Субутекс (subutex) Грузия

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Субутекс (subutex) Грузия

N eedle drugs seldom make a city look pretty, but some cities are more disfigured by them than others. In , when I first visited Tbilisi, Georgia, it had all the wrecked majesty of an ex-beauty queen with six years of track-marks down her arms. It was a great European capital in decay: crumbling bridges, refugees from war, and—most of all—cast-off syringes everywhere. So when I returned this year, I packed thick-soled shoes. It turned out that, but for the frigid temperatures and my own self-respect , I could have worn Tevas. The syringes, which once pumped opiates into the veins of as many as , addicts, are absent. The subway now feels safe, clean, and orderly, with no trash more revolting than a Snickers wrapper. If the addicts are still there, they have been persuaded to shoot up with greater discretion. And if they are now gone, the Georgians have accomplished something remarkable, which is the rapid diminution of smackheads. Georgia was spared widespread alcoholism, perhaps because it alone among ex-Soviet states is a wine-sipping land, instead of a vodka-slamming one. At its peak, one in 20 Georgians was on hard drugs, with Subutex driving the epidemic. Abbie Hoffman once said that the only dope worth shooting was Richard Nixon. But Hoffman was a free-love hippie, and sex is an effective anti-drug. He lived a joyless life in an existential depression, and he started shooting Subutex because it has many of the relaxing, time-killing properties of opium or heroin, but with none of the likelihood of it stopping his heart. At 38, he has the sallow skin of a wax statue and the soulless eyes of Vladimir Putin. He runs a market stall in Tbilisi, and he wears the modest clothes of a workingman. But he trained as a lawyer in university and—like most university graduates in this country—failed to find work befitting his education. Instead, he found opiates and has indulged almost nonstop ever since. In the early days, when he had the money, he took heroin and opium. But the best period of his life was his eight-year romance with Subutex. But once or twice a day was the minimum. They lasted longer, though, and he could at least be confident that he was shooting a pure product. But Subutex is a major improvement in several ways. First is the experience of patients: Methadone can put users in a sick stupor, but Subutex is so mellow and unobtrusive that they can drive cabs or wait tables while on it. The second big improvement is its safer and more effective schedule of delivery for patients. They become permanent patrons of methadone clinics, showing up daily like pigeons at a park frequented by old ladies with breadcrusts. The owners of the clinics make a bundle. The clinics require armed guards, because addicts will do anything for an extra dose of the blue, Windex-like fluid. I do mean anything. Consider that, in , an inmate in British Columbia died after drinking the puke of another methadone patient. The market for methadone vomit in prison is lively, and the preferred recipe for this cocktail is one part puke strained, please, bartender to one part Tang. In the United States, about 5, methadone users die every year, making it the single-biggest killer among prescription painkillers. Subutex comes in a white tablet, which the patient gets from a pharmacy and dissolves under his tongue over three to five minutes. It also means, of course, that Subutex patients have a much, much easier time diverting their supply to illegal markets. Methadone builds up in the body and slows down breathing to the point of death. Add alcohol or heroin, and the odds of death go way up. But even in combination with other drugs—and Subutex is often taken with other sedatives or benzos—Subutex will reliably yield a long, chilled-out, survivable high. This level of safety holds even if addicts take Subutex intravenously, as Pavel and almost all other street addicts did. The milky mixture is then ready to inject. The high lasts between twelve and 24 hours, which is several times the length of a ride on heroin. The pekhi never took more than an hour to return with a dose. But my Georgian-language phrasebook, printed by the Paris publisher Harmattan, gave me an early hint about how Subutex arrived. Those close cultural ties turned out to be disastrous. The only problem, however, was that a significant minority of the Subutex patients in France simply sold their pills. Tbilisi has, not surprisingly, some highly experienced addiction doctors, and one, Dato Otiashvili, is writing a doctoral thesis on Subutex. The real profit, however, came from export. The tablets, transported to Tbilisi on a wave of fellow-feeling, sold in Tbilisi for no less than euro and sometimes as much as euro at the peak of demand. Germany and Italy began prescribing Subutex, too, and their users sold their doses to make up the balance of the supply. Heroin gives the standard Trainspotting effects—zoning out, eyes like saucers, total incapacitation. Even if they suspected use, they had no urine tests for it until In time, Subutex smugglers became more sophisticated. Organized crime took its cut and piggybacked their drug smuggling on the already burgeoning used-car market. Georgia is filled with used cars—some bought, many stolen—from Western and Central Europe. Before crossing the border with them, smugglers packed their side panels with Subutex. The value of the car was tiny compared with the value of its contents. Late in the epidemic, Georgian officials brought up the matter to France Are you aware that your policies are causing our little country to be flooded with opiates? In other words, Georgia wanted someone willing to imprison drug abusers and punish them as harshly as we do in America. In , it found an enthusiastic enforcer in its new president, Mikheil Saakashvili—a young, intelligent Columbia Law grad who appointed an energetic, technocratic Cabinet, including boy-wonders such as a defense minister who at the age of 29 had to manage a war with Vladimir Putin. Saakashvili speaks excellent English, and once he was elected, he set out to reform his opiate-addicted, economically wrecked country along U. In drug policy, that meant a more robust and aggressive stance toward traffickers. By most accounts, re-invigorating the customs inspectors throttled the supply lines enough to take Subutex off the street within a few years. But the more radical steps involved brutalizing the addicts themselves. Fifty-three thousand people were stopped on the street in , or about one in 20 of the young men in Georgia. About a third of those passed dirty urine; first-offenders were levied a fine of several hundred dollars. One more dirty test amounted to a criminal offense. No country puts people in the prison for a positive urine test. Between and , the prison population tripled, and Georgia climbed to the number-f our position —three positions below the United States—for percentage of citizens behind bars, with about a third of them in for drugs. But many—including Pavel—cleaned up, at least for a while. There is a myth that opiate withdrawal is physical torture and reduces serious addicts to quivering, sweating messes on the brink of death. In fact, it lasts about two weeks, is no worse than a very bad fever, and has never killed anyone. When they emerged from their cells in or so, like bears emerging from their caves in the spring, Subutex had basically disappeared. And you are probably going to be caught. The problem with all this success was that Georgia still had thousands of depressed ex-junkies, and not all were ready to face reality sober. Pavel was one of them. Instead of retiring his syringe, he injected krokodil , a homebrew so vile that I had to ask him twice to repeat the recipe. It is simple. First get codeine from a pharmacy. Then mix it with toilet-cleaner, red phosphorus the strike-strips on matchbooks are a good source , and lighter fluid. Russian addicts pioneered the use of krokodil , and from there, the devil went down to Georgia. Georgian police still stop about 30, people per year. But the health effects are nonetheless horrific. Ironically, the opiate that is the active ingredient in krokodil —desomorphine—is fairly safe. Users find that their skin dies, and their veins rot inside their arms. Their lungs and nervous systems eventually go, too. Pavel started methadone treatment five months ago and is now on milligrams daily, a medium dose that keeps him off heroin and krokodil but still makes him nostalgic for Subutex. Getting rid of Subutex was the worst thing the government could do. Pavel said he wanted to be free and clean in five months to a year. I would not have bet money either way. If he was desperate enough to inject krokodil just one year ago, his disease must have been profound. And by his own account, he took drugs because he had a miserable life. One unit in Tbilisi, near Pushkin Square, actually uses Subutex, too—effectively weaning addicts off Subutex by giving them Subutex. And that means that the number of Subutex addicts—legal and illegal—in Georgia now might be in the triple digits, when just a few years ago, it was as much as a thousand times higher. Among experts, there is little doubt that making drugs easier to get makes people use them more, and sometimes a lot more. That was a stable equilibrium. Heroin kills, and OxyContin, unless badly mishandled, does not. So as in Georgia, no blessing in the drug war turned out to be unmixed. And marijuana is both slightly less addictive than opiates and infinitely less dangerous never killing users versus frequently killing them. But the pattern of abuse is similar: Sudden supply shocks, such as the legal availability even of regulated cannabis, have predictable effects on consumption. These effects are often unhealthy—at least in the short term. The National Institutes of Health believe that about one in ten people who try weed will get hooked on it. By contrast, about 23 percent of heroin users get hooked, and remain so for much, much longer and with much worse effects. Georgians, of course, would probably be happy to trade their Subutex problem and its krokodil successor for a pot problem. In fact, they have plenty of pot already. But would they trade it for an uninterrupted history of draconian enforcement and no epidemic at all? Quite possibly. What none of the solutions—whether tending toward radical reform, or severe enforcement—addresses is the impulse that led Pavel to drugs in the first place. He is a lawyer who runs a market stall, a frustrated man who evidently prefers to corrode his veins rather than prolong his misery with sobriety and good health. Ultimately, the solution to the drug problem might be the solution to the problem of life, which is how to navigate our time here with minimal suffering. Unfortunately, the policy that offers that solution will be not a drug policy but an existential one, and it remains as elusive as ever. Illustration by Tyler Wintermute. Graeme Wood is a contributing editor at The Atlantic. Sign Up.

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