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Monday, October 28, 2013

Boltushka: the cheap Ukrainian alternative to amphetamine


What will you get if you combine crushed cold medicine with warm water, household vinegar and potassium permanganate (KMNO4)? Apparently, this is the recipe for a cheap amphetamine substitute, boltushka, which is quite popular among poverty-stricken youth in Ukraine, particularly in Odessa. Its name comes from the Russian word meaning "shake" or "mix". Cold medicines containing phenylpropanolamine are used and the mixture is shaken until it becomes brown and smells of cherries. Some users substitute aspirin for vinegar, or use both. The active ingredient of boltushka is cathinone, a weak amphetamine-type stimulant.

Boltushka is usually prepared by small groups of people for personal use, rather than being sold. The cost of one dose is less than USD $ 1.00. This drug needs to be injected intravenously to take effect; drinking it will only cause bloating and nausea. It is most commonly injected into the veins of the arms and legs. If accidentally injected under the skin, it can cause an extremely painful abscess.

Most users inject boltushka five to six times a day. The initial "rush" of euphoria (known as prihod) lasts 15-20 minutes; it is followed by a short period of heightened energy and activity, lasting no longer than two hours. Apparently, many users follow a pattern of injecting boltushka for two or three days, going without sleep and food, then rest for a day and go back to injecting the drug. Not surprisingly, such intense use can lead to death within a year or less.

While most ingredients of boltushka (cold medicine, aspirin, vinegar) are easily obtained, potassium permanganate (a popular disinfectant in Eastern Europe) can be somewhat difficult to purchase legally, since it is now a controlled substance in Ukraine. It is often bought on the black market. Ironically, the authorities restrict the availability of potassium permanganate because of a concern that young people are using it to make explosives, not because it can be used to cook drugs.

In one study of boltushka users in Odessa, researchers found that the mean age at first use was only 16 years (range: 12-21 years). Chillingly, this cheap drug is becoming more and more popular among kids aged less than 14. It is primarily a drug of the poor, popular among homeless children and adults because it suppresses hunger, and among young prostitutes because, as one respondent put it, "it makes their work easy". Users reported sharing syringes and other unhygienic injection practices, which put them at risk of HIV and hepatitis B infections. There are also anecdotal reports of shaking, speech problems, memory loss and other symptoms of neurological damage caused by the drug. This neurological damage may be caused by residual KMNO4 present in the homemade solution, rather than by the cathinone itself. None of the users surveyed during the study reported participating in any type of treatment or prevention program.
  
Boltushka has some features in common with another cheap homecooked drug, popular in the U.S. and in some European countries - methamphetamine (boltushka is weaker, though). However, while fiery accidents are common when cooking meth (the procedure requires using flammable solvents and corrosive chemicals such as muriatic acid), the recipe for making boltushka doesn't look dangerous. Phenylpropanolamine-containing cold medications are available both in the USA and in Europe (it is an ingredient in prescription decongestants such as Rinexin) - one wonders why poor folks in countries other than Ukraine aren't using this method to get high. Is it because the main raw ingredient is available by prescription, rather than over the counter, or because the cathinone content in the homemade mixture is low? Or because alternatives are readily accessible (e.g. "bath salts", various synthetic chemicals related to cathinone)?




Image courtesy of: Grant Cochrane / Free Digital Photos (www.freedigitalphotos.net)


The procedure for making and injecting boltushka reminds me of the recipe for kompot, Polish homemade heroin cooked from opium poppies. It used to be popular in Eastern bloc countries back in the 80s. Kompot was prepared by boiling poppy straw, purifying the alkaloids with ion exchange resin, recovering them with ammonia water, evaporating the liquid and acetylating the alkaloid mixture with acetic anhydride. The end product was a bitter brown liquid containing heroin and morphine, along with a whole lot of impurities. Like boltushka, it had to be injected intravenously to take effect. Abscesses and inflamed veins caused by injecting this cocktail and hepatitis B from shared needles weren't the only risks associated with kompot use, however. I've heard least one story about an irate peasant who, seeing that young people are stealing his crop of poppies, sprayed the whole field with insecticides, causing the deaths of several addicts who cooked kompot from the tainted straw. 

Ironically, the word "kompot" actually means "compote", a tasty sweet drink made from stewed fruit, popular in Poland (when I was a kid in the 80s, the typical Polish weekday dinner would be soup, a second course - meat with potatoes or a meatless flour-based dish such as dumplings - and a glass of compote).

The bottom line? Poor people will always find a way to cook drugs from scratch.

Source: Chintalova-Dallas, R, Case P, Kitsenko N, Lazzarini Z. (2009) Boltushka: a homemade amphetamine-type stimulant and HIV risk in Odessa, Ukraine. Int J Drug Policy 20(4):347-51

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