CHASING the dragon—the practice of inhaling heroin fumes—can cause spongy holes in the brain, according to neurologists in New York.

Dragon chasers heat up their heroin then inhale the fumes through a straw made of aluminium foil. The method has become popular as it avoids the risk of HIV infection from injecting the drug with contaminated syringes.

But sometimes the practice can seriously damage the brain, says Arnold Kriegstein of Columbia University. He and his colleagues have treated three people who showed brain damage after taking the drug. The worst affected was a 21-year-old woman who had been chasing the dragon for six months. When Kriegstein saw her, she could no longer speak or sit up. The woman’s condition continued to worsen even after she had quit the drug. A magnetic resonance imaging scan revealed spongy holes in her brain’s white matter, a condition called progressive spongiform leukoencephalopathy. Worst hit was the cerebellum, a part of the brain at the back of the head that deals with fine motor skills. The damage also spread forwards. “It’s a distinctive pattern,” says Kriegstein.

Kriegstein thinks something mixed with the heroin or in the aluminium foil might have been to blame. The pattern of damage in the brain is strikingly similar to that caused by triethyltin poisoning, he says. But after analysing the aluminium foil that was used in these cases, he decided it couldn’t be responsible. “The amounts of tin seemed too low.”

http://space.newscientist.com/article/mg16422131.900-why-you-need-heroin-like-a-hole-in-the-head.html

• It’s very hard work to become an addict• Going cold turkey is quite easy
• People choose to get hooked…

For the past 14 years, I have worked as a doctor in a large general hospital in a deprived area of Britain, and in the even larger prison next door. In that time, I have seen heroin addiction rise from an infrequently encountered problem to a mass phenomenon. It has now become so widespread that the city council has politely asked residents not to put used needles and syringes in the weekly rubbish collections. No stairwell in any housing estate is complete without the discarded paraphernalia of drug abuse.

Rehab chic: The ‘horrors’ of drug withdrawal are faked for a fashion shoot that appeared in last month’s edition of Italian Vogue

Drug-addiction services have also grown massively. In our society, every problem calls forth its equal and supposedly opposite bureaucracy, the ostensible purpose of which is to solve the problem. But the bureaucracy quickly develops a survival instinct, and so no more wishes the problem to disappear altogether than the lion wishes to kill all the gazelle in the bush and leave itself without food. In short, the bureaucracy of drug addiction needs drug addicts far more than drug addicts need the bureaucracy of drug addiction.

The propaganda, assiduously spread for many years now, is that heroin addiction is an “illness”. This view serves the interests both of the addicts who wish to continue their habit while placing the blame for their behaviour elsewhere, and the bureaucracy that wishes to continue in employment, preferably for ever and at higher rates of pay. Viewing addiction as an illness automatically implies there is a medical solution to it. So, when all the proposed “cures” fail to work, addicts blame not themselves but those who have offered them ineffectual solutions. And for bureaucracies, nothing succeeds like failure. The Government spends more than a quarter of a billion pounds a year on drug treatment in the UK, despite there being little evidence of any reduction in the number of addicts. Since the bureaucratic solution to waste is to waste even more, you don’t have to be Nostradamus to predict that funding in Britain will continue to rise.  Before the expansion of heroin addiction in my city, I knew little about it. I’d known a few addicts in the higher echelons of society, but they had been peculiar even before their addiction. I had briefly run a drug-addiction clinic in a famous university town, at a time when I accepted what I now know to be myths about heroin addiction. But as more addicts came to my attention – I see up to 20 new cases a day in prison – I began to think about it more. The medical perspective, that these people were ill and in need of treatment, seemed less and less convincing. I discovered that most addicted prisoners stopped taking heroin in jail, even when it was available. They came into the prison starving and miserable, and went out relatively healthy. But within a few months, many were back in their former condition, and when brought once more before the courts, some would beg to be imprisoned. When, soon after their return, I asked them whether they intended to give up taking heroin, some would reply: “I’ll have to, I’ve got no choice.” Asked why, they would offer replies such as: “Because my girlfriend’s just had a baby and she won’t let me see it unless I do.” This answer was a strange one if these addicts truly thought of themselves as ill and in need of treatment. Instead, they clearly believed a purpose in life was enough to enable them to abstain. This is not how pneumonia, for instance, is cured.

No one would say: “I must stop having pleuritic pain each time I breathe deeply because I have just had a baby.” Yet the medical services allow addicts to focus exclusively on the physiological aspects of addiction, which in practice means the prescription of a drug such as methadone.

There is a strenuous, almost outraged, rejection of the idea that addiction is, at bottom, a moral problem, or even that it raises any moral questions at all. Of course, addiction to heroin and other opiates has serious medical consequences. I often saw addicts with deep vein thromboses or multiple abscesses; they would have TB; they would be malnourished and infected with Hepatitis B or C, or both, and HIV. It would be difficult to obtain blood from the veins in their arms or legs because they had injected so often. But medical consequences do not make a disease. Many mountaineers get frostbite, but mountaineering is not a disease. To conceive of heroin addiction as such seems to me to miss the fundamental point: it is a moral or spiritual condition that will never yield to medical treatment. Having started with a vague supposition that the medical approach to addiction must be right, I came to a different conclusion: that such an approach, having started no doubt as an honest attempt to help addicts, now represented a combination of moral cowardice, displacement activity and employment opportunity. The therapeutic juggernaut rolls on. It is easier, after all, to give people a dose of medicine than a reason for living. That is something the patient must minister to himself. 

In coming to these conclusions, I felt I was living in a world in which the plainest of truths could neither be said out loud nor acknowledged.

Every day I saw addicts selling their prescription drugs or continuing to take heroin and any other drug they could get; addicts who, despite their “treatment”, continued to commit crimes; addicts openly contemptuous of attempts to help them, who lied to and manipulated their helpers shamelessly; and addicts who had, without any assistance, given up heroin completely. Above all, I observed the true triviality of heroin withdrawal symptoms. Yet my observations did not seem to matter. It was almost impolite, and increasingly impolitic, to mention them to colleagues who dealt with addicts, though they must have observed the same things. I felt like a heretic who had better keep his beliefs to himself. Had I not been lucky enough to work with three eminent physicians who had observed precisely what I had, and drawn the same conclusions, I might have broken down.

The orthodox view of addiction is that a person is somehow exposed to heroin more or less by chance. It has a pleasurable effect, and he or she keeps taking it. Before long, the person is addicted and, to avoid the terrible suffering of withdrawal, must take more. Of course, to pay for this, addicts usually resort to crime, for their addiction precludes normal paid work but requires a large income. All powers of self-control are destroyed by heroin, and unless they take a substitute drug, such as methadone, or enter a lengthy rehabilitation programme, addicts cannot give up. They are hooked for life and need help – from the drug-addiction bureaucracy.

There is only a tiny grain of truth in all this. That physiological addiction exists is indisputable. But in practically all other respects the standard view is wrong, a masterpiece of rhetorical tricks. It is to heroin addicts what Marxism was to the Politburo of the former Soviet Union: a systematic pseudo-scientific justification for everything they do.

The orthodox view is self-serving for addicts because it implies no possibility of self-control and so no blame.

What, perhaps, is more surprising is that many doctors, therapists and social workers swallow such nonsense. The truth is people who are genuinely exposed to strong opiates by chance, such as after an operation, rarely become addicted to them.

It might once have been the case, before awareness of the addictive properties of heroin was so general, that unsuspecting people were introduced to the habit by others and were thus “hooked”.

Whatever may have been the case in the past, this is not a plausible explanation now.

Children may no longer know the date of the Battle of Hastings, but they know heroin is addictive. Many addicts say they did not know what they were getting themselves into when first they took heroin, but this is not credible; they could not have failed to know.

Again, the standard view is that the process of becoming addicted to heroin is swift. The future addict has to take the drug only a couple of times and then – hey presto – his willpower is gone.

He is hooked forever. But actually, you have to work quite hard to become a heroin addict. It is not something that creeps up on you unnoticed. In fact, addicts are people intent on rebelling against received norms.

They enjoy the feeling of swimmy calm that heroin produces and make a free choice to become an addict.

Nor are the withdrawal symptoms from heroin anywhere as terrible as normally painted. In the popular conception, going “cold turkey” is dreadful beyond all description, involving cramps, insomnia, vomiting, shaking and sweating.

But not a single addict has ever caused me as a doctor to feel anxiety for his safety on account of his withdrawal.

And all the genuine symptoms, which are never severe, such as muscular aching, diarrhoea, crying, sneezing and insomnia, have been relieved by simple, non-opiate medication.

Certainly, most withdrawing addicts have portrayed themselves to me as being in the grip of dreadful suffering.

They writhe in agony, claiming they have experienced nothing as bad in their lives, and they make all kinds of threats if I do not prescribe “something” – they mean an opiate – to alleviate their suffering.

The threats range from damaging their cells to killing themselves, others or even me. (Withdrawing alcoholics never make such threats.)

In fact, heroin addicts rarely carry out their threats. Those who say they are suicidal quickly admit they were merely trying to get methadone when I suggest they be put in a cell so bare that there is nowhere from which to suspend a noose.

My counter-threat produces in most cases the most miraculous improvement in their mood.

Not all the addicts I see exaggerate in this fashion. Some admit with a laugh that anyone who says cold turkey is terrible is lying and more than likely trying to bluff his way to getting methadone.

As long ago as the Thirties, experiments showed that salt solution could be substituted for morphine without the addicts’ knowledge, and they could be deceived out of their withdrawal symptoms.

Yet the established fact that withdrawal from opiates is not a serious medical condition is a truth universally ignored by doctors.

The great glory of withdrawal agony, from a career point of view, is that where suffering exists, it is necessary to employ more and more doctors, nurses, psychologists, social workers and counsellors to relieve it.

Yet consider what happened in China after Mao took power in 1949. At the time, China had more opiate addicts than the rest of the world put together – about 20million.

But Mao gave them a strong motive to give up: he shot the dealers and any addicts who did not give up their habit.

Within three years, Mao produced more cures than all the drug clinics in the world before or since, or indeed to come. He was, indeed, the greatest drug worker in history.

The point of this story is not to advocate a repetition of Mao’s methods. It is to demonstrate that, when a motive is sufficiently strong, many millions of addicted people can abandon their addiction without the paraphernalia of help considered necessary today.

It demonstrates that people take heroin out of choice, ultimately, and so can stop out of choice. Addicts are not blameless victims of some terrible illness they have no control over.

“As long ago as the Thirties, experiments showed that salt solution could be substituted for morphine without the addicts’ knowledge, and they could be deceived out of their withdrawal symptoms.” Yeah right you stupid bitch, my Mum who is a Midwife/Registered Nurse who worked in the local Cambridge DDU ( drug dependancy unit) tried to give me tablets she claimed were codeine. I believed her, but I was still sick as a dog, and she admitted to me days later they weren’t any such thing. I wonder how you would behave if one of your kids became an addict- GOD FUCKING FORBID YOU STUPID CLOSED MINDED BITCH.

One drug - a green liquid in a beaker - is an addictive opiate that takes users at least five weeks to come off. Another - a brown powder in a syringe - is an addictive opiate that takes users five days to come off. The liquid is methadone. The powder is heroin. One is legally prescribed by doctors. The other is illegally procured from dealers. What, they’re asking in Britain’s drugs capital, is the good of that?

By Mary Braid

Published: 19 July 2000

Alex Clark, a 38-year-old from Ruchazie, a run-down council estate on Glasgow’s east side, sits in Marco’s Gym and reels off a long list. They’re the names of neighbours and relatives, all smackheads, and all dead, ruined, or on the run. Alex’s cousin Danny, who has been on heroin since his teens, is the one on the run - somewhere in England, hiding from dealers to whom he owes money. In his case, flight was sensible. A few months back machete-wielding pushers put another cousin, Aldo, in the city’s Royal Infirmary for owing a few hundred pounds.

Alex Clark, a 38-year-old from Ruchazie, a run-down council estate on Glasgow’s east side, sits in Marco’s Gym and reels off a long list. They’re the names of neighbours and relatives, all smackheads, and all dead, ruined, or on the run. Alex’s cousin Danny, who has been on heroin since his teens, is the one on the run - somewhere in England, hiding from dealers to whom he owes money. In his case, flight was sensible. A few months back machete-wielding pushers put another cousin, Aldo, in the city’s Royal Infirmary for owing a few hundred pounds.

Meanwhile, Alex, after eight years on heroin, is seeking salvation through weights and stomach-wrenching sit-ups. It has been three months since he last shot up, and his abstinence has made his older brother Andrew, who is 39, proud. “What’s great is to see Alex with his two sons again, because for a while there he lost them,” says Andrew, whose skinny frame and hollow Celtic eyes are so similar to Alex’s that the brothers might be twins. “And it’s great to hear him laugh again. There’s not much laughing when you’re using.” Alex, still a little jittery, came off cold turkey, just as Andrew did two and a half years ago, following his own eight years on smack.

When it comes to kicking heroin, however, abstinence is not, generally, the Glasgow way. As in other parts of Britain, methadone, prescribed by GPs, is now the orthodox medical treatment for the 8,500 “jaggers” who have turned Glasgow into Europe’s heroin capital.

Widespread prescription of liquid methadone, taken orally as a heroin substitute, was introduced in the Eighties to curb the spread of HIV by needle-sharing addicts. But the strenuous promotion of methadone - an addictive opiate, just like heroin - as a medicine angered some communities, already drowning in drugs, and at least one in four Glasgow GPs still refuse to take part in the scheme. Methadone, none the less, has emerged as the treatment king.

Addicts, it seems, just can’t get enough. In 1992, there were just 140 Glaswegians on methadone prescription. Today, around 3,000 visit their chemist every day to swallow the sweetened green liquid provided by the state. There’s a waiting list to join the programme and Greater Glasgow Health Board has plans for further expansion. Last month a government drugs-advisory group held the Glasgow scheme up as a national model, after stricter supervision appeared to cut fatal methadone overdoses. This month, the first research into methadone in Glasgow sings its praises, claiming it reduces injecting, overdoses and crime.

Andrew Horne, of the Glasgow Drugs Crisis Centre, is among those who argue that methadone clearly reduces the harm heroin does, both to society and to the individual user. Dispensed in a non-injectable form, it is, he says, better for the health of addicts and also protects society from infection. “Methadone or heroin injected into the groin - which would you rather have?” he says.

Horne also argues that daily supervision of addicts on the methadone programme brings users into daily contact with services that can help them. There are no statistics to reveal how many addicts are helped by methadone to become drug-free. Horne says a large proportion of addicts simply grow out of opiate use, but he insists that the methadone programme does help significant numbers to kick their drug habit. “It is a stepping stone,” he says. “The best way to detox is to use a substitute drug and do it slowly.”

All of which would be dandy, except for critics’ claims that there is no evidence the opiate is actually doing what many presume to be its principal job: ie helping addicts to come off heroin and other drugs. Last year a record 152 people died from overdoses (mainly heroin) in the Strathclyde region, 52 more than the year before. Methadone, some warn, has now become just another dangerous drug swilling round a city infamous for “polydrug” misuse.

For their part, the Clark brothers hate methadone. Alex and Andrew’s brother-in-law, Davie, was prescribed it after five years of injecting heroin. It was supposed to ease his withdrawal and help him kick drugs. Ten years later, at the age of 33, he is still on methadone. It’s the same story, they say, with the rest of the old Ruchazie gang - at least for those who are still alive. Most have been on methadone prescription for years and - despite the scheme’s rules against using other drugs, enforced by urine testing - they continue to inject heroin and take other drugs.

The main difference between the opiates is that methadone, while it does not offer the intense high that heroin does, is longer-lasting. Addicts on the programme should not need to dose more than once a day, while heroin addicts come down much faster and need to “dose” at frequent intervals. But compared to heroin, they say, methadone is boring - a Volvo against the preferred Ferrari, and, therefore, treated just as a “top-up” to heroin.

“The health board would consider Davie a success story,” says Alex bitterly. “He does not inject or take other drugs. But he’s like a vegetable. He used to have a good head on him but now he just sits at home all day.”

Alex’s brother Andrew took methadone for four weeks when he broke with smack. “It did take away the aches and pains of withdrawal, but psychologically the benefits wore off in days - and coming off was worse than it was with heroin,” he says. It takes five days to come off heroin but five to 15 weeks to kick methadone, which is a consideration for addicts, with jail a constant occupational hazard.

Alex complains that drug centres never treat the individual addict but simply prescribe methadone to everyone. He relates how, three months ago, after 14 days without heroin, he went for medical help. “I wanted to stay off,” he recalls. “I had a house like the one in Trainspotting - there was nothing in it. A drugs counsellor took just 10 minutes to decide methadone was for me, though I told her I was already detoxed.”

Despite Davie’s experience, Alex admits he was tempted: “By then I was gasping for anything.” So he went along to his local methadone group. “There were 15 of them there, all slumped forward,” he says, now laughing. “I was introduced and - shit! - I realised I knew most of them.”

Alex made his excuses and left and finally gave into Andrew’s pleas that he join Calton Athletic Recovery Group, a hard-line abstinence group based in Denniston, in Glasgow’s East End, which was famous for a while as the technical adviser to the film of Trainspotting. Calton, which is bitterly critical of the methadone programme and currently embroiled in a funding row, is where Andrew came off, and where Alex is now trying to kick his habit. Some days are hard, but it was peer pressure, Alex says, which sucked him in in the first place. Now another peer group, he believes, can help rescue him.

Calton offers football, half-marathons, daily work-outs, and group-therapy sessions. Its controversial director, Davie Bryce - who is a hero to his fans and a bloody-minded svengali to his critics - believes exercise stimulates endorphins suppressed by years of addiction. As Bryce, a former heroin addict himself like everyone at Calton, earthily explains: “You don’t get better sitting on your arse.”

Calton is supportive, but tough. And Bryce, in track suit and trainers, is scathing of the suited professionals who blame addiction on poverty, giving addicts too many places to hide. Calton’s mantra is individual responsibility. “I used to blame social conditions and Thatcherism,” says Bryce. “I blamed everything and everyone, bar drugs.”

The health board, and a host of Glasgow drug centres, claim methadone helps addicts, as well as society, by stabilising them until they feel able to tackle dependence. But Calton bans all drugs - prescribed or otherwise - including alcohol. To Bryce, prescribing methadone makes as much sense as switching an alcoholic from whisky to gin.

“Methadone is not a treatment,” he says angrily. “It is a method of social control, introduced to contain HIV infection.” During the Aids panic, he says, the authorities had to reach the drug-taking population and methadone was the carrot that lured addicts in. Bryce reluctantly allows that methadone might have a very short-term application, if addicts moved off it before dependence set in. “But it’s not used as a means of getting people into detox,” he argues. Another Glasgow drugs counsellor, who does not want to be named, agrees. “You get these reports about methadone working miracles, but I don’t know anyone it has helped come off. Its an inexpensive way for the health board to look like it’s actually doing something. And no one takes the board on now because we all rely on it for funds.”

The study into methadone’s effect on the behaviour of Glasgow addicts - co-authored by Dr Laurence Gruer, public health consultant and the driving force behind Glasgow’s methadone programme - makes no assessment of methadone as an addiction-busting drug. Gruer’s fellow co-author Sharon Hutchison, of the Scottish Centre for Infection and Environmental Health, says that a drug-free life is the long-term goal of methadone programmes. But the study only covered addicts’ first 12 months on methadone - too soon, apparently, to expect long-term heroin users to become drug-free. But the question arises: if methadone brings such dramatic improvements to addicts’ lives, why are so many of them still relying on it, years after their first prescription?

Professor Neil McKeganey, of Glasgow University’s Centre for Drug Misuse Research, does not argue with the social benefits of methadone in curbing infection and crime. A £3m methadone programme looks good value when set against the £194m of goods that Glasgow addicts steal annually to fund their habits. It is generally accepted that given free methadone, addicts do steal less.

“But the big question has to be what effect, if any, is methadone having on heroin addiction,” says McKeganey. “And the truth is we don’t have any evidence either way.” McKeganey says that when psychiatrists were responsible for the care of heroin addicts - before Aids arrived and public health and infectious diseases consultants took over - they were largely sceptical about methadone as a treatment, as countries including France remain today.

McKeganey agrees that short-term use of methadone might stabilise an addict. “But stability is not an end in itself,” he warns. “Methadone should be the point from which other things take place and that’s not happening in Glasgow.”

From his own interviews with addicts, he believes that for some, the opiate may create an even stronger dependence than heroin. Professor Russell Newcombe, a drugs lecturer at Liverpool John Moores University, argues that because of the longer withdrawal period, methadone may, in fact, extend addictions by years. Yet there are no studies into the long-term effects of the drug.

Meanwhile Calton’s members believe that, secretly, the health board has given up on addicts, convinced they cannot be saved, or that saving them would cost too much. Janis, who is 29, finally came off heroin five years ago. “I had sold everything,” she says. “I slept rough on the streets. Eventually I joined a methadone programme, lying that I wanted to kick heroin just so I could get more drugs.” It was a year before a urine test revealed she was still using heroin and other narcotics.

“My habit just got bigger and my life got out of control,” she says. “I thought the only way you got out was to die. That was all I was seeing around me.” Bryce laughs that the health authority likes schemes that are “non-directive and non-judgmental” when directive and judgemental are just what addicts need.

“I wanted someone to tell me how to get off and stay off, ” remembers Janis. “I didn’t want someone to ask me what I wanted to do. How would I have known, the mess I was in?” Fundamentally, she says, she needed role models to show what was possible. That finally happened when she saw a Calton presentation in prison.

Janis, understandably, wants more abstinence schemes. But even drugs counsellors who support methadone projects, warn that Glasgow’s expanding scheme is facing problems because of scarce long-term rehabilitation programmes. “We have them on methadone but we can’t get them off,” says one drugs-project manager who prefers anonymity because he, like most others, relies on health-board funds.

Alex, meanwhile, struggles on with the daily sit-ups at Marco’s Gym. “I worried at first that it was all too late to get clean,” he says. “But I believe now that had I gone on methadone I would be sitting in the house just like [my brother-in-law] Davie.”

http://news.independent.co.uk/health/article266397.ece