Germany: Heroin OK For Clinical Treatment Of Addicts

[Unknown]

What would be a solution in your opinion? Do you believe that it is possible to stop all recreational drug use? To eradicate addiction as a disease?

The British system from the 1920s was to put addicts in treatment (drug of choice maintenance, access to harm reduction focused health care and services), and arrest anyone caught selling illicit drugs. By doing this, they kept the number of new addict cases low and kept the number of drug dealers on the street low, without overfilling the prisons (since drug users not dealers are the multitudes locked up for drug crimes).

In my opinion this is the ideal system, and it was the first response to the original social drug problem; now almost a hundred years later we're revisiting it.

I really don't know what should be done. It's a big catch 22. Both harm reduction and prohibition have drawbacks.

Wouldn't this be like giving an alcoholic a few glasses of beer everyday? Or a meth addict a shot of meth?

I believe that addiction can be treated, through will-power and support. I don't see how using diacetylmorphine for addiction will do anything other than "kick the can down the road".

I agree that some people might get sick of it, and change their life. But this is no different than other opiate therapies out there.

On the other side, controlled administration of diacetylmorphine will help prevent ODs, diseases/infections, and crime. I am curious to see how this works out...

 

[BeenArrested4Pot]

^
Are you for (all) drug legalization?

I think marijuana should be legalized. I think some drugs could be regulated but I believe to legalize all drugs without regulation is to inflict chaos upon society.

I just don't understand why the quality of life for heroin addicts warrants a heroin clinic, especially in comparison to the quality of life of other addicts. Would a cocaine clinic reduce crime and improve the quality of life of cocaine addicts? Of course.

why not make cocaine clinics?

 

[DexterMeth]

Unknown makes a good point btw...but anyways, Tchort...believe you me, I agree with everything you're saying/said and have "been there/done it", from what there is available in the US. I just noticed that little loophole of a line...you saying how safe and tight nit the program(s) are, yet junkies can have a doctor give them pure dia-amps...that'd be SOOOOO easy to cut like into 1/8th's (at the LEAST) and turn a profit while getting high for free. IMHO/FTR, YES!!!!...i'm definately "pro-legalize fucking everything"...including rape

Thats why clinics are being established as an alternative to outpatient ampoules. The other benefits of a clinic setting rather than outpatient prescribing are 1) the patients consume their dose in the presence of a medical professional so theres no chance for diversion 2) there are doctors and nurses on staff at the clinic who can attend to the individual physical and mental health needs of the patients.

To your previous reply, you are missing aspects of maintenance treatment.

Not everyone who undergoes Opiate Replacement Therapy (i.e. opioid maintenance) wishes to end their use of opioids forever. Some just want to reregulate their use, some want to take a break from the street hustle, some want a break from using to attend to personal matters, some need maintenance rather than abstinence-only treatment indefinitely to hold their lives together (job, family, etc).

These are all acceptable uses for opioid maintenance programs. Including Diamorphine maintenance.

As I posted above, the studies done with actual Heroin maintenance programs showed that many people voluntarily left the IV Heroin program to enter abstinence-only and Methadone maintenance programs instead, using the IV Heroin maintenance program simply as a first step in the ladder of getting clean, or regulating or reducing their use.

The idea that Heroin users will never stop using if they can have free unlimited quantities of pure Heroin is false, and has been proven false with the existing Heroin maintenance programs. Most people in the Swiss permanent Heroin maintenance program don't stay in it for more than 2 years (which is also the average time people spend on Methadone maintenance).

 

[Tchort]

I think marijuana should be legalized. I think some drugs could be regulated but I believe to legalize all drugs without regulation is to inflict chaos upon society.

I just don't understand why the quality of life for heroin addicts warrants a heroin clinic, especially in comparison to the quality of life of other addicts. Would a cocaine clinic reduce crime and improve the quality of life of cocaine addicts? Of course.

why not make cocaine clinics?

Cocaine prescription is currently under review in certain central European countries (and is happening in the UK).

The main reason is that opioids are simply different from other drugs of abuse and habituation. It is disingenuine to lump all substance abuse disorders together; yet this is exactly what the US War On Drugs and its prohibitionist and Christian-oriented 'treatment system' does. Sedatives, prayer and lock-up. Heroin addicts, sexaholics, compulsive gamblers, compulsive Amphetamine users; Benzodiazepines, Trazodone, 3 hots and a cot behind a locked ward, or even better, a religious retreat (where you can spend hours in the hot tub, by the pool, in the sauna, comtemplating how you have failed your maker and Christian society with your immoral behavior). Those days are almost over thankfully.

The quality of life, quality of health, quality of society issues are of supreme importance. If you are not a Heroin addict, why would you be interested in how Heroin addicts are being treated medically? Are you honestly against a treatment with proven benefits to the individual addicts and to society (both economically and via the criminal justice system)?

I keep seeing the same rhetorical hyperbole. It all comes back to the sensationalist and pseudo-scienctific theory known as 'The Moral Theory Of Addiction'. Chaos upon society if drug prohibition were ended? Ignore treatments that have proven efficacy based on the gut reaction of those that still believe in the defunk Moral Theory? Come on.

 

[BeenArrested4Pot]

First off I'd like to say this is a compelling conversation that has made me do alot of thinking... sorry if my posts are 'drug war propaganda influenced rhetoric 8)

I just don't understand the reason for heroin clinics, not traditional maintenance clinics like methadone, etc. I'm talking DIACETYLMORPHINE clinics. WHy does it have to be heroin is methadone not good enough? All these statistics prove the traditional clinics help people in their recovery from heroin addiction. I'm not sure that consistent access to heroin helps them recover. Especially considering most return to another treatments as stated in an earlier post.

And if it does have profound impacts why not have cocaine and methamphetamine clinics? How about the crack clinic.. IF it improves society and the lives of addicts so dramatically why are heroin addicts entitled to this and crack / meth addicts not?

Addict 1: " Nah man that clinic wasn't workin for me methadone dont work"
Addict 2: " Well how you gonna kick heroin now?"
Addict 1: "Dog i got this new treatment for kickin H... its called HEROIN.."

anyone see a problem there

 

[Green1]

i dont understand... soon there will be clinics stocked with methamphetamine or cocaine.. when will it end??

the requirements are 5 years of addiction and 2 rehab failures... so many people succeed in rehab after their 2nd attempt.. these addicts are even allowed to use needles!

i think this will motivate addicts in the wrong way: i.e.- lets suppose someone has been addicted fr 3 to 4 yrs and is tiring of the lifestyle.. they dont want to be sick, they dont want to be criminals.. but they want to do heroin. the solution? struggle through another yr or 2 of addiction and get the drugs from the good old heroin clinic.

why be so close minded ?

this to me, is a step in the right direction, they are trying something new

let's just wait for results before we anticipate anything ?

I have heard methadone is harder to quit then heroin ?

 

[Tchort]

First off I'd like to say this is a compelling conversation that has made me do alot of thinking... sorry if my posts are 'drug war propaganda influenced rhetoric 8)

I just don't understand the reason for heroin clinics, not traditional maintenance clinics like methadone, etc. I'm talking DIACETYLMORPHINE clinics. WHy does it have to be heroin is methadone not good enough? All these statistics prove the traditional clinics help people in their recovery from heroin addiction. I'm not sure that consistent access to heroin helps them recover. Especially considering most return to another treatments as stated in an earlier post.

And if it does have profound impacts why not have cocaine and methamphetamine clinics? How about the crack clinic.. IF it improves society and the lives of addicts so dramatically why are heroin addicts entitled to this and crack / meth addicts not?

Addict 1: " Nah man that clinic wasn't workin for me methadone dont work"
Addict 2: " Well how you gonna kick heroin now?"
Addict 1: "Dog i got this new treatment for kickin H... its called HEROIN.."

anyone see a problem there

Diamorphine maintenance treatment is for longterm Heroin addicts who have failed at least 2 other treatment modalities (usually Buprenorphine and Methadone maintenance, and cold turkey/tradtional rehabs). There has always been a hardcore subculture of Heroin addicts, especially in urban areas. They are 'treatment resistant'; in and out of jail, rehabs, MMT, etc for years/decades. These addicts are the most at risk for homelessness, HIV/AIDS, other infectious diseases, unprotected sex, criminal activity, incarceration, etc. Meaning, the group most in need of harm reduction, most in need of treatment, and the group most responsible for the economic and social costs of addiction.

This is a great thread on the global Heroin prescription programs. It has dozens of links to studies done, results, descriptions of methodology and protocol, etc.

Please read them over. A complete description of the treatment, why there is a need for it, what it does, what it accomplishes, etc can be found within.

Evolution Of The Harm Reduction Model In Switzerland:

http://www.bluelight.ru/vb/showthread.php?t=442310

I'd like to add that over the years, including the recent (10-15 year old) Swiss, Dutch and Uk trials, many countries and locales have tried using unconventional treatments and opioids to treat this 'treatment-resistant' hardcore group of addicts for years. Oral Dextromoramide, oral Morphine, IV Methadone, IV Morphine, oral Propoxyphene, IV Cyclazocine, IV Hydromorphone, oral Hydromorphone, etc.

Injectable and (in the Netherlands, Chasable) Diamorphine, Diacetylmorphine, Heroin, is the most effective Opiate Replacement Therapy opioid to use on this group. Patient compliance is the most important thing for these addicts, as access to Heroin maintenance gives these addicts access to broader health and social services, including employment agencies, free or discount housing, mental health services, food programs, etc.

Once they are stable, they mostly choose to move on to try MMT or abstinence-only rehab again. Diamorphine maintenance is a necessary first step for treating this once considered 'treatment resistant' or hopeless group of hardcore addicts.

Again, about other drugs (stimulants/depressants): Opioids are unique. An opioid addict with a constant supply of opioids is able to function normally, i.e. not be impaired. Opioids, once dependancy and addiction sets in, are a metabolic necessity like food or water. But once that need is met, the addict can function as they would if they were not addicted.

Stimulants and depressants do not cause metabolic necessity. There are no withdrawal syndromes; only rebound symptoms from abstinence syndrome (with excessive depressant use, abstinence syndrome results in rebound symptoms of anxiety, insomnia, delerium tremens, etc with front brain stimulant use, comes rebound symptoms of lethargy, anhedonia, depression, somnolescence). Stimulants and depressants when used compulsively impair the users ability to function rather than normalizing it.

You can't treat all substance abuse problems the same. A Cocaine clinic will not work the same way as a Heroin maintenance clinic for these reasons.

 

[Captain.Heroin]

This is wonderful. This way, if you want to get clean, you can use buprenorphine or methadone. If you're trying to get adequate pain relief or simply get high, you can use heroin.

Get ready for the future, everybody. It's coming quicker than you'd think.

 

[traumaissexy]

you all have really good points but as a recovering addict i think this has potential to be a really good thing. Different things work for different people. I've been off of opiates since Oct 08 and have been on suboxone since then. and i'm sure i won't be the first to tell you that its a bitch to kick.. the blocker in suboxone is just blocking the dopamine that my body has needed to recover, and inhibiting my own endorphine production. The options for an addict are so limited.

 

[Tchort]

you all have really good points but as a recovering addict i think this has potential to be a really good thing. Different things work for different people. I've been off of opiates since Oct 08 and have been on suboxone since then. and i'm sure i won't be the first to tell you that its a bitch to kick.. the blocker in suboxone is just blocking the dopamine that my body has needed to recover, and inhibiting my own endorphine production. The options for an addict are so limited.

That's actually not the case. Buprenorphine is a partial agonist, and has higher affinity than Naloxone. Regardless, Naloxone isn't even asborbed well sublingually, so it is barely entering the bloodstream (where it can't do anything due to Buprenorphine's higher affinity).

Being opioid addicted / dependant (which includes now, as Bupe is an opioid) is what is disrupting or altering your natural opiate system.

 

[pkt]

This is happening in more and more countries in E.U, im guessing within 20 years more and more countries will be boarding the ship and making this more of a normal thing, atleast in western europe where heroin is still as big as ever and a growing problem, take a walk downtown in most any major western european city and you can clearly see the affects of heroin on the community

 

[Captain.Heroin]

That's actually not the case. Buprenorphine is a partial agonist, and has higher affinity than Naloxone. Regardless, Naloxone isn't even asborbed well sublingually, so it is barely entering the bloodstream (where it can't do anything due to Buprenorphine's higher affinity).

Being opioid addicted / dependant (which includes now, as Bupe is an opioid) is what is disrupting or altering your natural opiate system.

Well said.

If you take buprenorphine in low enough doses, your body should still be able to have enough of its own endorphins going to use. I'm pretty sure this is true, anyone have anything else to add to this idea?

 

[qwe]

^ your body is always producing at least SOME endorphins. more tolerance = more downregulation of receptors for endorphins (they have less effect) and less production of endorphins, since the exogenous opiate drug does the same work as the endorphins, but i'm pretty sure your body would never go to "absolute zero" endorphin production

The argument surrounds DIAMORPHINE maintenance, the maintenance that is supposed to help people quit the exact drug being distributed in the clinic. The program is designed to resolve a heroin addict's addiction. The only thing the clinic does is clean the needles and get him high. You can throw any statistic you desire at me but that system has an incredible potential for abuse.

this is quite wrong. you don't get high on heroin, when recieving the same dose every day

And lastly, if the heroin maintenance program is a viable solution, then why is cocaine maintenance not the solution? Methamphetmine maintenance? Marijuana maintenance? Hell, magic mushroom or LSD maintenance? What sets heroin apart from these drugs? I suppose its because some of those drugs are harder on the body. Others are not harmful enough to justify maintenance prgrams... But this is all subjective, who decides what drugs are worthy of maintenance programs?

opiates are some of the least harmful drugs ever, in terms of how they are on the body, in terms of tissue damage etc. the reason there are opioid maintenance clinics, is because opioids have a stronger hold. LSD/mushroom use is very very rarely more than once or a couple times a week, and even then, there's near zero physical component to the addiction

I just don't understand the reason for heroin clinics, not traditional maintenance clinics like methadone, etc. I'm talking DIACETYLMORPHINE clinics. WHy does it have to be heroin is methadone not good enough?

same reason that different people respond differently to different antidepressants... antidepressants typically work for about 2/3 of the patients, and often if it doesnt work, the patient can rotate through and find one that does work, each rotation having about a 2/3 average chance of the next one working

methadone and buprenorphine have unique side effects, as does heroin. some struggle greatly with methadone's side effects, some are fine with methadone

PS why would there be a difference between a heroin and a methadone clinic? both offer the counseling needed to improve one's lifestyle and get off the psychological hook, and both offer opiate maintenance at a level that keeps the person functional but not high. and they test your vitals to make sure they're giving you just that amount...

also some people CANNOT get off an opiate and live a happy or functional life

 

[PetersKeys]

i dont understand... soon there will be clinics stocked with methamphetamine or cocaine.. when will it end??

the requirements are 5 years of addiction and 2 rehab failures... so many people succeed in rehab after their 2nd attempt.. these addicts are even allowed to use needles!

i think this will motivate addicts in the wrong way: i.e.- lets suppose someone has been addicted fr 3 to 4 yrs and is tiring of the lifestyle.. they don't want to be sick, they don't want to be criminals.. but they want to do heroin. the solution? struggle through another yr or 2 of addiction and get the drugs from the good old heroin clinic.

Sometimes people do much better on prescribed heroin rather than struggling everyday to get it illegally. The addicts will get on better with their lives since they don't have to worry about getting a fix. It is impossible to live life normally while in opiate withdrawal. I myself am on methadone, and it has saved me. I am now married, have a house, and a nice job.

Cocaine and meth are different. Since pure heroin(diamorphine) is not toxic to the system, they can give it to addicts without much harm. However with stimulants it is totally different because of the neuro and physical damage they cause. And there are many meds out there in meth/cocaine therapy programs. Selegiline and wellbutrin have been noted as successful in stimulant addiction.

 

[thugpassion]

I wonder what a clinics' response would be to a patient that brought with them, say some cocaine to speedball thier Heroin with? I wonder if they would refuse them access or try to stop them?

 

[Tchort]

I wonder what a clinics' response would be to a patient that brought with them, say some cocaine to speedball thier Heroin with? I wonder if they would refuse them access or try to stop them?

In Europe speedballs aren't as common as they are in the US it seems. The most common practice instead of a speedball is to inject Heroin, then smoke crack, then inject more Heroin, etc.

In the maintenance clinics, at this time, they will not allow this. But many of the programs have noticed the large co-dependancy rates among the chronic Heroin addict population (especially Cocaine or Alcohol co-dependancy). Some patients do use less crack/Cocaine after enrolling in the maintenance program though (this is true of Buprenorphine and Methadone maintenance programs as well), though there is still a minority group of patients who continue to use crack/Cocaine regularly. There is now a lot of focus on ways to treat hardcore, longterm Cocaine and crack habituated addicts. A Cocaine prescription program is being considered (one already exists in the UK; lots of people are prescribed Cocaine Hcl in sterile ampoules for IV injection everyday). We'll see how it goes.

However, there are safe consumption rooms in much of Europe (and in all of the countries that offer Diamorphine maintenance), where you can bring in drugs and use them under the supervision or guidance of a medical professional (usually a nurse). All manner of drugs are injected here, pills, street drugs, combinations, etc.

 

[diche]

thats some pretty strict circumstances. I boubt they'd not use that method much