THE COMPOUND OF THE MAIMED

especially in Glasgow.Derek Douglas investigates

There is widespread

anecdotal evidence among

the abusers that taking

Temazepam can lead to

unpredictable violence

A young man in his 20s

had to have a leg removed

above the knee. We've also

had to cut bits off other

limbs, fingers and toes

THE price of eggs will rise in Glasgow this weekend. By Monday the

cost will have moderated and street-corner dealers in Easterhouse,

Possilpark, Drumchapel and Castlemilk, will be trading at the normal

weekday price of #1.50 apiece. The drugs trade in Glasgow is no

different from any other market-place where the laws of supply and

demand prevail. At weekends demand for the small yellow, green or white

Temazepam ''egg'' capsules increases and the price rises accordingly.

Illicit use of Temazepam among Glasgow's drug abusers has reached

startling proportions and there is now compelling evidence to suggest

that with increased use of the drug has come a corresponding rise in

crimes of violence associated with it. There has been no definitive

study linking violence and Temazepam abuse but from the police,

courtroom lawyers, drug counsellors and the abusers themselves comes

anecdotal evidence that when addicts are high on Temazepam, and

especially when it has been used in a cocktail with alcohol and other

drugs, then it leads to unpredictably brutal behaviour, even when there

has been no previous history of violence.

In its proper medical application Temazepam is a relatively

short-acting hyponotic drug, one of the benzodiazepines. It is used as a

tranquilliser to treat insomnia, particularly in the elderly. It was

introduced in 1977 by two pharmaceutical manufacturers, Wyeth in the UK,

and Farmitalia in Italy. It comes in gelatin capsules and should be

taken orally. Abusers take the drug orally in large quantities or, more

dangerously, remove the liquid from the gelatin shell and administer it

by means of intravenous injection.

By the late eighties the manufacturers were sufficiently concerned at

the scale of abuse to re-formulate the drug by adding gelatin to the

liquid preparation inside the capsule.

However, the new gel-fix capsules did not prevent abuse and addicts

merely applied heat to the gel, which then melted. Once it was injected

into the body, though, it reformed as a gel and prouced horrendous

vascular problems which, in extreme cases, leads to amputation.

Currently, the various manufacturers are examining ways of rendering

the drug abuse-free. Their cause was not helped by a recent episode of

the TV drama Casualty which described in vivid detail how ''egg-heads'',

as abusers are known, went about their business.

There are reckoned to be 9000 drug abusers in Glasgow. A World Health

Organisation research project operating out of Ruchill Hospital in

Glasgow has given an indication of the Temazepam problem in the city.

In 1990 a survey of 503 abusers showed that 69 per cent were using

Temazepam regularly. Some 47 per cent of the total were injecting. Last

year the corresponding figures were 67 per cent and 45 per cent.

Temazepam is less popular among Glasgow abusers than heroin and

another prescription drug, Temgesic. However, because of its chemical

nature, Temazepam is the most likely to lead to violent behaviour.

Research fellow Avril Taylor says that drug abusers she has

interviewed were extremely aware of the often violent nature of a

Temazepam ''hit''. ''We've not actually done a study but certainly there

is widespread anecdotal evidence among the abusers themselves that

taking Temazepam can lead to unpredictable violence. This is what they

tell us,'' she says.

The reason for the particularly Glasgow nature of intravenous

Temazapan abuse is believed to result from the unwritten code operated

by GPs on the East coast where in Edinburgh and Dundee, because of the

Aids and HIV problem among injecting addicts, addicts are prescribed

oral methadone. This has not happened in Glasgow to any great extent. It

is a situation which many drugs field workers in Glasgow would like to

see changed. While the status-quo prevails Glasgow will remain the

Temazepam capital of the UK.

A REPRESENTATIVE sample of workers in the field of drug abuse have

agreed to speak to The Herald. Here are their Temazepam Tales:

THE MANUFACTURER

Don Barrett, director of corporate affairs, Wyeth.

TEMAZEPAM is a very safe compound with a short half-life. It passes

through the body quickly. It helps you get off to sleep quickly and

doesn't stay in the body for a long time and cause hangover the next

day. It replaced in that area the use of the barbituates which were not

very safe drugs as it was easy, for instance, to commit suicide with

that kind of compound. Many millions of patients take Temazepam for its

normal usage. When it was originally introduced by ourselves and

Farmitalia it was called Normason in the UK. It was at that time a

branded medicine but in 1985 the government produced a limited list of

drugs that were not available in branded name on the NHS. Its name was

changed to its generic name, which was Temazepam.

At that point a lot of other manufacturers introduced the compound as

well. We became aware that it was being abused in the late eighties by

hard-line drug users. They were drawing off the liquid substance from

the centre and injecting it. We introduced a tablet form which is now

very widely used and we also re-formulated the capsule so that it had a

harder central substance. This we believed would solve any problems of

mis-use but one understands that some of the more determined abusers are

in fact heating the capsule and are still injecting it. Our experience

is that this mis-use has not been a major problem other than in Glasgow

and, to a lesser extent, Edinburgh. We are in touch with the authorities

and are reviewing the situation. It is very difficult when you are

producing something which benefits millions but which is abused by the

few. We very much have the matter under active review and are looking at

the entire issue of abuse and its effects, including the future

formation of the drug itself.

THE COUNSELLORS

John McComish, Easterhouse Drugs Initiative

IN A normal week I'll see four or five Temazepam users a day. It's

been around for a long time but has been used by drug abusers for the

last five or six years. There's a lot of it about. Some of it is

prescribed and people will sell their scripts. Its conventional use is

as a sleeping pill. The regular dose is two or three a day but the

abusers are taking ten times that and most of them will be injecting it.

It's very addictive. It turns them into zombies. They think they're

invisible. It works like alcohol in that it can make people

unpredictably violent. Most times the addicts just cut each other up and

the papers aren't interested in that, so a lot of the violence goes

unreported but if they are stealing to support their habit then that's

where the reported violence can come in.

There are reckoned to be 9,000-plus intravenous drugs users in Glasgow

alone and I reckon that figure's on the low side. Two-thirds of those

will be on Temazepam. They call them eggs or jellies. The users are

called egg-heads. Temazepam isn't like heroin or Temagesic, which are

the other two most populars drugs for abusers. They are opiates and

don't make for violent behaviour. Temazepam works on a different part of

the brain called the ''reward'' centre. As a result the ''egg-heads''

can't differentiate between right and wrong. Just now it's selling on

the streets of Glasgow for #1.50 a capsule. That's not a lot for one but

it's a different matter when you consider that they're doing 20 or 30 a

day. The users will use taxis to go from one scheme to another to find

somebody that's selling. It's a big, big problem.

Anne Thomson, Ruchill Hospital, Glagow

IT SEEMS to be a drug which is particularly popular in Scotland. There

doesn't seem to be much misuse of it in England. Most of the drug

abusers that we see will have used it at some time or another. It is

used as a substitute for heroin or along with heroin. Users suffer

complete loss of inhibition. For instance, they will think they are

invisible and try to walk out of Marks & Spencer with 50 dresses under

their arm. They take it in large quantities by mouth and others take it

intravenously. Often they inject into the groin. The gel-fix preparation

causes horrendous problems. It causes clots. We are now seeing a large

number of cases of DVT -- deep venous thrombosis. In the worst cases it

can lead to loss of limbs.

THE POLICEMAN

Detective Chief Inspector Kevin Orr, deputy head of Strathclyde Drugs'

Squad

TEMAZEPAM is now the drug of choice of many of Glasgow addicts. In

some respects it is a peculiarly Glasgow thing, particularly injecting

it, but why that should be I don't know. As we succeed against heroin

and suchlike, the addicts turn to the next drug on the list and for many

of them that happens to be Temazepam. Much of the Temazepam on the

streets comes from down south. Pharmaceutical warehouses and delivery

vans are always being hit and the stuff ends up on the streets here.

Depending on availability it can cost between #1.50 and #3 a capsule.

That bears no relationship to how much it actually costs as a

prescription drug, where each capsule will only cost a matter of pence.

Lots of people have been warned off heroin because of all the deaths

in the city between November 1991, and February of this year. Those

deaths among addicts have never really been explained but the upshot was

that many of them turned to Temazepam. Because of the nature of the drug

there is a strong link between its misuse and violence. It depends to

some extent on the individual misuser, what he or she is taking it with

and whether they are injecting or taking it orally. Often if someone

takes it along with drink then they get totally hepped up. They're just

out of it. A lot of the prostitutes down on the strip just eat them like

sweeties. It keeps them totally divorced from reality.

THE DEFENCE COUNSEL

Jock Thomson, advocate

RECENT court cases have set me to thinking about the apparent links

between unaccountable violent crime and Temazepam. I had a case the

other week in which a 17-year-old youth was sentenced to six years for a

particularly nasty attack on an old man in the street. There was no

previous history of violence and no apparent motive for what was a very

brutal attack. The boy had been taking Temazepam before the incident.

That's not a defence, of course, but it does raise the question about

the connection between illicit use of the drug and incidents like these.

THE HOSPITAL SOCIAL WORKER

Maura Harraghan, Glasgow Royal Infirmary

I'M INVOLVED with the medical after-effects of drug mis-use. I see

large numbers of cases of DVT -- deep vascular thrombosis -- which

result from addicts injecting. With Temazepam the situation is

particularly severe because of its ''gel-fix'' preparation. The

intravenous misusers heat it up so that it turns to liquid, but at body

temperature it turns back into a gel and causes blockages in blood

vessels. One young man had most of a leg amputated. People who are not

involved in the drugs scene would obviously consider this to be dreadful

but I find that most drug abusers are fatalistic; it is a very

self-destructive thing.

Most of the people that I see inject in the groin because there are no

suitable blood vessels left anywhere else. The groin is a particularly

dangerous place in which to inject. Most of them don't know how to

inject anyway and so they hit an artery. If they inject this gel-fix

Temazepam into an artery then it will solidify and cut off the blood

supply to a limb. Obviously if they have injected into the groin then it

is a leg which is most at risk. Characteristically, the Temazepam users

I see will be in their 20s and they will have been using it since their

mid-teens. They will be admitted to hospital when their limbs have

swollen up. When you have a situation where people are using this stuff

it poses a real dilemma as to whether or not you should go so far as to

instruct them how to inject properly and how to get a vein and not an

artery and so on. Under this ''harm reduction'' scenario the object is

to keep them alive long enough so that they can be got off the stuff. I

also wonder whether we should have prescription drugs like Temazepam at

all when they can be abused in this way.

THE WHOLESALER

David Taylor, managing director, AAH Pharmaceuticals, UK's largest

pharmaceutical wholesalers.

THREE men with guns raided our warehouse in the north of Glasgow. As a

company we don't have a policy of heroics and the raiders gained access

to the security area where drugs like Temazepam are kept. At the time we

were keen to keep it pretty low-key because we don't particularly want

to advertise our presence. What I can say is that drugs of abuse, if we

can call them that, are kept under very strict conditions as laid down

by Home Office guidelines. They have to be. We operate all over the

country and Glasgow is the only area where we have had trouble like this

with Temazepam. In actual fact the raiders didn't get away with very

much and, strangely, most of it was found washed up on the Ayrshire

coast some time later, but despite the amounts involved it would have

had a very significant street sale value.

THE SURGEON

Douglas Gilmour, consultant vascular surgeon, Glasgow Royal Infirmary

WE'VE SEEN 15 cases of people suffering the dire consequences of

injecting Temazepam. We've had a number of amputations, the most serious

of which was obliterative surgery on a young man in his 20s who had a

leg removed above the knee. We've also had to cut bits off other limbs,

fingers and toes. Another injector lost an arm. They are hitting the

arteries when what they want to do is get the needle into a vein. If

they are regular users then they are more likely to hit an artery

because of the state the veins will be in from previous injections. But

the particular problem with gel-fix Temazepam could occur on the very

first injection.

I find that the patients I see are quite philosophical about what has

happened to them. Obviously it is traumatic to have to tell a young

person that a limb will have to be amputated, but the Temazepam abusers

are much more fatalistic about what has happened to them. In the case of

the young man who lost a leg perhaps his experience would make him think

twice about injecting again, but with the others who have narrow escapes

I'm not quite so sure.