DRUGS MENACE FRIGHTENING...

I WAS very surprised to read Robert Smith's articles about the growing
problem of heroin use in Bahrain (GDN, June 20, 21 and 22).

Having lived there for 18 years, not once did I witness an incident
involving intravenous drug use.

This may either be a result of my naivety as a teenager and the fact that
my parents took extensive measures to 'protect' me from the real world,
resulting in my profound ignorance at the time, or because our
socio-economic condition dictated that my peers only had enough money to be
naughty and vent their teenage frustrations by buying handfuls of cancer
sticks from the local cold store from the trusty South Indian attendant
(apologies for being stereotypical, but it's so true) who would gladly open
up a pack of Marlboro Reds and sell five cigarettes to boys and girls who
hadn't yet had their 15th birthday.

The cigarettes may now be well on their way to giving my friends emphysema,
bronchitis, ischemic heart disease and peripheral vascular disease, but
gone are the days when that was the major issue of concern.

Here comes the new wave of kids with the means to fund an expensive, far
more dangerous and lethal habit - heroin.

The article on the growing abuse of benzodiazepines in combination with
heroin is very worrying because it is not a new problem; it is something
that has been in the literature for many years and should be preventable.

Any reputable book on clinical guidelines will clearly state that although
benzodiazepines should be used to treat opiate withdrawal symptoms like
anxiety, it is absolutely crucial to ensure that there is adequate
infrastructure available to strictly regulate the prescription because of
precisely the problem outlined in the GDN articles.

Doctor-shopping by heroin addicts with claims of epilepsy in search of
benzos is one of the oldest tricks in the book.

Injecting benzodiazepines is quickly becoming a huge problem all over the
world especially with heroin addicts. It has gone to the extent where
manufacturers have been forced to stop producing certain benzos such as
temazepam in the gel-capsule form, simply to discourage injecting the drug.

Now that there is a dedicated service in Bahrain in the form of the
Almoayyed Drug and Alcohol Treatment and Rehabilitation Centre, I am
curious to know if there is a methadone programme available for addicts who
are serious about quitting and if buprenorphine is also being used.

Also, I'd like to know if any epidemiological data is available by the
Health Ministry on the prevalence of HIV, Hepatitis B and C amongst
intravenous drug users in Bahrain.

More importantly, if the report in the GDN is accurate, I find it hard to
believe that the doctors at the rehab centre can claim that the drugs they
prescribe (which may include Diazepam, Temazepam, Nitrazepam and/or
Clonazepam) "do not kill even if taken with heroin".

It is simply illogical to make that statement if they are prescribing
benzodiazepines to known heroin addicts in an outpatient setting, which is
what was implied by your article in the GDN.

There is absolutely no guarantee that they will not use the drug in
combination with heroin to result in a fatal overdose.

Imran Marzook

lA Health Ministry spokesman said: "Benzodiazepines which include megadon,
diazepam and sometimes xanax are prescribed to heroin addicts who are
receiving treatment at Almoayyed Drug and Alcohol Treatment and
Rehabilitation Centre as out-patients.

"Research has shown that these drugs do help patients to kick the habit.

"The number of new heroin addicts attending the centre increased four times
from 2002 and 2003 but this is not due to any change in our policy in
prescribing drugs to out-patients. It is because of other factors."