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Official websites use. Share sensitive information only on official, secure websites. E-mail: maged. Background: Khat chewing, which has many adverse health and social consequences, is highly prevalent and socially accepted in the Jazan region of the Kingdom of Saudi Arabia. Methods: A qualitative study was conducted with 47 adult male former khat users regarding their khat initiation, continuance, and cessation, the amounts of khat they had used, and the health and social consequences of their use and cessation of use. Results: Participants noted a desire to show maturity, ease of availability of khat, and peer pressure as reasons for initiating khat chewing. Many noted long leisure times with little to do as a reason for continuing use. Negative consequences of khat use were seen in economic, health, familial, and sexual areas of their lives. After quitting khat use, participants saw improvements in all of these areas. Keywords: Abstinence, health consequences, khat chewing, qualitative study, social consequences. Khat Catha edulis Forsk has been chewed since ancient times in Ethiopia, and its use spread to the east African countries 1 and down to South Africa 2. It also has been used in Yemen South of the Arabian Peninsula since the 6th century 3. Khat chewing has been considered a Muslim habit, and some authors relate its use to Muslim ceremonies 4 — 6. However, recently, its use has spread to various European 7 — 10 , Asian 11 , and Australian 12 , 13 countries, as well as to the United States The use of khat in these countries usually begins in African immigrant communities and then spreads to other residents Khat chewing is a slowly growing problem in the world, with its use growing most rapidly in Africa Khat is considered a natural amphetamine for its amphetamine-like action 3 , 17 — The main active substance in khat leaves is cathinone, which is converted to the less active substance, cathine, after harvesting 20 — Khat is usually used at social gatherings 23 , 24 for its mild psychostimulant effects, such as increased alertness, enhanced mood, and reduced need for sleep 9 , 25 — 27 , and as a sexual stimulant 28 — However, chewing khat has many adverse health effects. It decreases the feeling of hunger and increases systematic sympathetic tone It also accounts for a number of gastrointestinal tract problems: esophagitis, gastritis, and a delay in intestinal absorption, as well as the development of oral keratotic white lesions at the site of chewing Moreover, it is associated with hypertension 25 , 32 — 36 , vasoconstriction of the coronaries, and myocardial infarction 25 , 32 , 34 , 37 — Early life onset use of Khat, excessive use, and self-medication use for war trauma may lead to the development of psychotic symptoms A study using rats found that khat stimulates locomotor and stereotypic behavioral activity and can induce seizures It also increases susceptibility to stroke and death 33 , Although mild doses of khat improve sexual motivation without much effect on performance, larger doses have been found to reduce motivation, performance, and sperm count in studies using rats 29 , 43 , One study found that Khat chewing may also impair driving ability 45 and another found that khat chewing increases the risk of road accidents Khat chewing is also common in Jazan. Jazan University studies have shown that the prevalence of khat chewing among males is Its use is also high among male university and high school students Map showing the Jazan area in the south of Saudi Arabia and its relation to Yemen Color figure available online. This qualitative study seeks to explore the reasons for khat initiation, continuance, and cessation, the level of khat formerly used, and the health and social consequences of its use and cessation of use among a sample of male former khat users in Jazan, Saudi Arabia. An in-depth qualitative study was carried out on 47 adult male khat quitters in the Jazan area of Saudi Arabia Figure 1. All of them had completely stopped Khat chewing at least 1 year prior to the interview. Quitters were recruited through an nongovernmental organization NGO working on khat prevention in Jazan through a local announcement, which asked quitters to volunteer for the study because it would help other chewers to quit. We used a semistructured interview questionnaire in this study with 11 open-ended questions. Those who volunteered to participate were asked not to mention their names or other identifying information during the interview or afterwards unless they chose to support the NGO and participate in its activities. A verbal informed consent was taken from each participant before the interview. The informed consent mentioned that the participant could refuse to answer any of the interview questions and that he could stop the interview at any time without mentioning a reason. Trained NGO social workers were responsible for conducting the interviews. The study and the informed consent procedures were cleared by the research ethics committee of the Scientific Research Center at Jazan University. None of the participants stopped the questioning, although some of them 17 refused to answer one or two questions at most. As none of the available software for qualitative analysis is available in Arabic, we preferred to do the analysis of the results manually. The investigators, with the help of social workers, grouped similar answers and answers with similar meanings. Additional review was done by a group of Saudi colleagues to be sure that grouping of response categories was acceptable according to the local language. Analysis of the results was done manually by El-Setouhy and reviewed by both investigators. Forty-seven male Saudi khat quitters agreed to participate in this study. All of them were living in the Jazan area. Approximately one third of them were teachers, and nearly all of them were governmental employees or retired governmental employees. One of the primary reasons for initiating khat chewing was a participant's feeling that it is a sign of maturity, imitating their fathers or respected relatives. Another main cause for initiation of khat chewing and smoking was peer pressure. It is normal. Participants mentioned that the availability of khat, the social acceptability, and its use for social gatherings in the Jazan area were additional factors leading to their initiation of khat chewing. However, nearly all of the participants considered these latter factors as being more associated with their continuing use of khat rather than their initiation of use. One mentioned that he was spending two thirds of his monthly salary on khat chewing; another two mentioned that they were spending all their salaries chewing khat and that they often borrowed money from their relatives. An older participant calculated how much he spent on khat during his life and reported that it totaled approximately 2 million Saudi Riyal. One participant also sold khat and another one said that his father was a pusher. Deciding to quit was often due to multiple reasons. Additionally, 3 of the quitters decided to quit before getting married and noted that the adverse sexual effects of Khat are prevalent. Although sexual and religious factors were the most pressing reasons for quitting, many additional reasons were provided. These factors included getting older and having other health problems, insomnia, and restlessness. None of these symptoms was a quitting factor by itself. Users who initiated khat chewing while in the army quit when the Huthy war ended. Four of the participants quit in response to a tragic accident that had happened to them or one of their children. The participant who was selling Khat quit after a beggar to whom he had given some money came to the participant's house to buy khat. Feeling lost was another infrequent reason to quit. They all experienced regrets regarding their neglect of their children. One third of quitters experienced no physical symptoms in response to quitting. Most of these symptoms lasted for 7—14 days average of 10 days. It is an addiction that no one can get rid of easily except with God's help. Khat quitters experienced many changes on the social level, most of them positive. They became closer to their children, wives, and parents. Many of them felt that their wives were the happiest about their quitting. That is what khat was doing to me. Participants felt that they had better health, had saved extra money, did not owe money anymore, had a better working life, and paid their debts. They realized after quitting that this belief was not true. The response of the community to the quitters varied. Their families were supportive and encouraging, whereas khat-using friends were mostly against participants quitting. Khat chewing is an endemic social and cultural habit in the Jazan region of Saudi Arabia. The semiopen border between the Kingdom of Saudi Arabia and Yemen in this area is a major factor for the khat trafficking from a low- to a high-income country. Our quitters 47 adult males were all Saudi living in the Jazan area. This drop in the age of initiation reveals the failure of prevention strategies. The Egyptian smoking prevention program faced a similar problem, as smoking is prohibited religiously but is still highly prevalent 53 , This explicitly shows that an intensive role should be played by religious leaders to actively prevent khat chewing. Although stigmatization of smoking is a controversial issue 55 — 57 , stigmatization of khat use would help to diminish khat social dependence and community acceptance. Our quitters explained that erroneous beliefs maintained their khat use in Jazan. Many diabetics still believe that khat chewing controls blood sugar, although many studies have proved no effect of khat chewing on blood sugar 58 — This belief comes from the fact that khat chewing reduces users' appetite 27 and the thinking that less food intake may reduce blood sugar levels in diabetics. Our diabetic quitters did not experience any disturbance in their blood sugar after quitting. Another erroneous belief about khat is its positive effect on one's sexual life. Although this belief is still controversial and needs to be further investigated 43 , 61 , 62 , our quitters experienced a better sexual life after quitting. These mistaken beliefs need to be discussed within the community to help khat users to quit and to hinder initiation. Peer pressure always plays a major role in drug abuse and smoking initiation 63 — Our results showed that negative peer pressure was a force in the initiation of khat use and hindered quitting. However, positive peer pressure would be protective in these areas 66 — Peer training programs can help in changing the role of peer pressure from negative to positive. Such programs have been successfully used in the prevention of human immunodeficiency virus HIV 70 , 71 , hepatitis C 72 , smoking 73 , and narcotic use 74 , Some Khat quitters responded positively to pressure from their children to quit. This can be explained by their feeling that they were not meeting their children's mental, physical, and economic needs, similar to alcohol drinkers Adding to this was the negative impact of khat use on the family finances, which mainly affected their children. Participants' poor work performance and absenteeism also led them to be hesitant or unable to look their children in their eyes and is evidence of the effectiveness of the positive pressure of having children. A few publications discuss medical treatments to help khat users quit 78 , However, none of our quitters sought medical advice when quitting. This is likely because khat has mild or no withdrawal symptoms, unlike opiates, whose use can lead to severe symptoms during withdrawal The support of their families was the most helpful factor for participants to maintain abstinence from khat. Training family members, especially mothers and children, through family therapy about ways to support their quitters would be very helpful We faced some difficulties in obtaining certain details from khat quitters. First, we were unable to get information about alcohol use and other drug use. Although all drugs, including khat, are prohibited by the Saudi law, the law is much looser in Jazan regarding khat than other drugs, especially alcohol, which is nominated in the Holy Quran. Therefore, we were unable to relate khat use or quitting to the use of other drugs. Furthermore, Jazan being a closed community makes it difficult to obtain information from husbands about their wives. We were unable to know if quitters' wives were khat chewers or not. The conservative community also made it difficult to obtain in-depth information regarding sexual side effects. This small size is due to the fact that eligibility was restricted to absolute quitters, i. We encountered many potential participants who had stopped chewing khat except for during social events. One of the 7 main objectives of this strategy is to develop new preventive tools Substantial leisure time is one of the main contributing factors to the high prevalence of khat chewing in Jazan. Living in a hot, humid climate, being governmental employees, working few morning hours, and have nothing to do after work are other contributors. All of these factors need to be addressed. Our results should be very helpful in developing an effective prevention program for khat use. Reviewing the causes behind quitters' initiation, continuation, and quitting of khat chewing clearly shows that khat is a deeply rooted community problem. Most khat chewers have substantial leisure time, which they use to gather with friends and chew khat. Therefore, concerted efforts should be directed to developing a comprehensive community development program CCDP in the Jazan region, with khat elimination as a major objective. This CCDP should include various community, religious, health, and society leaders, in addition to policy makers, in order to allow every community partner to bear some responsibility and to have an ownership in khat elimination. The CCDP should tackle the excessive leisure time of residents in efforts to make that time productive rather than destructive. The CCDP should also include peer training and family training programs for different age groups and both genders, with 3 main objectives: stigmatization of khat use, changing negative peer pressure to use khat into positive pressure not to use, and to assert a gentle, effective pressure on users to quit. Other programs should include a strategic plan for behavior change and reduction of risk-taking behavior, following behavior change models such as Prochaska and DiClemente's stages of change 83 — The CCDP should include training and upgrading of the knowledge and attitudes of religious leaders and health professionals to deliver the right messages in an effective manner. Health professionals and families should also know that khat quitting has no or mild symptoms and that the main need of quitters is social support. In conclusion, we believe that a comprehensive community development program in Jazan would be the only way to overcome the khat-chewing problem in this community. As a library, NLM provides access to scientific literature. Subst Abus. Why Would Khat Chewers Quit? Find articles by Rashad Alsanusy. Find articles by Maged El-Setouhy. Issue date Oct. Open in a new tab. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel.

The drug-use situation in the Czech Republic

Buying Heroin Olomouc

Author: M. ZUDA , P. BEM , R. This article reports on a rapid assessment conducted in the Czech Republic during the second half of The main aim of the assessment was to describe patterns of illicit drug use, particularly in the capital, Prague. A Rapid Assessment Board was established to oversee the study, and both secondary and original data were collected from a range of sources. Illicit drug use was found to have increased throughout the country in the preceding five years, with amphetamines being the most popular substance. Polydrug use is common. There has been an increase in the use of the so-called 'dance drugs', especially lysergic acid diethylamide LSD , among younger people, and heroin, especially in the main urban areas. Injecting is on the increase, too. There is an urgent need to expand both fixed-site and community-based services. Not only has the Czech Republic long been ranked among countries with a high alcohol consumption, but the use there of illegal drugs and the abuse of medicines are also not new phenomena: illegal drugs were relatively widespread even in the s and s. However, one result of the extensive social liberalization that occurred after has been a marked increase in both the supply of and demand for these substances. The type of substances abused has also changed, and some new drugs have appeared that were previously relatively rare in the country. The opening up of the borders and the significant undermining of police authority that accompanied the change of regime transformed the Czech Republic overnight into a corridor through which drugs could be transported to the West without any effective controls and with minimal risk. This increase in drug shipments through the Czech Republic comes at the same time as the country has become a destination for contraband drugs such as heroin and cocaine'. The last five years have seen, alongside the growth in imported drugs, a dramatic increase in the domestic production of illegal drugs and their precursors: in particular, the cultivation of cannabis has been joined by the manufacture of amphetamines 'pervitin'. Operations mounted by both the police and the customs authorities in recent years show that drugs are also exported from the Czech Republic. The greater freedom enjoyed by society after has brought with it a decline in the authority of State institutions and a rise in non-conformity, particularly among young people, who are almost openly using soft drugs such as marijuana, hashish and LSD. This situation has been accompanied by ambivalence at the political level and confusing and conflicting messages from the media. The project described here aimed at giving an objective overview of drug-related issues in the Czech Republic. UNDCP funded a rapid assessment, carried out during the second half of , to investigate illicit drug use in the Czech Republic, particularly in Prague. A Rapid Assessment Board was set up to oversee the project. The Board was made up of experts in the treatment and prevention of drug use and in law enforcement. The Board met every two months to monitor the progress of the research and to facilitate the collection of primary and secondary data. A number of relevant studies were made available to the research team during the course of the study \[ \]. The rapid assessment was conducted under the auspices of the National Drug Commission. A wide range of agencies and institutions was involved in training and in the gathering of data, both from the field and from secondary sources. Secondary sources of information were the Public Health Service of the Ministry of Health, the police presidium and academic institutions. A project of this type would not have been possible without the cooperation of people from awide spectrum of professions who are in daily contact with drug users, one of the most at-risk sectors of the population. The main aim of the project was to make a rapid assessment of illicit drug use in the Czech Republic. In line with the rapid assessment methodology developed by UNDCP, a strategy was adopted whereby existing data would be collated and original material gathered to fill the gaps. Another aim of the project wag to familiarize researchers with techniques for collecting data on drug use, especially use by those not in contact with treatment services. Training street-based interviewers, about 30 in all initially in Prague, but later also in Ostrava, Brno, Olomouc, Usti ;. Interviewing key persons and experts in cities and regions throughout the Czech Republic to elicit information on regional differences;. In this section an overview is presented of the main findings of the rapid assessment A comprehensive account can be found in the report to UNDCP \[ 1 \]. Drug trafficking and drug tourism had become more common since the political changes of At the time of the study, although it was illegal to supply certain drugs, possession for personal use was permitted. The Government had taken a number of actions. The National Drug Commission was working on a drug policy for Anti-drug coordinators had been appointed in 81 districts throughout the Czech Republic, and since the beginning of , a national coordinator of drug epidemiology had been responsible for a nation-wide drug information system. It was found that primary and secondary drug prevention efforts had increased although there had in any case been a long tradition of secondary prevention in the Czech Republic , with much attention being given to secondary school pupils. In , an intensive media campaign had warned the public against the potential dangers of drug use. Moreover, changes in health insurance since the early s had led to the privatization of many drug treatment clinics, with an accompanying increase in non- governmental organization activity and low-threshold drop-in centres. Drop-in centres had pioneered needle and syringe exchange programmes, mainly in Prague but also in Brno, Olomouc, Usti and Labem. Some drop-in centres had also launched outreach services. Workers at the drop-in centres were well informed about the local drug scene. There were, however, no methadone programmes in the Czech Republic, although negotiations were under way to introduce pilot schemes. Original data collected specifically for the rapid assessment were supplemented by data from a number of secondary sources to assess the nature and extent of drug use. All measures showed a considerable increase in drug use in the five preceding years. Polydrug use was common, with marijuana, 'pervitin', heroin, LSD and 'ecstasy' being the most popular. More dm 20 per cent of boys in secondary school and 15 per cent of girls have used drugs, with higher rates in Prague and large cities. Research suggests that it is a matter of status among young people to have experienced drug use, but not for such use to have gone out of control. It was found that more than one third of long-term amphetamine or heroin users had not completed their secondary education and that the number of heroin users was increasing rapidly. Heroin use was concentrated in Prague and in northern and western Bohemia, while amphetamines were used throughout the country and solvents were common, mainly outside of Prague. One study of drug users seeking help showed that for 36 per cent of clients the primary drug was 'pervitin', for 21 per cent, it was opioids and for 10 per cent solvents. Twice as many men as women had sought help, and 40 per cent were 19 years or younger. This portion of the rapid assessment focused on drug users who had not sought help. A sample of regular drug users was recruited in Prague, Brno and Olomouc and in northern Bohemia and northern Moravia. The average age of the sample was 21 years median: 21 for men; 17 for women ; 43 per cent were unemployed, 21 per cent employed and 32 per cent students. Forty per cent had a permanent sex partner, with women more likely than men to be in a relationship with another drug user and to have begun to use drugs after developing such a relationship. Fifty per cent cited amphetamines as their drug of choice, with 41 per cent citing it as a secondary drug. Other secondary drugs were heroin 41 per cent , LSD 38 per cent , alcohol 36 per cent and hypnotics 20 per cent. The overall drug scene had changed: whereas once they had been home-based, drug dealing and consumption were now taking place at a range of public and semi- public venues, although there are regional differences, with public drug use most pronounced in Prague. It was learned that amphetamine users tended to use their drugs in the 'drug flat' where they had been produced. There were a number of findings on drug dealing. Networks of drug dealers had begun to overlap, and former small-scale amphetamine producers were becoming involved with organized criminal syndicates. Users said their most frequent source of drugs was a friend, and most of them relied on the drug dealer to ensure quality. Some drug users were also small-scale drug dealers. Drug use and drug injecting most often took place in the company of others, it was reported. Only 40 per cent of injectors always injected themselves, and they had often been initiated into injecting by another person. The majority of drug injectors had shared injecting equipment at some time, with only 35 per cent claiming never to have done so. The youngest injectors were most likely to share injecting equipment. Overall, 17 per cent of the sample said they would accept a used syringe from anyone and 20 per cent said they would accept one from a good friend. Intoxication was the main reason given for sharing needles and syringes, and women were most likely to share needles and syringes with a sex partner. However, when project results were compared with the results of an earlier study, it was seen that more injectors 25 per cent vs 10 per cent earlier always used new injecting equipment. Only 5 per cent used boiling water to sterilize injecting equipment, 4 per cent used disinfectant, 42 per cent rinsed in water and 24 per cent did nothing. Needles and syringes were obtained from pharmacies and exchange programmes and most often as a gift from friends, but they were also scavenged from hospital dumps and other high-risk sources. Places where there were syringe exchange schemes reported a lower frequency of needle and syringe sharing. It was found that 50 per cent of injectors had been tested for HIV compared with 18 per cent of non-injectors. There were low levels of HIV positive results, but high levels of sexual activity among injectors. Only 14 per cent reported regular condom use with casual partners, and 21 per cent reported selling sex for money or drugs. Focus groups were conducted in Prague and Brno to complement the survey data and data from secondary sources. More layers in the drug distribution network had led to a greater adulteration of the product and poorer quality, as well as substitution by producers, e. Drug supply varied, especially the supply of amphetamines, which were mostly available on weekends;. Drop-in centres were the preferred places at which to seek help, but there were fears about loss of anonymity;. New ways of marketing drugs had changed the nature of the drug scene, which had become less cooperative;. Some Brno drug users travelled occasionally to Prague for heroin and for amphetamines when they were in short supply;. Certain minority gangs often attacked dealers and robbed them of drugs and money. Child members of this minority were frequent users of solvents. While there is indeed regional variation in drug use, drug problems exist throughout the Czech Republic, and many drug users have no contact with established services. The main concentrations of problem drug use are Prague, northern Bohemia and northern Moravia. Drug users often travel to Prague to get medical care or to use drop-in centres, but they also buy drugs to take back to their hometowns. Moreover, Prague offers migrants work opportunities and acceptance among drug user groups. Amphetamines are the most popular drug in Moravia, in the eastern part of the country. In northern Moravia, Ostrava and Havirov are the main centres of drug use, and them are large numbers of solvent sniffers. Amphetmines and heroin are injected in northern Moravia, but no needle and syringe exchange schemes exist. The drug scene in central Moravia is more hidden than in places such as Prague. In the northwestern part of the country, heroin is more common, with northern Bohemia the central distribution point and considered to be a region at great risk. Increased needle-sharing is reported there, with few opportunities to obtain sterile injecting equipment. In western Bohemia Plzen Karlovy Vary there is an established network of drug use and distribution, especially amphetamines. Many people experiment with drugs but do not go on to develop drug use problems. Others fail to seek help until a range of psychological and social problems occur, including problems with parents, health, school, friends, work and sex partners. Heroin users particularly mentioned financial problems, and injectors reported more problems than non-injectors. Many drug users did not have sufficient documentation to permit gainful employment. Two thirds of drug users expressed a desire for some kind of help; only 10 per cent focused on abstention. Needle and syringe exchange programmes have encouraged contact with drug services. Drop-in centres are valuable low-threshold contact points because many drug users first seek help from them. Peer education, an approach in which drug users provide information to each other, could be an appropriate way to publicize services. The initiative generated by the rapid assessment should be sustained. The members of the Rapid Assessment Board should continue to meet, albeit under a new name, and to act as focal point for the collation of information on drug use. They should strive to incorporate all organizations interested in and involved in collecting data on drug use in the Czech Republic. Such a group would ensure the ongoing monitoring of the drug use situation using both quantitative and qualitative means. The 81 anti-drug coordinators should continue to collect data. Not only would such data form the basis of a database covering the country as a whole, it could also be used to develop services tailored to local needs and local drug profiles. All indicators point to a major risk of drug problems amongst the young, and both primary and secondary drug prevention interventions should be focused on this sector of society. Peer education programmes should be initiated to provide clear and non- sensational information to young people on the dangers of drug use. Drug services are inadequate in many parts of the Czech Republic, and serious attention needs to be paid to providing a broad network of treatment options throughout the country, including low-threshold services, such as drop-in centres and easy-access needle and syringe exchange programmes. These low-threshold services should be able to refer clients to detoxification and rehabilitation centres, as experience shows that those not already in contact with services are likely to approach a drop-in centre or a needle exchange programme as the first step in seeking help. Outreach services, too, need to be fully developed in the Czech Republic to allow making contact with the hidden population of drug users, especially in those areas outside the main cities where only limited services are being provided. Outreach services can also promote risk reduction to existing drug users and provide needles and syringes to injectors. Workers in drop-in centres and outreach programmes develop an excellent first- hand knowledge of the local drug scene. The outreach approach that was initiated during the rapid assessment should be nurtured and encouraged, allowing such knowledge to be collected routinely and passed on to the Rapid Assessment Board. Where the level of heroin use is high, consideration should be given to pilot methadone programmes. These should operate in line with international research, which suggests that doses lower than 50 mg are ineffectual in retaining patients and, amongst injectors, in reducing injecting behaviour. Treatment programmes also need to focus on counselling and primary health care for other target groups, particularly amphetamine and solvent users. The research confirmed that high-risk injecting practices led to HIV and other infectious diseases, notably hepatitis C. Outreach workers and peer counsellors should be used to identify high-risk activities. Interventions should then focus on reducing the risk, not only by providing sterile needles, syringes and other drug-injecting paraphernalia such as filters and water, but also by changing behaviour. This win mean working towards a situation whereby it is no longer acceptable in drug-using circles for needle and syringes to be shared. Former drug users and other respected figures in the drug user communities can be used to promote healthier lifestyles. Rates of HIV infection among drug users are currently low. To keep them low, vigorous risk reduction strategies notably easy access to sterile injecting equipment should be put in place immediately throughout the Czech Republic. To protect public health in general, measures should be taken to ensure the adequate disposal of used injecting equipment. This should include easy-access disposal bins, along with smaller disposal containers provided to individual drug injectors. Small-scale drug dealers might be used to assist in this matter. Attention should also focus on the sexual activity of drug users, and the use of condoms in heterosexual and homosexual sexual intercourse should be encouraged. Special services need to be developed for ethnic minorities and other groups who have their own cultural and linguistic needs. Also, the particular needs of female drug users and women in sexual relations with male drug users should be given priority. To provide an array of services to deal with the wide range of problems that drug users bring to helping agencies, multi-disciplinary teams are needed that include medical staff, psychologists and social workers. People working in the drugs field need comprehensive training to ensure a consistent approach and to bring them up to date on treatment ideas and the philosophy and practice of harm minimization. The police will need similar training. The fact that personal possession has been decriminalized means that drug users can be contacted by outreach workers at known congregation sites without fearing arrest. However expedient this may be, measures may nonetheless be needed to reduce the level of street-dealing. The rapid assessment has made clear the need to develop drug services in the Czech Republic. These services should be widely diffused geographically, they should be broad-based, they should be tailored to the needs of the target groups, and they should offer a mix of primary and secondary prevention, as well as harm minimization. Ministry of Health, Public Health Service, 'Epidemio-sociological study concerning drug use among secondary school students in the Czech Republic', unpublished manuscript. Ministry of Health, Public Health Service, 'Incidence of problem drug users 1st - 3rd quarter ', Ministry of Health, Public Health Service, 'Research on drug users carried out in the field specifically for the Rapid Assessment', annual report, United Nations. Office on Drugs and Crime. Site Search. Topics Crime prevention and criminal justice. Introduction Not only has the Czech Republic long been ranked among countries with a high alcohol consumption, but the use there of illegal drugs and the abuse of medicines are also not new phenomena: illegal drugs were relatively widespread even in the s and s. Background UNDCP funded a rapid assessment, carried out during the second half of , to investigate illicit drug use in the Czech Republic, particularly in Prague. Research strategy The main aim of the project was to make a rapid assessment of illicit drug use in the Czech Republic. Findings In this section an overview is presented of the main findings of the rapid assessment A comprehensive account can be found in the report to UNDCP \[ 1 \]. The situation in late Drug trafficking and drug tourism had become more common since the political changes of Drug prevention It was found that primary and secondary drug prevention efforts had increased although there had in any case been a long tradition of secondary prevention in the Czech Republic , with much attention being given to secondary school pupils. The extent of drug use: secondary sources Original data collected specifically for the rapid assessment were supplemented by data from a number of secondary sources to assess the nature and extent of drug use. The extent of drug use: the street-based survey This portion of the rapid assessment focused on drug users who had not sought help. Qualitative analysis of focus groups Focus groups were conducted in Prague and Brno to complement the survey data and data from secondary sources. Prague The salient information gathered in Prague may be summarized as follows: Young people year-olds were perceived to be at greatest risk of drug use and injecting; Drugs were widely available to experimenters; Shortages of drugs led to switching, typically from amphetamines to heroin; More layers in the drug distribution network had led to a greater adulteration of the product and poorer quality, as well as substitution by producers, e. Brno At Brno, some of the findings were the same as in Prague, others not: Teenagers were perceived to be at greatest risk of drug use and injecting; New ways of marketing drugs had changed the nature of the drug scene, which had become less cooperative; Amphetamines and toluene were the most common drugs; LSD was available in clubs, but neither heroin nor cocaine was widely available or used; Ephedrine, the raw material for amphetamine production, was smuggled from Poland or Hungary; There was a general mistrust of helping agencies, but drop-in centres were seen as attractive; Some Brno drug users travelled occasionally to Prague for heroin and for amphetamines when they were in short supply; Certain minority gangs often attacked dealers and robbed them of drugs and money. Features of drug use in individual regions While there is indeed regional variation in drug use, drug problems exist throughout the Czech Republic, and many drug users have no contact with established services. Drug users' problems and their expectations of help Many people experiment with drugs but do not go on to develop drug use problems. Conclusions and recommendations Research The initiative generated by the rapid assessment should be sustained. Service development All indicators point to a major risk of drug problems amongst the young, and both primary and secondary drug prevention interventions should be focused on this sector of society. Drug injecting and infectious disease The research confirmed that high-risk injecting practices led to HIV and other infectious diseases, notably hepatitis C. Targeted interventions Special services need to be developed for ethnic minorities and other groups who have their own cultural and linguistic needs. Service development and education To provide an array of services to deal with the wide range of problems that drug users bring to helping agencies, multi-disciplinary teams are needed that include medical staff, psychologists and social workers. References 01 M. United Nations Office on Drugs and Crime.

Buying Heroin Olomouc