Reaping what's sown.

August 11, 2009 10:38 AM

With inadequate access to basic health care (WHO .doc summary), impoverished Afghans turn to cheap and available opium as 'medicine' for pain relief, cough suppression and other ailments. The level of addiction among children is at a critical level. Jawed Taiman's film Addicted in Afghanistan provides some further perspective.

Previously on Metafilter.

posted by uaudio (35 comments total)

This story is one of the most depressing things I've ever read.
posted by Slothrup at 10:51 AM on August 11, 2009

Coming soon: Opium! The new Republican health care plan!
posted by fungible at 10:56 AM on August 11, 2009 [5 favorites]

Considering how many Americans are probably addicted to Oxyconton, Percocet, Talwin, etc... I don't think opium needs the quotation marks, really. Slap a brand name and a 3,000 percent markup on something and it becomes 'proper' medicine.

Yeah, the real sadness is that opium is cheaper than brand-name drugs. But that's as true in Chicago as it is in Kabul.
posted by rokusan at 11:12 AM on August 11, 2009 [6 favorites]

Considering how many Americans are probably addicted to Oxyconton, Percocet, Talwin...

And kids on Ritalin, which seems to have become the hammer for the "Your child talks too much" nail.
posted by PenDevil at 11:13 AM on August 11, 2009

I was watching CNN/Fox News yesterday...and I they were talking about how Americans are turning to heroin because prescription medicines are so expensive.

I HIGHLY doubt that people on lipitor are now taking heroin...but wow...fucking sensationalism.
posted by hal_c_on at 11:26 AM on August 11, 2009

Considering how many Americans are probably addicted to Oxyconton, Percocet, Talwin, etc... I don't think opium needs the quotation marks, really. Slap a brand name and a 3,000 percent markup on something and it becomes 'proper' medicine.

Yeah, the real sadness is that opium is cheaper than brand-name drugs. But that's as true in Chicago as it is in Kabul.
posted by rokusan at 1:12 PM on August 11 [+] [!]

Those may not be the best examples as I believe all three are available in generic forms, which, even without insurance, can be had relatively cheaply.

I do agree with your point, though, that there's no need for the scare quotes around "opium." There's got to be few natural medicines as effective.

and where's this cheap Chicago opium?
posted by jtron at 11:28 AM on August 11, 2009

Progress! they're at their Industrial England stage. Pretty soon they'll enter the modern age.

"If we have 50 cents, we buy opium and we smoke it. We don't use the 50 cents to buy soap to clean our clothes," explains Raihan, Beg's daughter and the mother of the 1-year-old. The toddler wears a filthy shirt and no underwear. "I can be out of food, but not out of opium."

Good to see good old drug scare tactics still work. I mean it is not like we ever had horror stories of similar vein. Poor people being addicted to drugs and turning into animals seems to be a common theme in journalism doesn't it?

It is not that I don't believe opium can be addictive, it certainly can, or that opium is abused when it is widely available and cheap, it is that these stories of mothers selling their babies crack/gin/opium seem to always recur with the same narrative, which is always a moral one, focused on the chemical of choice.

The country is a huge producer of opium and opium grows easily. 50 cents of opium? Give us some sort of metric. How much does soap cost? How about food? If they did not have opium would they be diligently saving up their money or would they be spending it on some sort of other good that would deliver immediate gratification?

I think, to some degree, they're lucky. Opium is a wonderfully powerful medicine. "If there is no medicine here, what should we do? The only way to make him feel better is to give him opium." In large parts of the third world access to opium is as remote as aspirin is in Afghanistan. Here they at least have something. But I'm guess I'm supposed to support burning poppy fields for wheat fields and understand why we're there because if there's anything I understand as an American it is that capitalism doesn't work and we need to show these uneducated third worlders what to grow and how to live their lives. It worked great in Dickensian England, if you know, didn't read Dickens.
posted by geoff. at 11:30 AM on August 11, 2009 [5 favorites]

I was watching CNN/Fox News yesterday...and I they were talking about how Americans are turning to heroin because prescription medicines are so expensive.

I don't know if The Straightener will be stopping by this thread, but I think I remember one of his pieces in City Paper (or Philadelphia Weekly?) talked about how people would seek out Oxycodone for the opposite reason, that it was cheaper or otherwise easier to access than heroin, if I'm not misremembering this.
posted by Blazecock Pileon at 11:32 AM on August 11, 2009

Considering how many Americans are probably addicted to Oxyconton, Percocet, Talwin, etc

You draw an interesting parallel there, rokusan -- even if your line of reasoning terminates in a pat attack against Big Pharma (worthy punching bag, if you're going at it without gloves on).

Basically, we can sketch the whole thing out in a syllogism:

-Downtrodden people often turn to drugs for solace (or at least escape)

-The Lumpenproletariat of both Afghanistan and the United States are downtrodden, indeed

-The Lumpenproletariat of Afghanistan and the United States are turning to drugs for solace (or at least escape)

Is there a chance that even if adequate health care infrastructures were instituted in Afghanistan -- or, say, Appalachia -- this sort of widespread drug abuse would continue? I can't speak for Afghanistan, but in Kentucky, my home state, the sale of Oxycontin and other contraband seem to function as a means of survival for a working class that's, y'know, got no work. You could almost read it as a wrongheaded, proto-political reaction to mass "ghettoization."

Whatever the case, the scene described by the AP reporter is truly heart-wrenching -- as are the scenes like it that occur by the minute in our ol', ghetto-fabulous U.S. of A.
posted by ford and the prefects at 11:36 AM on August 11, 2009

You draw an interesting parallel there, rokusan -- even if your line of reasoning terminates in a pat attack against Big Pharma.

Actually, I just picked the first three socially-acceptable versions of near-heroin I could think of and tried (and perhaps failed) to illustrate that as long as they're expensive and come with a brand-name label we accept them as fine, helpful medicine rather than problem drugs.

I don't particularly care that Big Pharma sells them at a high price: what I find interesting is how that seems to be part of what makes a drug into a "medicine".

It's just a long version of "but a DOCTOR prescribed this!"
posted by rokusan at 11:48 AM on August 11, 2009 [3 favorites]

And kids on Ritalin, which seems to have become the hammer for the "Your child talks too much" nail.

Not really the same topic, but yes, I agree Ritalin use in the USA is ridiculous.
posted by rokusan at 12:07 PM on August 11, 2009

and where's this cheap Chicago opium?

We used to walk from campus down through Washington park to 61st and King.
posted by The Straightener at 12:11 PM on August 11, 2009

Actually, I just picked the first three socially-acceptable versions of near-heroin I could think of and tried (and perhaps failed) to illustrate that as long as they're expensive and come with a brand-name label we accept them as fine, helpful medicine rather than problem drugs.

Heroin is not considered to have a medical use in the US primarily because its analgesic effect is not all that much more powerful than morphine but its potential for abuse is higher. For cases where a more potent drug is called for (e.g. extremely severe pain or pain relief in opiate-tolerant patients) there are drugs like fentanyl, which is 80 times more potent than morphine but not as pleasant as a recreational drug.

In fact, heroin was considered a 'fine, helpful medicine' in the US until 1924. Drugs like Dilaudid (hydromorphone) and Percocet (oxycodone) were discovered that were not quite as susceptible to abuse. Later, several other narcotics like hydrocodone and fentanyl were discovered as well as non-narcotic pain relievers like acetaminophen, ibuprofen, etc. These drugs provide a wide range of pain relief that is believed to be medically sufficient without throwing heroin into the mix.

Heroin remains a 'fine, helpful medicine' in the UK, where it is used to treat extremely severe pain, such as breakthrough pain in terminal patients. In the US we tend to stick with morphine and fentanyl in such cases.
posted by jedicus at 12:14 PM on August 11, 2009 [2 favorites]

There's got to be few natural medicines as effective.

It was my impression that opium was pretty damn close to natural.
posted by prak at 12:28 PM on August 11, 2009 [1 favorite]

"If we have 50 cents, we buy opium and we smoke it. We don't use the 50 cents to buy soap to clean our clothes," explains Raihan, Beg's daughter and the mother of the 1-year-old.

There is a tragedy here, and it is not about opium - it is that this mother has only 50 cents. With $2 she could get food, dope, soap, and some pens and paper for her kid.

Poverty like this sucks, and I guess I would rather be poor with easy access to cheap dope rather than just poor.
posted by Meatbomb at 12:40 PM on August 11, 2009 [4 favorites]

Their faces are gaunt. Their hair is matted. They smell.

This is exploitative bullshit. I have been in Afghan villages, and this is how (more or less) everybody looks. Grinding poverty means soap and clean clothes are rare, opium or no opium. I guess if you are needing a story and on a deadline, you spin it however you can.
posted by Meatbomb at 12:43 PM on August 11, 2009 [7 favorites]

impoverished Afghans turn to cheap and available opium as 'medicine' for pain relief

Well right, as other people have said, Opium is an actual medicine that relives pain for most people. Obviously something that's not addictive would work better, but it is certainly an effective pain killer.

to illustrate that as long as they're expensive and come with a brand-name label we accept them as fine, helpful medicine rather than problem drugs.

I don't particularly care that Big Pharma sells them at a high price: what I find interesting is how that seems to be part of what makes a drug into a "medicine".

Okay, now this is pretty ridiculous. Generic hydrocodone is like $10 for 30 pills. A quick google search brings up this price list. That's not really a "high price" for Most Americans. Generic drugs are generally pretty cheap.
posted by delmoi at 1:21 PM on August 11, 2009

So when're we gonna get some THC-based painkillers as alternative to opiates?
posted by pyrex at 1:21 PM on August 11, 2009

I was watching CNN/Fox News yesterday...and I they were talking about how Americans are turning to heroin because prescription medicines are so expensive

Saw the same thing. And then I saw Rick Sanchez say something to the effect of: "Americans can't afford prescription drugs so they are turning to drugs for medicine. It's not like people are on drugs first, they are going from prescription drugs to drugs. "

Drugs, drugs, drugs! Arbitrary difference. Presrciption drugs!

I was really taken by the difference he tried to highlight between prescription drugs and evil, dangerous, illegal drugs, as if prescription drugs weren't as dangerous, or even more dangerous. Slap 'em with a label, run 'em through the FDA, and voila - PROFIT! I sell a small baggie of smack to a sick person and I'm a drug-dealer. Pshaw, I say. Let us not forget that American companies had the monopoly on heroin distribution at one time. They're probably still trying to figure out a way to make money of the shite. I'll take Fentanyl any day over H, because that's not dangerous at all, you know, since it's prescribed by doctors. Oh, wait . . .
posted by IvoShandor at 1:29 PM on August 11, 2009 [1 favorite]

I was really taken by the difference he tried to highlight between prescription drugs and evil, dangerous, illegal drugs, as if prescription drugs weren't as dangerous, or even more dangerous.

That's pretty much what I was trying to say. I regret saying anything about the price tag. I meant that in a "look, a shiny box, a trademark, a commercial with an actor in a white coat and and expensive price means it's all good" way, but my point went off the rails somewhere.

Something something plate of beans.
posted by rokusan at 2:01 PM on August 11, 2009

Its fine to argue the fine line between drugs and medicine, but I personally have a difficult time knowing that Afghanistan makes 92% of the world's poppy crop and has been rewarded with 0% of the world's supply of baby aspirin and Robitussin.

Think what you like, but opiates are physically addictive. The Afghan people have been dealt a shit hand for generations, and to compare their plight to modern Appalachia is fucking ridiculous.
posted by uaudio at 2:15 PM on August 11, 2009

Pentagon Creates "Kill or Capture" List for Afghan Drug Traffickers
posted by homunculus at 3:05 PM on August 11, 2009

This statement is patently false:

There are at least 200,000 opium and heroin addicts in Afghanistan — 50,000 more than in the much bigger, wealthier U.S., according to the U.S. Department of Health and Human Services

New York state *alone* has 150,000-200,000 heroin addicts and this SAMHSA report gives a lower estimate of 500,000. for the country. In fact, in the U.S. in 2005, there were over 250,000 heroin addicts in treatment, which of course, is obviously not more than the number that exist!!! Anyone who thinks a majority of our addicts are in treatment is smoking something themselves.

The rest of it reads like your typical drug scare story-- in fact, it reads suspiciously like the story of the child heroin addict that won a Pulitzer prize that had to be retracted, because, in fact, the kid didn't exist. Real addicts rarely waste good drugs on children.

I mean, we're supposed to be selfish scum, but we're also supposed to share the thing we crave most with our kids in order to have them join us in our corruption?

And, honestly, of course prescription drugs are safer-- you know the dosage and the purity. Let's not pretend that that doesn't matter. Drug companies may be scum, the FDA may not be perfect-- but we don't hear about Oxycontin varying in purity or being contaminated with flesh-eating bacteria.
posted by Maias at 3:10 PM on August 11, 2009 [4 favorites]

Oh wow, Jimmy's World the fake Pulitzer Prize winning article is great. I like how precocious the 8 year old is. Based on that I'll present my primer on writing attention grabbing drug scare articles:

1. Show how much is spent on drug of choice even given dire poverty. Present the dealers as pimps who somehow are much more wealthy than the client's they serve.

2. Make sure this is seen as a new problem (it is cheap now / people are moving to a harder, new drug (opium -> heroin) / drug is somehow in higher concentration or better quality than it was before). Do not question how or why such innovations would come about in a market where the average product consumed is 50 cents or some small amount.

3. Cycle continues. The younger generation is unphased by drug use. 1 year olds playing with opium pipes! 8 year olds mimicking behavior of the parents!

4. Sex for drugs! Either because parent is inattentive and live-in boyfriend takes advantage or outright opium brides. That's right brides of the damned, sealed together in opium weddings (at least the flowers are pretty though).

5. Have an elder or simply older person provide wisdom. They cannot help themselves! No one has ever broken an opium addiction, if it is there it will be used!

I'll make a deal and if you make any money off your article you can pay me in drugs.
posted by geoff. at 3:37 PM on August 11, 2009 [1 favorite]

Let's not pretend that that doesn't matter.

Of course it does but only for people using said drugs according to labels. People die from prescription OD all the time, I'd be interested to see some comparison numbers vs. illegal drugs like heroin, if you have access to them. And flesh eating bacteria? That sounds like a typical drug scare tactic to me, not saying it is, but any story that talked about flesh eating bacteria in illegal drugs would certainly set off my bullshit/propaganda alarm.
posted by IvoShandor at 3:42 PM on August 11, 2009

Maias: The last link from the ISN cites the The UN Office on Drugs and Crime (UNODC) estimate of 920,000, or 3.7% of 27 million people. I don't know the methodology. The same agency estimates that 10.3% of the total population is involved in opium cultivation.
posted by uaudio at 4:00 PM on August 11, 2009

The same agency estimates that 10.3% of the total population is involved in opium cultivation.

Afghanistan could be a world power on the strength of a (legalized) pharma industry alone.
posted by rokusan at 4:32 PM on August 11, 2009

Uaudio, I was disputing the U.S. figures, not the Afghan ones. Claiming we have fewer than 200,000 opium and heroin addicts in the country when there are probably more than that in New York alone is just plain bizarre. I wouldn't put much stake in the UN numbers either, given how difficult it is to measure these things in a country that devastated-- but I'm sure those are the best numbers they have.

Ivo, the vast majority of prescription drug overdoses occur in drug addicts who mix opioids with other drugs. These mixes often include both legal and illegal drugs-- but there are more PDF that include prescription drugs than heroin, at least from what is claimed on death certificates.

However, it is clear that these are overwhelmingly not pain patients who make "a mistake and take too many"-- these are people who take, as, for example, Heath Ledger did, several different benzodiazepines and several different opioids and an antihistamine. The medical examiner declared his death to be due to "drug abuse"-- even though the media (guided by some family members and friends) tried to claim that he made a mistake with his pain meds. It may have been an accident in that he didn't intend to kill himself-- but it wasn't an accident as in, "Oops, I can't remember if I took my meds yet." He was trying to get high and didn't have any condition for which a doctor would have conceivably legitimately prescribed that combination of meds.

In most of these cases, there is a clear history of addiction and of things like getting scripts from multiple doctors.

Some additional stats are in these articles I've written for the New York Times, Time and MSN.
posted by Maias at 4:47 PM on August 11, 2009

P.S. regarding flesh eating bacteria. See here. Or google for yourself. As you might have guessed from my post, I am not a purveyor of drug scare stories-- but this one happens to be true from time to time.
posted by Maias at 4:52 PM on August 11, 2009

rokusan: I don't particularly care that Big Pharma sells them at a high price: what I find interesting is how that seems to be part of what makes a drug into a "medicine".

I find it hilarious (because laughing means I can't cry) that while it's OK for my doctor to prescribe me amphetamines, opiates, and benzodiazepines, to be taken every day, it's illegal to ingest certain plants/plant products that grow pretty freely and have effects up there with the prescriptions.

Maias: And, honestly, of course prescription drugs are safer-- you know the dosage and the purity.

Oh, definitely. Unless it's a generic, which means it only needs to be within 20% of the bioavailability of the name-brand pill (apologies if my numbers are off, at work).
posted by jtron at 5:33 PM on August 11, 2009

Jtron, I don't think we've seen a case of an overdose that was due to a generic substitution. If there have been some, please provide citations.

We have certainly seen cases where people overdosed on illegal drugs sold as heroin, particularly illegally manufactured fentanyl, however. This stuff is about a hundred of times more potent than morphine (50 times more potent than morphine) and so if you don't cut it properly, a few people get a dose guaranteed to kill, while everyone else gets pure filler. There were over 1,000 deaths related to this over the last few years.
posted by Maias at 7:06 PM on August 11, 2009

Oh, no, Maias - believe me, I wasn't trying to undercut your argument in general, and I apologize if it came off that way, because I recognize that in any sort of discussion on drug policy (or "bad kid" camps) you are going to have alllll sorts of facts at your ready disposal. And given the way drug companies work, I'd be surprised if there were as many cases where the medications were up to 20% over as there were cases where there was up to 20% under in terms of the active ingredients.

and the fentanyl-substituted-for-heroin thing is just nuts - one would think the "upline" of that particular transactional chain would be more interested in keeping loyal customers
posted by jtron at 7:40 PM on August 11, 2009

hey Jtron, it's cool... yeah, definitely, better to err on the side of *underdosing* though, as you say, you don't want to go too low or you will put off the customers...
posted by Maias at 8:06 PM on August 11, 2009

Afghanistan is dirt poor. America is waging war in Afghanistan. The poor and their children in Afghanistan are getting addicted to opium. Metafilter squabbles about big pharma and addiction levels in US. Sometimes you people make me throw up a little bit. AlJazeera was reporting on child addicts two years ago.
posted by adamvasco at 1:17 AM on August 12, 2009

The point is that the focus shouldn't be on addiction. Trying to fight addiction by detoxing people in 7 days and sending them home is worse than useless-- it's a waste of money that makes the addicts and their families even more hopeless and poor afterwards than beforehand.

Improving employment, education and living conditions would be a far more effective way of fighting addiction in Afghanistan than providing the odd 7 day detox-- which is known to be completely ineffective, even in the West where people go home to safe suburbs, not to a filthy, unsafe hovel filled with people who are still using.
posted by Maias at 2:39 PM on August 12, 2009 [1 favorite]