Drug of choice?

While in Surabaya, I heard that heroin (putaw) is no longer the drug of choice; it has been replaced by buprenorphine/Subutex. This legal drug is now being prescribed by many doctors. Buprenorphine is a synthetic opiate which is produced in pill form and should be dissolved under the tongue. So it doesn't have to be injected, and because it's legal, it doesn't trigger crime. And because its manufactured by Good Manufacturing Practices, its quality and dose is predictable.

Good news, you'd think. But the bad news is that many users grind up the pills, dissolve the powder in water then inject it - just like they did with putaw. The experts tell us that people don't inject just to get a quicker high, but because it becomes part of the habit - part of life, I guess. So although perhaps we're reducing crime, and indeed reducing costs to users (although buprenorphine is not cheap), we're not reducing the HIV infection risk.

In addition, buprenorphine doesn't dissolve in water. So the resulting suspension contains solid particles of buprenorphine, whose size depends on the effort put into grinding it up. A user in sakaw (withdrawal) is usually not very concerned with such niceties. Result is that an increasing number are suffering abscesses and other health problems from putting lumps of buprenorphine into their blood stream.

Buprenorphine 'competes' with methadone as opiate substitution therapy. But in Indonesia, there's really no competition. Although methadone is cheaper, it is only offered in a (still) relatively small number of designated clinics, usually only open in the morning. And the staff monitor its use. Buprenorphine, on the other hand, is available in most pharmacies, and if they require a prescription, that's easy! There's a doctor on the spot. And nobody cares how you use it.

Of course, all this was eminently predictable - and predicted, among others by Dr Erwin Wijono, the founder of the Jakarta Drug Dependency Hospital in the 1970's, and thus the 'father' of drug treatment in Indonesia. One day I'll write the history of how we got here.

Babé