Sisa: is meth use the latest face of the catastrophe in Athens?

Street art in Athens. Flickr/TheVRChris. Some rights reserved.

Meth – or Sisa, as it has been called on the streets of Athens – has become the drug of choice for some of Greece’s drug addicts. ‘Choice’ is the key word: Sisa is much cheaper than heroin, which has for decades been the ‘number one’ illicit substance in Greece. And since the Greek economy has been in a perpetual state of disarray for the past five years, this cheap alternative has seen a remarkable rise in popularity, as well as notoriety. People are desperate, the middle classes have dwindled, and now some appear to have completely given up, resorting to this ultimate quitter drug. But is the situation really that bad?

Unfortunately - and as is usually the case - there is no simple answer. Official figures do look promising: drug-related deaths are down, and so too are waiting times for treatment. But for every silver lining, there's a lightning cloud. There are record numbers of people filing for drug treatment programmes, and the number one whistle-blower regarding the spread of Sisa – Charalampos Poulopoulos, Chairman of KETHEA – has been on a tireless crusade warning everyone about the dangers of this new 'cocaine of the poor.'

What is Sisa?

Inconsistencies within underworld pharmaceuticals is common place, and Sisa is no exception. However, the general consensus holds that Sisa is a form of methamphetamine – also known as speed, crystal meth or simply meth. Beyond this, little else is known.

Part of the problem is that there has been little research by the Greek authorities into this new drug. The first official utterances of this new substance came only in 2011, approximately two years after its first appearance on the streets of Athens. And, to further compound the issue, Sisa has dubious origins and can be “cooked-up” with basic equipment in home laboratories with a variable concoction of fillers that can include battery acid, shampoo and salt. Nonetheless, what is clear is that its rise fits in with a global trend for cheap, home-cooked, DIY highs, along with the rise of black-markets in parts of Europe that allow for the production and distribution of meth. Add to this the porous nature of Greece’s borders, the drastically undermanned Greek police, known for its ineffectiveness and corruption, and 'imports' for either the drug itself or its precursors are easy to imagine.

We may not know exactly what Sisa is or where it comes from, but we do know who uses it; or rather, we can begin to deduce who does through drug treatment figures. Among the slightly declining population of heroin addicts, just under half reported to have used either cocaine or methamphetamines in 2011 (47.6%), of which only 5.3% mentioned meth as either their primary or secondary substance. Nonetheless, usage remains secondary to heroin, despite the apparent financial incentives. It costs just €2-5/hit, with heroin in 2011 costing anywhere between €8-20/g (or about €5/hit or more).

Addicts have repeatedly reported that they are well aware of the destructive traits of meth and are willing to go out of their way to avoid using it. Heroin usage has fallen 3.4 percentage points since 2009, whereas cocaine/meth usage has remained steady during the same period, having risen to its current levels since 2009, up from statistical insignificance in 2005/6. It would therefore be fair to assume that upon Sisa’s first appearance, a number of addicts were willing to try this new, cheaper drug, but the side effects of Sisa consumption, and the reduction in heroin prices have kept the numbers of meth users to steadily low levels over the past few years. Not then a cause for panic.

Other figures from rehabilitation centres in Greece show that the overwhelming majority of Sisa users are male, accounting for around 85.3% of the total number of those in treatment centres. Yet, perhaps the most surprising numbers are that about one in two users are aged between 25-34, and of these there has been a slight increase in individuals with a formal education, as well as a decrease in homelessness amongst addicts generally – a trend seen since 2002. On top of that, there are less individuals seeking treatment from within the traditional family set-up, while there has been a small increase in the number of unemployed among them, which, taking into consideration the family-based structure of Greek society, indicates that more (former) middle-class individuals are facing addiction problems.

Poor response                 

Staying true to the reactionary, panicky way of governance established over the past few years, in the midst of the financial crisis, the Greek government has so far attempted to address the issue and ‘clean the streets’ in two ways: more substitution programmes and more forceful relocation of addicts.

There have been eye-watering budget cuts for most treatment and rehabilitation programmes. For example, KETHEA (the Therapy Centre for Dependent Individuals – the largest rehabilitation programme in Greece, running ‘cold turkey’ programmes since 1983) has lost 70 of their 500 employees over the past few years. Yet, there is one exception: OKANA – The Organisation Against Drugs. Here, treatment is centred around methadone and ephedrine as substitutes for heroin, and with new centres and additional resources, their new reach has meant that more individuals have been able to receive this replacement therapy treatment – from 940 individuals in 2010 to 1761 in 2011.

Despite the apparent efficiency of these programmes and the drop in drug-related deaths over the past few years, a number of doubts still remain concerning their sustainability. While waiting lists at substitution centres have dramatically fallen from 7.5 years to 3.5 years – a tremendous achievement in its own right – they are still unacceptably long. Suffice to say, in most European countries waiting times range between a day and a month. Yet, perhaps the most worrying statistic is that these substitution programmes have had a steady drop out rate of approximately 14%. This is arguably down to the fact that these programmes only allow addicts to sustain an acceptable level of functionality, rather than allowing them to overcome their addiction.

It is this piecemeal and ineffective 'solution' to the problem that has given the Greek authorities a false glimmer of hope, as keeping the addicts in a perpetual state of limbo in these programmes helps to temporarily drive down the dangers associated with disease, death and also criminal behaviour.

Unfortunately for substitution advocates and Greek officials, commentators have backtracked the HIV outbreak in Athens to the dropping of other supplementary programmes. There is now an observable lack of clean needles and condoms available to those on the streets of Athens, which, when coupled with a rise in prostitution rates among addicts, and especially among Sisa users (which does not suppress sexual urges), is a health care catastrophe just waiting to explode. Add to that the very simple mathematics which indicate that for every euro spent on proper holistic treatment, the state saves another €6 on health and judicial expenses. Hardly a waste of money, especially considering the very high cost of pharmaceutical substitutes.

To make things worse, the abolition of the holistic treatment approach has been coupled with brute force replacing intellect. Indiscriminate police roundups and ‘cleansing’ of neighbourhoods are regularly taking place in visibly downgraded areas. This farcical game of ‘move the junkie around’ is further degrading even more neighbourhoods in the already largely ghetto-like historical centre of Athens, while creating ever more tension between the locals and the authorities.

It gets worse: there is no separate classification for Sisa, which has been dumped in the Cocaine/Methamphetamine category in all relevant reports, including those of addiction treatment bodies. There is a distinct lack of understanding. There has been no worthwhile research, nor has there been a single noteworthy arrest - in fact, the amount of synthetic drugs seized by the police has been following a downward trend since 2005 (150,932 tablets, down to 12,823 in 2010 and 70 in 2011). Judicial figures are no better, as the state’s zero tolerance policy to possession and distribution of all drugs leads to sentences for everyone, while all drug-related convictions fall within one – illogical – category.

So yes, the situation is quite grave. Greece, of all places in Europe, was probably the least qualified to deal with such an issue, even before the crisis struck. Meth may very well be the worst drug ever created by humankind, and yes, Greece could become the gateway for methamphetamines to reach European markets. But the doom-and-gloom approach adopted by most officials, journalists and whistle-blowers does not seem justified. Their stance could be part of a truly valiant effort to tackle the problem early, as well as to maintain financing, relevance and efficiency for neglected treatment programmes, but a 'Sisa pandemic' that would lead to countless rapes, robberies and HIV for everyone is not imminent – not yet anyway.

As the economic crisis deepens with a third bailout apparently looming, along with the ineffectiveness of the current treatment plans, are the issues of drug addiction, and Sisa in particular, only likely to become further entrenched? Probably. Can we expect an exponential increase in the nation’s healthcare bill over the next decade or so? Maybe. Will criminality rates skyrocket in a deteriorating financial environment where Sisa has secured a foothold in the heart of Athens? Most assuredly. But this is not the message. This is: the current hyperbole is a bit far fetched and is not going to fix any problems any time soon.

What is desperately needed is more funded research, an efficient plan for police action suitable for an EU member state, and a return to more holistic approaches to drug treatment. With this Athens – and Greece as a whole – just might return to some semblance of normality.