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 Connecticut, New Mexico, New 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?

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.

Russia's Krokodil Epidemic Continues

Ten months ago I wrote about about "Krokodil" in the former Soviet Union.  This week Simon Shuster of  Time magazine and Shaun Walker of the Independent offered excellent stories showing that krokodil abuse remains a large and growing problem among Russia's impoverished addicts.

The Russian government has taken an aggressive position in the War on Drugs.  Rehabilitation is largely left in the hands of private clinics and religious organizations: abuse of patients is commonplace and Human Rights Watch found that the treatment offered at state drug treatment clinics in Russia was so poor as to constitute a violation of the right to health.  Methadone maintenance therapy is illegal and needle exchange programs have been prosecuted for "aiding illegal drug use." Earlier efforts at poppy eradication helped limit the abuse of "hanka" (also known as "chernaya" and, in Poland, "kompot"), homemade heroin made from poppy straw. But those who could not afford the cheap Afghan heroin which has flooded Russia since the 1970s did not suddenly decide to just say "nyet."  Instead, they found a new and even more deadly way to attain opiate numbness.

Krokodil is produced by combining crushed codeine tablets with iodine, phosphorus, hydrochloric acid, gasoline, paint thinner, and various other cheap and readily available compounds according to various recipes which resemble the process by which psuedoephedrine is converted into bathtub crank.  The final product contains desomorphine, a substance that is eight times stronger than morphine but shorter-acting, along with a cocktail of other morphine analogues. But it also contains heavy metals, organic solvents, sediment from the crushed pills and other corrosive toxins.  And while even the most tweaked out meth cook will generally make at least rudimentary efforts to clean their speed before shooting it, krokodil users typically inject their final product straight. The end results of this are, as you might imagine, horrifying. (If you are at work or have a sensitive stomach, do NOT click this link).

According to Victor Ivanov, head of Russia's Federal Drug Control Service, seizures of krokodil have increased 23-fold since 2009: perhaps as many as 100,000 Russian addicts are using krokodil as a low-cost substitute for other opiates. As Zhenya, a recovering junkie, says "You can feel how disgusting it is when you're doing it," he recalls. "You're dreaming of heroin, of something that feels clean and not like poison. But you can't afford it, so you keep doing the krokodil. Until you die."

Danger, Protection and Poppies

[from http://kenazfilan.blogspot.com]

During my interview on the H2O Network, we discussed how the War on Drugs has led to all sorts of restrictions being implemented in the name of saving us from making bad choices. Omo Yemaya asked about what I had learned while writing and researching Power of the Poppy and what lessons I would like my readers to take away from the book.

One of the big ones was this: if we give our legislators the ability to regulate heroin, we also give them the ability to regulate aloe vera and other natural supplements. If we trust them to protect us from the terrorists who want to fly planes into our buildings, we shouldn't be surprised when they try to protect us from the "terrorists" who expose unsafe, inhumane and unsanitary factory farming practices.  Like any ally (spiritual or otherwise) our leaders need to be watched closely and treated with caution.  We all know that oxycodone or morphine use can quickly spin out of control. We need to remember that the same is true of government.

Another is this: all the laws in the world cannot triumph over the law of supply and demand, or over the Darwinian laws of natural selection. There will always be people who use mind-altering substances, and there will always be people who abuse them. Our efforts to discourage them through punitive means are doomed. From 1914's Harrison Narcotics Act to the present day, we have tried to criminalize drug abuse out of existence. We have succeeded only in creating powerful organized crime cartels, persecuting doctors, and feeding a prison/law enforcement complex that seeks ever-greater power in the name of "protecting our children."

Perhaps someday we will see a politician honest enough to say "Some day, somewhere, some lone zealot will succeed in blowing himself up on a crowded subway or on an airplane.  Our present trend of virtual strip-searches and toddler pat-downs cannot take away that risk: it can only take away our dignity. We are not even sacrificing our liberty for safety: we are giving it up for the illusion of safety. We cannot protect ourselves from Black Swans and anyone who says otherwise is trying to sell you something." The folks who are leading the war on drugs are also leading the war on terror. Ask yourself what they gain from your acquiescence in their schemes and what their "protection" is costing you.  Because that is another lesson which Poppy teaches: everything has a price and every action has a consequence.  No ally works for free and any ally will promote its interests over yours.

Power of the Poppy now Available

My fifth book, Power of the Poppy: Harnessing Nature's Most Dangerous Plant Ally, is now available on Amazon and elsewhere.  It's a departure from my usual Vodou-oriented writing, but not so large as one might think.  Because there was little available material on Haitian Vodou by and for serious practitioners, I wrote The Haitian Vodou Handbook.  And when I started doing research on plant shamanism and plant allies, I found that one of our most important plant allies had been almost completely ignored. I also found that nobody was talking about the quid pro quo which is such a part of a shaman's work with allies. They aren't just benevolent green spirits waiting to teach you wisdom - like the lwa, they demand payment for their services.

I really enjoyed writing and researching this book, and hope that my readers will enjoy it as well.

Ice, Ice, Baby or How Not To Treat an Opiate Overdose

James Mann's friend became unresponsive after consuming approximately 120mg of Oxycontin along with alcohol and marijuana.  Mann, a 20-year old Norcross, Georgia man, decided he would awaken him  Alas, while his heart was in the right place his judgment was fogged by 160 mg of oxycodone.  Thankfully, he was coherent enough to realize that he was in over his head after his efforts to rouse his friend failed.

When paramedics arrived on the scene, they discovered Mann's friend was indeed unconscious. He was also bleeding profusely as the result of injuries sustained when Mann had forced ice cubes into his rectum.  The victim was transported to Gwinnet Medical Center: Mann was charged with misdemeanor reckless conduct after police determined that his actions constituted "a gross deviation of standard care."

Mann's efforts to awaken his friend with Frosty the Enema may elicit some chuckles.  But many other opiate users labor under similar mistaken ideas.  It is quite common for users to throw ice water on an unresponsive friend, put them under a cold shower or throw them in an icewater bath.  But these methods will not bring a comatose user out of an overdose.  While the initial jolt of ice may cause gasping, it will not dislodge the opiates from their receptors.  Should the "treatment" persist it may cause hypothermia and shock, further complicating the situation.  Perhaps most important is the time which is wasted: when someone stops breathing a few minutes may be the difference between recovery and permanent brain injury or death.

If you are in the vicinity of an overdose, the best thing you can do is seek medical attention.  Unfortunately, many users do not receive aid - or receive it too late - because of heavy-handed law enforcement attacks on overdose victims and their companions.  One answer to this problem is "Good Samaritan" laws which protect those who seek medical treatment for themselves or their friends. Another would be ready availability of Naloxone, a powerful opiate antagonist which can reverse an opiate OD within seconds. But while these ideas have gained traction in a few areas, they still face resistance from those who equate harm reduction with encouraging drug abuse.

The Schneider Pain Clinic and the Pain Relief Network (Part II)

On June 10, 2008, when a lawyer representing Linda Schneider failed to return his phone call promptly, District Judge Monti Belot wrote a terse letter threatening to have lawyers who did not return his phone calls on the same day brought to court in handcuffs by U.S. Marshalls. In November 2008 he refused the still-jailed Linda Schneider's request for a bond.  In December 2008 he dismissed a request by Schneider's counsel challenging the prosecution's expert witnesses.

But on January 28, 2009 Belot ruled in favor of the defense, stating that prosecutors could present evidence to the jury on only four of the 59 deaths they claimed were connected to the Schneider Clinic. The prosecution immediately filed an appeal with the 10th Circuit Court of Appeals: on February 8, 2010 that court reversed Belot's decision, ruling that "A trial court's case management may not interfere with the government's ability to prosecute criminal activity any more than it can intrude upon a defendant's opportunity to defend."

Throughout these proceedings, Siobhan Reynolds and the Pain Relief Network continued to assist the Schneiders in their defense.  Reynolds, PRN's founder, is the widow of chronic pain patient Sean Greenwood.  Greenwood suffered from Ehlers-Danlos Syndrome, a rare and painful disorder of the connective tissues. After years of misery, he finally found relief when he came under the care of Dr. William Hurwitz, a pain management doctor and outspoken critic of the DEA's war on physicians. After Hurwitz received a controversial 25-year sentence for "drug trafficking"  (a sentence later reduced to 5 years on appeal), Greenwood was unable once again to receive adequate medication: later he died of a brain hemorrhage which Reynolds blamed on his long agony.

Reynolds saw the Schneider Pain Clinic case as a parallel to the attacks on Dr. Hurwitz and brought all the PRN's resources to bear in the case.  The PRN assisted in the Schneider defense, rented a billboard proclaiming "Dr. Schneider Never Killed Anyone," and regularly contributed to the media coverage of the trial.  Irritated by continual PRN criticism, the prosecutor's office sought a gag order forbidding the Schneiders, their family members and the Pain Relief Network from publicly commenting on the case. But once again Belot ruled for the defendants and denied the prosecution's request.