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Background: Since their inception, harm reduction services, including needle exchange programs, have aimed to improve and update knowledge about illicit drug consumption and injection practices in order to assess and regularly revise the effectiveness of preventive strategies. Methods: In this paper we describe the development of a scientific approach to obtaining this type of information through analysis of the residual content of used syringes. This was done using a validated liquid chromatography method with mass spectrometry detection to identify different molecules. Used syringes were collected from automatic injection kit dispensers at 17 sites in Paris and the surrounding suburbs each month for one year. Results: In total, syringes were collected. No compounds were detected in syringes. These analyses also showed the increased appearance of 4-methylethylcathinone between the summer and winter of Conclusions: Despite the bias involved in this approach, the method can provide rapid data on patterns of drug consumption for specific time periods and for well-defined locations. This kind of analysis enables the detection of new substances being injected and thus enables harm reduction services to revise and adapt prevention strategies. Abstract Background: Since their inception, harm reduction services, including needle exchange programs, have aimed to improve and update knowledge about illicit drug consumption and injection practices in order to assess and regularly revise the effectiveness of preventive strategies. Publication types Research Support, Non-U. Substances Illicit Drugs.

Trapped by the ‘Walmart of Heroin’

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By these signs ye shall know them. This was the portrait of the heroin addict in , offered by New York neuropsychiatrist Dr. Many are of engaging personality but, as often happens with personalities who are engaging, they are unstable, suggestible and easily led. Italian, Jewish, Irish, Scandinavian: they were the original second—generation ethnics. Philanthropy, though, was no more to be expected in connection with drug addicts in than it has been ever since. Heroin addiction was quite a new thing in the year Dr. Bailey was writing; new statistics just published by Bellevue Hospital showed that in just the last two years, the admission rate for heroin addicts seeking detoxification had soared from naught to nearly per year. Over the same two-year period, the admission rate for morphine addicts had plummeted from nearly per annum to zero. Since , thanks to a landslide of federal and state legislation restricting the availability of morphine, heroin had entirely supplanted it, with a notable surplus, as the drug of choice among the urban netherworld. The exclusion of heroin from the Harrison Narcotics Act is only explicable in view of the ignorance of the self-interested reformers and legislators who bullied it through Congress in March of They actually believed, along with quite a few practicing physicians, that heroin was a mild, non-addictive bromide useful in the treatment of respiratory ailments, and a promising adjunct for curing morphinists. In fact it was developed there by Heinrich Dresser, who in the s had confected aspirin himself—acetylsalicylic acid—as an alternative to sodium salicylate, a previously used analgesic which was, unfortunately, highly corrosive to the stomach. Substituting an acetyl molecular group for a sodium group turned out to be so stunningly effective that Dreser concluded he could do no wrong with acetyls. So in he took morphine, and inserted two tiny strings of acetyls between its great big matching alcohol and phenyl hydroxyl groups. The result, diacetylmorphine, was tested out on 60 patients at an Elberfeld dyeworks, and seen to be much more than a mere headache remedy: cough, catarrh, bronchitis, emphysema, asthma, and even tuberculosis responded most marvelously to this new drug. Period newspaper ads for Bayer Heroin grandiosely sang its virtues right alongside ads for menstrual and dyspepsia nostrums. The recommended cough suppressant dose was tiny, only three to five milligrams. But for only a little while. Within a few years after it went on the market, doctors everywhere were reporting some phenomenal side effects. A single dose of it lasted only a few hours. For a person with a bad cold, then, as many as four doses a day might be needed for a couple of days running, after which the patient would typically report some dreadful sensations: cramps, headaches, soggy sniffles, profound anxiety and depression, lasting for a couple of days more. If the patient had any remaining Bayer Heroin in the medicine chest, he or she was all too likely to take it, and then take some more. It was the same pattern that had been seen with morphine for generations, except, whereas it took weeks and months to build up an addiction to morphine, one could pick up a full-fledged heroin habit in just two weeks. By , then, a Heroin Debate had commenced in the pages of medical journals. The heroin debate was hot enough, though, to convince Bayer to soft-pedal its Heroin campaign, distributing it mainly to wholesale chemical companies to sell under various patented labels of their own. Doctors then as now derived virtually all their pharmacological know-how from drug-company ads, and in the absence of a Heroin ad campaign, most forgot, or never learned, that such a drug existed. At the turn of the century, when all this was happening, addicts mainly bought morphine on prescription or in patent medicines. Some were introduced to it by doctors. Physicians who considered the five-day hyoscyamine 'cure'—the most common detoxification procedure of the day—to be inconveniently messy and prolonged, were particularly keen on the two-day heroin cure as significantly tidier. Addicts tended not to go into hysterics or make messes when they were given diminishing doses of heroin; and when they left, they tended not to come back again very soon, which confirmed the idea that heroin was the detoxification for morphine. Such claims ceased abruptly after , but not before the philanthropic St. James Society had been persuaded to mount a massive campaign to supply morphine addicts who wanted to give up their habit with free samples of heroin, through the mail. Those addicts who attempted to detoxify with heroin learned, of course, that they could get just as high on heroin as on morphine, heroin was still available everywhere. Even in places where local ordinances banned it and long after the Congress belatedly banned it , heroin was a popular item with black market peddlers, since its undistinguished greyish color makes it much easier to cut, with a wider variety of agents, than pure white morphine. An alarming number of these new addicts—at least the ones who showed up at Public Health Service detoxification clinics—were young, aged 15 to The fact that heroin was sniffable—requiring none of the messy and fearful hypodermic apparatus of morphine—considerably enhanced its recreational appeal. The next dozen years were hell, he righteously assures us, a succession of cold-turkey cares in the Tombs every time he got busted, and a few voluntary detoxification attempts which even included the horrible hyoscyamine treatment. The folks around him were pretty much as Dr. Pearce Bailey described them, young men and women of respectable intelligence and decidedly appealing personalities, who used heroin pretty much for all the reasons Bailey presents—urban blight, boredom, peer pressure—and then some. Recreational drug use was not merely an escape from it, but a fundamentally affirmative rebellion against it. Dehumanized beyond redemption, and distorted into something supremely distressing, they were from then on destined to star in the next wave of anti-drug lobbying. Improving horror stories increasingly linked heroin to youth gangs, crime, and the threat of incipient rebellion. Heroin, he asserted, caused youngsters to run amok like so many cocaine-crazed southern Negroes. And since nobody at the time really knew anything about what heroin was or did, everybody believed him. There were mitigating circumstances: these were uncertain times, peculiarly susceptible to the most paranoid fancies. According to Congressman Rainey, some 80, draftees had been rejected because of heroin addiction. Later records put the figure at about 3, After the war, between and , the country was shaken by a rash of Bolshevik bombings, violent labor strikes, and IWW Industrial Workers of the World agitation. No doubt, the most openly radical three years of American history since the Revolutionary War itself. He theorized that insecure, imitative, and easily led teenagers were seduced into radical doctrines for the same reasons they were seduced into the heroin habit. Such grievous admonitions were inflated by Rep. That figure, of course, was completely bogus—the only reliable estimate from this period, compiled by Public Health Service physicians Lawrence Kolb and A. DeMez in , put the actual count at about ,—but it was taken quite seriously by law makers, newspapermen, and the public at large, and the spectre of one million Bolshevik teenage junkies sweeping into the heartland caused much alarm. After World War I, a massive crackdown on doctors, pharmacists, and narcotics addicts was launched by the Treasury Department, with predictable results: the expansion of black-marketeering in heroin and morphine selling at grossly inflated prices, and the creation of a whole new criminal class, composed of a few addicts who, denied maintenance opiates by doctors, were forced to steal to purchase the black market product. Naturally the number of narcotic criminals in jails went sky high; by , fully one third of the prisoners in federal penitentiaries were Harrison Act violators, for the most part addicts doing long, hard time. The chief propagandist for this clever statistical fiction was Col. Richmond T. Hobson warned young mothers to periodically check the food their children and, and he also recommended:. Hobson was echoed by a host of civic minded Americans. But heroin apologists were far-flung then, and have been ever since. This, of course, is precisely what did happen in when Rep. Stephen Porter, with the help of the Treasury Department, pushed a bill through Congress banning heroin, and plugging up the Harrison Act loophole airtight, and for good. Once heroin was banned, statistics indicate that the numbers of youthful chippers and addicts declined drastically, as did the entire US population. When the Federal Bureau of Narcotics checked up in there were exactly 1, addicts under the age of 20 in America. It took time—whole decades—for organized crime to build the illicit drug trade into an efficient, thriving big business. But, given the sheer economics of it, it was inevitable that they would. In the remote jungles of Burma, where much of the opium for illicit heroin comes from, a kilo of crude opium sells for 25 dollars. That same kilo will be 3. A cash turn over like that has, quite naturally, attracted a host of implacably ruthless businessmen. Even so, the heroin trade remains a difficult, inefficient, and risky business. Raw opium must be purchased in the jungles and hills where it is grown, converted to heroin, and smuggled into the States on a regular basis—despite the efforts of Customs and narcotics agents—for the operation to work. After the Harrison Law was passed, it took organized crime 40 years to make the drug trade viable, but today these heroin barons reap great profits. From all indications, the first organized mobster to amass a fortune from illicit narcotics was Vito Genovese, whose territory during the s included most of Manhattan. As Genovese built his heroin empire, Harry Anslinger, the head of the Federal Bureau of Narcotics, was devoting most of his time to a propaganda campaign accusing Communist China of being responsible for the rising amounts of heroin on the streets, he did so in collaboration with Senator Joseph McCarthy, while all the while supplying McCarthy—who was himself a morphine addict—with pharmaceutical narcotics. The FBN during the three decades —60 that Anslinger ran it never once indicted or, it would appear, even investigated organized crime and the drug trade. In the end, it was organized crime itself that finally brought down Genovese and his heroin business. It worked: Genovese was convicted of narcotics smuggling and jailed for 15 years. Narcotics laws have not only benefited organized crime and criminalized addicts, they have also bred corruption in the ranks of those entrusted to enforce them. The very first narcotics commissioner, Col. Levi G. Nutt, was promptly retired after a federal grand jury disclosed in that his son, Rolland Nutt, a lawyer, had been working for Arnold Rothstein, an underworld figure who, even before Genovese, was enriching himself on the illegal drug trade. The grand jury also heard allegations that narcotics agents had routinely taken bribes, lost evidence in important cases, and padded their accounts by adding narcotics arrests made by local enforcement agents to their own record in an effort to secure more federal funding. However, even in the face of the most blatant evidence that the law and order approach to addictive drugs and drug addicts was not working, the grand jury recommended that the FBN be given more money, and that penalties for drug addiction be stiffened. This was done, with predictably disastrous results. Attempts to legislate drug addiction out of existence have resulted only in more addiction, more profits for organized crime, and more police corruption. Ironically, it was the American involvement in Vietnam that was substantially to blame for a surge in the availability of illicit heroin during this period. The successive South Vietnamese governments of Ngo Dinh Diem and Nguyen Cao Ky had supplemented their war chests with profits from opium, which had been widely used in Vietnam since the midth century when French colonialists established an opium monopoly there. From to approximately , then, to aid our allies, the American Central Intelligence Agency set up a charter airline—Air America—to transport raw opium from growing regions in the highlands of Burma and Laos to Saigon. Much of it was transported to Marseille by Corsican gangsters to be refined into heroin and shipped to America by way of the famous French connection. The result was a full fledged heroin epidemic. The United States addict population swelled to ,, and there was a proportional jump in addiction related crime, accompanied by more overcrowding in prisons, more stagnation in the courts, and more hepatitis and overdose deaths. The epidemic subsided with the fall of Saigon, as heroin smugglers searched for a new source of raw opium. This situation prevailed until , when a program was instituted by the United States and Mexican governments to spray poppy fields with the defoliant Agent Orange. No sooner, though, had the Mexicans begun eradicating the poppy than there was a new upsurge of Southeast Asian heroin: when that source dried up as a result of severe drought in , the heroin barons found ample new supplies of opium in the Golden Crescent Iran, Afghanistan, Pakistan , where political upheaval had removed any previous restraints on poppy cultivation. All this was the inevitable result of unsound legislation. When one source of opiates dries up, another replaces it; when one trafficker is arrested, a successor is always at hand. For some enforcement officials, this is not necessarily a bad thing. That, of course, would mean not only the loss of millions of dollars in profits to organized crime, but millions of dollars in enforcement agency budgets, so it is not an opinion very often voiced in law enforcement circles. Drug enforcement, after all, is also a big business. And what does the American taxpayer get for all this money? At the present time, officials of the Drug Enforcement Administration DEA 4 admit its agents are able to intercept only about five percent of the illegal heroin coming into America. To their credit, the pressure narcotics enforcers bring to bear on smugglers tends to keep the quality of heroin low and the price high 5 which certainly deters a few people from trying the drug and insures that addicts are not likely to overdose in alarming numbers. Disrupt this laborious process at any point, and the whole rickety money train is derailed; and the poppy peasants migrate before they can plant a new crop. Instead, though, the heroin always gets manufactured, and the rest of the money is spent, as it were, trying to put the toothpaste back in the tube. This is the very height of bureaucratic incompetence: a multi-billion dollar business, ostensibly created to stop people from taking opiates, which is positively dependent on opiates and opiate users for its survival. Meanwhile, the heroin is synthesized, shipped and distributed by modern day robber barons, and everyone profits amain. Bayer has never sued anyone for appropriating its brand name for daceylnorphine. Necessary Required. Cookies that the site cannot function properly without. This includes cookies for access to secure areas and CSRF security. Name : CraftSessionId. That is done via the PHP session cookie. This cookie will expire as soon as the session expires. Statistic cookies help us understand how visitors interact with websites by collecting and reporting information anonymously. Marketing cookies are used to track visitors across websites. The intention is to display ads that are relevant and engaging for the individual user and thereby more valuable for publishers and third party advertisers. There has developed a distinct class of heroin addicts, with a certain amount of freemasonry and cooperation among themselves. These latter are necessary to make it easy for users to procure heroin and to safeguard one another in the indulgence of a practice strictly forbidden by law. As a result, heroin addicts exist in large groups, the individuals of which know and help each other; in this way the habit is not only maintained but spreads rapidly. The majority of the present takers are boys and young men whose easy sociability has been developed in the gangs who later flock together in leisure hours at the dance halls, the movies and at that form of entertainment which they all seem to like best, vaudeville. For a long time the boys remain for the most part in good health, and all along they possess a fair degree of intelligence. Some examined by the Simon Benet test show mental defects, but the majority are not materially defective in intellectual qualities. Like most adolescents with social tendencies, they lack individual initiative, are imitative and easily led; they fall into the habit easily and—this is the tragic part of it—ignorantly and innocently. Once the habit is established, they lose interest in work, become late and irregular, throw up their jobs easily. Many are good workmen, but will only work for the purpose of getting money with which to buy heroin. Among the frequent misdemeanors charged against the heroin boys besides those directly concerned with the use or possession of the drug, are stealing and destruction of property. The customs entailed by the habit and the effects on character of the drug itself are doubtless potent factors in forming and holding together that criminal class which certain idealists do not seem to believe exists. The Journal of the American Medical Association ran these remarks in , the year a New York State law—the Boylan Act—banned all other commercial opiates: Dope users who found that police surveillance made it very difficult to secure opium, morphine and cocaine, soon learned that heroin could be easily obtained. No prescription is necessary. As a result they began using this drug, and the habit grew by leaps and bounds. It is in them that mental contagion which spreads up to hysterical mass movements, spreads with the greatest rapidity, and in their minds sedition finds an easier route than realism. Hobson warned young mothers to periodically check the food their children and, and he also recommended: In using any brand of face powder regularly, it is a wise precaution to have a sample analyzed for heroin. As early as , the AMA House of Delegates forthrightly resolved that heroin be eliminated from all medicinal preparations and that it should not be administered, prescribed, nor dispensed; and that the importation, manufacture, and sale of heroin should be prohibited in the United States. In the Knapp Commission convened in New York City under United States District Court Judge Whitman Knapp to study allegations made by police officer Frank Serpico, concluded in part: Corruption in narcotics law enforcement has grown in recent years to the point where high ranking police officials acknowledge it to be the most serious problem facing the Department. In the course of its investigation, the commission became familiar with. Storing narcotics, needles and other drug paraphernalia in police lockers. Accepting money or narcotics from suspected narcotics law violators as payment for the disclosure of official information Financing heroin transactions. Of course the danger if you leave it organized and minimize it, is the problem of police corruption. Donate Subscribe. Sign up for our newsletter and get an email every week. Interview Kim Wozencraft by Jill Eisenstadt. Interview Kneecap by Tadhg Hoey.

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