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."