Author Topic: This looks bad ...  (Read 4540 times)

Offline roxyoxy (OP)

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Re: This looks bad ...
« Reply #14 from previous page: December 10, 2016, 03:50:37 PM »
roxyoxy, the US is being flooded with deadly Fentanyl cuts, analogs etc.

Are you seeing any fent carnage in Germany ?

In Australia we only see the odd fent patch and no fent or opioid RC's.

Yes, Fentanyl is used & abused in Germany and sometimes people die because of this. In the past years doctors thought is much safer to prescribe "pain patches" then pills who can be crushed and injected.

Doctors were so naive. There are at least two easy ways to abuse Fentanyl patches. Of course patients did that and developed an abnormal tolerance and later ended up taking Methadone or dying from an overdose. But we don't have that many deaths. In Germany even 50 deaths / year in a big city like Munich is seen as a huge problem. So the local government writes letters to the doctors to create awareness.

Fentanyl prescriptions are now handled with more care but in general opioid prescriptions are going up and compared to 2014 we had around 200 more deaths in 2015 but I can't tell you how many of these 200 around are related to opioids.

Yes, the fentanyl patch is somehow odd but the patch is extremely easy to use and can be made injectable. And injecting such a potent opioid is fucking dangerous. Most users don't realize how dangerous it is and totally underestimate the potency of Fentanyl and don't have any understanding what the potency means. There is an other, safer way to abuse Fentanyl but this method still creates a hugh tolerance very fast.

Abusing Fentanyl is bad bad bad because of the dangers related to its high potency.

Offline roxyoxy (OP)

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Re: This looks bad ...
« Reply #15 on: December 10, 2016, 04:01:38 PM »
Here in Canada, the government seems quite progressive with regards to the opioid epidemic. We have government run Needle Exchanges where one can go and get all the syringes and cookers and things you might need so all your stuff is new and sterile. Totally free and no questions asked. Is there anything like this in Germany, or do you just get your supplies at a Pharmacy?

We do have Needle Exchange programs in the big cities. In big cities we also have automats were drug addicts can buy needles & everything else you need to consume intravenous Heroine in a safe way. Well it is not medical sterile but still as safe as you can get on the street.

Exchanging needles and consume Heroine in of these consume rooms is free but you have to register with your name and follow some rules like not hanging around in the front of the entrance door.

I sometimes buy needles in the pharmacy to inject Testosterone or just for some experiments. They always treat me very professional. Needles are cheap but needle sharing is still a problem in prison.

Not every prison has treatment programs for opioid addicts. So some still consume Heroine when they can get their hands on it. And of course it is problematic to get fresh needles in a prison so needle sharing is problem in these institutions. Some organisations advocate for needle automats in prison but of course the authorities will never ever allow such automats. There are no drugs allowed in a prison and so there is no need for needle automats. But still people get infected with Hep-C & HIV because of needle sharing in prison. You can't keep drugs outside a prison.

Offline roxyoxy (OP)

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Re: This looks bad ...
« Reply #16 on: December 10, 2016, 04:37:17 PM »


It's been over 20 years since the maintenance over here got going, and things just looking worse over time instead of have improved.

Take homes are the main tool of controlling, manipulating, blackmailing, humiliating and generally breaking people down since they don't want (or maybe just can't afford themselves) totally get rid of them (I mean remove clients from the MMT, for oh-so-obvious financial advantages).
It's an "ultima ratio" of the staff, kinda simplest, behavioral shit, as efficient as fairy easy to handle/use.
Take homes are that special point around which revolves the world of MMT.
Could be said, it's what kinda sets all in motion, in some very sick way.

...

 

Sad to read your story. It always reminds me how lucky I am having access to opioids without any troubles. In some cases it just doesn't seem fair to distinguish between chronic pain patients and patients with a habit. Someone with a habit can be very responsible and another person with the same habit extremely irresponsible. It looks like that the approach from many doctors is to assume the worst case.

Could you explain what you mean with "MMT"?

"Take Home" is the legal expression in Germany. These two words are written into the German narcotic law (Betäubungsmittelgesetz, BtmG).

Well, the Benzo thing. In Germany it would be impossible to get Take Home prescriptions when you take Benzodiazepines. When you take Benzodiazepines you have a huge problem with your doctor because the combination of Benzos and Opiods is considered extremely dangerous which under some circumstances is very true.

In your situation however it is just sad and the reason you left this "therapy" is completely understandable. Many patients in Germany leave treatment for similar reasons and go back to Heroine or start buying Methadone, Buprenorphine and everything they can get from the street. This may work when you live in a big city like Berlin and have enough but most go straight back to Heroine because they prefer to keep their dignity.

In Germany most doctors tolerate it when you consume Cannabis but every other substance can with abuse potential can lead to huge problems. Sometimes you just can't get Take Home prescriptions but often you are subject to high frequent urine or spit tests. Consuming Heroine together with Methadone is tolerated for a while but when you can't stop the Heroine you have to go.

Many patients feel that the doctors are abusing their power and that they are just a tool to make money.

I do know that things aren't that bad as some say but it is hard to tell how things really are because I am not part of this system and every doctor is different. But ya, your story fits in the German system perfectly.

Benzodiazepine maintenance treatment only works for a small percentage of patients under 1% I would say. Most others just develop more and more psychological symptoms. Too bad that after so many years of successful treatment a young doctor who is afraid to make a mistake and is guided by his prejudices his unwilling to look at your situation with an open mind.

I am sorry   

Offline nikita70

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Re: This looks bad ...
« Reply #17 on: December 11, 2016, 06:11:03 AM »
@roxyoxy ,

Thanks a lot for your respond.
With MMT I do mean Methadone Maintenance Treatment what is an official expression for this type of therapy in English-language countries, using alternately with a term "substitution", as I believe. However, I noticed the term "maintenance" tends to be avoided where I live, because of the subtle suggestion of a lifetime using and incurability entered/encoded in it, instead of the "right one" concept of slowly pointing towards sobriety.
It's meant as an opposite of the right direction, like "maintenance" versus "therapy".

Also, we don't use "Take Home" expression for description of this procedure in Poland. There's some other term, what sounds pretty ridiculous to me-might be freely translated as something akin to an "advance", like an "advance payment". "Did you get an advance for your holiday?"
This is some colloquial expression, but even the staff of the clinics used to tell like this. The formal term sounds quite enigmatically, too-"home treatment".     

As for benzodiazepines-the saddest part of the story is that even if they are basically forbidden to use for methadone patients, I've been prescribed them right IN THE METHADONE CLINIC for 16 years. So how could they put my life upside down just because of the new doctor's "whim"? I'm not going to blame the prior doctors, since they didn't "administer" me this pills, just following my wish to get a script without to ask me any extra questions. Also, they kept turning a blind eye for using cannabis, what is over since the new doc is in charge.

As for my decision, I have enjoyed the privilege of 2 weeks long Take Homes since they only have such a possibility implemented-never ever tested positive for opioids or speed... Take Homes were always somehow crucial to me-something like a measure of freedom within my dependency.
I'm searching for some private doctor, who is ready to prescribe me methadone or morphine.
Bupe is the last resort since there's something WRONG with it. The point is this is strong, indeed, but kinda wrong oriented.
That's how I feel it. People report it's not STRONG enough, as I consider it to be some pretty potent stuff working the wrong way.
No matter how much would I do, I never be able to get this typical opiate relief I used to expect from this type of meds.
I can feel as if I had much enough, maybe even more than I need, and symultanously I do experience some severe deprivation/shortage "on the other side".
I think my reaction perfectly reflects/matches with the profile of this drug-as Kappa(??) receptor is "affected", the "Mi" one left still unsatisfied, so to say, this is why my system sends me kinda "mixed messages". 
As if there were some void, some inherent vice built in this shit.
This is some pretty efficient painkiller, but its mixed, antiagonist/antagonist properties kinda "nullifies" it for addicts. It seems not to be a proper answer for people who are used to the very distinct episodes of relief, warmth and safety coming from outside.
I definitely prefer "unipolar" (so to said) opioids (like morphine, codeine or just natural opium), even if they work milder.
I can always do more to multiply/improve the result, without to risk any extra dose to increase undesirable  side effects (headache, feeling uptight and       
annoyed, not to be able to stop and take some rest, kinda "bad speed" effect).
 
« Last Edit: December 11, 2016, 06:20:15 AM by nikita70 »
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Offline roxyoxy (OP)

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Re: This looks bad ...
« Reply #18 on: December 11, 2016, 07:26:33 AM »
I never experienced any feelings of safety, relief, euphoria when taking opioids. They just are a very effective instrument to control my RLS symptoms.

About buprenorphine: there are also many opioid dependent people who are quite happy with it and I know reports were patients prefere it even over Heroine because sometimes buprenorphone can have some unique antidepressent, stimulating effects.

Some say they don't like it because it isn't a warm opioid like Methadone, Morphine or Heroine.

In my opinion it shows that there are many different types of opioid addiction / dependence and this is why we need different options and not used Methadone and Buprenorphine because Methadone can have some nasty side effects like insomina, non existing libido, massive weight gain, increase of QT time and Methadone also is very hard to stop when you can switch to Heroine or Morphine before reducing the dose.

And yes, buprenorphine is a potent opioid but because of its pharmakodynamic profile its effect are limited which is fatal overdose almost only can happen when it is used together with alcohol or benzodiazepines. This makes buprenorphine the safest opioids of all the potent one's.

I aggress: some private discrete Doctor who silently writes you the necessary prescriptions would be best for you.

Offline Chip

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Re: This looks bad ...
« Reply #19 on: December 11, 2016, 07:57:43 AM »
The main reason they push bupe, apart from it's intense affinity for receptor binding, is because it is very safe due to it's low ceiling.

Tolerant individuals will find it near impossible to OD as well as preventing OD.

However, opiate naive individuals have the opposite problem where if they OD on Bupe then Naloxone won't pull them out of it unless given bolus doses of 3+ g. followed by high dose infusion.

I have never met a recreational Bupe user so I can't comment further.

I have never tried Bupe and don't expect to.
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Offline roxyoxy (OP)

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Re: This looks bad ...
« Reply #20 on: December 11, 2016, 05:57:23 PM »
The main reason they push bupe, apart from it's intense affinity for receptor binding, is because it is very safe due to it's low ceiling.

Tolerant individuals will find it near impossible to OD as well as preventing OD.

However, opiate naive individuals have the opposite problem where if they OD on Bupe then Naloxone won't pull them out of it unless given bolus doses of 3+ g. followed by high dose infusion.

I have never met a recreational Bupe user so I can't comment further.

I have never tried Bupe and don't expect to.


I've read posts from recreational Bupe users. Some say it is the best opioid they ever tried and they prefere it over everything else.

Some like the activating effect it has and those wo don't like it complain about sleeping disorders.

I can remember one guy who wrote it is the one and only drug from him and Bupe is all he wants.

So my conclusion is that it can be highly addictive to some folks while the big majority enjoys classic Opiates like Morphine, Heroine or opioids like Oxycodone much more.

And you are right: Bupe is hard to antagonise if opioid naive individuals OD on it.

You then have two other options despite high dose Naloxon: (I don't know if Naloxone will always work)
 
a) you can ventilate them if you know how to and later just intubate them
b) use a more potent opioid antagonist then Naloxon or mixed antagonist at the mu and agonist at the kappa-Receptor.  There are like 1 or 2 options but most likely the average ER won't have them.

Probably ventilation is the only safe method to safe someones life in the field. Especially in the field high doses of Naloxone are probably not always available??

Offline Griffin

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Re: This looks bad ...
« Reply #21 on: December 13, 2016, 01:50:34 AM »
Hey @roxyoxy sorry to detract from the thread but I have a ton of questions for you about Germany if you don't mind answering some of them when you have some free time. I read the thread so sorry if you answered these already and I missed it.

Is methadone available in jails and prisons in Germany, like if you are prescribed to it, will they continue to give it to you while you are in jail or in prison? How expensive is Methadone treatment there, is it free, or does it vary in different cities?

Is weed(marijuana) legal there for recreational or medical purposes and if so to what degree? like what are the punishments if illegal or stipulations around it if it's legal? What kind of heroin do you guys have mostly, brown powder, white powder, black tar? What are the criminal punishments for possession of heroin or other opiates? Is it a crime to possess syringes? Is narcan(naloxone) readily available?

Sorry for all the questions I would love to travel there and was just wondering about the laws and such and am curious about these types of things in all parts of the world. I live in Colorado and we were one of the first states in the US to legalize weed for recrational purposes for adults if you are curious about any of that feel free to ask. We finally passed a law last month allowing some bars and clubs to allow weed use, but the law is poorly written so I don't know if there will be any that actually open up.

Like people above me said the laws vary a ton from state to state, each state is different, like here weed is legal and where I am from Oklahoma which is one state over you can life in prison for some weed crimes. We also have needle exchanges and the one where I live is freaking awesome, they dispense narcan, needles, cookers, cottons, alcohol swabs, clean water, needle disposal boxes, tourniquets, and everything else you might need for free.

They also do needle clean ups in the city once a week, and get needle disposal boxes put in high use areas, and a ton of other stuff to make it easier for us. They lobbied to get a law passed so now it's legal for everyone who is registered with the exchange to posses syringes and everything else needed for IV drug use so you can't charged with any crimes for having them on you. They also help pass the law which makes narcan available without a prescription.

There is mainly only black tar heroin here so overdoses aren't as high as they are in some states on the east coast, because there isn't hardly any fentanyl laced heroin here. Opiate use and traffic accidents have both gone down since weed was legalized too.

Offline roxyoxy (OP)

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Re: This looks bad ...
« Reply #22 on: December 15, 2016, 01:19:06 AM »
Methadone availability in jails depends on the jail. Some offer treatment with Methadone and Bupe, some don't. We do have around 80,000 people in prison and 25-30% of those are addicted to drugs like Heroine.

In a prison in Bavaria a patient was denied treatment. He sued the prison and ended up at the European Court for Human Rights. This court ruled that denying him access to treatment is a violation of (his) human rights.

So in theory everybody in prison should have access and even Chancellor Angela Merkel signed some paper that by 01.01.2011 some european guidelande, granting everybody in prison access to MMT is implemented.

But the reality is different. In all depends on the doctors and the state the prison is in. Most patients still don't have access to treatment and infect themselves with HIV or HEP-C when they share needles in prison.

They say methadone treatment is around 1,000 EUR per month but from people who have a private insurance or pay for treatment by them self I heard it is more like 300-400 EUR / month. Insurance always will pay for treatment and in Germany almost everybody has insurance.

Methadone treatment has the same price in every city. Treatment with Buprenorphine is more expensive because Buprenorphine is more expensive then Methadone. Since April 2015 we have treatment with Morphine. Morphine is even more expensive. It all depends on how much the drug does cost.

Weed is not legal in any state in Germany but if you just consume or have a small amount of weed with you, depending on state between 5 - 15 g, you won't get into trouble, at least not legally. But if you have a driver licence the police sometimes reports it to the driver licence authorities and they may question you or call you in for drug testing.

In cities like Berlin the police won't care if you smoke weed. They most likely will just ignore if you don't provoke  them or looking for any kind of trouble.

I don't have information what kind of heroin we have. In real life I have like no contact to the Heroine scene. I had a friend there for a while but I stopped contact. From all I know the "public" sold Heroine has poor quality. It looked like brown powder. They say it has a quality between 5-10%. So if you don't have any private connections you will most likely get bad quality. 1 gramm sells for 10 EUR (or 10 EUR for one bubble, how they say).

Criminal punishment for heroin (and other opiates) is a complex topic. In general it is fair to say that they will allow you to keep your stuff in a city like Berlin or Frankfurt but in Munich they will probably arrest you but in the end nothing much will come from it because they let you go after 24 hours and the state's attorney will drop the case.

Of course it is something different when they catch you with 100 gramms of pure Heroine. In theory up to 5 years in prison is possible, probably 10 years but for 10 years you need to be super criminal who smuggles tons of Heroine.

You can buy needles and syringes in every pharmacy. We also do have needles exchanges and supervised rooms were drug users can safely consume their Heroine. Also some places have automats were you can buy all the stuff you need to inject Heroine (except the Heroine itself hehehe) like Coke.

You will need a prescription for Naloxone but if you give the pharmacist a damn good reason he could sell it to you without a prescription. But that would be unusual.

We don't have any Naloxone in Europe which you can administer through the nose like they have in the U.S.

We simply don't have so many opioid overdoses and deaths related to the use of opiopiod prescription painkillers. That's why the issue of Naloxone availability probably never came up.

The Naloxone we have is available in vials / ampules. You'll need needple plus syringe and then you can inject it i.V. or i.M. s.c. would probably work, too.

Every pharmacy is forced by law to always have some Naloxone available. 

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Re: This looks bad ...
« Reply #23 on: December 15, 2016, 10:36:16 AM »
Your awesome thank you for the reply and all the answers! It looks like they are more progressive there then here, I might have to research more about it now. It sounds like a pretty legitimate place.

Offline roxyoxy (OP)

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Re: This looks bad ...
« Reply #24 on: December 15, 2016, 05:55:57 PM »
Your awesome thank you for the reply and all the answers! It looks like they are more progressive there then here, I might have to research more about it now. It sounds like a pretty legitimate place.

Germany is in many ways just very reasonable and professional. We learned from our mistakes in the past.

For example of course we try our best to integrate all the refugees from Syria etc. because if just ignore them a big group of them will turn criminal, start selling drugs or turn to organised crime because they simply don't have any other way of living.

We have hard battles in our politic system and so often it is so annoying but at least the outcome in numbers is very good for us. We have free universities, free health care for everyone who can't afford to pay insurance and there is no difference in quality.

We also do have some private insurance system but only around 8 Million are in this system. The fees become very expensive when you get older and have more health problems. Only people who worked for the government / authories can really pay there fees because 80% of the costs are paid by the state and they only have to pay 20%.

When it comes to drug laws Switzerland and Portugal are even more progressive. And Austria had a Morphine Maintenance Program years before we had one in Germany. Switzerland also has regular Heroine tablets and not just a a Heroine i.V. program like we have in Germany.

After all middle and west / north Europe are in many ways more liberal then the most liberal states in the U.S.

I think there are already some clubs in Spain or Portugal were regional people can buy cannabis and of course we have the Netherlands. The regional parliament in Berlin is discussing legal ways how to open a legal store who sells cannabis because there are some parks in Berlin were they sell weed like hot-dogs. The police doesn't find any solution to this problem and they don't want anymore. It is just not possible. However federal law is creating problems.

In general Germany is a very good place to live but sometimes it is just not warm enough and the people like to complain too much, especially about refugees.

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