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Addiction, Opiates, heroin & methadone
Written by Norbert Loimer   

OPIATE USE & ABUSE IN AUSTRIA


Opium poppies have long played a traditional role in the Austrian na:tional culture. What impact has this had upon illicit drug use in Austria? Norbert Loimer examines the emergence of Austria's opiate problem


INTRODUCTION

The use and abuse behaviour of opiates in Austria are reported on from the earliest findings of poppy seeds in Europe (Heer, 1865; Hartwich, 1911) to the morphinism in the nineteenth century (Neudorfer, 1865) and S. Freud's 'cocaine' therapy (Freud, 1884; Bankl, 1989). Furthermore, the development of the Austrian post-war drug subculture is discussed. A detailed list ing of the fatalities and an analysis of the spread of HIV-1 infection among the drug addicted are presented. In the fol]owing sections, this paper limits itself to opiates and does not touch upon any other substances of abuse.


HISTORICAL REVIEW

In Switzerland, carbonised poppy seeds have been found (Harwich, 1899) indicating that the poppy was already cultivated in Neolithic times. The seeds did not descend from the original Papaver setigerum.

It is hard to acertain whether the poppy was cultivated for the production of poppy seed oil or for the poppy milk. In fact, it is difficult to say when the cultivation of poppy started, and when opium was first misused.

Seeds of the white poppy were misused to calm crying babies (Tabernaemontanus, 1731; Wacho1z, 1890), a tradition maintained in eastern Austria until World War 11. Opium was reputed to be a medicine and was misused until the mid-1830s.

One of the greatest opium fanatics was John Brown whose opium therapy (Jantz, 1974) 'infected' the whole of Europe. In Vienna, his system was enthusiastically adopted by Josef Frank (1802). After the discovery of, morphine in 1804 (Schmitz, 1983) and its first commercial production, the number of addicts increased, especially after the wars when it was used as an analgesic Today it is unbelievable that S. Freud prescribed his friend, M. Fleischl, cocaine to overcome his opiate addiction (Freud, 1884; Bankl, 1989). Fleischl died after a cocaine overdose.

OPIATE USE IN AUSTRIAN EVERYDAY LIFE

In the Austrian cuisine, poppy seeds have a long tradition. They can be bought by anyone and everyone in any supermarket or drug store anywhere in Austria without any restriction. Its cultivation as an alternative crop is subsidised by the Government in Austria.

The dissemination of poppy-heads and poppystraw is not under governmental control. At Austrian bakeries and confectioneries about 20 different sweet dishes using poppy seeds as an ingredient are sold. In Catholic Austria, eating meat is forbidden on Fridays, and so, many dishes containing poppy heads are sold.

OPIATES AND THE AUSTRIAN LAW

In Austria, the first Opium Act, enacted in 1928, drew heavily from international conventions and proceedings. During the Nazi occupation their laws regulated drug affairs. After the liberation of Austria in 1945, a new Opium Act was passed in 1946, amended in 1948 and 1951. The most recent amendment was made in 1985. Austria signed the Single Convention on Narcotic Drugs of New York, revised version (Foregger and Litzka, 1985). In 1987, methadone was introduced by official order as a therapeutic means for addiction treatment.

OPIATE ABUSE IN AUSTRIA

After World War 11 several hundred morphine addicts, mainly doctors, nurses and war disihQd, were registered and their illness was dealt with by pre*scribing long~term treatment with morphine (Schriftenreihe des Bundesministerium, 1981 ,a, b, c) In the mid-1960s, this situation changed rapidly. In 1970, the number of drug users was estimated at 10000; about 500 injected raw opium. Up until today the number of illegal drug users has been constantly increasing. In 1980 the number of unknown cases must have been 8000-10000 heroin addicts. Heroin predominantly comes from the Lebanon and Iran but it is also smuggled from The Netherlands to Austria. Each year, from 1981 to 1988, 4500-5500 people were reported to the police for illegal drug abuse or an infraction of the Opiurn Act (Bundesministerium, 1985): cannabis was abused by twothirds of the above, opiate and descendants by onethird. Cocaine and the wide variety of other substances remained below 1 per cent in Austria. The number of crimes coming under the Opium Act have also been on the increase.

In addition to heroin, 'opit-imtea' is consumed by some Austrian opiate addicts exclusively, or when heroin is difficult to obtain. The opituntea is extracted  from dried poppy-heads. Depending on the country of origin, they contain a considerable amount of the substances found in raw opium.

Of those accused in respect to the Opium Act 1953, 7 per cent are still employed in 1988. The number of fatalities within the addicted population increased during the period from 1981 (Pakesch et al., 1987) to 1988 (Loimer et al., 1989).

According to a regulation issued by the Ministry of Health regarding licensing of services for drug addicts (Foregger and Litzka, 1985), 66 different services for drug addicts are licensed, including 9 institutions for short- and medium-term inpatient treatment, and 5 for long-term treatment and rehabilitation.

PUBLIC ANNOUNCEMENT FOR METHADONE PRESCRIPTION

On September 25 1987 methadone was legalised for therapeutic use in drug addiction treatment in the following cases:

1 . Long-terin drug addiction with intravenous application of the drug, and several unsuccessful withdrawal therapies
2. Opiate addiction through intravenous application of the drug along with an existing HIV- 1 infection.

HIV-1 INFECTION AND INTRAVENOUS DRUG USE

Since December 1985, a standardised method for monitoring HIV-1 infection levels and trends among intravenous drug users (lVDUs) has been used at the drugdependency outpatient clinic of the Psychiatric Clinic, University of Vienna to develop an effective programme to reduce the further spread of HIV-1 among drug users.

All IVDUs visiting the clinic were tested for HIV-1 antibodies by means of a screening test (enzyine-linked immunosorbent assay - ELISA) and a supplemental test (Western blotting) in December 1985/January 1986, December 1986/January 1987, April 1988 and February 1989. All the patients were clinically examined and a standardised questionnaire about their drug use history and behaviour was administered.

In the first sample, HIV-1 antibodies were found in 8.5 per cent (7), in the second sample in 14.5 per cent (23), in the third in 27.9 per cent (36) and, in 1989, the HIV1 incidence among IVDUs in Vienna was 29.7 per cent.

Compared with figures from the Tyrol (44 per cent) (Fuchs et al., 1985), and Switerland (joiler-iemelka et al., 1985) the infection rate in Vienna remained low, maybe because of the high proportion of IVDUs using sterile needles and syringes exclusively 85/86 (23.1 per cent); 86/76 (38.1 per cent); 88 (28.8 per cent) and 89 (31.7 per cent) or the availability of poppy-heads. The increase of HIV-1 seroprevalence from 1986 to 1988 might be explained by the introduction of a methadone maintenance programme in late 1987 primarily addressing HIV- 1 -infected drug users. Many IVDUs underwent HIV-1 tests to obtain, if infected, the benefits of methadone maintenance. The high attraction of our clinic for HIV- 1 -infected drug users increased the number of patients seeking treatment, but the frequency of HIV- 1 penetration through an injecting population can be stopped by keeping the drug user away from riskladen practices. As could be demonstrated, the availability of an opiate substitute which cannot he administered intravenously lowers the risk-laden behaviour within the injecting population.

SEXUAL BEHAVIOUR AND HIV- 1 INFECTION AMONG DRUG ADDICTS

When considering the spread of HIV-1 infection through the heterosexual population, it must he pointed out that sexual behaviour playsan all important role in social life, because IVDUs represent a possible somrce of danger if they are sexual partners of healthy people.

In February 1989, 223 drug addicts (53 female, 170 male) were questioned by ineans of a standardised interview, at the drug dependency outpatient unit of the Psychiatric Hospital of Vienna, to gain information about their sexual behaviour. One-third of the sample had heterosexual relationships with non-addicts; 10-15 per cent had homosexual relationships.

Half of the HIVA-infected IVDUs never used condoms; nearly 80 per cent of the HIV-negative WDUs did not use condoms. An important finding was the loss of sexual activity in 90 per cent of the methadone population.

EPILOGUE

In Austria, where drug users can buy or exchange syringes and needles we have seen an HIV-1 infection rate of about 30 per cent in eastern and 40-50 per cent in western Austria (Pelinka, 1989). The availability of an oral opiate substitute which cannot be injected seems to prevent the injecting population more effectively from an HIV-1 infection than 'heroin or methadone maintenance'. Such programmes are under consideration in Switzerland and the city of Hamburg. If the infection rate explodes among IVDUs, this is a sign of a conservative policy. The drug users should be helped to avoid risk-laden practices in order to protect themselves from further harm. In Austria, every doctor has the right to prescribe methadone for drug-addiction treatment. The patient has to drink the methadone in a public pharmacy every day, except on weekends. However, there is still no law to control how prescriptions are prescribed. It is suggested that there might be a con-, nection between the introduction of methadone and the increased number of fatalities among IVDUs in 1988 because of a methadone overdose.

 


Norbet Loirner
Department of Psychiatry, University of Vienna,
Wahringergurtel
18-20, A-] 090 Vienna, Austria

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