Needs and gaps in treatment and rehabilitation for people who use drugs in selected countries of EECA

Report on the needs and gaps in treatment and rehabilitation for people who use drugs in selected countries of EECA

This report presents the results of an assessment on the availability of and access to treatment and rehabilitation services for people who use drugs (PWUD) in selected countries of the Eastern European and Central Asian (EECA) region. It was carried out through a regional approach developed by the AFEW Network within the programme ‘Bridging the Gaps: health and rights for key populations. Phase 2’, fi­nanced by the Ministry of Foreign Affairs of the Netherlands.

The assessment focused primarily on the topics of rehabilitation and human rights. AFEW International was responsible for information at the international level, whilst regional level assessments focused on EECA countries where the AFEW Network implements the project amongst PWUD, namely, Georgia, the Kyrgyz Republic, the Russian Federation and Ukraine. We expect the results of this assessment will be used to improve the current situation with access to treatment and rehabilitation services for PWUD in the EECA region, particularly in those countries in which the AFEW Network works. Findings from this analysis of existing gaps, this assessment represents the fi­rst step to developing rehabilitation services and human rights under the AFEW regional approach. Furthermore, the ­findings will inform the development of pilot projects on advocacy, service delivery or capacity building and the continuous monitoring of results.

The full version of the report is available here.

Georgian Youth for Music and Harm Reduction

For the first time in the history of Georgian music festivals, a team of volunteers delivered harm reduction services 24 hours a day during 4GB festival

Author: Irma Kakhurashvili, Georgia

4GB is an annual electronic music festival which has been held in Georgia since 2011. The festival is dedicated to the memory of DJ Giorgi Bakanidze – one of the Georgian club music pioneers. This year, 4GB was held in an abandoned Cosmic Constructions Centre near the Saguramo village. Apart from the high-quality lineup, sound systems and headliners performing on stage, 4GB festival had another prominent feature – for the first time in the history of Georgian music festivals, a team of volunteers delivered harm reduction services 24 hours a day. Mandala – Harm Reduction youth project team members did their best to make sure that more than one hundred participants of the festival stay healthy. Thanks to this project, drug and alcohol intoxication, overdoses and other risky situations were brought to naught.

Information as weapons

Information about the new project first appeared in social networks. Several days before opening of the festival, organizers announced that due to the growing number of drug-related deaths (last month, seven young people died in Georgia – author’s note) they decided to protect their guests and music lovers with the help of Mandala – Harm Reduction.

With the financial support of Doctors of the World (France), 20 young volunteers, who received harm reduction training, were engaged in the project.

“Last month, several young people died of drugs, and we thought that in such circumstances our initiative will be very timely. We still remember the last-year GEM FEST, where 22-year-old Natia Tavartkiladze died of drug intoxication in Anaklia. Therefore, our goal was to give all people, especially young ones, objective information about health, drug use and personal safety,” says Temur Khatiashvili, Project Coordinator.

20 young volunteers, who received harm reduction training, were engaged in the project

According to Temur, the awareness-raising materials distributed at the festival were specially developed for young people – pocket-size brochures with the original design, which used simple language to describe a number of popular club drugs, their potential harms, and universal overdose prevention and safety rules. The brochure included a matrix showing the compatibility of different low- and high-risk drugs and a map of the festival territory marking the tent offering harm reduction services. In the friendly atmosphere of the tent, all interested people could receive consultations, get free condoms, drinking water and hematogen (nutrition bar that is often considered to be a medicinal product and is used to treat or prevent low blood levels of iron and vitamin B12 – editor’s note).

Project to be continued

The 4GB festival had a happy end. Participants of the Mandala – Harm Reduction project coordinated their efforts with the ambulance team, which they contacted over the radio in case of need.

The 4GB organizers welcomed Mandala – Harm Reduction as it clearly demonstrated that such project is important for thousands of people who are brought together by such large-scale music event. Participants of the festival were also positive about the project.

21-year-old Tamar Ninua thinks that today electronic music is the fastest growing youth culture in the world, and such projects are especially important for people who may use drugs, not being fully conscious of the consequences of their unsafe behaviours. In such cases, access to timely assistance is very important.

“Despite of the high health risk, people still use various substances. The festival is not an exception. The efforts of Mandala volunteers helped to mitigate the risks. Many young people lose self-control in the euphoria of the festival. The Mandala volunteers, who were easy to recognize as they were wearing kind of a uniform, were moving around in an organized way and were promptly responding to any cases who might need help,” says Tamar.

The project initiators are optimistic and say that in the nearest future the idea of festival-based harm reduction will be extended to cover all the music events in Georgia. They hope that they will receive support not only from different harm reduction charities but also from the mayors’ offices.

It is not that easy

In the nearest future the idea of festival-based harm reduction will be extended to cover all the music events in Georgia

“We will try to improve this project and will learn to overcome the barriers that we face. E.g., festival organizers said that we could by no means hand out syringes. They said that young people might see it as an incentive for using drugs. However, we insisted until the end that this service is necessary. Besides, they were against the distribution of naloxone but we were able to prove that having a highly effective medication to deal with overdoses is vital,” told Mariam Ubilava, project volunteer and coordinator.

According to Mariam, the project is aimed at preserving the health of each festival participant, at mitigating the negative consequences of substance use and achieving behaviour changes.

“We noticed one more problem. When some young people saw us, they were more eager to practice risky behaviours, hoping for our help. Thus, they reduced their own responsibility, shifting it on us. That is why we will have to think how to prevent it from happening in future and find a balance,” says Mariam.

Such projects as Mandala – Harm Reduction are widely implemented at various music events all over the world, such as Amsterdam Open Air, Lollapalooza Paris, Tomorrowland, etc.

188 NGOs Call on the United Nations to Condemn Bangladesh Drug War

Civil society calls on the UN to take action in response to the killing of 130 people suspected of drug dealing by the Bangladeshi police.

BANGKOK, 6 June 2018 Over 130 people have been killed and more than 13,000 people arrested in Bangladesh since Prime Minister Sheikh Hasina launched a nationwide anti-drugs campaign in May 2018.

In a manner reminiscent of the Philippines drug war, Bangladeshi police justified these killings as supposedly happening during ‘gunfights’ with rival gangs or law enforcement officers acting in self-defense during anti-drug operations. The government has also closed down health and harm reduction services for people who use drugs and some clients have disappeared. In addition, the government is now considering legislation to impose the death penalty for drug offences.

188 NGOs sent an open letter to the two major UN drug control bodies—the UN Office on Drugs and Crime (UNODC) and the International Narcotics Control Board (INCB)—calling on them to take urgent action to prevent further deaths and human rights violations in the name of drug control in Bangladesh, but also in other countries such as the Philippines, Indonesia and Cambodia.

Evidence worldwide have shown that such a violent and abusive approach has not managed to curb the illicit drug market, but it can be used as a political tool to win political elections and target unwanted opposition.

Anand Chabungbam, coordinator of the Asian Network of People who Use Drugs which co-initiated the open letter with the International Drug Policy Consortium, said: “As human rights abuses in the name of a war on drugs are increasing every day around Asia and are now seemingly the ‘new normal’, it may have given false hope for certain political leaders that they no longer have to account for killing their own poor and vulnerable citizens. We will do all we can to bring perpetrators to justice”.

In a strong statement issued today, the UN Human Rights Commissioner called for a stop to the killing of people suspected of drug offences in Bangladesh as ‘indicative of a total disregard for the rule of law’. He concluded: ‘People do not lose their human rights because they use or sell drugs’.

The leadership of the UNODC and INCB is critical to ensuring that the repressive approaches adopted by Bangladesh and others do not have a snowball effect in the region. NGO signatories to the letter called upon the UNODC and INCB to take the following urgent actions to prevent further killings and abuses:

  1. Issue a high-level statement to condemn the killings, urge the Government of Bangladesh to suspend its current anti-drug operations until it has set up protocols that are based upon human rights and the rule of law; and advise the Government against instituting the death penalty for drug offences
  2. Recommend and assist with the implementation of drug policy measures based on evidence, human rights, human security and public health (especially harm reduction, drug treatment and other services for people who use drugs, including in prisons)
  3. Remain vigilant to other countries showing signs of adopting similar repressive policies, and initiate constructive and inclusive dialogue at an early stage to avoid further human rights violations in the name of drug control.

FOR FURTHER INFORMATION, PLEASE CONTACT:

Mr. Bikas Gurung
Program and Communication Manager, Asian Network of People who Use Drugs
Based in Bangkok, Thailand
E-mail: bikas@anpud.org
Mobile phone: +66 991892286

Ms. Gloria Lai
Regional Director: Asia, International Drug Policy Consortium
Based in Bangkok, Thailand
E-mail: glai@idpc.net
Mobile phone: +66 826960334

Mr. Jamie Bridge
Chief of Operations Officer, International Drug Policy Consortium
Based in London, UK
E-mail: jbridge@idpc.net
Mobile phone: +44 7815 047603

Source: IDPC

Drug Policy Reform in Georgia – Any Reason for Optimism – Part II

Author: Irma Kakhurashvili, Georgia

Thanks to the harm reduction and methadone programmes, the rate of HIV transmission among injecting drug users went down in 2011-2017. We decided to find out who facilitated implementation of those programmes, fighting for people’s lives.

Implementing harm reduction programmes, changing attitudes towards drug users and protecting their rights was possible, in particular, thanks to the incredible efforts and commitment of civil society organizations. Thus, the Georgian Harm Reduction Network was founded in 2006, bringing together 27 organizations. In 2008, the Network had 9 service delivery sites all over the country. Starting from July 2013, 14 service delivery sites have been operating in 11 Georgian cities. Such sites offer free services to people who use drugs: testing, clean syringes, counselling, legal support, case management, etc. In 2017, 30,000 people who use drugs received at least one service offered by the Georgian Harm Reduction Network.

“Considering current repressive drug policies, it is not easy to bring a person who injects drugs to a service delivery site. That is why in cooperation with the community of drug users and various NGOs we offer our services not only in our centres but also in the places convenient for drug users. Besides, the Georgian Harm Reduction Network has six mobile clinics, which deliver services in 65 cities of Georgia. They do testing not only among drug users but also among the general population,” tells Maka Gogia, Director of the Georgian Harm Reduction Network.

Hoping for the expertise of civil society organizations

Since 2013, with support of the Global Fund, the Network was able to mobilize the communities of drug users in response to the epidemics of hepatitis C and HIV. The first self-organizations – Hepa Plus and New Vector – became the champions in fighting for the rights of drug users. The community of drug users was the first to speak against the practice of compulsory drug testing, informing the drug users that they may refuse to undergo such testing run by law enforcement agencies. Apart from the fact that this procedure is rather humiliating, it also costs a lot of money to the country. According to 2015 data, GEL 15 million (about EUR 4.7 million) were spent for drug testing.

The Georgian Harm Reduction Network hopes that after the Global Fund leaves the country and cuts the funding of harm reduction programmes, the government will rely on the experience of civil society organizations. Taking into account the coverage and the positive impact of such programmes in terms of reducing the spread of risky behaviours and preventing new cases of HIV and hepatitis, international experts strongly recommend increasing the state funding allocated for such programmes to cover more people who need such services.

Another problem that drug users in Georgia face – difficulties in receiving medical aid in case of overdose, despite the fact that overdose is one of the main causes of deaths among drug users. Regulation of the Ministry of Health, which was in force since 2000, did not allow ambulances to take patients with drug overdoses to inpatient hospital units before the arrival of patrol police. Besides, taking into account that in Georgia drug use is a criminal offence, drug users tried to hide any cases of overdose and even in critical circumstances refused to call an ambulance. According to the survey held by the Georgian Harm Reduction Network in 2013, 26.7% of drug users aged 30-35 years old had an experience of overdose, 42.1% were present when another person had an overdose and only 15.80% of them called an ambulance.

A big success of civil society organizations and human rights activists was the ban on notification of police by healthcare workers in case of overdoses in 2014.

“We do not have the exact statistics, but changes in the laws reduced the number of deaths. However, it is only a minor improvement comparing to what the government should do to humanize the drug policy,” says Konstantin Labartkava, Chairman of the Network of People who Use Drugs in Georgia (GeNPUD).

One of the most effective response measures to overdoses is naloxone, but in Georgia, this medicine can only be bought in pharmacies by prescriptions. On numerous occasions, various NGOs requested the Ministry of Health to increase the accessibility of naloxone, but there still have been no changes in this regard.

Activism against the repressive system

Despite all changes, the Georgian drug policy remains inhumane. For example, a person who has four ecstasy pills may receive a stricter punishment than a person who commits a murder or a rape. Lack of reintegration programmes for ex-prisoners does not allow them to find a job, renew their social connections or receive an adequate psychosocial support.

“My dependence is 16 years old. I have spent over three years in prison for drug use and almost died of the abstinence syndrome. My family fell apart. After I got out of jail, I have been looking for a job for a long time, but in vain. Nobody wanted to give me a job when they learned that I had a criminal record… Several times police took me for drug testing, right from the street and from my own yard, where I was having a walk with my small son… Four times, I received drug treatment, I did my best but as there is no psychosocial rehabilitation in Georgia, it all went wrong. If I had no support of my friends from the New Vector NGO, this drug policy would totally ruin my life. Now I am a social worker and I help other drug users to fight for their rights and their health. I think that the repressions which ruined so many lives should end!” says Giorgi M., former drug user, 38 years old.

That is why activists and the community advocate for the decriminalization of the drug use. They are not ready to accept a compromise and call on the government to use more humane approaches to drug users and amend the existing legislation.

The court supported decriminalization

Two years ago, the central avenue of the Georgian capital – Tbilisi – became the epicentre of protest demonstrations. The protesters called on the authorities to change the repressive drug policies; new coalitions were founded; campaigns were initiated through mass media. The activism of civil society organizations, including self-organisations of drug users, gradually started bringing its result. The Prime Minister, Giorgi Kvirkashvili appealed to the Parliament calling for drug policy liberalization. On 16 June 2017, members of the Parliament supported the draft law developed by the Ministry of Justice, stating that 70 grams of dry cannabis and 140 grams of raw cannabis were considered as small amounts of the substance, the purchase and possession of which leads only to administrative responsibility.

In December 2017, the Constitutional Court of Georgia supported decriminalization of cannabis. It decided that bringing up criminal proceedings for the use of cannabis was against the Constitution and banned such practice. Georgian people said that this court decree was revolutionary.

Striving to accelerate the progress in changing the laws and establish a humane drug policy, experts and civil society activists founded the National Drug Policy Platform. Over 40 participants of the Platform were involved in the development of a draft law, stipulating decriminalization of all types of drugs in adequate quantities and the development of harm reduction and psychosocial rehabilitation programmes. The draft law is based on the international expertise and is supported by such reputable organizations as UNAIDS, the Global Commission on Drug Policy and the International Drug Policy Consortium. The Portugal model was used as the best practice as it allowed reducing the number of people with drug dependence, significantly decrease the growth of new HIV cases and deaths caused by drug overdoses.

“None of the countries which made their laws more liberal observed the growth of drug use. Decriminalization surely does not mean encouragement of the drug use,” says David Otiashvili, Director of the Alternative Georgia NGO.

Alternative drug law

Recently, consideration of the draft law registered by the Platform in the Parliament in July 2017 was postponed for two months. The reason of such delay was the lack of consensus among the clergy, MPs and the Ministry of Internal Affairs.

It appeared that the Ministry of Justice developed an alternative draft law on the amounts of narcotic substances. This draft law defines the amounts of only six substances (amphetamine, desomorphine, MDMA, LSD, ephedrone, and methamphetamine) and reduces the small amounts of two substances (heroin and methadone).

According to the civil society activists, such amendments are fragmentary and do not resolve the existing problems. They say that the draft law developed by the Ministry of Justice ignores many injustices and systematic issues in the drug policy.

Drug Policy Reform in Georgia – Any Reason for Optimism – Part I

Author: Irma Kakhurashvili, Georgia

The Georgian drug policy calls for radical changes. Currently, it is aimed at the strict punishment of drug users and their isolation from the society. Data of the 2016 Council of Europe report show that every third prisoner in Georgia is convicted for drug-related crimes. However, such repressive approaches do not make people quit drugs. In prisons, people suffer from the abstinence syndrome and lose their health as well as years of their lives. Authorities think that the prison “cures” people, but according to the research studies by Human Rights Education and Monitoring Centre (EMC), 89% of drug users go back to drugs after they are released. The rest of them return to their drug using habits within 11 months.

According to the Georgian Ministry of Corrections and Probation, support of people convicted for drug-related crimes costs the government up to GEL 40 million (or about EUR 12.5 million) a year, while the Ministry of Health spends only GEL 4 million (or about EUR 1.25 million) on drug treatment and rehabilitation, including substitution therapy, which is 10 times less.

At the same time, the government spends more money to identify and arrest drug users than to treat and rehabilitate them. Prison stay of one person convicted for drug-related crimes costs the state GEL 12 thousand (about EUR 3.8 thousand) a year, while treatment of one person costs only GEL 2.2 thousand (about EUR 690) a year, which is 5.5 times less.

Many people agree with the fact that the Georgian drug policy does not stand up to criticism. Apparently, the government also agrees with it – the governing party Georgian Dream wrote about the need of drug policy liberalization in its pre-election programme in 2012, but in fact, there have been no major changes in the situation. Humanizing draft laws are lost in the parliamentary labyrinths, leaving no trace, and the statistics on the number of injecting drug users grows – in the recent seven years it went up from 40,000 to 52,500 people (data of Bemoni NGO and Curatio International Foundation).

Georgia could become a part of drug-trafficking transit chain

In Georgian history, the use of cannabis as a narcotic drug is first mentioned in the XIII century – the king of Georgia Lasha-Giorgi sometimes used it. However, none of the historical sources mentions Georgia as a producer of drugs, though, considering its geographical location, there has always been a risk of the country becoming a part of the drug-trafficking transit chain. It happened in the 90s, when drugs were coming from Afghanistan and Central Asia to Europe. Part of such drugs remained in Georgia, which increased drug use in the country.

In this period, police was the main agency responsible for countering drugs, with punishment considered as the most effective method of “help.” Though drug users were able to access voluntary treatment, there was no integrated, people-centred and human rights-based prevention and rehabilitation system. Escalation of drug use was caused by social, political and economic developments in the country – the war in Abkhazia, aggravating the criminal situation, corruption, economic collapse, crisis of values in the society and unemployment.

The 90s were also associated with the onset of the HIV epidemic. The first case of HIV in Georgia was registered in 1989. Now the estimated number of people living with HIV in the country is about 12,000 people. About 5,000 of them are aware of their HIV status.

Regional centres and counselling rooms

For many years, injecting drug use was the main route of HIV transmission. That is why drug use gradually turned out to be not only a social and criminal issue, but also a health issue.

Since 1997, led by the Public Health Department, the Scientific Research Institute of Narcology started implementation of the State Drug Abuse Prevention Programme. However, most resources allocated for the programme were used to cover drug tests. The average of just GEL 250-200 thousand a year, and since 2005 – GEL 50 thousand a year were used to cover other areas of activities. For example, a network of drug services was created – 10 regional drug centres and 21 regional drug counselling rooms.

As the year 2000 approached, the drug laws did not change, but the first harm reduction programmes were already implemented. A number of non-governmental organizations started “field” work to exchange syringes for drug users. It was a difficult job as social workers had to overcome the resistance of police, on the one hand, and gain the trust of drug users, on the other hand.

On 5 December 2002, the Georgian Parliament adopted a law on drugs, psychotropic substances, precursors and drug treatment, which came into force in March 2003. The main principle defining the new laws was the maximum restriction of the purchase and use of drugs, while recognizing drug users as people who need treatment. The new law defined obligations of the government to drug users – it had to provide drug users with expertise, diagnostics, treatment and rehabilitation. However, due to the economic crisis, it was impossible within the state programme.

Heterosexual route of transmission is leading

According to the Scientific Research Institute of Narcology, the number of officially registered drug users grew nine-fold from 1990 to 2004. By the end of 2004, 24,000 people were officially registered as drug users. However, according to the estimates, the real number of people who use drugs is much higher – 200-240 thousand, including 80-90 thousand of people who inject drugs.

In 2003, Georgia received a grant from the Global Fund to Fight AIDS, Tuberculosis and Malaria and started to successfully fight communicable diseases. As a result, Georgia became the only country in Eastern Europe and among post-Soviet states with an absolute accessibility of antiretroviral drugs for people with HIV/AIDS. All people who need treatment and who are citizens of Georgia can access it. At the same time, the country started implementing a methadone programme, which has been supported from the state budget since 2008. Currently, over 9,000 people participate in the programme (7 sites in Tbilisi and 9 – in other regions).

Thanks to the harm reduction and methadone programmes, the rate of HIV transmission among injecting drug users went down in 2011-2017. Today, the biggest route of HIV transmission is heterosexual – 45.2%, while injecting drug use accounts for 41.6% of new HIV cases.

In the second part of our article, we will tell about the role of civil society organizations and activists in the promotion of harm reduction programmes and drug policy changes.

A Drug-Free Life: how Methadone Changed the Life of a Former Drug User from Tajikistan

Author: Nargis Khamrabaeva, Tajikistan

Methadone substitution therapy for drug dependent people has been used for many years, but so far there are both supporters and opponents of this method. 40-year-old Karim from Tajikistan shared how he personally benefited from the substitution therapy.

Heroin for breakfast, lunch and dinner

Karim started taking drugs when he was 20. At first, it was hashish and weed smoking with friends from time to time. He was 34 when one of his friends handed him a stronger cigarette with hashish and heroin mix.

“I thought, well, it is okay, in this life you have to try everything. A couple of days later I started feeling not very well. It seemed like flu, and back then I did not know that those were the withdrawal symptoms,” Karim is saying.

Karim did not manage to cope with the terrible feeling that people who use drugs get when the whole body aches and pains, there are chills, nausea and weakness. He had to buy a dose, then another one. As a result, he became seriously hooked on heroin. Heroin was for breakfast, lunch and dinner. Karim’s was thinking only about how to get another dose.

At times he would listen to his mother and wife and go to the narcology clinic to get treatment but without any success. He went to work far away, to Russia. Karim did not manage to make money but got addicted to drugs even more. Moving to another place did not help either. The wife left with the children on the condition that she would return when her husband coped with the addiction. Nevertheless, even this did not motivate Karim to knock the habit.

“Of course, I wanted to kick the drug addiction, because I realized that if the situation continued, I would lose my family. But quitting heroin is not easy, you need to harness all your willpower to do it, and not give up. I did not want to suffer. I would last a day or two, and everything began anew,” Karim says.

AFEW helped with methadone

In 2015, Karim heard that AFEW-Tajikistan helps drug users to cope with this craving with methadone substitution therapy. At first, Karim did not believe that something else could help but decided to use this opportunity.

“I went to the organization, received a referral to treatment and started taking strictly defined doses of methadone under the supervision of a doctor. By the way, I did not receive it in the form of injections but got it as a syrup instead. Over the period of three years, the dose of methadone was gradually reduced. Methadone helps to get off the needle and not spread HIV and hepatitis via a common syringe,” he says.

According to Karim, he no longer experiences withdrawal symptoms and hopes that the complete denial of drugs is around the corner.

“Now I am leading a normal life, my wife and four children are back with me,” Karim is saying.

GeNPUD is Allowed Official Registration

A landmark judgment allowing an official registration of Georgian Network of People Who Use Drugs for Human Drug Policy (GeNPUD) was delivered on March 26, 2018, by Tbilisi City Court Judge Tamar Chuniashvili.

The lawsuit was prepared on behalf of GeNPUD after the network was refused official state registration as stated in LEPL National Agency of Public Registry’s decision. The rejection of registration was based on the “name issue.” Public Registry references the law which says that the name of GeNPUD (any kind of drug users’ organizing assembly) seemed to be an attempt “to put the illegal activities in the legal framework” and is misleading the entire society. GeNPUD is disagreeing saying that this is the violation of the community’s fundamental rights guaranteed by the Constitution and the European Convention.

Within the lawsuit and during the Court hearing among legal arguments versus the Public Registry, Strasbourg Court’s judgments solid arguments as well as factual circumstances that demonstrated the importance of the network activities in the process of human rights protection, harm reduction services’ effective delivery to the targeted groups, liberalization of the drug policy, formation of effective health system and in overall all for public benefit were presented.

GeNPUD believes that Tbilisi City Court’s judgment would be an important step in the protection of the communities’ rights and interests not only at the local level but at the international scene and it will become the new window of opportunities to fight for health and the fundamental rights of the community members. It is believed that this judgment will further strengthen the democratic values on the way of establishing the effective drug policy.

Source: Drug Policy Georgia

Conclusions of the WHO International Meeting on Prisons and Health

People in prison have higher rates of drug use and injecting than the general population, and people with drug-related problems make up a significant proportion of people in prison. Among high-risk drug users in the community, many will have repeat experience of prison. The likelihood of having contracted an infectious disease is higher among high-risk drug users with a prison history than among those who have never been incarcerated, and the risk of overdose death in the immediate period after release from prison is high.

Such were the talks during the World Health Organization (WHO) international meeting on prisons and health, held in Lisbon, Portugal, on 11–12 December 2017. The meeting participants proposed some conclusions for wider dissemination to all those who could improve the current position worldwide with respect to drugs and drug-related harms in prison, which continue to challenge prison systems and the wider community:

Taking note of the current facts and figures regarding drugs and drug-related harms in prisons worldwide and the high rate of post-release mortality, as presented to the meeting by acknowledged international experts,

Based on the evidence and experience of recognized experts in addressing drugs in prisons and their related harms, such as HIV, hepatitis B and C, and tuberculosis (TB), as well as mental health problems,

Justified by the available evidence on effective harm-reduction measures, encouraged by the proven beneficial results obtained from initiatives such as opioid substitution treatment in prison and overdose prevention before release in other countries in the world,

Aware of the potential for prisons to contribute to global public health protection and hence to a reduction of health inequalities by allowing opportunities to intervene in a vulnerable and high disease-burdened population which would impact on wider community health outcomes,

Understanding that effective prevention depends on early recognition of those at risk at all stages of the criminal justice system,

Emphasizing the fact that drug treatment in prisons must not be isolated from health services available in the community,

Recognizing the significantly higher level of tobacco-smoking behaviour among people in prison and the opportunity to support smoking cessation in prison settings,

Considering the health and economic burden of alcohol-related violence and the potential of prison settings for the delivery of effective alcohol interventions to achieve better health and rehabilitation outcomes for prisoners,

Acknowledging the standards set out in the United Nations Standard Minimum Rules for the Treatment of Prisoners (also known as the Nelson Mandela Rules), including Rule 24, on providing the same standards of health care in the prison setting as in the community and ensuring continuity between the two, and Rule 25, on paying particular attention to addressing health care needs that may hamper rehabilitation,

This meeting recognized the need for consideration of the following measures, programmes and guidelines aimed to reduce drug use and its associated harms in prison and invites policy-makers, health and justice professionals, and prison administrators to:

  • Implement a “whole-of-government approach” to prison health care, ensuring that the health and social care needs of people in prisons are considered in all policies, taking account of the need for integration between prison health and wider public health and social care systems, and recognizing prisons as a setting in which to address health inequalities, improve health and thereby reduce reoffending;
  • Operate within a framework of equivalence of health care outcomes between prison and community based on need and the requirement for continuity of care between community and prison;
  • Treat the person as a whole, including psychosocial support as well as effective pharmacological treatment, recognizing that drug treatment should take account of wider health and social care issues;
  • Ensure that service design is informed by research evidence and that service delivery is evaluated by audit and/or appropriate implementation data that take into account the prison setting and the transition into the community from custody, requiring multiagency partnership work and a systems leadership approach to health;
  • Develop and agree minimum staffing levels (both healthcare and custodial staff) and skill mix; ensure appropriate training and professional development for all staff to assure improvements in service delivery, acknowledging the challenges of working in a prison setting and the opportunities for all staff to impact on rehabilitation and reducing recidivism;
  • Encourage use of the United Nations comprehensive package of services to address HIV, TB, and viral hepatitis B and C; and undertake prison reform measures to improve living and working conditions, and broader criminal justice reforms to develop, adopt and implement alternatives to conviction or punishment and to reduce the excessive use of pre-trial detention.

The World Health Organization (WHO) international meeting on prisons and health, held in Lisbon, Portugal, on 11–12 December 2017, brought together more than 100 experts in the field of prison and public health from 30 countries worldwide; besides the WHO Regional Office for Europe, several other international and European agencies were represented, including the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), the Council of Europe’s Pompidou Group, the European Centre for Disease Prevention and Control, the United Nations Office on Drugs and Crime, and the Ministry of Health and the Ministry of Justice of Portugal; support was provided by Public Health England (PHE), the UK Collaborating Centre for the WHO Health in Prisons Programme (HIPP).

Source: WHO

Bridging the Gaps in Clinical Guideline to Care in Pregnancy for Women Using Psychoactive Substances

All the regions of Kyrgyzstan already received the developed clinical guideline

The estimate number of people who use injected drugs (PWID) in Kyrgyzstan is about 25,000 people. Many of these people are women. Such is the data from the research that was conducted within the framework of the Global Fund’s grant in 2013.

Applying recommendations in practice

In 2016, Public Fund (PF) Asteria, a community based organisation that protects rights of women who use drugs in Kyrgyzstan, applied to AFEW-Kyrgyzstan seeking for a help in developing a clinical guideline to care in pregnancy for women who use drugs. Within the framework of the project Bridging the Gaps: health and rights for key populations, AFEW-Kyrgyzstan decided to support this initiative as there were no modern standards for working with women who use drugs in the country before. A working group that included an expert in narcology, an obstetrician-gynecologist, an expert in evidence-based medicine, and a representative of the community of women who use drugs was created. In January 2017, the clinical guideline “Care in pregnancy, childbirth and the puerperium for women who use psychoactive substances” was approved by the order of the Ministry of Health and became mandatory for doctors’ use.

“When the guideline was approved, we realized that it is not enough to simply distribute it among the doctors. It was necessary to organize a comprehensive training for the family doctors, obstetrician-gynecologists and other specialists so that they could not only apply the developed recommendations in practice, but also share their experience with their colleagues,” said Chinara Imankulova, project manager of the Bridging the Gaps: health and rights of key populations at AFEW-Kyrgyzstan.

In April 2017, trainings were organized for the teachers of Kyrgyz State Medical Institute for postgraduate students. The manuals for teachers with presentations have been developed so that in the future trained teachers could deliver reliable information to the course participants. This approach gives an opportunity to train all healthcare professionals in the country and provides them with an access to the protocol.

In August 2017, trainings were offered to obstetrician-gynecologists of the centers of family medicine and obstetrical institutions. During the trainings, specialists got acquainted with the latest research in this field, studied the peculiarities of pregnancy, prenatal and postnatal period of women, who use drugs, as well as ways to avoid or minimize the risks of drug exposure to women and children.

“Two or three years ago, when our pregnant women who use drugs visited doctors, they were afraid that doctors would force them to have an abortion. In September 2017, our client Victoria, who at that time was on methadone therapy, visited the obstetrician-gynecologist. Victoria gave birth to a healthy girl, and doctors treated Victoria and her child very well. Moreover, the doctor even helped Victoria to get methadone so she could spend enough time in the hospital for rehabilitation after the childbirth,” said Tatiana Musagalieva, a representative of PF Asteria.

Women should not be discriminated

During the trainings, 100 specialists who are working in the republic of Kyrgyzstan were trained. Doctors from the regional centers were also invited for the training. It is very important to provide access to quality medical services for women who use drugs in the rural areas. Doctors also learned to get rid of their stigma towards women who use drugs and always treat them with respect. A class on stigma and discrimination was taught by women from the community of drug users. They told the participants of the training their stories, talked about how difficult it was when doctors refused to treat them or insulted them. This part was useful in reducing stigma and discrimination among doctors, in showing them that women who use drugs are just like the others.

“Before the training I met several pregnant women who use drugs. To be honest, I was not sure that they could give birth to healthy children. Having received the clinical protocol, and with the knowledge I have got in the training, I realized that these women should not be discriminated. I learned about scientific recommendations for conducting pregnancy in the situations that cannot do harm to either mother or child. This helped me a lot,” said the participant of the training, obstetrician-gynecologist Kaliyeva Burul.

All the regions of the republic already received the developed clinical guideline. Doctors who have been trained, share their experiences with their colleagues and help women who use drugs to safely plan their pregnancies and give births to healthy children. AFEW-Kyrgyzstan continues to monitor the work of specialists who have been trained, and monitors if all health specialists have access to the guideline. In the future, AFEW-Kyrgyzstan will continue to work on improving the quality of life of people who use drugs, and will monitor the usage of this protocol by doctors.

Spices – New Threat for the Tajik Youth

Photo source: http://brosaem.info

Author: Nargis Hamrabaeva, Tajikistan

While several years ago Tajikistan was concerned with young people being into opiates and stronger synthetic drugs, today there are concerns about the new-generation drugs – so-called spices.

Spicy naswar

The official reports of law enforcement agencies fail to contain any data on the seizure of spices. However, a quick survey among the young people showed that those smoking blends have long been popular in the country.

Spices are the smoking blends, which contain dry herbs and roots. The dried components themselves are not dangerous, but to make the smokers feel a more intense euphoria, the producers add cannabinoids, which are strong narcotic substances. 

“For what I know, earlier spices were distributed in the nightclubs, but now they are mostly sold in the internet and through the grapevine. I also heard that sometimes naswar – the type of smokeless tobacco typical for Central Asia, containing tobacco and alkali (hydrated lime), which is popular among many local people – is processed in the same way as the spices,” says Aziz, a student from Dushanbe.

“Rich kids” having fun

Our anonymous respondent who has 20 years of experience working at law enforcement agencies said that it would not be right to say that young people in Tajikistan are addicted to spices, but this threat should not be disregarded.

“Yes, spices can be easily accessed, but their price is higher than the price of marijuana which young people have traditionally been smoking and continue smoking now. After the heroin “rush” at the turn of the century, many people who use drugs have been massively switching to marijuana and opiates. They strongly believe that marijuana is not more harmful than cigarettes,” he says.

According to him, spices are mostly used in nightclubs by those, who have enough money for it – the so-called “rich kids.”

“They think that spices do not cause addiction and that they can quit using them whenever they want as opposed to opiates and heroin,” says the law enforcer.

Spices do not have the euphoric effects they used to

However, Dr. Mahmadrahim Malakhov who studied the sociocultural aspects of the substance use in Tajikistan, says that the dependence develops much quicker when using spices than when using natural marijuana.

Meanwhile, the exact number of people who use drugs in Tajikistan is not known. Doctors say that few people who use drugs seek medical assistance when they want to quit. They are the ones who are included in the official statistics, which shows that there are a little more than 7 thousand people who use drugs in the country.

Last year, Tajik law enforcers seized about 4.5 tons of narcotic drugs, which is 29.8% more than the year before.

“In particular, 110 kg of heroin, 1.2 tons of raw opium, 2.4 tons of hashish and 742 kg of cannabis drugs were seized. The offences of 52 criminal groups consisting of 115 individuals were investigated and terminated, including five organized transnational groups,” said Murtazo Khaidarzoda, Deputy Head of the Drug Control Agency of the Republic of Tajikistan at the press conference.