| Af Kåre B. Videbæk, dyrlæge
25/2 BRAGTE TV2 “Rigets tilstand”, og emnet var kampen mod narko. Der skal åbenbart være folketingsdebat om, hvorvidt de håbløse narkomaner skal have tilbud om gratis heroin for at redde dem fra et nedværdigende liv med stor risiko for medfølgende sygdom og død. Overbevisende Falliterklæring Sober oplysning |
Nanna W. Gotfredsen
| Danskerne er markant positive. Vilstrup Research har, i løbet af det seneste år, spurgt i alt 2000 repræsentativt udvalgte om deres holdning til heroinforsøg. Dette er sket i tre undersøgelser, hvoraf januar-målingen var den mest omfattende og en måling primo oktober d.å. den seneste. Undersøgelserne viser en stabil og markant tilslutning. Godt 2/3 af den danske befolkning er positive overfor iværksættelse af heroinforsøg. Hvem er “de positive”? Når de enkelte demografiske variable betragtes, ses følgende forholdsvis tydelige tendenser: Mænd er lidt mere positive overfor heroinforsøg end kvinder. De yngre, d.v.s. de 18 – 29 årige, er lidt mindre positive end de 30 – 59 årige, mens “kun” halvdelen af de 60 årige eller derover er positive overfor heroinforsøg. På politisk tilhørsforhold ses der ingen tydelige tendenser. Dog er man på venstrefløjen og i midterpartierne lidt mere positive, mens man i Socialdemokratiet, Det Konservative Folkeparti og i Venstre ligger på landsgennemsnitsniveau, d.v.s. omkring 67 %. Hvad ligger bag? De positive billeder. Mere overraskende er det måske, at hele 58 % af respondenterne spontant afgiver svar som kan kategoriseres under, at stofmisbrugerne ville få en højere levestandard socialt og / eller psykisk. Her er kun få uspecificerede. En pæn andel svarer, at stofmisbrugerne ikke længere ville være tvunget til at begå kriminalitet og/eller prostituere sig, at de ville få en højere livskvalitet, et værdigt liv, og at heroinbehandling ville være fremmende for resocialiseringen. En lidt mindre gruppe på 12 % mener, at flere ville kunne nås af behandlingssystemet, flere ville blive afvænnede og et par procent fremhæver en forbedring af relationerne mellem stofmisbrugeren og dennes familie. Ca. 1/5 nævner, at stofmisbrugerne ville opnå en forbedret fysisk levestandard. Dette specificeres bl.a. med færre tilfælde af smitte med hhv. HIV- og leverbetændelse. Godt 1/4 fremhæver mere generelle aspekter som positive følger, så som mindre synlig narkoscene, opløsning eller omstrukturering af de belastede miljøer og lavere tilgang (d.v.s. færre nye stofmisbrugere). Endvidere nævnes større tryghed for de øvrige samfundsborgere, primært med henvisning til en reduceret risiko for at blive udsat for kriminalitet. Enkelte svarer spontant, at blot det at prøve noget nyt er positivt, da “alt andet jo har slået fejl”. 4 % nævner økonomiske aspekter, som specificeres med besparelser hos politiet, i fængselsvæsenet og i sundheds- og hospitalssektoren. De negative billeder. Godt 1/10 frygter øget tilgang; d.v.s. at flere ville påbegynde stofmisbrug, mens mindre grupper ser heroinbehandling som en opgivelse af “kampen mod narkotika” eller som en “for nem” løsning for samfundet. 8 % udtrykker bekymring for, om heroinbehandling vil være muligt at kontrollere i tilstrækkeligt omfang. Økonomiske aspekter påpeges af ca. 1/10: “Det bliver dyrt!”. Nogle nævner specifikt øget skattetryk og flere offentligt ansatte, mens enkelte påpeger negative konsekvenser i form af arbejdsløse behandlere (sic!). Til sidst nævner knap 1/10 etiske eller moralske aspekter som negative konsekvenser, herunder statslig vedligeholdelse af og støtte til narkomani. Stillingtagen til politiske argumenter. Forbedret levestandard? Fald i følgekriminaliteten? Øget tilgang? Færre afvænnes? Kommentar: Først og fremmest skal det forsøges påvist i hvilket omfang myter og fordomme florerer, samt hvilken betydning disse har for holdningen til heroinforsøg / behandling. Der udtrykkes bekymring for fastholdelse i stofmisbruget ved behandling, hvori heroin (som i øvrigt også lyder det mindre “farlige” og mere medicinske navn diatylmorfin) indgår. Gør denne bekymring sig også gældende ved metadonbehandling, som vel kun de færreste i dag er modstandere af? Unddrager metadonvedligeholdelse sig at være omfattet af begrebet “statsunderstøttet narkomani”? Et begreb som især i formiddagsaviserne ofte kædes sammen med heroinbehandling. Alene af kemiske årsager må risikoen for fastholdelse i stofmisbrug ved metadonbehandling formodes at være mere udtalt grundet metadonens længere halveringstid. Ligeledes kan det omfattende sidemisbrug blandt metadonister frygtes, at gøre stoffriheden som endestation næsten illusorisk. For mon ikke blandingsmisbrug er en endnu mere kompliceret problemstilling end det rene heroinmisbrug? Føres stofmisbrugeren således fra asken til ilden? Enkelte nævner arbejdsløse behandlere som en negativ konsekvens af iværksættelse af heroinforsøg. Man fristes til at spørge, om en sådan effekt overhovedet kan betragtes som andet end den ultimative succes … Med hensyn til bekymringen for den øgede tilgang, kunne man stille spørgsmålet: “Hvor skulle nye få stoffet fra, hvis stofmisbrugerne får lægeordineret heroin?”. Det er først og fremmest utopi at forestille sig, at en stofmisbruger ville sælge sin heroin. Dernæst vil det, hvis heroinbehandling tilrettelægges som f.eks. i den hollandske model, være fuldkommen umuligt at tage stoffet med ud. Der er nemlig panserglas mellem stofmisbrugeren og stoffet og forsøgsdeltagerne er omgivet af spejle og konstant under opsyn. Og hvorfor skulle det ikke gå med heroinhandelen på gadeplan, som med en hvilken som helst anden type virksomhed? Uden et marked for et givent produkt, intet produkt. Hvis heroinbehandling gennemførtes som et permanent behandlingstilbud til de særligt hårdt belastede stofmisbrugere, ville jo netop gruppen af højfrekvente aftagere bortfalde. De mange pushere som sælger for at finansiere eget forbrug, ville ikke længere have behov herfor. Og bagmændene (hvem de så end er …) risikerer vel alene denne hårdt strafbelagte form for kriminalitet, i forventningen om den store fortjeneste. Bekymringen for den øgede dødelighed blandt stofmisbrugerne (enkelte anser dog dette for at være positivt!), vil i det kvalitative studie måske eller sandsynligt forklares ved den fejlagtige antagelse (men dybt rodfæstede myte), at selve stoffet heroin er farligt eller vævsgiftigt. Hvorfor er den i øvrigt ekstremt polariserede debat så stof-fikseret? Burde den ikke i stedet være optaget af, hvordan man kan levere en massiv social behandlingsindsats, understøttet af metadon, minnesota-model, LAAM, buprenorfin, heroin eller hvad der nu findes egnet til at nå målgruppen? At tro, at al følgekriminalitet vil bortfalde er nok utopi. Men schweizerne fortæller os, at den reduceres betydeligt. Hvilken betydning vil dette få for angsten for at blive udsat for kriminalitet? “Det bliver dyrt!”. Ja – det er sikkert rigtigt, men hvor store vil mon besparelserne på udgifter til fængselsophold være? Det koster knap en halv million om året, at have en enkelt person siddende i et lukket fængsel. Og hvad med besparelserne på den politimæssige side? I København er hver 4. kriminalbetjent fuldtidsbeskæftiget med narkotikakriminalitet og antallet af sager efter hhv. lov om euforiserende stoffer og straffelovens narkotika bestemmelser tyder på, at store dele af kontrolapparatets ressourcer anvendes på stofmisbrugernes egen handel med stoffer. Det er vanskeligt at sige noget nærmere om, hvor stor en del af ordenspolitiet, der er beskæftiget med disse opgaver, men en enkelt aften på Maria Kirkeplads giver en vis forestilling herom. De fleste kan vel blive enige om, at sociale problemer bedst løses ved sociale tiltag. Man kommer dog let i tvivl om, hvorvidt stofmisbrug ses som et socialt eller som et strafferetligt problem. Ved fraværet af en klart formuleret overordnet politisk målsætning og med paradokserne i de politiske midler (når f.eks. politibilen holder lige bag ved kanylebussen i Skelbækgade på Vesterbro), må risikoen for at konsekvenserne bliver både kaotiske og katastrofale være særdeles nærværende. I den kvalitative fase vil det forsøges belyst, hvilke dele af problematikken befolkningen anser som værende sociale problemer og hvilke der betragtes som strafferetlige problemer. Hvordan defineres f.eks. en bagmand? Er det generelt den der sælger narkotika, eller findes der at være en så afgørende forskel på den der alene pusher for fortjenestens skyld og den som blot forsøger at finansiere eget stofforbrug, at man bør vælge helt at afholde sig fra at sætte strafferetligt ind overfor sidstnævnte? Er et politisk ideal overhalet? Har befolkningens holdning overlevet det politiske ideal? Eller har befolkningen, med andre ord, overhalet det politiske niveau indenom? Noget tyder herpå og skal søges belyst i de planlagte kvalitative projekter, som vil blive gennemført ultimo d.å. |
Notat af Torben B.B. Hansen.
Medl. af Roskilde Amtsråd 1999
| Baggrunden for dette notat er den kendsgerning, at bekæmpelsen af narkotikamisbruget i Danmark er slået fejl, samt, at det muligvis er på tide, at Fremskridtspartiet reviderer sin 20 år gamle politik på narkotikaområdet, da den på visse punkter kunne tænkes at være forældet, og dermed trænger til at blive ført “up to date”.
Historisk redegørelse I perioden 1965 til 1983 er sigtelserne for overtrædelser af narkotikaloven steget årligt med 30%, hvilket er en ganske alvorlig udvikling, når også politiets indsats er øget. Siden 1972 har det officielle tal for stofmisbrugere været mellem 5.000 og 10.000 personer, men vi har kun lidt direkte viden om, hvor mange stofmisbrugere der faktisk er og har været. I halvfjerdserne og firserne var det primært Storkøbenhavn og de store provinsbyer, som var berørt af stofmisbrugsproblemet, men i 1995 er stofferne spredt til alle afkroge af Danmark. Over årene er prisen på f.eks. heroin faldet fra kr. 4.000/g. til i dag ca. kr. 500/g., og på samme tid er renheden steget fra 15% til ca. 40%, og alligevel omsættes der årligt for meget store summer. Hvis 10.000 narkomaner (det mindste antal narkomaner man anslår der er i Danmark anno 1995) i gennemsnit bruger kr. 500 om dagen på stoffer, skal der på et år bruges: (10.000 X 500 X 365) kr. = 1.825.000.000 kroner (1,825 mia.) Ca 1/3 af narkomanerne er kvinder, og de skaffer hovedsageligt pengene ved prostitution, mens de mandlige narkomaner betjener sig af andre veje. Hvis vi antager, at 1/3 af pengene for mændenes vedkommende kommer fra røverier m.v. svarer dette årligt til 400 millioner. Tyvekosterne m.v. kan gennemsnitligt sælges for mellem 10 til 20% af værdien, og dermed stjæles der værdier for mellem 2 til 4 milliarder kroner for at finansiere narkoen. Hertil kommer kvindernes andel, som anslås til 750 millioner, og samfundet taber dermed mindst 3 til 5 milliarder kroner årligt på grund af narkomanernes kriminalitet. Det ses, at samfundets omkostninger er ganske betragtelige, men hertil kommer udgifter ved udlevering af metadon. I 1985 blev der udleveret metadon til 1387 narkomaner, og dette tal var steget til 4443 i 1993, mens de sundhedsmæssige omkostninger forsigtigt skønnes til 3 milliarder årligt. Hertil skal lægges belastningen af fængsler, domstole og ikke mindst politiets indsats i forbindelse med efterforskning, anholdelse og fremstilling overfor en dommer. Gøre den samlede regning op taler vi sandsynligvis om et beløb i størrelsesordenen 8 til 10 milliarder kroner årligt. Problemerne er endda stigende, da nye stoffer som crack og rygeheroin er dukket op på markedet. Disse stoffer skal ikke optages gennem kanyler og sprøjter, men ryges eller sniffes, og dermed har der åbnet sig et helt nyt marked for narkobagmændene og deres lakajer. Vi må desværre forudse, at problemernes omfang er stigende, og vil være det i de kommende år, medmindre vi snarest lægger indsatsen i Danmark radikalt om. Hvis vi ikke omlægger indsatsen risikerer vi at få tilstande på rusmiddelområdet, som i USA, og det ville være en katastrofe. Regeringens redegørelse at fra 1986 til 1993 er der sket en fordobling af sager vedrørende overtrædelser af narkotikalovgivningen. at stofmisbrugere påfører samfundet betydelige omkostninger i forbindelse med kriminalitet, domstolsafgørelser, afsoning, sociale- og medicinske udgifter (HIV & AIDS), overdoser, selvmord og øvrige dødsfald. at antallet af dødsfald blandt stofmisbrugere er i drastisk stigning. at mellem 25 og 50% af de indsatte i fængslerne er stofmisbrugere. (Jyllands Posten siger 70%) at der i december 1993 var 4500 personer, som modtog metadon. at det samlede antal stofmisbrugere skønnes at ligge på mindst 10.000. På trods af en øget indsats omkring forebyggelse, behandling og politiets ligeledes øgede indsats vokser problemerne år efter år. Med opbruddet i Østeuropa er der efter 1990 åbnet nye veje for smugling af narko, og politiet står i realiteten magtesløse overfor de ressourcestærke narkoligaer og -karteller. Det illegale marked fungerer efter princippet om udbud og efterspørgsel, og som liberale ved vi, hvordan vi kan ødelægge eller skævvride et marked, som eller er frit. Staten kan udnytte et monopol eller lovgivningen til at fastlægge rammer, som griber afgørende ind i den frie konkurrence. Iøvrigt et kunststykke, som skiftende danske regeringer har gjort med stor “succes”. Hvad vil vi gerne opnå ? mindske kriminaliteten blandt narkomaner aflaste fængsler, politi og domstole forebygge hospitalsindlæggelser (årligt 3 mia) “omskole” narkomaner fra et liv på det offentliges regning til at kunne fungere normalt; både socialt og på arbejdsmarkedet Når man ser på den enkelte narkoman kan man have to vidt forskellige indgangsvinkler: Narkomisbrug er en sygdom, som kan helbredes. Målet er derfor stoffrihed, og behandlingen bør indeholde metadon i en kort nedtrapnings- og afgiftningsfase. Narkomisbrug er en del af en meget kompleks problemstilling, hvori indgår sociale, psykiske, helbreds- og samfundsmæssige elementer. Hvad taler imod en “delvis” legalisering ? Påstand nr. 1 Svar: En total legalisering vil medføre, at mange flere har adgang til narkotiske stoffer, men f.eks. har kampagner mod cigaretrygning medført langt færre rygere blandt unge, der dog alle har adgang til at købe tobak og cigaretter. (med statsnarko er der ikke tale om blot en delvis legalisering, da gadehandel fortsat vil være strafbart) Påstand nr. 2 Svar: Hvis man får en overdosis kan det nemt medføre døden, men den største fare er der faktisk i dag. Dette skyldes et illegalt marked uden kontrol med kvaliteten og garanti for stoffets sammensætning, når det købes ulovligt på gaden. Risikoen for at købe katten i sækken er derfor stor. Påstand nr. 3 Kriminaliteten blandt 150 narkomaner faldt med 96% Ingen dødsfald over en periode på 10 år. Ingen blev smittet med HIV-virus. Næsten alle levede en normal tilværelse med arbejde på trods af deres narkovaner. Over de ti år forsøget varede holdt halvdelen op med at misbruge narkotiske stoffer. Påstand nr. 4 Der er sikkert yderligere en lang række indvendinger, men der er ingen, som for alvor kan rokke ved det vigtigste aspekt. Nemlig, at det er på tide at få lavet nogle seriøse forsøgsordninger, så vi kan få samlet vigtige erfaringer og dermed få løst de meget påtrængende problemer, som følger i kølvandet på narkomisbrugerne. Såvel de samfundsmæssige, som de personlige. Udgangspunktet er fortsat en fejlslagen politik/indsats, og vejen frem er nytænkning, og ikke flere fængsler. Misbrug skal behandles, ikke straffes ! Statsnarko som et begrænset forsøg Ved at køre forsøget i sygehusregi kan forsøget sandsynligvis gennemføres uden en lovændring, da udleveringen er en del af et behandlingsforløb. Klinikken vil muligvis kræve døgnbemanding, da narkomaner skal have heroinen injiceret 3 til 4 gange i døgnet. Personalet kunne være 4 socialrådgivere/socialpædagoger samt en læge, lægesekretær, en psykolog/terapeut samt 4 sygeplejersker. Bemandingen sikrer, at der er lægefagligt personale tilrådighed, samt personale, som efterfølgende kan tage sig af rådgivning og den sociale opfølgning/hjælp. Man opnår på klinikken, at stofmisbrugerens hverdag bliver langt mindre stressende, og at udlevering af narkoen holder dem væk fra kriminalitet og prostitution. Gennem den sociale behandling/terapi skal de efterfølgende motiveres til at få løst deres reelle problemer, og til at påbegynde en egentlig behandling af misbruget. Med tiden er der meningen, at den enkelte stofmisbruger skal have en uddannelse og et fast arbejde, dvs. en egentlig resocialisering. Hvis forsøgene med statsnarko falder heldigt ud, kan det udvides til at gælde alle narkomaner i Danmark, men det er vigtigt at komme i gang med nogle forsøg, for at kunne anvise alternativer til den nuværende og fejlslagne politik/indsats. Uden nytænkning risikerer vi at tabe kampen mod narkoen og dens ressource stærke bagmænd. ——————————————————————————– |
Efterspørgslen er prisufølsom og en hårdere indsats mod narkotikahandlen vil medføre mere og ikke mindre kriminalitet.
Af Gunnar Thorlund Jepsen, Professor
En forstærket politimæssig og strafferetlig indsats mod narkohandel og stofmisbrug fører blot til højere priser og større omsætning på dette illegale marked. Vejen frem er derfor at underminere markedet – ikke hverken at forstærke indsatsen eller det modsatte: At legalisere stofmisbrug.
Dette er efter min opfattelse den uundgåelige konklusion efter at have lœst og vurderet internationale analyser af problemet og efter at have afprøvet en økonomisk model på narkotikamarkedet.1 Ved narkotika forstås i denne artikel såkaldt hårde stoffer som heroin, kokain og amfetamin. Disse stoffer har i nutidens samfund følgende karakteristika:
De efterspørges af en bestemt kundekreds – såkaldte misbrugere – ikke af alle.
De er vanedannende, dvs. de giver en tilvænning, der er vanskelig at komme ud af, og hvor ophør af forbrug endda kan give stærke abstinenssymptomer.
Import af og anden handel med disse stoffer er forbudt, hvorfor markedet for disse stoffer er illegalt.
Der er bivirkninger for brugerne i form af social deroute, HIV-risiko, leverbetændelse m.v.
Der er bivirkninger for andre i form af sociale og andre offentlige udgifter, kriminalitet som berigelsesforbrydelser for at skaffe midler til stoffer samt eventuelle ‘krige’ mellem organiserede bander om markedet.
Disse karakteristika er for nogles vedkommende tilsyneladende en følge af, at markedet er illegalt. I en interessant artikel: »The price elasticity of hard drugs: The case of opium in the Dutch East India 1923-38« i Journal of Political Economy, vol. 103, no.2, 1995 demonstreres, at i et – nœsten – legaliseret marked er kundekredsen større og består også af brugere, der kan ‘styre’ deres forbrug af opium (casual users). Derimod viser undersøgelser, at selvom andelen af befolkningen, der bruger narkotika, falder, så falder forbruget ikke vœsentligt. De nœvnte karakteristika synes derfor at have vœsentlige implikationer for narkotikamarkedets natur.
Efterspørgslen er prisufølsom.
For det første er efterspørgslen meget lidt prisfølsom. Narkotikamisbrugerne står for den helt væsentlige del af efterspørgslen og finansierer den fortrinsvis ved kriminalitet. Deres daglige stofforbrug skal opfyldes på den ene eller den anden måde og det uanset markedsprisen og uanset konsekvenserne ved anskaffelsesmåden.
Økonomer taler om efterspørgselselasticiteten, der udtrykker, hvor meget efterspørgslen falder ved prisstigninger. For markedet for narkotika vurderes den til at vœre lav – nœr nul i de industrialiserede lande. Det skyldes, at markedet er illegalt, og at der er meget få ikke-misbrugere blandt efterspørgerne.2 Den anden side af markedet er udbuddet. Her taler man om den såkaldte udbudskurve, der viser hvilke priser, udbyderne vil have for at sœlge. Udbudsprisen synes at vœre ret uafhœngig af, hvor risikabelt i form af anholdelse og straf det er at handle på det pågœldende marked. Risikoen for at blive anholdt og få en hård straf indkalkuleres i prisen som en slags ‘risikoprœmie’. Således skriver Miron og Zwiebel (jf. note 1): »Perhaps the most incontrovertible effect of prohibition is an upward shift in the supply curve for drugs«.
Alt afhœngig af indsatsen mod narkotikamisbrug og straframmerne varierer denne ‘risikoprœmie’ fra land til land, hvorfor også priserne gør det. I Aloyz Prinz artikel (ligeledes note 1) er gennemsnitspriserne for udvalgte lande angivet for heroin og kokain. Samtidig angives koefficienten for prisens variation, der synes at vise, at de varierer meget lidt, hvor priserne er lave.
I øvrigt betyder kriminaliseringen også, at begrebet kundeloyalitet bliver af stor betydning. Det er vigtigt for pusherne at kende deres købere, så de ikke blivet ‘stukket’. Det er også af betydning for mellemhandlere og bagmœnd. Forbrugerloyaliteten sikres ved konstant kvalitet og sikre leverancer til afgrœnsede grupper, men hindrer ikke, at ‘risikoprœmien’ må betales af den endelige forbruger: Narkotikamisbrugeren.
Større politiindsats – større kriminalitet
Efterspørgslen er altså prisuelastisk. Udbuddet er derimod altid til stede, hvis ‘risikoprœmien’ – og en rimelig avance – betales. I fig. 1 og fig. 2 på næste side er vist to skematiserede eksempler på, hvorledes narkotikapriser dannes på to markeder – et marked med en lempelig narkopolitik (små straffe, lille politiindsats ) og et marked med en stram narkotikapolitik (høje straffe, stor politiindsats ). Figurerne er naturligvis teoretiske, eller om man vil, postulerede, men bygger på den vurdering, at efterspørgslen ikke er sœrlig elastisk, og at udbuddet isœr er følsomt over for narkotikapolitikken – forhold der synes empirisk veldokumenteret. Af figurerne ses, at prisen er vœsentligt højere på markedet med en stram narkopolitik, fordi ‘risikoprœmien’ her er høj.
Da narkotikamarkedet er illegalt, og stofmisbrugere i det vœsentlige skaffer pengene kriminelt, kan man tilnœrmelsesvist måle kriminalitetsomfanget ved at se på den mœngde penge, der omsœttes på narkotikamarkedet. Det er vist skraveret i fig. 1 og fig. 2. Set fra en økonomisk synsvinkel er der således intet som helst paradoks i, at en hårdere indsats mod narkotikahandelen medfører mere – og ikke mindre – kriminalitet.
Markedet søges opretholdt
Et andet karakteristikum ved markedet er det tidsmœssige aspekt. Markedet vil dø ud, hvis der ikke hele tiden sikres en tilgang af nye afhœngige. Under den forudsœtning vil de interesserede parter derfor i deres ønske om profit forsøge at bevare markedet intakt ved hele tiden at lokke nye kunder ind ‘i butikken’. Til dette formål vil narkotikahandlerne (både de små: pusherne og de store: bagmœndene) anvende pris- og ‘marketing’politik. En strammere narkotikabekœmpelsespolitik vil øge bestrœbelserne på at bevare markedet med stœrkere konsumentloyalitet.3 Hertil kommer, at fordi narkotikamisbruget er mest latent i kriminelle og asociale kredse, vil en større kriminalisering øge tilgangen af misbrugere. F.eks. skaber fœngselsmiljøet tilsyneladende i sig selv misbrugere.
Man kan nu spørge, hvilke implikationer narkotikamarkedets sœrlige natur må have for narkotikapolitikken.
Det vil vœre en for hastig konklusion, at man afkriminaliserer markedet. For dette vil medføre, at efterspørgsels- og udbudsforholdene vil œndres. Priserne vil falde, og man vil få et større narkotikaforbrug uden for egentlige misbrugskredse. Formentlig vil man få de samme problemer som på markedet for spiritus – måske bortset fra, at spiritus fysisk er et mere farligt stof end f.eks. opiater.
Eliminér den illegale efterspørgsel
I stedet for at sœtte ind på udbudssiden af markedet, f.eks. ved at gøre salg straffrit, kunne man forsøge at eliminere efterspørgselssiden. Hvis man på én gang fandt en mirakelkur, hvor man kunne motivere alle stofmisbrugere til afvœnning, ville der ikke mere vœre nogen efterspørgsel af betydning på det illegale marked.
Det ville dø ud.
Følgevirkningerne heraf ville vœre, at narkotikakriminaliteten, forstået som den kriminalitet der er en direkte følge af narkotikamisbruget, ville falde vœk. Det ville påvirke tilgangen af nye stofmisbrugere, der ville blive mindre, fordi den netop er betinget af det asociale og kriminelle narkomiljø. Det ville også vœre et vœsentligt modtrœk mod alle de andre negative aspekter ved narkotikamisbruget (HIV-spredning og andre sygdomsrisici, kriminalitet, bandedannelse mv.).
Indfør legal dosering
Er det muligt at eliminere den illegale efterspørgsel? Måske ikke fuldstœndigt. Men hvis man i København indrettede klinikker, hvor f.eks. heroinmisbrugere under lœgekontrol kunne få deres doser, ville mange vœlge dette frem for en stadig kriminel jagt på penge til stoffet. Samtidigt ville man komme i kontakt med misbrugerne og få mulighed for at motivere dem til behandling. Forslaget er altså ikke at give markedet frit. Tvœrtimod ville chancen for at ødelœgge det illegale marked og lokke stofmisbrugerne i behandling fortsat vœre størst, jo mere stressende det er at skaffe sig midler til stoffer på det illegale marked. Så tilbuddene om kontrolleret legal narkotikadosering kunne udmœrket ledsages af en hårdere jagt på stofmisbrugere og pushere på det illegale marked.
Effekten af en sådan ‘pisk- og gulerodspolitik’ må ikke bedømmes kortsigtet. Den risiko, den gratis heroin kan medføre ved at lokke nye misbrugere til, er nok til stede, selvom lœgekontrollen kan modvirke den. Men den må vurderes i lyset af det – formentlig langt større antal – misbrugere, man undgår ved, at det illegale narkotikamarked og miljøet deromkring forsvinder. De forsøg med gratis heroindosering, der for tiden foregår i f.eks. Schweiz, kan, alene fordi de kun omfatter en lille delmœngde af misbrugerne, ikke bruges som eksempler på, hvad en total eliminering af det illegale marked vil betyde. De økonomiske mekanismer, der styrer markedet, er generelle.
Begynd i fœngslerne
Det er dog et område, hvor man eventuelt kan foretage et økonomisk eksperiment – nemlig fœngslerne. I stedet for forsøg på at isolere sœlgerne, dvs. de såkaldt stœrke fanger, kunne man ødelœgge deres forretning ved gratis under lœgekontrol at give deres kunder de stoffer og med tiden den behandling, de måtte ønske.
Det er hyklerisk at acceptere en nœrmest monopolagtig udnyttelse af fœngslede misbrugere, når dette monopol på en gang kan knuses ved at dosere stofmisbrugerne det stof, de i alle tilfœlde vil købe via de stœrke fanger. Doseringen skal følges af behandlingtilbud – naturligvis.
At det selv i et så isoleret miljø som fœngselsmiljøet volder modstand at ødelœgge det illegale narkotikamarked ved legal dosering viser imidlertid, at der er nogle psykologiske barrierer – ikke mindst hos vore politikere – der skal overvindes, før man erkender, at vejen frem er ved legal dosering at lokke stofmisbrugerne i behandling og ud af narkotikakriminaliteten. Det er ellers min opfattelse, at en sådan politik på lœngere sigt kan bringe os tilbage til Danmark før 1960′ erne – Danmark uden illegal narkotika og uden narkotikamisbrug af betydning.
Note 1: For nœrmere vurdering af det europœiske narkotikamarked kan jeg henvise til Aloys Prinz: »Do European Drug Policies Matter?« i »Economic Policy – A European Forum«, oktober 1997, hvor der findes en indgående empirisk baseret beskrivelse af narkotikamarkederne og narkotikapolitikken i de europœiske lande samt en artikel af J.A. Miron og J. Zwoebel i Journal of Economic Perspectives, 1995. »The Economic Case against Drug Prohibition«.
Note 2: En undersøgelse af disse forhold er vanskelig, fordi markedet netop er illegalt, men der kan henvises til f.eks. M. Grapendahl: »Economic Behaviours of Amsterdam Opiate Users«, the International Journal of Addictions, 1992.
Note 3: For en teoretisk behandling af dette forhold henvises til: Gunnar Thorlund Jepsen og Peter Skott: »On the Effects of Drug Policy« (Working Paper no. 1997-15), Institut for Økonomi, Aarhus Universitet.
Gunnar Thorlund Jepsen, professor ved institut for Økonomi, Aarhus Universitet
The Drug Users Union surpass 19 years!
1.11 more than 130 guest celebrated the 19th birthday.
The duo “Raske Penge & TopGunn” performed with their superhit “Baghave” ….
Hepatitis ABC
a brochure for people who inject drugs, describes the latest scientific knowledge on the differing forms of hepatitis: their respective causes, symptoms, and prevention and treatment options
For Injectors
This brochure is for people who inject drugs and want more information about Hepatitis A, B and C. It tells about the most common types of viral (caused by a virus) Hepatitis and how you can reduce your risks of getting or spreading this disease. For people who inject drugs, Hepatitis is a serious health threat: one of the most common ways of getting Hepatitis is through sharing injecting equipment. In most areas today–rural, suburban or city–injectors are more likely to have Hepatitis B or C than HIV!
Hepatitis means “inflammation of the liver”. It is usually caused by one of three viruses: Hepatitis A, B, or C. The effects of each virus are different, but in some cases viral Hepatitis can lead to cirrhosis (scarring) of the liver, eventually causing serious, life-threatening disease, and even liver cancer. Although less common, Hepatitis can also be caused by heavy long-term alcohol use, some medicines, and illnesses passed down from your parents.
The liver keeps your body functioning smoothly. It helps digest food and get rid of toxins and other things foreign to your body (like drugs!). When the liver gets so damaged that it can’t work properly, a transplant may be your only medical option. Liver transplants are difficult, expensive and hard to get. Even after a transplant, Hepatitis C may sometimes re-appear in your new liver. This is why preventing Hepatitis, and, if you’re infected, early detection and care that keeps your liver from being seriously damaged, is so important!
Hepatitis A
Hepatitis A (HAV) is caused by a virus found in feces (shit). You can get Hepatitis A if you have contact with infected feces. The most common way this happens is through swallowing contaminated food or water. You can also get it through sexual acts like rimming (licking someone’s asshole) or sucking a guy off immediately after he’s had anal sex. In either case, the virus can be transmitted by tiny amounts of feces that you can’t see. Foods and liquids get contaminated by hands that aren’t washed, or aren’t washed right. Pots, pans, plates, knives and forks, serving spoons, etc can also be contaminated if not cleaned properly. And sometimes sewage pollution can contaminate food or drinking supplies.
Almost everyone infected with Hepatitis A recovers completely in about 4 to 8 weeksYou may have no symptoms, or you may suffer from nausea, vomiting, jaundice (yellow skin and/or eyes), diarrhea, and/or an extreme lack of energy. Hepatitis A is rarely dangerous, unless you also have Hepatitis C. When you have active Hepatitis A, you can pass the virus on to another person-even if you have no symptoms. Once you recover, you can’t spread Hepatitis A and you’re immune to getting it again. This is because your immune system develops antibodies that are able to fight off future exposures to Hepatitis A .
Hepatitis B
Hepatitis B (HBV) is caused by a virus found in blood, semen (cum), vaginal fluids, breast milk, and saliva (spit). It is spread by sharing syringes or infected water when injecting. It can also be spread by sharing other injection equipment (like cottons and cookers) and, perhaps, snorting or smoking devices (like straws or crack pipes).
Hepatitis B is transmitted sexually too, through unprotected vaginal, anal, or oral sex with a person infected with Hepatitis B. Hepatitis B can be transmitted from a pregnant woman to her fetus in the womb, or to her infant during or after birth. And because it is so easily transmitted through body fluids Hepatitis B is sometimes spread by ordinary household contacts —possibly through sharing things such as toothbrushes and razors.
When you are infected with Hepatitis B the sickness may start gradually, usually lasting a month or two. Sometimes you may not know you’re infected because you don’t look or feel sick: the virus can remain active within your system, and you can still infect others.
Only about 1% of people who get HBV die, and most people recover completely from Hepatitis B within about 6 months. These people are said to have had acute Hepatitis B. However, about 5 – 10% of people who get Hepatitis B remain capable of spreading the virus for the rest of their lives and can develop chronic liver disease.
These people are said to have chronic Hepatitis B.
Hepatitis C
Hepatitis C (HCV) is another virus found in blood and mostly transmitted through blood to blood contact. It is usually spread by sharing syringes or infected water when injecting.
It can also be spread by sharing other injection equipment (like cottons and cookers) and, perhaps, snorting or smoking devices (like straws or crack pipes).
Non-sterile tattooing and body piercing equipment can transmit the virus, too.
Sometimes Hepatitis C can be transmitted from a pregnant woman to her fetus in the womb.
It may also be possible to get it from ordinary household contacts like razors and toothbrushes shared with someone who has the virus.
In a small percentage of cases, Hepatitis C is transmitted through sexual contact, although not a lot is known about how this happens.
The risk of getting Hepatitis C from blood products is much less today since all blood products are now screened.
Most people do not know they are infected with Hepatitis C. Only a very few people with Hepatitis C develop the usual symptoms of hepatitis–jaundice, fever, and flu-like symptoms that can last up to six weeks–right after getting infected.
Others only discover they’re infected years later when they get sick and testing confirms they have the virus.
A large percentage of people (75-85%) with Hepatitis C never clear the virus out of their system. These people can continue to infect others, and are said to be “chronically infected”.
Most studies have reported that cirrhosis develops in 10-20% of the people who are chronically infected with Hepatitis C over a period of 20-30 years after the initial infection, and liver cancer in 1-5% of these people.
•fatigue
•mild fever
•muscle or joint aches
•nausea/vomiting
•loss of appetite
•mild stomach pain
•loss of taste for cigarettes
•diarrhea
•dark urine, light colored stools and jaundice (skin and/or the whites of the eyes look yellow)
Unfortunately, Hepatitis often goes undiagnosed because symptoms are mild or suggest only a flu-like illness.
Many people have no symptoms at all.
The only way to know for sure if you have Hepatitis is to have a blood test. Ask a doctor or needle exchange where you can have this done.
For more information about cleaning syringes and other injection equipment, contact a needle exchange or see HRC’s Getting Off Right IDU Safety Manual for a complete discussion of safer injection methods.
•It’s safest to use a new, sterile syringe and equipment (including cotton, filters, caps, spoons, cookers, and alcohol swabs) every time you inject. You can get new syringes in exchange for used ones at needle exchange programs -or pharmacies, in some states. Needle exchanges and other harm reduction programs can also provide you with cotton, alcohol swabs, and clean water.
•If you can’t get a new syringe, using bleach to clean your works and equipment (including caps and cookers) is effective against killing the Hepatitis B virus, but only if the bleach is in contact with what’s being cleaned for at least 2 minutes. This is different from the usual guidelines for cleaning syringes to kill HIV. The Hepatitis viruses are hardier than HIV, and therefore more difficult to destroy. It is believed that using bleach for 2 minutes also kills the Hepatitis C virus.
•It’s possible blood containing Hepatitis C can remain infectious outside of your body for up to 14 days. Do not put your syringe, plunger, or needle down on a dirty surface -such as a tabletop that has (or may have had) blood on it- as you could contaminate your syringe. Wash your hands thoroughly with soap and water before using your finger to find a vein, or to pick up a cotton. (It’s even better if you can wipe your fingers with an alcohol swab, too!)
•Use sterile water if possible. Otherwise, always use the cleanest water you can find for mixing and injecting drugs and rinsing injection equipment.
•Shoot your own drugs, if at all possible. One study has suggested that you have a higher risk of sharing needles if other people inject you: your partner might not be as careful about using someone else’ syringe as you would be!
Another study has observed groups of users where only one person knew how to shoot up. The person doing the injecting would get blood on his or her finger and then touch (and contaminate) the injection sites of everyone else in the group.
If you can’t inject yourself, make sure that the person who’s injecting you does not get his or her blood, or anyone else’s, on or around your injection site.
And make sure that they use a new, or at least properly cleaned, syringe!
To prevent Hepatitis A:
• Be as careful as possible to only eat food prepared under clean
• Keep your bathroom separate from your cooking and eating facilitiesconditions
• Wash your hands thoroughly after using the bathroom, and before cooking or eating
• Use protection when having sex (with condoms, dental dams, latex gloves), especially when practicing anal sex, or combinations of anal and oral sex
• Get vaccinated
To prevent Hepatitis B:
• Use protection when having sex (with condoms, dental dams, latex gloves)
• Use the safer injection guidelines outlined in this brochure
• Use less risky methods to take your drugs, like snorting and smoking with your own straws and pipes
• Get vaccinated
To prevent Hepatitis C:
• Use the safer injection guidelines outlined in this brochure
• Use protection when having sex (even though Hepatitis C is not commonly spread sexually, many people choose to practice safer sex to reduce the risk)
• Use less risky methods to take your drugs, like snorting and smoking with your own straws and pipes
Hepatitis A and B can be prevented by getting vaccinated. Currently, there is no vaccine for Hepatitis C. The Hepatitis A vaccine consists of two shots over 6 months. The Hepatitis B vaccine consists of 3 shots over 5-6 months.
To get full protection (immunity) against Hepatitis A or B, you must get all of the shots in each series.
If you are chronically infected with Hepatitis C, you may be at an increased risk to die from a Hepatitis A infection. If you have the Hepatitis C virus, vaccination against Hepatitis A is medically necessary.
Because so many injection drug users are also at risk for Hepatitis B, vaccination against both Hepatitis A & B is advisable.
WHERE DO I GET HEPATITIS A AND B VACCINES?
When you go to see a health provider, whether it’s your regular one or not, be confident in asking for the vaccines (you may want to bring this brochure with you).
Some clinics will only vaccinate you if you are a certain age, if you ask, or if you are a regular patient.
If you don’t have a regular health provider, or are having trouble finding one who will vaccinate you, ask your local needle exchange program or city or county health department where to go.
And remember, it’s always a good idea to get screened for Hepatitis A & B antibodies before you get vaccinated to make sure you aren’t already infected.
You can also call:
The National Hepatitis Hotline, 1-800-465-4837 or 1-800-GO-LIVER
There is no medication for Hepatitis A, nor for acute Hepatitis B. Rest and avoiding things that are toxic to your liver (like alcohol) help the healing process.
In severe cases that require hospitalization there are medicines, though, that lessen the symptoms of Hepatitis A and acute Hepatitis B: Compazine for nausea and intravenous fluids for dehydration. If it is causing health problems, chronic Hepatitis B can be treated with alpha interferon and/or 3TC (an HIV medicine).
About 33% of those treated will improve. Hepatitis C can also be treated with alpha interferon along with an anti-viral medication, ribavirin. This combination is expensive and difficult to take (and doctors are often reluctant to give it to active users), but it has been effective in 30-40% of the people with chronic Hepatitis C who have received the treatment.
Before taking interferon (or interferon and ribavirin), it is important to weigh the potential benefits against the very common negative side effects (flu-like fatigue, chronic fever, lack of energy and appetite, insomnia, depression, etc.). Depending on your personal situation, treatment with these drugs may or may not be advisable, so be sure to talk this over with your health provider.
Many people use alternative or complimentary therapies (such as acupuncture, herbs, and vitamins) to treat Hepatitis A, B and C. Although some people report that these therapies work, their effectiveness has yet to be scientifically proven. Contact the Harm Reduction Coalition if you would like more information on this subject.
• Try to cut back on alcohol use, or stop altogether. Your liver has to work extra hard to process alcohol; the more you drink the greater the chance of progression to serious liver disease from Hepatitis C.
• Get vaccinated against Hepatitis A, if you’re not immune. Hepatitis B may make you sicker if you already have Hepatitis C, so it’s probably a good idea to get vaccinated for Hepatitis B too.
• See a doctor regularly who understands Hepatitis C — and be sure to discuss all medicines, including over-the-counter and herbal, you are taking. If you have HIV too, you need to be careful about the medicines you take for it, as some are toxic to your liver.
• Be aware that street drugs can also be hard on your liver, and you never know what they’re cut with. Using smaller amounts, using less frequently, or stopping altogether will help your liver.
• It’s a good idea to be kind to your liver, by eating well and reducing stress! Minimally eat a balanced diet, but find a professional who can help you develop a personal menu. Consider exercising on a regular basis and finding stress management and relaxation techniques, such as meditation or yoga, that work for you.
Because our knowledge about Hepatitis is constantly changing and improving, the information in this brochure-collected in May, 1999- may no longer be current by the time you read this. Be sure to check with your health care provider for the latest developments in Hepatitis care and prevention.
Special thanks to Sharon Stancliff, M.D. for advice and edits, and to Kristen Ochoa and the UFO Study of the UCSF Department of Epidemiology, San Francisco General Hospital for permission to use portions of their Hepatitis brochure. Additional thanks to Robert Heimer, Ph.D.; Paula J. Lum, M.D., MpH; Brent Patterson; and David Perlman, M.D for their assitance.
©HRC 1999 The Straight Dope Education Series
Created to provide accurate information about drugs so that people can make rational, safer and informed decisions about their drug use.
This publication is designed to provide accurate and authoritative information about the subject matter covered. It is distributed with the understanding that the Harm Reduction Coalition is not engaged in rendering medical, legal, or other professional services.
“Narkotikarådet skal hermed anbefale, at der lægges vand ved de værktøjssæt med sprøjter og kanyler der uddeles og sælges af amterne som en del af den gældende danske skadesreduktionspolitik.
Anbefalingen skal ses på baggrund af de store problemer stofafhængige landet over har med at skaffe rent vand til injektion af stoffer. Det medfører, at de ofte benytter andre mere uhygiejniske væsker som øl, sodavand, regnvand eller vand fra urinaler der kan give alvorlige fysiske skader.
Manglen på rent vand medfører også hastig udbredelse af smitsomme sygdomme som f.eks. Hepatitis C, fordi stofafhængige deler væske i skyllebægre. Det høje risikoniveau er veldokumenteret i udenlandsk litteratur.
Anbefalingen er vedtaget af rådet på baggrund af en indstilling fra rådets skadesreduktionsarbejdsgruppe, der har til opgave at følge udviklingen på området og komme med eventuelle anbefalinger til rådet. Der gøres opmærksom på, at de offentlige repræsentanter i rådet på grund af sagens karakter har valgt ikke at udtale sig for eller imod rapportens indstillinger.
Som bilag blev der vedlagt rekommandation fra rådets skadesreduktionsarbejdsgruppe og notat fra sygeplejerske fra “Sygepleje på Hjul”, Nina Brunés, der er medlem af arbejdsgruppen:
Bilag 1:
Rekommandation fra arbejdsgruppen til rådet:
I henhold til kommissoriet for Narkotikarådets Skadesreduktionsarbejdsgruppe skal gruppen følge udviklingen på området og fremkomme med eventuelle anbefalinger til rådet. Kommissoriet indeholder ikke nærmere tilkendegivelser om formen for sådanne rekommandationer.
Skadesreduktionsgruppen har på to møder diskuteret de betydelige problemer der foreligger m.h.t. at skaffe rent vand i forbindelse med narkotikaafhængiges injektion af deres stoffer. Det har tidligere været diskuteret, om der ikke burde vedlægges en ampul med destilleret vand i de sæt med sprøjter og kanyler der uddeles/sælges som led i den gældende danske skadesreduktionspolitik.
Der vedlægges et notat fra gadesygeplejerske Nina Brunés om de problemer, mangelen på rent vand forårsager for narkomanerne på bl.a. Maria Kirkeplads.
På grund af manglende adgang til rent vand anvender de stofafhængige alle mulige andre væsker, herunder øl, sodavand/cola, regnvand eller urin jf. notatet.
Tilsvarende uhygiejniske teknikker er vel bekendt fra andre steder, hvor de stofafhængige behøver vand til at tilberede deres fix.
Det har tidligere i Narkotikarådet været fremført, at den stigende udbredelse af bl.a. Hepatitis C kan skyldes, at stofafhængige deler vand i bægre, der står frit fremme, eller i øvrigt deler værktøj.
Også andre infektioner kan foranlediges af injektioner med usterilt vand, ligesom injektion af sodavandsprodukter og alle mulige andre vandige produkter kan give anledning til skader.
Det høje risikoniveau er veldokumenteret i den internationale litteratur og at der vedlægges rent vand ved udlevering af værktøjssæt er en velkendt hygiejnisk foranstaltning i flere lande med en lang historie med sprøjte-/kanyleudlevering.
Det har tidligere været fremført, at udgiften til en vandampul er ca. 1 kr. pr. sæt.
En af arbejdsgruppens medlemmer, BrugerForeningens repræsentant, Jørgen Kjær, har foretaget forespørgsler herom i udlandet og har fået oplyst, at vandampuller vil kunne tilvejebringes for ca. 60 øre pr. stk. ved indkøb af tilstrækkeligt store kvanta.
Skadesreduktionsgruppen vil senere vende tilbage med en mere omfattende indstilling om udlevering af og indhold af værktøjssæt.
I betragtning af problemets presserende karakter finder gruppen imidlertid, at en rekommandation vedr. vand i værktøjssættene ikke bør afvente en sådan mere omfattende indstilling.
Det er vigtigt for de stofafhængiges helbred og overlevelse, at der foretages alle overkommelige foranstaltninger for at mindske deres helbredsrisici.
Gruppen skal derfor anbefale, at Narkotikarådet snarest udsender gruppens anbefaling til alle relevante instanser og fremhæver den vigtige skadesforebyggende virkning et sådant tiltag vil have.
Om ønsket skal gruppen gerne vende tilbage med nærmere oplysninger om, hvor og hvordan billige vandampuller kan fremskaffes.
Bilag 2:
Manglen på adgang til rent vand på Maria Kirke Plads.Af Nina Brunés
Det er et faktum at der er et særdeles aktivt stofmisbrug på Maria Kirke Plads.
Det er et faktum at der skal anvendes vand for at opløse stoffet inden det injiceres.
Der er ikke adgang til rent vand uden for kirkens åbningstid.
Det er ikke muligt at hente vand i de nærliggende forretninger, hoteller eller udskænkningssteder.
Brugerne er ikke velkomne.
Resultatet er, at alle former for uhensigtsmæssig væske i stedet anvendes.
Eksempelvis øl, sodavand, juice, kakaomælk m.m.
Ofte trækkes væske fra efterladte bægere eller beholdere indeholdende ukendte komponenter.
Det kan være inficeret med diverse bakterier og vira eller kemiske forbindelser, hvis helbredsmæssige konsekvenser hos den enkelte er uoverskuelige.
Nogle trækker vand op fra vandpytter. I og med at der ikke er adgang til toiletter, er disse vandpytter dels opstået på grund af urinering og dels på grund af regn.
Regnvandet i København er ikke injicerbart.
Tilføres der vand i værktøjssættene, vil vi formodentlig kunne reducere ganske mange skader i forbindelse med det intravenøse misbrug.
Dels vil den enkelte stofbruger opleve færre helbredsmæssige problemer, og dels vil samfundet undgå unødige udgifter i form af pleje og behandling af de opståede skader.
Use The Heroin With Great Caution
This information is only for people who are mature enough to respect the dangers involved with injecting heroin. These dangers include physical and mental addiction and the possibility of contracting a terrible disease like AIDS or hepatitis if the user doesn’t take the time to be as sanitary as possible and NOT ever SHARE NEEDLES!.
Being on heroin is exactly the same (albeit more powerful) as being on pain pills like Vicodin, Percodan, MS-Contin, etc. It gives a pleasant feeling of well-being just like being high on pain pills: warm, drowsy, a tiny bit itchy. The only way to get anywhere near one’s money’s worth is to shoot it (unless one comes across snortable stuff like China White, almost-pure powder heroin). Smoking it is a terrible waste which, by the way, isn’t done by putting on top of buds and hitting it with a direct flame.
It’s done by “Chasing the Dragon”: it’s put on aluminum foil and heated from the bottom and allowed to run down the foil if possible while inhaling the smoke. From personal experience, the user can be on heroin for a few days straight ( a quarter-gram or so per day ) and stop cold- turkey with no symptoms of physical withdrawl whatsoever.
Staying on it for periods longer than this is playing with fire.
What is a good dosage of heroin for a beginner to start with?
Purity of street drugs can vary so much that it would be dangerous to give an estimate.
The first time the user tries it he or she should start out with a teeny, tiny bit and go up from there until the user gets an idea of what a good dose is.
Personally, it’s a good idea to always inject half of the dose and wait a minute ( leaving the needle in ) to see how it feels and then inject the rest.
**************************************************************************
This information is only for people who are mature enough to respect the dangers involved with injecting heroin. These dangers include physical and mental addiction and the possibility of contracting a terrible disease like AIDS or hepatitis if the user doesn’t take the time to be as sanitary as possible and NOT SHARE NEEDLES.
-Alcohol swabs are available in a box of about 100 for $2 at Safeway. -A commonly used syringe is the U-100. It is 1CC which is divided into 100 “units”.
-The bottom of a soda pop can is commonly used as a “spoon” to dissolve the heroin in because it is curved inward like a spoon. The bottom is torn off of a can as close to the bottom as possible.
Procedure:
· The “spoon” is thoroughly cleaned with an alcohol swab. In this example black tar heroin is used. In my area a $15 chunk is about the size of 2 tic-tac candies side-by-side and works just fine. It has no smell exept for a faint smell of vinegar. It comes wrapped in plastic inside a tiny balloon.
· A chunk is placed in the spoon.
· The syringe is used to suck up about 50-75 units of water and squirt it into the spoon.
· The spoon is then heated from the bottom with a lighter to make it dissolve better.
· The plunger can be pulled out of the syringe and used to stir the heroin solution.
· The end of the plunger should be clean before putting it back in the syringe.
· A piece of cotton is rolled into a ball a little bigger than a tic-tac.
· It is a good idea to clean one’s fingers with an alcohol swab before rolling the cotton.
· The cotton is dropped into the heroin and it puffs up like a sponge.
· The tip of the syringe is pushed into the center of the cotton and the plunger is slowly pulled back until all of the heroin is sucked in.
· This cotton is necessary to filter out any particles and such in the heroin solution.
· The area on the body chosen for injection is thoroughly cleaned with an alcohol swab.
· I think the spot on the bend of the arm is so commonly used because it’s so darned easy to get the needle into the vein properly.
· The needle is placed almost flat on the skin so it doesn’t get wiggled around too much.
· The needle is inserted so it goes down the length of the vein and not across it.
· Going across it just makes it way too easy to accidentally poke through the other side or pull out.
· Holding the syringe almost flat against the skin after the user feels the needle is deep enough in keeps the syringe from accidentally being jostled around and the needle being pulled out or pushed through the side of the vein.
· Now for the tricky part.
· The user has to make sure that the needle is in the vein before injecting.
· If the heroin is injected when the needle isn’t in the vein the heroin will just form a big heroin blister which takes hours and hours to get absorbed by the body.
· Usually it will burn while it’s being injected if it’s not going in the vein.
· This is one way to tell if it’s not going in the vein.
· The user should also keep a close eye to see if a blister is forming.
· When the needle is inserted the plunger is pulled slowly a tiny bit to see if blood comes in.
· This shows that it’s in the vein.
· Sometimes when the plunger is pulled, only a slow trickle of blood comes in and the rest is air.
· With practice it’s easier to tell if this trickle indicates a good enough insertion into the vein.
· Injecting a tiny bit of air ( about an eighth-inch ) with the heroin is harmless but if the user is nervous about this the syringe could be tilted so the air floats to the other end.
· From personal experience a quarter- inch (about 10 units) of air being injected with heroin is harmless but there’s no need to make a habit of injecting air. With a little practice the user can be pretty sure the heroin is going in the vein without first checking for blood but still checking for a burning feeling where it’s being injected or a blister forming.
· When trying heroin for the first time the user, of course, starts out with a tiny bit to see how his or her body reacts to it.
· As with pain pills sometimes the stomach gets queasy when the body isn’t used to it.
· In the case of an overdose the only thing I know to do is to keep the person up and walking around to keep the heart going.
· If medical attention is needed I’m pretty sure the paramedics use a drug called “narcan” which blocks the effects of opiate narcotics like heroin.
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Final Report on Injecting Rooms in SwitzerlandBy Kate Dolan and Alex Wodak. Unpublished Manuscript, 26 July 1996.
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Summary
This report describes injecting rooms in three Swiss cities (Zurich, Basel and Bern) based on a visit which took place in February 1996.
The first injecting room in Switzerland was established a decade ago with the intention of reducing the public nuisance caused by injecting in public areas (toilets, parks) and public health problems such as HIV transmission and overdose. Injecting rooms are now generally well accepted by the Swiss public although opposition had arisen initially when some injecting rooms were located in residential areas. Injecting rooms also operate in some Germany cities. Injecting rooms are planned for some Austrian cities. There are virtually no publications in English on injecting rooms.
The Centres visited differed in strictness of operation and many other organisational details but were similar in many respects. All have medically trained staff who supervise all injections on the premises and revive clients who have taken an overdose. Staff were able to control the number of clients who entered the premises and the actual room where injecting takes place. All Centres were well patronised and provided free injecting equipment and advice on injecting. No staff assisted IDUs to inject. At least 100 clients visit each Centre daily. Tens of thousands of injections have been supervised and thousands of abscesses treated annually. No overdose deaths have occurred in any Centre.
The main benefits of injecting rooms have been reduction of public nuisance and improvement of health in a very vulnerable and unhealthy group of IDUs. Injecting rooms have enabled the adoption of less hazardous injecting practices, reduced the number of overdose deaths, minimised the nuisance to the community of injecting in public places and probably reduced HIV transmission. The Centres are well tolerated in Swiss communities. Some IDUs have entered treatment as a result of attending injecting rooms. Legal problems surrounding the operation of injecting rooms have been overcome. Police work with the staff of injecting rooms.
The annual cost of running a centre was about $300,000. Behaviour of some IDUs has been problematic. The Centres, apart from the actual injecting rooms, were heavily polluted with cigarette smoke.
Injecting rooms are only needed in areas of cities with particular characteristics, such as frequent public injection. It is relatively easy to demonstrate success in reducing public injection. Evaluation is technically quite difficult. Staff believe that risk behaviour has been reduced because of interactions between IDUs and staff. It seems clear that the benefits of injecting rooms in Switzerland have outweighed the costs but the ratio of benefits to costs is not as dramatic as with, say, needle exchange or methadone maintenance
Introduction
This report describes a visit to injecting rooms in three Swiss cities (Zurich, Basel and Bern) in February 1996 and reports on discussions with health workers and researchers who have worked in or evaluated these injecting rooms in Switzerland (appendix a).
The main aims of operating injecting rooms in Switzerland are to reduce the public health risks and the public nuisance associated with drug injecting. These health risks include death from overdose and infection with blood borne viruses (HIV, HBV and HCV) from the shared use of injecting equipment. The Centres are also important points of contact for IDUs not in treatment. Medically trained staff are available at all times to resuscitate clients who experience a drug overdose on the premises.
The context within which these injecting room exist should be noted. Switzerland has implemented a number of innovative HIV prevention programs which have rarely been adopted elsewhere. Examples include `needle parks’ or open drug scenes where IDU buy, sell and use drugs, a trial of provision of heroin which includes current prisoners) and syringe exchange schemes for prisoners. Some of these initiatives have been more successful than others. The distinguishing characteristic of Swiss authorities is the acknowledgment that existing policies have been ineffective (and often counterproductive) and a preparedness to experiment to identify more effective measures. Switzerland has a surprising high number of IDUs. Because of housing shortages, they are very visible in the streets. HIV prevalence among IDUs was already high, up to 50 percent in some cities, when HIV /AIDS was first recognised. Switzerland now provides excellent needle exchange and methadone programs.
The first injecting room in Switzerland was established in Bern in 1986. Health workers had noticed IDUs had become marginalised from mainstream society and were being shunned from cafes and restaurants. These health workers proposed establishing a special cafe for IDUs which could also be used as a convenient point of contact with IDUs who did not utilise health services. IDUs then began injecting in these cafes. The workers soon realised that this provided an excellent opportunity to monitor and modify IDUs risk behaviour to reduce harms associated with injecting. Initially, some injecting rooms were placed in settings later found to be unsuitable. These rooms had to be relocated. Community opposition in Basel decreased after concerned residents attended an open day at the Centre. Another factor was the desire to reduce public nuisance resulting from IDUs injecting in parks and public toilets.
Descriptions of the Centres and the injecting rooms
In Zurich, Centres with injecting rooms are funded by the Department of Welfare. Non government organisations operate injecting rooms in the other cities. The injecting rooms are housed within Centres which also contain a cafe, a counselling room and a clinic for primary medical care. The injecting rooms are discrete rooms within the Centres. These two terms `the Centre’ and `the injecting room’ will be used to distinguish between the two levels of intervention.
In Zurich, door-men are employed to manage the flow of clients into the Centre. They ensure that only residents of Zurich enter the Centre and also prevent clients from congregating outside.
The actual injecting rooms are small and have a `sterile ambience’. All injecting rooms contained two or three tables where clients sit to prepare and inject their drugs. The three rooms visited had spaces at tables for six, six and twelve clients to sit and inject. Injecting paraphernalia – such as needles and syringes, a candle, sterile water and spoons – were placed at each position at the tables where the clients sat. There were also paper towels, cotton pads, bandaids and rubbish bins nearby. The walls of the injecting room were tiled up to a height of approximately two metres. The tables tops were made of stainless steel which enabled the surfaces to be cleaned easily.
An overwhelming impression of all the Centres visited was the constant in and out movement of clients. Movement in and out of the injecting rooms was less common as IDUs generally stayed inside for up to half an hour. Once clients were inside the Centre, most appeared content to wait for their turn to inject. Many preferred to remain in the Centre for some time after injecting.
Access to the injecting rooms
In Zurich, clients were required to show evidence of residence in that city before entering the Centre. This restriction was imposed in response to the Centres being inundated with IDUs from other cities. Staff must verify that clients are at least 16 years old and have a history of injecting before they are allowed to use the injecting rooms. The order in which clients enter the injecting room was regulated by a queuing system in two cities. In Zurich, clients took a number and entered the injecting room when their number was called. In Basel, clients were required to sit in chairs forming a queue just outside the room. However, this system sometimes resulted in disputes about who was next in line as clients would often leave their seats. In Zurich, clients’ first names were recorded on a diagram which depicted where they were sitting in the room. This allowed staff to know who each client was in case of an overdose.
Most Centres had a maximum capacity limit. When this limit was reached, clients were only admitted when others left the Centre. In Bern, the door to the Centre was only opened every half hour for five to ten minutes. Clients could only enter or leave the Centre during this time. It would be almost impossible to enter the Centre, visit the injecting room, inject and leave the Centre within the brief period that the door was opened. This meant that clients had to remain in the Bern Centre for at least half an hour, making the Centre more crowded than perhaps it needed to be. The Centre in Bern originally provided clients with identity cards which had to be shown to gain entry. This system has been abandoned as clients tended to loose the cards.
Rules
In addition to rules which are common in most drug agencies (such as no violence or drug dealing), there were specific rules for the injecting rooms. Clients must wash their hands on entering the injecting room and clean their own place at the table after injecting. Clients were not allowed to smoke in the injecting rooms. Most Centres had a maximum time limit (30 or 60 minutes) that a client could spend in the injecting room. Clients are only allowed to prepare their own drugs in the injecting room. In some injecting rooms, clients were allowed only one injection per visit to the room. Staff were not permitted to help clients inject in any Centre. Breaking the rules resulted in clients being barred from the Centre for a few days or up to a few weeks depending on the nature of the infringement.
Staff and operation
All Centres had at least one staff member present in the injecting rooms at all times. This staff member changed every hour or so as extended periods in the injecting room were considered to be too taxing. All staff have been trained to resuscitate clients if they overdose, although one staff member had the prime responsibility for this duty.
Most Centres opened for approximately seven hours a day. Some Centres are closed for one or two days a week. Centres usually operated at full capacity. In cities with a number of Centres, operating times were staggered to increase the number of hours per day that IDUs could inject safely. Some Centres have allocated specific times for female injectors to inject drugs. There were usually three or four staff on each shift. In Basel the Centre was initially closed on Sundays. Demand has been as high that the Centre is now open every day. Doctors were employed on a sessional basis to visit the Centre for a few hours a week. The cafe areas were filled with cigarette smoke. The Centres preferred to employ smokers as these conditions are often difficult for non smokers. One Centre had a light indicating when the toilet was occupied. The toilets could be opened from the outside in case of an overdose. Some Centres had direct phone lines to the police and ambulance service.
In the event of an overdose
When a client collapses, the worker in the injecting room calls another worker to assist. A small bottle of oxygen is taken to the client and administered via a face mask and simple resuscitation bag until the client regains consciousness. If the client was unable to resume breathing within ten minutes, an ambulance is called. Naloxone, a narcotic antagonist, is not used to revive clients in any Centre.
Clientele
Most IDUs in Switzerland inject a cocktail of cocaine and heroin. There are an estimated 6,000 IDUs in Zurich and 2,000 in Basel. Most clients have had hepatitis. Clients were generally older than the average IDU, although one Centre did have a predominantly younger clientele.
Other Services
A safe injecting environment is just one of several services offered by the Centres. Counselling, referral, free soup, tea and coffee and cheap fruit and vegetables were provided in the Centres. In Zurich, clients volunteered to work in the cafe and to collect discarded syringes in the vicinity of the Centre. So many clients volunteer to help that work is allocated by a lottery system.
Research into injecting rooms
Research evaluation of the injecting rooms includes monitoring the number of needles and syringes distributed and returned, number of injections, overdoses, abscesses and the number of times an ambulance has been called. Approximately 100 clients a day visit the Centres in Zurich and Basel. In three centres in Zurich, there were an estimated 68,000 injections, 3,000 abscesses treated, 22 clients resuscitated and ten calls for an ambulance to attend in a one year period.
A comparison of clients surveyed in Bern in 1990 and 1995 was undertaken. Clients were mainly (70%) males and aged about 30 years. Most (73%) had a history of imprisonment. The mean age clients started injecting was 19 years. There had been a significant increase in the proportion of clients reporting that their first injection occurred with a sterile needle and syringe over the study period. Reuse of injecting equipment decreased significantly during the study. Self reported HIV positive status was 12 and 16 percent in 1990 and 1995 respectively. There has been a strong resistance to testing IDUs for research purposes in Switzerland. Therefore, most HIV data are based on self report.
The main reasons given for attending injecting rooms in 1995 were: to inject in peace (86%), to obtain free injecting equipment (33%) and because medical attention was available. Approximately half of the clients reported injecting several times a day. There have been no deaths in any injecting rooms in Switzerland to date. Workers in Basel believe that the number of deaths due to overdose in the community has decreased as a result of injecting rooms. In Bern, workers believe they have made the injecting ritual less dangerous by moving clients from 2 ml to 1 ml syringes which carry less risk of blood borne infection.
According to the Report “Evaluation der Gassenzimmer I, II, und III in Basel”, injecting rooms have provided drug users with hygienic and controlled conditions, prevented infection through the provision of sterile syringes, needles and condoms and gave access to medical care and opportunities for intervention with possible emergencies such as overdoses. The demonstration project was overwhelmingly welcomed by all key parties: the evaluation team called for the continuance of the strategy, so as to provide a stable environment for Basel IDUs.
Injecting equipment
Three different methods were used to distribute injecting equipment in the three cities visited. In Zurich, staff provided equipment to clients as they entered the injecting room and there was a strong emphasis on exchange. In Bern, clients were provided with a free syringe and charged a small fee for additional syringes. Clients in Basel helped themselves to injecting equipment from a dispensing tray on the wall. No Centres provided butterfly infusion sets. Only one Centre provided 5 and 10 ml syringes which clients use for the injection of methadone syrup. One brand of syringes available in Switzerland has detachable filters that are removed after drugs are drawn into the syringe. Samples of these syringes were obtained.
Conclusions
Experience over the years suggest that injecting rooms have probably not been as successful as syringe exchange or methadone programs in reducing HIV infection, but the benefits clearly outweigh the costs. Injecting rooms seem very likely to continue in Switzerland. Injecting rooms only seem to be needed under particular circumstances and in certain locations.
Ms Rosann Waldvogel
Social Welfare Department
Lagerstrasse 107
Zurich 8004
ph: 41 1 242 5085
Fax: 41 1 291 5470
Centre located at:
Neufrankenstrasse 15
Zurich
BASEL
Nicholas Heller
Social Worker
Ph: 41 61 261 1101
Centre located at:
Spitalstrasse 6
Basel
BERN
Anita Marxer
Social Worker
ph 41 31 378 22 391
Centre located at:
Nageligasse 3c
Bern
Dr Robert Haemmig
University Psychiatric Services
KODA-1
Freiburhstr. 30
CH-3010 Bern
ph: 41 31 382 92 22
fax: 41 31 382 9234
Dr Jean Pierre Gervasconi
University of Lausanne
Institute of Social and Preventive Medicine
Bugnon 17
1005 Lausanne
ph: 0011 41 21 314 7295
fax: 0011 41 21 314 7373
The last time I overdosed I was revived with Narcan. While it was a terrifying experience, I am extremely grateful to both the person who found me and the paramedic who saved my life. I overdosed because I used too much dope in too short a time period, and because I had taken a large quantity of viks, percs, and benzosN within the last 24 hours. Even as I did repeated shots, I knew I was using too much. But at the time that fact was irrelevant; the most important thing to me was to get out of my head! Looking back, I can say that I was stupid, acted irresponsibly and put a lot of people at risk for getting busted, or having to deal with a dead body upon arriving home. But that’s in retrospect.
One of the things outreach workers always tell us is not to use drugs alone. This is an excellent idea but not always a viable one. Being strung out is more about day to day survival and less about partying and being social. Furthermore, we often use drugs in isolation because of the social stigma. All of this makes it difficult for each of us to interact with other users.
From experience, I understand why it is safer to use with someone else. For instance, I know I am using too much if the other person is doing one shot for every five I do, or vice versa. Dangerous things can still happen, but at least you have a sounding board. Also, if you are using with someone else or a group of people, this would imply that you want to be around others (or have to because you have no choice) and therefore have to interact on a social level to some degree. If you are using by yourself, the implications are completely different. At least they are for me. When I use alone it is because I want to get as high as I can and not have to be accountable to anyone, or it means I have a habit–which would make it physically impossible to use with someone every time I do a shot.
When I make the choice to use by myself, it is usually for the reasons I stated above. It is not because I want to kill myself, and not because I don’t understand how to avoid overdosing, but because I am depressed and because I am bored. For a lot of people, I know it is either deeper than that, or it isn’t. Some people are on a suicide mission every time they use. Others just wanna get off. I am pretty clear about my intentions before and after I use, and yet that still does not prevent me from repeatedly overdosing.
Going back to the last time I od’ed, I was alone all night, while my husband was at work. The agreement was to wait for him to get home so we could get high together, but I was bored and decided I wanted to get a few shots in before he returned. In the five hours he was gone I did a ton of dope, and the fact that I was going to be gowedN N when he got back didn’t seem to matter all that much. In fact, when he finally came home, I was more than gowed—I was unconscious. Despite having fears about calling 911, he realized he could not revive me on his own. We were fortunate in that the cops did not respond to the call along with the paramedics.
Like all users, I have heard horrible things about Narcan. But, as I said in the beginning, I am grateful to the paramedic who administered it because if she hadn’t, I wouldn’t be alive. The paramedic who gave me the shot did not hate junkies. After I had been revived, she was decent enough to explain to me the steps she’d taken to bring me back. First, she took care of my breathing so I didn’t die while she was waiting to see how much Narcan was needed to revive me. Second, my breathing was monitored for over three hours to see whether I needed additonal shots. Getting hit with Narcan is fucked up. One minute you are unconscious, and the next minute you are completely straight. The main thing I remember about it is that I really wanted to get high again, and I couldn’t stop shaking or get my teeth to stop chattering. I was also super agitated, a feeling I spend a lot of time, energy and drugs trying to avoid. Narcan is scary; even the name makes me nauseous. (I’ve been with people who have been brought back from an OD with Narcan and just hearing the word “Narcan” makes them stand up and bolt from the door.) But no matter how tucked up it felt, if it had not been given to me by someone who knew what they were doing, I wouldn’t be writing this today.
I realize that within the Harm Reduction movement there is a debate among service providers surrounding the pros and cons of the distribution of Narcan. Until we understand the effects of consistent, widespread Narcan distribution. the debate should continue, without hindering users’ access to this potentially lifesaving tool. However, as an opiate user, I also feel it is imperative to let other opiate users know that a shot of Narcan will not revive someone from an overdose every time. Each overdose I have been involved in where Narcan was necessary has required more than one dose, administered over several hours. In fact, it has required repeated injections, and more importantly, someone who knew how to perform resuscitative breathing. Users have learned how to do this through their own self-education and through needle exchange programs that offer CPR training and overdose prevention groups. When you throw Narcan into the mix, you are merely providing an additional tool to prevent a lethal overdose. But, it should not be used exclusively in the absence of a more extensive program of overdose prevention and lifesaving tools.