People who want to buy codeine-based painkillers will face probing questions from their pharmacist under proposals aimed at deterring drug addicts.
New Zealanders spend more than $13 million a year on the popular medicines, including Nurofen Plus and Panadeine, which are commonly used to treat the likes of headaches, back pain and toothache.
Within weeks, the Health Ministry will make a final ruling on the recommendations of the medicines classification committee that would switch the drugs from over-the-counter pharmacy sales, to "restricted medicine" status.
Only qualified pharmacists - not pharmacy sales staff as at present - would be permitted to sell them and they would be stored behind the counter out of public view.
Buyers' names and addresses would be recorded and they would be quizzed on why they wanted the medicine, asked if an alternative might be preferable, and advised of the possible side-effects and risk of addiction.
Pack sizes would be cut from upto eight days' supply now, to a maximum of five days', and they would be labelled with an addiction warning. Larger supplies would be available only on a doctor's prescription.
The committee chairman, Dr Stewart Jessamine, who also heads medicines regulator Medsafe, said the recommendations were in line with changes in Australia and Britain, and reflected increasing rates of codeine addiction.
Auckland's Community Alcohol and Drug Services (CADS) sees one or two new clients a week - thought to be the visible tip of a much wider problem - who are taking excessive doses of over-the-counter codeine medications.
Some are taking up to 100 tablets a day and have stomach ulcers or kidney damage from the ibuprofen in Nurofen Plus or liver damage from the paracetamol in Panadeine.
CADS sees roughly the same number of new clients who are addicted to straight codeine, which is prescription-only.
The makers of the over-the-counter drugs opposed the committee's moves, saying responsible users would be needlessly penalised because of the actions of a small number of addicts.
Pharmacists interviewed by the Weekend Herald already storethe drugs behind the counter, but support the committee's proposalsto tighten the restrictions.
"Bloody good idea," said west Auckland pharmacist Warren Flaunty.
A member of the Waitemata District Health Board, he has campaigned for tighter controls on codeine and pseudoephedrine, an ingredient in cough and cold medicines and the illegal drug P - both to protect pharmacists and to fight drug addiction. Mr Flaunty said codeine had long been behind the counter at his Westgate Pharmacy because a lot of it had been stolen from open shelves.
South Waikato pharmacist Richard Heslop said it was easy to identify bulk-codeine shoppers, especially if they visited twice. If he became suspicious, he probed their motives and restricted them to a small pack, and turned them away if they returned.
"It's the way they ask - if they want a specific product and won't have anything else. But people do get frustrated, the genuine purchasers, when you ask them questions."
A specialist medical officer at CADS, Professor Brian McAvoy, said many of its clients who had been abusing over-the-counter codeine were otherwise functioning effectively, had jobs and did not take illegal substances.
"They're just taking these tablets on a gradually escalating basis, thinking that they are treating their backache or migraine. Some are quite surprised when we say there is an issue around addiction here."
The main treatment approach is to switch them to straight codeine and gradually reduce the dose until they are taking none.
TIGHTENING UP
* October 7, 2009: Health Ministry warns that most cough and cold medicines should not be given to children aged less than 6.
* October 8, 2009: Prime Minister announces pseudoephedrine cold medicines will become prescription-only - virtually a ban.
* 2010: Ministry expected to further restrict public access to painkillers containing codeine.
PHARMACIST'S CODEINE CAMPAIGN
When making of homebake heroin was at its height, Auckland pharmacist Warren Flaunty took unusual steps to curtail the illegal trade in codeine.
The opium-linked painkiller can be converted into a form of heroin. Before the rise of illegal methamphetamine laboratories, drug cooks concentrated on homebake. For this they needed a supply of codeine or painkillers containing it, obtained by pharmacy burglaries or by buying large quantities.
Mr Flaunty said that in the 1990s and early 2000s, when homebake was a big problem, he voluntarily recorded details of all purchasers of codeine-based medicines and sometimes went even further if he suspected a customer was a bulk-buyer.
"I would follow purchasers all the way to the airport. They would just come shopping for a day in Auckland then catch a plane home.
"I would follow them to four or five different pharmacies on their way to the airport."
He passed information about them to the police, said Mr Flaunty, a campaigner for tighter controls on codeine and pseudoephedrine, the cold-medicine ingredient used to make methamphetamine or P.
"Addicts would come in and get uptight and say, 'I'll smash all your windows'."
Codeine demand dropped dramatically as the illegal drug fashion switched from homebake to P.
"We've seen an upsurge in demand for codeine-based products since pharmacies have become tighter on pseudoephedrine."
Friday, January 22, 2010
Thursday, January 21, 2010
Pending Legislation for Mandating Drug Addiction Treatment for Teens
A grieving mom from New York has enlisted the help of state Senator Brian Foley to help bring awareness of teen drug abuse to the forefront of the government. Sen. Brian Foley is sponsoring a bill called ‘Denise’s Law’ designed to increase parental control when it comes to enrolling minor children in drug addiction treatment
Under current law, children under the age of 18 can check themselves out of drug rehab. If Denise’s Law is passed, however, it would allow parents as well as guardians to obtain court orders, remanding their children back into treatment programs, regardless of the child’s desire to continue.
Professionals at Mountainside Drug Rehab and Alcohol Treatment Center in Connecticut and New York feel this step might only be moderately beneficial to families. “We are in complete support of any action that helps an individual overcome his or her dependence on drugs and alcohol. The only caution we would issue is that it has been our experience that successful, prolonged recovery is generally seen in individuals who have personally expressed a desire to enter into a drug rehab program and have participated in that program on their own free will.”
Many 12-step programs such as Alcoholics Anonymous and Narcotics Anonymous firmly believe that an individual must hit their personal “rock bottom” in order to understand the gravity of their choices and be willing to undergo treatment for their addiction. The professionals have Mountainside have noted that where many people enter treatment with varying degrees of willingness that the ultimate successful treatment, and recovery depends on an individual’s commitment and willingness. “We certainly aren’t saying that mandating drug rehab can’t be effective. An unwilling individual could enter into treatment and, through the course of their evaluation and duration of stay, end up a motivated, willing participant. That would certainly be our goal and the optimal outcome of such a situation and we do everything we can to nurture that desire.”
Senator Foley has promised that this bill would help remove “road blocks” for families trying to help their children.
Under current law, children under the age of 18 can check themselves out of drug rehab. If Denise’s Law is passed, however, it would allow parents as well as guardians to obtain court orders, remanding their children back into treatment programs, regardless of the child’s desire to continue.
Professionals at Mountainside Drug Rehab and Alcohol Treatment Center in Connecticut and New York feel this step might only be moderately beneficial to families. “We are in complete support of any action that helps an individual overcome his or her dependence on drugs and alcohol. The only caution we would issue is that it has been our experience that successful, prolonged recovery is generally seen in individuals who have personally expressed a desire to enter into a drug rehab program and have participated in that program on their own free will.”
Many 12-step programs such as Alcoholics Anonymous and Narcotics Anonymous firmly believe that an individual must hit their personal “rock bottom” in order to understand the gravity of their choices and be willing to undergo treatment for their addiction. The professionals have Mountainside have noted that where many people enter treatment with varying degrees of willingness that the ultimate successful treatment, and recovery depends on an individual’s commitment and willingness. “We certainly aren’t saying that mandating drug rehab can’t be effective. An unwilling individual could enter into treatment and, through the course of their evaluation and duration of stay, end up a motivated, willing participant. That would certainly be our goal and the optimal outcome of such a situation and we do everything we can to nurture that desire.”
Senator Foley has promised that this bill would help remove “road blocks” for families trying to help their children.
Wednesday, January 20, 2010
Drug Addict Jailed for Stealing Car Stereo
A 31-year-old drug addict has been jailed for 14 months after he admitted to stealing a car stereo and CDs in May two years ago.
Saviour Agius had broken into a Peugeot 205 which was parked in Qormi at around 1 p.m. on May 11, 2008 and taken the Clarion stereo and a CD holder.
Mr Agius admitted to being the thief and to relapsing.
Magistrate Doreen Clarke jailed him after taking into consideration his early admission and the fact that he has a serious drug problem.
She also sent a recommendation to the Director of Prisons for Mr Agius to be given all the help necessary to kick his drug habit and for him to start a drug rehabilitation programme.
Police Inspector Malcolm Bondin prosecuted.
Saviour Agius had broken into a Peugeot 205 which was parked in Qormi at around 1 p.m. on May 11, 2008 and taken the Clarion stereo and a CD holder.
Mr Agius admitted to being the thief and to relapsing.
Magistrate Doreen Clarke jailed him after taking into consideration his early admission and the fact that he has a serious drug problem.
She also sent a recommendation to the Director of Prisons for Mr Agius to be given all the help necessary to kick his drug habit and for him to start a drug rehabilitation programme.
Police Inspector Malcolm Bondin prosecuted.
Tuesday, January 19, 2010
Study Reveals More Details on the Mechanics of Cocaine Addiction
A new study provides important clues about the mechanism behind cocaine addiction, and may offer new avenues for pharmacologic treatment. The study, published in the journal Science, reveals genetic changes which can occur in the brain as a result of repeated exposure to cocaine. The study’s results join a growing body of research in the relatively new branch of science called epigenetics, which explores how lifestyle and environmental effects may change gene expression over time.
The research team was lead by Ian Maze, a Ph.D. student in the Department of Neuroscience at the Mt. Sinai School of Medicine. “We identified a gene known as G9a whose job is basically to maintain homeostatic levels of the gene expression in cells,” Maze explains. “Following a single dose of cocaine, you have increased expression of this particular gene and protein, G9a. And once it’s increased its expression, it’s very rapidly recruited to turn genes off that become inappropriately expressed or turned on in response to that single dose of cocaine.”
That response to a single dose of cocaine dose is what the G9a protein is supposed to do — regulate and mitigate the brain’s response to new chemical stimuli to ensure that genes are not switched on or off aberrantly. “The normal function of G9a is to basically maintain normal levels of gene expression” says Maze. “And so, it very effectively and efficiently does its job in response to its first dose of the drug.”
But over time, as cocaine exposure is repeated, the protein’s reaction appears to lessen, almost as if the brain begins to accept the presence of cocaine as normal. “Following repeated dosing of the drug, G9a expression is actually reduced and its activity is reduced,” Maze explains. “Therefore, a number of genes that turn on in an aberrant fashion in response to repeated cocaine are now unable to be returned to their normal basal level of gene expression. A lot of these genes that are turning on inappropriately are involved in synaptic plasticity, which means that you’re actually having new synaptic expressions forming in response to repeated cocaine, as opposed to acute, and this leads to increased behavioral sensitivity to the drug.”
The study was funded by the National Institute of Drug Abuse (NIDA). In a statement, NIDA Director Nora Volkow said the finding is potentially groundbreaking. “This fundamental discovery advances our understanding of how cocaine addiction works. Although more research will be required, these findings have identified a key new player in the molecular cascade triggered by repeated cocaine exposure, and thus a potential novel target for the development of addiction medications.”
The study’s findings build on previous research which had already shown that cocaine can induce changes in gene expression. This research deepens the understanding of the precise biochemical mechanism through which that occurs. “We have known before that repeated cocaine use leads to increased gene expression,” says Maze, “However, nobody had actually ever shown a role for histone methylation, which G9a basically controls. Nobody had ever really provided a solid mechanism that may help to explain some of the persistent changes in gene expression that we see.”
The potential for the discovery to lead to more effective treatments for addiction to cocaine (and potentially for other drugs as well) lies in this more precise identification of the specific mechanism behind the addictive response. “The importance of this study is that it explains a novel mechanism by which synaptic plasticity occurs following exposure to drugs of abuse,” Maze explains. “And it helps us to identify new genes that are being regulated by this molecule that may actually end up being good targets for future therapeutics.”
In fact, in the study, Maze and his team were actually able to demonstrate that by countering the effect of repeated cocaine exposure’s on G9a, they could blunt cocaine’s addictive effect. “If cocaine’s job is to reduce G9a, then G9a being reduced would lead to this increase in sensitivity to the drug,” Maze says. “And of course, we found the opposite — when you oppose the effects of cocaine and you over-express G9a, you can completely block increased sensitivity to the drug.”
The research team was lead by Ian Maze, a Ph.D. student in the Department of Neuroscience at the Mt. Sinai School of Medicine. “We identified a gene known as G9a whose job is basically to maintain homeostatic levels of the gene expression in cells,” Maze explains. “Following a single dose of cocaine, you have increased expression of this particular gene and protein, G9a. And once it’s increased its expression, it’s very rapidly recruited to turn genes off that become inappropriately expressed or turned on in response to that single dose of cocaine.”
That response to a single dose of cocaine dose is what the G9a protein is supposed to do — regulate and mitigate the brain’s response to new chemical stimuli to ensure that genes are not switched on or off aberrantly. “The normal function of G9a is to basically maintain normal levels of gene expression” says Maze. “And so, it very effectively and efficiently does its job in response to its first dose of the drug.”
But over time, as cocaine exposure is repeated, the protein’s reaction appears to lessen, almost as if the brain begins to accept the presence of cocaine as normal. “Following repeated dosing of the drug, G9a expression is actually reduced and its activity is reduced,” Maze explains. “Therefore, a number of genes that turn on in an aberrant fashion in response to repeated cocaine are now unable to be returned to their normal basal level of gene expression. A lot of these genes that are turning on inappropriately are involved in synaptic plasticity, which means that you’re actually having new synaptic expressions forming in response to repeated cocaine, as opposed to acute, and this leads to increased behavioral sensitivity to the drug.”
The study was funded by the National Institute of Drug Abuse (NIDA). In a statement, NIDA Director Nora Volkow said the finding is potentially groundbreaking. “This fundamental discovery advances our understanding of how cocaine addiction works. Although more research will be required, these findings have identified a key new player in the molecular cascade triggered by repeated cocaine exposure, and thus a potential novel target for the development of addiction medications.”
The study’s findings build on previous research which had already shown that cocaine can induce changes in gene expression. This research deepens the understanding of the precise biochemical mechanism through which that occurs. “We have known before that repeated cocaine use leads to increased gene expression,” says Maze, “However, nobody had actually ever shown a role for histone methylation, which G9a basically controls. Nobody had ever really provided a solid mechanism that may help to explain some of the persistent changes in gene expression that we see.”
The potential for the discovery to lead to more effective treatments for addiction to cocaine (and potentially for other drugs as well) lies in this more precise identification of the specific mechanism behind the addictive response. “The importance of this study is that it explains a novel mechanism by which synaptic plasticity occurs following exposure to drugs of abuse,” Maze explains. “And it helps us to identify new genes that are being regulated by this molecule that may actually end up being good targets for future therapeutics.”
In fact, in the study, Maze and his team were actually able to demonstrate that by countering the effect of repeated cocaine exposure’s on G9a, they could blunt cocaine’s addictive effect. “If cocaine’s job is to reduce G9a, then G9a being reduced would lead to this increase in sensitivity to the drug,” Maze says. “And of course, we found the opposite — when you oppose the effects of cocaine and you over-express G9a, you can completely block increased sensitivity to the drug.”
Friday, January 15, 2010
No help for those battling addiction in Lebanon
Maher (not his real name) had been arrested more than 32 times and was constantly in and out of prison on drug charges before finally receiving help for his addiction problems. “I started using [drugs] in 1985 after being influenced by some friends,” he said. “I didn’t know about the dangers.” What started as casual use of hashish quickly turned into an addiction to heroin.
Although the 1998 narcotics law stipulates that those with drug addictions are to be considered to be suffering from an illness, and not criminals, this provision is rarely upheld. The law says people like Maher should be sent to government-run rehabilitation clinics, but because of the dearth of such facilities, they usually end up in prison.
Incarceration is a lonely place for those battling addiction. Drugs are widely available and there are no provisions for those experiencing withdrawal.
“In jail I can honestly tell you I wished I was dead,” Maher said. “If you’re a drug addict, your calls for help fall on deaf ears. I wasn’t offered any treatment.” During one spell behind bars, Maher said he was visited by a psychologist once a week but it didn’t help much. “Prison breaks your spirit. Even if your body is drug free, your problems don’t disappear.”
On top of run-ins with the law, those with addiction problems in Lebanon also have to contend with considerable social stigma. Recognizing this, addiction rehabilitation organization Skoun on Thursday organized a workshop with religious figures to try to communicate that shunning drug addicts was more damaging to society than helping them.
Souha Bawab, a psychologist in Skoun’s prevention department, said the targeting of religious figures was important because they helped shape popular opinion in Lebanon.
“We are trying to decrease the stigma surrounding addiction, so that people with addiction problems don’t hesitate as much to seek healthcare services, because this is what the stigma is doing,” she said. “At the end of the day, people with addiction problems are staying stuck in their addiction, which increases their suffering, the suffering of their families and the suffering of the entire community that they belong to.”
Lana Captan Ghandour, project manager of the peace building project at the United Nations Development Program, which is funding the project, said the workshop comes amid growing awareness of drug and other addictions among the general population. “The problem with drug addiction in Lebanon is escalating,” Ghandour said.
A few years ago, “people with family members who had drug addictions wouldn’t want the community to know about it … Now there is a movement … to combat the challenges of drug addiction. Now people want to talk about it because they are being touched by it.”
Religious figures could play an important role in this growing dialogue through spreading messages in their sermons “to better deal with drug addicts rather than isolating them,” Ghandour added.
Statistics about drug use in Lebanon are scarce, but anecdotal evidence suggests widespread availability and consumption. Skoun has said field workers estimate the number of drug abusers to be between 10,000 to 15,000 people, although it is likely an underestimation. Relatively cheap prices – heroin costs around $20 per gram and cocaine about $100 per gram – means that almost anyone can buy something.
“Many of my friends at university smoked hashish,” Maroun [not his real name], a graduate of the Lebanese University, said. “Now I know that four of them take heroin and most of the others are always using [ecstasy] pills or cocaine at the weekend.” Those working with addicts say drug use is an issue that has long been neglected by the authorities.
While those with addictions in Lebanon face several difficulties, Maher is proof that it can be overcome with support. “I am very happy now,” he said. “I’m actually working and smiling. There was a time when I couldn’t even smile but things are looking up today.”
He added: “Few people have compassion for drug addicts but thanks to non-governmental organizations, things are beginning to change.”
Although the 1998 narcotics law stipulates that those with drug addictions are to be considered to be suffering from an illness, and not criminals, this provision is rarely upheld. The law says people like Maher should be sent to government-run rehabilitation clinics, but because of the dearth of such facilities, they usually end up in prison.
Incarceration is a lonely place for those battling addiction. Drugs are widely available and there are no provisions for those experiencing withdrawal.
“In jail I can honestly tell you I wished I was dead,” Maher said. “If you’re a drug addict, your calls for help fall on deaf ears. I wasn’t offered any treatment.” During one spell behind bars, Maher said he was visited by a psychologist once a week but it didn’t help much. “Prison breaks your spirit. Even if your body is drug free, your problems don’t disappear.”
On top of run-ins with the law, those with addiction problems in Lebanon also have to contend with considerable social stigma. Recognizing this, addiction rehabilitation organization Skoun on Thursday organized a workshop with religious figures to try to communicate that shunning drug addicts was more damaging to society than helping them.
Souha Bawab, a psychologist in Skoun’s prevention department, said the targeting of religious figures was important because they helped shape popular opinion in Lebanon.
“We are trying to decrease the stigma surrounding addiction, so that people with addiction problems don’t hesitate as much to seek healthcare services, because this is what the stigma is doing,” she said. “At the end of the day, people with addiction problems are staying stuck in their addiction, which increases their suffering, the suffering of their families and the suffering of the entire community that they belong to.”
Lana Captan Ghandour, project manager of the peace building project at the United Nations Development Program, which is funding the project, said the workshop comes amid growing awareness of drug and other addictions among the general population. “The problem with drug addiction in Lebanon is escalating,” Ghandour said.
A few years ago, “people with family members who had drug addictions wouldn’t want the community to know about it … Now there is a movement … to combat the challenges of drug addiction. Now people want to talk about it because they are being touched by it.”
Religious figures could play an important role in this growing dialogue through spreading messages in their sermons “to better deal with drug addicts rather than isolating them,” Ghandour added.
Statistics about drug use in Lebanon are scarce, but anecdotal evidence suggests widespread availability and consumption. Skoun has said field workers estimate the number of drug abusers to be between 10,000 to 15,000 people, although it is likely an underestimation. Relatively cheap prices – heroin costs around $20 per gram and cocaine about $100 per gram – means that almost anyone can buy something.
“Many of my friends at university smoked hashish,” Maroun [not his real name], a graduate of the Lebanese University, said. “Now I know that four of them take heroin and most of the others are always using [ecstasy] pills or cocaine at the weekend.” Those working with addicts say drug use is an issue that has long been neglected by the authorities.
While those with addictions in Lebanon face several difficulties, Maher is proof that it can be overcome with support. “I am very happy now,” he said. “I’m actually working and smiling. There was a time when I couldn’t even smile but things are looking up today.”
He added: “Few people have compassion for drug addicts but thanks to non-governmental organizations, things are beginning to change.”
Tuesday, January 12, 2010
Pakistan's drug problem
It is perhaps the bright colours, the vibrant clothes that make the pictures even more shocking. Or perhaps it is the images of lives disrupted, lives destroyed.
I'm being shown a series of pictures of life on the streets in Pakistan. This isn't for the tourist brochures or company report - this gives a graphic reality to the country's growing drug problem.
It is hard to know which of the images is the most painful to look at.
It could be the one of the "street doctor" who is paid to find a vein by the junkies, about to earn his next payment from the emaciated but desperate man standing above him.
Or maybe it is the group of people, openly injecting themselves, oblivious to anything but their burning need for the next high. Or it could be the body of the man, ignored, abandoned and decaying.
It estimated there are half a million people who inject heroin in Pakistan, and maybe five million drug users in total.
Ruined lives
Iftikhar Ahmed was once a drug addict, injecting heroin to get high. The 26-year-old was confronted by his father, who told him of the disgrace he was bringing on his family.
'Street doctors' are often used by the addicts to get their fix
"Every time he left the house, he returned hanging his head in shame. He was always being asked about me and now he no longer wishes to go out," Iftikhar said.
Iftikhar earned enough as a tailor to finance his habit, and when money ran short, he sold possessions like his video camera.
"After the high had worn off, I would wake up and realise what I'd done, but it didn't stop me," he said.
Until one day on the streets, he was approached by an outreach worker from the country's biggest rehabilitation programme, Nai Zindagi, or New Life.
And now in the warmth of the late winter sun, in the hills around Barakoh, he is preparing the ground for his vegetables.
He's been here 15 days. He's clean and looking to going some way to restoring the family honour: "I have nothing in my life but regrets. I never took a stand. I spent my whole life high. I wasted myself, I wasted time.
"But I don't regret this as much as I regret bringing shame to my family. God willing, I'll pay them back. Nai Zindagi picked me up off the street. We were worse than stray dogs. I'm very grateful to them for lifting me up from the ground to the sky. Now I'll live this new life in their name," Iftikhar said.
Road to recovery
The farm programme where he works is a key plank in Nai Zindagi's operation.
Aid workers warn that not helping addicts could leave them open to 'recruitment for terrorism'
Financed by their own fund raising efforts, some state backing and the support of foreign governments like the Dutch, every day it helps around 22,000 addicts across Pakistan.
It gives clean needles to addicts to stop the spread of HIV, it gives advice on health issues, treats wounds and abscesses, and gives addicts the chance of getting clean.
First they travel to a detoxification centre, and when they are done, many of the lucky ones are given the chance to work on the farms.
Money raised here is poured back into the system. The addicts are shown how to grow vegetables, tend their crops and increase their yield. They must stay two months; they can stay up to three.
When they leave, they are given the chance to run their own little patch of ground and sell anything they grow.
Kaleem Amir helps the addicts when they arrive. As a former addict, he knows what they are going through. He was picked up by the outreach workers in Lahore and went through rehabilitation and four years later he is clean and now helping the charity that helped him.
"It helps when they walk through the door to get motivational force from the senior people that were also in the same conditions days, weeks or months ago," he said.
Plenty of victims
Tariq Zafar, the founder of the programme, is a tall man with a grey beard which is beginning to win ground in his darker hair. He too is a former addict.
"It started when I was in college," Zafar said.
Zafar gave up because the initial excitement of the high, the enjoyment of the hit soon gave way and he realised what lay ahead.
With the help of his family he quit and decided to do something to help others who didn't have the backing of supportive parents.
He realises Pakistan is facing problems on many fronts, but he sees the war on drug addiction as a long one, with the potential of many casualties.
"Terrorism is a different thing, this is an epidemic. If we do not respond to increased drug use in the country, and now people being infected with HIV, a lot of people are going to be angry about the fact that they have a disease they were not informed about.
"A lot of people are going to be disillusioned with life and you might have a group of people who you could recruit for terrorism," he said.
The authorities say Pakistan has the highest number of drug users in the world.
This is a battle which at the moment has little publicity, little funding but plenty of victims.
I'm being shown a series of pictures of life on the streets in Pakistan. This isn't for the tourist brochures or company report - this gives a graphic reality to the country's growing drug problem.
It is hard to know which of the images is the most painful to look at.
It could be the one of the "street doctor" who is paid to find a vein by the junkies, about to earn his next payment from the emaciated but desperate man standing above him.
Or maybe it is the group of people, openly injecting themselves, oblivious to anything but their burning need for the next high. Or it could be the body of the man, ignored, abandoned and decaying.
It estimated there are half a million people who inject heroin in Pakistan, and maybe five million drug users in total.
Ruined lives
Iftikhar Ahmed was once a drug addict, injecting heroin to get high. The 26-year-old was confronted by his father, who told him of the disgrace he was bringing on his family.
'Street doctors' are often used by the addicts to get their fix
"Every time he left the house, he returned hanging his head in shame. He was always being asked about me and now he no longer wishes to go out," Iftikhar said.
Iftikhar earned enough as a tailor to finance his habit, and when money ran short, he sold possessions like his video camera.
"After the high had worn off, I would wake up and realise what I'd done, but it didn't stop me," he said.
Until one day on the streets, he was approached by an outreach worker from the country's biggest rehabilitation programme, Nai Zindagi, or New Life.
And now in the warmth of the late winter sun, in the hills around Barakoh, he is preparing the ground for his vegetables.
He's been here 15 days. He's clean and looking to going some way to restoring the family honour: "I have nothing in my life but regrets. I never took a stand. I spent my whole life high. I wasted myself, I wasted time.
"But I don't regret this as much as I regret bringing shame to my family. God willing, I'll pay them back. Nai Zindagi picked me up off the street. We were worse than stray dogs. I'm very grateful to them for lifting me up from the ground to the sky. Now I'll live this new life in their name," Iftikhar said.
Road to recovery
The farm programme where he works is a key plank in Nai Zindagi's operation.
Aid workers warn that not helping addicts could leave them open to 'recruitment for terrorism'
Financed by their own fund raising efforts, some state backing and the support of foreign governments like the Dutch, every day it helps around 22,000 addicts across Pakistan.
It gives clean needles to addicts to stop the spread of HIV, it gives advice on health issues, treats wounds and abscesses, and gives addicts the chance of getting clean.
First they travel to a detoxification centre, and when they are done, many of the lucky ones are given the chance to work on the farms.
Money raised here is poured back into the system. The addicts are shown how to grow vegetables, tend their crops and increase their yield. They must stay two months; they can stay up to three.
When they leave, they are given the chance to run their own little patch of ground and sell anything they grow.
Kaleem Amir helps the addicts when they arrive. As a former addict, he knows what they are going through. He was picked up by the outreach workers in Lahore and went through rehabilitation and four years later he is clean and now helping the charity that helped him.
"It helps when they walk through the door to get motivational force from the senior people that were also in the same conditions days, weeks or months ago," he said.
Plenty of victims
Tariq Zafar, the founder of the programme, is a tall man with a grey beard which is beginning to win ground in his darker hair. He too is a former addict.
"It started when I was in college," Zafar said.
Zafar gave up because the initial excitement of the high, the enjoyment of the hit soon gave way and he realised what lay ahead.
With the help of his family he quit and decided to do something to help others who didn't have the backing of supportive parents.
He realises Pakistan is facing problems on many fronts, but he sees the war on drug addiction as a long one, with the potential of many casualties.
"Terrorism is a different thing, this is an epidemic. If we do not respond to increased drug use in the country, and now people being infected with HIV, a lot of people are going to be angry about the fact that they have a disease they were not informed about.
"A lot of people are going to be disillusioned with life and you might have a group of people who you could recruit for terrorism," he said.
The authorities say Pakistan has the highest number of drug users in the world.
This is a battle which at the moment has little publicity, little funding but plenty of victims.
Monday, January 11, 2010
Cocaine Study Leads to More Effective Addiction Treatment
Scientists studying the effects of prolonged cocaine use have uncovered changes in genes in the brain, prompting them to research more effective treatment options.
The study was funded by the National Institutes of Health in coordination with the National Institute of Drug Abuse, one of its many divisions. Scientists at Mount Sinai School of Medicine allowed mice to ingest cocaine in a chronic pattern. They noted a specific enzyme malfunctioning by not effectively shutting down pleasure sensors in the brain. This lead the mice to crave cocaine. The more the mice used cocaine, the more they were attracted to the drug.
For the study, one group of mice was given routine doses of the drug. Another group was given saline and sporadic doses of the drug. Those who were given the routine doses experienced more disruption in the genes controlling their pleasure sensors. They developed a strong preference for cocaine over saline.
The particular gene at question is gene 9A. This gene manufactures an enzyme that switches other genes on ad off. By increasing the activity of gene 9A, which is compromised due to cocaine use, individual mice exhibited a weaker pull toward cocaine use.
The same study will be applied to try and decode other addictive patterns with drugs such as alcohol and nicotine. Scientists may be able to develop enzyme therapy to help those suffering from addiction overcome the physical and mental need to use the drug.
The study was funded by the National Institutes of Health in coordination with the National Institute of Drug Abuse, one of its many divisions. Scientists at Mount Sinai School of Medicine allowed mice to ingest cocaine in a chronic pattern. They noted a specific enzyme malfunctioning by not effectively shutting down pleasure sensors in the brain. This lead the mice to crave cocaine. The more the mice used cocaine, the more they were attracted to the drug.
For the study, one group of mice was given routine doses of the drug. Another group was given saline and sporadic doses of the drug. Those who were given the routine doses experienced more disruption in the genes controlling their pleasure sensors. They developed a strong preference for cocaine over saline.
The particular gene at question is gene 9A. This gene manufactures an enzyme that switches other genes on ad off. By increasing the activity of gene 9A, which is compromised due to cocaine use, individual mice exhibited a weaker pull toward cocaine use.
The same study will be applied to try and decode other addictive patterns with drugs such as alcohol and nicotine. Scientists may be able to develop enzyme therapy to help those suffering from addiction overcome the physical and mental need to use the drug.
Friday, January 8, 2010
Key to Cocaine Addiction May Lead to Treatment
A key mechanism in the brain that helps explain how people become addicted to cocaine has been identified by U.S. government scientists, who say their finding could lead to the development of new treatments for drug addiction.
In experiments with mice, the team at the National Institute on Drug Abuse (NIDA) showed how cocaine affects an epigenetic process called histone methylation. An epigenetic process is a process that influences gene expression without changing a gene's sequence.
These epigenetic changes in the brain's pleasure circuits likely add to an acquired desire for cocaine, according to the study published in the January issue of Science.
"This fundamental discovery advances our understanding of how cocaine addiction works," Dr. Nora D. Volkow, director of NIDA, said in an agency news release. "Although more research will be required, these findings have identified a key new player in the molecular cascade triggered by repeated cocaine exposure, and thus a potential novel target for the development of addiction medications."
"The more complete picture that we have today of the genetic and epigenetic processes triggered by chronic cocaine [use] give us a better understanding of the broader principles governing biochemical regulation in the brain, which will help us identify not only additional pathways involved but potentially new therapeutic approaches," study investigator Dr. Eric J. Nestler, director of the Brain Institute at Mount Sinai School of Medicine in New York, said in the release.
In experiments with mice, the team at the National Institute on Drug Abuse (NIDA) showed how cocaine affects an epigenetic process called histone methylation. An epigenetic process is a process that influences gene expression without changing a gene's sequence.
These epigenetic changes in the brain's pleasure circuits likely add to an acquired desire for cocaine, according to the study published in the January issue of Science.
"This fundamental discovery advances our understanding of how cocaine addiction works," Dr. Nora D. Volkow, director of NIDA, said in an agency news release. "Although more research will be required, these findings have identified a key new player in the molecular cascade triggered by repeated cocaine exposure, and thus a potential novel target for the development of addiction medications."
"The more complete picture that we have today of the genetic and epigenetic processes triggered by chronic cocaine [use] give us a better understanding of the broader principles governing biochemical regulation in the brain, which will help us identify not only additional pathways involved but potentially new therapeutic approaches," study investigator Dr. Eric J. Nestler, director of the Brain Institute at Mount Sinai School of Medicine in New York, said in the release.
Thursday, January 7, 2010
Group slams China's drug user detention centers
Drug addicts are denied proper treatment in China's state-run rehabilitation centers and are sometimes beaten and forced to work without pay, a human rights group said Thursday.
A 2008 law demanding humanitarian treatment and banning punishment of drug users in detention has been poorly implemented, leading to continuing - sometimes lethal - abuse, Human Rights Watch said in a report.
"Warehousing large numbers of drug users and subjecting them to forced labor and physical abuse is not rehabilitation," Joe Amon, the New York-based group's director of health and human rights, said in a statement.
"The Chinese government should stop these abuses and ensure that the rights of suspected drug users are fully respected," Amon said.
The report examines China's centers for "compulsory isolation and detoxification" and includes interviews with 33 current and former detainees and 25 workers for private groups dealing with AIDS and drug-use issues.
Chinese drug addicts are routinely sent to such detention houses for terms of at least two years, without charge or trial. At any given time, about half a million addicts are believed to be held, the report said. Most are heroin users.
The 2008 law ended the practice of sending drug users to labor camps, ordering them instead to be sent for community rehabilitation or to specialized drug rehabilitation centers. It also banned physical and verbal abuse and required that they be provided with proper treatment and paid for any work they performed.
However, Human Rights Watch said the law was vaguely defined and has been largely ignored, resulting in a continuation of past practices under a different legal rubric.
Virtually wiped out after the 1949 Communist revolution, drug use came roaring back in the 1980s following the relaxation of economic and social strictures. China now has about 1.2 million registered drug addicts, although the actual number of users is believed to be far higher.
The ministries of public security and health did not immediately respond to requests Wednesday for comment on the report.
Giovanni Nicotera, who heads the U.N. Office on Drugs and Crime's China office, said the government knows the system doesn't work - addicts going through rehabilitation at these centers very often return to drugs - and is working to address the problems.
"Being detained in these centers not only does not help drug users to recover, as evidenced by the high rates of relapse, but also increases the likelihood that an individual will become infected with HIV," said Nicotera, who had not seen the Human Rights Watch report.
Recent advances include the setting up of methadone clinics and adoption of new laws and regulations, he said.
Despite that, AIDS activist Wan Yanhai, founder of the Beijing-based Aizhixing Institute, said many addicts remain fearful of the rehabilitation system.
"Many drug users, when caught by police, would rather admit that they are trafficking drugs than using drugs because at least there is some kind of legal procedure involved in a drug trafficking charge," Wan said.
An Aizhixing volunteer in the southwestern province of Yunnan bordering the "Golden Triangle" drug-producing region said complaints of abuse at rehabilitation centers are rife.
"The beating of drug users is still a very common problem," said the volunteer, who spoke on condition of anonymity due to the sensitivity of the issue. "The beating has just become more hidden after the new law."
A 2008 law demanding humanitarian treatment and banning punishment of drug users in detention has been poorly implemented, leading to continuing - sometimes lethal - abuse, Human Rights Watch said in a report.
"Warehousing large numbers of drug users and subjecting them to forced labor and physical abuse is not rehabilitation," Joe Amon, the New York-based group's director of health and human rights, said in a statement.
"The Chinese government should stop these abuses and ensure that the rights of suspected drug users are fully respected," Amon said.
The report examines China's centers for "compulsory isolation and detoxification" and includes interviews with 33 current and former detainees and 25 workers for private groups dealing with AIDS and drug-use issues.
Chinese drug addicts are routinely sent to such detention houses for terms of at least two years, without charge or trial. At any given time, about half a million addicts are believed to be held, the report said. Most are heroin users.
The 2008 law ended the practice of sending drug users to labor camps, ordering them instead to be sent for community rehabilitation or to specialized drug rehabilitation centers. It also banned physical and verbal abuse and required that they be provided with proper treatment and paid for any work they performed.
However, Human Rights Watch said the law was vaguely defined and has been largely ignored, resulting in a continuation of past practices under a different legal rubric.
Virtually wiped out after the 1949 Communist revolution, drug use came roaring back in the 1980s following the relaxation of economic and social strictures. China now has about 1.2 million registered drug addicts, although the actual number of users is believed to be far higher.
The ministries of public security and health did not immediately respond to requests Wednesday for comment on the report.
Giovanni Nicotera, who heads the U.N. Office on Drugs and Crime's China office, said the government knows the system doesn't work - addicts going through rehabilitation at these centers very often return to drugs - and is working to address the problems.
"Being detained in these centers not only does not help drug users to recover, as evidenced by the high rates of relapse, but also increases the likelihood that an individual will become infected with HIV," said Nicotera, who had not seen the Human Rights Watch report.
Recent advances include the setting up of methadone clinics and adoption of new laws and regulations, he said.
Despite that, AIDS activist Wan Yanhai, founder of the Beijing-based Aizhixing Institute, said many addicts remain fearful of the rehabilitation system.
"Many drug users, when caught by police, would rather admit that they are trafficking drugs than using drugs because at least there is some kind of legal procedure involved in a drug trafficking charge," Wan said.
An Aizhixing volunteer in the southwestern province of Yunnan bordering the "Golden Triangle" drug-producing region said complaints of abuse at rehabilitation centers are rife.
"The beating of drug users is still a very common problem," said the volunteer, who spoke on condition of anonymity due to the sensitivity of the issue. "The beating has just become more hidden after the new law."
Wednesday, January 6, 2010
Fawcett's son jailed on parole violation
Redmond O'Neal, son of actors Ryan O'Neal and Farrah Fawcett, is back in jail after violating his parole with a drug-related charge last week.
O'Neal and his father were arrested in September 2008 when police found methamphetamine during a probation search intended for Redmond at the Malibu home of Ryan O'Neal.
Last week, on Dec. 29, Redmond O'Neal was ordered back into custody by the Los Angeles County Drug Court following a drug-related probation violation, his attorney told CNN. The violation occurred while he was completing a court-mandated rehabilitation program for the previous offense.
He was ordered by a judge on Tuesday to spend 30 days in an in-custody treatment module at the Los Angeles County jail, according to O'Neal's attorney Richard Pintal.
The judge will review his client's progress on Feb. 2, Pintal said.
Last April, a Los Angeles judge placed O'Neal, 24, in an intensive drug rehabilitation program that included in-custody treatment at Wayside Honor Ranch.
In May, Los Angeles County Deputy District Attorney Tony Estradas said that O'Neal could face up to four years in prison if he failed to complete the rehabilitation program.
O'Neal began rehabilitation in September at the Impact Drug and Alcohol Treatment Center in Pasadena. He was ordered to undergo treatment for one year. He was in the process of completing his treatment at Impact when he most recently violated his probation.
His mother, Fawcett, died of cancer on June 25, 2009. She was 62.
O'Neal and his father were arrested in September 2008 when police found methamphetamine during a probation search intended for Redmond at the Malibu home of Ryan O'Neal.
Last week, on Dec. 29, Redmond O'Neal was ordered back into custody by the Los Angeles County Drug Court following a drug-related probation violation, his attorney told CNN. The violation occurred while he was completing a court-mandated rehabilitation program for the previous offense.
He was ordered by a judge on Tuesday to spend 30 days in an in-custody treatment module at the Los Angeles County jail, according to O'Neal's attorney Richard Pintal.
The judge will review his client's progress on Feb. 2, Pintal said.
Last April, a Los Angeles judge placed O'Neal, 24, in an intensive drug rehabilitation program that included in-custody treatment at Wayside Honor Ranch.
In May, Los Angeles County Deputy District Attorney Tony Estradas said that O'Neal could face up to four years in prison if he failed to complete the rehabilitation program.
O'Neal began rehabilitation in September at the Impact Drug and Alcohol Treatment Center in Pasadena. He was ordered to undergo treatment for one year. He was in the process of completing his treatment at Impact when he most recently violated his probation.
His mother, Fawcett, died of cancer on June 25, 2009. She was 62.
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