Heroin addicted in BerlinWhere addicts are taken seriously as sick people

The report / archive | Article from 07.03.2021

Heroin addicted in BerlinWhere addicts are taken seriously as sick people

By Michaela Vieser

Heroin is processed by an addict (picture alliance / empics / Darryl Dyck)

40 years after Christiane F., heroin is still an issue in a city where drugs are part of nightlife. Exclusion and stigmatization still exist in Berlin today, but there are also promising therapeutic approaches.

Daniel is tall, moves stiffly, something is wrong with his neck. He wears a casual gray retro jacket, underneath a t-shirt with neon green hip-hop illustrations. An amulet that his girlfriend gave him dangles from his chest. It's supposed to keep bad vibes away, he says. Daniel has been injecting heroin for a long time. Now he is in a substitution program, receiving the opiates medicinally.

The drug game

It is difficult for him to find a beginning. He tries drugs because he finds it exciting. Daniel is well acquainted with the chemical processes that take place in the brain when taking drugs and can tell about receptors, how they work and when. That's why he dreams of becoming a chemical assistant. But once trying it out turns into a dive. When he first took heroin because his girlfriend had cancer. Her chances of recovery were slim. It was killing him. "I just couldn't get any rest, I just couldn't sleep and I just had this need: I just want to get out of there for a moment."

Drug addict takes an injection. (picture alliance / Rolf Kremming)

He manages the jump, withdraws himself. He still has the strength to do so. Something happens again that pulls him down. He plays with the drug. dance with her When he thinks the addiction is getting the better of him, he detoxifies again. Thinks he's above it. But then he has an argument with a security officer. "It was really just a little love message, with a sharpie on a trash can. It really wasn't a really bad malicious act because there were really a lot of people on me and my spine was pulled through quite badly."

Self-medication with heroin

Daniel paints graffiti on a trash can and is pushed against the metal by the cleaners so much that his neck snaps. He went from doctor to doctor for months but was never properly diagnosed. He is accused of just wanting to get the painkillers. So he starts medicating himself. Again with heroin. "At first I was happy that I wasn't in pain anymore. That's an important point, and of course you don't have any mental pain either."

The security guard's company was sued. What happened to Daniel is something many drug users report: stigma. exclusion. Even with the doctors: simply not being taken seriously by those who are supposed to be listening.

"It's also the case with heroin consumption that there are many people who use heroin without becoming addicted straight away. So it's predominantly the majority of substance consumption, it's not addicted consumption at all. But people come to us who have lost control of it and are looking for help in dealing with it. And that's still a very high number. But it's still a minority in society and unfortunately that's how they're treated, stigmatized, excluded, criminalized. And that's what we're trying to do here to be dealt with as comprehensively as possible."

exclusion and stigmatization

dr Till Kinkel runs a group practice in which people who are dependent on substances are provided with medication. Instead of the white coat, Kinkel simply wears everything in black: jeans, hoodie, Converse and even a mask. The mid-50-year-old founded his practice with three colleagues in a new building just outside the Berlin S-Bahn ring. He wants a society where drug addicts are no longer marginalized and where substance use is not seen as a character flaw as it used to be, but as a treatable disease. Just as someone with diabetes needs insulin, someone with an addiction needs medicine designed for it.

"In itself, this is a disease of the brain's reward system, meaning that people very often cannot achieve the feeling of being rewarded, of being at peace, of being satisfied with normal, shall I say, stimuli. So normal stimuli that make us feel like Satisfying people who are not addicted to drugs, leading to satisfaction, is normally, let's say sexuality, or parents have that cuddling with children. Small children also have that with being close to their parents or good conversations, good food. Music can do something like that, exciting Activities. I think each of us also knows what satisfies us and what doesn't. It's different for people."

Shortcut to happiness

One of his patients compares injecting heroin to a video game shortcut: In every digital car race, there is this shortcut you can take to get to the next level. While the young man would never cheat in a computer game, he wonders about himself in real life: For him, using heroin is like taking a shortcut to a feeling of happiness that is otherwise difficult to get. He doesn't really want to understand why he would never take the simpler solution in the game, but in reality he would.

"With people who are addicted to drugs, especially opiate addicts, when you talk to people, we often see this inner or outer cage that they live in. And there are people who say to me: Doctor, my cage in which I sit is so narrow. I can't even turn around. But I'm actually a bird. And those are therapy goals that can be defined differently. For some, it's a goal first of all, that you, for example just put a bit of carpet in the cage. That's something that makes it not so cold and hard. And for some, you might just want to make the cage a little bit bigger. For some, maybe bend the bars apart. For a lot of people it is Freedom to be recognized, to be respected, to be loved."

Twice a day heroin in its purest form

In Germany there are only twelve practices like that of Dr. Kinkel. There, the people are substituted and can then learn everyday life again. You don't need to go shopping all the time, be afraid of bad stuff, live illegally. With a prescription from the health insurance company, the physical urge to take the drug is taken away and the soul can concentrate on normal needs again.

Diamorphine can be hygienically self-administered here. (Deutschlandradio / Michaela Vieser)

The participants in diamorphine therapy, a medicinal form of heroin that Dr. Kinkel offers in his practice, have to visit the practice twice a day, because the drug may not be taken home. It's heroin in its purest form. Vacation or going away for a weekend is not possible for the patients. Quite a corset, this freedom from yourself.

In a white-tiled room, the patients then inject the diamorphine under the supervision of the staff. "There are people who apply it to themselves. Then they get up and go to work. And there are also people who first rest with their heads on the tabletop for a few minutes. Depending on the stage and In what degree of severity, so to speak, of the disease a person is, the therapy is also a bit different."

Holistic medical care

The sounds of computer games can be heard from some of the rooms in Kinkel's practice, while in others it is eerily quiet. On one floor of the building, patients can discuss problems with social workers, receive psychological care and social advice, and there is a lounge at the top. It is warm, there are board games, a sofa and a smoking area.

dr Kinkel's intern Elena is part of the tour. She belongs to a new generation of young medical professionals who are naturally aware that people who consume substances also need holistic medical care. It sounds trivial, but society is still a long way from it. So Elena dreams of one day opening a dental practice for such people.

Supply and hygiene are guaranteed under supervision. (Deutschlandradio / Michaela Vieser)

In the common room, an elderly woman with gray hair is making tea. Her age is difficult to guess, also because of the mask. She walks slightly hunched, her clothes are thrown together, the Norwegian sweater is much too big, her pants are held together with a belt over her hips.

"Everything is too late for me. There is only one root, nothing more."

"Do you actually have a set of teeth in there?"

"No."

"Then, yes, they'll get their teeth in a few years."

"I won't be able to wait that long. So I've been thinking. I think, with everything that might be pending. Well, the thought immediately comes up that it's not worth it anymore, something like that. But it would be nice , if I imagine I could again, well, I'm a vegetarian, but still, it would still be very nice to be able to eat something that wasn't made of rice. And yes, you also have to chew vegetables."

dr Kinkel and Elena look at the woman's mouth. Nod. She smiles.

"Some doctors should be banned"

"It's really so honorable, really nice that they take care of it. Well, before that I actually only had negative experiences with doctors. Well, when I was younger, not, but I could choose it, so to speak. If someone doesn't I liked it, then I left immediately. But when you get old and then somehow no longer have the strength to do anything for yourself, then you are more or less always at your mercy. I really was at the doctor's for almost ten years , it was so bad. There are doctors. Some should actually be banned."

She then tells how the last doctor listened to her, slipped her 20 euros and groped her everywhere as she left. As other patients have reported, and no one is doing anything about it.

Sex workers have been offering their services on Kurfürstenstraße for 130 years. Despite the corona epidemic, business seems to be going on in the open street here, customers wear masks. Many new residential buildings are currently being built, gentrification is progressing, the new tenants want a clean neighborhood in which they don't notice anything from the original milieu. They don't want to see prostitutes or drugs. For Nele, who works in the Olga women's club, that means a lot of work. She conducts talks with the city, the neighbors and the women in order to enable the most harmonious coexistence possible. During a walk in the neighborhood, she shows the hotspots.

Less heroin on the streets

"We're dealing with two stigmas here. Firstly, it's just sex work and then, of course, homelessness and drug addiction. And of course it's also about structural violence." The women who work here primarily have to earn money to live, to support their families. Many in this milieu also use drugs.

Prostitution on Kurfürstenstraße (picture alliance / picture alliance / Wolfram Steinberg)

"Definitely crystal methamphetamine. And of course there are women who use heroin, intravenously, but also smoke folio. So I would say that there are definitely more stimulant substances that are used."

Heroin has become less common among women on the streets. Everyone takes what suits them best. Valium to calm down when stealing. Pleasure-enhancing substances during work. Depending on. Syringes, pans, filters, condoms and masks are therefore distributed at the women's meeting point Olga so that people don't infect each other or spray dirt with them. Classic prevention and care, in the form of food offered daily in Olga's soup kitchen. Olga is also the first point of contact for gynecological examinations. Pregnancies are not uncommon. Then reference is made. While alcohol and cigarette consumption are usually not even considered drugs, they often lead to birth defects during pregnancy. Opiates like heroin don't do that.

From the jungle to the middle of society

At the Charité there is an outpatient clinic for addictions and infections during pregnancy, headed by Dr. Jan Peter Siedentopf. It originally arose because women from the drug scene became pregnant and because of the poor hygienic conditions often suffered from infections, back in the 1970s mainly from syphilis, then AIDS and today hepatitis C.

Jan-Peter Siedentopf has his own vaccination appointment against Covid-19 and has time to talk about his department on the long walks through the many hospital buildings. The Berlin Ambulance was founded after the Vietnam War, the returning GIs brought the heroin from the nightmare in the jungle and spread it to mainstream society. The consumption of heroin in Germany increased abruptly.

"More and more addicted people came back from every war and then this drug consumption also spilled over into the families and thus also to the women. There were drugs in every war and always. The mixture of, so to speak, dealing with the experiences, with the dramas experienced and disasters and medical treatment as a painkiller. Heroin is also very suitable as a painkiller and often it wasn't heroin addiction, but other opiates as well."

A year and a half on the needle

"How did you feel when you took heroin?" "Warm. And calm. I didn't care that they were trying to kill me, I didn't care that I could be woken up in the middle of the night because snipers were throwing bombs at us and we had to run into the hole and get out. I didn't care. I mean, when it happened, I didn't care, but I wasn't worried. I wasn't scared that it might actually happen. I wasn't scared that those fuckers wanted to kill me every day . And of the ten guys I got here with, there were four left. The other six were already dead as hell. I didn't think about it. Because of the heroin. I didn't care."

Thomas Farr tried to compensate for his experiences in Vietnam with heroin. (Deutschlandradio / Michaela Vieser)

Thomas Farr was a sniper during the Vietnam War. He worked for a year and a half in Vietnam – and he never had to worry about supplies.

"Oh, the Vietnamese sold you every kind of drug cheap. You are the enemy and you can buy anything. I had a hooker. I mean, I had a girl who looked after my shack that I lived in and she cost me five dollars a week. She cleaned the cabin, cleaned my uniform, shined my shoes and did all the sexual things I wanted for five dollars a week. And if you wanted heroin, she came back with a bagful of it, and it wasn't a penny, you know, and I was on heroin for about a year and a half."

Learning to live with the spirits

Thomas has his 67th birthday today, his roommate in the assisted living facility is baking him a blue cream cake.

"I have 163 confirmed kills. Personally I think it's closer to 200, but there's 163 confirmed. And that was like a huge debt on my shoulders after the war. And I never really thought much about it until I started doing it myself Having kids. And then a lot of these guys were dads. What did I do to their kids? And then my drug use increased because I didn't want to think about it. I just didn't want to admit it."

Thomas has learned to live with the spirits. The drugs help. He tells of times when he drank four bottles of whiskey a week, smoked weed to stay focused, and when things got really bad, injected heroin. He's been clean for almost a year. Pictures from all decades hang in his room and tell of his unusual life: in the mid-1970s, after the Vietnam War, he moved to Berlin.

He flew over the Wall weekly and photographed it for the Allies, he was there when agents were exchanged on the Glienicker Bridge, and later he worked as a photographer during operations in the hospital. It was his last wife who talked him into going to rehab. There he worked up a lot, made pottery, strange tentacle-like structures that are now between his books. The nightmares will probably never let him go completely.

Things you just want to push away

What the returnees from the Vietnam War were in the 1970s are today the refugees who come from crisis regions and have experienced things that one cannot imagine or like. Things you just want to push away. Christian Hennis is the manager of the Birkenstube in the Moabit district of Berlin. Illegal drugs are allowed here. Unless there is a corona epidemic, the waiting room is full. Now a social worker sits in front of the consumption rooms and only lets three people in at a time.

"What has changed? Well, first of all, of course, this was an institution that worked with the traditional Berlin clientele, who were heavily dependent. And there were many, many Germans and people of the second or third generation whose parents had come here. And that changed then around the turn of the year 2015/16 and then after 17 things went really fast.So that suddenly there were people from 30 different countries here, with a corresponding number of languages, people from cultures that we didn’t even know here and also had no cultural experience with them And especially people who didn't speak German or English and with whom it was of course difficult to communicate."

Sharing drugs strictly prohibited

Cultural differences are also reflected in drug use, and even experienced social workers like Christian Hennis have to feel their way around everything. If you want people to continue to use the place as a safe zone, they have to abide by the rules that are in place there. That is the first requirement.

"You are not allowed to share your piece or your coke with anyone here and outside. Here in the Birkenstube or in the German drug consumption rooms you are allowed to have small amounts of narcotics for your own consumption according to paragraph ten of the Narcotics Act. That distinguishes the situation here from the situation on the across the street. But what you can't do is share what you've brought with someone else. That's forbidden, we have to watch out for that. Sorry, you're not allowed to share, you're not allowed to smoke heroin from a tin , mustn't let that go around and this is a cultural no-go, for example. Basically for them. But for us it's one thing that we have to push through."

And those who are not allowed to consume inside are banned back onto the streets, into illegality. That's why it's important to deal with such cultural subtleties. Christian Hennis leads through the other rooms.

"Here we are in a room full of metal, shelves, everything full of needles, syringes, ascorbic acid, gloves, band-aids, everything you need for drug use, room, vomit bag. The syringes are from England, they will be whole specially made, so for our customers in different colors. And we're a bit scared now with Brexit that it will somehow become more difficult. Brexit is stupid. They come in four different colors and they're going well. So our customers use syringes with one hand, right? And they have to run well for that. So the plunger has to move back and forth well in the plunger. And not every syringe does that."

Syringes, plungers and wooden handles

You have to have an eye for 100 different items, says Christian Hennis. Wooden handles for example. "What do we need wooden handles for? Wooden handles are so-called bamboo curtains cut apart and you need them, you put them on a pan where the heroin is boiled up so you don't burn your fingers. It's not just a nice gesture ", but it's medically important if you look at the fingertips of the customers. They're just cracked and rough and open. We don't want them to be the entry point for germs. And that's why we also offer such grips for those who want them, that Don't burn your fingers."

It is a parallel world that opens up here. Once you have completed the paradigm shift in your head and see the consumption of substances as a clinical picture and not as a purely illegal activity, such places are indispensable, places where people can quietly take substances that help them to cope with everyday life. Places that offer products that make it safer to use drugs that are made in a factory somewhere because there's a market for them. Pans, filters, wooden handles.

An overdose every ten days

In the Birkenstube there is a room where you can spray, one for smoking and one for treating wounds. Social workers help with the search for housing or with legal disputes. "Last week we had one who squirted cocaine and heroin together in a spoon. And then for five minutes there was complete excitement from cocaine, cramps and suddenly he starts whimpering weird things, fingers at each other rap and we like that, calm down, get up. Not like that, please sit down again and zack your head falls back and it turns blue. And then the heroin started with its breathtaking effect. And then it's just really chic , when you have cool, relaxed, practiced, experienced, cold-blooded colleagues with whom you then manage such a situation."

An overdose happens every ten days. And then it's good if it happens in a drug consumption room where lives can be saved. Employees need patience and tact. They like to know that their clients are in their care because they are only safe here in the rooms.

"So the 95 percent of the people who come here are purposeful, polite, cooperative, fine people. Only 5 percent have difficulties because they always have difficulties everywhere, because their psyche is corresponding or their upbringing was corresponding and we are there now "I can't shoot something that quickly anymore. But my ambition is also that these five percent, who have it particularly difficult here, have an educational influence on them. That we can do it after all. Sometimes people get it then only for a week - and then they're gone for a while because they behaved badly. And then they come back. That's just the way it is with you. You have to check that and realize that that are people who are under constant stress. Through fear of withdrawal, fear of pain, exclusion from society as a whole. They are the last thing in the eyes of most. And you get that, you notice and ents you react by speaking."

Understand addiction as a disease

The concept catches on. Christian Hennis reports that social workers come from Thailand and even from the USA to learn from them. The Federal Ministry of Health recently made a 3D film of the facility as teaching material. Something is also happening in the other areas and institutions. dr Every year, Kinkel teaches the Master's degree in International Health at the Charité. Policy makers from around the world are introduced to a new way of looking at drugs: don't label them, but do them. show humanity. Capture addiction as a disease. A lot has happened since the fate of Christiane F., the girl from the socially deprived Gropiusstadt.

Graffiti is painted on a wall in front of the Birkenstube. Then a boy holding an elephant whose tusks have fallen out. Next to it is written: "As long as you are standing, give a hand to those that have fallen."

more on the subject

Fixerstuben in Hamburg – addicts have been living more dangerously since Corona (Deutschlandfunk Kultur, Zeitfragen, February 22nd, 2021)

Drug help in Cologne - clean injection equipment at the church (Deutschlandfunk Kultur, Religions, March 29, 2020)

Berlin drug scene - when the daughter steps into a heroin syringe(Deutschlandfunk, Germany today, October 2nd, 2019)

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