A drug subsitute becomes an addiction

Subutex is an opiate narcotic which doctors frequently prescribe to help heroin addicts kick their habit. But here in the Czech Republic, some addicts have discovered ways to abuse the drug, which is also known as buprenorphine. A government study recently confirmed a disturbing pattern of subutex abuse, much of which happens in plain sight.

At 3:30 pm on a weekday, commuters crisscross the central hall of Prague's main railway station. To them, this seedy plaza is a bottleneck to get past as quickly as possible. But for the drug users who linger by the entranceways, the station is the destination.

"This is the main drug place in Prague, and there are a lot of drug users around. For them it's really easy to find here some dealers."

David Valouch is a counselor who has worked with drug addicts for several years. About three years ago, he started noticing that heroin users were gravitating to a new drug, subutex, which was prescribed as a substitute to help end their addiction. Only they weren't always using subutex as intended.

"In Prague there are about 8,500 intravenous drug users. I think most of them use subutex know. It's a kind of opiate drug that is made from opium. They should use orally, but for them it's not so strong, or they don't feel the effect so they put inside their veins. But this is not healthy, this is very dangerous actually."

The adverse effects of injecting subutex can include: clogging of the veins leading to gangrene, severe respiratory problems, and of course if the needles are shared, they can spread diseases like HIV and hepatitis.

"Let's go outside because there we can find some drug users because most of them want to smoke....Hey, do you take subutex?"

In the park just outside the station, we meet Mirek, who's been puffing a cigarette in the rain. He looks to be in his twenties, is wearing clean clothes and a baseball cap, and shifts his weight anxiously from one foot to the other as he talks.

"I've been taking subutex for 3 or 4 years now. When I started it was as a substitution, which helped me get out of the worst of a crappy situation. But it helped. Yeah, I get it from the doctor, legally."

Mirek told us he'd like to quit, but years after first taking subutex, he still hasn't succeeded. The substitute has become his addiction now.

"I used heroin for five years. Subutex is different. Subutex you take just to avoid feeling bad, whereas with heroin you get a kind of high, a euphoria. With subutex, there's less of a rush because you don't get so high. I take subutex every day, twice daily, morning and night."

Prague's main train station
Generally, doctors prescribe subutex to be taken only once a day, and the entire treatment should last a matter of months, not years

On this afternoon, Mirek is the only subutex user willing to speak to Radio Prague. But there's no shortage of addicts in the area. When David Valouch and I go back inside the station, we find a lively black market for the drug taking place right under the nose of the police who patrol the station.

A man in a bulky coat attracts a crowd after he takes out a perforated plastic sheet of pills, and starts distributing them in exchange for handfuls of 100 and 200 crown notes. A gram of subutex costs about 300 crowns, or fourteen US dollars, making it three times cheaper than heroin.

A few metres away, outreach workers distribute needles, alcohol swabs, and filters to remove at least some of the particles that make crushed subutex so dangerous.

"My work is mostly in the street, helping clients exchange dirty needles for clean ones. I come here two times a week. Earlier most of our clients used heroin, but two or three years ago, when subutex, arrived they started taking it instead."

Ales Termer is with Sananim, the largest Czech non-governmental organisation providing services to fight drug addiction. At four in the afternoon, he and his two co-workers draw a constant stream of clients. Many of them are clearly homeless and mentally unstable, but others are clean-cut and indistinguishable from the mass of commuters passing through the station. He says subutex is dangerous to anyone precisely because it can seem harmless.

"It's not as strong as heroin, they don't get as wasted. They can stay more stable. It's also cheaper and they don't need to steal as much to pay for it. Also, the buzz lasts longer, as much as 24 hours as opposed to three or four hours for heroin. The bad health effects don't kick in right away, usually it happens after they've been using for a while, it all adds up in combination with other drugs. And then they die."

Although the government agency that collects statistics on drug use hasn't counted any deaths yet from subutex, these outreach workers believe some abusers have died in connection with the drug.

Some steps have already been taken to curb subutex abuse. Where once any doctor could prescribe subutex, now only about ten physicians in Prague are authorized to write a prescription. Viktor Mravcik is with the National Monitoring Centre for Drugs and Drug Use, an official government body. He says the authorities do know about the subutex problem and have plans to tackle it:

"The Czech Republic is aware of the fact that it has...shifted to the black market. For next year we have prepared two main measures aimed at preventing it. The first one is a register of patients on a substitute, including Subutex. And the second measure is the expected registration of Suboxone, which is a similar drug but with an even better safety profile."

Suboxone is considered promising because there's little or no effect if you take it intravenously - it must be administered orally to work. It remains to be seen whether subutex's users will be willing to make the switch.