(THIS ARTICLE IS MACHINE TRANSLATED by Google from Norwegian)
It is early afternoon, but the day has just begun for drug addicts in Oslo. Or rather; substance abuse holders.
For that is what Arne Hart prefers to use as a common denominator for the friends he has received in an unorthodox manner among the outcasts in our capital over the past five or six years.
Arne Hart – physiotherapist by education – has run a training program for drug addicts. Played football with them, jogged with them, or when heroin intoxication has been too inhibiting; gone for a walk with them.
After a couple of years, the district stopped the allocations for the training program. Arne still continued one day a week with outreach work and a training group, and five years of experience Arne has recently shared with others through his book "Hospits Central".
Five years of trailing in and out of hospices to bring in drug users to training, five years in support of their fight for treatment, five years stagnant against the health bureaucracy wall. And not least five years of friendship.
Taken from the medicine
- I do not know if we find Pål on the record. But that is where they meet almost every day, says Arne on the way to Jernbanetorget at Oslo Central Station.
Pål is one of many Arne has come to know for several years. He was one of the lucky ones to get medical treatment to get away from the heroin hell. But a few weeks ago he was thrown out of methadone treatment.
- He lost the treatment because he has a difficult temperament and made too much noise, they say. OK, Pål is not the easiest to deal with. But to take the medicine from him… They could have arranged it so that those who are difficult could have come to special times at the methadone center, so that they did not disturb the others, says Arne in almost fluent Norwegian as we walk past the Postgiro building.
Arne Hart is from the Netherlands, but moved to Norway at the beginning of the 80s. Of all things, he used to do physical therapy for skating at that time, and has been to the Dutch, Australian and Norwegian national teams.
- Had to seek them out
But after years of top sports, it was time to do something different and Arne ended up as a physiotherapist in Uranienborg Majorstuen district.
- One day the social services office had a summary of what they did for the residents in the district, I asked what we did for the drug addicts, Arne remembers.
There was silence around the summary table. But then Arne threw the glove back: Do something for them you.
The year was 1995, so it ended up with the original idea of a training program for the drug users.
- But to get people to the trainings, I had to seek them out and invite them to join, says Arne.
Thus began the years of wandering the streets of Oslo and visits to the capital's countless hospices.
Hospice AMI
- No, Pål is not here. We get to go to the hospice and see if he is there, says Arne.
In small clusters – or waiting alone – the herd of drug users stands outside Oslo S; some clearly marked by the hardships of life, others seemingly untouched.
- She who stands there alone with an alpine hat, she sees I am new here, says Arne and nods to some old acquaintances as we go north towards Nordahl Bruns gate.
We pass the ransom newspapers in Akersgata, and we get into the media's interest in his book and what it takes up.
- When I spoke to the editor-in-chief of Dagsavisen, she said that they did not want a mention of the book in the newspaper. It certainly did not fit into their book categories. Strange, he wonders.
The hospital in Nordahl Bruns gate is called AMI. This is where Pål lives. At the reception, Arne asks if he is in his room. The receptionist calls the room, and after a while it answers at the other end. Arne gets the pipe.
- Just taken a shot
- Hi, it's Arne here, how are you…? You, we can come up and visit you; I have the journalist from Ny Tid with me, Arne asks.
As the telephone conversation goes, it is clear that we are coming at an inconvenience.
- No, says Arne after hanging up.
- Pål has just taken a shot, so it is not so good to have a chat with him now.
We are standing a little outside the hospital.
- Pål has been thrown out of the methadone project twice. He has been on heroin for 20 years and is so old and tired now that he is willing to say yes to treatment without methadone. The day after tomorrow, I will go with him to the social services office, says Arne, and takes out his mobile phone.
He gets in touch with Geir, one of the other friends from the now closed training group.
- Geir is home in a few hours and would like to meet us. Let's have a cup of coffee in the meantime.
methadone monopoly
- Norway violates human rights. No, those who are employed to deal with this violate human rights, Arne corrects himself when the coffee comes to the table in the nightclub with the occasionally inappropriate name Justisen.
Hardly anything in this work upsets him as much as how the public refuses drug users medication and painkillers. The key word is the methadone monopoly, as Arne calls it.
- Countless examples show that methadone helps people away from heroin, and thus prostitution and crime. But while other countries give heroin-addicted methadone from day one to help them out of hell, the methadone monopoly, politicians and the Norwegian Board of Health implement a criteria regime that sends people straight back to heroin hell, Arne fires.
To receive methadone treatment in Norway, you must be over 25 years old, not live in a hospice and undergo detoxification to become reindeer – a detoxification that can take up to 45 days to get rid of traces of hashish in the urine.
- Law to humiliate
- Methadone is the only medicine where age is required. Imagine; If an 18-year-old girl is addicted to heroin, she must wait until she is 25 before receiving methadone. During this time, she needs four million kroner for heroin. If she has to earn three-quarters of the money by going on the streets, it means that she has to have sex with around 5000 customers before the methadone monopoly thinks she is mature enough, Arne calculates.
He also has no great sense of the hospice criterion.
- A lot has been written negatively about the hospices in Oslo, and often rightly so. But for some, the hospice is a place where they can meet others and have a social community. In this way, the most chaotic heroin addicts, such as those without a fixed address, are excluded.
As mentioned, the authorities in most countries Norway likes to compare themselves to the fact that it is medically justifiable to give methadone to drug users the same day they stop using heroin.
- Nevertheless, the Norwegian Board of Health and politicians allow the methadone monopoly to humiliate and torment patients with withdrawal pain for weeks before they receive methadone. This can lead to severe psychosis, Geir can tell about when we meet him afterwards, says Arne, and orders a new cup of coffee.
- The left side disappoints
- It is not that I believe that methadone is a miracle cure and that people must receive such treatment. Those who want to should feel free to get drug-free treatment, if it helps them. Methadone does not solve the underlying problems. They still do not want friends, do not have contact with the family and are without a job – three good reasons for mental problems, Arne believes.
- But those responsible have a kind of moral attitude that pain must dispel pain.
It is a well-known case that many from the left are working in the health and social care sector. It does not help the conditions for the drug users, shall we believe Arne.
- It is disappointing that people on the left are the ones who meet the drug addicts in this negative way and stand for a restrictive methadone treatment. And at the top of the entire methadone hierarchy is SVeren Helge Waal. If he had been responsible for such catastrophic results in ordinary hospitals, he would have been without a job now, he says, after we have paid the bill at Justisen and stroll east towards Grünerløkka.
- Most often failed
- Maybe a case should be brought against Waal, the Norwegian Board of Health and the Ministry of Social Affairs in the human rights court in Strasbourg, Arne wonders.
For Arne, Helge Waal is a representative of the restrictive Norwegian attitude. Waal became head of MARIO, Center for Drug-Assisted Rehabilitation, from its establishment in 1996. It will become clear in the following days that Ny Tid will not get hold of Waal for comments, but will instead have a chat with MARIO's new leader Jan Dahl (see box) ).
- In Norway there are at least 10.000 heroin addicts. Most of them have been referred to drug-free treatment options, which often mean unsuccessful stays and the fastest way back to the streets. Take the Greenhouse, for example. Several of those I know have simply fled to Denmark to receive a painless treatment with methadone, says Arne, and adds that 75 percent of those who have been addicted to heroin are treated with methadone in the Netherlands – a treatment they receive from day one , regardless of age and type of residence.
And as Arne points out, the remaining 25 percent know that they can resort to methadone as a rescue plank at any time.
- The only way out
Svein welcomes you in his small apartment at the bottom of Grünerløkka. Already at the age of 17, the Oppsal boy took his virgin shot. Since then, the 43-year-old has seen one after another in his childhood die of overdose.
- Today we are five or six left in the Oppsal gang, Svein says.
Svein goes on methadone today. It works well for him, at least when he stays away from baptism.
- I know quite a few who have taken the evening because they did not get methadone. For me, it was the only way out of hell, he says.
However, the road to getting approved in the methadone project has been hell.
- In 1999, my roommate got a trip to methadone treatment in Denmark. But the social services office at Vålerenga, where I belonged, refused me the same treatment, he continues.
- It is tragic that Svein was not allowed to travel with his cohabitant; they had managed to save 10.000 kroner. In addition, treatment in Denmark is three times cheaper than in Norway, Arne adds.
- Not a peep from the social
- When we contacted the Danes, they first said that the money did not hold for a sufficient treatment. But when I told them that Svein was walking around the streets of Oslo with pneumonia in sleet and rain, they agreed to treat him, Arne adds.
- Yes, they were all right in Denmark, Svein agrees.
However, the money ran out. Svein then applied to Vålerenga social services office for support for further treatment – without result.
- The treatment manager sent three faxes from Denmark, but did not hear a beep, Svein says.
A year later he was granted the wish for methadone treatment in Norway. But it should start with a shock shock and a psychosis.
- It was in February last year. I was admitted to detox in the emergency room at Ullevål, Svein remembers, looking for words to describe the hell he went through.
- First it was four days where I only got C-preparations, or quack drugs, as we call it. The withdrawal pain was damn, I was lying and spitting and turning on me, Svein continues.
psychosis Hell
Then he noticed that he was getting into psychosis. Svein already knew what that meant (see research on Svein's psychosis in prison).
- I said that I was on my way into psychosis, but no one bothered to listen to me. The others who were admitted to the emergency room tried to help me, but…
- After first being sent incomplete medical records, we received pressure from Svein's medical record afterwards under pressure from the health and social services ombudsman. It was full of gaps, but documents that the nursing staff wrote alarmingly about the condition, without the doctors intervening. They let him go into a psychosis, and then gave him a megadose of valium to get him out of the psychosis again, says Arne.
- The psychosis was hell, almost as damn good as the one I had in prison. But I managed to carry out the plan, despite the fact that one of the employees tried to piss me off so that they could pull me out, Svein triumphs.
- I think it was bravely done by you. You plunged into it even though you knew that the shock detoxification could give you psychosis, Arne brags.
- Should have experienced it myself
- I doubt that most people know what is going on. The people who have decided this should have experienced it for themselves. Then they would never have agreed to it, I will swear at that, Svein states.
He knows two people who have managed to get out of the heroin addiction without methadone. For most, he believes that methadone is the only thing that helps, as he himself has experienced.
- What they should do is address the young people. Now 11-12-year-olds go on the record and buy drugs. And then there is the 25 year limit to get methadone. They sit on the school bench and learn what is good for us. Instead, they would go out into the streets and talk to people. There is no point in sitting in an office and having a moral reluctance, says Svein.
- One day
Svein feels that he is now well able to stay drug-free, and wants to reduce the use of methadone.
- But I struggle with anxiety and wish I could get valium to reduce anxiety. The methadone center has said no to that, he says resignedly, but adds battle-ready:
- One day I will cut out everything, that is my goal. I can be very stubborn. But if you have been doing drugs for a long time, it is not just a matter of turning your hand around, Svein explains.
The 43-year-old has known Ninni Stoltenberg for many years and has one last thing on her mind before thanking us.
- Only when people are high on straw – like Thorvald Stoltenberg – stand up and speak from the liver, then they will do something for us. At least they say…
Swine's psychosis hell
It was a few years ago when I went inside. First came the hell of withdrawal. For three or four days, I lay joking and staring at me. It is impossible to explain how sick you are, it must be experienced.
When I started to go into psychosis, they first put me in isolation. They probably thought I was playing. Psychosis is the most fucking thing I've ever experienced.
Five men came and fetched me. They wore solid rubber suits, only the faces seemed. Then they took me down to the basement and used me to stake some sewer pipes. I thought they were going to kill me.
One of them sprayed something in my nose so I was being suffocated. Then one of the nurses went berserk on me with an ax. I looked out of the hatch and saw the prison sink down so I was buried under the prison.
There was so much I saw ... My sister and I were with her came to fetch me, but couldn't find my body. There were lots of bodies rolling around on the floor of the basement. My sister wore my head in a plastic bag, looking for my body. With the help of telepathy, I asked them to smash my head against a rock ...
Then I was fired into a thousand pieces, but the nurse couldn't kill me. I could go into his hat and tease him and really drive him crazy. He became quite a cook, straining the yeast.
They gave people lying in the basement spraying their bodies up, making it easier for them to chop us up and kill us ...
It was absolutely fucking ... You can't explain it. No one has been able to explain what it is like to experience psychosis hell.
- Terrible that people are dying
Department Director of the Norwegian Health Inspectorate, Ingrid Hauge Lundby:
- Why in the world are there such strict criteria for receiving medical treatment in the form of methadone?
- It is actually not safe to use methadone. A new study that was presented in Today's medicine shows that of sudden deaths in the last two years, 30-40 had methadone in the body. We do not know if they died because they were part of the methadone project or if they had otherwise obtained methadone. Before we change the criteria drastically, we need to know that users have a constructive benefit from the drugs. Out of an estimated 9000-12.000 heroin users in Norway, 1350 were on methadone treatment at the end of August this year. Of these, several have received good help for a better life, but about a third are unable to follow up on the treatment.
- Is it not better that people get methadone than that they go on heroin, which involves crime, prostitution and a deteriorating health?
- When you ask that way, it seems easy to answer yes. But there is professional disagreement in this area. We can not go out with a lifelong project until we know the results and can document whether it helps. We are therefore now waiting for the evaluation of the methadone project, and would like to take part in discussing the entire drug policy in Norway. But it's horrible that people die along the way.
- Is not heroin worse than methadone?
- Yes, it is. Methadone is a potent type of medicine that can help, but it must be done under proper conditions.
- A girl who, for example, is 20 years old and addicted to heroin, and therefore has prostituted herself, has to wait for five years before she can get methadone?
- The criteria are under consideration, and this with age is one of those that are questioned.
- If you had a 20-year-old daughter who was a prostitute and went on heroin, would you not want her to receive methadone treatment if she wanted to?
- Of course, I would do everything I could to help her. But if she did not get methadone, then it would be the same wall in health care that I could encounter elsewhere. For example, a 35-year-old pregnant woman cannot have amniocentesis taken; there is an age limit of 38 years.
- Do you think it is comparable to the situation of a heroin addict?
- I do not want to go into comparisons. If I meet the wall, I will work for changes, such as the age limit in relation to methadone treatment.
- Does that mean that you personally would like to see a change in this criterion?
- I hope for professionally justified changes. It has no purpose if we do not know what is useful. We know very well that people suffer, and there is a constant discussion about the criteria for methadone treatment.
- No matter what I mean
Head of the Metadon Center MARIO, Jan Dahl:
- Why does a drug addict have to be 25 years old before he or she can receive methadone treatment?
- When we have now worked for a long time with people in this situation, we see that even younger people could have benefited from methadone.
- So you think the age criterion is too strict?
- It does not matter what I think about it. The authorities say that this is a treatment offer for the advanced. Methadone is a lifelong project.
- Is it not important that you who are experts in this have a public opinion?
- It is the politicians who set the terms and decide. Methadone is expensive, so this is an economic issue.
- Does the economy control the treatment of other types of patients in Health Norway in the same way?
- Well, I do not want it to be my opinion that the economy controls this. But this is the case in many other areas of the health service. Politicians must answer for themselves.
- But do you agree that a young woman who is addicted to heroin and has prostituted herself, will have to wait for years to get methadone?
- Now you turn the issue completely upside down. She should be offered treatment without intoxication. It's not as black and white as you put it.
- What about the criterion that you can not get methadone if you live in a hospice?
- It's a problem. The municipality must do its duty and provide the drug addicts with housing.
- Why do you have this criterion then?
- It is not believed that it is possible to rehabilitate people who live in a chaotic living environment.
- But it probably does not help a heroin addict to get no to methadone because he lives in a hospice; does not his life situation become even more chaotic then?
- If this is the problem, the person should be admitted to an institution to train their resident. It can also be combined with methadone treatment.
- What about detoxification, which often leads to psychosis and other disorders?
- I am relatively new as head of the methadone center, and am not a doctor. I will therefore not comment on it.
- But do you have an opinion on whether it is right to inflict pain on patients during treatment?
- I am absolutely sure that there is potential for improvement in our emergency rooms.
- Sad and sad that they die
Vice President of the Medical Association, Hans Kristian Bakke
- Do you think it is right that you must be 25 years old to receive methadone treatment?
- The Norwegian Medical Association has probably not taken these questions up for principled assessment. We welcome the Minister of Social Affairs' warning that substance abuse care will be transferred from the social services to the health service. Substance abuse care has not been satisfactory. But there must be some clear criteria for methadone treatment. Whether they should be as they are now, however, must be considered.
- Many people think it is bad that, for example, a young woman who is addicted to heroin and has prostituted herself, will have to wait years to get methadone?
- I understand that this seems sick. In almost all other contexts, patients receive treatment according to individual needs.
- So you mean that the age criterion has failed?
- I prefer that you do not have to become more Catholic than the Pope.
- What about the criterion of permanent residence?
- I'm not sure what is behind this, but I guess it is important that people have enough structure around them for the treatment to work. I understand that, although I do not fully understand that living conditions should be a criterion.
- In other countries do drug addicts avoid undergoing detoxification?
- I know that it is different, for example in Denmark. But I understand the demand for detoxification, not least because it can be dangerous with the mixture of methadone and other narcotics.
- So it is more dangerous than that the detox leads to suffering and that the patient gives up, and then ends up on the streets with heroin and poorer health?
- I know too little about this.
- Are they so wrong in the other European countries where they do not have these criteria?
- That is the eternal dilemma; one should believe in Norwegian or foreign expertise. From a medical point of view, however, we are required to follow Norwegian law and expertise.
- Many of those who have been refused methadone treatment end up on the streets and die of overdose. Is not that a paradox?
- One thing is that a patient overdoses and dies; it is terribly sad and sad. But if they die from our treatment, many of them will be grateful to come to us. It is also a problem.
Hospice Central
If Arne Hart's book Hospice Central does not create anger against the health and social system, if it does not open the eyes of politicians, if it does not create understanding for the outcasts, and if it does not give us the belief in the good in man, then we have not read it with the heart.
- A gallery of life destinies. Despair, distress, and lofty dignity. Replicas carved in stone. You also meet the occasional Samaritan. And as usual, not just of the good type, Professor Nils Christie writes in the preface.
- This book tells about life that is so far removed from the reality we thought our welfare state had stacked in place for the outcasts of society, that it is uncomfortable reading. It is therefore highly recommended, writes lawyer and former Health and Social Affairs Representative Helge Hjort in the afterword.
Hospice Central available in bookstores and on the internet; it should be under the Christmas tree of people you know.
