by the US./UK. Secret Service!
The annual United Nations World Drug report on world drug consumption by region provides some interesting intriguing data on global heroin consumption, but a little math sheds some much needed light on the numbers.
Heroin use is declining in the United States, but rising in Europe, according to the latest report, which noted that European users smoke or inject about 25 percent of the 340 metric tons of heroin consumed worldwide each year.
U.N. officials said that cultivation of opium, the compound used to make heroin, has decreased 13 percent in the last year, to 657 tons.
Especially high demand for heroin, and also for cocaine, in Western European countries such as the UK, Italy and France, has led to the emergence of new trafficking routes in West Africa, the report states.
The Regional Breakdown for Heroin Consumption:
- Europe – 26% at 88 metric tons
- Russia – 21% at 70 metric tons
- China – 13% at 45 metric tons
- Africa – 7% at 24 metric tons
- U.S.A. & Canada – 6% at 21 metric tons
- Pakistan – 6% at 21 metric tons
- India – 5% at 17 metric tons
- Southeast Asia – 5% at 17 metric tons
- Iran – 5% at 17 metric tons
Looks like Europe is the biggest overall consumer of heroin, but which region or country has the biggest heroin problem per capita?
The Math:
Russia’s 141,927,297 people consume 70 metric tons or 70,000 kilos, for a total of .000493 kilos per person. Russia’s per capita heroin consumption is nearly double that of Iran, the runner-up. Iran’s 72,000,000 people consume 17 metric tons or 17,000 kilos, for a total of .000236 kilos per person.
Europe comes in third for global heroin use per capita. Europe’s 710 million people consume 88 metric tons or 88,000 kilos, for a total of .000123 kilos per person.
Pakistan ties Europe for third place in overall per capita heroin use. Pakistan’s 169,869,000 people consume 21 metric tons or 21,000 kilos, for a total of .000123 kilos per person.
Per capita heroin use falls off sharply among the U.S., Canada, and other countries that make up the top ten global heroin consumers. U.S.A. & Canada’s 341 million people consume 21 metric tons or 21,000 kilos, for a total of .000061 kilos per person. China’s 1,324,655,000 people consume 45 metric tons or 45,000 kilos, for a total of 0.0000339 kilos per person.
Africa’s 840 million people consume 24 metric tons or 24,000 kilos, for a total of .0000285 kilos per person. Southeast Asia 593,000,000 people consume 17 metric tons or 17,000 kilos, for a total of .0000286 kilos per person. India 1,182,500,000 people consume 17 metric tons or 17,000 kilos, for a total of .0000143 kilos per person.
See the U.N.’s breakdown of the world’s heroin and other drug consumption by geographical region, here.
For more info: UN
source:http://www.examiner.com/x-8543-SF-Health-News-Examiner~y2010m6d28-Who-uses-most-of-the-worlds-heroin
The drug subculture which developed as part of the rise in narcotic drug use in the
1960s has received much attention. Academic sociologists and the media found this, as
an area of deviant behaviour, a subject of considerable intellectual interest and also of
popular fascination. Drug taking as an alternative way of life, where, as Jock Young
puts it, „drug use is given a different meaning from that existing previously“, has
become part of the sociology of deviance. Issues such as the formation and role of the
altemative subculture, the social reaction against deviant drug use, and the particular
importance of the changing social class of drug takers as providing justification for a
moral response, have attracted attention. The transformation of the typical drug user
in the 1960s from a middle-class middle-aged female into a young working-class male
had, it is argued, much to do with the social reaction evoked, and the type of legal and
social controls put into effect.‘ In the 1980s, the link with unemployment has again
been stressed; and the reappearance of cocaine as a „smart“ drug has also provided
another source of sensationalism for the popular press. However, the widespread
assertion that drug taking has now become more „normal“ would seem to downgrade
the ’60s emphasis on drug use as a subcultural activity.2 Certainly, the „junkie“
stereotype is less prominent in media coverage.
Read more:medhist00064-0055
Introduction:
Hepatitis C, Substance Use,
and Dependence
Illicit drug and alcohol abuse and dependence are problems
of major medical importance in the United States, leading
to high rates of morbidity and mortality from end-stage
liver disease. The prevalence of illicit drug use in the United
States, as estimated by the National Survey on Drug Use
and Health in 2002, stands at 19.5 million Americans above
the age of 12; half of Americans aged 12 or older (51.0%)
reported being current drinkers of alcohol, an estimated
120 million people [1•].
Salient illicit drug use and practices
are presented in Table 1. The Centers for Disease Control
has estimated that 60% of all new cases of hepatitis C are
related to injection drug use [2]. Injection drug practices
include the use of heroin, cocaine, methamphetamine, and
prescription opioids (Table 1).
It has been estimated that
there are at least 800,000 untreated injection-heroin users
[3]. However, the population of opioid-drug users may be
grossly undercounted, because some surveys have found up
to three times more illicit drug users in particular regions
than commonly estimated [4].
Drug addiction is a chronic, relapsing neurophysiologic
disease resulting from the prolonged neurologic
effects of drugs. The neurochemical abnormalities resulting
from chronic use, such as opioids, underlie many of the
observed physical and behavioral aspects of addiction
(Table 1). The brain abnormalities associated with addiction
are wide ranging, complex, and long lasting [5,6].
They can involve genetically abnormal brain signaling
pathways, social factors, psychological conditioning or
stress, and result in cravings leading to a predisposition to
relapse even months or years after drug use cessation.
Recent studies have identified risk factors for the transition
to injection drug use that include the following: emerging
drug practices, differential characteristics of opiate injectors
versus inhalers, and patient-related factors that predict
entry into substance abuse treatment [7•,8].
The importance
of limiting individuals from progressing to injection
drug use can be vividly seen from data comparing the
hepatitis C incidence between injection and noninjection
drug users [9]. This longitudinal surveillance study in
New York City showed an annual incidence rate of
hepatitis C in young noninjection drug users of 0.4 per 100
person-years compared with 35.9 per 100 person-years in
injection drug users (IDUs).
Thus, delaying or preventing
the transition to injection drug use can have a significant
health benefit by reducing the risk of comorbid conditions
associated with substance abuse and addiction.
read the full file here: 002_HP04-3-1-05
An exploration of heroin use among non-dependent and controlled dependent heroin users who saw their use as relatively problem-free.
Little is currently known about groups of occasional and controlled heroin users. This study aims to improve our understanding about patterns of heroin use, the nature of dependence and ways of controlling it.
The study describes how this largely hidden population maintained stable and controlled patterns of heroin use. Drawing on an internet survey of heroin users, followed by in-depth qualitative interviews, it examines their reasons for starting to use heroin, previous and current patterns of use, what helped to control use, and why they saw their use as fairly problem-free.
Heroin is a dangerous drug. It can have a devastating impact on individual lives, on users‘ families and on the wider community. However, as the report shows, some people, in some circumstances, can effectively manage and regulate their use. This raises important issues for treatment. Can dependent and chaotic heroin users learn from the experience of this group? Should controlled heroin use be regarded as an acceptable short- or middle-term goal for clients of drug treatment services? Should popular beliefs about the inherent uncontrollability of heroin dependence be left unchallenged?
The report deconstructs some of the myths surrounding heroin use and heroin dependence. It is relevant to policy-makers, those working in the drug treatment field, academics and drug researchers.
This is a massive File but interesting to read:1859354254
Evaluation of Opioid-Dependent Prisoners in Oral Opioid Maintenance Therapy
Dose Determination in Dual Diagnosed Heroin Addicts during Methadone Treatment
Urine Labelling Marker System for Drug Testing Improves Patient Compliance
Quality of Life as a Means of Assessing Outcome in Opioid Dependence Treatment
Why There Has Been an Excess of Overdoses in Norway Since 1990
To their surprise, researchers at Georgetown University Medical Center (GUMC) have discovered that morphine (a derivate of the opium poppy that is similar to heroin) protects rat neurons against HIV toxicity – a finding they say might help in the design of new neuroprotective therapies for patients with the infection.
The discovery, being presented at the annual meeting of the Society of NeuroImmune Pharmacology, also helps explain why a subset of people who are heroin abusers and become infected with HIV through needle sharing don’t develop HIV brain dementia. This brain disorder includes cognitive and motor abnormalities, anxiety and depression.
„We believe that morphine may be neuroprotective in a subset of people infected with HIV,“ says the study’s lead investigator, Italo Mocchetti, PhD, Professor of neuroscience at GUMC. „That is not to say that people should use heroin to protect themselves – that makes no medical sense at all – but our findings gives us ideas about designing drugs that could be of benefit.
„Needless to say we were very surprised at the findings,“ he added. „We started with the opposite hypothesis – that heroin was going to destroy neurons in the brain and lead to HIV dementia.“
The researchers conducted the study because they knew that a number of HIV-positive people are also heroin abusers, and because of that, some are at high risk of developing neurological complications from the infection. Others, however, never develop these cognitive problems, Mocchetti says.
Because little is known about the molecular mechanisms linking opiates and HIV neurotoxicity, Mocchetti and his team conducted experiments in rats. They found that in the brain, morphine inhibited the toxic property of the HIV protein gp120 that mediates the infection of immune cells. With further investigation, they concluded that morphine induces production of the protein CCL5, which they discovered is released by astrocytes, a type of brain cell. CCL5 is known to activate factors that suppress HIV infection of human immune cells. „It is known to be important in blood, but we didn’t know it is secreted in the brain,“ says Mocchetti. „Our hypothesis is that it is in the brain to prevent neurons from dying.“
They say morphine blocked HIV from binding to CCR5 receptors it typically uses to enter and infect cells. The researchers believe CCL5 itself attached to those receptors, preventing the virus from using it. In this way, it prevented HIV-associated dementia. This effect, however, only worked in the M-trophic strain of HIV, the strain that most people are first infected with. It did not work with the second T-trophic strain that often infects patients later.
„Ideally we can use this information to develop a morphine-like compound that does not have the typical dependency and tolerance issues that morphine has,“ says Mocchetti.
April 17, 2010
Red Orbit
http://www.redorbit.com/news/health/…rain_from_hiv/
INHALT
Zusammenfassung
1. Einleitung
1.1. Zum Frühverlauf der Schizophrenie
1.2. Zur Komorbidität von Psychose und Sucht
1.2.1. Epidemiologie
1.2.2. Erklärungsansätze zur Komorbidität
1.2.3. Probleme in der Therapie komorbider Patienten
1.3. Fragestellungen dieser Arbeit
2. Material und Methoden
2.1. Untersuchungsrahmen
2.2. Art der Datenerhebung
2.3. Beschreibung der Gesamt-Stichprobe
2.4. Beschreibung der Stichprobe der berücksichtigten Patienten
2.5. Zusammenfassung
3. Ergebnisse
3.1. Psychopathologie im Verlauf
3.2. Bestimmung der Parallelisierungszeitpunkte
3.3. Das Konsummuster zwischen 1988 und 1997
3.4. Varianzanalyse zum Konsummuster
3.5. Das Konsummuster an den Parallelisierungszeitpunkten
3.6. Einfluß von subjektiver Symptomatik und Diagnose-Zeitpunkt
4. Diskussion
4.1. Methodische Fragen
4.2. Diskussion der Ergebnisse
4.3. Fazit und Ausblick
weiterlesen: PsychoseundSucht_Studie
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