“I know what Subutex does to someone’s body and mind. Giving it up is all about how strong your will is,” Karim (name changed) is 39. He started using Subutex in around 2000. He quickly became addicted and has had a long history of trying to give up. He’s been clean for two months now and he’s very determined to keep it this way.
Subutex is used for treating dependencies for hard drugs. A pill contains 1mg of heroin and drug users in Tunisia have started seeking it as a cheaper alternative to other expensive drugs. A pill costs around 40 dinars and could be divided by 8, while a gram of heroin costs about 250 dinars. It first came to Tunisia between 1999 and 2000 and has since became extremely popular among drug circles.
Karim recalls his first experiments with Subutex. “It was Ramadan and there was no alcohol. Some friends told me there’s this new, good thing that came from abroad, but they didn’t tell me it was Subutex. They asked me to try it so I did, I got high and I liked it.” The situation developed and soon Karim was using it on a daily basis. “I became so addicted that I used to inject it when I woke up during the night to go to the bathroom.”
Karim’s family has already tried to talk to him. “Since high school my mom always knew I loved getting high. She understands my situation, but she couldn’t convince me to stop. My sisters also tried, but without success. It’s all in the mind.”
Over the last 16 years, Karim has experienced periods where he has been subutex free, “People my age already have families and kids. It’s about time I started taking my own life seriously. I actually feel kind of ashamed of myself.” He was compelled to stop after seeing the damage that injecting Subutex does to someone’s body. “I had no example in front of me when I started, (using it) otherwise I would have had a different view. People get their toes and arms amputated because of infections, others die because of hepatitis C.” However, waithdrawal is no easy ride. Karim recalls how the pain became so intense that he could neither move nor think, “When there’s no Subutex around, I used to get very stressed and I couldn’t think of anything other than how to get my next fix.”
Khaled (name changed), 40, is another ex-user. He started with heroin when he was a teenager in the mid nineties, then switched to Subutex when it came to the country. He stopped in 2009 and has since became a peer educator who works with a prevention center on the streets, giving advice to current users on either how to stop, or how to reduce the risks of using it.
Khaled remembers his own addiction and how difficult it was to quit. Whenever he met with his friends, all they would talk about were drugs and how good it was to get high, “In working class neighborhoods, it’s difficult to find [interesting] topics to talk about. There are no cultural centers, no football fields and basically nothing young people can do to distract them from talking about drugs or using them.”
Nowadays Khaled gives advice to users on how to stop, or how to use narcotics while causing the least harm. “I tell people to drink alcohol, to smoke whatever they want, but don’t use needles. Many people carry hepatitis without being aware of it.” He also expressed his disappointment over how people refer to drug addicts, mocking them and calling them “puppets” instead of wishing them a better recovery. “This stigmatisation is not helpful at all. They are normal people who need help.”
However, Khaled says his work and that of the center is not enough to stop the rising tide of Subutex. He criticized the way the government deals with drugs,. “Catching small-time users won’t get anyone anywhere. They should track down the big smugglers.”
Free time and long periods of inactivity can both be triggers. Moez Boulila is an occupational therapist in charge of the Centre d’Accueil pour la Prévention at Mellassine. They provide a variety of services, including free needle exchanges, and activities to drug users and former addicts, such as rooms where people can watch movies, play board games, go online or even have their hair cut. “These people have a lot of free time that would be better spent in doing physical or cultural activities rather than just sitting at cafés talking about drugs,” Boulila told Tunisia Live.
The activities provided by the center also play a big role in boosting users’ confidence. “[With football matches] they started by saying ‘We can’t do that, we can barely walk and you’re asking us to run’ but with time things changed and they became obsessed by the idea of winning. They looked for ways to cheat!” Boulila says. Instead of talking about drugs and ways to get high, they now talk about their activities or their next match, says Boulila.
Psychologist Bilel Ben Taleb, who’s also project manager at Association Tunisienne de Lutte contre les Maladies Sexuellement Transmissibles et le SIDA, told Tunisia Live “The idea [behind the Mellassine center] is to get rid of anything associated with drug use. This way the beneficiary can only focus on either stopping or decreasing their use.”
Dr Samir Bouarrouj is vice-president of, Association Tunisienne d’Information et d’Orientation sur le SIDA et la Toxicomanie (ATIOST) and has worked extensively on drug addiction and how to deal with it. He has conducted several surveys with his team on the topic. “Out of 21 governorates where we carried out investigations, 19 had intravenous drug users,” he told Tunisia Live. “And when talking about intravenous drugs, we’re basically talking about Subutex as it represents about 98%, (of all drugs consumed intravenously). Heroin and cocaine are expensive, so only a minority of users consume them.” He says there are an estimated 25,000 to 30,000 intravenous drug users in the country, with the greatest number located in the major or coastal cities.
According to Bouarroui, there is no safe way to consume subutex. Further to the dangers inherent to needle sharing, the starch (amidon in French) found in subutex pills also carries risks. “This substance can block veins and restrict blood flow. That’s why we always tell drug users to only inject the substance if it’s water-like and not colored,” he says. “We also distribute awareness booklets where we use cartoons to show the effects of drug use, or at the very least, the body regions one has to avoid when injecting.”
Prior to working as a journalist, Inel worked as a computer programmer. Inel is fluent in English, French, and Arabic. He writes mainly about freedoms, liberties, and minorities' rights in post revolution Tunisia. He currently blogs about films in French and writes metal reviews.