Heroin

RSS Feed for this category

San Francisco Marks 600th Overdose Death Prevented

For the past eight years, the San Francisco Department of Public Health has been handing out the opioid antagonist naloxone (Narcan) in a bid to reduce heroin overdose deaths. This week, the city marked what it said was the 600th life saved by using the overdose-reversal drug.

This drug stops heroin overdoses -- 600 so far in San Francisco (wikimedia.org)
The city distributes naloxone through needle-exchange sites, nonprofit organizations, and community organizations that deal with injection drug users. The department also prescribes the drug to people in residential hotels and the friends and families of heroin users, and conducts training sessions in the county jail.

Not only have hundreds of overdose deaths been averted, but the department also reported that heroin-related visits to the city's emergency rooms had declined by half between 2004 and 2009.

The lifesaving measure is funded by a department expenditure of $73,000 a year, which goes to the Oakland-based Drug Overdose and Prevention Education Project (DOPE Project). DOPE uses the money to buy and distribute the drug and train people on how to use it.

"San Francisco has always been a heroin town," Alice Gleghorn, DPH's head of Community Behavioral Health Services told the SF Weekly. "At one time, San Francisco had an overdose death every day, and that rate has really gone down. I hope our naloxone programs have contributed to that drop. But we don't have the money to do the research."

Eliza Wheeler, director of the DOPE Project, compared naloxone to insulin and said its use posed few problems for injection drug users. "The folks we see are pretty adept with administering drugs, so they'll be okay. People are very capable and willing to save their friends' lives... my experience is that people are really proud of themselves," Wheeler said.

Harm reduction is saving lives in San Francisco. Perhaps other cities and counties should take heed.

San Francisco, CA
United States

Chronicle Book Review: The Power of the Poppy

The Power of the Poppy: Harnessing Nature's Most Dangerous Plant Ally, by Kenaz Filan (2011, Park Street Press, 312 pp, $18.95 PB)

Kenaz Filan thinks that Poppy (always capitalized in the book) is a sentient being. Before you roll your eyes as you recall the fervent mushroom cultists who say the same sort of thing, recall also that more mainstream authors, such as foodie Michael Pollan, have been known to talk like that, too, posing similar questions about what plants want. I'm not personally convinced about the sentience of plants, but I find that adherents of such a position definitely bring something of value to the table: respect for their subjects.

The opium poppy certainly deserves our respect. It can bring miraculous surcease from suffering through the pain-relieving alkaloids within, but those same alkaloids can also bring addiction, oblivion, and death. Our "most dangerous plant ally" can be both kindness and curse, boon and bane. Only by respecting Poppy, writes Filan, can we learn how best to manage our relationship with her.

The Power of the Poppy is part historical treatment, part cultural essay, part pharmacopeia, part practical guide. As such, positions on plant consciousness notwithstanding, it's a fascinating and illuminating treatment of the poppy and its derivatives. Filan traces the history of man's relationship with poppy from 6,000-year-old archeological digs in Europe, through early uses in the Roman empire and the Islamic world, and on to the current era of the war on drugs.

While Filan addresses the war on drugs and finds it stupid, this is not mainly a book about drug policy, and he dismisses the issue in short order. "Our war on drugs has been a one-sided rout," he writes in the introduction. "We keep saying 'no' to drugs, but they refuse to listen."

In his few pages devoted to the past century of opium prohibition, he reiterates the futility of trying to stamp out poppy even as its cultivation spreads. "Poppy is happy to fulfill our needs as long as we propagate her species," he writes. "To her, our 'war' is like locust invasions and droughts -- an annoyance, but hardly something that will endanger the continued existence of her children."

From there, Filan turns to the chemistry and pharmacology of opium and its derivatives and synthetics. He traces the isolation of morphine, codeine, heroin, thebaine (from which is derived hydromorphone [Dilaudid], oxymorphone [Opana], hydrocodone [Vicodin], and oxycodone [Oxycontin]), kompot (East European homebrew heroin), methadone, and fentanyl. Along the way, Filan touches on such topics as the lack of pain-relieving poppy products in the developing world, the development of Oxycontin and the rapid spread of "hillbilly heroin," and controversies over needle exchanges, safe injection sites, and methadone maintenance therapies.

In nearly every case of the development of a new opiate or opioid drug, researchers were hoping to find a substance that maintains poppy's analgesic qualities while eliminating or at least reducing its addictive ones. No such luck. "Despite the best efforts of our chemical minds," Filan writes, "Poppy still demands her bargain…Even as we go to war with Poppy, we are forced to do business with her."

In his next section, demonstrates the bargain poppy extracts as he profiles 11 famous users, including Confessions of an Opium Eater author Thomas de Quincy, Samuel Taylor Coleridge, William Burroughs, Lou Reed (whose Velvet Underground-era Heroin and Waiting for My Man put the 1960s New York junkie experience to music), and DJ Screw, whom I must confess I never heard of until reading The Power of the Poppy. Mr. Screw, whose real name, it turns out, was Robert Earl Davis, was a Houston DJ who rose to hip-hop fame after smoking Mexican weed and accidentally hitting the pitch button as he mixed tapes. The ensuing distorted vocals and slowed down beats became known as "screwed down" and Davis picked up the moniker DJ Screw.

Among the favorite topics of Screw and his crew was "purple drank," a concoction of soda pop, codeine cough syrup, and Jolly Ranchers candy, that created a warm, relaxed high. Screwed down music was the perfect accompaniment for a drank-fueled evening. While DJ Screw died young, in part because of his fondness for drank, he was also an overweight, fried-food loving smoker. While drank may have helped make DJ Screw, as always, poppy exacted her part of the bargain.

In the final segment of the book, Filan gets practical. He describes how to grow your own (from papaver somniferum seeds widely available at gardening stores) and how to extract the raw opium. He describes poppy tea brewing recipes, as well as how to use poppy in pill, tablet, or capsule form; as well as eating smoking, snorting, and shooting it. And he doesn't stint on explaining the dangerous path one is on when one embraces the poppy. Although I don't recall Filan ever using the words harm reduction, he is all about it as he cautions about overdose, dependency, and addiction.

The Power of the Poppy elucidates the many ways the histories of man and poppy are intertwined, and it's full of interesting tidbits along the way. Who knew that the use of "dope" to mean drugs came from Dutch sailors mixing opium and tobacco off China in the 17th Century? They called the mixture "doep," like a greasy stew they ate. Or that calling seedy establishments "dives" derived from scandalized descriptions of California opium dens, with the patrons reclining on divans? Or that the scientific name for snorting is "insufflation"?

If you have an interest in opium and its role in human affairs, The Power of the Poppy will be both entertaining and enlightening. And -- who knows? -- maybe you'll start treating that plant and its derivatives with the respect they deserve.

‘Shooting Galleries’ Take Aim at Illicit Drug Market

Location: 
United Kingdom
Lately, a few British politicians have revived the idea of dispensing taxpayer-funded heroin. Spurred by successful trials in the U.K. and elsewhere in Europe, the idea that governments can reduce both addiction and street crime — and maybe bleed black markets dry — by managing drug distribution has gained momentum. "It is time to replace our failed war on drugs with a strict system of legal regulation," a British MP named Bob Ainsworth said at the end of last year. "We must take the trade away from organized criminals and hand it to the control of doctors and pharmacists."
Publication/Source: 
Miller-McCune (CA)
URL: 
http://www.miller-mccune.com/legal-affairs/shooting-galleries-take-aim-at-illicit-drug-market-27940/

Scottish Liberal Democrats Back Prescription Heroin

Scottish Liberal Democrats at their party conference in Perth voted Saturday to make campaigning for heroin maintenance treatment part of their party platform. Heroin users should not be fined or imprisoned, but should be given the drug through the National Health Service, party members agreed.

Tavish Scott's Lib Dems want "heroin on the NHS." (Image via Wikimedia)
The Liberal Democrats are an opposition party in Scotland, holding 16 of 129 Scottish Parliament seats, 11 of 59 Scottish seats in the British Parliament, and one of six Scottish seats in the European Parliament. They are fourth of five major political parties, behind the National Party, Labor, and the Conservatives, but ahead of the Scottish Greens. They are led by Tavish Scott.

The Lib Dems argued that both society and heroin users would benefit from prescribing the drug. Overdose and tainted drug deaths would decline, and addicts would not have to turn to crime or prostitution to feed their habits, they said.

"For drug offenders, fines and jail time simply don't work. In fact a fine will make it much more likely for a drug user to turn to a life of crime to fuel their habit," said Callum Leslie, a candidate for Mid Fife and Glenrothes. "Instead, the Liberal Democrats want to see a much greater use of Drug Treatment and Testing Orders (DTTOs) and Community Service Orders (CSOs). The evidence shows that these methods work. Offenders are forced to pay back the community they harmed and have a chance to get drug free for good. Controlled diamorphine [heroin] treatment is a method that works where other methods have failed. It stops offenders getting street heroin, which can be fatal and turns offenders to further crime to fund their habit."

"There is a great cost to society, and the public purse, if offenders are just abandoned to a cycle of crime and prison," said Alex Cole-Hamilton, Liberal Democrat candidate for Edinburgh Central. "DTTOs and CSOs are measures that would save public money by keeping drug abusers out of jail. Drug offenders should not be treated the same as murderers. We should work to treat the problem of drug abuse, not lock addicts away and condemn them to a life of crime."

United Kingdom

Copenhagen Safe Injection Site Set to Open

A private safe injection site for heroin users is set to open in Copenhagen this week despite warnings from police and over the objections of neighbors. The harm reduction operation will be located in the city's Vesterbro district near Central Station. It will be the first in Denmark.

Copenhagen's Vesterbro district (Image via Wikimedia)
Police said they did not oppose the site's opening, but would shut it down if they find people using drugs there. "The room is not illegal per se, but possession of narcotics is illegal," Copenhagen Police spokesman Arne Wissing told the Copenhagen Post.  "We have no intention to sit passively and witness criminal acts, so if we see people in possession of illegal drugs, we will certainly act."

But safe injection site organizer Michael Lodberg Olsen said there was nothing illegal about it. "If that's the case, then they could just as well have shut down all of Vesterbro 30 years ago," he said, referring to needle exchange programs that have operated there for decades. "A report from the UN states that handing out clean needles to drug abusers is the same as establishing an injection room," he said.

Safe injection sites are already operating in Australia, Canada, Germany, Luxembourg, the Netherlands, Norway, and Spain. There are no safe injection sites in the US, although there has been talk about establishing one in San Francisco.

Copenhagen
Denmark

How Afghan Poppy Eradication Efforts Are Helping the World's Largest Heroin Dealers

Location: 
Afghanistan
It has long been known inside Afghanistan that heroin dealers in high positions benefit from the United States and Afghan governments' counternarcotics policies. Now the American public can get a glimpse. US embassy cables published recently by WikiLeaks expose the insider opinion that Afghan officials are using poppy eradication teams to weed out the competitors of major traffickers with whom they are linked.
Publication/Source: 
Truthout (CA)
URL: 
http://www.truth-out.org/how-afghan-poppy-eradication-efforts-are-helping-worlds-largest-heroin-dealers67175

Heroin Drought Causing Problems in England

A scarcity of heroin in England is leading to a growing number of drug overdoses and poisonings as users ingest dope cut with other substances by dealers trying to stretch supplies, The Guardian reported this week. Scene watchers there are calling it the worst drought in years.

Are you sure that's heroin? Be careful out there, especially in England
The drought is being blamed not on seizures by law enforcement agencies, but on a fungus that has blighted the Afghan opium poppy crop, reducing the size of this year's poppy crop by half. Afghanistan accounts for more than 90% of the world's opium production and likely 100% of the British heroin supply.

"There is a very significant heroin shortage across the UK at the moment," said Gary Cross, head of drug policy for the non-profit group Release.  "It has been going on for some time now, but the last two months have seen stockpiles exhausted."

"I've never known anything like it in 30 years," wrote one long-time heroin user on an on-line forum discussing the shortage.

As dealers and users scramble to grapple with the shortage, users are turning up at hospitals after ingesting adulterated heroin or, in some cases, fake heroin consisting of a powerful sedative, caffeine, and paracetamol, a bulking agent. Some have passed out after smoking or ingesting, while others have reported vomiting, amnesia, and flu-like symptoms.

"This 'heroin drought' appears to be serious and geographically widespread," said Neil Hunt, director of research at KCA, a nationwide community drug treatment service. "Street heroin is in a complete and utter muddle at the moment, and users are collapsing unexpectedly. We need to standardize information about what's out there.

"If people use this intravenously, perhaps on top of alcohol and methadone [the prescribed substitute drug for heroin], it is extremely risky," said Dr. John Ramsey, who runs a drug database at St. George's Medical School in London. "We have had many reports of people overdosing. It's really important that accident and emergency departments understand that they may not be dealing with a 'normal' heroin overdose when people are brought in," he said.

Harm reduction drug agencies are aware of the problem and working to address it. Several of them held an urgent meeting last week to discuss setting up an online warning system to give users notice about contaminated or adulterated drugs.

London
United Kingdom

Alcohol More Harmful Than Heroin or Crack, British Study Finds

A study published Monday in the Lancet assessed the harms of various substances and found that alcohol caused more harm in the United Kingdom than heroin or crack cocaine. The study was done by the Independent Scientific Committee on Drugs, which is headed by Professor David Nutt.

drug harm comparison chart, from the Lancet study
Until this time last year, Nutt was head of the governmental Advisory Council on the Misuse of Drugs, but he was fired for criticizing the then Labor government as basing its decision to reclassify marijuana on politics rather than science. He also offended government sensibilities by saying that riding horses was more dangerous than taking ecstasy. After his firing, he and other scientists formed the Independent Scientific Committee on Drugs.

The study, Drug Harms in the UK: A Multicriteria Decision Analysis, assessed the relative harms of different legal and illegal drugs to drug users and to society and concluded that "alcohol was the most harmful drug (overall harm score 72), with heroin (55) and crack (54) in second and third places."

It also demonstrated that Britain's drug classification scheme bears little relation to the harms caused by the various substances it regulates or fails to regulate. Alcohol, ranked most harmful in the study, is not a controlled substance, but cannabis (20 points) is Class B, the second most serious drug schedule. LSD (7 points) is a Class A drug, the most serious drug schedule, while tobacco (26 points) is not a controlled substance.

"Our findings lend support to previous work in the UK and the Netherlands, confirming that the present drug classification systems have little relation to the evidence of harm," the authors said.

A group of experts looked at drug-specific mortality, drug-related mortality, drug-specific damage, drug-related damage, drug-specific impairment of mental functioning, drug-related impairment of mental functioning, loss of tangibles, loss of relationships, injury, crime, environmental damage, family adversities, international damage, economic cost, and harm to the community and assessed weighted values for each to arrive at a final figure.

"The weighting process is necessarily based on judgement, so it is best done by a group of experts working to consensus," Nutt and his coauthors said. "Extensive sensitivity analyses on the weights showed that this model is very stable; large changes, or combinations of modest changes, are needed to drive substantial shifts in the overall rankings of the drugs."

Science-based drug policy, anybody?

United Kingdom

FDA Appoves Drug to Treat Heroin, Morphine Addiction

The Food and Drug Administration has approved an injectable drug designed to treat people addicted to opiates who have undergone detoxification treatment. Vivitrol, made by Massachusetts drug maker Alkermes, is a so-called extended-release formulation of the drug naltrexone that is injected once a month into the muscle, according to an FDA statement. The drug works to block opioid receptors in the brain.
Publication/Source: 
All Headline News (FL)
URL: 
http://www.allheadlinenews.com/articles/7020200536?FDA%20Appoves%20Drug%20To%20Treat%20Heroin,%20Morphine%20Addiction

Cambodia Opens First Methadone Clinic

The Cambodian Ministry of Health has opened a clinic where people addicted to opiates, primarily heroin, can be administered methadone. The move is a significant departure in a country in which "drug treatment" has typically meant imprisonment, forced labor, and unproven herbal treatments.

Royal Palace, Cambodia (wikimedia.org)
The opening of the clinic is the culmination of years of quiet effort by harm reduction organizations, the BBC reported. Two of those groups, which run outreach programs for drug users, will identify candidates for treatment.

The program is strictly voluntary. Participants will be taken to the clinic for a needs assessment in line with international standards. The clinic is inside a public hospital and run by the Ministry of Health with support from the UN's World Health Organization.

While harm reductionists and public health workers are pleased with the government's new approach, they said more steps need to be taken to shut down the existing, punitive drug treatment centers. But the government says it has no plans to do so.

Read an expose of existing Cambodian drug treatment centers here.

Cambodia

Drug War Issues

Criminal JusticeAsset Forfeiture, Collateral Sanctions (College Aid, Drug Taxes, Housing, Welfare), Court Rulings, Drug Courts, Due Process, Felony Disenfranchisement, Incarceration, Policing (2011 Drug War Killings, 2012 Drug War Killings, 2013 Drug War Killings, 2014 Drug War Killings, 2015 Drug War Killings, Arrests, Eradication, Informants, Interdiction, Lowest Priority Policies, Police Corruption, Police Raids, Profiling, Search and Seizure, SWAT/Paramilitarization, Task Forces, Undercover Work), Probation or Parole, Prosecution, Reentry/Rehabilitation, Sentencing (Alternatives to Incarceration, Clemency and Pardon, Crack/Powder Cocaine Disparity, Death Penalty, Decriminalization, Defelonization, Drug Free Zones, Mandatory Minimums, Rockefeller Drug Laws, Sentencing Guidelines)CultureArt, Celebrities, Counter-Culture, Music, Poetry/Literature, Television, TheaterDrug UseParaphernalia, ViolenceIntersecting IssuesCollateral Sanctions (College Aid, Drug Taxes, Housing, Welfare), Violence, Border, Budgets/Taxes/Economics, Business, Civil Rights, Driving, Economics, Education (College Aid), Employment, Environment, Families, Free Speech, Gun Policy, Human Rights, Immigration, Militarization, Money Laundering, Pregnancy, Privacy (Search and Seizure, Drug Testing), Race, Religion, Science, Sports, Women's IssuesMarijuana PolicyGateway Theory, Hemp, Marijuana -- Personal Use, Marijuana Industry, Medical MarijuanaMedicineMedical Marijuana, Science of Drugs, Under-treatment of PainPublic HealthAddiction, Addiction Treatment (Science of Drugs), Drug Education, Drug Prevention, Drug-Related AIDS/HIV or Hepatitis C, Harm Reduction (Methadone & Other Opiate Maintenance, Needle Exchange, Overdose Prevention, Safe Injection Sites)Source and Transit CountriesAndean Drug War, Coca, Hashish, Mexican Drug War, Opium ProductionSpecific DrugsAlcohol, Ayahuasca, Cocaine (Crack Cocaine), Ecstasy, Heroin, Ibogaine, ketamine, Khat, Marijuana (Gateway Theory, Marijuana -- Personal Use, Medical Marijuana, Hashish), Methamphetamine, New Synthetic Drugs (Synthetic Cannabinoids, Synthetic Stimulants), Nicotine, Prescription Opiates (Fentanyl, Oxycontin), Psychedelics (LSD, Mescaline, Peyote, Salvia Divinorum)YouthGrade School, Post-Secondary School, Raves, Secondary School