6 October 2021 01:48 am Views - 424
Doctors have used Methadone to treat drug addicts because it also reduces suicide and helps to retain them in treatment programmes
- Since there are no medical professionals to address the problem, it has ended up as a criminal problem
- It was also reported that Methadone was used in the1970s to detoxify the opium addicts in Sri Lanka
- Out of the 8 doctors who treated heroin addicts in 2009, many gave up because these doctors were humiliated, threatened and were not respected
Heroin surfaced in Colombo in the early seventies. In 1983 a pack of heroin was Rs. 10. By 1990 a pack of heroin
The war camouflaged the trafficking and distribution of heroin. The war and political tension in the country diminished the ability of the law enforcement to round up drug trafficking adequately.
Balloon effect
When one area was raided by the Police, the heroin addicts moved to neighbouring areas in search of heroin. Thereby, a pack of heroin that was Rs. 50 in 1990 rose to Rs. 100 by the year 2000. It became Rs.500 in 2010. By 2014 it went up to Rs. 1,000 per pack. A gram of heroin was sold at Rs. 12,000 in 2014.
By the year 2000 there were 45,000 regular users of heroin [REID and CONSTGAN 2002].
In 2000 a heroin addict had to spend Rs. 300 on heroin for a day. In 2010 to buy heroin an addict had to spend Rs. 1,500 for a day. Many heroin addicts did not have that amount of money. Robberies, burglaries, pickpocketing, cheating, prostitution, various underworld activities, selling of properties and camouflaged businesse increased.
Many found a safer and an easy way by becoming drug peddlers. Each addict introduced heroin to 10-15 people. It was an easy task to introduce it to cannabis users. They introduced it to school children, problem children, young men, old men and almost anyone; including women. Facebook and easy-cash were helpful in spreading heroin.
These peddlers come to Colombo buy 1 or 2 bundles and go back. For example, at DAMBULLA bus stop 10 to 15 new heroin users wait in the evening for the drug peddler’s arrival. These 30,000 peddlers caused a rapid increase in the number of heroin addicts all over the country. That was one of the main reasons for there to be more than 450,000 heroin addicts.
In 1990 Methadone 5mg tablets, Methadone syrup, Buprenorphine (Temgesic), Naltrexone, Clonidine, Dilaudid, Lofexidine and Nalaxone were available in Sri Lanka to treat heroin addicts. Methadone was available until May 2021. None of the other medicines were available for a long time. It was also reported that Methadone was used in the 1970s to detoxify the opium addicts in Sri Lanka.
In 1988 there were 15 doctor who purchased Methadone and Dilaudid from the Civil Medical Stores of the Ministry of Health. Other Medicines were available in the private sector.
By 2009, there were only 8 doctors who purchased Methadone from the M.S.D. of the Ministry of Health. The clinics of the doctors were inspected by the Food and Drugs inspectors. DPDHS made th recommendations. All the doctors received the quotas of medicines approved by the Director General of Health Services (DGHS).
In 1993 WHO/HEDIP funded by an Italian co-operation, conducted a training programme for the 15 doctors. Treatment given by the doctors saved lives. If the doctors continued to treat the heroin addicts then there would have been absolutely no reason for 30,000 addicts to become peddlers.
Out of the 8 doctors who treate heroin addicts in 2009, many gave up because these doctors were humiliated, threatened and were not respected.
For example on April 1, 2009 the Director General of Health Services (DGHS) wrote, “Director/MSD was requested to inform Chairman/SPC to supply the indented quantities of the above drug (Methadone) as early as possible.”
Again on July 22, 2009 DGHS wrote, “It would be greatly appreciated if you could ensure that Methadone is being imported on a priority basis to treat heroin addicts, as this could be imported only by the MSD. If there is any issue about the importation, please discuss with me with the relevant file. Please treat this as urgent.”
When the DGHS was striving hard to get Methadone an informant instigated another higher-up, and that person wrote on July 22, 2009 “We are informed that you have obtained/purchase 51,000 and 7,768 Methadone tablets in 2008 and 2009 respectively, which is a controlled substance, which has to be used only for approved medical use. In terms of the law and international conventions, it is a narcotic substance, hence its use is illicit. Please let us know the names and addresses of persons on whom you had administered that narcotic substance.” (NB – There were over 9,000 names and addresses, and it was necessary to safeguard professional secrecy)
These vicious persons discouraged the doctors. Some doctors had their quotas slashed or cut off.
During the past 34 years there were 4 occasions when Methadone 5mg tablets were out of stock at the MSD.
1. From March 2009 to October 2010
2.During 2014
3. From March 2017 to November 2017
4. Again from May 2021 Methadone has not been available at the MSD.
On May 2021 NMRA issued the quota approval letter for the next 5 years. But the quota approval letter had not taken any effect as yet.
The Police announced that during the first six months of 2021 Rs. 9 billion worth of heroin was seized. Using the rule of the thumb by the law enforcement community, they assume that the seized quantity represents only 10% of the total trafficking.
Sri Lanka is situated close to the Golden Crescent on the left and Golden Triangle on the right. Therefore heroin filters into this country with ease. In 2001 Afghanistan produced 185 tons of heroin. In 2011 it produced a staggering 5,800 tons. Indian or Sri Lankan authorities do not possess any evidence to say that heroin is being smuggled out of Sri Lanka.
Heroin that was brought into the country was for the consumption of 450,000 heroin addicts. Gradually it will destroy all the heroin addicts and their families. But, there was no Methadone and other indicated medicines to treat them. Those who decided to prevent giving Methadone and other medicines to heroin addicts have done a colossal and a catastrophic mistake. Methadone is the most effective drug in treating heroin addicts.
1. It requires treatment only once a day, because it is effective for 24 hours.
2. It prevents the use of illicit heroin, criminal activity, and the spread of diseases like HIV, Herpes Simplex and Hepatitis C.
3. It is cost effective. The amount of money a heroin addict has to spend for a day’s supply of Heroin is adequat to get medicines for 10-14 days.
4. It improves social health and productivity. Heroin addicts can go to work and earn money while taking treatment.
5. Methadone also reduces suicide and helps to retain them in treatment programmes.
6. When heroin addicts go to prisons and other isolations they mix up with seasoned heroin addicts and get rid of any fear of the Police and Prisons. For some heroin addicts Prisons are like their homes. Methadone reduces imprisonment. By September 2020 out of Sri Lanka’s 30,000 inmates who are in prisons 60% were for drug related offences. It is alleged that Justice Minister Ali Sabry had said that 553,000 people (about 2.5 percent of the population) are addicted, which means one in every 40 people in this country is a drug addict.
7. Many European countries keep heroin addicts in Methadone programmes, thereby preventing drug cartels raking in billions of dollars.
Criminalisation of heroin addiction, which is a disease, is a blunder. Heroin use of long duration causes permanent changes in the brain and brain functions. That means many have altered brains. Heroin affects the Mesolimbic Dopaminegic pathway (Reward pathway). The mesolimbic pathway is heavily implicated in neurological functions of 1) Heroin addiction 2) Schizophrenia and 3) Depression. Heroin addiction, Schizophrenia and Depression have similar changes in the brain. Patients with Schizophrenia and Depression are treated by doctors and the necessary medicines are available. Heroin addiction is a similar disease. There are mor than 450,000 heroin addicts in the country. Some heroin addicts get early clinical features of Alzheimer’s disease. Many heroin addicts over the age of 50 years have multiple organ diseases.
ABSTINENCE NOT THE CURE
Heroin residue that remains in the fatty tissues for over six years can cause relapses even after long periods of abstinence. For example, a person who had taken heroin for three years, does not take any treatment and goes to Saudi Arabia to work, will not get any heroin while he is in Saudi Arabia. Yet, when he returns after two years, at the Katunayake Airport he starts to yawn, tears appear, sweating, shaking, nervousness and agitation will occur. All the involuntary withdrawal symptoms appear and he is forced to take heroin again. Heroin addicts who are in prisons and other isolations, when they are released, they come out yawning. They will get all the withdrawal symptoms again. If detoxification is done during th first five years of addiction, then we can cure them almost completely.
Detoxification is made possible by 1) Methadone and other symptomatic treatment. 2) Medicines and excess liquids are given to remove the heroin residue that is there in the fatty tissues along with urine. 3) Heroin residue is removed with the faeces using detoxifiers. 4) 3-4 litres of medicated fluids are given orally and they are kept in steam baths for 1 ½ to 2 hours. A lot of heroin residue is removed along with urine and sweat.
In 1996 there were 1,816 heroin addicts admitted for rehabilitation. In 2000 the number had increased to 3,500 (NDDCB).
There is only a very limited capacity for rehabilitation. REID and COSTIGAN said there were 45,000 regular heroin addicts in 2000. [REID and COSTIGAN 2002]
By 2018 there were more than 450,000 heroin addicts in the country. There should be mass treatment to save many of these heroin addicts, before brain damage occurs. There should be doctors and there should be necessary medicines. Methadone is the drug of choice that is used to treat heroin addicts all over the world. When medicines were not available, many heroin addicts used to phone me and I could overhear the chaos and agony in their homes. In the absense of Methadone and doctors to treat heroin addicts many quacks and some pharmacies gave heroin addicts drugs which are not indicated to treat heroin addiction.
The high cost of heroin and the unavailability of treatment in Russia has led to the use of cheap, but much dangerous drugs such as DESOMORPHINE which has the street name of KROKODIL. Krokodil is an example of the havoc that bad drug policies can wreak on communities. The use of Methadone to treat heroin addicts has been increased annually by all the countries where there is heroin.
USA- 20,000 Kg per year [1 Kg = 200,000 Methadone 5 mg tablets] UK - 1,833 Kg per year.
Australia- 100 Kg per year Australia’s population 25.8 million in August 2021 74,000 heroin dependents in Australia (i.e. 6.9 per 1,000) Sri Lanka - Methadone 0.135 Kg per year since 2014 Srilankan population 21.8 million in 2019. There are more than 450,000 heroin addicts in the country. Yet, there are no Methadone tablets available at the MSD for the past four months. According to the British National Formulary (BNF) the usual daily dose of Methadone is 6 to 12 tablets. But, the quota allocated for a month was so inadequate, a patient was given ½ to 1 tablet for a day and to compensate for the very low dose used, several symptomatic treatments were given.
It was a wrong professional move by the 15 doctors. Due to their discontinuation of treating heroin addicts, other doctors who would have endured treating heroin addicts also kept off. Now every town has many heroin addicts. There should be many mental asylums in the country to accommodate longstanding heroin addicts with extensive brain damage.
The real picture of theheroin epidemic in this country is much more darker and gruesome. Proper involvement of the medical profession in the heroin epidemic is 2-3 decades overdue. All know that heroin addiction is a medical problem. Since there are no medical professionals to address the problem, it has ended up as a criminal problem, and many of our youth are being criminalized. “IT IS TIME TO SAVE LIVES”
“Save lives” is the theme of 2021 International Day against Drug Abuse and Illicit Trafficking.