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Understanding changing patterns of drug use in Georgia:
Implications for service delivery and policy development
DDavid Otiashvili, M.D.
Irma Kirtadze, M.D.Addiction Research Center, Alternative Georgia
Global Addiction Conference
Piza, Italy
May 7, 2013
Brief information on Georgia
Indicator Info for 2011
Surface area 69.700 sq km
Population 4.497.6 m
GDP per capita in PPS
2549.09 euro
Unemployment rate 15.1%
Prison Population Rate (per 100.000)
524
Drug use
• General population
No data
• Problem drug use40,000 (95% CI: 39,000-41,000)
prevalence 1.5% among 15-64 years old
• Drugs injectedshift from traditional opium, heroine and
buprenorphine to home-made ATS (“vint”, “jef”) and opioids (desomorphine, “krokodile”)
Drugs injected
Abuse of over the counter medications
• 2003 – explosive abuse of poppy seeds
• 2005-2008 – injection use of Coaxil (Tianeptin)
• 2010-2011 – widespread oral consumption of anticonvulsant Lyrica (Pregabalin)
Common features of Georgian drug scene
• Drugs use intravenously (no sniffing, smoking or inhaling)
• Daily dose is low
• Opioids combined with sedatives
• Unstructured poli-drug use is common
Drug use trends shaped by socio-economic and policy context
• Buprenorphine abuse
• Home-made stimulants
• Home-made opioids
• Poppy seeds, Coaxil, Lyrica
New drugs – new harms
• Injection risk behavior
• Toxicity
• Overdose
New cases of HIV infection, 1990-2011
Treatment response
Treatment response
• No comprehensive treatment approach
– Treatment planning
– Case management
– Continuum of care
• No gender-focused services
12
Drug legislation
• Drug use (trace of controlled substance in urine) is punishable under the Administrative Code
• Repeated drug use is punishable under the Criminal Code (up to 1 year imprisonment)
• Possession of ANY amount of drugs, regardless of purpose, is punishable under the Criminal Code
• Tables of quantities of drugs (any amount of amphetamine – 7 to 14 years)
Prison population
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 20110
5000
10000
15000
20000
25000
30000
Disproportionate resource allocation
• Coverage of treatment – 6%
• 6,500 adults received health service vs 27,000 episodes of drug testing and police investigation
Major policy reform needed
• 2013 – Drug Policy Coordination Council• National Drug Strategy• Action Plan• Legislative proposal
HEALTH CARE PROFESSIONALS’ ENGAGEMENT CRITICAL!
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