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...
