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!

Thank you

dato@altgeorgia.gedatohupo@yahoo.com

www.altgeorgia.ge