Why did doctors evade treating heroin addicts?

Doctors have used Methadone to treat drug addicts because it also reduces suicide and helps to retain them in  treatment programmes

• Since there are no  medical professionals to address the problem, it has ended up as a criminal problem
• It was also reported that  Methadone was used in  the1970s to detoxify the opium addicts in  Sri Lanka
• Out of the 8 doctors  who treated heroin  addicts in 2009, many gave up because these  doctors were humiliated,  threatened and were not  respected

Heroin surfaced in Colombo in the early seventies.  In 1983 a  pack of heroin was Rs. 10. By 1990 a pack of heroin became Rs.  After the tolerance has developed an addict needed at least 3  packs for a day. 
The war camouflaged the trafficking and distribution of heroin.  The war and political tension in the country diminished the  ability of the law enforcement to round up drug trafficking  adequately.

Balloon  effect 

When one area was raided by the Police, the heroin addicts  moved to neighbouring areas in search of heroin. Thereby, a pack  of heroin that was Rs. 50 in 1990 rose to Rs. 100 by the year  2000. It became Rs.500 in 2010.  By 2014 it went up to Rs. 1,000 per pack.  A gram of heroin was sold at Rs. 12,000 in  2014.
By the year 2000 there were 45,000 regular users of heroin  [REID and CONSTGAN 2002].
In  2000 a heroin addict had to spend Rs. 300 on heroin for a  day.  In 2010 to buy heroin an addict had to spend Rs. 1,500 for  a day. Many heroin addicts did not have that amount of money.  Robberies, burglaries, pickpocketing, cheating, prostitution,  various underworld activities, selling of properties and  camouflaged businesse increased.

Many found a safer and an easy way by becoming drug peddlers.  Each addict introduced heroin to 10-15 people. It was an easy  task to introduce it to cannabis users. They introduced it to  school children, problem children, young men, old men and almost  anyone; including women. Facebook and easy-cash were helpful  in spreading heroin.  

These peddlers come to Colombo buy 1 or 2 bundles and go back. For example, at DAMBULLA bus stop 10 to 15 new heroin  users wait in the evening for the drug peddler’s arrival. These 30,000 peddlers caused a rapid increase in the number of heroin  addicts all over the country. That was one of the main reasons for there to be more than 450,000 heroin addicts.  

In 1990 Methadone 5mg tablets, Methadone syrup, Buprenorphine (Temgesic), Naltrexone, Clonidine, Dilaudid,  Lofexidine and Nalaxone were available in Sri Lanka to treat  heroin addicts. Methadone was available until May 2021. None  of the other medicines were available for a long time.  It was  also reported that Methadone was used in the 1970s to detoxify  the opium addicts in Sri Lanka.
In 1988 there were 15 doctor who purchased Methadone and  Dilaudid from the Civil Medical Stores of the Ministry of Health.  Other Medicines were available in the private sector.

By 2009, there were only 8 doctors who purchased Methadone  from the M.S.D. of the Ministry of Health. The clinics of the  doctors were inspected by the Food and Drugs inspectors.  DPDHS made th recommendations. All the doctors received the  quotas of medicines approved by the Director General of  Health Services (DGHS).
In 1993 WHO/HEDIP funded by an Italian co-operation, conducted a training programme for the 15 doctors. Treatment  given by the doctors saved lives. If the doctors continued to  treat the heroin addicts then there would have been absolutely no  reason for 30,000 addicts to become peddlers. 

Out of the 8 doctors who treate heroin addicts in 2009, many gave  up because these doctors were humiliated, threatened and were  not respected.
For example on April 1, 2009 the Director General of Health  Services (DGHS) wrote, “Director/MSD was requested to  inform  Chairman/SPC to supply the indented quantities of the above  drug (Methadone) as early as possible.”

Again on July 22, 2009 DGHS wrote, “It would be greatly  appreciated if you could ensure that Methadone is being  imported on a priority basis to treat heroin addicts, as this could  be imported only by the MSD.  If there is any issue about the  importation, please discuss with me with the relevant file. Please  treat this as urgent.”
When the DGHS was striving hard to get Methadone an  informant instigated another higher-up, and that person wrote  on July 22, 2009 “We are informed that you have  obtained/purchase 51,000 and 7,768 Methadone tablets in 2008  and 2009 respectively, which is a controlled substance, which  has to be used only for approved medical use. In terms of the law  and international conventions, it is a narcotic substance, hence its  use is illicit. Please let us know the names and addresses of  persons on whom you had administered that narcotic substance.”  (NB – There were over 9,000 names and addresses, and it was  necessary to safeguard professional secrecy)
These vicious persons discouraged the doctors. Some doctors had  their quotas slashed or cut off.  
During the past 34 years there were 4 occasions when Methadone  5mg tablets were out of stock at the MSD.        

1. From March 2009 to October 2010
2.During 2014                                                                                                                                       
3. From March 2017 to November 2017                                                                                                                  
4. Again from May 2021 Methadone has not been available at  the MSD.

On May 2021 NMRA issued the quota approval letter for the  next 5 years. But the quota approval letter had not taken any  effect as yet.
The Police announced that during the first six months of 2021 Rs. 9 billion worth of heroin was seized. Using the rule of the thumb  by the law enforcement community, they assume that the seized  quantity represents only 10% of the total trafficking. 
Sri Lanka is situated close to the Golden Crescent on the left and  Golden Triangle on the right. Therefore heroin filters into this  country with ease.  In 2001 Afghanistan produced 185 tons of  heroin. In 2011 it produced a staggering 5,800 tons. Indian or Sri  Lankan authorities do not possess any evidence to say that heroin  is being smuggled out of Sri Lanka.
Heroin that was brought into the country was for the  consumption of 450,000 heroin addicts. Gradually it will  destroy  all the heroin addicts and their families. But, there was no  Methadone and other indicated medicines to treat them.  Those who decided to prevent giving Methadone and other  medicines to heroin addicts have done a colossal and a  catastrophic mistake. Methadone is the most effective drug in treating heroin addicts.                                                                                

1. It requires treatment only once a day, because it is effective  for 24 hours.                                            

2. It prevents the use of illicit heroin, criminal activity, and the  spread of diseases like HIV, Herpes Simplex and Hepatitis C.                                                                                                                                  

3. It is cost effective. The amount of money a heroin addict has  to spend for a day’s supply of Heroin is adequat to get medicines  for 10-14 days.                                                                                                 

4. It improves social health and productivity.  Heroin addicts  can go to work and earn money while taking treatment.                                                                                                                                      

5. Methadone also reduces suicide and helps to retain them in  treatment programmes. 

6. When heroin addicts go to prisons and other isolations they  mix up with seasoned heroin addicts and get rid of any fear of the  Police and Prisons. For some heroin addicts Prisons are like their  homes. Methadone reduces imprisonment. By September 2020 out of Sri Lanka’s 30,000 inmates who  are in prisons 60% were for drug related offences. It is  alleged that Justice Minister Ali Sabry had said that 553,000  people (about 2.5 percent of the population) are addicted, which  means one in every 40 people in this country is a drug addict.                                                                                                                                         

7. Many European countries keep heroin addicts in Methadone  programmes, thereby preventing drug cartels raking in billions of  dollars.  

Criminalisation of heroin addiction, which is a disease, is a  blunder. Heroin use of long duration causes permanent changes  in the brain and brain functions. That means many have altered  brains. Heroin affects the Mesolimbic Dopaminegic pathway (Reward pathway). The mesolimbic pathway is heavily  implicated in neurological functions of 1) Heroin addiction 2)  Schizophrenia and 3) Depression. Heroin addiction,  Schizophrenia and Depression have  similar changes in the  brain. Patients with Schizophrenia and Depression are treated by  doctors and the necessary medicines are available. Heroin  addiction is a similar disease. There are mor than 450,000 heroin  addicts in the country. Some heroin addicts get early clinical  features of Alzheimer’s disease.                                  Many heroin addicts over the age of 50 years have multiple  organ diseases.                                                                 

ABSTINENCE NOT THE CURE  

Heroin residue that remains in the fatty tissues for over six years  can cause relapses even after long periods of abstinence. For  example, a person who had taken heroin for three years, does not  take any treatment and goes to Saudi Arabia to work, will not get  any heroin while he is in Saudi Arabia.  Yet, when he returns  after two years, at the Katunayake Airport he starts to yawn, tears  appear, sweating, shaking, nervousness and agitation will occur.  All the involuntary withdrawal symptoms appear and he is forced  to take heroin again.  Heroin addicts who are in prisons and other isolations, when they  are released, they come out yawning. They will get all the  withdrawal symptoms again. If detoxification is done during th first five years of addiction,  then we can cure them almost completely.

Detoxification is made possible by 1) Methadone and other  symptomatic treatment. 2) Medicines and excess liquids are  given to remove the heroin residue that is there in the fatty  tissues along with urine. 3) Heroin residue is removed with the  faeces using detoxifiers. 4) 3-4 litres of medicated fluids are  given orally and they are kept in steam baths for 1 ½ to 2 hours.  A lot of heroin residue is removed along with urine and sweat.
In 1996 there were 1,816 heroin addicts admitted for  rehabilitation. In 2000 the number had increased to 3,500 (NDDCB). 

                                                                                                                                   
There is only a very limited capacity for rehabilitation. REID and COSTIGAN said there were 45,000 regular heroin  addicts in 2000. [REID and COSTIGAN 2002]
By 2018 there were more than 450,000 heroin addicts in the  country. There should be mass treatment to save many of these  heroin addicts, before brain damage occurs. There should be  doctors and there should be necessary medicines. Methadone is  the drug of choice that is used to treat heroin addicts all over the  world.          When medicines were not available, many heroin addicts used to  phone me and I could overhear the chaos and agony in their  homes. In the absense of Methadone and doctors to treat heroin  addicts many quacks and some pharmacies gave heroin addicts drugs which are not indicated to treat heroin addiction.                                                                                                                                      
The high cost of heroin and the unavailability of treatment in  Russia has led to the use of cheap, but much dangerous drugs  such as DESOMORPHINE which has the street name of  KROKODIL.  Krokodil is an example of the havoc that bad  drug policies can wreak on communities. The use of Methadone  to treat heroin addicts has been increased annually by all the  countries where there is heroin.                                                                                                                           

   USA- 20,000 Kg per year [1 Kg = 200,000 Methadone 5 mg  tablets]                                                                                    UK - 1,833 Kg per year.                                                                                                                                           
Australia- 100 Kg per year Australia’s population 25.8 million in  August 2021 74,000 heroin dependents in Australia (i.e. 6.9 per 1,000) Sri  Lanka - Methadone 0.135 Kg per year since 2014   Srilankan population 21.8 million in 2019. There are more than  450,000 heroin addicts in the country. Yet, there are no  Methadone tablets available at the MSD for the past four months.                                                                                          According to the British National Formulary (BNF) the usual  daily dose of Methadone is 6 to 12 tablets. But, the quota  allocated for a month was so inadequate, a patient was given ½ to  1 tablet for a day and to compensate for the very low dose used,  several symptomatic treatments were given.                                                                                                                                          
It was a wrong professional move by the 15 doctors. Due to their discontinuation of treating heroin addicts, other  doctors who would have endured treating heroin addicts also  kept off. Now every town has many heroin addicts. There should  be many mental asylums in the country to accommodate  longstanding heroin addicts with extensive brain damage.
The real picture of theheroin epidemic in this country is much  more darker and gruesome. Proper involvement of the medical profession in the heroin  epidemic is 2-3 decades overdue. All know that heroin addiction  is a medical problem. Since there are no medical professionals to  address the problem, it has ended up as a criminal problem, and  many of our youth are being criminalized. “IT IS TIME TO  SAVE LIVES”  
“Save lives” is the theme of 2021 International  Day against  Drug Abuse and Illicit Trafficking.