Sunday, October 31, 2010

Yunnan Province: Life in China's Heroin Zone

Despite its abundant natural resources, Yunnan is one of China's poorest and most underdeveloped provinces. While Yunnan's GNP tripled between 1991 and 1996, the number of its people living in poverty increased. Those belonging to "minority groups" - some 38% of Yunnan's 43 million people - have gained little from China's capitalist experiment.  Han Chinese leaders in Beijing are more likely to greet Yunnan's disempowered with suspicion than concern: among them are Muslims with ethnic and cultural ties to the Uighurs of restive Xinjiang Province and Tibetans fleeing that region's long separatist conflict.

In the days of the Silk Road, this poor and remote area was a major stop for merchants selling silk, spices and the region's still-famous Pu-erh tea. Today it has become a major stopping place for a more shadowy trade. Located at the base of the Burmese/Laotian Golden Triangle, much of the heroin which makes its way to Southeast Asia passes through Yunnan - and a fair bit of it stays there.

In the late 1980s Dongxiang merchants, descendents of nomadic Mongolian converts to Sunni Islam, began trading with the Miao - a Hmong people related to tribesmen in nearby Laos and Vietnam - and the Dai, whose language and history connected them to Thailand.  These hill tribes passed at will over the porous border between China and Myanmar, bringing back opium and heroin which the Dongxiang could sell to traffickers in Hong Kong.  

At first Chinese law enforcement, wary of stirring up trouble amongst minorities, turned a blind eye to this trade.  So long as the heroin was being exported - and the proper palms were being greased - the flow to the outside world could continue unabated.  But then local youths began spending their newly-found wealth on heroin: more than a few became addicted.  As one Dongxiang heroin seller said:
Yes, drugs are illegal. But our people don't usually get hooked. It is only the Han who are weak, and we don't care so much about them because they have never cared about us.
And with the drug came a new disease. In 1991 397 of China's 410 confirmed AIDS cases were in Yunnan Province: by 2006 Yunnan had 30,000 recorded HIV-positive residents, with experts speculating the actual number could be as 200,000.   Many of these cases were contracted through sharing needles: others could be traced to the sex trade which rose up alongside the heroin industry.  Meanwhile, the province's drug problem was now spreading throughout the country, as smugglers catered to an increasingly prosperous market.  Some enterprising farmers in Yunnan and other southern provinces even returned to old family traditions: today as much as 15% of China's heroin is made from locally grown poppies.

Faced with these threats, Chinese leaders have taken the expected forceful response against traffickers. Those caught with over 50 grams of heroin face a death sentence. (British subject Akmal Shaikh was recently executed after being caught with four kilograms of heroin, despite strong diplomatic pressure from Great Britain).  Those caught using drugs are often sent to Orwellian compulsory drug rehabilitation centres where forced labor and beatings are commonplace.  Still, heroin use continues to increase along with disposable income, while widespread police and judicial corruption helps ensure the biggest players in the drug game can buy their way out of sentencing.

Despite these problems, Beijing has made comparatively little effort to shut down the Golden Triangle's heroin industry.  They may see the major opium producing groups in Myanmar as a counterbalance against the ethnic Burmese military junta, since most have direct ties to China. The Kokang are descendants of Chinese who moved to the area in the 17th century. The Wa once were most famous for their habit of ritual decapitation. But during the 1960s many of the Wa gave up headhunting for Maoism, becoming part of a well-armed (by Beijing) Communist insurgency.

Friday, October 22, 2010

Anti-Abuse Mechanisms: TIMERx and OxyContin OP

In James Fogle's classic autobigraphical novel Drugstore Cowboy "blues" - Numorphan tablets containing 10mg of oxymorphone - are the Holy Grail of drugstore heists.  Containing few binders, these little azure beauties dissolved easily in water and made for the greatest (and not infrequently the last) rush of a junkie's shooting career.  In 1972 Numorphan tablets were pulled off pharmacy shelves, thanks to a rash of abuse-related deaths.

When Endo Pharmaceuticals decided to re-introduce oxymorphone to the market as Opana ER (Extended Release)®, they employed TIMERx®, a drug delivery system created by Penwest.  TIMERx tablets contain xanthan and locust bean gum. When swallowed, these components become a tight, thick gel which slowly releases oxymorphone into the patient's system.  This allows for steady, gradual dosing. It also makes it nearly impossible to use Opana ER intravenously.  When water is added to the powdered tablet, it becomes a needle-clogging gel which cannot be drawn up into a syringe or injected into a vein.  

Alas, an Opana ER tablet can be insufflated if it is powdered and kept dry: while there will be some gelling in the nose, plenty of oxymorphone will still reach the bloodstream through the sinuses.  And as the gel goes into the stomach via post-nasal drip, it will continue to have an effect.   While oxymorphone has a low oral bioavailability - roughly 90% is digested via "first pass" metabolism before entering the system - it is still twice as powerful milligram for milligram as a comparable dose of oxycodone. Snorted Opana has become very popular amongst many opiate afficionados for its long-lasting and euphoric high: quite a few of said afficionados have found themselves facing a harsh withdrawal when their Opana supply ran out. 

Purdue Pharma is still stinging from the debacle surrounding their "abuse-proof" oxycodone formulation, OxyContin®.  Soon after its release users discovered that one could gain instant access to the active ingredient merely by crushing the pill.  Many took to shooting them up as a supposedly "safer" alternative to street heroin.  (In fact, IV usage of pills is extremely dangerous: talcosis, abscesses and other damage can result). Others snorted them to gain a slightly quicker rate of onset, despite the risks associated with that mode of usage.

The newest formulation of OxyContin, OxyContin OP, is a plastic matrix shot through with oxycodone.  The tablets are nearly impossible to crush and can only be shaved into flakes through hard work with a hose clamp, file or similar object.  They also gel when exposed to water: people who have tried snorting them report near-suffocation as their nose became clogged by a gluey substance with the texture of hot mozzarella cheese. As a result, OPs are not favored by those who use OxyContins recreationally. After their release the price of the original formulation rose to as much as $120 for an OC 80, while OP 80s could be had for $15 to $20. 

Unfortunately, OxyContin OPs have fallen out of favor with many chronic pain patients as well.  Many report the undigestible pills cause serious stomach upset.  Others claim they are considerably less effective for pain management. Many recreational users have put their minds to breaking the polymer matrix by microwaving and freezing, soaking it in Coca Cola,  using chemicals like acetone and MEK, placing them in epsom salts, or other equally ingenious methods. So far the results have been mixed: some users have injured themselves trying to IV the results of their home chemistry experiments, while others have turned to heroin as a cheaper, easily available substitute.

Coaxil and the Crocodile: Post-Soviet Heroin Substitutes

Thanks to Bugsy of Opiophile and Dankycodone of Bluelight for pointing me toward some primary sources!

*This link contains graphic imagery: discretion in clicking is advised.

The former Soviet Republics have seen better days - and even those weren't particularly good.  Between the Berlin Wall's collapse and 2001, the average ex-comrade's buying power decreased nearly 25% in Russia, approximately 60% in Georgia, and over 80% in Tajikistan.  The social services provided by the Party (such as they were) got swept aside in the new rush to economic freedom: the entrenched culture of corruption and oppression remained firmly in place.  A few plutocrats became richer while most of the populace got a whole lot poorer.

Seeking solace or anesthesia, many turned to drugs. Today much of the region is awash in cheap Afghan heroin, imported through Uzbekistan, Kyrgyzstan, Tajikistan and Kazakhstan.  But many users who lack the means to support a heroin habit - or who would rather avoid harsh penalties and legal harassment - have discovered new ways to abuse drugs which are readily available at their local pharmacies.

Antidepressants like Prozac and Paxil act as SSRIs, selective serotonin reuptake inhibitors.  They interfere with the brain's uptake of serotonin, thereby leaving more available at the synapses to stimulate the receptors.  Tianeptine, the active ingredient in the Russian antidepressent Coaxil, has the opposite effect: it encourages uptake and decreases extracellular serotonin levels. Nobody is sure why this also alleviates depression, or indeed, how tianeptine works within the human brain.  But some experimentally-minded addicts have discovered that it also has a pronounced effect on the opiate receptors.  Users compare intravenous Coaxil to a slightly speedier heroin shot, with a euphoric if somewhat short-lasting rush. 

Alas, these effects only appear at a comparatively high dosage.  A Coaxil tablet contains 12.5 milligrams of tianeptine: to get high, users shoot dozens of pills. The resulting solution is filled with insoluble particulates. Most Coaxil abusers use large needles to avoid clogging: this causes damage upon the first venipuncture and results in greater quantities of thrombosis-causing gunk pouring into the circulatory system. Abscesses and gangrene* are common: amputations are frequently required.

Other addicts start with codeine tablets, which are widely available in most pharmacies.  After crushing the pills, they engage in a multi-step chemical process akin to the making of "bathtub meth." Iodine and red phosphorous are added to solvents in an effort to transform the codeine into desomorphine, a powerful analog 10 times stronger than morphine and 5 times more powerful than heroin.

The end result of this process contains some desomorphine: it also contains codeine and large amounts of iodine, phosphorous, acids and other toxic chemicals. Russians call it "Crocodile" because users soon develop open sores, peeling and ulcers on their skin*.  The liquid is highly corrosive and acidic, causing enormous damage to the circulatory system.  Excessive iodine poisons the kidneys, thyroid and liver*: excessive phosphorous can cause bone loss and necrosis of the jawbone, known among 19th century matchmakers as "phossy jaw." Intravenous codeine can cause pulmonary edema and histaminic shock. And because desomorphine is a relatively fast-acting opiate, users tend to inject repeatedly, thereby magnifying the consequences of each dose.