dopetalk

Core Topics => Drugs => Opiates & Opioids => Topic started by: roxyoxy on December 09, 2016, 03:27:16 AM

Title: This looks bad ...
Post by: roxyoxy on December 09, 2016, 03:27:16 AM
I'm from Germany, med school student and taking opioids since 2011 for chronic pain related to a severe Restless Legs Syndrome, worsened by over a decade of mistreatment with antipsychotics, Lithium and antidepressents.

My dose equals aprox 200 mg Morphine, a dose I most likely never would get in the U.S.

The U.S. have 20.000 deaths per year related to opioid painkillers and another 10.000 related to Heroine.

In 2015 Germany had a total of 1226 deaths related to the abuse of drugs and narcotics. In Germany we treat people addicted to Heroine / opioids with Methadone, Buprenorphine, Morphine and even Heroine. But Heroine is only available in some special clinics. Patients have to visit these clinics two times a day and inject their dose of Heroine their. Needles can be bought at everywehere. There is no prescription necessary.

I want to ask: is it really true that you need a prescription to get needles in the U.S.? I know about the severe problem with Hepatitis-C because of needle sharing. This is so scary! In Germany almost every big city (except the ones in the South East who are more conservative) has rooms where opioid addicts can go and consume under supervised circumstances intravenous Heroine. We also have some towns were the consume of Crack (intravenous or using a pipe) is possible.

The 1226 deaths in the year 2015 includes prescribed Methadone. I couldn't find any number for prescribed opioid painkillers. Looks like we don't have any big problems with prescription painkillers.

I monitor the scene since 2011 and for addicts it is kinda hard to get a prescription for opioid painkillers while it became easier for regular patients. Yes, some people sell drugs like Morphine or Oxycodone on the street but Methadone, Buprenorphonie and of course Heroine is way more common and cheaper.

Also doctors don't prescribe opioids that easy but when there is a real reason you will get a prescription.

I was started on Oxycodone at the age of 27 and I didn't ask for it. It came as a complete surprise.

In Germany doctors are somehow more conservative then in the U.S. Also drug advertasing is way more regulated and in general everyone knows here that opioids are f***** addictive.

But when you look at the U.S. now it seems to be almost impossible to get a prescription for opioids. I follow the international RLS discussion board and almost everyone has trouble getting a prescription for opioids and when they get one it is only short term and low dose or only to specific RLS drugs who made problems but rarely as a long term solution.

For sure doctors in the U.S. would see me as an addict, overpresenting symptoms and cut me off from the opioids. Scary! It took years to finally stabalize and opioids are a big help but I still need other pain medication to control my symptoms.

And as an addict in the U.S. .... it doesn't look like that their are many doctors and clinics where you can get a methadone or buprenorphine prescription.
And of course methadone is causing a lot of problems and buprenorphine very often is just not "strong" enough. This is way Austria started to introduce Morphine as a treatment option for addicts. Later Switzerland followed and since 2014 Morphine is used in Germany, too.

Just look at the numbers relative to the people who live in these countries and then look at the U.S.

I just hope the situation improves now since so many people from the white middle class are now affected by opioid addiction.
Title: Re: This looks bad ...
Post by: Chip on December 09, 2016, 05:29:45 AM
Germany sounds very progressive.

I see no reason to not prescribe Morphine or Heroin.

You are very fortunate to live there ... and welcome to our site.
Title: Re: This looks bad ...
Post by: bonedust on December 09, 2016, 05:37:14 AM
It varies state to state. In my state you do not need a prescription to get syringes. It also is at the pharmacist's discretion whether you get them or not.
Title: Re: This looks bad ...
Post by: roxyoxy on December 09, 2016, 06:23:18 AM
Germany sounds very progressive.

I see no reason to not prescribe Morphine or Heroin.

You are very fortunate to live there ... and welcome to our site.

Yes, compared to the U.S. Germany is relatively progressive but we still have issues.

Morphine was introduced in 2014 and many doctors who substitute opioid addicts are very sceptical about using it because they fear intravenous abuse. Most doctors who use it only offer the option that patients take it directly at the clinic / doctor's office. And many still don't use Morphine because of the costs and discussions with the insurance companies.

Also it is very hard to find a doctor who treats addiction when you live outside the big cities. In the countryside and villages doctors who treat addiction are full and don't accept any new patients. There are long waiting lists.

And Heroine is only available in 8 big cities like Frankfurt, Berlin, Stuttgart & Hamburg. Most patients don't have access to the Heroine program.

Well and even if you take Buprenorphine, the German narcotic law only allows Take Home prescriptions for a maximum of 7 days. So even the socialised working addicts who are stable on Buprenorphine or Methadone have to see their doctor every 7 days to get a new prescription.

Once per year they are allowed to get a prescription for a maximum of 30 days to go on vacation but this is associated with a lot of paperwork.

Oh and most patients have to see their doctor or some clinic every day. "Take Home" is an exception, only for the most reliable patients and some doctors don't have any "Take Home" patients at all because they can make much more money when the patient has to come every day. And even the law says that "Take Home" only is an exception. There are lots of fights about this topic and how the law should be interpreted.

There are doctors who really wanted to help their patients but in Bavaria (the state where Munich is the capital) the government is trying everything they can to enforce narcotic laws. Doctors who have been to liberal got prosecuted and lost their licence and worse. But there you have it. The state who is most conservative and is trying to enforce the laws the strongest also has the most deaths (in percentage related to population and I think in absolute numbers, too)


My Neurologist writes a Hydromorphone script for me for 100 days and for Morphine around 65 days. I can get a new script without seeing him. I think the nurses at the doctor's office control after how many days I ask for a new script but since their never have been any issues things got very liberal. Also this is a practice where they don't take any patients with addiction or severe psychiatric disorders. I also get Oxycodone because sometimes Morphine doesn't work so well. They write a script for 50 days and I can take it as I feel necessary. The last script for Oxycodone held 1 1/2 years. So I guess they see me as a very responsible patient and another factor might me that I am med student. Hm and I have to admit that 1 1/2 years ago I was taking a much higher dose ... around 500 mg of Morphine and was going higher and higher. But this was related to other medications who were worsening my RLS. After stopping this drugs and I came down to 150 mg Morphine within 14 days. This also maybe dissipated fears of addiction and abuse.

So after all Germany is not paradise. Austria is a real conservative country. Much more then the state of Bavaria but somehow they are very liberal when it comes to the treatment of opioid addicts. Morphine is relatively easy to get as a substitute and because of this it was and still is heavily abused. They inject the pills and many addicts get doses around 1,000 mg of Morphine and more. They inject 3 x 200 mg during the day and sell the rest to buy Heroine or other drugs. This is why many politicans and doctors were afraid of using Morphine as a substitute in Germany. Doctors started using it very slowly. For now it is almost impossible to buy on the black market, even in cities like Berlin, Frankfurt, Hamburg or Munich.

Switzerland is probably the most progressive country. It is the only country I know of who uses Heroine-Tablets. Of course pharmacology it doesn't make that much sense because 99% of the Heroine is quickly transformed into Morphine before it reaches the brain. So you could give the patients just Morphine tablets or pills and very likely it would have the same effect on them. But maybe the psychological effect shouldn't be underestimated.

I also know the countries like Portugal, the Netherlands & the Czech Republic a very progressive. I don't know so much about the Scandinavian countries but these countries have often been a little more advanced then the countries in central and west Europe.

I am really interested in the situation in the U.S. and how the states approach this opioid epidemic. I watch videos on YouTube and read articles on Websites but my experience is that you get the best information from the people who experience it.

Germany is not paradise but I have to say we are a very well organised country. Everyone can get insurance and treatment for his addiction. You have to pay 5 EUR per prescription and if you don't have money you even can get around this. When you don't have an apartment and living on the street because of addiction it may take some time but the local authorities will help you find an apartment. You start low like living together with a lot of other people who just have been homeless but in the end you can have an apartment on your own. But you can see that many people don't have the patience. They want everything just now, can't wait and often destroy their live with alcohol.

Still sounds all like paradise when I think about the situation in the U.S. and how some people live.

In the end it is like this: up to date treatment of opioid addiction can improve the life of the addict, resocialize him in many cases, make him an tax payer and ultimately save the society a lot of money.

Title: Re: This looks bad ...
Post by: nikita70 on December 09, 2016, 09:47:29 AM
Thank you for sheding some light on the subject.
Glad to hear that Germany follows the "good (or rather the best ever) practice" of its "oldier siblings in substitution", like Switzerland or UK, so to say-even if the the word "substitution" somehow "underestimates"/might be not the most proper word to convey the procedure of giving people EXACTLY what they want (heroin "maintenance").
By the other hand, it's hard to me to figure out even the most obstinate/zealous junkie ever to be able to cope with the "handcuffs" being at least twice as short and tight as i.e. those methadone induced.
I mean the idea to get to the clinic every day just to say "hello, nurse, that's me again" and swallow your dose (without even having an opportunity to "adjust" the schedule of dealing with your medicine to your own needs and rhytms) is bad enough, but, hell, to be a twice-a-day-frequenter over there seems to be an option for desperados only.
I have no doubts this outrageous regimen might be able to deter even the most greedy and voracious individuals ever. Do they accept sick(!) leaves at least?
"Sorry I missed my yesterday's evening shot, but I've been way too sick to get there. My welfare just arrived so I just took an easy way and knocked my nextdoor guy. Maybe you should consider home delivery or so?"   
   
Title: Re: This looks bad ...
Post by: Snout on December 09, 2016, 02:31:51 PM
If you want some first hand views on what it's like to be a junkie in the states, I can shed some light: it fucking sucks! We are treated like criminals. The stigma is tremendous. The methadone laws are absolutely ridiculous. No morphine maintenance .
     However, we have lots and lots of HEROIN!!! God bless america....
Title: Re: This looks bad ...
Post by: Chip on December 09, 2016, 05:22:04 PM
roxyoxy, I can see that you are well trusted, good for you !

I no longer use opiates or inject anything but found far more value in the extended release Morphine when taken orally. I found IV M. to be too unpleasant and too short in duration.

In some cases, here in Australia, some people can transition to Morphine from Methadone if the Methadone causes complications to their health.

Australia is in some way lenient but still closer to the USA in it's stance on opioid addiction treatment - Bupe is the main treatment of choice for new patients as Methadone is seen as a riskier option.

Hydromorphone is only used in hospitals and you have to jump through hoops to get Oxycodone or Morphine.

I really think that I'd love to visit Germany one day !
Title: Re: This looks bad ...
Post by: dizzle on December 10, 2016, 12:39:12 AM
for the record, those numebrs you've stated of deaths in the US HAVE TO BE incorrect. The way doctors are TERRIFIED to prescribe opiates and the cheap, ease of availablility of heroin would shock me if heroin wasn't killing more people than prescriptions.


I know what the "official numbers" say, but I personally have a feeling those numbers are skewed to show the prescription "epidemic needs to be fixed".... I know, let's have the DEA regulate it more! Yeah! That's the ticket! Shiiiiiiit.....

Honestly, I don't trust official numbers. I think a lot of the "official stories" are made to make the public opinion sway a certain way. I don't believe them. Unless I literally saw each and every coroners report on every death, I wouldn't believe it.


I'll give you a PRIME example:


This was last February, my best friend was not answering his phone. He was in a bad place at the time, not literally, he had his own apartment, but I mean figuratively. He was shooting dope and crack every day.

I had keys to his place as he had keys to mine, we were homeys like that. I went to his place and found him dead on his bed. It was a bad fucking scene in there. Needles and crack pipes all over. cookers and empty bags.

I called 911 after I regained whatever composure I could muster after walking into that scene and feeling his cold bloated skin as I tried to feel for a pulse on his neck.


The pigs came in and took a look around, immediately walked out, told the fire department to just leave, called the bodysnatchers (literally that's what the called the people that come get the body). I spoke to the homicide investigator for a moment as he asked me the typical questions, after it was done he said "pretty sure the cause of death is multiple drug toxicity", which I knew was false, he hadn't gotten paid and didn't come into any cash recently (still hadn't gotten his tax returns), so I knew he didn't OD.

When I saw the coroners report later, they called it prescription drug OD.

no joke, apparently because methadone and diphenhydramine was in his blood that's what they called it. They neglected to factor in the heroin and crack, and the fact that he had an enormous blood clot and persistent infection in his foot.

So, don't believe everything you read. The US LOVES to skew data by moving the reporting around.


Take chicago for example, you hear about all the gun deaths. Well, years ago it wasn't that way, or was it? Well, becasue the police cheif wanted to lower the shooting stats to show he was doing a GREAT job, shootings were classified as something else, but not explicitly a shooting or murder. See?
Title: Re: This looks bad ...
Post by: roxyoxy on December 10, 2016, 08:25:37 AM
Thank you dizzle!

Well, I already knew that it may be hard / impossible to distinguish between death by prescription opioid painkiller or by Methadone / Heroine. Most people on Heroine also would take at least opioid prescription painkillers and most likely even Methadone when they can get their hands on it.

Medically is death by opioid / opiate overdose. So somehow all the same.

And maybe you are right. At least it wouldn't surprise when some states / departments are tampering with the numbers and that they classify a death as prescription painkillers when they just find one empty Oxycodone bottle or a little bit of Methadone in his system.

Personally I don't care so much if they died from opioid painkillers or Heroine. The medical background and the effects on the CNS are the same. And I have no doubt that many addicts got introduced into opioids with a valid prescription or getting an Oxycodone pill from a friend.

The sales of Oxycodone in the years after 1996 were just crazy.

Title: Re: This looks bad ...
Post by: roxyoxy on December 10, 2016, 08:36:11 AM
Thank you for sheding some light on the subject.
Glad to hear that Germany follows the "good (or rather the best ever) practice" of its "oldier siblings in substitution", like Switzerland or UK, so to say-even if the the word "substitution" somehow "underestimates"/might be not the most proper word to convey the procedure of giving people EXACTLY what they want (heroin "maintenance").
By the other hand, it's hard to me to figure out even the most obstinate/zealous junkie ever to be able to cope with the "handcuffs" being at least twice as short and tight as i.e. those methadone induced.
I mean the idea to get to the clinic every day just to say "hello, nurse, that's me again" and swallow your dose (without even having an opportunity to "adjust" the schedule of dealing with your medicine to your own needs and rhytms) is bad enough, but, hell, to be a twice-a-day-frequenter over there seems to be an option for desperados only.
I have no doubts this outrageous regimen might be able to deter even the most greedy and voracious individuals ever. Do they accept sick(!) leaves at least?
"Sorry I missed my yesterday's evening shot, but I've been way too sick to get there. My welfare just arrived so I just took an easy way and knocked my nextdoor guy. Maybe you should consider home delivery or so?"   
 

You are right. Doctors and patients altogether complain about the handcuffs in the German system. Doctors could be more liberal with Morphine maintenance because the same rules apply for all opiates / opioids (except Heroine) used in substitution.

Many patients feel bullied by the system and yes, even when you are sick you have to come get your script. In theory the doctor then could write a 2-day or 7-day prescription but I don't know if they do it or if patients even bother to ask.

The cynicism you expressed is how many patients. Just getting up daily at 6 am and run to your doctor for your daily dose of Methadone / Morphine is bad. Some doctors have longer hours but when the doctor also has lot's of regular patients his opioid patients have to come before normal patients arrive. I think you can guess why. 
Title: Re: This looks bad ...
Post by: Chip on December 10, 2016, 09:00:01 AM
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.
Title: Re: This looks bad ...
Post by: mickeyaye6989 on December 10, 2016, 11:48:14 AM
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?
Title: Re: This looks bad ...
Post by: Thoms on December 10, 2016, 12:15:43 PM
There are two really really huge things that jump out at me. Number 1, the access to Narcan tells the tale of just how hated us junkies are wherever we may be. And number 2, heroin is better without the e at the end :D (laugh cricket laugh)
Title: Re: This looks bad ...
Post by: nikita70 on December 10, 2016, 12:17:45 PM


Well and even if you take Buprenorphine, the German narcotic law only allows Take Home prescriptions for a maximum of 7 days. So even the socialised working addicts who are stable on Buprenorphine or Methadone have to see their doctor every 7 days to get a new prescription.

Once per year they are allowed to get a prescription for a maximum of 30 days to go on vacation but this is associated with a lot of paperwork.

Oh and most patients have to see their doctor or some clinic every day. "Take Home" is an exception, only for the most reliable patients and some doctors don't have any "Take Home" patients at all because they can make much more money when the patient has to come every day. And even the law says that "Take Home" only is an exception. There are lots of fights about this topic and how the law should be interpreted.

There are doctors who really wanted to help their patients but in Bavaria (the state where Munich is the capital) the government is trying everything they can to enforce narcotic laws. Doctors who have been to liberal got prosecuted and lost their licence and worse. But there you have it. The state who is most conservative and is trying to enforce the laws the strongest also has the most deaths (in percentage related to population and I think in absolute numbers, too)

Sounds exactly, I mean E-XA-CTLY like "sweet home Krakow"... Different country-same shit.
However, two diffent countries may as well share the same "backyard", right? Didn't I tell you we are from the same "hood"?
(as for the word "hood", you were not sure the meaning/context of, I'm not too much versed in American slang, but seems me it's just the abreviation of the word "neighborhood" and refers to the area you share with your HOMIES/HOMEYS(?). If you hear (read) someone talking about one's "hood", then be sure to expect the word "homie"/"home" to emerge sooner or late. I noticed these both words are somehow tight related and almost always occuring together, as if they were inseparable. I'm also not sure if the wordplay between "hood" meant as headgear (typical for gangstas living in their "hoods") and "neighbor-hood" is deliberately or coincidentally.)   


@roxyoxy ,

Take-homes at that. (Sigh.)
Man, you are that one who said this term first, not me. (kidding) 
And you did it without even to know you have opened a Worm Box. You'd better don't start me to get into it.  :(
"Take-homes" is definitely the mostly "sore" point and the weakest link, so to say, within the Polish substitution system.

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.

The main reason of whole evil that occurs in clinics.
This is what makes almost all fights keeping. Almost all tears sheding. All hands shaking out of anxiety. All curses murmuring under breath.
From crying to slamming the door. From snitching each other to the doctor, to almost sueing the same doctor to the court.
 
Any reason is good enough to cancel your take homes. I have lost them, just like that, after 16 years (sic!) of being a faultless, exemplary one patient (just listen to how loony does it sound, "an exemplary patient", are we in some Kindergarten or so?).
The official reason was I have had positive tested for benzodiazepines, the pills I've been constantly and legally prescribed (needless to tell have a nice habit developed) over all this time, by both of PREVIOUS DOCS who have run the Program before this new shrink has emerged like out of the air and put the world upside down.
They (the predecessors) apparently didn't deem using benzos (not "abusing", just 2mg/day) to contraindicated as in MMT. 

Long story short-I gave up the treatment since it was getting obvious this shrink is going not to give me ANY break/not to break off, by no means, however, the final, crucial "trigger" was not what he did, but the way he was acting-I mean his endless arrogancy and willfullnes I don't wanted to be a part of (or rather the "subject" of) anymore.

I was sure I'm going to be able to make it on prescripted bupe (not any childish rules and humiliating procedures), but I definitely underestimated how my "monkey" has acquired strenght since my last "transitioning"/switching, that has been proceeded relatively painless.
So I ended up at the point I truly believed never ever to find myself again.
 
After about a month of drudgery (insomnia was definitely the most burdensome symptom ever since I wasn't able to sleep a wink without of some additional dose of benzos and barbiturates), so I gave up and back to the 'done, since I just couldn't afford to develope an extra-habit, as these two ones (opiates and benzo) are bad enough to struggle with.

As I wonder about the balance of the profits and loss this shrink has exposed me for with his thoughtless decision, the result is like ONE (or rather ZERO) to TEN.
I mean I'd be able to name at least TEN or even more harmful results, (the lifethreatening/lethal ones including)-these already ongoing (under way) and those potential, that I HOPE never to come true/happen.

I do really wish he could see that monster avalanche of harm and pointless pain induced by his "anti-benzo crusade"(I'm not the only one affected by).
I don't wanted to sound exalted and spoiled, but the "nightmare scenario" involves losing freedom (and maybe even life, as a result of complicated, acute w/d from both substances-benzos and methadone symultanously), just for two pills of benzodiazepines per day.
Does shit like this make any sense at all?   

My life got literally paralysed and stuck "deadlocked" since I realized I need to rely on "swinging moods" of the vendor, so each next dose might be questionable-over the 16 years of "prosperity" and safety I totally forgotten how bloodcurdling and weird does it feel.

So not any plans for me at the moment, since I lost my grip. All my daydreams to come true-nullified, thwarted or in the best case-postponed for an indefinite period.     
Living on the verge of panic constantly, freaking out every time the guy doesn't pick up the call ("He sure got caught so I'm done.")

Running out of my savings and almost being able to figure all this nice items I could buy instead and exciting things I could do-all gone.
And being fully aware something is totally wrong with this system and I didn't deserve such a maltreat, since I'm entitled to get it for free as I got it before for so long, but symultanously not to be able to help anything against this lawlessness.

Finding myself wondering "when the fuck are they going to finally start substitution in this city??? Do they wait until I'll be totally broke?" and suddenly recoiling as I realize THERE IS something AKIN to substitution existing here, but since I'm fired over there there's nothing to wait to me. 

Incriminating myself/take a risk every time I'm scoring the 'done, as I'm rather some neurotic book worm type of person than criminal.

Not being able to watch ANY drug war related documentary without to get paranoid and having obsessive thoughts plaguing me ("I may be the next one..."), no matter how ridiculous this idea sounds, since I just can't wrap my head around the idea/put my mind up to the idea I got deprived of the MEDICINE I use just to stand upright, so to say.

OK, cut the crap, you said "take homes" first so you are that one who started it. (kidding)

P.S. As for Bavaria/Munchen (sigh again), this is some superconservative area, indeed. I have had some doubtful "pleasure" to score over there in 1992. Englischer Garten, is this how this huge park in the middle of the city does call? 20ml of Kodeinsaft was able to fix me pretty well, since I didn't have any significant habit, rather an "initial one".       

   

 

Title: Re: This looks bad ...
Post by: roxyoxy on 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.
Title: Re: This looks bad ...
Post by: roxyoxy 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.
Title: Re: This looks bad ...
Post by: roxyoxy 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   
Title: Re: This looks bad ...
Post by: nikita70 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).
 
Title: Re: This looks bad ...
Post by: roxyoxy 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.
Title: Re: This looks bad ...
Post by: Chip 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.
Title: Re: This looks bad ...
Post by: roxyoxy 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??
Title: Re: This looks bad ...
Post by: Griffin 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.
Title: Re: This looks bad ...
Post by: roxyoxy 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. 
Title: Re: This looks bad ...
Post by: Griffin 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.
Title: Re: This looks bad ...
Post by: roxyoxy 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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