phr
Bluelighter
Subu must die: How a nation of junkies went cold turkey
GRAEME WOOD
New Republic
5.7.13
Needle drugs seldom make a city look pretty, but some cities are more disfigured by them than others. In 2006, when I first visited Tbilisi, Georgia, it had all the wrecked majesty of an ex-beauty queen with six years of track-marks down her arms. It was a great European capital in decay: crumbling bridges, refugees from war, and—most of all—cast-off syringes everywhere. Alleys, parks, and tunnels under the Soviet-style boulevards all had this spiky detritus, which badly spoiled Tbilisi’s old-world romance and instead put it into a permanent state of biohazard.
So when I returned this year, I packed thick-soled shoes. It turned out that, but for the frigid temperatures (and my own self-respect), I could have worn Tevas. The syringes, which once pumped opiates into the veins of as many as 250,000 addicts, are absent. The subway now feels safe, clean, and orderly, with no trash more revolting than a Snickers wrapper. The tunnels under Rustaveli Avenue still smell pissy, but so do most big cities’ tunnels. If the addicts are still there, they have been persuaded to shoot up with greater discretion. And if they are now gone, the Georgians have accomplished something remarkable, which is the rapid diminution of smackheads.
Charting Georgian drug abuse through time, you’d see a low baseline, starting when Georgia won its independence from the Soviet Union in 1991; a lack of free trade meant few drugs. Then, during the chaos of the ’90s, the line would jump a few times, with little epidemics of heroin—called shavi, or “black,” for its tarry appearance—club drugs, and marijuana. Georgia was spared widespread alcoholism, perhaps because it alone among ex-Soviet states is a wine-sipping land, instead of a vodka-slamming one.
But starting after 2000, you’d see the line jump dramatically, as if stuck in the ass with a syringe. What drove it up was an opiate called buprenorphine—brand name Subutex, street name “subu”—that effectively did not exist in the country before 2000. At its peak, one in 20 Georgians was on hard drugs, with Subutex driving the epidemic. “It was like a millennium gift for Georgians who wanted to use drugs,” says George Tsereteli, a physician who is a member of Georgian parliament.
And now it’s gone: from zero users to hundreds of thousands and back to zero again, in a decade or less. The journey has been torturous, a case study in grotesque consequences and appalling trade-offs—some former Subutex devotees have taken to injecting pills dissolved in gasoline instead—and it shows that, whatever you think the solution to drug abuse is, you’re probably mistaken.
Abbie Hoffman once said that the only dope worth shooting was Richard Nixon. But Hoffman was a free-love hippie, and sex is an effective anti-drug. The first addict I met in Tbilisi—a man I’ll call Pavel—had no such consolations. He lived a joyless life in an existential depression, and he started shooting Subutex because it has many of the relaxing, time-killing properties of opium or heroin, but with none of the likelihood of it stopping his heart.
At 38, he has the sallow skin of a wax statue and the soulless eyes of Vladimir Putin. He runs a market stall in Tbilisi, and he wears the modest clothes of a workingman. But he trained as a lawyer in university and—like most university graduates in this country—failed to find work befitting his education. Instead, he found opiates and has indulged almost nonstop ever since. We drank tea in his doctor’s office, and the chill in the room wicked the heat from our teacups within minutes, giving me a taste of Pavel’s own wintry life. In the early days, when he had the money, he took heroin and opium. Now he’s on doctor-prescribed methadone, as he tries to go sober.
But the best period of his life was his eight-year romance with Subutex. “Subutex was my only happiness during my period of addiction,” he says. “If I could, I would inject seven or eight times a day. But once or twice a day was the minimum.” He says the highs never matched the highs from heroin. They lasted longer, though, and he could at least be confident that he was shooting a pure product.
It’s no surprise that Subutex got him off heroin. In the ’90s, after a decade of clinical use as a painkiller, Subutex was introduced to wean addicts off the drug, much in the same way that methadone has been used since the 1960s. But Subutex is a major improvement in several ways. First is the experience of patients: Methadone can put users in a sick stupor, but Subutex is so mellow and unobtrusive that they can drive cabs or wait tables while on it.
The second big improvement is its safer and more effective schedule of delivery for patients. Methadone’s reputation has taken a beating for some years, as doctors have observed how often addicts relapse or just keep taking methadone. They become permanent patrons of methadone clinics, showing up daily like pigeons at a park frequented by old ladies with breadcrusts. The owners of the clinics make a bundle. “Those methadone clinics are cash cows,” Mark Kleiman, a drug-policy expert at UCLA, says, adding that “a lot of state senators from ghetto areas” end up with a financial interest in them, giving them an incentive to keep better drugs off the market. The clinics require armed guards, because addicts will do anything for an extra dose of the blue, Windex-like fluid.
I do mean anything. Consider that, in 2010, an inmate in British Columbia died after drinking the puke of another methadone patient. The market for methadone vomit in prison is lively, and the preferred recipe for this cocktail is one part puke (strained, please, bartender) to one part Tang. And this leads to methadone’s biggest drawback: If you take too much of it, it will kill you. In the United States, about 5,000 methadone users die every year, making it the single-biggest killer among prescription painkillers.
There’s no market for Subutex vomit. Subutex comes in a white tablet, which the patient gets from a pharmacy and dissolves under his tongue over three to five minutes. That means Subutex users aren’t forced to visit clinics daily, dramatically increasing the efficiency of delivering doses to compliant patients. It also means, of course, that Subutex patients have a much, much easier time diverting their supply to illegal markets.
A major reason it’s safe to dispense Subutex at pharmacies is that Subutex almost certainly won’t kill you. Methadone builds up in the body and slows down breathing to the point of death. Add alcohol or heroin, and the odds of death go way up. But even in combination with other drugs—and Subutex is often taken with other sedatives or benzos—Subutex will reliably yield a long, chilled-out, survivable high.
This level of safety holds even if addicts take Subutex intravenously, as Pavel and almost all other street addicts did. “I put the tablet into an empty syringe, pressed the plunger to crush the tablet into a powder, then added water,” he says. The milky mixture is then ready to inject.
The high lasts between twelve and 24 hours, which is several times the length of a ride on heroin. “If someone injects heroin in the morning, he is in withdrawal in the evening,” Pavel’s doctor, Zura Sikharulidze, says. “With Subutex, you inject it once a day and feel great till the next day.”
continued at source
Link!
GRAEME WOOD
New Republic
5.7.13
Needle drugs seldom make a city look pretty, but some cities are more disfigured by them than others. In 2006, when I first visited Tbilisi, Georgia, it had all the wrecked majesty of an ex-beauty queen with six years of track-marks down her arms. It was a great European capital in decay: crumbling bridges, refugees from war, and—most of all—cast-off syringes everywhere. Alleys, parks, and tunnels under the Soviet-style boulevards all had this spiky detritus, which badly spoiled Tbilisi’s old-world romance and instead put it into a permanent state of biohazard.
So when I returned this year, I packed thick-soled shoes. It turned out that, but for the frigid temperatures (and my own self-respect), I could have worn Tevas. The syringes, which once pumped opiates into the veins of as many as 250,000 addicts, are absent. The subway now feels safe, clean, and orderly, with no trash more revolting than a Snickers wrapper. The tunnels under Rustaveli Avenue still smell pissy, but so do most big cities’ tunnels. If the addicts are still there, they have been persuaded to shoot up with greater discretion. And if they are now gone, the Georgians have accomplished something remarkable, which is the rapid diminution of smackheads.
Charting Georgian drug abuse through time, you’d see a low baseline, starting when Georgia won its independence from the Soviet Union in 1991; a lack of free trade meant few drugs. Then, during the chaos of the ’90s, the line would jump a few times, with little epidemics of heroin—called shavi, or “black,” for its tarry appearance—club drugs, and marijuana. Georgia was spared widespread alcoholism, perhaps because it alone among ex-Soviet states is a wine-sipping land, instead of a vodka-slamming one.
But starting after 2000, you’d see the line jump dramatically, as if stuck in the ass with a syringe. What drove it up was an opiate called buprenorphine—brand name Subutex, street name “subu”—that effectively did not exist in the country before 2000. At its peak, one in 20 Georgians was on hard drugs, with Subutex driving the epidemic. “It was like a millennium gift for Georgians who wanted to use drugs,” says George Tsereteli, a physician who is a member of Georgian parliament.
And now it’s gone: from zero users to hundreds of thousands and back to zero again, in a decade or less. The journey has been torturous, a case study in grotesque consequences and appalling trade-offs—some former Subutex devotees have taken to injecting pills dissolved in gasoline instead—and it shows that, whatever you think the solution to drug abuse is, you’re probably mistaken.
Abbie Hoffman once said that the only dope worth shooting was Richard Nixon. But Hoffman was a free-love hippie, and sex is an effective anti-drug. The first addict I met in Tbilisi—a man I’ll call Pavel—had no such consolations. He lived a joyless life in an existential depression, and he started shooting Subutex because it has many of the relaxing, time-killing properties of opium or heroin, but with none of the likelihood of it stopping his heart.
At 38, he has the sallow skin of a wax statue and the soulless eyes of Vladimir Putin. He runs a market stall in Tbilisi, and he wears the modest clothes of a workingman. But he trained as a lawyer in university and—like most university graduates in this country—failed to find work befitting his education. Instead, he found opiates and has indulged almost nonstop ever since. We drank tea in his doctor’s office, and the chill in the room wicked the heat from our teacups within minutes, giving me a taste of Pavel’s own wintry life. In the early days, when he had the money, he took heroin and opium. Now he’s on doctor-prescribed methadone, as he tries to go sober.
But the best period of his life was his eight-year romance with Subutex. “Subutex was my only happiness during my period of addiction,” he says. “If I could, I would inject seven or eight times a day. But once or twice a day was the minimum.” He says the highs never matched the highs from heroin. They lasted longer, though, and he could at least be confident that he was shooting a pure product.
It’s no surprise that Subutex got him off heroin. In the ’90s, after a decade of clinical use as a painkiller, Subutex was introduced to wean addicts off the drug, much in the same way that methadone has been used since the 1960s. But Subutex is a major improvement in several ways. First is the experience of patients: Methadone can put users in a sick stupor, but Subutex is so mellow and unobtrusive that they can drive cabs or wait tables while on it.
The second big improvement is its safer and more effective schedule of delivery for patients. Methadone’s reputation has taken a beating for some years, as doctors have observed how often addicts relapse or just keep taking methadone. They become permanent patrons of methadone clinics, showing up daily like pigeons at a park frequented by old ladies with breadcrusts. The owners of the clinics make a bundle. “Those methadone clinics are cash cows,” Mark Kleiman, a drug-policy expert at UCLA, says, adding that “a lot of state senators from ghetto areas” end up with a financial interest in them, giving them an incentive to keep better drugs off the market. The clinics require armed guards, because addicts will do anything for an extra dose of the blue, Windex-like fluid.
I do mean anything. Consider that, in 2010, an inmate in British Columbia died after drinking the puke of another methadone patient. The market for methadone vomit in prison is lively, and the preferred recipe for this cocktail is one part puke (strained, please, bartender) to one part Tang. And this leads to methadone’s biggest drawback: If you take too much of it, it will kill you. In the United States, about 5,000 methadone users die every year, making it the single-biggest killer among prescription painkillers.
There’s no market for Subutex vomit. Subutex comes in a white tablet, which the patient gets from a pharmacy and dissolves under his tongue over three to five minutes. That means Subutex users aren’t forced to visit clinics daily, dramatically increasing the efficiency of delivering doses to compliant patients. It also means, of course, that Subutex patients have a much, much easier time diverting their supply to illegal markets.
A major reason it’s safe to dispense Subutex at pharmacies is that Subutex almost certainly won’t kill you. Methadone builds up in the body and slows down breathing to the point of death. Add alcohol or heroin, and the odds of death go way up. But even in combination with other drugs—and Subutex is often taken with other sedatives or benzos—Subutex will reliably yield a long, chilled-out, survivable high.
This level of safety holds even if addicts take Subutex intravenously, as Pavel and almost all other street addicts did. “I put the tablet into an empty syringe, pressed the plunger to crush the tablet into a powder, then added water,” he says. The milky mixture is then ready to inject.
The high lasts between twelve and 24 hours, which is several times the length of a ride on heroin. “If someone injects heroin in the morning, he is in withdrawal in the evening,” Pavel’s doctor, Zura Sikharulidze, says. “With Subutex, you inject it once a day and feel great till the next day.”
continued at source
Link!
are throwing all presciption narcotic drugs under the bus so to say and trying to change regulations and laws to make them less available even to patients with legit needs. They would like to make it so that more people would have to be on methadone and subs. So, I find it very interesting to find that idea that many politicians may have a monetary interest in methadone clinics... that would explain some things IMO. It never made sense to me that we are constantly bombarded with the media stating how oxy is THE killer, the pill from hell, the reason society in our country is going downhill and making every single person who uses it a junkie and killing so many when methadone is a much more dangerous drug by most standards. I would like to find out more info on those stats here in the US (including information about politicians involvement in methadone clinics).
