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Závislost na jehle

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Závislost na jehle

10.06.2010 | Sekce: Zdravotní

Vyšlo v Dekontaminaci

 

Článek doktora Kamila Kaliny o nitrožilnímu užívání Subutexu.

Už to tu jednou bylo...

Kdy? Dávno, dávno tomu, v minulém století... V letech 1975 - 1985 byl na české drogové scéně velmi populární Alnagon, lék proti bolestem obsahující opiát kodein. Zpočátku byl volně k dostání v lékárnách. Tehdejší uživatelé návykových látek rychle přišli na to, že Alnagon skýtá značné možnosti, jak si "užít". Nejen polykali značné množství tablet, ale naučili se upravovat Alnagon rozpuštěním a filtrací pro nitrožilní aplikaci. Protože nejvíce rozpustný je kodein, filtrát obsahoval největší množství právě této učinné látky opiátového typu.

 

Závislí si vstřikovali do žíly Alnagon v dávce až 20 tablet denně. Odborníci-pamětníci popisují časté záněty žil a žilní trombózy vedoucí k úplnému zničení povrchového žilního systému. Proto docházelo i k aplikaci do svalů, což zase vedlo k tvorbě abscesů s horečnatými stavy. U chronických uživatelů se vyvinula závislost opiátového typu.

Účinným opatřením bylo tehdy snížení dostupnosti Alnagonu, který přestal být volně prodejný a byl k dostání pouze na lékařský předpis. Zavedení Alnagonu na recept ovšem nesnížilo zájem o opiátové návykové látky. Začal se šířit „braun" a od poloviny

90. let, kdy se stal dostupný heroin, dávají uživatelé přednost heroinu.

 

Už tehdy, za časů Alnagonu, ale odborníci popsali tři složky závislosti:

  • závislost somatická, charakterizovaná syndromem odnětí drogy („absťák"),
  • závislost psychická vyjádřená silnými „chutěmi",
  • závislost na rituální složce nitrožilního podávání drogy.

A už je to tu zase...

Před dvěma lety začal pronikat na drogovou scénu Subutex (buprenorfin). Původně byl určený jako pomocná látka při detoxifikaci u závislých na heroinu, ale rozšířil se jako návyková látka a částečně nahradil dokonce i heroin.

Subutex se vyrábí ve formě tablet, které na rozdíl od „pravěkého" Alnagonu nejsou určeny k polykání, ale vkládají se pod jazyk. Díky bohatému cévnímu zásobení tohoto místečka se účinná látka vstřebává přímo do krevního oběhu. Obchází tudíž zažívací trakt a má bezprostřední účinek, jako by byla podána přímo do žíly.

Ale injekčním uživatelům heroinu něco chybělo... a začali nejen užívat značné množství tablet (někdy je polykali, což samozřejmě účinek snižuje), ale naučili se upravovat Subutex pro nitrožilní aplikaci. „Závislost na jehle" se znovu objevila v čisté, ba nejčistší podobě. Dnes víme, že jde nejen o závislost na rituálu injekčního vpichování, který ničí žíly, působí zánětlivé komplikace a může do těla přinést nebezpečnou virovou infekci - to dobře znáte ze stránek DEKONTAMINACE! Jde také o jev, popisovaný jako „placebo efekt"... účinek nějakého léku či drogy se dostaví, pokud v něj člověk věří a očekává jej. A tak injekční uživatelé Subutexu, kteří očekávají „nájezd" na základě zkušeností s nitrožilním podáváním heroinu nebo i pervitinu, opravdu „nájezd" prožívají. A co že to je nakonec, ten „placebo efekt"? Hm, sebeklam, nic víc.

 

Nejlepší je nebrat

Tohle také znáte ze stránek DEKONTAMINACE - nebo ne? Nejlepší je nebrat - to je nejméně rizikové. Když už bereš, neber nitrožilně - to je víc rizikové než nebrat, ale méně rizikové než brát nitrožilně. Když už bereš nitrožilně, nesdílej injekční náčiní a dbej na sterilní přípravu a vpichování drogy - to je daleko víc rizikové než nebrat vůbec, víc rizikové než si nepíchat, ale pořád ještě méně rizikové než si píchat do žíly jako čuně (promiňte laskavě tento výraz) a riskovat všemožné infekce, zdraví, a často i život.

Když už tedy berete Subutex, stačí se rozloučit s jedním rituálem a jedním sebeklamem, vstrčit si ho pod jazyk, a jste na docela dobré cestě ke snížení rizik. Ale nejlepší je nebrat. Haha, moudrej doktor, ať zkusí ten rozdíl, subáč do pusy nebo do stříkačky! Nemám potřebu to zkoušet. Mám svou dýmku a červené víno, obojí je spojené s řadou rituálů, takže o tom něco vím. A jednou jsem svou dýmku kouřil v cofee shopu v Amsterdamu, kde všichni kolem kouřili marihuanu, a měl jsem představy, ach! ... a věděl jsem, že mám v dýmce obyčejný tabák. Ani to nebyl „placebo efekt". Takže vím něco i o tomhle. Vy zkuste!

 

MUDr. Kamil Kalina, SANANIM

Komentáře

 

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Surgical Technologists, generally known as surgical techs or precise techs, have always been section of the allied professional medical profession of which caters typically to precise assistance before, during, and after surgeries. associates tech

Broadly chatting, the period 'communications technology' can consider any technology allowing its end users to communicate with each other. Using that (unquestionably loose) meaning, two-way radios and mobile phone devices fall into your category connected with 'communications technology'. comman tech

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