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New Age Austerity Highs Prebagabalin NEW AGE AUSTERITY HIGHS In the 1980s heroin use rocketed alongside spiralling N o I deprivation. So ofus T o H P why, now we have € returned to an era of austerity, is heroin has followed the global financial and but like most pharmaceuticals they have banking crisis, with deep cuts in public multiple uses. While robust and reliable use falling? services, a flat-lining economy and the national data regarding prevalence of 2011 riots all echoing the troubled times their use in heroin-using communities Steve Wakeman and of three decades ago. However, there is a is non-existent at present, in the locale curious exception here: heroin. Contrary of our research we have observed it to Toby Seddon have to the expectations of many, according be commonplace, with considerable to NTA’s statistics, the number of heroin demand developing for these drugs. some answers. users, far from exploding, appears to Recently, whilst waiting for a heroin be falling, as is the use of crack. The dealer to arrive, ‘Ryan’ (a long-term accepted wisdom that there are strong heroin and crack user in his early forties) Thirty years ago, in the early 1980s, the connections between drug problems and explained the current situation: social and political outlook in Britain deprivation suddenly no longer seems Ryan: People can’t get them [pregabalin] was bleak: economic recession, public quite so secure. as much as they’d like to really. I can, but I spending cuts, youth unemployment Faced with this puzzle, we have keep that quiet, you know? If everyone gets and inner-city disorder. Making a bad been attempting to re-evaluate the use on them they’ll [the doctors] stop giving situation worse – most notably in the of heroin in today’s ‘austerity Britain’ them out. It’s like there’s more demand than post-industrial cities of the North and through an ongoing ethnographic supply just now. Scotland such as Liverpool, Manchester research project on a housing estate in SW: So how much do they sell for then? and Glasgow – arrived cheap, brown North West England. And, we have made Ryan: Depends on the tab, the 60mg ones heroin. It spread like wildfire amongst several small but significant observations not much, they’re not that good, you need young people in the most deprived that provide some clues as to what quite a bit of it you see, but the 150mg ones, neighbourhoods. Many commentators might be going on. We focus here on one they’re like a quid a pill or something like claimed this heroin ‘epidemic’ to be a of these emerging findings: the sharp that, you can do alright with them if you’ve symptom of the country’s wider socio- rise in the use of two prescription-only got loads. economic malaise. painkillers, pregabalin and gabapentin. This particular individual was Rather depressingly, much of this is As anticonvulsants, these drugs are prescribed pregabalin as a result of pain familiar today in the austere climate that primarily used to treat neuropathic pain, caused by methadone withdrawal, but 14 | DRUGLINK SEPTEMBER/OCTOBER 2013 he has subsequently started sourcing drug markets are structured, and in turn, times of economic hardship). However, them from elsewhere too (mainly from for what we know about them and the our project reveals more complex a non-heroin-using amputee prescribed levels of drug use they contain. intersections between illicit drugs proper pregabalin for ‘phantom’ pains in an Despite national estimates indicating and various pharmaceutical drugs that amputated leg). a decline in ‘problem drug use’, our are being used and sold illicitly, than Despite his claim to be ‘keeping things research suggests there may be more those that went before it. quiet’, we have witnessed the use and going on here than first meets the This presents an obvious challenge sale of these two drugs spread across eye. Based on our observations, there for conventional approaches to policing the whole heroin-using population on is a case for considering the role of and law enforcement, which are this estate. They have quickly become substances like pregabalin in the predicated on more clear-cut divisions established components of the drug reported falls in heroin use, especially between legal and illegal commodities. market here, especially pregabalin, and because of its dual functionality for There may also be implications for this – in our estimation at least – might users. The use of pregabalin to enhance health. The problems associated with the represent a significant development the effects of heroin means one requires illicit use of benzodiazepines and other regarding the real nature of reported falls less heroin to maintain a habit. similar drugs are well documented; it in heroin use. is possible that what we are looking at As we will explain, it is possible failing to Monitor new with pregabalin is the start of something that the use of drugs like pregabalin is similar. On a number of occasions users affecting the recorded rates of heroin patterns of drug taking have expressed to us their belief in the use. Our interviews and observations Behaviour does not ‘harmlessness’ of pregabalin due to it suggest this drug has been adopted so being ‘non-opiate’. Whilst it is true that feverishly because of its ‘dual utility’. Mean they do not exist it is not an opiate-based substance, Pregabalin enhances the desired effects we are less convinced it is necessarily of heroin in that it helps the user ‘gouge But this does not necessarily equate to harmless, particularly when used in the out’, but it also has the capacity to reduce less problematic drug use. At the same quantities we observed and alongside the undesirable effects of withdrawal time, on a number of occasions we other substances. From a public health symptoms too. That is, for the heroin have witnessed heroin users utilising perspective, this has the potential to be users we have been spending time with, pregabalin’s opposite capacity by problematic. pregabalin maximises pleasure and detoxing themselves at home with an What are we to make, then, of this minimises pain concomitantly. Illustrating illicitly sourced supply. We leave aside emerging picture of heroin in austerity this, ‘Anton’ (a male heroin user in the question of whether or not this Britain? It seems to us, first of all, that his early thirties) gave the following ‘works’. What is critical here is that this politicians (and others) have been far response to a question about the effects behaviour can preclude a user’s contact too hasty in celebrating drug policy of pregabalin: with treatment agencies and as a result, ‘successes’: failing to monitor new They do the job, they smash me right in. their appearance in treatment data. We patterns of drug taking behaviour does On top of a smoke [of heroin] like, they’re like certainly acknowledge this is speculative not mean they do not exist. We would being pissed, except you know what you’re at the moment, but if similar shifts are suggest that any complacency now doing and that. happening elsewhere then a potential would be ill-judged and irresponsible – However, during a subsequent distortion of national drug trend data David Cameron’s assertion in December meeting whilst he was attempting becomes conceivable at the very least. 2012 that “we have a drug policy that to withdraw from heroin (again), he In other words, what appears to is actually working, drug use is coming was still consuming pregabalin (in be a decline may actually be a more down” may be more like political wishful large quantities too). When asked complex process of diversification. And, thinking than it is an evidence-based about whether or not this ‘worked’, he given the fact that there are currently fact. responded: no accurate quantitative measures of Announcements of the death of It’s not perfect, but nothing’s ever going this diversifying picture, we have no the drugs-deprivation link may also be to be is it? It does do the trick though in way of knowing whether drug markets premature. Our research suggests that a way, it deffo helps, like really helps you as a whole are growing or shrinking. All illegal substances remain important know? One of the main things for people is we can say is that our own qualitative commodities circulating within the the cramps and twitching legs and that, and observations actually run counter to the ‘shadow’ economies that thrive in the it really helps with them, but also with sleep, quantitative measures we do have. If we most disadvantaged neighbourhoods, I’d say that’s the main thing for me, it lets me also consider the fast-moving market and that they grow in stature and appeal sleep – if I take enough of them that is. in ‘legal highs’, only some of which are in close correlation with the decline So pregabalin has attractive qualities on the policy and monitoring radars, of legitimate economic opportunities. on two fronts; this is not simply a matter then reports of a shrinking drug problem What is now urgently needed is further of pleasure seeking, or pain-avoidance, seem less than convincing. It may be ethnographic research in areas such as but both at the same time. Whilst more plausible to suggest that our this to build our understandings of their pregabalin is not the cheapest black- monitoring systems are simply falling rapidly evolving local drug markets. market pharmaceutical in circulation, it behind rapidly evolving drug markets. Only then will we be able to develop is not the most expensive either, and it Our findings resonate strongly with policies and services that can fix today’s has become highly sought after in this earlier studies on the 1980s heroin problems rather than yesterday’s.
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