sixthseal.com in Singapore’s newspaper

Thanks for the tip off, Kristian.

http://www.straitstimes.asia1.com.sg/think/story/0,4386,257247,00.html

The link expired, here is the emailed version, courtesy of The Sunday Times:

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This message was forwarded to you from Straits Times Interactive (http://straitstimes.asia1.com.sg) by me@sixthseal.com

Are they drug dealers with stethoscopes?
by Salma Khalik

MICHAEL, 36, has a list of 20 doctors whom he calls ‘sellers’.
These are general practitioners (GPs) who willingly sell sleeping pills
to addicts.

These GPs don’t bother with consultation. They charge $3 to $5 a pill for Dormicum and $12 for Erimin.

The man who calls himself Michael is a former computer technician
and a drug addict for 20 years. He told The Sunday Times: ‘It takes
just 1 1/2 minutes to get the pills from them.’

Those 90 seconds or so are the sum total of the doctor’s
‘treatment’ – all the time he needs to check when he last prescribed
pills to this patient. To satisfy health authorities that they are not
overprescribing, they stick to the guideline of a pill a day.

This cynical approach to rules designed by the health authorities
to protect addicts from themselves may be at the core of a worrying
change in Singapore’s drug culture. Over the past decade or so,
effective police action has reduced access to hard drugs like heroin
and cannabis. The addicts’ solution: prescription drugs.

More interested in profits than healing, unscrupulous GPs are
believed to have already turned Dormicum and Erimin sales to addicts
into a sizeable business. Doctors are the addicts’ main suppliers: An
Institute of Mental Health (IMH) survey found that three in four
addicts got their supply from GPs. The black market accounted for only
22 per cent.

Each pill costs a doctor just a few cents to buy. The selling price
of a Dormicum pill ranges from about 70 cents at public hospitals to
about $5 at some private clinics, with most selling it at $3. Dormicum
pills alone can bring in thousands of dollars a month for a clinic. If
a doctor freely sells both Erimin and Dormicum, well, he won’t have to
do much doctoring to earn a good income.

Since 1990, the Singapore Medical Council has censured 18 doctors
for prescribing sleeping pills too freely to patients – with six dealt
with this year alone. Several other doctors are now under investigation
for this breach of professional conduct.

But the practice continues, and not just in Singapore. There are
Internet chatrooms – like weblog sixthseal.com – where addicts share
their favourite drug recipes and experiences.

There is no shortage of supplies. No one seems to know exactly how
many sleeping pills are imported into Singapore. The Health Ministry
does not keep records of the 79 different brands and generic
benzodiazepines – a category that includes Dormicum, Erimin, Valium and
Xanax – that are allowed in. But people in the know estimate an annual
import of between 25 million and 30 million benzodiazepine pills.

Either taken on their own or in a cocktail mixture with other
drugs, alcohol or even Coca-Cola, the sleeping pills can give a feeling
of well-being, or in Michael’s words, make ‘everything more beautiful’.

Called hypnotics or depressants, Erimin, Dormicum and the like are
highly addictive. If taken long term, they can damage internal organs,
cause memory failure and weaken muscles.

Moreover, society suffers. An IMH survey of 50 such addicts found
that at least a third of them shoplifted while under the influence of
the drugs.

Michael has been arrested and thrown into jail several times for
this. But he can’t recall doing it at all. All he remembers is waking
up in prison and being charged with the crime.

He was sent for drug rehabilitation, but relapsed the moment he was
out. As he put it: ‘Sobriety brings clarity. With clarity comes
responsibility. And responsibility sucks.’

In 1998, in an attempt to keep a lid on such addiction, the Health
Ministry set a cap on the amount each clinic is allowed to buy. Clinics
are permitted a maximum of 12,000 Erimin and 21,600 Dormicum pills a
year.

In 2002, the ministry issued warnings that one pill a day for just two weeks could lead to addiction.

But this guideline seems to have had little effect. Michael and his
sleeping-pill addict friends, who take more than a pill a day, visit an
average of five GP clinics a month for their supply. Doctor-hoppers
have an average of 12 doctors prepared to prescribe for them. One
person went to 23 different doctors.

The addicts identify three supplier categories: pure ‘sellers’ who
aren’t the least interested in the people asking for such pills;
‘reluctant’ GPs, who charge high for the pills, claiming that this is
to discourage addiction; and ‘concerned’ GPs, who try to help them
overcome their need while still supplying them with the pills.

Says Dr Munidasa Winslow, head of IMH’s Community Addictions
Management Programme (Camp): ‘In private practice, you have to be both
businessman and doctor.

‘The vast majority of doctors practise ethical medicine, but there
will be some who are more businessmen then doctors. It is highly
competitive and there is a lot of pressure on doctors to give patients
what they want.’

Singapore can’t just stop the pills’ import as the drugs have real
medical value. Dormicum, for example, is often used to sedate patients
undergoing a colonoscopy to check for cancer and other problems in
their large intestines.

People doing shift work may also have difficulty getting enough
sleep, because their body clocks get disoriented by changing sleep
patterns.

Most hospitals and clinics don’t stock Erimin, because this
Japanese product is a controlled drug and involves a lot of paperwork.
Non-doctors caught selling it can be jailed 10 years and given five
strokes of the cane.

Clinics that do prescribe Erimin buy an average of 6,000 pills a
year. Most clinics stock Dormicum and they buy about 2,400 to 3,000
pills a year.

Yet last year, 23 clinics bought the maximum of 12,000 Erimin pills
and 12 clinics bought the maximum 21,600 pills allowed for Dormicum.

Before 1998, when no limits were placed on the number of pills
clinics could buy, sleeping pill revenues were even higher. Some
clinics circumvented the Health Ministry cap by opening more outlets.

Grace Polyclinic was one such clinic. It was in the news recently
when its doctor-owner was struck off the medical register and no longer
allowed to practise. Seven of its other doctors are either under
investigation by the Singapore Medical Council or have been censured
for grossly overprescribing sleeping pills. The clinic had seven
outlets each buying the maximum 12,000 Erimin tablets a year. Each
outlet also bought between 3,600 and 19,800 of the less lucrative 15mg
Dormicum pills in 2000 and 2001. Six of the seven outlets have since
closed.

Dr Winslow suspects that a surge of sleeping pill addicts in the
1990s followed successful police crackdowns that made heroin and
cannabis more difficult to get. With their drug sources drying up,
addicts had to look for alternatives, and these were readily available.

This was what happened in Michael’s case.

He started his drug trip when he was in his late teens. He wanted
to be ‘one up’ on his school mates. So while they smoked cigarettes, he
puffed on marijuana.

A few years later, he progressed to heroin. Being a drug addict was
an expensive vice. He would spend about $60 a day to get his fix. He
once splurged $4,000 on a two-week binge.

‘I had to be manipulative and scheming to get the money for drugs,’
he says. When he couldn’t borrow or steal the money, he would help his
colleagues with their work, and suggest they thank him with cash.

It was partly the high cost – the price for one straw of heroin
shot from $7 to $8 in the late 1980s to $15 to $20 in the mid-1990s –
and partly the increasing difficulty of getting heroin that pushed him
towards sleeping pills and high-codeine cough mixtures.

He needed as much as $90 a day for heroin, but only about $30 for pills.

Dr Winslow says addiction is an expensive business as addicts would
spend hundreds or even thousands of dollars a month to satisfy their
cravings. Since early last year, more than 200 sleeping-pill addicts
have sought cures at IMH. Three in four addicts surveyed by the IMH
said GPs were not interested in discussing their plight.

Breaking the addiction is far more difficult than getting hooked.
Michael, who is married ‘to a saint who has stuck by me’ and has two
young children, is now entirely cured.

But he still attends therapy because the temptation to return to a
drug-induced paradise is everywhere. Every time he goes to the toilet
(where he used to hide to take his drugs), ‘I think of how beautiful
life was,’ he says. ‘Everything I see is a trigger.’

Brutally honest, Michael admits that being on drugs has stunted him
emotionally: ‘My thinking, my personality, it’s still that of a 16 year
old. I still throw tantrums.’

It was to help people like him that the IMH set up its addiction clinic.

Ms Catherine Dong, the Camp psychologist who did the survey on
addicts, thinks that just treating patients is not enough. She wants
something done at the source of such suffering.

Her suggested solution: a national registry of benzodiazepine users so addicts can’t doctor-hop.

Such a move would involve considerable paper work, but it should
drastically reduce the amount of such pills available to addicts.
Addicts can also be identified and sent for treatment. It would not
only cut down on addiction, but also shoplifting and other crimes that
go hand-in-hand with drug abuse.

*****
Quote: There are Internet chatrooms – like weblog sixthseal.com – where addicts share their favourite drug recipes and experiences.
The Straits Times, Singapore

This kind of publicity, I don’t need. I have received news from
another friend who tells me that my residence will be violated very
soon. I have to do housekeeping, excuse me.