Heroin Addiction, Detox, Ibogaine And Recovery

Filters.... 'Sterifilt' VS Micron

2012-03-04T15:01:00.001-01:00

These are the only available filters on the market designed specifically for IDU's..

And this is the clinical study commissioned by the manufacturers of the 'sterifilt'

I can see they would be useful for filtering heroin/ and or crack for a single shot.

But when it comes to pills they're pretty useless!

Even after twice filtering with cigarette filters, I managed to get around 0.2ml through before it blocked, the solution also had a speck of paper fibre floating in it!

My honest opinion? They're a bit 'gimicky' and money would be better spent elsewhere!

As I said before, in Australia, wheel filters are supplied as standard.. (Heroin is in short supply there, more often than not, when you buy 'heroin' you would get some MST/MS-Contin AND a small bottle of Acetic Anhydride ((A precursor for manufacturing heroin)).

When preparing pills this proper filtration is a necessity!

I got some samples from my local exchange to try,..... issues:

They are designed to fit on 1ml insulin syringes (with needle tip intact), not normal barrels (2-10ml)
The filter is small, paper (around 8mm diameter) and blocked up within seconds (although what I did get through was pretty clear!
As I said, the finished solution had a paper fibre floating in it!.. Not great if your trying to avoid cotton fever!

Now I understand micron filters are extremely expensive, (best I've found is £80 for 100pcs) but compared with he amount of irreversible damage talc/cellulose and wax can do to you the capillaries in your lungs I think justifies this?

I've even offered to pay towards the cost, so here's hoping I'm listened too!

There are lots of great resources online with regards to pill injecting, here are a few links...

http://en.wikipedia.org/wiki/Drug_injection

http://www.heroinhelper.com/curious/chemistry/internet_pills.shtml
http://www.drugs-forum.com/forum/showthread.php?t=139166
http://forum.opiophile.org/showthread.php?28507-Injecting-Pills
http://www.aivl.org.au/database/sites/default/files/resources/Safer%20Injecting.pdf
http://www.needle.co.nz/fastpage/fpengine.php/templateid/56

Pill injecting is obvoiusly taboo, especially at a time of workdwide; recession, obviously drug users and other 'non essential' serices suffer first in budget cuts but does this really make sense?

The gist of the main study I posted below:

Hot VS cold prep yields minimal differences in returned morphine (within a couple of percent)
Cigarette filters are nowhere near fine enough to rid the mix of talc an binders
0.22 micron syringe filters really are the only way to eliminate talc sized particles
Even small amounts of talc/wax can lodge in the small bronchial tube, causing a whole host of pulmonary conditions
The contaminants that pass the lungs can adhere to the main heart valve/artery and cause granulomas, the knock on effect of this is pulmonary hypertension (dangerously high blood pressure)
In one extreme case a lung transplant was needed
Once the damage is done, it's done, it can be very difficult to treat and the evidence from the studies confirms a significant of early death. (One case of granuloma was from a patient who reported injecting approximately ONLY 200 pills.

Other points worth mentioning:

Service users are nervous about presenting as pill injectors due to anxiety about loosing their script
There is a hell of a lot of conflicting 'recipes' online for extraction, more research needs to be done!
Lack of client engagement and feedback to the exchange and they're suppliers means nothing will change until someone stands up!

Ambivalence towards treatment will always be an issue with heroin addicts, I wish more of us would stand up for our rights!

If you, or anyone you know injects pills, please pass this information on, and go visit your needle exchange, if enough people ask it's more likely micron filters will become an option for us...

Study on harmful effects on injecting oral opate medication

2012-03-04T12:59:00.002-01:00

Here's another, if slightly scary study about the dangers of injecting oral opiates (oxycontin/MS Contin(MST UK)/Dialaud etc)

The long and short of it is that no matter which method is used, cold vs hot prep, without using 0.02u micron filters, large particles of talc and cellulose get through cigarette filters and even with short term use these can build up in the lungs and cause a whole host of serious, life threatening conditions including, but not restricted to pulmonary embolism, talcosis of the lungs (the study references an addict requiring a full lung transplant), granulomas forming in the pulmonary arteries causing pulmonary hypertension (high blood pressure in the main artery feeding the heart), talc can even make its way into the eyes and cause loss of sight!

All in all, it's really not a good thing to do!

In Australia, where 'homebake' heroin is common these micron (wheel) filters are handed out as standard but in the UK where it's less of a problem not one exchange suppliers company stocks them.
They are a specialist filter used in labs and can therefore only be bought from lab suppliers, they are also prohibitively expensive for most drug services budget to cope with as around £1 is the cheapest I can find (min order of 100)

Pill injecting IS an ongoing problem with IVDU's in the UK and is something that needs to be addressed.

The cost involved in treating later complications from IV pill use is minuscule compared with the cost of the filters.

It's a subject I'm currently researching and will be updating this blog about it but for now here is the study!

And here is the type of filter that is needed to get particles down to the size of talc out...

Abstract

Background

Injections of mixtures prepared from crushed tablets contain insoluble particles which can cause embolisms and other complications. Although many particles can be removed by filtration, many injecting drug users do not filter due to availability, cost or performance of filters, and also due to concerns that some of the dose will be lost.

Methods

Injection solutions were prepared from slow-release morphine tablets (MS Contin^®) replicating methods used by injecting drug users. Contaminating particles were counted by microscopy and morphine content analysed by liquid chromatography before and after filtration.

Results

Unfiltered tablet extracts contained tens of millions of particles with a range in sizes from < 5 μm to > 400 μm. Cigarette filters removed most of the larger particles (> 50 μm) but the smaller particles remained. Commercial syringe filters (0.45 and 0.22 μm) produced a dramatic reduction in particles but tended to block unless used after a cigarette filter. Morphine was retained by all filters but could be recovered by following the filtration with one or two 1 ml washes. The combined use of a cigarette filter then 0.22 μm filter, with rinses, enabled recovery of 90% of the extracted morphine in a solution which was essentially free of tablet-derived particles.

Conclusions

Apart from overdose and addiction itself, the harmful consequences of injecting morphine tablets come from the insoluble particles from the tablets and microbial contamination. These harmful components can be substantially reduced by passing the injection through a sterilizing (0.22 μm) filter. To prevent the filter from blocking, a preliminary coarse filter (such as a cigarette filter) should be used first. The filters retain some of the dose, but this can be recovered by following filtration with one or two rinses with 1 ml water. Although filtration can reduce the non-pharmacological harmful consequences of injecting tablets, this remains an unsafe practice due to skin and environmental contamination by particles and microorganisms, and the risks of blood-borne infections from sharing injecting equipment.

Background

It is common for many injecting drug users to prepare injections from tablets that are designed for oral administration [1,2]. Tablets contain therapeutically inactive ingredients to facilitate the lubrication, disintegration and dissolution of the dosage form [3]. These ingredients include talc, cornstarch, cellulose, magnesium stearate and waxes, which are not water soluble and their injection can cause complications. After injection into any blood vessel, particles will move downstream until they encounter a vessel too small to pass, where they lodge forming an embolism. Blockage of a vessel causes ischemic damage through a reduction in blood supply to the tissue downstream and can result in necrosis of the distal tissue. For example, injection of particles into a peripheral vein can lead to pulmonary granulomas, pulmonary oedema, emphysema and pulmonary fibrosis and hypertension [4,5]. Smaller particles (< 3-4 μm) can pass through capillaries and remain in the circulation until sequestered by the mononuclear phagocytic system, mainly in the liver and spleen [6]. Intra-arterial injection, whether deliberate or accidental, can impair blood supply to a limb and cause severe tissue ischemia and necrosis, leading to amputation [7].

Adverse reactions to illicit drug injections are commonly aggravated by infections due to the non-sterile methods of preparation and injection procedures. This is seen with local skin and soft tissue infections, which are the most common cause of hospital admissions of injecting drug users [8]. Filterable contaminants in drug injections contribute to many other cardiovascular and infectious complications [9,10].

Although appropriate syringe filters can remove particles from solutions for injection, their use has not become routine amongst injecting drug users. While there are many factors contributing to this, including cost, availability and performance of syringe filters, one substantial reason is the concern of many drug users that some of the drug would be lost in filtration.

The current study was designed to replicate preparation and filtration methods used by injecting drug users for injection of slow-release oral morphine tablets (MS Contin^®, also known as MST Continus^®in some other countries). This was selected as injection of morphine tablets was reported as the last drug injected by 15% of the 2270 injecting drug users interviewed in the national 2008 Australian Needle and Syringe Program study [11] and as injected in the past six months by 47% of the 909 frequent injecting drug users interviewed nationally in the 2008 Illicit Drug Reporting System study [12]. MS Contin is the morphine tablet most commonly injected [12]. The current study aimed to compare the effectiveness of different types of commonly used filters on their ability to reduce particle content, and also their effect on amount of morphine remaining in the filtered solution.

Methods

Procedures used by injecting drug users

A survey of injecting drug users in the Hobart area (Tasmania, Australia) presenting to needle and syringe distribution outlets (n = 260) was conducted to determine the filtering methods they applied on their last occasion of morphine injection [13,14]. One-third (29%) had not used any filter; 41% used cigarette filters (34% hand-rolling cigarette filters); 21% used 0.22 μm syringe filters accessed through needle and syringe outlets. Minorities reported use of 0.45 μm syringe filters (2%), cotton balls (3%), combinations of cigarette and syringe filters (3%) or other makeshift filters (such as tampons, 1%). Injecting drug users in the Hobart area (n = 11) subsequently participated in detailed interviews to describe how they prepared injections from tablets and their filtration procedures. The methods used in this laboratory study are based on these methods.

Extraction of morphine from tablets

One sustained-release 60 mg tablet of morphine sulfate (MS Contin^®, Mundipharma, UK) was wiped with a sterile swab containing 70% isopropyl alcohol (Briemarpak, Briemar Nominees, Australia) to remove the orange coating (replicating the process used by injecting drug users), then placed on a glass petri dish to dry. The tablet was then extracted using either cold or hot Water for Injection BP (Pfizer, Australia). In the cold method, the tablet was thoroughly crushed using a glass mortar and pestle, and mixed with 3.0 ml water. The mixture was then stood for 5 min with occasional stirring. Injecting drug users employ a variety of improvised methods, such as crushing the tablet between two spoons. However, it was considered preferable to use a single, reproducible method in this study, although it is probably more efficient than the improvised methods and may result in fewer large particles.

The resulting drug extract was either kept for filtration, examined for particle content by light microscopy or analysed for morphine content by high performance liquid chromatography (HPLC). The mixture was transferred into a 5 ml plastic specimen tube for particle counting or a 50 ml volumetric flask for morphine analysis. The effect of different methods of filtration on the particle and morphine content of the extracts were also examined. Control solutions were prepared in an identical manner except that the tablet was omitted.

In the hot method of morphine extraction, the tablet was crushed by a porcelain pestle in a small (3 cm diameter, 4 cm high), round nickel crucible and the remnants adhering to the pestle were scraped into the crucible. Then 3.0 ml water were added and the crucible placed on a hot plate and gently boiled, with mixing, for 30-45 s by which time the mixture appeared to be clear and melted wax could be seen floating on top. The mixture was then stood on the bench until it felt cold to touch (about 5 min) before further treatment as described for the cold preparations.

It is important to note that cold extraction methods are recommended by Australian Intravenous Drug Consumer groups (Network Against Prohibition http://www.napnt.org/health/filtering_pills.htm webcite; Safer Injecting Net http://www.saferinjecting.net/injecting-ms-contin.htm webcite) due to a perception of loss of active dose following hot extraction techniques.

Filtration

Cigarette type filter

A filter used for hand-rolled cigarettes (Ranch Slims, Stuart Alexander & Co., Australia) was cut down the side and the encircling paper removed. Following precisely the methods reported by injecting drug consumers, the filter was placed in the drug extraction mixture and moved around with the tip of a 5 ml syringe (Luer-Lok, sterile, BD Medical, Melbourne, Australia) until it became saturated with the liquid. The tip of the syringe was gently pressed against the side of the filter and the mixture slowly drawn up. This was repeated at two other sites on the filter, and the filter usually became blocked before all of the liquid was drawn up. A second filter was added to enable the filtration to continue until there was no mixture left.

As described for the unfiltered extract, the filtrate was kept for further filtration, particle counting or morphine analysis. Two successive 1 ml rinses of water were added to the mortar or crucible and, after moving the filter around in the liquid, taken up into the syringe and added to the first filtrate. With the hot preparation method, each rinse volume was briefly boiled then cooled before filtration. All containers were tared and weighed again at different stages to estimate the volumes collected. Despite the presence of tablet constituents, it was assumed that the specific gravity of all the mixtures was that of water to enable the volumes to be calculated. Aliquots of each rinse were taken for morphine analysis.

Cotton ball filter

A cotton ball (Home Brand Cotton Balls, Australia) was cut into four equal parts which were rolled into smaller balls. One small ball was placed in the drug extraction mixture and gently moved around with the tip of a 5 ml syringe to absorb the liquid. The mixture was taken up into the syringe and treated as described for the cigarette type filter.

Syringe filter (0.45 or 0.22 μm)

The mixture was taken up into a 5 ml syringe fitted with a 19G needle. The needle was removed and replaced by a 0.45 or 0.22 μm sterile syringe filter (33 mm diameter, Millex, Millipore, Ireland) and the syringe contents were slowly pushed through the filter. In some experiments the filter was flushed with a 1 ml rinse volume of water.

Combined filters

After initial filtration through a cigarette type filter, followed by two 1 ml rinses, the combined filtrates were taken up into a 5 ml syringe and then the needle was replaced with a 0.45 or 0.22 μm syringe filter and the syringe contents gently expelled into a container. The filter was flushed with another 1 ml water.

Analysis of particle content

Glass microscope slides and coverslips were cleaned in laboratory detergent (Decon 90, Decon Lab., Sussex, UK), rinsed in tap water, distilled water and methanol, then dried in air. In some experiments an overnight acid wash (conc. nitric acid) was included before the water rinses.

A 20 μl aliquot of each sample was pipetted on to a slide and covered with a 22 × 22 mm coverslip. This volume filled the area under the coverslip. The slides were viewed under a light microscope (Gillet and Sibert, London, UK) in transmission mode. The eyepieces (Leitz Wetzlar, Germany) had reticules which enabled particles of different sizes to be counted. One eyepiece showed a rectangular area (360 × 250 μm with 20× objective) and the other a linear scale (0-10 by 0.1 unit) whose length was 400 μm with 20× objective. The rectangle and scale were calibrated using the ruled lines of a Neubauer blood cell counting chamber (Hawksley, London, UK). Thus the smallest particle that could be measured with the 20× objective was 4 μm (0.1 on the scale) although smaller particles could be seen and counted. For each sample, five fields were chosen for counting, at the four corners and centre of the coverslip, selected by moving the microscope stage without looking through the eyepiece. Particles were counted if they were inside the rectangle, or overlapped the bottom or right side, but not if they overlapped the top or left side.

Particles were counted in size groups, using the scale and a factor based on the magnification of the objective to estimate size. For example, particles 50-99 μm were counted with the 5× objective, and corresponded to scale readings 0.3-0.5. Particles 20-49.9 μm were counted with the 20× objective and corresponded to scale readings 0.5-1.24. Clearly this level of precision was not possible, and borderline particles could have been assigned to either of two adjacent groups. Total particles in each size group were estimated from the average count per field multiplied by the ratio of field area/coverslip area (= number of particles in 20 μl), then by the ratio of the volume of the injection (ml)/0.02 ml to give the number of particles in the injection mixture. Counts are given as mean ± SD of three replicate preparations. Photomicrographs of slides were taken with an Olympus BX50 microscope fitted with an Olympus DP50 digital camera.

Analysis of morphine content

The tablet extract or its filtrate was made to volume (50 ml) with 0.5% acetic acid. About 5 ml was filtered through a syringe filter consisting of a nylon prefilter and 0.45 μm filter (Chromacol, UK). This step was required to remove particles before HPLC analysis. The relatively large volume and acidic pH was expected to maximise the dissolution of any morphine that remained in the particles, and to minimise any retention by the filter. An aliquot of this filtrate was diluted ten-fold and analysed, in duplicate, by HPLC using a Varian 9010 instrument (Varian, Australia), a C18 reversed-phase column and UV detection at 286 nm. The mobile phase was 90% phosphate buffer (50 mM, pH 3) and 10% methanol, and flow rate 0.7 ml/min. Injections were made using a 20 μl loop. Standard solutions were prepared from morphine sulfate BP (British Drug Houses, London, UK) and there was no internal standard. The retention time of morphine was 4.2 min. Calibration curves from 2.5 - 200 μg/ml were prepared each day and linearity was excellent (r²> 0.99). As the morphine content of the tablets is given in mg morphine sulfate, we have done the same with the morphine recovered from the tablets.

Results

Cold extraction, unfiltered

The outer coating was readily removed with an alcohol swab and the tablet crushed easily although continued grinding did not result in an ever-finer powder since the waxy nature of the powder resulted in some re-compaction.

The crushed tablet suspended in cold water gave an opaque suspension with a milky appearance (Figure 1). Macroscopic particles were evident on the wall of the tube. The mean morphine content (as morphine sulfate) was 56 ± 2 mg from 60 mg tablets (Table 1). Microscopic examination showed many particles ranging in size from > 400 μm to < 5 μm (Figure 2A). Particles were not uniformly distributed across the coverslip area. Most of the fields counted were crowded and heterogeneous, making it difficult to count every particle, and the fields were usually dissimilar. The larger particles (> 50 μm) tended to be amorphous in shape and to some extent appeared to be agglomerations of smaller particles (Figure 2B). In counting the particles, the size group was taken to be that of the agglomeration, regardless of how friable it appeared. Thus the assignment of particles to size categories was based on a subjective judgement of whether they appeared to be separate or joined. Small particles (< 5-10 μm) sometimes drifted across the field, and had to be counted quickly while they remained in view. However, some particles would have been missed. The smallest particles (< 5 μm) were generally too numerous to count accurately, and their counts represent a minimum number.

Figure 1. Injection mixtures (cold extraction). Each mixture was prepared from one tablet as described in Methods. 1, unfiltered; 2, cigarette filtrate; 3, cigarette then 0.45 μm filtrate.

Figure 2. Particles in unfiltered mixture (cold extraction). Photomicrographs of particles from a single preparation.

Table 1. Recovery of morphine after cold extraction and filtration

In some preparations regular crystalline shapes were seen, with sizes ranging from rectangles of 10 μm × 25 μm, to rods of 1-2 μm × 5-10 μm (Figure 2C and 2D). Treatment with weak acid (0.5% acetic acid) dissolved the crystals. This, together with their shape, and the absence of other likely candidates in the tablet formulation, suggested that the crystals were morphine hydrate, which precipitated because of the alkalinity of the glass. This was confirmed by examining an extract which gave abundant crystals on the standard glass slides. The same extract gave no crystals on either glass slides which had been soaked overnight in nitric acid, or plastic slides. Because their formation was considered to be artifactual, the crystals were not included in the particle count. All slides were examined when freshly-prepared as crystal formation increased with time on the slide.

A solution of morphine sulfate 60 mg in 3 ml Water for Injection had a pH of 4.6. An aliquot (50 μl) was mixed with an equal volume of 50 mM NaOH, resulting in the formation of masses of small rods of the same appearance as those found in the tablet extracts. The cold unfiltered tablet mixture had a pH of 6.4, which was unchanged after filtration through the cigarette filter or 0.45 μm or 0.22 μm filters.

Figure 3 shows the number of particles sized 5 μm and larger in the total injection volume for three preparations: control (no tablet), cold extraction and hot extraction. Figure 4 shows the additional particles in the smallest size group (< 5 μm) of the same preparations, plotted separately because their counts were an order of magnitude greater than for the larger particles. The upper panel of Figure 3 shows the particle counts in unfiltered preparations. Even in the absence of a crushed tablet, some small (up to 20 μm) particles were found (Control: Unfiltered), reflecting contamination from the local environment. The unfiltered cold tablet extract produced a much larger number of particles of all sizes, with the numbers tending to increase as the size became smaller (Figure 3, Cold: Unfiltered). Although not apparent in Figure 3, there were also significant numbers of particles in the largest size group (> 400 μm), 12,000 ± 14,000 in the 3 ml injection volume. The large SD shows the inherent variability of the particle counts.

Figure 3. Particles 5 μm or larger in injection mixtures. Numbers of particles (in thousands) estimated to be in the total injection volumes, prepared without a tablet (control) or with cold or hot extraction. Upper panel, unfiltered; lower panel, cigarette filtrate. Total injection volumes are given in Table 1. Values are mean ± SD (N = 3).

Figure 4. Particles less than 5 μm in injection mixtures. Numbers of particles (in thousands) estimated to be in the total injection volumes. The unfiltered extracts were passed successively through a cigarette filter then a syringe filter (0.45 μm or 0.22 μm). Values are mean ± SD (N = 3).

Cold extraction, filtered

Two cigarette filters were required to enable the mixture to be taken into a syringe without the filter being blocked. The filtrate was milky, like the unfiltered mixture, but it was also more translucent and there were fewer particles on the wall of the tube (Figure 1). Only about half (1.7 ml) of the 3 ml water used to prepare the mixture could be recovered, with the remaining liquid remaining in the wet filters (Table 1). The mean morphine content of the filtrate was 32 mg, which is the amount expected to be in this fraction (1.7/3.0) of the total volume of extract. This indicates that the morphine was not binding to the filter, but was being retained because some of the solution was held up in the filter. Two successive 1 ml rinses with water recovered most of the remaining morphine (Table 1).

Some large particles escaped this filtration (Figure 5A), and there were large numbers of smaller particles and crystals (Figure 5B). The cigarette filter produced a large reduction (60-80%) in numbers of particles > 50 μm, a smaller reduction (10-20%) in particles sized 10-50 μm, and an increase (20-40%) in the number of smaller particles (< 10 μm; Figures 3 and 4).

Figure 5. Particles in cigarette filtrate (cold extraction). Photomicrographs of particles from a single preparation.

The cotton ball filter gave a similar result to the cigarette filter: a milky filtrate with limited removal of particles (data not shown). However, the recovery of morphine may have been slightly lower (Table 1). Also, it was difficult to consistently reproduce the size and density of the filters.

The 0.45 μm syringe filter gave a clear solution (Figure 1), but the filter tended to block and it required considerable pressure to deliver the last of the filtrate. Additionally, the volume of filtrate was low (1.9 ml), containing only 34 mg morphine. However, this was the amount expected for the fraction of mixture which was filtered. The filtrate was relatively particle-free, and this will be described under the combination filtration procedure.

Hot extraction, unfiltered

The tablet could only be coarsely crushed in the crucible, but everything melted or went into solution when the water was boiled. Care was taken to minimise evaporative water loss, since this tended to increase crystal formation. On cooling, the mixture became turbid and some large waxy solids separated. The largest masses were not taken up into the syringe and were therefore not included in the particle count. The aspirated mixture had a milky appearance, similar to that produced by cold extraction. The morphine extraction (59 ± 1 mg, Table 2) was virtually complete. Microscopic examination showed that, compared to cold extraction, there were fewer particles sized 10 μm or larger, and more sized less than 10 μm (Figures 3 and 4). However, the injection still contained an average 50,000 particles in each of the size groups 50-99 μm and > 100 μm. Figure 6A shows a field with one very large particle (> 400 μm) and many smaller particles, and panel B shows what appear to be solidified droplets of melted wax. The microscopic appearance of hot extractions was characterised by droplets, particles, and crystals (Figure 6A and 6D). The larger droplets had inclusions, either particles or other droplets. The formation of many small droplets contributed to the large number of small particles present.

Figure 6. Particles in unfiltered mixture (hot extraction). Photomicrographs of particles from a single preparation.

Table 2. Recovery of morphine after hot extraction and filtration

Hot extraction, filtered

Aspiration through a cigarette filter removed all of the largest particles (> 100 μm) but only 10-50% of the smaller particles (Figures 3 and 4). In preliminary experiments it was found that, if the mixture was still warm, many more of the wax droplets passed through the filter. As with the cold preparation, nearly all of the dose could be recovered after 2 × 1 ml rinses with water (Table 2).

Filtration through cotton wool balls gave no better recovery of morphine (Table 2) and, because of the variability in forming these filters, was not further considered.

The 0.45 μm syringe filter again gave a clear solution with recovery of 41 mg morphine, which increased to 52 mg after a 1 ml rinse (Table 1). The particle count is described after combination filtration.

Combination filtration

Fresh extracts were prepared using cold and hot water and passed sequentially through a cigarette filter then syringe filter (0.45 μm or 0.22 μm), with rinses. After both cold and hot extraction with cigarette filtration, the subsequent syringe filtration step did not significantly reduce the recovery of morphine (Tables 1 and 2). Both syringe filters greatly reduced the particle count, to levels at or below the control counts (Figures 7 and 4). In some samples (e.g. 0.45 μm filtrate after hot extraction) there appeared to be large numbers of small (< 5 μm) particles or droplets. However, this will require confirmation by re-investigation using cleaner conditions.

Figure 7. Particles 5 μm or larger in syringe filtrates. Numbers of particles (in thousands) estimated to be in the total injection volumes, prepared without a tablet (control) or with cold or hot extraction. Upper panel, 0.45 filtrate; lower panel, 0.22 μm filtrate. Total injection volumes are given in Table 1. Values are mean ± SD (N = 3).

Discussion

Morphine in the MS Contin^®slow-release tablet is embedded in a complex dual matrix of hydroxyethyl cellulose and cetostearyl alcohol, designed to release the drug over 12 h [15]. Crushing the tablet disrupts this matrix, allowing the rapid extraction of morphine. The amount of morphine in prolonged-release tablets is permitted to vary by 5% [16] so a 60 mg tablet could contain from 57 to 63 mg morphine sulfate. The extraction of morphine by cold water (56 mg) and hot water (59 mg) was therefore essentially complete. None of the filters bound morphine, and their retention of morphine was due to the volume of liquid which remained. Consequently, rinsing the filters increased the recovery of morphine. Repeated rinses brought diminishing recoveries of morphine, and increased the volume to be injected, and therefore the number of rinses used in the combined filtration method was a minimized but nevertheless gave a good recovery (84-93%) of the extracted morphine. Overall, the extraction of morphine and its recovery after filtration was similar after cold and hot extraction.

The MS Contin^®tablet contains a number of constituents with low or no water solubility which are liable to produce particles in the extract [17]. These include cetostearyl alcohol, which is a mixture of two waxes: cetyl alcohol (1-hexadecanol, mp 49°C) and stearyl alcohol (1-octadecanol, mp 61°C); magnesium stearate (mp 88°C); talc, a hydrated magnesium silicate; and hydroxyethylcellulose (a gelling agent which is insoluble in water). The coating contains other insolubles such as iron oxide, but this was usually removed in preparing the extracts.

There are advantages and disadvantages in counting particles by microscopy rather than an instrumental method, such as the Coulter Multisizer which has been used to study the effectiveness of filters for heroin injections [18]. In this latter study, the instrument required considerable dilution of the sample (50 μl to 75 ml) with the possibility of dissolution of some particles which would have been present in the smaller volume to be injected. The dilution was made with an electrolyte (saline) which may also have affected particle solubility or aggregation. Microscopy avoided dilution and enabled examination of the appearance of particles, which gave insights into their origin (such as crushed solids, condensed wax droplets, and crystallised morphine) which in turn can indicate how they could be removed. However, microscopy necessarily examines only a small part of the total sample, adding to errors as discussed below.

Counting particles, especially in the unfiltered preparations, was inherently variable due to the large amount of insoluble material and its complex physical form. This variability also affected instrumental counting, and Scott [18] considered that variability in the particle counts made the exact values meaningless although useful for comparison of filters. In our study counts are presented as the number of particles in an injection volume in order to relate the data to health impacts. This required a large multiplier factor. For example a count of one 100 μm particle in 5 fields using the 5× objective would give an estimated 8,897 particles in the 3 ml dose volume, and one 10 μm particle (20× objective) would give 161,333 particles in 3 ml. If there were no similar particles in the other two replicate mixtures, then the mean particle counts would be 2966 for the 100 μm particle and 53778 for the 10 μm particle. The particle counts are therefore reported in thousands to avoid implying a level of precision which would be misleading. The counts are indicative estimates rather than precise determinations, but are nevertheless able to show that filtering can greatly reduce the number of particles injected.

The working area for preparing the injections was neither sterile nor particle-free, since the aim was to reproduce the typical conditions used for illicit preparations by injecting drug users. Consequently, a significant number of particles and fibres were found when control injections were prepared, showing that particles are ubiquitous unless removed by specific cleaning procedures. Fibres, however, were not counted as particles since they were present on control slides and were not considered to be tablet-derived. Environmental particles will vary widely according to local conditions but will add to the total particle burden in the injection. Not using a clean workplace became a limitation in counting particles in the cigarette plus 0.22 μm filtrate, in which virtually all tablet-derived particles had been removed.

The form of the waxes was evidently altered after melting and re-solidifying, with the formation of wax droplets of various sizes. Hot extraction resulted in a shift in particle size distribution, with the formation of more small particles (< 5 μm) and fewer larger particles. However, the remaining particle burden in unfiltered preparations was still too large for this to be considered other than harmful to inject. Pharmaceutical standards require that, measured by microscopy, injections of less than 100 ml must have, in total, no more than 3000 particles > 10 μm and no more than 300 particles > 25 μm [16]. The hot unfiltered morphine tablet preparations had, in the total volume of 3 ml, an average 1.1 million particles > 10 μm and 368,000 particles > 20 μm. For the cold preparations, the numbers of particles were 7.2 million > 10 μm, and 4.0 million > 20 μm.

The aqueous solubility of morphine is critically dependent on its ionization and therefore the pH, as the ionized form is freely soluble and the free base has a low water solubility (0.25 mg/ml at 35°C) [19]. These authors found that, at 35°C, the solubility of morphine in water was 13.39 mg/ml at pH 6.35 and 5.75 mg/ml at pH 6.69. This change in solubility with pH could be explained by the change in ionization and the low free base solubility. A 60 mg tablet of morphine sulfate (MW = 758.9) contains 45.1 mg morphine (MW = 285.3), or 15.0 mg/ml in the 3 ml extract. Using the amount of morphine sulfate recovered in cold extracts, this concentration would be 14.0 mg/ml. In either case, the concentration of morphine in the 3 ml extract will be critically close to, or exceed, its solubility, especially as the pH is slightly higher (6.4) and the temperature was considerably lower (about 20°C). From the pKa of morphine (8.08) and the buffer equation, pH = pK_a+ log₁₀([base form]/[acid form]), it can be calculated that morphine is 1.8% unionized at pH 6.35 and 2.1% unionized at pH 6.40.

It was considered that morphine crystal formation was an artifact due to alkalinity in the glass microscope slide or cover, since they did not form on acid-washed glass or plastic slides. However, there is a significant risk of formation of morphine crystals in the tablet extracts,, and conditions of preparation could reduce this problem by decreasing pH or, preferably, increasing the volume of water. Although morphine will eventually dissolve in blood this will take some time, and any crystals which remain undissolved during the brief transit time from injection site to capillary bed are liable to cause embolisms.

The unfiltered tablet extracts must be considered extremely harmful as they contained many particles of all sizes. After intravenous injection, particles will flow through ever-widening vessels back to the heart and then they will enter the pulmonary circulation, where the smaller arteries which are 300-400 μm diameter [20] could be occluded by the largest particles found in unfiltered mixtures. Arterioles (9-40 μm diameter) and capillaries (7-9 μm diameter) could be blocked by the smaller particles. Even particles too small to embolize may cause vascular injury. Small airborne particles (< 2.5 μm) have been implicated in cardiac and vascular damage, including endothelial dysfunction and promotion of atherosclerotic lesions [21]. Large numbers of particles of this size were present in the unfiltered mixtures.

The cigarette filter reduced the number of particles, especially the larger particles. This filter was more effective when used after hot extraction, but the remaining particle burden remained too high for injection. Of course, cigarette filters are not designed for liquids. The morphine recovery from the cigarette filters was nearly complete (90%) after two rinses. The unfiltered mixtures caused a block of the syringe filters, but the cigarette filtrate passed through them, as did the rinse volumes. Scott [18] found that both 0.22 μm and 0.45 μm syringe filters blocked with heroin injections, and abandoned them in favour of 5 μm filters. However, these blockages can be prevented by the use of a preliminary, coarse filter, such as the cigarette filter applied here.

The combination of cigarette filter then syringe filter mostly gave a good recovery of the extracted morphine. The 0.22 μm filter is considered to be sterilizing because, unlike the 0.45 μm filter, it will remove bacteria. In a trial with injecting drug users [22], it was found that 0.22 μm syringe filters were effective in removing bacteria from 3 out of 4 injections, while larger pore filters (15 - 20 μm) were completely inadequate.

Conclusions

When a tablet of slow-release morphine (MS Contin^®) is crushed and mixed with water, the resulting mixture contains millions of particles, of sizes from less than 5 μm to greater than 400 μm. These particles will cause great harm if injected into the bloodstream. The number of particles can be greatly reduced by filtration. A low-porosity syringe filter (0.45 or 0.22 μm) is most effective, but is likely to block unless a coarser filter is used first. Little of the morphine is lost in filtration if the filters are rinsed.

Hot extraction does not significantly increase extraction of morphine, and carries the risk of filtering a warm mixture which allows wax to pass through the filter, producing particles when it cools and solidifies. In practice, it is uncommon for solutions to be left for long before filtration and injection, producing the potential for a substantially greater level of filtrate contamination with wax than identified in the current study.

It is not possible to prepare an injection of pharmaceutical standard without clean facilities, as some particles will remain even after filtration through a syringe filter, and the injection will not be sterile. Also, the manufacturer cautions against using Millex^®sterile filters for suspensions or emulsions, because they are not designed for this purpose (Millipore Millex User Guide, 2008). However, filtration with a 0.45 μm or 0.22 μm filter can remove virtually all of the tablet-derived particles and should be a standard method of harm reduction for injecting drug users (a plain language summary of this study is provided in Additional file 1 in order to facilitate health interventions). The 0.22 μm filter is to be preferred, as it can remove the organisms (e.g. Staphylococcus aureus, Candida) which commonly produce cutaneous and systemic infections in injecting drug users [7,8,10]. Although it cannot remove the much smaller virus particles, including Hepatitis C [23], viral infections are mostly due to blood contamination from shared equipment and are avoided by not sharing. In one Canadian hospital, the two most common reasons for admission of injecting drug users were pneumonia and soft-tissue infections [24], both potentially preventable by effective skin swabbing and filtration of injections. The average daily cost of hospitalization was $CAN610 ($USD420 at the time of the study), which makes the use of alcohol swabs (currently <$USD0.02 in Australia) and filters (<$USD0.90) extremely cost-effective.

Additional file 1. Plain Language Summary: Effect of filtration on morphine and particle content of injections prepared from slow-release oral morphine tablets.
Format: DOCX Size: 15KB Download file

Competing interests

The authors declare that they have no competing interests.

Authors' contributions

SM contributed to the design of the study, carried out the particle counting, and drafted the manuscript. RB conceived of the study, participated in its design and coordination and helped to draft the manuscript. SB developed and conducted the morphine assays. BG interviewed the injecting drug users and summarised their methods. All authors read and approved the final manuscript.

Acknowledgements

The authors are grateful to Inn Chua for assistance in preparing the photomicrographs, and to Tania Hunt from the Tasmanian Council on AIDS, Hepatitis and Related Diseases for assisting with organisation of consumer interviews and surveys, and to the consumers who shared their knowledge and expertise.

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New Study On Iboga Deaths

2012-03-04T12:44:00.000-01:00

Hi everyone, sorry for not updating for such a long time!

The life of an addict is a hectic one so finding the time to write original and intersting material can be difficult!

Anyway, the long awaited study relating to deaths with Ibogaine has finally been released and here's the abstract!

ABSTRACT: Ibogaine is a naturally occurring psychoactive plant alkaloid that is used globally in medical and nonmedical settings for opioid
detoxification and other substance use indications. All available autopsy, toxicological, and investigative reports were systematically reviewed for the
consecutive series of all known fatalities outside of West Central Africa temporally related to the use of ibogaine from 1990 through 2008. Nineteen
individuals (15 men, four women between 24 and 54 years old) are known to have died within 1.5–76 h of taking ibogaine. The clinical and postmortem
evidence did not suggest a characteristic syndrome of neurotoxicity. Advanced preexisting medical comorbidities, which were mainly cardiovascular,
and ⁄ or one or more commonly abused substances explained or contributed to the death in 12 of the 14 cases for which adequate
postmortem data were available. Other apparent risk factors include seizures associated with withdrawal from alcohol and benzodiazepines and the
uninformed use of ethnopharmacological forms of ibogaine.

I'm not sure what the situation is with copyright, and the file is too big to copy and paste so if anyone wants a copy please email me and ill forward you the full document.... londonpunk@live.co.uk

Holidays!

2011-12-22T14:21:00.003-01:00

Christmas is always difficult for me, quite apart from my annual drink (a bottle of baileys) and tears with my mum and sisters, on a more practical level... Dealers don't work Christmas day!

Thing's haven't been going too well recently, I was 'let go' from my job, for no particular reason other than the boss got out of giving me my Christmas bonus by sacking me two shifts before the holidays!

I usually spend Christmas in Brighton with my family, most years there's some drama, we're not the most stable bunch!
Every year I have a guilt trip about not being able to afford decent gifts for everyone, this year is worse than most as I was depending on my last two days work, plus bonus to buy gifts, let alone travel fare to get there!

It doesn't look like I'm even going to be able to go now, I can't afford the £30 ticket... (I'm only mentioning the price as I don't understand how British rail can justify charging that much to travel 50 miles!)... and I don't have any presents for anyone if I did.

I could quite happily stick my fingers in my ears and sing 'nadenadena' till new year actually!

Drug's wise, I'm quite pleased with myself, apart from one slip up a week or so back I've barely used at all!

That's the problem with heroin, once you have experienced that comforting, emotion numbing buzz, it's incredibly difficult to go through life without it!
Every day is a battle with myself to not pick up, it's tedious and often infuriating but as I have to keep telling myself, all I can do is try.
If I'm not trying, I've given in to it and that's not a compromise I'm willing to make.

We will find any excuse to use, I guess most people would think we are most likely to pick up when were feeling down or struggling with something, but feeling crap about things is just one of many triggers,... for me at least.

Years ago when I used to have regular counselling, every fortnight I'd walk out thinking about scoring, in the end I had to STOP the counselling as sitting talking about drugs for an hour was actually making me use!

I often feel like I'm being elitist or judgemental but I can't stand going to the local drug service or hospital, having to sit in the waiting room with addicts talking about drugs or whatever. I don't fit in there!
I've always kept myself to myself when it comes to drugs, addicts seem to be drawn to one another, like some sick magnetic, self destructive opiated mess, I'ts often easier to be together when hustling/scoring I guess..

I've always steered clear of junkie relationships,
I always saw that as a really slippery slope, the last thing I need is a co-dependant junkie boyfriend!

My partner of 8 years, while being far from 'straight edge' has never and would never touch anything like heroin or crack, and I like to keep it that way!

If I'd known I'd be staying in London this year I would have been volunteering for 'crisis at christmas' , they do fantastic work every year, taking in London's street homeless, feeding, bathing and just looking after them for a few days.
Over a few different venue's crisis has doctors, nurses, dentist's, counsellors, alternative therapists etc etc available for free to people living on the streets,.... amazing..!

At 19 I was living in a car park in Brighton, begging every day for food and drug money so I know how shit it is.

One of my most vivid memories was sitting in my sleeping bag, begging, in the pouring rain and just crying and crying, I couldn't understand how people could just walk past a vulnerable, homeless teenager.. and trust me they do!
It's the loneliest place in the world to be, it really is.. Such a cruel world we live in, I got pissed on once by some drunk lads, they thought it was hysterical,... I nearly slit my wrists.

Anyway, on that note ;).... whatever your all doing this year, I hope you have a good one!
Till next year!

Peace Out..

Sid

Petition to stop the amazing Sarah Glatt from facing police charges!

2011-12-03T20:00:00.000-01:00

PLEASE SIGN & SHARE THE LINK!

The petition is this here:

http://www.ipetitions.com/petition/petition-against-the-arrest-warrant-for-sara/

Sara Glatt is one of the best-known ibogaine treatment providers for the Western world. For more than a decade, people from all over the world, suffering from drug dependency were seeking her help in order to concur their addiction. With a high percent of success rate, Sara Glatt was able to help hundreds of people by using the psychoactive substance called Iboga, which effects the complex interactions between multiple neurotransmitter systems and can restore the proper functioning of the brain's neurochemistry. The substance has shown incredible results in treating addiction. In many countries the substance is banned, in the Netherlands this is not the case.
Unfortunately one of the world's most well-known iboga treatment providers is currently facing legal troubles, after a fatal accident on the highroad A2 on 18 March this year, where a man was hit by a truck. The man was suffering from alcohol dependency and soon after he received his treatment, he demanded to leave. The man quickly started getting aggressive towards Sara's youngest daughter, so having her hands tied, she took him out with the car, trying to talk him out of his idea of leaving so early after the treatment. He demanded to be left in a nearby hotel, where later during the same night, Sara had sent a volunteer to check on him. During the visit, the man seemed well, but unfortunately on the following morning news about his accidental death on the highroad was reported back to Sara Glatt.
She is currently facing arrest warrant and legal actions with the Dutch authorities.
What Sara Glatt did was trying to help, the same way she has been helping for over ten years to people who were seeking her help.
A mother of five children, who was legally providing iboga treatments for people, who seek them, should not be held in such a position!

A letter to me...

2011-12-01T19:47:00.001-01:00

If it was possible to write a letter to myself as a child this is what it would probably say….

Dear 10 year old Gary,

Embrace your feelings of being ‘different’, roll with it, it’s a good thing!

Try to enjoy your childhood!, Stop worrying about growing up so quickly, it’s really not all that…

Something bad is going to happen to you soon, something that will change the course of your life.

Just remember, it’s not your fault!

Dear 11 year old Gary,

You have a big decision to make now… I want you to know that you’re not alone. Tell someone, stop thinking your strong enough to deal with it alone.

When you’re offered counselling, take it!

Don’t worry about telling mum, she will cope, your dad is another story, I know you’re starting to realise already that he’s a crap father, he doesn’t change so get used to it now.

Tell the truth, tell the police the extent of it, not just that one time.. he groomed you for it.

Again… This is not your fault.

Dear 13 year old Gary,

You’re not coping with what’s happened…

You are at the start of a very slippery slope that you will struggle with your whole life if you don’t make a change now.

Rather than smoking bucket bongs and taking speed, talk to someone!

You have worked out by now that you are gay too. It will take you many years to separate your sexuality from the rape.

He didn’t make you gay, you were anyway!

The feelings of guilt are natural, you didn’t ‘lead him on’ or encourage him, he was an adult and you were a child.

You are a sensitive kid and you’re not dealing with the emotions and issues this has bought up. Drugs and drink will be your crutch for the rest of your life and the decisions you make now will affect the extent of damage you will cause in later life.

If I told you that at 31 you would be a heroin addict would you do something about it now?

I wish I could turn back the clock to where you are now and make the right choices. If I could make you understand that no matter how appealing drugs seem right now, you have now spent the majority of your life a heroin addict and you are terribly unhappy.

Instead of desperately trying to prove how grown up you are, spend what little time you have left as a child at home with your family… you’ll wish you had when your older.

Instead of trying to fit in with the ‘gay scene’ just be yourself! Sitting in gay bars, dressing like ‘them’ and sleeping around won’t make you happy.

Instead of taking as many drugs you possibly can at once, chill the fuck out and go seek out therapy.

Instead of self-harming follow your dreams and keep playing the piano, you’re talented and people will notice that.

Instead of putting yourself in dangerous situations where you will be physically and sexually assaulted again, find some friends that care about you, stop being so fiercely independent and needy.

Instead of seeking out partners with ‘issues’ stop worrying about needing a boyfriend, respect yourself and enjoy your teens!

I'ts a sad thing but you will learn over the years that in general people will take advantage of you, your an easy target, your too trusting, remember not everyone is your friend..

If only I could say all this to you....

One more thing! .... As you have now discovered, you could have claimed compensation for what happened, unfortunately by 2011 the files will have been destroyed and owing to lack of evidence it will be too late to make a claim... This will be the icing on the cake, He took your childhood away, was let free in the court as there wasn't enough physical evidence and would have got on with his life.. Leaving you emotionally scarred and in pain for the rest of your life...
Like I said, life is shit, you can make it better if you make the right choices while you still can!

Going for another Ibo treatment!

2011-10-20T11:30:00.000Z

My life's been manic for the past few months. I've been working loads and trying to hold everything together so this blogs been pushed to the back of my priorities.

I've been offered an opportunity for a low cost treatment with a proper provider if I take part in a follow up documentary to 'detox or die'.

It will be filmed by David Graham Scott, the guy that featured in the original BBC film.

I'm sick of being on maintenance. I'm getting too old for it all!
I worry that junkies don't usually get much older than me. We end up in prison or dead!

It's only an idea at the moment but I'm hopeful it will happen. And of course ill document it all here.

I'm hoping that going for a proper treatment with a provider as opposed to my half assed DIY attempts at home will make a difference.

Anyway... More soon,.. I have stinking flu and need to curl back up in bed and feel sorry for myself.

News article last night about diamorphine prescribing in London

2011-07-05T19:49:00.000Z

http://www.bbc.co.uk/news/uk-england-london-14016887

This news piece is actually pretty shockingly biased... for the BBC!

They quote the diamorphine prescribing had a 6% success rate in getting people clean versus oral methadone also at 6%!

Now I don't know where they're getting they're facts from but the accurate RIOTT results are here
and here

And to top it off, they wheeled out Anne bloody Widdicoombe to tell us that we shouldn't be giving junkies a free hit on the state! ... again .. by the same argument we should then not be giving smokers nicotine patches!

From the article:

Supervised administration of injectable ‘medical’ grade heroin leads to larger reductions in street heroin use in chronic heroin addicts who are failing on treatment, than does either injectable or oral methadone. The findings of the Randomised Injectable Opiate Treatment Trial (RIOTT ) trial are reported in an article in this week’s Lancet, written by Professor John Strang and colleagues from the National Addiction Centre, Institute of Psychiatry (IoP), King’s College London (KCL).
At least 5–10% of heroin addicts fail to benefit from established conventional treatments but whether they are untreatable or just difficult to treat is unknown. A scientific evidence base is emerging to support the effectiveness of maintenance treatment with directly supervised medicinal heroin (diamorphine or diacetylmorphine) as a second-line treatment for chronic heroin addiction.
This randomised controlled trial looked at chronic heroin addicts who were receiving conventional oral treatment but continued to inject street heroin regularly. Patients were assigned to receive supervised injectable methadone, supervised injectable heroin, or optimised oral methadone. Treatment was provided for 26 weeks in three National Health Service (NHS) supervised injecting clinics in England (London, Brighton, Darlington). During weeks 14–26 50% or more tested negative for street heroin on weekly random urine analysis.
The researchers found that at 26 weeks, 80% of patients remained in assigned treatment - 81% on supervised injectable methadone, 88% on supervised injectable heroin and 69% on optimised oral methadone. Proportions of patients achieving 50% or more negative samples for street heroin were highest in the injectable heroin group (66%) followed by injectable methadone (30%) and oral methadone (19%). The measure of measurable improvement, the pre-selected primary outcome, was that through Months 4-6, at least 50% of randomly collected urines tested negative for street heroin (from weekly random urine analysis). The authors report on 'abstinence from street heroin' also, and a similar greater benefit of the supervised heroin treatment was seen, compared with the other two treatments.
The authors say: 'We have shown that treatment with supervised injectable heroin leads to significantly lower use of street heroin than does supervised injectable methadone or optimised oral methadone. Furthermore, this difference was evident within the first 6 weeks of treatment.'
They conclude: 'Rolling out the prescription of injectable heroin and methadone to clients who do not respond to other forms of treatment’, is detailed in the UK Government’s 2008 Drug Strategy, subject to the results from this trial. In the past 15 years, six randomised trials have all reported benefits from treatment with injectable heroin compared with oral methadone. Supervised injectable heroin should now be provided, with close monitoring, for carefully selected chronic heroin addicts in the UK.'
Professor Strang said: 'Our scientific understanding about how to treat people with severe heroin addiction has taken an important step forward. The RIOTT study shows that previously unresponsive patients can achieve major reductions in their use of street heroin and, impressively, these outcomes were seen within 6 weeks. Our work offers government robust evidence to support the expansion of this treatment, so that more patients can benefit.'
The National Addiction Centre is jointly run by the IoP KCL and South London and Maudsley NHS Foundation Trust (SLaM). Both are part of King's Health Partners, an Academic Health Sciences Centre (AHSC) for London, bringing together clinical and research expertise across both physical and mental health. For more information, visit www.kingshealthpartners.org.
The article ‘Supervised injectable heroin or injectable methadone versus optimised oral methadone as treatment for chronic heroin addicts in England after persistent failure in orthodox treatment (RIOTT): a randomised trial’ can be found here, along with a podcast featuring Professor Strang discussing the trial: www.thelancet.com. Professor Strang can be seen also on the new SLaM website talking about RIOTT: http://www.slam.nhs.uk/news/latest-news/treating-heroin-addiction.aspx.

Government Cuts Hit Local Drug Services - Part Two

2011-06-26T18:45:00.000Z

Govenment budget cuts hit local services...

More..

So.... A little update on the situation at the SAU (Specialist Addiction Unit)

Since my psychiatrist left the service due to funding cuts things have gone from bad to worse!

All the clients now have 'key-workers', no one actually gets to see a doctor any more.
My 'key-worker' has taken a disliking to me because I dare to challenge and question the way things are done... Like I said before, and as people have confirmed in the comments to the previous post, drug services are set up for your stereotypical 'junkie' .... Take your methadone, jump through all the hoops, tick the boxes and shut up...

Well, I'm sorry but that's just not me!...

I was so happy when I was first referred to the SAU, and met Dr Crawford,... For the first time in fifteen years of counsellors, key-workers and doctors I actually felt like this doctor gave a shit about me and my treatment.

We had a great relationship, we kept in touch by text which meant I could get in contact any time I needed, and we developed a good treatment plan.. together.. (which is really bloody important)

So often, addicts are relegated to a life on methadone or subutex and drug services seem to exist solely to keep people alive....

Dr Crawford actually listened to me, we trusted each other and she gave me chances I wouldn't have got with any other NHS psychiatrist (MST for a start, she also spent money getting me music equipment, got me into one of the best music tech colleges in London, sent me to one of the most expensive rehabs in the country and has worked with me very step of the way when it comes to medication)

I would see her every two weeks, we would chat for an hour or so, and decide where to go from there.
Most recently I came with the suggestion of trying MST and amazingly she agreed.

I had to sign a contract stating I wouldn't take any other recreational or prescription drugs (diazepam, cannabis, crack cocaine etc)

When she asked what I had been taking I was always honest and it's never been a problem, until now!

Now my key-worker keeps bringing up the contract, testing my urine for 'illicit' drugs which when positive for cannabis and benzodiazepines she reminds me that I am breaching my agreement and risking my treatment.

I saw her for all of 4 minutes last week, she literally gave me my script, asked how I was doing and fucked me out the door.

The reason I smoke the odd spliff and take a valium a couple of times a week, is because I'm not stable and can't sleep when I'm sick!

Now I'm struggling on 200mg MST twice daily. I'm ill, it's barely keeping me well, let alone helping with cravings. I was really hoping it would.
I'm also still stuck on daily pick up at the chemist which is incredibly difficult when your trying to hold down a job!

I need an increase, I wake up every day ill, and run to the chemist.. take my morning dose and then have to try and leave it as late as possible before taking my evening dose so I'm not too ill when I wake up.

I don't see the point, when I'm barely well I want to use! I might as well not be on anything!
I need a dose increase, and I need weekly pick up at the chemist.

Now if Dr Crawford was still at the service she would sort it out on the spot.
Now I have to ask, and my key-worker 'takes it to the team' ... The weekly meeting of key-workers and doctors... I've been waiting a week already for a decision.

I want to get on with my life! I want to work, I can't when I'm ill!

I hope this post doesn't come across as sounding arrogant or self centred.. I understand there are budget cuts and things are changing.. but the treatment I'm getting at the moment is no treatment..! I might as well use and not bother going to the SAU at all...

Who is this meant to help?

I thought the idea was to work with people to get them clean.. Not trying to fuck people over at every opportunity...

I want to write to the new doctor over-seeing the SAU but am scared if I stick my neck out it will get chopped off!

We're not meant to complain and challenge the doctors, they know best, they've been to medical school and learnt about addiction.. they know best! Who am I to dare have some input to my treatment?!

I actually don't even want to go to the SAU any more, the idea was to get me stabilised on a suitable dose of MST and then refer me back to my GP. I wish they would just do it now actually... At least with my GP we have quite a good relationship.

Anyway, moan over...

How drugs services SHOULD be run...

2011-06-21T15:53:00.002Z

So, here are my thoughts on how a drug service should be run....

The service should be based around these core principles:

Harm Minimisation
Appropriate Opiate Substitution Prescribing & Maintenance
Detoxification & Abstinence
A Client Centred Approach
Relapse Prevention

Government Drugs strategys' should include:

Early Drug & Alcohol Education In Schools
De-Criminalisation Of Cannabis
Raising The Price Of Alcohol In Supermarkets
Regulation Of Advertising Of Alco-pops
Working Towards De-Glamorising 'Hard Drugs'
Early Intervention Where Drug Use Is Suspected In Teens (Education In Schools)
Reducing 'Binge Drinking'

The most important of these is 'client centred' - By this I mean, working with the client to define and attain sensible and achievable goals.

For some reason this government has gone backwards! Drug services are being told to push clients towards detox and abstinence, long term maintenance is being phased out..

Forcing addicts to detox WILL NOT WORK!

I believe the best approach to drug treatment would be...

It should be decided with the client what his/her expectations of treatment are and then:

Re-assessing current dosing guidelines (30mls methadone is not enough to keep an average addict well), to stabilise the client (this means a dose that 'holds' the client as well as attenuates cravings, over 60mls in most cases)
Prescribing suitable opiates for the individual client based on history of use, age etc. whether this be methadone, subutex, MST or diamorphine, the full range of medication available should be employed as required.
Working with injectable opiates for injecting users.
Working with smokeable forms for smoking users.
Not punishing the client for topping up with street drugs whilst titrating substitute.
Establishing whether the client wants to detox or maintain.
Allowing clients to maintain for as long as required.
Providing intensive support for clients wishing to detox.
Providing regular 'key-work' and counselling sessions.
Providing access to a nurse.
Providing proven 'alternative' aids to detox (auricular acupuncture, meditation, CBT, NLP, Hypnosis)
Providing 'shooting rooms' for clients, providing on-site medical support for injectors including workshops on safer injecting techniques.
Providing support for clients wishing to detox at home, home visits, detox plan, adequate medication (benzodiazepines, quinnine, immodium, vitamins, clonidine etc)
Post detox medication. Provision of Naltrexlone implants and tablets
Support groups for abstinent clients

Now, the way I see it, the above really isn't that far from reality, and isn't anything totally out there or unachievable.

Most of these have been used either in the past in the UK or are currently being used around the world in other countries.

Appropriate prescribing of diamorphine to heroin addicts is a controversial subject and one that inevitably raises concerns. In every trial that has ever been done, diamorphine vs methadone has better results in terms of attenuating illicit drug use, clients getting on with they're lives, finding jobs and contributing to society etc.
Yet the government for some reason will not roll it out nationwide.

(You can sign the petition to the government here by the way)

The same old arguments come up every time... 'why should we give them heroin', 'the diamorphine will be diverted to the street', it's too expensive'.

Let me tell you now, the lucky few on diamorphine prescriptions do not 'divert' they're scripts, why would they!? And why should we give nicotine patches to smokers?
Prescribing pharmaceutical heroin to addicts is the right thing to do, injecting street heroin carries so much risk, not least collapsing veins and DVT's, the spread of viruses like HIV/HCV through sharing of injecting equipment, risk of overdose with constantly changing batches of heroin of varying strength and purity etc..

MP's always say diamorphine maintenance would be prohibitively expensive and apparently there is a worldwide shortage.
It is only expensive because in the UK we use freeze dried preparations. A powder in an ampule to which sterile water is added.
The extra step of freeze-drying is unnecessary and as far as I know only done to prolong the shelf life.

The cost of producing diamorphine would come down as demand increased and would level out at around the same price as methadone.
(On a side note, I along with most addicts would happily pay the cost of the medication)

Post detox, providing naltrexlone implants on the NHS is a must. Currently there are only a handful of private clinics in the UK that carry out the procedure and it's very expensive.

The crux of the issue is about working with the client and not re-hashing old treatment models that don't work.
Listening to the hopes and wishes of the client and providing the support for them to achieve them.

It doesn't seem like too much to ask, and as I say it's not exactly groundbreaking stuff I'm talking about.
It could all be done with a few minor changes to protocol with the existing network of local drug services and agencies.

Stand up for your rights, stop laying back and letting Cameron and Klegg fuck you up the ass just because you found opiates relieved whatever issues or pain you can't cope with in your lives.
Seek help. challenge existing ways of working, post comments in your DDU's' suggestions box.
Start a local users forum, sign the petition, write to your MP...

Just because your an addict does not make you a bad person, you are human and deserve equal treatment to anyone else...

Peace out...

Government Cuts Hit Local Drug Services

2011-05-31T22:23:00.003Z

Government Cuts Hit Local Drug Services

We all know the state of the country's finances..!

Greedy politicians have systematically fucked the UK up the ass since time immemorial, but over the last few years things have gotten worse.

There are cases going through court now, politicians claiming 'expenses' they are not entitled too.. evidently £80,000 a year isn't enough!

A politician went to prison just today for claiming expenses for a house he didn't even live in!

Add this to the bankers loaning and mortgaging the public with money that doesn't exist, and the government borrowing money that doesn't exist, the UK national debt now stands at a trillion pounds!

We are paying £120,000,000 (that's 120 million pounds) a day just in interest!

Long and short of it, we're fucked!

local authorities are having they're budgets cut drastically and the services being hit the hardest are grass roots and community organisations, hospitals, charities, police and fire services and DRUG SERVICES!

Unemployment has hit record levels, people are loosing they're properties and assets yet they're cutting funding to essential services that help people in desperate situations like the citizens advice bureau.

Personally, I can't find a job, no matter how many interviews I go to, and we are struggling!

Recently my psychiatrist that I've seen for years, and had a great relationship with, told me she's leaving work.

She was the consultant at my local Specialist Addiction Unit.

Budget cuts meant the hospital had decided to merge the alcohol and drugs units, and they wanted her to take a new role overseeing the whole department. No longer seeing patients and basically managing everything.

She decided it wasn't for her, and gave notice.

At my last appointment with her we were discussing upping my MST dose, and she had no problem with it, we decided I would try another week at 180mg twice daily and if I couldn't manage we would increase the dose.

When I went for my next appointment I discovered that I no longer get to see a real doctor, I now have a 'key worker'..

Basically someone with no qualifications and little experience in the addiction field who has power over me and my treatment.. I was getting flashbacks of the incredible incompetence I experienced at 'Addaction/lifeline' - our local Drug Dependency Unit.. (The name changes every year when the contracts are issued... the only thing that changes is the name, and a lick of paint)

I left Addaction years ago, sick of the endless stream of useless 'key workers' and demanded a referral to the hospitals SAU, but that's a whole other story!

Anyway, basically, my 'key worker' (hell, I'm probably more qualified to do her job than her with my NVQ3 counselling diploma and drugs awareness certificates), has absolutely no power to make a decision regarding my medication and treatment so now has to take it to the team... (a weekly meeting of doctors and key workers)

I've been waiting nearly three weeks now for a decision, I ended up having to meet with the new consultant to get it a 20mg increase!

I was hoping the MST would help with cravings as well as withdrawals but the dose im on barely keeps me well...

Now I understand I'm just another junkie, and most people probably don't see addiction services as the highest priority when it comes to hospital budgets, but we are people too, and we deserve equal treatment..

I have and always will fight for my rights as a patient, it seems sometimes these 'drug services' go out of they're way to stop you getting on with your life, it's difficult to hold a job down when your on daily pick up at the chemist or have to go to a counsellor every two weeks, then see your GP just to get a methadone script!

These services are set up for your average 'junky' - Im talking about the ones that shoplift and mug old ladies for they're drug money.
If you decide you want to provide for yourself, hold down a job and contribute to society it seems they will put as many barriers in the way they possibly can.

My Top Blogs

2011-05-22T11:08:00.000Z

Go check them out and give some love... active addiction is hell, people always see us as narcissistic and selfish.
It's no party trust me...

http://gledwood2.blogspot.com/

http://ppfaceannagrace.blogspot.com/

http://melodyleeisdamned.blogspot.com/

Using Ibogaine With Different Opiates

2011-05-15T13:13:00.015Z

Using Ibogaine for detox from differing opiates

I'm writing this piece in response to questions around the suitability of Ibogaine detox from short acting opiates like heroin vs long acting like methadone and subutex.

I would like to make it clear that in no way am I a professional in the field, I'm writing only from my personal experience and what seems to be the general consensus from various forums and mailing lists composed of Ibogaine users and treatment providers.

My blog was recently used in a thread on the suboxone forum as evidence that Ibogaine doesn't work for long acting opiates like Suboxone or Methadone.

The person quoting me (without my permission) and also by the way had no personal experience of Ibogaine was arguing that Ibogaine has no effect on PAWS and cravings and that it only postpones the inevitable withdrawals.

It is generally accepted that Ibogaine is much more effective for treating SAO's like heroin, it's also true that most treatment centres (any that genuinely care anyway) advise people switch to a SAO for at least a month before treatment.

This doesn't mean Ibogaine does not work for LAO's like subs/methadone, because with a suitable dosage regime and some willpower from the client it can!

Dosing for detox from heroin vs methadone/subs are very different, LAO's hang around for a long time, especially if they have been used for many years.

As with any opiate detox there is no quick fix, this does not mean Ibogaine doesn't work! and it annoys me when people say otherwise.

To complicate matters, there has been many 'clinic's' popping up in Canada and Mexico offering 'instant, painless detox'. Inevitably people are going to be let down, high expectations play a big part in peoples negative views to Ibogaine.

A lot of these 'clinic's' are run by unscrupulous providers that are looking to make a quick buck.

I've heard many horror stories about people being left under dosed, in pain and thrown out if they kick up a fuss. These providers are exploiting desperate addict's, looking for a way out.

Another problem with Ibogaine is as it is still experimental and schedule I in the U.S there isn't much research going on, and a lack of scientific evidence about it's efficacy.

No one is even sure still exactly how it works. We know it affects pretty much every system in the human body, it seems to fill opiate receptors although it is not an opiate, and it seems to empty the receptors of any existing opiates thereby having the perceived effect of 're-setting' tolerance.

I can vouch for the tolerance re-set personally, and I can also say 100% that it stops acute withdrawals by around 95% for around three days (after a full flood dose)

This, by the way is true for any opiate, methadone or heroin (I've used it for both)

The issue of PAWS is a big one, and will exist whether Ibogaine has been used or not, and this I think is the crux of this argument.

People say Ibogaine doesn't work because some people struggle with PAWS and cravings post detox.

Well of course some people will! Ibogaine or not!

There are a small majority of people that have successfully detoxed with a single flood dose and did not suffer PAWS, cravings and are still clean today.

But for most people, especially people with years of use behind them and those using LAO's boosters will be needed, and sometimes even a second flood dose.

For methadone/Subutex, after the initial 100mg 'test' dose, a flood of around 19mg/kg is given, boosters of around 400mg(TA) or 200mg(HCL) are then given as required for as long as the next two weeks!

Please do not write off Ibogaine as a treatment option simply because some people struggle afterwards... I have tried pretty much every method of detox over the years and Ibogaine is the easiest I have ever done.

Next to a traditional quick methadone reduction and cold turkey, Ibogaine is a walk in the park.

And don't take my experiences as evidence it will not work for you!

Every one reacts differently to Ibogaine, and everybody's body is different, the speed the Ibogaine is converted, the amount's of body fat that hold LAO's longer, age (research has shown those over 30 have a higher chance of attaining abstinence) and willpower have so much to do with your chance of a successful detox that it's not sensible as simple as taking one persons word for the outcome of your treatment.

Do your homework, read the existing research papers, get medically checked before contemplating treatment and make an informed decision.

MST Update - SMART UK

2011-05-09T15:11:00.000Z

So, after seeing my psychiatrist last week I'm now taking 180mg twice daily..

Apparently for working out equivalencies they take the MST dose and divide by six, I read on the 'release' (Page 19 Here) *PDF*

website that it's actually more like dividing by eight though.

This means I'm taking the equivalent of between 45-60mg/mls methadone, which is a pretty standard dose I guess...

I really don't want to go too high, I'm just making it more difficult for myself to get off!

MST withdrawal isn't very nice apparently, but it can't be any worse than Methadone or Subutex! And I've done both...

I've also discovered 'SMART Recovery' - Taken from they're website...

Our purpose is to help individuals seeking abstinence from addictive behaviours to gain independence, achieve recovery and lead meaningful and satisfying lives.

The approach is secular and science based; using motivational, behavioral and cognitive methods. We view substance/activity dependence as a dysfunctional habit, while recognising that it is possible that certain people have a predisposition towards addictive behaviour.

Our self empowering, 4-point recovery programme consists of:

· Point 1: Enhancing and Maintaining Motivation to Abstain

· Point 2: Coping with Urges

· Point 3: Problem Solving (Managing thoughts, feelings and behaviours)

· Point 4: Lifestyle Balance (Balancing momentary and enduring satisfactions)

It was started in the U.S as an alternative/adjunct to NA/AA.

It's based on a similar group therapy model, BUT... (and this is the important bit to me) there is no 'finding your higher power' involved, it was set up by a group of addiction specialists, counsellors, CBT practitioners and the theory is to use a bunch of 'tools' to help a person attain abstinence.

Another fundamental difference to NA is that the group meetings are run with the aid of a 'facilitator', trained to oversee the meeting.

The movement is growing in the UK, there are a few face to face meetings around the country but they also offer online web chat style meetings weekly.

I intend to get involved, I always found NA to be unwelcoming, judgmental, cliquey and hypocritical.

I never felt welcome as a newcomer, and was made to feel bad for taking methadone/sub/mst/ibogaine.

There always seems to be a pecking order, junkies below alcoholics, alcoholics below coke-heads etc...

Silly really, but I guess that's humans for ya!...

Tapering With MST - Morphine Sulphate Continus

2011-05-04T16:47:00.001Z

So this is my latest attempt at detox and abstinence..

Surprisingly my psychiatrist has agreed to prescribe me MST,
in it's slow release form its supposed to last 12 hours so I dose twice a day.
It has a half life somewhere between heroin and methadone.

Were currently trying to find a dose I'm comfortable on.
At the moment I'm taking 120mg twice a day, it's difficult to work out equivalences with other opiates due to differing half lives but it's around the same as 30-40mg methadone.

Once stable I'll start to reduce. At a rate I'm comfortable with. No point rushing it or I'll just end up going backwards. Maybe 10mg a week but I'll see how it goes.

The plan at the end of the taper is to swap to naltrexone.
Starting a full opioid antagonist like naltrexone is notoriously difficult.

If started too early it can cause precipitated withdrawal as it nocks out any opiates left on the receptors.
Swapping from mst which has quite a long half life means I will have to go a few days in-between the two drugs.

EDIT: After consulting with the stapleford clinic, apparently its ok to start naltrexlone on day 6 after stopping MST (Max 25mg) Five completely clean days in-between are essential.
Apparently a receptor flooding/blocking dose is around a 20th of a tablet, so it's advised just to take the lot... Iv'e also had people advise to nibble a couple of grains though the first time to challenge any remaining opiates. I'll probably stick to that plan...

I'll Document everything anyway. In the hopes it may help someone else going through a similar thing. I also want to show that morphine has a place in treating addiction in the NHS.
Currently it's something that you can only really get privately.
Luckily I have a psychiatrist with an open mind!

This Blog...

2011-05-03T14:57:00.000Z

Needs a new name I think!

Initially I wanted to write about using Ibogaine to stop my cycle of addiction to heroin, but I now seem to be documenting my battle with my addiction and my various attempts at getting clean, and maintaining abstinence...

As such, I want to write a bit about a previous attempt at detox, I got clean around 2006 using methadone. And as this seems to be the only option available to most people I want to say it can be done!

At the end of the day it comes down to willpower and determination, and unfortunately these are two things that can-not be forced.

So, here is the story of how I got clean (and stayed clean for two years) using methadone and subutex.

By the age of twenty six, I had been using heroin for nearly ten years. I was at this point, homeless and begging on the streets for cash every day to support my habit.

I befriended an American girl and we used to work together as two people is better than one when it comes to begging.

I guess we hung around together for about a year.. We would wake up, have our morning hit and go begging, get £40 together, which would take a few hours, then go and score, have a hit and go back out do the same again for the evening money. Out of this we would make sure we either saved enough gear for our morning hit (the most important one of the day) or have enough cash left over to score in the morning..

This went on, day in, day out for what seemed like forever, it's soul destroying, everything would revolve around using heroin, and getting the cash to buy it.

It got to the stage where I was so sick of it I decided to go to my GP and get a methadone script and clean up.

I guess the old cliche of having to hit rock bottom is true, as it took me getting to the stage of having nothing to actually want to clean up.

I offered to share my script with her if she wanted to clean up too but she wasn't ready, we ended up having a screaming row and we parted ways.

I literally stopped using that day, and I didn't touch heroin again for three and a half years.

I went through a period of being ill while we found a dose of methadone I was stable on, 120mls I believe.

Within a month I started to reduce my dose, and believe me I felt every drop, Id drop 1ml and wouldn't sleep well for a few days, once I felt OK again I'd drop another 1ml, hence why it took eighteen months to get off the stuff.

I also had to split dose as it never held me for the full 24 hours. This was fine when I was on high doses, eg on 60mls I'd have 30mls when I woke up, and 30mls around 6pm.

When I got down to 10mls I hit 'the brick wall' people talk of, when it's difficult to get any lower, plus having to split dose, 5ml and 5ml twice a day it was getting harder and harder to measure it.

I talked to my GP and we decided to swap me onto Subutex for the last bit of the taper.

The swap was difficult, because of methadone long half life you have to wait a minimum of 24 hours after the last dose of methadone before starting Subutex or you can go into precipitated acute withdrawals due to Subutex being a partial opiate antagonist.

Subutex (Temgesic/Buprenorphine) Is a strange semi-synthetic opiate agonist/partial antagonist.

It fills the opiate receptors and also blocks them (at sufficient doses) so any other opiates can-not get in.

I stabilised on Subutex after about a week, I ended up on a dose a lot higher than I thought I would need (16mg) and soon after started to taper.

It's a lot easier to taper on subs, once I was down to 2mg you can cut the tablet with a razor, I think I got down to a quarter of a 2mg tab...

When it came to stopping altogether, I was so anxious about going into withdrawals, but I didn't!

I was FINE!

I didn't suffer PAWS, the only problem I had was with depression, I'm prone to depression anyway, that's why I started taking heroin in the first place!

I researched anti-depressants that help after long term opiate use and I started taking Venlaflaxine (Effexor)

It definitely helped, it stopped me feeling suicidal at least!

So... here I am again, well, I'm not on methadone this time, after the hellish 18 months it took to get off it last time I will never touch it again hence the MST.

But I wanted to give people on long term methadone maintenance that there is hope, it is possible IF you have the will power and determination to do it!

My Latest Relapse

2011-04-28T05:08:00.001Z

Wow... they say heroin addiction is a chronic, relapsing condition...

That always sounded very pessimistic to me, but theres a lot of truth in that statement!

Ibogaine is fantastic for acute withdrawals, and in low doses, physically for PAWS... but for me, the cravings got too intense.

I've relapsed a few times, and I'm struggling. I don't enjoy living like this, when your in pain physically, and all over the shop emotionally, it's very hard not to give in sometimes.
Ive been to see my old psychiatrist anyway, and I'm going onto a short MST script, taper and onto Naltrexone, the opiate blocking drug...

Ill update properly soon..

Booster Day

2011-03-23T18:48:00.000-01:00

I just took a booster dose.. well I say booster, it's more like an in between booster and flood dose.. Ive got 2000mg TA and am going to split it into 4 or 5 doses over a couple of days.

My ears are starting to buzz as I type.. and the screen is too bright. (The first symptoms you notice when you take it)

The point of all this is to top my nor-ibogaine levels.

Ibogaine converts to nor-ibogaine in the liver and it has a significantly longer half-life to Ibogaine.

A lot of people claim the majority of the 'addiction interrupting' properties are attributable to the nor-ibogaine.

It can hang around in the body for some weeks after flood dosing, which is though to help with cravings post detox.

I've also got some root bark (the raw root powder with all the different alkaloids) left over for after/PAWS

As I've been reading, it seems very important to have an aftercare plan in place after the detox

Be that counselling, yoga, acupuncture or exercise. Group therapy is particularly noted to help.

My problem is that I have no willpower to talk of, and I'm so un-disciplined! And I always have been, not just since starting on heroin.

I really need to work on myself, I need to find a vocation that I actually WANT to do, I'm 31 now and I still haven't a clue what I want to do with my life!

Don't get me wrong, I have worked the majority of my habit, doing jobs as diverse as tree surgery and body piercing, to counselling/key work, and managing bars and clubs.

I'm not aversed to working, I just want to be doing something I believe in.

My passion is music, I'm a grade eight pianist, I play guitar, drums, accordion, some strings. etc...

I would dearly Love to find a career in music but I always talk myself out of it, (self sabotage button again)

But I'm slowly realising that I need to follow my heart if I'm ever going to find any peace and fulfilment!

I need some guidance, I don't help myself, I'm lazy, I'd quite happily watch TV all day, but nothings going to fall into my lap that way..!

I guess I just need to work out a plan and some life goals... and sharpish... I'm sick of always staying in the same place (psychologically and physically!

Long Overdue Update!

2011-03-03T13:04:00.000-01:00

I've been crap at posing recently, all my energy is going into staying clean right now..!

Its been six weeks I think now? Every day drags, I'm still not sleeping properly, I'm consumed 24/7 thinking about heroin..
I've actually ordered some more Ibogaine, it helps with the cravings, when your on Ibo the last thing on your mind is heroin. I've been going to the obligatory NA meetings, I forgot how elitist and judgemental the people can be!

I sit in them and inevitably feel like I'm going to have a panic attack, gripped with fear, wanting to 'share' but the words won't come out.
It keeps me busy though, gives me a focus and something to do every day.

Unfortunately heroin addiction is a 'chronic relapsing disease' and is incredibly hard to get off and stay off. Although I definitely feel a difference this time to the last time I cleaned up.

Last time I was so determined, I stopped using altogether and tapered off methadone over the next two years!
I had used heroin and methadone for ten years at that point and technically I should have suffered with PAWS. I actually hadn't heard of PAWS then though so maybe that had something to do with it.

I didn't get PAWS, the only symptom I had was severe depression and I'm talking suicidal depression for nearly a year, in fact I'm amazed I didn't relapse. Ibogaine helps a hell of a lot with the depression side of things, I guess I feel flat but I'm definitely not suicidal this time round.

The physical difference this detox is huge, endless low grade withdrawal (PAWS) which really gets to you.

Unfortunately the longer you use opiates every day the more your brain adapts to it. The serotonin/noradrenaline/dopamine pathways actually end up hard wired to a constant flow of opiates and this is what causes all the problems when they're stopped.

It can take up to two years for the brain to re-adjust, which is a very long time to suffer PAWS!
The average is around 3-6 months.

This is just the physiological side of it, physchologically it manifests in 'using dreams' - vivid dreams where I run around scoring, cook up and usually I wake up just as I'm injecting...! It's pure torture!

One of the hardest things is to remain positive, it's all too easy to look back with rose tinted spectacles and forget all the bad stuff about having a habit, all the crap is easily forgotten when your craving... It's so easy to talk yourself into 'just one little hit'

I forget all the times I've spent hours, in tears trying to get a vein, sick, knowing that once the amount of blood vs heroin in the needle reaches a certain point it will clot and the drugs will be lost..
I forget all the hassle of trying to get cash, then waiting around for hours in freezing parks/bus stops or dodgy council estates for a 14 year old on a bike to drop the gear to you.
I forget about the damage I've done to my body from 14 years of injecting, I get pins and needles in my arms, I have no superficial veins in my arms and hands any more so I really feel the cold plus my hands look like boxing gloves!
I forget the pain using causes my loved ones, my long suffering partner who has somehow stayed with me throughout this relapse.

One thing I can say though is although I didn't get the spiritual awakening that a small amount of people that have used Ibogain get, I'm talking about the ones that take it once and never want to use again.
I have found that it is slowly helping me see things a bit more clearly.
It's subtle, when I think about my life now and the reasons I used things seem to make more sense, it's very difficult to describe!

Every year I was on it I would swear to myself that I wouldn't still be using on my next birthday, having a date to work towards helps.
The years are whooshing past faster and faster, I turn 31 in less than a week and have wasted more than half my life using heroin. It makes me sad to think about it but I also know I'm still young enough to do the things I want to do...

Con-Dem Drug Strategy For 2011

2011-01-29T13:28:00.000-01:00

Now this is scary....

How on earth do they think people are going to detox just because they tell them too?

In my experience addicts are inherently anarchic.. plus the nature of addiction is that change has to come from the inside, a person will not clean up for family/friends/partners etc.. An addict will not change until they are ready, often not until reaching that cliche 'rock bottom'

Putting people onto enforced methadone detoxes is not going to work Mr Cameron... They will just end up using heroin again..!

'To prevent unplanned drift into long term maintenence' .. I quote

Good luck with that one...!

Day Sixteen! & Another Iboga Death

2011-01-29T13:14:00.000-01:00

Unbelievably, I'm on day sixteen!

I have good days and bad days, the night sweats seem to have stopped, although the insomnia is still there, some nights I hardly sleep at all and others I can get six to eight hours straight! Which two weeks after detox is pretty bloody good!

PAWS are bearable, just slight goosebumps and hot flashes, restless legs, yawning with watery eyes and runny nose, nothing horrendous anyway.

I read today about a massage therapist that travelled to Cameroon for an Iboga initiation and sadly died from a heart attack, she was about my age and fit and healthy as she was a tennis player.

It does make you think, and worry about just how dangerous Iboga can be! Anyone taking it needs to be 100% sure that it's the right thing to do. Although it has been used for thousands of years it does have the potential to kill you if not administered safely or if you have any heart or liver conditions.

Unfortunately, this is not going to help the cause, in the article linked to above they only mention the use of Iboga for heroin addiction in the last sentence! They focus more on the 'hallucinogenic root' aspect.

Medical Students And Addiction

2011-01-21T10:07:00.000-01:00

I've done it a handful of times now,... given talks to medical students about my experience of addiction and treatment.
I've given talks to an auditorium of second years before, and yesterday my GP asked me to talk to some fourth year grads.
I do it because I've experienced prejudice in A&E before, and because these students are just so naive!
Some of the questions they ask... one yesterday asked what diamorphine is ??
Humans are prejudice, and doctors are only human, I know that when you need to go to A&E and you tell them your medical history and that your on methadone/heroin they're attitude changes straight away, you don't get adequate pain relief and your treated with a 'well you did it to yourself' attitude.
I learnt in the end, to just not tell them you were an addict.. which obviously isn't good if your not being honest with them, what if they are treating you with something with a known contra-indication to methadone/opiates/subutex etc..?!

I went in after breaking two ribs coming off my bike a few years ago and after telling them I was a heroin addict etc I was left screaming in pain for HOURS... and told if I didnt stop moaning I would be escorted out!
Now I know, if I hadn't mentioned that I would have been seen by a doctor and given some pain relief while I waited.
I walked out in the end and just scored, it was easier, and helped the pain....

Anyway, these students mouths always hit the floor when I tell them about what I used to do, explaining about injecting heroin and crack at the same time, and how good it feels.
They cant believe people take more than one recreational drug at the same time!
I always make sure they understand that it's not only the lower end of society that end up heroin addicts, but plenty of doctors/nurses/lawyers too.... especially anaesthetists!

I told them all about Ibogaine too, and how it's the only thing that's ever helped really.. out of ten odd trips to rehab, years of counselling and psychotherapy a plant from Africa has the power to break addiction!

Maybe, I planted a seed in one of they're heads, and they go on to work in addiction, and start researching Ibogaine... you never know!

Day 7 - Post Ibogaine, The Experience!

2011-01-19T17:31:00.000-01:00

Thought I'd write a little about the actual experience as I haven't yet!

I worked my dose out at the standard opiate addicted persons 15-20mg/kg dose, at 65ks that meant about 1600mg Ibogaine HCL, I took this plus 1000mg TA Extract the first time and it blew my head off and really took me a long time to recover after, so the second and third times I titrated the dose over 24 hours, this last time I took 600mg HCL initially then another 400mg TA about 6 hours later, both ways of dosing had the desired effect, I just didn't want the nausea and intense hallucinations.

My First time was the strongest, at the full 19mg/kg dose all at once. I did throw my guts up, projectile vomiting, but didn't really have any massive spiritual awakening. I did hallucinate, everything went green and purple and I was in the blitz being bombed by the nazi's!

I was quite upset I wasn't shown anything that could help me change my current behaviours, people say it takes some time afterwards for the bits to fall into place.
Also that war type, violent visions are quite a common theme.

Some people say they felt the ibogaine scrubbing them clean from the inside out, a lot of people meet with the plant spirit too.. unfortunately I didn't get that.
I'm quite a spiritual person so was hoping to have a full on psycho-spiritual experience, shame I didn't.

It's what seems to keep people clean in the long run, that and the occasional booster dose...

Ibogaine has been called an 'addiction interuptor' and that's exactly what it does, it will not keep a person clean long term unless there is a determination from that person. Maybe this is why it seems to work in better with people in they're thirties and over?

It breaks the cycle of addiction, takes away 95% of the acute withdrawal symptoms and PAWS but you also need to keep working at your recovery.

Counselling, therapy, yoga, exercise etc all help a great deal.

Physically, I'm feeling 'ok' still lethargic and suffering with restless legs/night sweats and insomnia but it's all bearable, knowing that I don't have to find cash and score every day makes up for it!

What's really amazing this time is I haven't gone into the chronic depression I did when I came off methadone, ibogaine re-sets dopamine/serotonin receptors to a certain degree. This is what causes PAWS, it can take up to a year for the brain to re-adjust to making it's own happy chemicals and not being flooded with opiates constantly..

It also gets harder the longer you are taking it, I know I struggled a lot more this time around than last time..
Three shots at iboga detox in the last eight weeks!

But I persevered because I knew, the first time I took it that this stuff actually works! It's just how you use it..
I made the mistake of thinking I wouldn't need boosters the first time and paid the price, going back into withdrawal after four days and having to relapse as I couldn't get more Ibo..

The 'trip' isn't scary at all, (mind you I've taken my fair share of hallucinogens in the past) It kind of makes you feel safe, but you know something powerful is going on! After about 6 hours the main vision part is over and you go into a kind of catatonic 'dream state' where you can move much, sleep or eat... This feels like it's never going to end and is quite hard to get through..

Weirdly, Ibo also seems to reset your senses too, food tastes strange, you can suddenly smell in stereo technicolour, and sunlight is so bright, taking a puff on a cigarette tastes like an ashtray full of water.!

My partner made me laugh today, he said 'so from where I'm sitting it seems like people coming off heroin are either crying, laughing uncontrollably or masturbating' ... haha .. sounds about right!

Day Six - Post Ibogaine

2011-01-18T14:59:00.000-01:00

Thought I'd better write up how it's going.. they say recovery after an ibogaine flood dose is like recovering from a general anaesthetic.
Well, I can tell you... it is...!
Most people say it takes two weeks to feel ok and two months to feel 'normal' - this is more likely caused because of the combination with PAWS too usually....
Day six, and I feel fine, had a flat day yesterday, was really craving gear! Thing is, like any habit, if you have done something every day for so many years when you try to stop you have to deal with the body/brain still thinking it needs that fix...
I slept a pretty solid eight hours last night! Its really exhausting recovering after ibo, it's a stimulant so you literally cant sleep for days after. The first couple of days it's all you can do to lay in bed, pissing in a bucket!
It re-sets nicotine receptors too, so every time I take it, I stop smoking, haven't for a week nearly now, probably for the best really as I have chronic asthma and have had to take steroids and inhalers for years.
(which I haven't used since the Ibo too)
Physically the only things I'm struggling with is restless legs, and slight flashes of goosebumps, but no sweats or cramps... Diorreah, but that's normal after Ibo, after all, detoxing from a constipating opiate is going to cause that.
Hot baths every six hours is the only thing that helps with the RLS, well that and ibogaine root bark in small doses..
When I woke up this morning, like when I was using, you have that 30 seconds to a few minutes where your half awake where your not thinking of gear, or being sick, it's when you remember that the sickness kicks in...
Anyway, this morning, the same happened, and for a moment I started to feel ill, my eyes started watering and I was yawning, then I realised I wasn't sick.... just psycho-somatic
Honestly, that felt amazing, knowing that I didn't have to score, or take methadone.. It's definitely one of the things that makes getting clean 'worth it'
It's weird having great big pupils too! Getting used to sunlight without tiny dilated pupils hurts!
I worked out how much I've spent over the years on heroin, at an average of £20 a day, 14 years, £153,000!!!!
I coulda bought a fuckin house!
I spent more than that most days too, paying £30 on a g

I think if someone put a needle of heroin in front of me I'd probably still take it, I'm not that strong yet, but I remember the last time I cleaned up I couldn't even look at a 'heroin story' on the news, seeing people cook up/inject would bring back such strong cravings..

Once you've experienced heroin, it is hard to go back, it's too nice.. Living in a nice warm cocoon 24/7 is nice.. end of... it's the damage you do to yourself that's the problem, especially as an injector, I literally have NO veins left.. groin, neck...my only options the last year or so... my arms and hands are covered in scars that will never leave me..
That's the shit side... and I have to keep reminding myself of it, unfortunately, like most things with humans we look back with rose tinted specs, well I do anyway, and I only remember the good bits... well bit.. the rush after you inject!

Day 4! Again...

2011-01-16T14:03:00.001-01:00

Well I did it!

No PAWS this time. I'm so happy..

Hardly even craving. Will write it all up soon.

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