Saturday, September 3, 2011

Opiates and Protecting the Children: for St. Louis County

When you look into the face of death and it is your child, you will never be the same. I hope that no other person has to bury a child - especially over heroin.  
Marilyn Smalley, who lost her 18-year old son to a heroin overdose
Once confined largely to the poorer and blacker neighborhoods of their more urban neighbor, diacetylmorphine has found a growing fan club amidst the rolling hills of suburban St. Louis County. Says Lt. Chuck Bossert of the St. Louis County Sheriff's Department, "The stigma is gone. That's what rock stars do; that's what celebrities do. Kids use it as a recreational drug and don't think it's dangerous." As of July 31 of this year, 49 residents have lost their lives to heroin: their average age ranged between 25 and 30, with a distressing number of teenagers among the dead.

To counter this trend, the National Council on Alcoholism & Drug Abuse - St. Louis Area and Missouri Division of Alcohol and Drug Abuse are sponsoring a program entitled Curiosity + Heroin: Not Even Once.  They have held numerous open meetings to inform parents and students of the dangers of heroin abuse, and provide links for treatment options and counseling for those who wish to get clean.  I appreciate their concern, and would like to suggest two ways by which they could tackle their growing opiate mortality rate. 

Naloxone:  In 2006 Boston began making Narcan™(naloxone), a powerful opiate antagonist, available to addicts.  Since that time overdose deaths in the city have plunged: according to Rita Nieves of the Boston Public Health Commission “This is one of the first times I have felt that we have found something that has had a quick and immediate impact on the mortality rate, and can keep people safe, while we work to connect them with treatment."  Impressed by Boston's success, Massachusetts implemented a statewide Narcan distribution program which has to date prevented over 1,000 overdose deaths.  

"Good Samaritan" Laws:  When an overdose happens, prompt medical care can mean the difference between life and death.  Unfortunately many addicts do not receive this care because they or their friends fear arrest and prosecution.  "Good Samaritan" laws ensure that those who call 911 or bring an OD patient to the hospital will not face legal repercussions for seeking medical treatment.  These laws are already on the books in ConnecticutNew MexicoNew York and Washington State, and are supported by the United States Conference of Mayors.

Measures like these may not sit well with those who equate harm reduction with being "soft on crime." They prefer treating overdose victims as a warning to all others who might consider following in their paths.  And, to be fair, this approach has a long history.  The Roman Empire had public crucifixions and medieval cities had gibbets outside the city gates where the hanging corpses of highwaymen and brigands were left as a message for their peers.  But in the end we much ask ourselves which is more important -  saving the lives of young people who made stupid choices or letting them die so we can prove that drugs are bad?

Thursday, September 1, 2011

Heroin in East Africa: Poppy Returns to Zanzibar

During the British Raj (Britain's 1858-1947 occupation of much of the Indian subcontinent) many Parsis    took advantage of the business opportunities presented by the Pax Britannica.  Refugees from 10th century Islamic persecution, these Persian Zoroastrians had long been a prosperous merchant class in India.   Since 1773 the British East India Company had controlled Bengal's poppy fields and sought out new markets for Indian opium. The Parsis followed this trade, setting up shop - and one of the Parsi diaspora's largest communities - in the East African island nation of Zanzibar.

With the Zanzibar Revolution of 1964 the Parsis, and the Omani Arab/Persian aristocracy which had ruled the island since the days of the slave trade, were driven from power.  Fleeing violent mobs, the Zanzibar Parsis made their way back to India and other formerly British states.  (One Zanzibar refugee, Farrokh Bursala, would become England's first South Asian rock star, Freddie Mercury).  But though the Revolution, and a similar anti-Indian pogrom in Uganda, drove away an important professional class, it did little to smuggling routes which had existed since the Sumerians.

Today, as Reychad Abdool of the United Nations Office on Drugs and Crime says, "Zanzibar has been established as a major heroin-consuming island." Carried on the dhows which have traversed the Persian Gulf for centuries, a great deal of Afghani heroin finds its way to Zanzibar and from there to Europe.  A fair bit also remains behind for local consumption: among the 1 million people living in Zanzibar, an estimated 4,000 to 6,000 are intravenous users.  Where once Zanzibar attracted well-heeled tourists drawn to its quiet beaches, it has begun to attract visitors who are more interested in the $15/gram heroin.  And while this may be a cheap sum for visitors, it is a hefty price in a country where the average annual income is less than $1 per day.

Addiction has fueled a steady rise in crime, particularly sex work.  Because needle exchanges are non-existent syringes are widely shared and reused.  A 2006 survey of IV users in Zanzibar found 26% were HIV-positive, while 22% had Hepatitis C and 15% syphylis.  These rates are not likely to shrink in the face of "flashblooding," a common practice whereby addicts inject syringes full of their own blood into withdrawing friends or acquaintances to alleviate their suffering.