The Big Question: Why is opium production rising in Afghanistan, and can it be stopped?

Why are we asking this now?

Nato and the US are ramping up the war on drugs in Afghanistan. American ground forces are set to help guard poppy eradication teams for the first time later this year, while Nato's defence ministers agreed to let their 50,000-strong force target heroin laboratories and smuggling networks.

Until now, going after drug lords and their labs was down to a small and secretive band of Afghan commandos, known as Taskforce 333, and their mentors from Britain's Special Boat Service. Eradicating poppy fields was the job of specially trained, but poorly resourced, police left to protect themselves from angry farmers. All that is set to change.

How big is the problem?

Afghanistan is by far and away the world's leading producer of opium. Opium is made from poppies, and it is used to make heroin. Heroin from Afghanistan is smuggled through Pakistan, Russia, iran and Turkey until it ends up on Europe's streets.

In 2008, in Afghanistan, 157,000 hectares (610 square miles) were given over to growing poppies and they produced 7,700 tonnes of opium. Production has soared to such an extent in recent years that supply is outstripping demand. Global demand is only about 4,000 tonnes of opium per year, which has meant the price of opium has dropped. In Helmand alone, where most of Britain's 8,000 troops are based, 103,000 hectares were devoted to poppy crops. If the province was a country, it would be the world's biggest opium producer.

In 2007, the UN calculated that Afghan opium farmers made about $1bn from their poppy harvests. The total export value was $4bn – or 53 per cent of Afghanistan's GDP.

Is it getting better or worse?

There was a 19 per cent drop in cultivation from 2007 to 2008, but bumper yields meant opium production only fell by 6 per cent. Crucially, the drop was down to farmers deciding not to plant poppies, and that was largely a result of a successful pre-planting campaign, led by strong provincial governors, in parts of the country that are relatively safe.

Only 3.5 per cent of the country's poppy fields were eradicated in 2008. High wheat prices and low opium prices are also a factor in persuading some farmers to switch to licit crops.

In Helmand, one of the most volatile parts of Afghanistan, production rose by 1 per cent as farmers invested opium profits in reclaiming tracts of desert with expensive irrigation schemes. Opium production was actually at its lowest in 2001. The Taliban launched a highly effective counter-narcotics campaign during their last year in power. They used a policy of summary execution to scare farmers into not planting opium. Many analysts attribute their loss of popular support in the south, which contributed to their defeat by US-led forces in late 2001, to this policy.

How are the drugs linked to the insurgency?

The Taliban control huge swaths of Afghanistan's countryside, where most of the poppies are grown. They tax the farmers 10 per cent of the farm gate value of their crops. Antonio Maria Costa, head of the UN Office on Drugs and Crime, said the Taliban made about £50m from opium in 2007.

They also extort protection money from the drugs smugglers, for guarding convoys and laboratories where opium is processed into heroin. The UN and Nato believe the insurgents get roughly 60 per cent of their annual income from drugs. The Taliban and the drug smugglers also share a vested interest in undermining President Hamid Karzai's government, and fighting the international forces, which have both vowed to try and wipe out the opium trade.

What about corruption?

The vast sums of drugs money sloshing around Afghanistan's economy mean it is all too easy for the opium barons to buy off corrupt officials.

Most policemen earn about £80 a month. A heroin mule can earn £100 a day carrying drugs out of Afghanistan. Most Afghans suspect the corruption reaches the highest levels of government. President Karzai is reported to have called eradication teams to halt operations at the last minute for no apparent reason.

When an Afghan counter-narcotics chief found nine tonnes of opium in a former Helmand governor's compound, he was told not burn it by Kabul – but he claims he ignored the order.

President Karzai's brother, Ahmed Wali Karzai, is widely rumoured to be involved in the drugs trade – an allegation he denies. The New York Times claimed US investigators found evidence that he had ordered a local security official to release an "enormous cache of heroin" discovered in a tractor trailer in 2004. Privately, Western security officials admit they suspect that a number of government ministers are drug dealers.

Where does that leave the international community?

Right across Afghanistan, the government is corrupt and Afghans are fed up. The police organise kidnappings. Justice is for sale. Violence is spreading and people don't feel safe. The progress promised in 2001 hasn't been delivered.

Education is a rare success. There are now more than six million children at school, including two million girls, compared with less than a million under the Taliban.

But the roads which link the country's main cities aren't safe. Taliban roadblocks are increasingly normal. UN convoys are getting hijacked.

A report published by 100 charities at the end of July warned violence has hit record highs, fighting is spreading into parts of the country once thought safe, and there have been an unprecedented number of civilian casualties this year.

General David McKiernan, the US commander of almost all the international forces in Afghanistan, insited to journalists at a press conference on Sunday that Nato isn't losing. The fact he had to say it suggest public perception is otherwise. He also said that everywhere he goes, everyone he speaks to is "uniformly positive" about the future. Those people must be cherry-picked.

Crime in the capital, Kabul, is rising. The Taliban broke 400 insurgents out of Kandahar jail this summer, and they attacked the provincial capital in Helmand last weekend. People are frustrated at the international community's failures and scared that the Taliban are coming back.

What does that mean for the future?

President Karzai has touted peace talks with the Taliban through Saudi intermediaries. The international community maintains it will support the Afghan government in any negotiations, but privately diplomats admit that if they opened talks tomorrow they would not start from a "perceived position of strength".

General David Petraeus is about to take command at CentCom, which includes Afghanistan, and he is expected to focus on churning out more Afghan soldiers and engaging tribes against the insurgents.

Meanwhile, in Pakistan, it remains to be seen whether Asif Ali Zardari will rein in his intelligence service and crack down on the Taliban safe havens in the Pakistani tribal areas, which they rely on to launch attacks in Afghanistan.

There are also elections on the horizon. The international community is determined that they must go ahead, despite the obvious security challenges, and anything the Afghan candidates do should be seen in the context of securing people who can deliver votes.

Does the war on drugs undermine the war on terror?

Yes

*Working to eradicate poppies will remove farmers' best source of income and turn them against Nato

*Using resources to fight against the entrenched poppy trade diverts them from the war with the Taliban

*Corruption in government means that battling opium turns the mechanism of the state against our forces

No

*In the end, an Afghanistan without opium production will be much less prone to the influence of the Taliban

*Money from the international drugs trade may find its way to terrorists outside of Afghanistan

*Removing the source of corruption will strengthen the country's institutions in the long term
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source: http://www.independent.co.uk

My father gave me my first hit of heroin

Crime was part of my life from my earliest memory. Not just the seedy, dark kind, but the day-to-day-to-pay-the-bills crime. This included theft, fraud, robbery and drug-dealing. Mum had left us when I was three. Dad did whatever he could to keep us going. Crime was how we survived, and as I grew older it became a father and son business.

Dad was first released from prison in 1982. We were living in a smart flat in Kensington and he'd gone straight back to dealing drugs to bring in money - getting a job wasn't even on his radar. Part of our income came from a 2kg block of Peruvian cocaine he was holding for a mate. Dad woke me up on my 16th birthday with a massive line of coke neatly presented on an antique mirror. I loved it. It never felt as if he was being irresponsible. It was normal to me.

A few weeks later, I was watching him dealing with two new customers. They were buying heroin. I'd been snorting a lot of coke and had overdone it. The hash was no longer balancing the buzz of the coke. I wanted something stronger. Dad clearly thought smack was something special - he told me it calmed the erratic, euphoric hit of cocaine. I became convinced this was what I needed for my amphetamine-frayed nerves. I'd asked him for heroin plenty of times, but he'd always flatly refused. When it started to look as if I was going to ruin this transaction with the new customers, he took me into the kitchen.

"Look, kid, I don't know what you're up to, but we need their business - I have to pay the rent." He took out a six-inch square of silver foil from the cupboard. "You can have some of this, but only a little, then piss off to your room and let me seal the deal."

My heart beat faster. This was the rite of passage I'd been waiting for, and another step deeper into Dad's world. I knew what to do - I'd seen him do it plenty of times. The narcotic rush that ran through my body was physical and emotional. I instantly understood why Dad loved it so much. It made everything easier, happier and safer. In that moment I felt a deeper connection to my father. It sounds shocking but, for me, it was no different from your average father and son sharing their first quiet pint down the local pub.

This initiation into the world of class As happened at a time when I was terrified of what the future held. Dad had been locked up for the previous three years, and had missed my transition from boy to teenager. We had a lot of catching up to do.

My smack habit developed quickly, partly from the little Dad gave me to calm me down and partly from the stuff I nicked off him to keep me stoned. I once angrily asked him why he gave it to me and he told me he wanted to keep me off the streets. At least this way he could "keep an eye on me". It was a twisted paternal protectiveness that led to our relationship breaking down completely, and ended with him back in prison and me locked up for the first time in my life.

My father was essentially lazy; crime was a means to getting us to a better place. Long-term, he wanted me to go to college; get some qualifications and a "proper" job. He was well-intentioned, but hopelessly deluded by the painkilling drugs he loved so much.

A while back I heard that the dysfunction our parents hand down to us gives us something to work with, something to motivate us out of the gutter; that's if we're lucky enough to survive our early years. Giving me heroin was a mistake my father grew to regret deeply - I knew this because he told me, many times. It accelerated me to a place to which I was already heading. And, looking back, the quicker I got there the better. My destination was prison, for dealing and taking drugs.

At 21, I was released on bail to go into rehab and I was able to do what my father never managed through all his years in prison, reading books and meditating: I got clean from drugs and alcohol, and I've stayed clean ever since.

That day in the kitchen had a dark beauty to it. Taking drugs was part of the way my father and I connected. I'm thankful I was able to get a little closer to him during that time. Heroin took my father's life, through a deliberate overdose 16 years ago. Bizarrely, it gave me mine. I still love and miss him deeply.
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source: The Guardian, http://www.guardian.co.uk

Guns and Poppies

In the morass that is Afghanistan, not just the Taliban are flourishing. So too is opium production, which increasingly finances the group’s activities. There is no easy way to end this narcotics threat, a symptom of wider instability. Even a wise and coordinated plan of attack would take years to bear real results. But the United States and the rest of the international community are failing to develop one. They must work harder, smarter and more cooperatively to rescue this narco-state.

The scope of the problem is mind-numbing. Opium production mushroomed in 2006 and 2007, and Afghanistan now supplies 93 percent of the world’s heroin, with the bulk going to users in Europe and Russia. According to official figures, the narcotics trade rakes in about $4 billion a year, which is about half of Afghanistan’s gross domestic product. It strengthens the extremist forces that American and NATO troops are fighting and dying to defeat; it undermines the Afghan state they are trying to build; and it poisons drug users across Europe, where many people do not see Afghanistan as their problem and leaders are shamefully ignoring the connection.

Last week, the United Nations reported an alarming new development: Afghan drug lords are recruiting foreign chemists, mostly from Turkey, Pakistan and Iran, to help turn raw opium into highly refined heroin. Doing so adds value and lethality to the product they export.

American, European, Afghan and United Nations officials have sabotaged their mission by continuing to bicker over why poppy cultivation has skyrocketed, what to do about it and who should act. In a particularly damning indictment in The Times Magazine, Thomas Schweich, a former State Department official, blamed corrupt Afghan officials, internal policy divisions and the reluctance of American and NATO military to take on counternarcotics roles, as much as the Taliban.

Mr. Schweich should have pointed a finger at President Bush for the fundamental failure in Afghanistan. Mr. Bush put too few resources into the country after 9/11, then left the aftermath to NATO and various warlords while America shifted focus to the disastrous war of choice in Iraq. The results: a Taliban and Al Qaeda resurgence coupled with historic poppy crops.

It is very good news that 20 of Afghanistan’s 34 provinces may soon be free of poppy cultivation, but that means production is overwhelmingly concentrated in the south, largely in Helmand Province, where the Taliban are strongest and the government is weakest.

Mr. Schweich’s main recommendation — to aggressively eradicate poppy crops by aerial spraying — is politically untenable and of questionable value. Other things can be done, or done better, including building a criminal justice system that can prosecute major drug traffickers and having American and NATO forces play a more robust role in interdiction. The Afghan and American governments have broken ground on a new airport and agricultural center in Helmand — an encouraging attempt to help farmers shift from poppies to food crops.

Allegations that President Hamid Karzai protects officials and warlords in the trade are troubling. Washington and its allies must press him to address this problem. They also should seize assets and ban visas for major traffickers who have homes outside Afghanistan.

Longer term, the answer lies in a consistent, integrated and well-financed plan to establish security throughout Afghanistan, put kingpins in jail, develop a market economy and a functioning government in Kabul, and rapidly expand incentives for smaller farmers to stop growing poppies. It is all one more daunting Bush administration legacy that will be left for the next president to fix.
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source: The New York Times

Illegal Painkiller Overdoses Kill More Than 1,000 Americans

More than 1,000 Americans died in 6 cities between 2005 and 2007 from overdosing on nonpharmaceutical fentanyl (NPF), in the biggest ever epidemic of overdoses involving illegally produced versions of the painkiller. Health officials predict there will be further outbreaks of NPF overdose because the illegal narcotic is easier and cheaper to produce than heroin.

The figures are being reported today by the US Centers for Disease Control and Prevention (CDC), in the 25th July issue of the Morbidity and Mortality Weekly Report (MMWR).

Illicitly manufactured nonpharmaceutical fentanyl (NPF) is 30 to 50 times more potent than heroin. It is a synthetic opioid and classed by the US authorities as a narcotic.

The findings of a CDC and Drug Enforcement Agency (DEA) investigation showed that between 4th April 2005 and 28th March 2007, a total of 1,013 deaths occurred in six US jurisdictions; the largest NPF epidemic to date. This is nearly 10 times higher than an epidemic in the 1980s when 110 people died of fatal overdoses of different fentanyl analogs, said the report.

The largest number of deaths were in metropolitan Chicago (349), Philadelphia (269), and Detroit (230). The other areas were St. Louis, Missouri, and the states of Delaware and New Jersey.

Emergency medical staff said some of the victims were found with the needle still stuck in their arms. The drug was so powerful that they died before completing the injection, said Dr Stephen Jones, a co- author of the report who is now retired from the CDC, reported Reuters.

The authorities decided to carry out the investigation after receiving a number of reports of overdoses linked to NPF. For instance in April 2006 increases in overdoses among illegal drug users were reported in Camden, New Jersey, which triggered similar reports in other jurisdictions, including Chicago and Detroit, which had been discovered earlier but falsely attributed to heroin overdose until urine samples of some of the dead showed traces of fentanyl.

Thus in May 2006 the CDC started ad-hoc case-finding surveillance in six state and local jurisdictions. This was later taken over by the DEA. This is how the 1,013 NPF related deaths were identified. After this the DEA started regulating access to N-phenethyl-4-piperidone, which is used to make illegal analogs of fentanyl.

The CDC report said the pattern of NPF overdoses points to illegal distribution networks, citing as an example that the NPF found in Chicago and Detroit most likely came from a clandestine production site in Mexico. However, they can't explain why they did not find any NPF-related deaths in other areas of high heroin use, such as in New York City.

As well as the deaths discovered through the CDC/DEA surveillance system, over the same period there were reports of other NPF-related deaths from suburban and rural areas of Illinois, Michigan, and Pennsylvania and in Kentucky, Maine, Maryland, Massachusetts, New Hampshire, Ohio, and Virginia.

The CDC suggested that although the number of NPF-related deaths spotted by the CDC/DEA surveillance system fell substantially in 2007, they predict further epidemics of NPF overdoses are likely because the drug is easier and cheaper to produce than heroin.

Deaths related to heroin and other illicit drugs are well documented in the US. From 1999 to 2005, the figure went up by 87.5 per cent, from 4.0 to 7.5 per 100,000 of the population (age-adjustied deaths from unintentional drug poisoning, mostly linked to pharmaceutical and/or nonpharmaceutical drugs).

The CDC said their report had four limitations: first the figures could be under-reported because for example only participating centers in six jurisdictions were included in the surveillance; second, there is no standard toxicology definition of cause of death for fatal drug overdoses; third, some of the deaths could be misclassified as NPF when they were really pharmaceutical fentanyl-related deaths (ie legal use); and finally, in addition to fentanyl, other substances may have contributed to the overdoses, including alcohol.

Nevertheless, the CDC said the figures are sufficient to warrant improvements in a number of areas relating to drug overdoses. These include improvements in identifying and reporting drug overdose, so law enforcers and public health officials can act more quickly (eg to seize drugs and provide outreach support).

The agency also said there was a need to develop or expand:

* National standards for toxicologic testing and classifying cause of death in drug overdose and poisoning.

* Professional standards for referring overdose surivivors for addiction treatment and education, such as those that exist for suicide survivors.

* Public health programs to help drug users get treatment, be educated about risks of overdose, and learn ways to avoid and deal with overdose.

Jones said in a telephone interview reported by Reuters that the report highlights "an extraordinary episode of fatal drug overdoses".

"But it's got to be recognized as part of the bigger problem of the increasing numbers of drug overdose deaths in the United States," he added.
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source: MediLexicon

Mixed progress for bupe

As city includes hard-core addicts, more drop out

Baltimore has doubled the number of people using the medication buprenorphine to shake off heroin addiction but has struggled to keep them in treatment.

As the Baltimore Buprenorphine Initiative has accepted more hard-core drug addicts dealing with complications such as mental illness, more drop out. At the start of the initiative in October 2006, officials had picked mostly highly motivated participants.

The retention rate dropped to 52 percent for the year that ended June 30 compared with 65 percent in fiscal year 2007. That is prompting city health officials to question which patients do best on buprenorphine, sold as Suboxone and widely known as "bupe."

"Who is the right candidate for bupe?" asked Dr. Joshua M. Sharfstein, Baltimore's health commissioner. "It's just really hard to tell." He said officials will examine that issue closely.

The initiative, which cost about $2 million last year, is "continuing to gain momentum," he said. "More clinics are participating. More patients are being treated. More doctors are interested in seeing patients."

The novel program introduces addicts to Suboxone in city-backed clinics that stabilize patients before transferring them into the care of private doctors who have become qualified to prescribe the drug.

The city has streamlined its process of securing health insurance for the mostly low-income participants and added clinics and doctors to expand access.

But the 771 patients who entered the program over the past year are taking longer than the first year's 388 patients to make the transfer because they still abuse drugs other than heroin, such as cocaine.

Some studies have shown that methadone is better for longtime heroin addicts while Suboxone is best for people who are newly addicted or who are hooked on pain pills like OxyContin. Sharfstein hopes that pairing public and private resources will render buprenorphine an effective new weapon to battle heroin addiction.

In 2006, more than 10,000 city residents were admitted to facilities for heroin addiction treatment. Each year more 200 die from overdoses of heroin and other narcotics.

Valarie Clark abused heroin for nearly 20 years. After enrolling in the city initiative nearly two years ago, she has experienced her longest stretch without using heroin.

But her struggles demonstrate the challenge of getting even the best patients - Clark was held up as model before the City Council last summer - to stick with treatment.

Last month, after a dispute in her recovery house, Clark moved out and stopped taking Suboxone, without consulting her doctor or therapist at Total Health Care, the city's largest participating clinic.

She fell into a depression that left her with a choice: heroin or bupe.

"I would have used," said Clark, 52.

But she chose the bupe, starting again with the pills left over from her earlier prescription. "The depression went away and I'm continuing my therapy," she said. "I'm back in the [recovery] house."

A recent report showed that fewer addicts stuck with Suboxone treatment after 90 days than in the first year. The city's goal was to retain 67 percent at least that long. In the period from October 2006 to June 2007, the initiative succeeded in keeping 65 percent that long. But that dropped to just over half in the 12 months ending June 30.

"The retention rate has fallen," Sharfstein said.

One major reason is that the initiative has broadened its reach to take in people who are new to treatment, who suffer from other psychological problems or addictions and who engage in high-risk activities like prostitution.

It also took longer for patients to get off all drugs so they could be transferred out of city-backed clinics into the care of private doctors. Many patients stop using heroin but continue to abuse cocaine, leaving them ineligible to transfer. The city had wanted to transfer patients to the medical system after 90 days. In the first year, it took an average of 155 days. For the year that ended June 30, it took 163 days.

In addition, the initiative's pace of training doctors has lagged. Sharfstein had wanted 100 doctors to receive the federal waiver required to prescribe the pills. So far, 82 have received the clearance after completing an eight-hour training course.

The initiative also made a special effort to recruit more psychiatrists to deal with patients suffering both addiction and other mental illnesses.

"I would characterize this as good progress," Sharfstein said in an e-mail. "While we have not had 100 new waivered doctors yet, I am confident we will get there."

Suboxone's expense remains an issue. Methadone for heroin addiction costs about $8,000 per person over two years, the city reported last year. Suboxone treatment costs nearly twice that and has gotten more expensive.

Wendy Merrick, who directs addiction care at Total Health Care in West Baltimore, said the price per bottle of 30 pills has increased from $107.15 to $111.70.

To help cut costs, the Baltimore Substance Abuse Systems Inc., which manages most of the budgets for nearly all of the participating addiction treatment centers in Baltimore, has started buying in bulk, said Marla Oros, a consultant with BSAS.

The city's first report on its initiative in July 2007 made little mention of efforts to prevent misuse and illegal sales of buprenorphine. In December, The Sun published a three-part series that showed that abuse of Suboxone was on the rise across the nation as its availability increased. The drug was rolled out in 2003 after the federal government allowed doctors to prescribe it from their offices, unlike methadone, which is dispensed from highly regulated clinics.

The latest report devotes an entire section to efforts that the city has taken to minimize misuse of the drug: counting pills, testing urine and monitoring patients when they first start taking the pills. But the report states that "there is no evidence of a significant public health threat from buprenorphine diversion in Baltimore at this time."

A survey of 30 Baltimore physicians conducted by a consultant with the drug's manufacturer, Reckitt Benckiser Pharmaceuticals Inc., found that 67 percent were "aware of buying and selling of Suboxone, a percentage higher than the national average," the report states.

Clark, who was profiled in the series and has returned to treatment at Total Health Care, said she has seen the street demand for Suboxone increase.

"I was just at Lexington Market getting lunch and, wow, it's amazing," said Clark, who first tried Suboxone on the street. "It's almost like people are asking for Suboxone more than other things. The bupes. They ask for bupes."
________________
doug.donovan@baltsun.com

Copyright © 2008, The Baltimore Sun

Who lives in a park? Who lives in a cage?

Thanks to blogs of David and others from Wired In, I am slowly getting familiar with the current situation in drug policy and services in UK and I read the debates around its expected transformation with a lot of concern. As I understand it (and correct me if I am wrong…), the situation has reached the point when methadone treatment is applied as a number 1 choice for heroin users who may then stay on the substitution for a long time without any (or only small) additional support.


In Czech Republic, we experience a different situation, partly because of the fact that heroin is not as popular here as in UK and partly because of the fact that not many practitioners or psychiatrists are actually willing to prescribe any kind of substitute drug. But it seems that the general direction goes towards more methadone and Subuxone prescriptions. I do not think it is bad but it needs to be followed by efficient and improving ways of recovery. Apparently, the problem starts when these approaches are seen as binary oppositions. Then, this „treatment“ x „recovery“ controversy would remind me of similar contradiction between a cage and a park.


The famous experiments with rats in a cage with access to unlimited source of heroin or cocaine are well known. A surgically implanted catheter was hooked up to a drug supply that the animal self-administered by pressing a lever. Their increasing consumption of the drug was used as an explanation for the assumption that the drug is causing the addiction which is progressive and leads to death.


Professor Bruce Alexander, a Canadian psychologist from Simon Fraser University, tried similar experiment, but with an alteration. He did not place the rats into a cage, but into an „Eden“ for rats: it was a place 200 times larger than the cage, there were cedar shavings, boxes, tin cans for hiding and nesting, poles for climbing, and plenty of food. Also, because rats live in colonies, the „Rat Park“ housed sixteen to twenty animals of both sexes. Bruce Alexander put there two bottles: in the first one, there was plain water, in the second one, there was a morphine-laced water.


The results were very clear: unlike rats in cage, the rats in park preferred the plain water to the morphine. The modification of this experiment was that the rats had access only to the morphine water for some time.After several months, a bottle with plain water was added and the rats in the park were more likely to switch to the water! „Addiction“ did not seem progressive, chronic and untreatable any more. More importantly, it seemed that it is not the drug that induces the addiction.


People do not live in cages. But we do not even live in parks. However, in some conditions, life can look like a cage, the same as life can look like a park. Since drugs, as heroin or cocaine, may be the only possibility how to cope with life in a cage, in a park, it is one of the many options. And what needs to be said: people are not at the same distance between cage and park. But even if some are caught in a cage, many of them find their way to the park.

Obviously, we want to help people who are in a cage. As I see it, methadone makes the life in cage less stressful. Recovery is a way from the cage.
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source: http://pavelwiredin.blogspot.com

Opiate And Nicotine Addiction Shown To Have Additional Similarities

"That was good!" "Do it again."

This is what the brain says when people use tobacco, as well as 'hard drugs' such as heroin. New research published in the February 13 issue of The Journal of Neuroscience indicates that the effects of nicotine and opiates on the brain's reward system are equally strong in a key pleasure-sensing areas of the brain - the nucleus accumbens.

"Testing rat brain tissue, we found remarkable overlap between the effects of nicotine and opiates on dopamine signaling within the brain's reward centers," says Daniel McGehee, Associate Professor in Anesthesia & Critical Care at the University of Chicago Medical Center.

McGehee and colleagues are exploring the control of dopamine, a key neurotransmitter in reward and addiction. Dopamine is released in areas such as the nucleus accumbens by naturally rewarding experiences such as food, sex, some drugs, and the neutral stimuli or 'cues' that become associated with them.

Nicotine and opiates are very different drugs, but the endpoint, with respect to the control of dopamine signaling, is almost identical. "There is a specific part of the nucleus accumbens where opiates have been shown to affect behavior, and when we tested nicotine in that area, the effects on dopamine are almost identical," says McGehee.

This research is important to scientists because it demonstrates overlap in the way the two drugs work, complementing previous studies that showed overlapping effects on physiology of the ventral tegmenal area, another key part of the brain's reward circuitry. The hope is that this study will help identify new methods for treating addiction - and not just for one drug type.

"It also demonstrates the seriousness of tobacco addiction, equating its grip on the individual to that of heroin. It reinforces the fact that these addictions are very physiological in nature and that breaking away from the habit is certainly more than just mind over matter," says McGehee.

This work is supported by grants from the National Institutes of Health, T32GM07839 and F31DA023340 to JPB, DA015918 and DA019695 to DSM.

Source: Scot Roskelley
University of Chicago Medical Center

Methadone Deaths Gain Attention Of Medical Examiners

Formerly a drug used only to treat heroin addiction, methadone is becoming more popular in recent years to treat pain.

As the use of the drug increases, so too do the deaths at an "alarming rate," according the National Drug Intelligence Center. Florida has become one of the leading states for methadone overdose deaths, according to the Center for Disease Control.

Now, authorities are wondering if methadone may be fatal even in therapeutic doses.
"I would never let anybody in my family take methadone unless they were a heroin addict to begin with," said Hillsborough County Medical Examiner Vernard Adams.

The chairman of the Florida Medical Examiners Commission on Friday distributed a study to other commissioners citing increased instances of sudden deaths among methadone users.

Researchers in Oregon reported in the study published last month that methadone has been implicated as a likely cause of sudden death at therapeutic doses. In the study published in the American Journal of Medicine, the researchers recommended clinical safeguards and further studies designed to enhance the safety of the drug.

Adams said he's also noticed some methadone-associated deaths that are different from other deaths attributed to drug overdoses.

In addition to the fact that deaths are occurring at therapeutic doses, Adams said some methadone deaths involve heart issues. Most drug overdoses involve respiratory failure, Adams said.

But Adams said he has no statistics and cannot cite specific cases related to this possible phenomenon. He said he just has a general sense that this is something that should be examined.

"The fact that these people are dying from methadone at therapeutic concentrations, this is anecdotal," Adams said. "We haven't studied it the way these people in Oregon have."

In Hillsborough County, methadone was listed as a contributing cause in 37 deaths in the first six months of last year. Methadone was listed as the only cause in five deaths. In 2006, methadone was listed as a cause in 49 deaths, according to medical examiner data. In ten deaths, methadone was listed as the sole cause. In 2005, methadone was listed as a cause in 30 deaths in the county and as the sole cause in 10 more.

The numbers reflect a trend in Florida, where methadone was listed as a cause in 392 deaths in the first six months of 2007 and in 716 cases in all of 2006, compared with 2005 when the drug was a cause in 620 deaths.

Stephen J. Nelson, the chairman of the state Medical Examiners Commission, distributed the Oregon study at the commission's regular meeting. Nelson said he wanted medical examiners to be aware of the potential problem and to be on the lookout. It's possible, he said, that the commission may attempt to track methadone levels in the deceased.

In November, the National Drug Intelligence Center published a study titled, "Methadone Diversion, Abuse and Misuse: Deaths increasing at Alarming Rate." According to the report, the quantity of methadone dispensed nationwide more than tripled between 2001 and 2006.

The report described methadone as "safe and effective when used as prescribed," but said the drug has increasingly been misused and abused.

Methadone has been used in addiction treatment for the past 50 years, according to the report, which noted that the drug's use in pain management has increased steadily since the late 1990s. Physicians turned to methadone as an alternative to oxycodone and hydrocodone, which were being increasingly abused. It also can be used less frequently and is less expensive than other drugs, the report states.

source: msnbc.com

Residential rehab places taken by Dutch addicts

Residential drug rehabilitation places at one of Scotland's leading addiction hospitals are being taken by Dutch heroin users because authorities in Scotland will not pay to use them, preferring to put addicts on methadone instead.

Peter McCann, chairman of Castle Craig Hospital in Peeblesshire, told The Observer that Scottish addicts were missing out on the best care available because of an obsession with meeting Holyrood methadone treatment targets, despite 'overwhelming' evidence showing that the drug is 'ineffective'.

McCann said that at the private Castle Craig hospital up to 30 beds for intensive detox and long-term care which should be available at any one time for home-based addicts - at a cost of £800 a week paid for by their health authorities - now go to patients from the Netherlands. With only 300 residential rehabilitation places available across Scotland, this represents 10 per cent of the total.

'The take-up for these places from authorities in Scotland is extremely poor and has been for a number of years now,' McCann said. 'We have an excellent reputation around Europe, and as a result we fill the beds with people from the Netherlands, where health authorities are happy to pay for the rehab here.'

A study by the Centre for Drugs Misuse at Glasgow University concluded that one in three heroin users who had residential treatment was drug-free after three years. But only 3 per cent of those who were just on methadone were clean after the same treatment period.

The head of the centre, Professor Neil McKeganey, said: 'Residential rehab is expensive, but where is the economic sense of providing a treatment that is ineffective. Methadone is cheaper - but it is not working.'

McCann traced the decline in uptake of places to the year 2000 and the establishment of the Alcohol and Drug Action Teams. These partnership organisations, which are paid for by local government, the NHS and the police, were set up to tackle the joint issues of alcohol and drug problems prevalent in Scottish society.

He said: 'Methadone has proven to be next to useless in terms of getting people off drugs, but it seems to satisfy their need to meet targets for care, and this would appear to be more important than whether they are useful or not.'

But Tom Wood, chairman of the Scottish Association of Alcohol and Drug Action Teams, argued: 'There is a lot of evidence in support of methadone - it reduces the amount of chaos in an addict's life and does help. However, it is a tourniquet which if left on too long can leave you with gangrene. We have to develop our other support services as well.Residential rehab is the Rolls-Royce treatment, and while it is good for some people it is not good for others. It is also very expensive - which is why we are investing in community-based care. Castle Craig is a fine institution, but it is also a private business and our budgets are finite.'

The anomaly at Castle Craig emerged close to the second anniversary of the death of two-year-old Derek Doran, who drank 50ml of his mother's methadone at their home in Elphinstone, East Lothian. This tragedy in December 2005 and other high-profile cases involving children spurred the then First Minister, Jack McConnell, to order a major review of the way Scotland deals with heroin users and led to a report critical of the lack of support given to those prescribed methadone.

But the study came down in favour of the methadone programme as the cheapest and most effective treatment available.

McKeganey said that 'nothing has changed' since Derek Doran's death, and there were thousands of children who remained at risk.

There are 51,582 known heroin users in Scotland. A third of these are believed to be caring for children under the age of 16.

Source: Thomas Quinn
Sunday December 2, 2007
The Observer

From the streets to the classroom

From the rough streets of Vancouver's drug districts to the soft lecture hall seats at the University of Toronto, Nanaimo's Jason Devlin is taking an unorthodox path to becoming a doctor.

Today, Devlin is finishing up another summer in the Applied Environmental Research Lab at Malaspina University-College, where he has been working on innovative ways to measure contaminants in water. Six years ago the high school-dropout was living in Vancouver, spending his days with friends, high on heroin, as 'normal' life went on around them.

Devlin has travelled far from that place of his life, and he's not done yet. The recent bachelor of science graduate at Malaspina University-College packed up his desktop computer this week as he prepares for medical school in Ontario.

If there's one thing he learned, though, it's that he didn't get here on his own. Because of the services available for street kids in Vancouver, Devlin, now 23, was able to stay reasonably healthy until he was ready to recover.

He benefitted from the services, but he knows that many of the estimated 150,000 homeless youth across Canada often do not.

"Vancouver is very good to its homeless," he said.

"Without the services everybody would be hooking, robbing and stealing. It's weird because the services made it easier for me to stay in, but they were necessary for me when I wanted out."

With at least four years of medical school ahead of him, Devlin has yet to decide on a specialty, but he will likely return to the streets where he can battle the HIV/AIDS epidemic, or other communicable diseases that plague the country's poorest people.

Few doctors will have a story like Devlin's. His high school in Powell River expelled him at 14 because of his wild and elaborate clothing choice

Bored in his small town, he and friends would take Ritalin or whatever else they could find to get high.

He later became hooked on cocaine and crystal methamphetamine.

After two years of sleeping on the street, Devlin moved into an apartment, where he said things only got worse. He and his friends would pump heroin into themsleves and then simply lie around in their own filth, until it was time to get more. This pattern continued until the junkies set a date to kick their habits for good. When January 2002 came, only Devlin had actually reduced his drug use to the point where he could quit. Leaving his friends behind, he packed up and returned to his parent's home in Powell River.

When he finished the last of his small stash of heroin, Devlin said the pain was nearly unbearable.

To keep his mind off the long-term withdrawal symptoms, he enrolled in adult basic education programs at the Malaspina campus in Powell River. A year later he graduated high school and enrolled in a four-year degree program in Nanaimo. During his four years he won the Undergraduate Summer Research Award from the Natural Sciences and Engineering Research Council three times. He also received the Governor General's Academic Silver Medal for outstanding achievement in a four-year degree program.

Devlin hopes those achievements, combined with his academic knowledge and unique personal experiences, will give him the skills he needs to bring his life full circle: Back to the streets of Vancouver, to help those who need it most.

author: Derek Spalding

DSpalding@nanaimodailynews.com

The Economics of Addiction

Is it possible that heroin junkies and crackheads are actually rational?

I feel that it is time to share a secret. When I left on my vacation just over a week ago, I was fighting a battle with a deep-rooted addiction. I feel able to admit this, since over the course of my holiday I was able to go through cold turkey, conquer the addiction, and face the world clean.

It's decaffeinated coffee for me from now on.

Addiction—even to something as benign as filter coffee—is an unlikely topic for an economist to tackle, because most economic theory is predicated on rational behavior, and addiction seems to be quintessentially irrational.

The logical response appeared in 1988. "A Theory of Rational Addiction" was published by Kevin M. Murphy and Nobel laureate Gary Becker, and has defined economists' approaches to addiction ever since. The theory is easy to state: Addicts choose their poison despite knowing that it is habit-forming and dangerous, and they do so because they expect the highs to outweigh the lows.

Even other economists are skeptical. "They don't know what they're talking about," opined Thomas Schelling when I met him shortly after he, too, was awarded the Nobel Memorial Prize in Economic Sciences. Schelling had spent years trying to kick his tobacco addiction.

Yet perhaps the rational addiction approach is not quite as absurd as it seems. Some habits are rational to acquire. Dating my girlfriend was habit-forming enough to ask her to be my wife. So far, I have no regrets.

It seems absurd to compare the decision to drink coffee or start dating with the decision to smoke cigarettes or inject heroin, but if Becker and Murphy are right, the difference is not of kind but of degree.

Rational addicts should behave in certain ways. They should, for instance, respond not just to current price increases but to expected future price hikes. If heroin is likely to get more expensive, rational addicts should consider trying to quit before that happens. Addicts may even be more sensitive to lasting price shifts than nonaddicts. And since addiction is self-reinforcing, when the rational addict wants to quit, cold turkey is the efficient way to do it.

Economists have found some evidence to support these ideas: Pamela Mobilia finds that betting at racetracks falls in anticipation of increases in bookies' takings; Nilss Olekalns and Peter Bardsley find that coffee addicts show similar foresight; Philip Cook and George Tauchen found that when some U.S. counties raised taxes on alcohol, liver cirrhosis fell more sharply than overall consumption, suggesting that it was the alcoholics who cut back most.

My own addiction was perfectly rational: I am working on a new book, and as deadlines loomed, I drank more and more coffee, even though I was becoming dependent on the caffeine. Manuscript submitted, I went cold turkey on holiday, knowing that the headaches and sluggishness of mind would be both less painful and less important while wandering around the Welsh coast.

That is only caffeine, of course. But even heroin users can addict themselves and then quit as circumstances dictate. Psychiatrist Lee Robins found that almost half of American soldiers used heroin or opium while in Vietnam, but rather fewer were actually addicted, and almost 90 percent of those kicked the habit upon returning to the United States. I have absolutely no desire to try heroin myself, but it seems that both the decision to start and the decision to try to quit were, like my coffee habit, rational responses to circumstances.

I can't help noting that a large number of British cabinet ministers decided to smoke marijuana at college and then quit later. Whisper it softly, but perhaps not only addicts are rational, but politicians, too.

source: Slate.com

author: Tim Harford

Ending illegal opium production in Afghanistan: Why there are no silver bullets

There is broad agreement among countries whose soldiers are fighting and dying in Afghanistan that peace and stability will never be achieved unless something is done to curtail the country’s soaring opium production.

Afghanistan is now a narco-state. It produced 92 per cent of the world’s opium last year, according to the latest UN World Drug Report. The illegal trade involves everyone from poor farmers, to warlords, to senior government officials. Drug money buys weapons that are used to continue the conflict. It fuels the rampant corruption undermining the fragile institutions of the Afghan state. And it defeats attempts, some of them funded by Canadian taxpayers, to build a viable economy and national system of law and order.

But while the problems caused by illegal opium production are all too clear, what to do about it is not. How do you wipe out an industry that employs an estimated 2.9 million people and accounts for somewhere between one-quarter and one-third of the economy without destroying an already devastated country?

In such a situation, simple solutions — so-called silver bullets — have an understandable allure. At least three are being debated: eradication, where chemicals or bulldozers are used to destroy poppy crops; alternative livelihoods, where farmers are given support to grow other crops or pursue other businesses; and legalization, where opium is purchased from producers and used to make legal painkillers.

A sobering predicament

Would that they were as simple as they sound. They are not. Two experts with long experience in Afghanistan outlined the drawbacks of each approach at a recent conference in Ottawa organized by the International Development Research Centre and the Aga Khan Foundation Canada. David Mansfield, a drugs and development specialist, has spent 10 years in the country doing research in rural areas. William Byrd is a World Bank economist specializing in South Asia. Their analysis was sobering.

Eradication is favoured by the United States, which has used crop spraying in its so-called war on drugs in South America and wants to do the same thing in Afghanistan. The problem is that the two crops are not the same. Coca leaves that are used to make cocaine grow on bushes that take time to mature, and destroying them can set producers back years. Poppies are an annual crop. Wipe them out one year and they can be replanted the next, sometimes in the same area, sometimes in a different part of the country. The opium industry is "footloose and flexible," Mr. Byrd said. Eradication also hits the poorest farmers the hardest. It deprives farm families of funds from the current crop, but also plunges them further into debt because many of them have borrowed money against anticipated earnings from the harvest. They face stark choices: plant more poppies next year to make up for the shortfall, sell some of their meagre assets, or even arrange marriages for their young daughters.

Those with money can bribe government officials to overlook their fields. But this results in an uneven application of eradication, which only increases discontent with the government among the poor.

Canada favours alternative livelihoods

Encouraging alternative livelihoods sounds wonderful. And if Afghanistan is to survive as a country, all those involved in the illegal drug trade will have to find some other way to make money. This is also the policy prescription that Canada favours. (Canadian troops are not involved in the eradication campaign.)

But while the goal is clear, how to make the transition is not.

As Mansfield points out, no other crop offers the same attractions as opium. It is easily transportable, does not perish en route to market, and garners much higher returns than most agricultural products. The UN report said the farm-gate price of opium was $125 US per kilogram last year. (The farmer would not keep all of that, as he would have costs, such as labour and bribes.) The average yield is 37 kilograms per hectare. Poppy cultivation is more labour intensive than other crops. Switching to wheat or vegetables, where soil conditions make such crops possible, automatically means higher unemployment.

Still, in areas where land is fertile, transport reliable, and there are markets nearby, wheat and vegetables represent viable alternatives. They fetch a lower price, but the risks of having the crop confiscated by a warlord or wiped out in an eradication program are low. However, much of Afghanistan has poor soil and bad roads. Farmers in these areas have fewer choices.

Development workers can sometimes worsen the situation with well-meaning but poorly thought out interventions, says Mansfield. For example, building a new irrigation system to give farmers access to more water might actually encourage them to grow more poppies if they do not have access to a market for other crops. Each area is different, so programs have to be tailored to local circumstances, which are changing all the time.

Legalization requires a functioning government

Legalization of the illegal industry, which is being promoted by the Senlis Council (and was recommended at least as a pilot project in a recent report of the House of Commons National Defence committee), also has its drawbacks. It has been done successfully in Turkey. Other countries, such as India and France, have legal opium industries. But as these two experts point out, a legal industry requires government infrastructure to impose and enforce regulations, something that Afghanistan lacks. The majority of the opium in Afghanistan is produced in the unstable provinces of the south and southeast, where Western troops, including those of Canada, are still fighting.

Without strict government oversight, illegal production could flourish alongside the legal industry. Only three per cent of farmland is currently used for poppy cultivation, leaving lots of room for expansion. They also believe there is no shortage of legal opium globally, so producer countries will have to cut production to make room for Afghan production. This last point is disputed by the Senlis Council. Finally, it is not just the Afghanistan government’s ability that is lacking, it is also its willingness to end an illegal trade that involves some senior government officials. So what is the answer? Attractive as the idea seems, there is no silver bullet. Instead, a mix of well-designed and well-integrated policies is needed to tackle illegal opium production in Afghanistan. And even then, success will take decades, not years.

Of course, there is another approach that governments outside of Afghanistan could take. The market for opium and its derivatives, such as heroin, operates like any other on the principles of supply and demand. All of the solutions proposed above tackle the supply end. But what about demand? If that were wiped out, there would be no market for illegal opium and the suppliers would have to find other ways to make a living.

This is a problem best tackled from both ends, and not just on the ground in Afghanistan.

author: Madelaine Drohan
source: Canadian Broadcasting Corporation