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.

In Kyrgyzstan, Fines for Drug-Related Offences will Grow 30-Fold

Street lawyers of the Ranar Foundation provide legal counselling to people who use drugs

Author: Olga Ochneva, Kyrgyzstan

Kyrgyzstan has adopted new legislation on drug-related crimes. Amendments have been introduced into a number of national legal codes within the broad judiciary reform in the country. The amendments will come into force starting from 2019. Initiators of the reform declare the ideas of humanisation and decriminalisation, but the practitioners and the community expect an opposite outcome.

Unaffordable fines or imprisonment

Aybek (the name is changed) has recently been released from jail. He spent three years behind the bars for 3.5 grams of hashish, which he bought for his own use.

“In 2014, Aybek was caught with drugs and was told to pay a fine of 30,000 Kyrgyz Soms (375 euros) and was let go. Soon, he was seized again for a similar offence. The fine was left in force and in addition, Aybek was sentenced to three years of imprisonment,” the street lawyer of the Ranar Foundation Denis Kucheryaviyis telling. “Now Aybek lives in our social dormitory. He has no passport and he has no job. During his years in prison, he was able to pay only 30% of the fine. He has been told he cannot get his passport unless he pays the whole sum. How can he find a job with no documents? Recently, we learned that he was put on a wanted list due to his failure to pay the fine, so now he faces the threat of imprisonment again.”

According to the Criminal Code currently in force, possession of drugs with no intent to sell in big amounts exceeding one gram for heroin and three grams for hashish is now punished with a fine of 250 to 650 euros or with imprisonment for a term of up to five years. In the new Criminal Code, the fines will be increased up to 3,250-3,750 euros.

“There will be a huge increase in fines. The minimum fine will be 3,250 euros. Will a person injecting drugs be able to pay such a sum at least once in his life?” asks Sergey Bessonov, Executive Director of the Harm Reduction Network Association. “An alternative to paying the fine is deprivation of liberty for up to five years, though the fine will not “disappear” completely and will only move to another category of 1,250-1,750 euros. Now Aybek does not know how to pay 375 euros, and starting from 2019 people will be released after years in prison with fines, which will be 3-5 times higher.”

Humanisation or criminalisation

Fines for the small amounts of drugs (up to 1 gram of heroin and up to 3 grams of hashish) will also be increased. The administrative fine will grow 30-fold: from 12-25 euros to 370-750 euros.

Sergey Bessonov: “We need alternative punitive measures and effective treatment programmes”

“The punishment for the small amounts of drugs will be toughened in the Code of Administrative Offences depending on the number of similar offences during a year. For the first offence, the fine will amount to 2,000 Kyrgyz Soms (23 euros); for the second offence, an administrative arrest for five days will be applied; for the third offence, the fine will amount to 650 euros. In the new Code of Offences, the punishment will not be toughened and there will be no criminal record. Probably this is what the humanisation is about,” assumes Sergey Bessonov. “However, if we look at the practice, most people are seized with the amount of heroin 1.2 -1.5 g which is considered to be a big amount and falls under provisions of the Criminal Code. After the fines are increased, there is a probability that the number of people seized with small amounts of drugs will be growing. The worst thing is that violation of the Code of Offences may also lead to the imprisonment in case if the fine is not paid on time. A person will have two months to pay 370 euros. After this term, the fine will be doubled and the payment period will be extended by one more month. After this month is over, if the fine is still not paid, article 351 of the Criminal Code will come into force meaning from 2.5 to 5 years of imprisonment.”

Currently, Sergey Bessonov and the lawyers of his organisation desperately fight not only for Aybek to stay free, but also to change the legislative amendments proposed. They are due to come into force in one year so there is still a chance to collect evidence that such amendments will lead to the criminalisation of people who use drugs.

“Introducing heavy fines may lead to the growth of corruption practices and increase in the number of prison population, which will have a negative impact on the national budget. Now we are making attempts to show the evidence of all the risks to people developing the new codes,” says Sergey Bessonov. “We need alternative punitive measures and effective treatment programmes. Members of the community were not able to take part in the development of the new codes, but we hope that our voices will be heard. We are doing our best at the national level and we also plan to tell about the recent developments in the drug policy to the international community at AIDS 2018 Conference.”

Bridging the Gaps Returned the Faith

Tahmina’s story is one of the positive stories of women in Tajikistan, who, due to the social and legal support of the project Bridging the Gaps: Health and Rights for Key Populations 2.0, again received hope and planned positive changes in their lives.

Family issues pushed to drugs

“When I studied in the 4th grade, my parents already had five children. This is the usual situation in Tajik families in the rural areas. Due to the frequent childbirth and burdensome care for five young children at the same time, my mother often fell ill. I had to drop out of school and take care of everything by myself,” Tahmina is saying.

Tahmina was taking care of all the things in the house, raised her brothers and sisters, helped them with school. Because of the health problems, her mother was constantly in hospitals. Her father spent days at work and came home late at night.

In one of such evenings, when the father was late at work and the mother was in the hospital, Tahmina’s uncle – her father’s brother – visited their house. Asking little Tahmina to come out of the house with him, the uncle raped her. Some time later, the neighbour found unconscious Tahmina and brought her to the hospital. Long investigations started, her mother and father were almost having nervous break-downs because the relatives of the girl started to hate her and blamed her for everything.

“Policemen always came to our house and asked me strange questions. I remember that when I came to the courtroom and saw my uncle there, I just fainted,” Tahmina is saying. “My uncle eventually was sent to prison and I became the cast-away for many of the relatives from my father’s side. Trying to save me from them, my parents sent me to the relatives from my mother’s side. I was always traveling to Dushanbe or to the other cities of the country.”

The girl started to meet different people, became friends with other girls in Qurghonteppa. During one of the meetings, the girls offered Tahmina to smoke cigarettes and then marihuana. They introduced Tahmina to Azam (the name is changed) who turned to be the big drug-dealer in Qurghonteppa.

“During a year and a half, he was keeping me locked in one of his apartments. Sometimes late at night, he would take me to the restaurants,” the woman recalls. “Taking all of this into consideration, he was still sending money to my parents. He taught me how to use drugs. This is how I became addicted to heroin. After some time, Azam’s interest to me faded away and I found myself on the street. Because at that moment my life totally depended on heroin, I started to steal and do sex work so that I could get a doze. As a result, I went to prison.”

The key visit to AFEW-Tajikistan

In 2013, Tahmina went to prison because of the theft. Being imprisoned for a quarter of her term, she got free because of the amnesty. When she went back home, the woman again faced the threats from her father’s relatives side. She had to leave her home and started to live on the streets again. After many unpleasant adventures, Tahmina met people who use drugs whom she knew before, and she started to use again.

Once, Tahmina met Bahriddin whom she knew before. He was also using drugs, but, to Tahmina’s surprise, he changed, and was looking good and happy. It turned out that Bahriddin started to work in the public organisation AFEW-Tajikistan as a peer consultant. He told Tahmina about how he succeeded to change, and he also mentioned the help and services that his organisation is providing. Tahmina got interested in that and decided to visit the drop-in center for the drug users and see everything by herself.

When she just came to AFEW-Tajikistan’s drop-in center, Tahmina was surprised that even though she had a dirty dress and flip-flops were barely covering her bloody feet, she was greeted very warmly. She was offered some tea and the workers talked with her about her health.

“I was very skinny and dirty, and I could not remember the last time I took shower or bath,” Tahmina is remembering that day now.

The social workers helped Tahmina with taking care of herself. They also helped her to come back to her parents’ house, arranged the documents for her and sent her to the doctors so that she could be checked and her health could be improved.

To see the sun again

Since summer 2017, Tahmina comes to the drop-in center very regularly. She is also taking part in self-help groups of people who use drugs. She learned the basics of her personal hygiene, HIV prevention and sexually transmitted infections (STI.) She got to know how to cope with the drug use and the possibilities to live sober. During one of the meetings, Tahmina got to know about opioid-substitution treatment (OST.) The friendly and warm atmosphere, respect and the possibility to get methadone for free inspired Tahmina to change her life.

Since August of the same year, Tahmina started to take part in OST programme that is located in the drug center where she would never go by herself. Nowadays, Tahmina is taking methadone and continues to take part in self-help groups. She found many friends who understand her and are ready to support her.

“With the support of AFEW-Tajikistan, during half of the year, I changed for better. I believed the peer consultants and social workers and started to help my mother, and I have not done so since I left home. AFEW helped me to gain the trust in myself again. My eyes are shining like it was before, I again see the sun and I want to live!” Tahmina is finishing her story with the smile on her face.

Only in 2017, 688 female drug users and vulnerable women in the Republic of Tajikistan were provided with the prevention and social services within the project Bridging the Gaps: Health and Rights for Key Populations 2.0 that is financed by the Ministry of the Foreign Affairs of the Netherlands.

Decriminalising Cannabis – a Step Forward to the Liberal Drug Policy: Opinions and Reflections of Discussions in Georgia

Author: Irma Kakhurashvili, Georgia

The former clergyman David (name changed – editor’s note) from Georgia, who was charged with cultivating cannabis, will have to pay 2,000 laris to the government based on the law and the plea agreement plus 500 laris for using marijuana.

David did not keep it secret from the police that he was growing and using cannabis for self-treatment and herbal therapy. According to the man, for two years it helped him to overcome pain and lose appetite, as Giorgi has diabetes, pancreatitis, cholecystitis, hepatitis C and hepatic cancer.

The former clergyman was “lucky” not to find himself behind the bars as on 30 November 2017 the Constitutional Court of Georgia resolved that the provision on criminal responsibility and imprisonment was a human rights violation, even in case of the repeated use of cannabis.

No legalization

The decision of the Constitutional Court only applies to people who use cannabis. Now cannabis possession for personal use within the set limits will not be prosecuted in line with the Criminal Code, but will rather be treated as an administrative offence.

The government will also expunge the convictions of those who were prosecuted for the use of cannabis in the past. The studies initiated by the Human Rights Education and Monitoring Centre in Georgia show that currently every third inmate is convicted for drug-related crimes. People using cannabis are also on this list.

In the joint survey conducted in 2015 by the National Centre for Disease Control and Public Health, 32% of men and 2.9% of women in Georgia reported having used marijuana. The issue of cannabis decriminalisation and legalisation was first raised five years ago, but then the initiator of this idea – civil movement “The 2nd of June” – failed to get support even from the community of people who use drugs because they demanded to decriminalise not all the drugs, but only cannabis.

Kote Rukhadze, activist of the Georgian Network of People Who Use Drugs, explains that advocating for cannabis separately from other drugs is not fair.

“Marijuana is also a psychoactive substance. Any person with physical or mental dependence needs help. Therefore, we will not support only those who smoke weed”, says Kote.

Despite the decision of the Constitutional Court, people advocating for reforming the Georgian drug policy are convinced that decriminalising cannabis is only a small part of positive changes in the repressive approaches of the state, though it gives hope for better results – decriminalisation of all drugs.

David Otiashvili, director of the Alternative Georgia NGO is sure that the decision of the Constitutional Court will help to change the attitude of the government to other drugs as well and will make the general approach more humane.

“The injecting drug use more often leads to dire consequences, which is clearly demonstrated by the number of overdoses and the spread of infectious diseases. Therefore, the reform should first of all focus not on the people who smoke but on improving the situation of people who inject drugs”, says David Otiashvili.

Pros and cons

The discussion of the draft law stipulating decriminalisation of all the types of drug use causes heated debates in the Georgian Parliament.

“I represent the generation of people whose friends started from smoking weed and then died of hard drugs. I am against decriminalisation, which will lead to the danger of uncontrolled distribution of drugs in the country and will paralyse the police”, says Giga Bukia, a member of the Georgian Dream parliamentary group.

The results of the research study published on the website of the Chief Prosecutor’s Office of Georgia demonstrated that for 79.2% of probationers the first substance they tried was marijuana and the second one was opium.

However, one of the leading substance abuse treatment specialists, Nika Kapanadze notes that in his practice he has never seen any patients physically dependent on marijuana.

“Marijuana does not cause an acute abstinence syndrome. When people use it systematically, they may develop psychological dependence, bronchitis, sometimes short-term troubles controlling movements or concentrating, but nothing more,” says the doctor.

When meeting the MPs, Kaki Zoidze, chairman of the parliamentary healthcare committee and one of the supporters of the draft law, always reminds them that the document does not stipulate legalising drugs, cannabis in particular.

“This draft law is about liberalisation, and liberalisation does not cover article 260 on drug dealing and distribution. It will remain a criminal offence,” he explains.

Parliamentary majority member Dmitri Khundadze thinks that this draft law is a danger to the society as in Georgia there is no rehabilitation for people who use drugs, and without this component even dreaming about decriminalisation is dangerous.

The President of Georgia Giorgi Margvelashvili does not support the drug policy which has “ruined the lives of many people.”

“I am for developing a more adequate drug policy,” said the President to the experts working on the draft law.

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The assessment document prepared by the parliamentary healthcare committee describes various scenarios of the expected outcomes which may come out of drug policy reform. According to the document, if the reform is not implemented, by 2027 the number of people who use drugs will grow by 12.06% as compared to 2017 and will amount to 55,614 persons, and the number of people who use drugs infected with HIV will increase by 154%.