Coaxil madness in Russia

The drug market has changed completely in past few years in Moscow. “The time of synthetics has come!”-say drug users.

Everything was clear before: heroin, cannabis, “clubbing” pills. Today the main drugs are so-called pharmaceutical drugs: drugs that cannot be sold without a prescription, but nevertheless they are sold in big quantities through dishonest pharmacists. The most widely-spread and most dangerous one is antidepressant Coaxil. Its affordable and life-threatening if injected intravenously.

The first character of my material on “pharmaceutical drugs” didn’t make it to our introduction by two days-he died from blood infection. His name was Sashko.
-He injected Coaxil for the first time in spring. His leg swelled...- My mate Sergey, who was supposed to introduce me to Sashko didn’t expect such a turn of events himself. – But Sashko said:”So what”- and carried on. In autumn his leg started getting cold and swelled even more. Imagine how this Coaxil switches off your brains: his leg is getting black, but the guy is still injecting it. When gangrene started, they cut off his leg. But when I called my mother yesterday, she said he was gone...
The further you listen the worse it gets. The same guy Sergey told me about 20-year old Svetlana, who was on Coaxil as well. She didn’t make it to our first meeting either.
-She had already lost her leg from the knee down,- said bewildered Sergey. –So she started injecting her groin and caught her artery. The artery got blocked and she was taken to hospital for the second amputation. She is now in the hospital with no legs...
20-24-17-year olds... So early, so absurd, so irretrievably... Do you think it only those two? Hundreds of these terrible tragedies have happened in Moscow for the past three years. Coaxil madness is one of the darkest and dirtiest secrets of the capital.

First meeting. The surgeon.

For the first time I found out about Coaxil users from people in infectious diseases  hospital on Sokolina Gora(one of the districts in Moscow).The told me about epidemic among young Moscow citizens, who dissolve Coaxil pills in water and then inject them. Tiny crumbs block blood vessels and as a result you get gangrene. They spoke about dozens of guys and girls with no arms or legs, locked up on one of the floors of the hospital.

So then I asked my friend who works as a surgeon in the hospital N15. The hospital specialises in vein diseases. Ivan(my friend’s name is Ivan) told me that 2-3 Coaxil users a shift have been brought to his hospital every day for the past three years! And surgeons are amputating arms and legs of young people aged 17-25. “ We feel sorry not so much for them, but for their mothers, who are howling with pain:”Save my child’s legs!”-Ambulance workers are aware of that,-says Ivan.-They take them to us immediately. Day by day we have more and more such patients. We have at least 5 coaxil patients at a time in our department.

Why does gangrene start? What happens?
-If you watch the process of making coaxil substance by drug users you will see quite clearly why. They crush the pills and dissolve them in water, very often it is tap water. Then they get a disperse substance and it’s particles cause damage to a vessel and build a thrombus (clot) inside it. The thrombus starts growing rapidly. The thrombus itself is a very good environment for various  microorganisms and that provokes purulent complications. If a drug user by chance injects coaxil into an artery –then that develops thrombus not only in a big vessel, but even in small ones, called arterioles. In these cases gangrene starts very quickly. As a rule complications come in the first six months of using the drug, sometimes even sooner. Very often “neophytes of coaxil” slip up at first injection. The most careful and accurate can last maximum for a year.

In what condition are people brought to the hospital?
If we are talking about a vein, then the turn of events is as following: couple of hours after injection swelling appears together with severe pain and darkening of arm or leg. If a person injected an artery then severe pain starts practically at the time of injection and the arm gets dark and cold, covered with blemishes.

Are complications unavoidable?
Definitely not. Most of the time a case like this ends with amputation.

Let’s say you get a coaxil patient, what happens next?
Next is that we try to treat him: ultrasound of his blood vessels, then anticoagulant and anti-inflammatory, supporting therapy. In the case of artery thrombus we wait to see the level of gangrene indication to find out at what level to perform amputation, to prevent the spread of gangrene further...
Amputations are very common. I can’t give you the exact numbers, as approximate statistics are being completed just now. I want to point out that drug users don’t stop after one or two injections. As a rule as soon as they are released they carry on doing it. But normally they spare the other limb, so they carry on injecting the one, which has been treated. And all of this leads to continuation of the process and gangrene in the end.

What condition are people in?
It all depends on the period of taking the drug, patient’s health history. If it is his first-third injection and there are no viral hepatitis, HIV and no damages to arteries, then he can get away with just local problems. If this patient is treated and he quits Coaxil, then he has a chance to leave shedding hardly any blood. But let me tell you: no one quits.
It’s a different story with experienced drug users. In fact they are all infirm septic patients who are coming along with a bouquet of infectious diseases. They develop severe complications. Their health projection is not looking good. Most of them stay hospitalised for months, they get operated on numerous times to clear their abscesses and devitalised tissues. As a rule these patients are resuscitation ones and they are in constant need of electrophrenic respiration and other support. We cannot save a certain percentage of these patients with all our efforts. Reasons for death are: pulmonary embolism(when thrombus blocks pulmonary artery), blood infections-sepsis; multiple organ failure...
What sort of people are your patients?
 Only 10 years ago most of them were asocial, demoralised people, who use “dirty” drugs, now our contingent has changed dramatically and has become much younger. These days they are teenagers and youngsters 16 to 27 years old. They can be schoolchildren, students of prestigious universities, managers of different companies, anyone . They are not people from dysfunctional families - more often the other way round.
We have an unpleasant tendency developing now: teenagers, trying to hide the use of drugs, start injecting groin-and therefore they develop quite serious complications very quickly. They very often get pulmonary embolism and bacterial endocarditis which require heart valve prosthesis.
There are old drug users who used to take heroin before. They are a separate contingent-the most difficult and the most ungrateful. These kind of patients need very long and very serious treatment, which they refuse to accept. They often get withdrawal pains in the hospital and simply escape, they come back to us sooner or later but in worse condition.
Do you remember the most horrifying case?
A young woman with both legs amputated, who has a child. But she survived. A lot of them don’t...

Do you feel sorry for your patients?
Sometimes we feel sorry for those kids, who were clueless and lost their arms or legs at the first injection. I tend to believe that they really did not know how dangerous this drug was. But if it is not his or her first time, this means they know about possible complications, and then there is no place for sympathy in our hearts-only irritation. Bitter disappointment and irritation...

Second meeting. The pharmacist.

Only four years ago Eastern region of Moscow and Butovo were considered “spiral” zones. North of Moscow, Kuzminki, Ljublino were heroin areas, closer to the centre and west were “amphetamine“ places. “Pharmacy” existed too, but just desperate people were using it.
You will not believe it-but there is no heroin in Moscow now. But it is not such good news: disappearance of substance unfortunately is not disappearance of drug taking. Demand is still here. Disappearing heroin has been replaced by “pharmacy” and that includes mainly prescription drugs: Coaxil, Zolidar, Stadol.
Young people don’t inject less-they simply got themselves familiar with other ways of using drugs and have found a new one-by means of medicine. But this way is dangerous, not only because of complications, but also because a drug user doesn’t quit the main drug.
-Today if a person can’t afford heroin, he simply goes to a pharmacy,-says Aleksei Petrov, who works for HIV/Aids preventive measures office “Yasen”.- That means that heroin users became Coaxil users, and this is all that has changed. If heroin comes back, they will start injecting it again...
 As we have found out –there is quite a few pharmacies in Moscow which wouldn’t mind to earn some extra on selling drugs. Imagine, only a thousand clients a month buying this drug will bring the pharmacy 13.5 million rubles! And according to official numbers there are 30 thousand drug users in Moscow.
-I myself know six pharmacies where I can buy any drug,-says Coaxil user Olga. –But as far as I understand we have them in any area. They are normally open at night. There was a time when pharmacy workers used to have Coaxil and syringes under the counter. It is not hard at all to find a pharmacy like that, if you are an observing person. That’s how I found it on “Yuznaya”: I was on the way to the tube station, when I saw empty Zoldiar and Coaxil packs lying around and they brought me to the pharmacy in the end...
-There is no such thing in any other city. I know some people, who came to Moscow and stayed here just because they can buy anything in a pharmacy,-says Lesha Petrov. –It’s paradise for drug users. Mecca! It’s clear that you Nastja won’t buy it and not every pharmacy will sell it to you. Let’s go and check...
Yasnevo. A small pharmacy, Lesha hadn’t even managed to finish his cigarette as he pointed out at two guys wearing jeans and tracksuit tops walking in to this pharmacy.
-They’ve come to get Coaxil- I’m 100% sure. If you want we can go and check.

 We came in and played an old traditional game:”A journalist as a mystery shopper”. I stood next to the guys with a concerned look on my face. Lesha started the dialog:
-What are you going to buy?
-A toothbrush for my kid...
One of the guys handed out a thousand note through the window and then a strange thing happened: the purchase took only a second- the pharmacy worker didn’t even turn to get it from the shelves or draws. I had a feeling that she had it in her hand all along. She took the money with one hand and gave out the drug with another. The guy quickly walked out of the pharmacy.
-What was that?-I wondered.-He said “Novopossit”?
-Are you deaf? ..”Two Coaxils” 500 each. She keeps it under the counter.
...”Semenovskaya” tube station and another small pharmacy. I came here with my mate Andrey. He is a character: 15 years of using heroin, now he is on Coaxil. Because of his looks and a black outfit I won’t sell Andrey even baby powder. But the pharmacist took a 500 note trying to avoid eye contact and handed out Coaxil and three syringes without any prescription. According to Andrey  the curious thing is that pharmacists always sell Coaxil out of the box and with no instruction...

Third meeting. The Coaxil users

There are three of us in the kitchen: Andrey, his girlfriend Olga and I. This kitchen was decent one time, now it is completely ruined and smells because of the toilet, which is built next to it like in any flat of typical three storey block from Stalin’s era. Andrey put our illegal shopping on the table and brought some cotton pads and toilet paper to make filters. Olga sat next to the window and took out her makeup bag.
Being busy in the kitchen, Andrey was giving me lectures:
-The most important thing is that the dishes should be clean. God forbid any fat or dirt will get into the substance! That would be terrible! The best toilet paper is the cheapest one, any foreign paper will make the liquid pink or purple...
Then Andrey put the pills in a cup and rinse them under the tap, pouring out white liquid into the sink. Then he wiped them-no joke-with brown boxer shorts, which were kept in the corner of the table for that particular purpose-they were covered in white stains.
Then the pills were mashed with a spoon-imagine those bits and pieces left there.
I won’t describe any further process but I didn’t like the final product at all: a white, turbid liquid, which wouldn’t become clear even after long filtration.
-And these idiots...-Andrey was staring into the liquid;-they filter it through cigarette paper and are happy with it...
Poor Andrey-I gave him a copy of our conversation with a surgeon, at least I could be helpful in this situation...
Meanwhile Olga was sitting and was doing her face-she was going to work. She had been on coaxil with no complication(as she thought) for half a year. Only her sight worsened a little bit. But right infront of me with a mirror in her hand, I was wondering if she had noticed how swollen it was. ..
It is very simple, -she says, slowly moving her makeup brush,- Coaxil costs 450-500 rubles, heroin-one and a half thousand for less than a gram. Buying heroin is like playing a lottery-you never know what you buy or if you will even manage to buy it. It’s difficult...

So its you FKSN cares about.
-About me?!- she turns her face away from the mirror. –They fight heroin, but offer me Coaxil instead-is that how they care about me?! There was a time when Andrey’s dose was 12 packs a day. He earned up to five thousand a day-and all of it he kept in the pharmacy. From January to June he left there about a half million rubles! If you watch a pharmacy for about three-four minutes you will see that six people out of ten buy Coaxil.

Are there a lot of people on Coaxil now?
A lot, despite the fact that they all know they can lose their arms and legs. Coaxil was not made for injecting. But they inject it even outside or in bushes...
-There is a pharmacy in “Yuzhnaya” area, -says Andrey.- You can enter any block of flats and on the stairs leading to flats you will see typical water stains after  filtration of this specific drug liquid. People make this drug substance outside on the stairs, in dirt and cold water. Three days, for at least a month. These pills don’t dissolve completely and leftovers stay in your kidneys. Then you veins get blocked and you lose your arm from the elbow down, then higher-and you become disabled and the government has to support you. But it’s useless to prove anything to some people. If you start this conversation with them in a pharmacy-they just give you a shrug, probably thinking to themselves “Whatever!” They are the kind of people who lose their arms and legs. I am often in the area and I see a lot of armless people. And they still go to the pharmacy and they still buy the drug. Coaxil is terribly addictive...
So you both want Coaxil to be banned?
We will only say thank you!- they answered simultaneously. There would be no temptation for us. Otherwise it is very affordable and available everywhere. There is a big difference between spending 1.5 thousand or just 500.
There is a new heroin “hole” at “Electrozavodskaya” station for instance, -says Olga.-But only three stops from here there is a pharmacy where I can buy three times more Coaxil for the same money. But I want to quit and get baptised ...

It’s called bees against honey...
-I want to live. I need my arms and legs! And this is a total demolition of people!
The final meeting.

I think there has never been a drug more destructive than Coaxil. Doctors and drug users themselves fight for it’s ban. But they forget one thing-Coaxil is already a prescription only drug!
-Of course we need a tougher control over this drug,-says Aleksey Petrov.-But these restricting measures are not that effective, when the product demand is so high. We should not fight the substance, but we should support the person who is trying to quit it.

-But they still take this rubbish, knowing how it will all end...
This is a money matter. If they had money they would buy a different drug. If a person doesn’t have any self-sufficiency , life satisfaction , then any drug is an easy way to feel confident, social, calm. Do you know the main problem a teenager faces nowdays? Teenagers don’t feel that they are needed in their families.
What do they hear from their parents? “You have to study. You need a qualification. You need, you have to! And we(parents) need to go to work to support you. And I don’t like the way you dress!”  It is hard for a teenager under these circumstances to open and tell them about what really bothers him. And streets are simple.
Parents are no longer able to talk to children. The closest person to us is TV. The dearest friend is internet. The most reliable friend is blog. That’s why drugs is an easy way to get away from soul pain.

No one would think that a drug user can suffer from pain, especially soul pain.
-Believe me they live in such shit- God forbid...

Published in newspaper “Moscow Komsomolec” N0 24921   24.11.2008