Mr. Dezhakam’s Speech in the Annual International Congress of Addiction science
I hope you are keeping well and I have to thank my colleagues specially Dr. Amin. Now, I will mention a few points about non-governmental organizations (NGOs). Firstly, “the products or services offered should be valuable in order to be beneficial for trade; otherwise, it will be useless”. In general, an NGO should have three main pillars and these pillars are the obligatory parts of the organization.
The first pillar is that the organization should have KNOWLEDGE in its field. For example, if it operates in the field of environmental conservation, or planting trees, it should have up-to-date knowledge in that area. If it deals with kidney diseases, it should have up-to-date knowledge about kidney diseases.
.jpg)
The second issue is that the organization should have specialized personnel in the fields in which it operates. If it lacks such personnel, it should train them.
The third point is that the organization should have financial resources. In other words; therefore, it should have knowledge, specialized personnel, and financial resources. Having these elements is essential to provide valuable products or services, if it lacks one of them, then it will not work well.
The organization can have these things only if its product is valuable for trade. On that occasion, these things are provided and come into existence. Today, my discussion is about the treatment with Opium Tincture (OT), its advantages and disadvantages. We face several issues. When I say "black", we all know what black is. When I say "white", you know what white is. I say "Tehran", we know what Tehran is; however, when I say "cure", we don't know what treatment means. Some people say that addiction has no cure, it is a mysterious, incurable and progressive disease. They believe there is no cure available. Some say No, it has a cure. However, no one claims addiction has a cure. The only person who claims addiction has a cure is “I”. Some people say that this treatment should be done in the physiological aspect, a completely medical procedure. Some say it is not a psychological work, some say it is a psychiatric and some say it is a spiritual work. So, which one is correct? Is there a cure? Now they claim there is a treatment, does this treatment really exist or not? And if it does, which one is it? Spiritual, physical, or physiological? Which one is it? Here again, we have a few points, which in my personal opinion, when I say cure, by cure I mean that we should cure a heroin addict and after the treatment, this person goes to a heroin laboratory and works there without consuming drugs or without any craving to consume. Or after cure, you make an opium abuser work in a field of opium cultivation and incise seedpods with multi-bladed tool (called Gozan), and the person has not any craving to use opium. For instance, we (Congress 60) are working with 300 or 400 clinics, and in each clinic, we have a supervisor, who has been once an opium abuser, but now he is working in a clinic and he works with Opium Tincture and gives it to the patients, this is the CURE. Who is an addict? What do we mean by an addict? What is meant by addiction?
We do not have a definition for addiction. They used to say that the World Health Organization defines addiction as an old chronic poisoning disease, which in my opinion is completely and totally wrong. This wrong definition has caused great tragedies. Based on this definition, detoxification came into being, which was a very, very dangerous job. And based on the same detoxification, URD and UROD and fast URD and superfast URD came to vogue which were very very dangerous. If we want to say that addiction is chronic poisoning, we must first prove that drugs are poisonous. If you prove that drugs are poisonous, then we can claim that a drug abuser is poisoned. Which of the addictive drugs are poison? Opium is morphine, the best-selling drug in the world is codeine, the most critical drug in the medical system is codeine. Thebaine, cotamine, and papaverine, thebaine, nacreine, and protopine all are used in the medical system. Protopine, for example, is used for regulating heart rate. All of these drugs are used in the medical system as medicine.
Heroin is one of the derivatives of morphine. Heroin is diacetylmorphine (it is made up of morphine) and is used as a drug. Several hundred tons of heroin were prescribed in Germany as medicine when it was first made. Hashish or cannabis is THC (Tetrahydrocannabinol ) which is used in cough syrups and many other medical items are made from it. “Ice” is amphetamine and methamphetamine, and it is also medicine. When you look you see all of them are medicine and none of them are poison or cyanide. You may claim that using excessive amount of these drugs will result in death, yes, if you consume too much Barbari bread (a type of Iranian bread), it can cause death. Just like drinking too much water which can cause death. Breathing too much air can also cause death. Diazepam and lorazepam, if consumed excessively, can cause death. Some individuals commit suicide using psychiatric medications, do they say that diazepam is a poison? This definition is completely wrong, it is meaningless.
.jpg)
Some say addiction is a drug dependence, this is also meaningless. It does not make sense. So we don't understand what we are saying at a global level [the world is not aware of what they claim], like blind people looking for a needle in a haystack, and then you see that they don't know addiction is. They claim addicts are selfish people. One of the Congress 60 members described it very well, he said people always use labels to address addicts, always asking what is the disease of the addicts? What disease? Which parts of the person’s body is broken down? If it's psychological, which part of psychology has failed? If it's physiological, where is it in the physiology? Where is the place of failure in the body? Where do you want to fix? And it's interesting that even they think methadone is like Chelo-Kabab (an Iranian delicious food). Generally, all people order of portion of Chelo-kabab or one portion of rice and stew in restaurants. When they want to give methadone to addicts, they prescribe 8 cc for all the individuals. One will have hangover, [the other will be high]. Remember, methadone is not Chelo-kabab! This is a drug. It depends on individuals. In the old days, before Iran’s revolution, for example, one person weighing 150 kg drank a cup of alcohol and got drunk, while another person drank two bottles and nothing would happen to them. The body's resistance to drugs or alcohol can vary greatly. They have provided a protocol for opium tincture, they give them 10 cc. I want to talk about the doses. If the person is given 10 cc, it will cause death. It will be deadly if an adult drinks 10 cc of Opium Tincture which is 1 gram of opium. First, you have to give them a little amount, if it was sufficient, ok; if it was not sufficient for him, you can add it, give him 5 more cc.
These prescriptions show that they are not aware of the disease of addiction. In Congress 60, which cures addiction, we give a person only .3 cc of Opium Tincture, and for another person we may prescribe 16.5 cc. In this latter case, we give him 60 times as much as a person receiving .3 cc. we should ask and consult experts how much drug we should prescribe. We should prescribe the amount of needed drugs according to the experts’ diagnosis. We are not allowed to prescribe one or two pills for all the people. This is totally wrong. One of our challenges is that sometimes in the street, Congress 60 members are arrested and taken. Although they say I am a Congress 60 member and I am under treatment, I go to a clinic and take medicine, they will be left under arrest. One of the challenges is this and the authorities do not pay attention to the point that this person is under treatment and has gone to a clinic while he was under treatment with .5 cc OT. They give the arrested person 8 CC of OT. If he doesn't take it, they will beat him; however, excessive use of Opium Tincture can cause problems for the kidneys and liver in the near future. One needs one cc, the other may need two cc. A drunk person was arrested and sent to a judge.
The judge says, “Give him a thousand lashes”. The person says, "Either you don't know how many a thousand lashes is, or you have never been whipped before. It's like when they say, give eight cc of OT to someone. It may be a small amount for one person and a large amount for another. That's why the person feels bad after they come out of the prison. Because the authorities have multiplied his consumption several times. One may consume only .5 gram of opium. I was talking to one of the officials who believed that Opium Tincture is not good and causes constipation for the addicts and their digestive system stops working. I asked him, "How much OT do you give to these people?" In response, he said, "Sixty cc at once." I asked in how many intervals you give them 60 cc of OT. He said, at once. I asked you really give them 60 cc of opium to a person? Do you know what 60 cc of OT means? 60 cc OT is equal to 6 grams of opium! One gram of opium is fatal when consumed orally. You give 60 cc of opium to a person who used to consume .5 gram of opium. .5 gram of opium equals 5 or .5 cc of OT. Sometimes a person smokes .5 gram of opium and it equals .5 cc of OT. When you decided to treat such a person, you have increased his own .5 cc to 60 cc and then they set him free. All of these are the challenges we are faced with the treatment of addiction.
"Who is an addict? An addict is a person whose biochemical systems are impaired. We have conducted a research study and the University of Bristol did the macroarray procedures to see how the immune and dopamine and other systems are affected [by addiction]. They analyzed what areas in an addict’s system has been impaired, they realized that the whole genetic system and gene expression have been disrupted, possibly around 400 to 500 circuits in his body have stopped working. My statements today are not based on the results of a questionnaire. We have taken blood tests and studied 18,000 genes out of 22,000, evaluating all genetic pathways. These pathways, such as the dopamine pathway and metabolism, are impaired in an addict. It is true that he has stopped consuming drugs, but all of these systems are impaired. There is a high prevalence of obesity, suicide, and various diseases in these individuals, although he has quitted drugs for 5 or 20 years, but the [natural and internal] systems have not been reconstructed. The reason for all relapses and cravings is this very matter, that is why the person returns back to [addiction] again. An addicted person is damaged in three aspects: body, psyche, and worldview. All these three sides have been damaged.
What is Opium Tincture? It is a substance that contains 10% opium, 80% alcohol, and the rest is distilled water. Alcohol is used to prevent the syrup from molding, to avoid sedimentation, and to act as a solvent. What are the challenges here? One of the major challenges is that the price of drugs is very low. The price of the Opium Tincture is very low. It should not been so low. It holds true for methadone too. The price of OT should be balanced with the price of opium. I mean the price of OT must be the same as the price of opium in the black market. If it comes true in this way, then then the black market for opium will vanish. In this case, a 250-gram OT, which now costs 40,000 tomans, will not be sold for 1.2 million tomans in the black market. A bottle of OT is 40000 tomans, but in the black market it is sold for 1.2 million tomans, although, its price has come down a little, and it is sold for 700000 or 800000 tomans. They think if they do it, the addict will provide it easily, but the addict is entangled in finding it. Therefore, the difference between free and government-controlled price is like the difference between government-controlled and free dollar, now we have government-controlled and free price OT, which harms addicts. Now people buy OT and then boil it, and change it to opium, but we do not want this OT to be boiled, just buy it and put it in the sun, it will be evaporated with sunlight, it will be dry in 24 hours. Therefore, if the OT provided by the government is the same price as the free market, the black market will vanish. You can use the extra amount of money as tax, the price of a bottle of OT is 40000, that is ok, you can sell it for 400000 or 500000 with additional costs for taxation and budget to the Anti-drugs organization, to the research center of Anti-drugs organization, to non-governmental organizations or NGOs which have lots of financial problems, and operate with difficulty.
This is one of the major challenges [we are faced with]. What I have mentioned repeatedly is that prices should match with the market, and no one has listened to me, (I am clearly telling you the advice, whether you take advice from my words or get tired of them). I am not speaking as a Congress 60 member, but as a non-governmental organization. Now, there are 16,000 individuals under treatment in Congress 60. As soon as the price of opium increased, half of our members were not accepted in the clinics. The price of methadone was 12000 but it was 1.2 million tomans. The price in the black market was 100 times the real price. Why is it so? Because the herbal stores are selling methadone either. Prices and their distance from the free market should be filled. Sometimes in the past, they imposed taxes on sugar and put this money into building roads, what job is better than this? Now, the government should do this and accomplish it. I did not have any power point slides, and part of my time is left. The next point, protocols written for selling Opium Tincture are not good protocols. One of the challenges is these protocols, the current protocols for Opium Tincture are not appropriate. These protocols state that patients with heart diseases should not use Opium Tincture, even though Opium Tincture is the best medicine for these individuals. Because if an opium addict with a heart disease changes his drug to methadone syrup, they will suffer severely, it will bring about a disaster for him; however, if he is treated with Opium Tincture, it will be the best thing for him. Or a pregnant mother who is a consumer of opium, if she uses methadone, it is a tragedy. The best medicine for her is Opium Tincture, but the protocols contradict this, stating that a person with a heart disease or a pregnant woman should avoid opium. These are the problems we encountered. If you have any questions, you can ask.
Thank you very much all.
Translated by Elahe