This looks bad ...

[roxyoxy]

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.

[Chip]

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.

[bonedust]

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.

[roxyoxy]

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.

[nikita70]

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?"   
   

[Snout]

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....

[Chip]

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 !

[dizzle]

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?

[roxyoxy]

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.

[roxyoxy]

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. 

[Chip]

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.

[mickeyaye6989]

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?

[Thoms]

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 (laugh cricket laugh)

[nikita70]

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".       

   

 

[roxyoxy]

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.