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By using our site, you agree to our collection of information through the use of cookies. To learn more, view our Privacy Policy. To browse Academia. Given our current preoccupation with conducting a war on drugs, we run the danger of forgetting that, once upon a time, the sale of opium was widely condoned and, in some Asian societies under colonial rule, even monopolized by the state. While this clearly encouraged the widespread use of opium in these societies, some have claimed that it at least served to keep more dangerous and addictive drugs at bay. Within Asia there is no question that the postwar era has seen a dramatic shift away from opium to other addictive drugs, in particular heroin, and that this has coincided with the introduction of anti-opium laws. Are we then justified in concluding that the success of the anti-opium movement in prohibiting opium has served to encourage the spread of heroin? To provide an overview of the availability of pharmaceutical opioids and the evidence on the extent of diversion and injection in South Asia. Reports indicate that prescribing for all types of pain is inadequate. There is a paucity of empirical data across South Asia regarding the mechanisms and extent of the diversion and misuse of pharmaceutical opioids, although the problem is widely acknowledged. A recent decline in use of natural opiates has been accompanied by an increase in pharmaceutical opioid misuse and increasingly, injection, particularly in Bangladesh, India, Nepal and P Clandestine heroin laboratories have been a feature of the Malaysian illicit drug scene since soon after the abuse of heroin emerged in The first few clandestine heroin laboratories which synthesised heroin via the acetylation of imported morphine were uncovered in and By the mids, this type of laboratory was replaced by heroin-cutting laboratories whereby imported high-grade heroin was cut to street heroin. This was to meet the rising demand for the drug owing to the rapid escalation of the number of drug users. Caffeine has remained the major adulterant and chloroquine is detected in virtually all recent seizures. This report has been prepared in order to provide a contextual background describing the heroin markets of the world, and Australia in particular. It covers opium cultivation, heroin production and the trafficking of heroin from the different opium cultivation areas to the final market destinations. In Australia, the history of both opium and heroin consumption and supply are detailed from the first instances of opium smoking in the country to the diverse heroin markets of the s in Sydney and Melbourne. Studii de teoria categoriilor vol. X Editura Academiei Romane, Journal of Petroleum Exploration and Production Technology, Log in with Facebook Log in with Google. Remember me on this computer. Enter the email address you signed up with and we'll email you a reset link. Need an account? Click here to sign up. Self and community based opioid substitution among opioid dependent populations in the Indian sub-continent Jimmy Dorabjee Luke Samson. The availability, diversion and injection of pharmaceutical opioids in South Asia Tasnim Azim. Heroin in Malaysia and Singapore Joey Ng. Global and Australian heroin markets Wayne Hall. Equilibrio Melany Torres Gomez. International Journal of Drug Policy 9 — Self and community based opioid substitution among opioid dependent populations in the Indian sub-continent Jimmy D. Substances such as cannabinoids and opioids have found their way to Western markets at substantial profit margins and this resulted in international pressure for supply reduction and crop eradication measures. In Asia traditional forms of opioids gave way to the manufacture of heroin in the Golden Triangle and the Golden Crescent regions. The purity of the heroin manufactured in the SE Asian region, as well as the reduced availability of opium products resulted in the switch to a more cost effective mode of use. Hong Kong s first saw a shift, Crofts, , from smoking to injecting of heroin with Thailand s , Laos s and North East India s following suit. All rights reserved. Introduction Brown sugar was introduced into the Indian opioid market in the early s at a street cost of Rs. However, the low introductory price soon doubled and kept rising making it unaffordable to the street using populations with the resultant phobia of withdrawals due to the high tolerance levels. The continuing price spiral led to an increase in criminal activities related to addiction and the demand for detoxification and treatment services. Dorabjee, L. By the late s and early s, injectable buprenorphine gained popularity as an alternative among the heroin users and this mushroomed into epidemics of injecting in the larger cities of the Indian subcontinent Biswas et al. The populations engaged in injecting behaviour had little access to health services, safe injecting equipment and related information. Rampant reuse of unsterile equipment, high frequency of needle sharing and extremely poor health status, all contribute to potential epidemics of endemic proportions. The density of slum populations involved in injecting drug use IDU coupled with high frequency of sexual contacts raise the prospect of an explosive and uncontrolled epidemic of HIV, which in turn threatens hard won public health gains. The rise in IDU in the cities has been attributed to price increase as well as the reduction in availability of heroin, mainly due to supply reduction efforts. In the North East, injecting of an opioid analgesic dcxtropropoxyphene, which is available in capsule form, has resulted in major health hazards. The positive aspects of injections of buprenorphine are that they are cheaper than heroin, a 2 ml 0. Buprenorphine is also clinically safe, the ampoules are unadulterated and manufactured with strict quality controls, besides having little overdose potential and are readily available in pharmacies. The low threshold intervention utilises between 2 and 6 mg sublingual buprenorphine among its street clients. Feedback from clients on the non-availability in pharmacies and chemists of sublingual tablets as compared to injectable buprenorphine in 0. Research prior to development of the intervention showed that buprenorphine was available in sublingual form although far less easily than injectables. More specifically, buprenorphine: 1. The SHARAN programme had already established contact with drug users and the community through periodic detoxification camps and later through AIDS awareness programmes that discussed the dangers of needle sharing. It was in the detoxification camps that the swift spread of injecting was documented and the need for substitution of injectables with sublingual medication was subsequently addressed. Dosages of substitute medication were open to negotiation and the opinion of the clients was continually taken into consideration. On receiving a positive response from the clients and the community in the pilot phase, we began to expand the reach from 30 to reach a target of Feedback of some clients on withdrawals due to low dosages was accepted and, following a literature review, an increase in dosing up to 8 mg commenced. The medical officer associated with the programme relied on feedback and opinion of outreach staff when prescribing. The focus of the programme, a drop in centre providing a non judgmental and safe environment, was opened in the slum worst affected by drug dependency which was also a major drug dealing and using area. A doctor visits the centre thrice weekly providing wider health treatments such as TB and this was also made available to family members of clients. Open 12 h daily, the centre provides the following: 1. Oral substitution therapy 2. Medical checks and care services 3. Specialist health care referrals 4. Individual and family counselling 5. Health education and promotion 7. Drug awareness programmes 8. HIV pre and post test counselling Free condoms and regular condom use demonstrations Recreational facilities indoor games Outreach support Weekly client group discussions Peer educator sessions Home based and community based detoxification 3. Results From February till January the programme has serviced clients of whom regularly attend the drop in centre. Retention on the programme is more for older clients with a longer history of drug use and a few detoxification attempts. In treatment clients frequently opt for detoxification or rehabilitation services, indicating a compatibility of this approach with other treatment methodologies. Of clinical pharmacological relevance, we found that sublingually 2 to 6 mg buprenorphine was an effective dose for maintenance of IDUs injecting up to 3 mg buprenorphine daily and heroin inhalers using up to 2 g per day. This maintenance dose is significantly lower than in reported clinical experiments where doses of up to 16 mg and above have had the best results, and may be due to differences in client population profile. However, there is still a significant cost effective factor when considerations of public health and criminalisation are taken into account. Further, initiation and retention rates on the programme are high especially when compared with other treatment modalities. Self medication by injecting of crushed and partially soluble capsules of dextropropoxyphene in the North Eastern States has become prevalent due to rising prices and non availability of heroin. Such substitution behaviour raises serious questions about uninformed legislation that affects the availability of buprenorphine for currently dependent populations. The programme has had national, regional and international impact. Requests by agencies in other Indian cities to replicate the programme have been received and SHARAN is now examining the feasibility of a national programme in five cities. Both countries share similar IDU profiles with India. The views expressed in this paper are those of the authors and do not represent any official view of the Commission. Conclusions Programmes using a similar methodology of buprenorphine substitution are attractive and acceptable to out of treatment opioid dependent populations. There is an immense need for the development and replication of the programme in the Indian subcontinent. To this effect an evaluation of the cost effectiveness of sublingual buprenorphine therapy and the need for the availability of higher dose formulations 2— 4 mg other than the present 0. The alarming health risks including the increased frequency of injecting episodes, swollen limbs which become gangrenous leading to amputation, occluded veins and the rapid deterioration in venous architecture, associated with self substitution with dextropropoxyphene in the North East Eicher, need to be considered and harm reduction efforts in this area are imperative. The sustainability of similar programmes is a critical question especially in the context of behaviour change interventions and the need for such interventions to be considered on a long term basis is crucial to its success. The promotion of alternative behaviours against one off intervention depends on: 1. Acknowledgements This programme has been made possible with financial assistance from The Commission of the References Bharadwaj, A. Self injecting of drugs gains popularity in Punjab, Times of India, 1 July, Buprenorphine: dose-related blockade of opiod challenge effects in opiod dependent humans. Journal of Pharmocology and Experimental Therapeutics ; 1 — Biswas S, et al. Hooked to a new high, India Today, April, Crofts N. Assam, October Dorabjee J. IDU Reports. Eicher AD. Use of buprenorphine in the treatment of opiod addiction II physiological and behavioural effects of daily and alternate day administration and abrupt withdrawal. Clinical Pharmacology and Therapeutics ;47 4 — 8. Human pharmacology and abuse potential of the analgesic buprenorphine. Archives of General Psychiatry ; — A controlled trial of baprenorphine treatment for opioid dependence. Journal of the American Medical Association ; 20 — 5. Buprenorphine versus methadone maintenance for opiod maintenance. Journal of Nervous and Mental Disease ; 6 — Kumar, Daniels. Safety and side effects of buprenorphine in the clinical management of heroin addiction. Drug and Alcohol Dependance ; — Lewis JW. Drug and Alcohol Dependence ; — Buprenorphine suppress heroin use by heroin addicts. Science ; — 9. Buprenorphine effects on human heroin self administration. An operant analysis. Neil A. Affinities of some common opiod analgesics towards four binding sites in mouse brain, Panda S, Chatterjee A. Injecting drug use in calcutta: a potential focus for an explosive HIV epidemic. Shreshtra DM, Lohani J. Buprenorphine abuse in Nepal, Related papers Vol. Basic Physics of Semiconductors Shashwat Popli. Laporan Uji Urinalisa Tresna Herdani. Fintech dalam revolusi industri 4. Disusun Oleh Muhammad Adrian. Silva Ortiz Jonathan Pullas. Francois Rochon. Reasons and Causes: We are not as rational as we think we are John Shand. Imaginea si simbolul vietii. When mental illness and cancer collide: An investigation of the predictors of outcomes for cancer patients with a history of mental health problems Lisa Reynolds. Effects of chronic ammonium and nitrite contamination on the macroinvertebrate community in running water microcosms Matthias Liess. Interview with Owen A. Exploring the link between household debt and income inequality: an asymmetric approach Hamid Raza. Review and investigations on geothermal energy extraction from abandoned petroleum wells Ekaterina Wiktorski.

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