Saturday, September 17, 2011

Warning: Graphic Photos – Krokodil: Addicts rotting to death and other signs of a democracy in trouble

To me, this story illustrates the dangers of failing democracy. This is what happens when democracy is in severe distress. Is our nation there yet? No, thank God. But you have to wonder how much more mismanagement, by all parties and all sides of the conservative/liberal divide, it will take to get us there. Fortunately, there are some reasons why this drug is showing up in near failing democracies, not here.

I'll start with some article excerpts, though the entire article is worth reading...

Krokodil: The drug that eats junkies - Europe, World - The Independent
The home-made drug that Oleg and Sasha inject is known as krokodil, or "crocodile". It is desomorphine, a synthetic opiate many times more powerful than heroin that is created from a complex chain of mixing and chemical reactions, which the addicts perform from memory several times a day. While heroin costs from £20 to £60 per dose, desomorphine can be "cooked" from codeine-based headache pills that cost £2 per pack, and other household ingredients available cheaply from the markets.
It is a drug for the poor, and its effects are horrific. It was given its reptilian name because its poisonous ingredients quickly turn the skin scaly. Worse follows. Oleg and Sasha have not been using for long, but Oleg has rotting sores on the back of his neck. "If you miss the vein, that's an abscess straight away," says Sasha. Essentially, they are injecting poison directly into their flesh. One of their friends, in a neighbouring apartment block, is further down the line.

"She won't go to hospital, she just keeps injecting. Her flesh is falling off and she can hardly move anymore," says Sasha. Photographs of late-stage krokodil addicts are disturbing in the extreme. Flesh goes grey and peels away to leave bones exposed. People literally rot to death.
President Dmitry Medvedev ... has not ordered the banning of the pills. Last month, a spokesman for the ministry of health said that there were plans to make codeine-based tablets available only on prescription, but that it was impossible to introduce the measure quickly. Opponents claim lobbying by pharmaceutical companies has caused the inaction.
"A year ago we said that we need to introduce prescriptions," says Mr Ivanov. "These tablets don't cost much but the profit margins are high. Some pharmacies make up to 25 per cent of their profits from the sale of these tablets. It's not in the interests of pharmaceutical companies or pharmacies themselves to stop this, so the government needs to use its power to regulate their sale."
In Tver, most krokodil users inject the drug only when they run out of money for heroin. As soon as they earn or steal enough, they go back to heroin. In other more isolated regions of Russia, where heroin is more expensive and people are poorer, the problem is worse. People become full-time krokodil addicts, giving them a life expectancy of less than a year."
'via Blog this'
First of all, this post is about addiction, which always increases when economies fail, and it is about the financial costs of addiction on society. It is also about government regulation and the health care system.

People wonder why addicts don't just quit. People wonder why addicts don't have the will power to quit. Well, I am sure that most of the poor souls involved with late stage krokodil addiction would like to quit, however they are trapped in addiction and cannot. The bio-psycho-social misery of withdrawal is more painful than having their flesh fall off. Most addicts experience this level of decay when it comes to their day to day lives, their families and friends, and their souls, but these addicts can dramatically experience it with their bodies as well.

This story, to me, illustrates something I've always felt, that addicts do have tremendous will power. You'd have to have tremendous will power to take a drug with such devastating effects. For addicts, it is not a lack of will power, it is a lack of power over their addiction. I am sure every one of these people have told themselves, at some point, that this was the last time they would do krokodil, especially when the gangrene started setting in, but then the withdrawals kick in and they do what they must in order to survive, according to the addict part of their brains. They may be losing a leg, but they still feel they need to use in order to keep the rest of themselves running, and that means cooking up another batch. But I do not know if it is really possible for anyone who has not personally had to deal with addiction issues to really understand this.

So, what does this have to do with politics? Well, first there is the question of regulation. Or, in this case, deregulation and possible corruption. The drug is made from codeine which is available over the counter in much of the world outside of the Untied States. A very effective way to reduce the numbers of people using this drug would be to just make it a prescribed medication.

In Oregon, antihistamines made with pseudoephedrine have been limited to prescription sales for a couple years now because of their use in the manufacture of methamphetamine. Sure, since then, Oregon has not become the first meth free state in the union, but it has had some effects. In Russia, where the whole reason why people are turning to krokodil is because they cannot obtain heroin or other opiates, due either to its price or its unavailability, this simple action could really have an effect in reducing the numbers of people taking this drug. Of course, it might also increase the crime rate as more and more opiate addicts turn to crime to gain the funds to obtain their fixes, but at least it would get the "zombie drug" off the street.

So why has Russia not done this? Well, for one thing, an increased crime rate would effect non-addicts more than the walking zombie Krokodil users. Let them suffer for their sins while keeping the crime rates from climbing. And I suppose this might make sense, depending upon your ethics.

However, greed and corruption probably have a lot more to do with it than any concern about crime rates. As stated in the article excerpted above, the profit margins on the codeine pills are high for the pharmaceutical companies and the local pharmacies, so there is no interest on their end in losing money, and in the Russian system these days, even more than ours, money talks.

One of the central roles of government, in my eyes, is to protect its citizens. To me, this means protecting them from the dangers of unregulated capitalism and greed as much as it means protecting them from foreign threats. The pictures below show one danger from unregulated capitalism. Also, it is the government's job to protect as many of its citizens as it can, not just the majority or the ones we like. Not just the ones with the most money. Even the lowest in our society have basic human rights. Letting corporations feed on the lowest in society is not a sign, to me, of a healthy civilization.

Yes, addicts are not seen by most people as people we want to help, but people who have made devastatingly poor choices who just need to be locked up or left to suffer in the misery of their own making. However, once an addiction has taken hold, true addicts have little choice left to them when it comes to drugs and alcohol, and the science these days seems to support the idea that addiction has a strong genetic component, which means that most addicts do not have much of a choice about their addiction in the first place. Of course, if they never picked up anything, then likely they would never become addicts. But is that realistic? This biological component to addiction is why many, or even most, people can party a little too hard in their teens and twenties while still hanging on to their choices in life and becoming productive members of society while others cannot and end up having their lives ruled by drugs and alcohol while being trapped at the bottom levels of modern society, consuming more than they are able to produce.

It would easy to say that we should let the free market run with no restrictions whatsoever, because, especially cases such as this, people are free to make their own choices. But addicts are not really free to make these choices. They are already the victims of their addiction. Do we need to let the be the victims of the greedy, as well? Especially when the cost of such greed is so costly to society as a whole, not just to the addicts?

These costs are borne by society in two main ways, the criminal justice system and the health care system.

With the criminal justice system, we are talking law enforcement officers to wage the war on drugs, pursuing users and dealers, the street cops to protect the citizens from the addicts committing crimes to pay for their fixes, and the high costs of jails and prisons to hold all of these people. Especially, when it comes to incarceration as the solution to society's addiction issues, most studies show that this is an overly expensive and ineffectual solution to the problem of addiction. It is why the War on Drugs has not led to a drug free America in the last twenty or thirty years.

To me, a better solution is focusing more on treatment than incarceration when it comes to addicts who have committed crimes because of their addiction. In the long term, it is cheaper and it is more effective. And when it comes to incarceration as a deterrent? Well, if an addict is willing have their limbs rot off, what do they fear about jails and prisons, other than reduced, though not eliminated, access to drugs and alcohol?

I also believe that health care, in a country with the wealth of ours, should be a right, not a privilege. To me this means having a strong, well funded health care system available to everyone. This would include mental health treatment and treatment for addiction.

In our country, an unfortunately large segment of our society does not seek out treatment for their wounds and illnesses until they have really gotten out of control. In the realm of this story, that would mean getting their abscesses treated before the gangrene sets in and limbs need to start being amputated. Access to health care is probably not the main reason that these wounds have become so severe, of course, though it could be a reason why their addictions have become so severe that they are willing to continue using a drug with such devastating side effects. However, that does not change the fact that many people in our country do not seek treatment for their ills because they are uninsured and cannot afford any sort of health care. This problem is not limited to addicts.

Unfortunately, this increases the cost of health care for everyone, because health care organizations end up having to absorb the costs for these patients, costs which are passed on to everyone, insured and uninsured alike. In this case, a quick doctors visit to have an abscess drained and treated, a few antibiotics offered, is way cheaper than the thousands of dollars it takes to perform surgeries, hospital stays, aftercare treatment, and post-amputation rehabilitation.

This is the argument that I use with the more draconian of the free market health care crowd. They will say, why should we have to pay for these people? I don't want to pay taxes for people who cannot take care of themselves. Well, with the system we have, we pay for them one way or the other. Sure, we could change the system so we flat out deny care to people without insurance or money to pay out of pocket, we could just let them die, but while that is the effect our current system has on occasion, it is not the system we have in place right now. Hospitals cannot refuse to treat patients with life threatening conditions because of the patient's ability to pay. So we all pay. And I doubt that system will change, though if it does, it is not a change for the better, it is not a sign of an improving democracy.

As I said earlier, to me addiction is a health care issue, but most people see it as a crime issue. As a health care issue, we need to regulate corporations so they are not selling poison directly to anyone and we need to provide public health support for both the symptoms and causes of addiction. Treatment and recovery options for the addiction and medical care for the secondary health issues caused by the addiction. We need to help addicts find the cure for their addiction, not to just lock them up. Though, I do know, that many will always need to be taken off the street in order to protect the innocent, we need to have the funds in place and the resources available to help addicts that can be helped, both before and after they enter into the criminal justice system or end up requiring the state to pay for catastrophic and/or long term health care.

Anyway, I feel that the story of these krokodil addicts is the story about victims of a failing democracy. They may not be the most sympathetic of victims, but they are victims never the less. As I said earlier, there are several reasons why this drug is a problem in eastern Europe and not in the United States, and it is because our government is, for now, healthier than theirs, not because we lack the opiate junkies willing to ride their addictions to such lows. In fact, in our country, opiate addiction is creeping deeper into the fabric of our society through prescription drugs.

But while our democracy is not in a level of distress, yet, where such horrors are being allowed to occur right now, these sorts of effects can be expected if we, as voters, do not make good, informed choices about those we elect to serve us in our government.
Very graphic and disturbing photos and videos of "long" term Krokodil addicts after the break:

The following two pictures are from the video at the end of the post, from around the three minute mark.

From the YouTube description: 

This video shows a male patient, 26yo with a hepatitis C, dry gangrene of the foot and a wet gangrene of the thigh - the result of intravenous injections of Koaxil - new drug that is popular among heroin-addicted people because of the price (cheaper than opioids) and easy access (most of the Russian pharmacies sell it without a prescription). The tool that was used to cut the bones is called "Gigli" saw. The procedure shown on video was needed because of the potential contamination and/or ethical concerns. The doctors amputated the rest of his leg later during regular surgical operation. The main concern of that poor guy was how painful procedure will be. Because of the necrotic process in the tissue during a gangrene all nerves are damaged so the person does not feel a thing.

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