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These datasets underpin the analysis presented in the agency's work. Most data may be viewed interactively on screen and downloaded in Excel format. All countries. Topics A-Z. The content in this section is aimed at anyone involved in planning, implementing or making decisions about health and social responses. Best practice. We have developed a systemic approach that brings together the human networks, processes and scientific tools necessary for collecting, analysing and reporting on the many aspects of the European drugs phenomenon. Explore our wide range of publications, videos and infographics on the drugs problem and how Europe is responding to it. All publications. More events. More news. We are your source of drug-related expertise in Europe. We prepare and share independent, scientifically validated knowledge, alerts and recommendations. About the EUDA. Similarly, the content of this particular summary does not necessarily reflect the official opinion of the Republic of Georgia and should be seen as the product of the particular programme of technical assistance. Authors: J. Javakhishvili, L. Sturua, I. Kirtadze, N. Balanchivadze, D. Otiashvili; edited by T. This country overview and auxiliary papers were created within the framework of the project Introducing Addictology in Educational System in Georgia and its component NDO. Last update: May It is defined as the value of all goods and services produced less the value of any goods or services used in their creation. Unemployed persons comprise persons aged 15 to 74 who were: without work during the reference week; currently available for work; actively seeking work. Prison population rate per inhabitants. Georgia is located in the South Caucasus, a traditional trafficking corridor from Asia to Europe. The country consists of 11 regions; Tbilisi is the capital city with a population of 1 Other major towns are: Kutaisi , Rustavi , Batumi , Zugdidi , Chiatura 70 , Gori 70 , and Poti 50 The official language is Georgian, and in the territory of Abkhazia it is Georgian and Abkhazian. The main religion is Georgian Orthodox Georgia was annexed by Russia in the nineteenth century and then again by Soviet Russia in , becoming the Georgian Soviet Socialist Republic and part of the Soviet Union. Following the break-up of the Soviet Union Georgia regained its sovereignty on 14 November ; by a popular vote it became a presidential republic. Since then the country has gone through several economic, political and social crises, and two internal political conflicts with the Russian Federation that eventually led to the Georgian—Russian war in August The war resulted in de facto Russian occupation of two important border regions of Georgia — Abkhazia and South Ossetia — and internally displaced persons left those two regions. The relaxation of political, social and trade control since the fall of the Soviet Union and the existence of territories and borders not controlled by the legitimate government was accompanied by an increased and more visible use of illicit psychotropic substances and their greater availability. No data is available on drug use among the general population; no general population survey has ever been conducted due to lack of funding, nor is one planned by the national authorities for the foreseeable future. A sample of students aged 15 to 16 and representative of the capital city were interviewed in spring The study found that marijuana was the most frequently reported drug: 3. Ecstasy was the second most frequently used illicit drug, with a lifetime use reported by 7. Lifetime use of crack cocaine was reported by fewer respondents 1. Lifetime prevalence of powder cocaine use was reported by 0. At least one experience with drug injecting was reported by 0. Primary prevention of drug use by both the Georgian government and international donors has received limited attention so far. From the late s on there has been sporadic activity, insufficient funding, limited projects and beneficiaries, and a lack of quality control mechanisms for prevention activities. Currently, drug prevention activities are either substituted by general programmes promoting a healthy lifestyle or they are, to some extent, integrated into HIV-prevention activities. The extent of problem drug use in Georgia was traditionally calculated using estimates with unclear definitions and unknown authors that were widely used by media and decision makers. Until the mids, raw acetylated opium was prevalent in the black market. Heroin became the drug of choice for Georgian problem drug users PDUs from the late s until approximately — Since —09 home-made stimulants prepared from cough medicines containing pseudo-ephedrine or phenylpropanolamine which are easily available from pharmacies without a prescription have been among the most widespread injected drugs Otiashvili et al. There is no consensus among the experts regarding what is the final injectable product in this case, although desomorphine is definitely present in the final preparation personal communication with Tsulaia Ekaterine. Reliable and valid national data on the overall number of patients treated for drug use disorders do not exist in Georgia, as the standards according to which existing clinics are collecting and processing the data on the treated patients differ significantly and are not coordinated. In , there were patients males, 7 females enrolled in the opiate substitution treatment OST programmes funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria, while 1 individuals of whom 17 were female were in a methadone maintenance programme run by the state-funded OST services. For more details see the section on treatment response. Most were 29 to 40 years of age at the time of testing. In 2 cases the infection has progressed to the AIDS stage, and of these people have died. As of May , the cumulative shares of these two routes in all known HIV cases were In , some In the early s the registration of drug-related deaths was interrupted and there were no data available pertaining to drug-related deaths or mortality until In , a special drug-related mortality study based on matching the national narcologic register with the general population mortality register was launched by the Georgian Research Institute on Addiction currently The Centre for Mental Health and Prevention of Addiction within the SCAD Programme. As a result of this study, the lower limit for the number of males aged 18 to 64 that were registered with the narcologic register and died in was determined, which was 6 per 1 people of the same age group. This rate was double the mortality rate among the general population of males of a similar age group in Todadze, Since , The Levan Samkharauli Forensic Expertise Bureau re-started registration of drug-related death cases, though the number of the registered cases is very low from 39 cases in to 15 cases in and according to anecdotal evidence from the harm reduction services it does not reflect the reality in Georgia. Currently there are four clinics providing residential drug dependence treatment in Georgia, three of which are based in Tbilisi and one in Batumi. Before , a limited number of residential treatment cases were sporadically financed from the State budget, but from —09 the State did not fund any drug treatment case. In , the Ministry of Health resumed funding programmes for a limited number of treatment cases. In , the State programme funded the treatment of 80 patients out of a total of patients treated by the four clinics that are providing addiction treatment in Georgia. There are no mechanisms in place for the long-term follow-up of patients, and no national treatment guidelines or protocols exist; therefore, treatment effectiveness is not properly monitored and evaluated. In psycho-social rehabilitation services were introduced to strengthen the sustainability of the abstinence oriented treatment, though the number of patients involved both in AOT and psycho-social rehabilitation has declined every year since Opioid substitution treatment was initiated in Georgia in , with methadone as the only legal medication. Contrary to abstinence oriented treatment, demand for opioid substitution treatment OST and opioid-assisted detoxification is on the rise — there has been a steady increase in the number of patients, expanding geographical coverage and diversified treatment modalities included in the OST programmes. Additionally, the State co-funded 11 OST sites operating in different regions of Georgia, covering the costs of substitution medication, while patients paid approximately EUR 70 per month for services. In , some 1 people received services in the frame of the State-funded OST programme with methadone of which 17 were females. In , some prisoners were detoxified using methadone in a treatment site at Prison no. One of the significant outcomes of these efforts is the emergence and rapid growth of the HR-focused non-governmental organisations NGOs. In , seven organisations working in the field of harm reduction formed the Georgian Harm Reduction Network GHRN , which brought together 20 organisations in By the end of there were 10 HR sites of a combined type clients could receive both sterile equipment for injection and VCT in the same site run by members of GHRN in different towns of Georgia. In there were The GHPP commenced in and provides: risk reduction counselling to people who inject drugs; counselling and testing on HIV; testing for HCV and HBV; and peer-to-peer education and outreach services by employing the model of community level interventions. Many drug users have switch to new home-made substances that are in general more toxic and harmful. In comparison, a single dose of home-made preparations of amphetamine-type stimulants or opioids costs EUR 3—5. The amount of heroin seized by the Ministry of Internal Affairs of Georgia varied from However, the amounts of illegal drugs seized in Georgia have been constantly smaller compared to those seized in neighbouring countries. According to data from the Supreme Court of Georgia, 3 people were convicted of drug-related offences in Article 33 of the Penal Code of Georgia. Some1 of these were convicted for the illegal consumption of drugs. Thus, although the rate of imprisonment for drug consumption related offences has been gradually decreasing in the last three years, the number of people fined or subjected to conditional sentencing for these offences remains high relative to the population and the estimated number of drug users. Drug use per se constitutes an offence under Georgian legislation. It is punishable with both administrative and criminal sanctions. Court decisions on drug use offences are mostly based on rapid stripe test results positive urine test for either illicit drugs themselves or the inactive metabolites of drugs conducted by the forensic laboratory of the Ministry of Internal Affairs MoIA. However, such testing has become widespread. Out of 27 people tested for drugs and metabolites in , less than a third 8 gave a positive result using the rapid stripe tests. Possession of any amount of drugs is a criminal offence under the Penal Code of Georgia Article , with no differentiation between the possession of drugs for personal use or for trafficking. For the majority of substances that are widespread in Georgia there is no legal definition of what constitutes a small quantity, and therefore any amount found in the illegal possession of a person is deemed a large amount, leading to severe punishment. In , the Parliament of Georgia adopted a document setting out the main directions of the National Drug Strategy. The national priorities were defined as follows: treatment and rehabilitation; prevention; harm reduction; staff capacity building; informing the public; establishing a drug information system; coordination. The elaboration of the action plans according to the approved priorities and main aims was delegated to the relevant ministries, but no action was taken. Hence, the country was left with no formal or comprehensive drug strategy until In the Ministry of Justice of Georgia took the lead and started to facilitate strategy elaboration. The process is still ongoing. On 22 November the President of Georgia issued special decree no. The newly established Interagency Coordinating Council started work in , facilitated by the Ministry of Justice of Georgia. The Council unites representatives from the different supply and demand reduction governmental agencies, non-governmental legal entities and international organisations, experts and scientists working in relevant areas. The main objectives of the Council are: i the elaboration of drug abuse prevention policy based on human rights protection principles; ii the development, periodical revision and monitoring of the implementation of a national anti-drug strategy and corresponding action plans; iii the development of proposals and recommendations for elaborating the national anti-drug strategy; iv the coordination of interagency activities in the process of implementation of the national anti-drug strategy for the purpose of promoting implementation of corresponding measures. Baramidze, L. Chokoshvili Otar, A. Kirtadze, I. National Statistics Office of Georgia n. Available at www. Otiashvili, D. Sikharulidze, E. Sirbiladze, T. Todadze, Kh. Homepage Quick links Quick links. GO Results hosted on duckduckgo. Main navigation Data Open related submenu Data. Latest data Prevalence of drug use Drug-induced deaths Infectious diseases Problem drug use Treatment demand Seizures of drugs Price, purity and potency. Drug use and prison Drug law offences Health and social responses Drug checking Hospital emergencies data Syringe residues data Wastewater analysis Data catalogue. Selected topics Alternatives to coercive sanctions Cannabis Cannabis policy Cocaine Darknet markets Drug checking Drug consumption facilities Drug markets Drug-related deaths Drug-related infectious diseases. Recently published Findings from a scoping literature…. Penalties at a glance. Frequently asked questions FAQ : drug…. FAQ: therapeutic use of psychedelic…. Viral hepatitis elimination barometer…. EU Drug Market: New psychoactive…. EU Drug Market: Drivers and facilitators. Statistical Bulletin home. Quick links Search news Subscribe newsletter for recent news Subscribe to news releases. Breadcrumb Home Publications Overview of the national drug situation in Georgia Overview of the national drug situation in Georgia Last update: May Contents Drug use among the general population and young people Prevention Problem drug use Treatment demand Drug-related infectious diseases Drug-related deaths Treatment responses Harm reduction responses Drug markets and drug-law offences National drug laws National drug strategy Coordination mechanism in the field of drugs References. National Bank of Georgia, , Annual report. Council of Europe.

Policing, massive street drug testing and poly-substance use chaos in Georgia – a policy case study

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Official websites use. Share sensitive information only on official, secure websites. Since early , intensive policing, wide scale street drug testing, and actions aimed at limiting the availability of specific drugs have been implemented in Georgia. Supporters of this approach argue that fear of drug testing and resulting punishment compels drug users to stop using and prevents youth from initiating drug use. It has been also stated that reduction in the availability of specific drugs should be seen as an indication of the overall success of counter-drug efforts. The aim of the current review is to describe the drug-related law enforcement response in Georgia and its impact on illicit drug consumption and drug-related harm. We reviewed relevant literature that included peer-reviewed scientific articles, stand-alone research reports, annual drug situation reports, technical reports and program data. This was also supplemented by the review of relevant legislation and judicial practices for the twelve year period between and Chaotic poly-substance use and extensive utilization of home-made injection drugs, prepared from toxic precursors, became common. Massive random street drug testing had little or no effect on the prevalence of problem drug use. Intensive harassment of drug users and exclusive focus on reducing the availability of specific drugs did not result in reduction of the prevalence of injecting drug use. In most cases, these shifts were associated with the introduction and use of new toxic preparations and subsequent harm to the physical and mental health of drug consumers. Keywords: policing, drug testing, drug market, home-made drugs, poly-substance use, policy analysis. The need for an evidence-based and balanced approach to illicit drug consumption has been repeatedly acknowledged in scientific literature and, increasingly, in political advocacy \[ 1 , 2 \]. With a growing number of jurisdictions willing to experiment with drug control approaches, the national and international debates on rational and effective policy models have been gaining momentum. An integral part of these debates has been focusing on the impact of different enforcement measures on illicit drug markets and patterns of drug use. While in the developed world there has been a fair amount of literature accumulated on the issue \[ 3 — 6 \], research investigating this topic in low and low-middle income countries has been scarce. Current analysis aims to fill this gap through critical review of supply reduction interventions and associated changes in patterns of illicit drug use in the former Soviet Republic - Georgia. Home of 3. Following the fall of Soviet regime in , Georgia went through a turbulent period of economic transformation and civil unrest. A perceived rapid increase in illicit substance use, in particular injection drug use has been attributed to the relaxation of social fetters and border control, severe economic crisis and reassessment of values \[ 7 , 8 \]. Neither the Georgian system of post-Soviet narcology addiction medicine nor the government were prepared to meet the challenges posed by escalation of drug use and associated problems \[ 9 \]. Despite some moves towards the introduction of evidence-based health interventions introducing methadone treatment in priority was given to repressive measures and supply control \[ 10 \]. Annually, tens of thousands of people were detained in the streets and subjected to drug testing \[ 12 \]. Positive tests resulted in an administrative fine double of average monthly salary , if documented for the first time, or in criminal sanctions, including one-year imprisonment, if documented for the second and subsequent times during 12 months. In addition, popular campaigns demonising specific drugs, which were the most popular at the time, and law enforcement interventions targeting illicit supply of those drugs have been common. Supporters of this approach argued that fear of drug testing and following punishment compelled drug users to stop using, and prevented youth from initiating drug use. It was also stated that reduction in availability of specific drugs should be seen as an indication of the overall success of law enforcement measures \[ 13 \]. The aim of the current review is to describe the drug-related law enforcement response in Georgia and to assess the impact of enforcement-based supply and demand reduction interventions on illicit drug consumption and drug-related harms. For this policy case study, we reviewed relevant literature that included peer-reviewed scientific articles, stand-alone research reports, country annual drug situation reports, technical programmatic reports and programme data. In addition, we made a detailed review of relevant national legislation and judicial practice for — The literature was obtained between March-May through searches of a number of databases and online resources. Documents included in this review were those containing information on legislation, policy and framework documents, and law enforcement and public health statistics related to illicit drug use. Of particular interest were annual drug situation reports, research reports and other documents that focused on evidences and analysis of policy and law enforcement practice, and patterns of illicit drug use and other behaviours exercised by people who inject drugs PWID. Since there is no drug information system in Georgia that would make a comprehensive assessment of drug market changes, we relied on two major sources — results of two surveys that have been systematically collecting standardized and comparable data on current injection drug use defined here as the last week or last month injection use. The first was a programme database of the Georgian Harm Reduction Network GHRN - a non-governmental non-profit organization that runs 14 low threshold programmes in 11 cities and is a single major provider of harm reduction services to PWID in Georgia. Starting from , GHRN has collected data on socio-demographics and injection practices including drugs injected during last month among current injection drug users utilizing its services. Respondents for this annual, brief 16 questions , paper based survey, administered by social workers at each site, were recruited based on a convenient sampling among the clients of needle exchange programmes in all 11 cities. Total sample size varied from 1, to 2, depending on a year of the survey. Data were entered into excel database and results of a descriptive analysis were reported by GHRN systematically. BBSS has been implemented by the consortium of public and private research agencies and has employed standardized methodology for all waves of the survey. This anonymous, paper-based, interviewer-administered survey, among other data, has been collecting information on current use last week use for , , and , and last month use for , , and The survey utilized Respondent Driven Sampling approach and recruited on average 1, current injection drug users for each wave in six largest cities of the country. BBSS reports, released at the end of each wave, included results of descriptive and bi- and multi-variate analysis. The primary outcomes of interest were prevalence and patterns of illicit drug use, measured through indicators of current use of four major injection drugs: heroin, buprenorphine, home-made ATS, and home-made opioids desomorphine. Our analyses included critical assessment of policy changes and law enforcement interventions along the timeline of events, and concurrent changes in patterns of use. At about the same time marked increase in injection use of home-made amphetamine-type stimulants ATS known as vint and jeff was observed Fig. The emergence of home-produced stimulants was evidently linked to increased mobility and labour migration to Russia and Ukraine, as well as diffusion of information, including recipes via internet \[ 16 \]. Since then concurrent, often-unstructured use of multiple substances has remained an important characteristic of Georgian drug scene. For example, in on top of use of major injection drugs as seen in Fig. Expectedly krokodil users composed a significant share of admissions in addiction clinics \[ 20 \]. Both heroin and buprenorphine showed signs of increase, with the former drug regaining the status of the most often injected illicit substance for the first time since \[ 21 , 22 \]. Oral abuse of tramadol in combination with sedatives was reported in mid s \[ 7 \]. In Georgia experienced an explosive abuse of an injection preparation produced from poppy seeds that were normally used as an ingredient for different food confectionery manufacturing \[ 7 \]. We identified two major events that contributed to the improved availability of and access to evidence based treatment for substance use disorders. The first was the new Law on Narcotic Drugs, Psychotropic Substances, Precursors and Narcological Aid adopted in and which permitted use of substitution treatment with opioid agonists \[ 24 \]. The second event was the decision of the Ministry of Labour, Health and Social Affairs to allocate funding for opioid substitution treatment and the launch of state co-funded programs in State support allowed for rapid expansion of the treatment. By the end of , there were seven-teen treatment sites in the country that served a total of 4, patients annually \[ 17 \] — see Fig. Treatment of more than two thirds of those patients was co-funded by the state. Number of patients treated for substance use disorders in — Tsertsvadze, V. Drug Situation in Georgia Javakhishvili, Otiashvili, D. Used with permission. In relation to enforcement measures we distinguished three principal elements that were characteristic for drug-related response in last decade. The first was introduction of stricter measures over the control of specific substances in response to the increased abuse of these substances. This was done in relation to tramadol, poppy seeds, buprenorphine, tianeptin, pregabalin, codeine and few other substances. For example the New Law on Drug Crime adopted in introduced further restrictions for individuals sentenced for drug-related crimes. The law was intended to discourage illicit drug use via deprivation of driving license, arms license, a ban on passive election right, a ban on certain professional activities, lawyer, physician, teacher and the like and other rights \[ 25 \]. And finally, the critical element of the enforcement was large-scale street drug testing introduced since In late the Georgian government announced a war against crime, with drugs being one of the highest priorities. Massive drug testing was launched with a fold increase in the number of persons tested annually between and \[ 12 \]. The fine for the first time drug use positive urine test increased 5-fold and reached double the amount of the average monthly salary in the country \[ 26 \]. Since then, annually, tens of thousands of people have been tested for presence of derivates of controlled substances in their urine Fig. Following the peak in , the number of tested individuals was gradually decreasing until the new peak in Notably, the proportion of negative versus positive test results has remained stable — Number of individuals tested for drugs and number of positive results, — Figure 17 in Alavidze, S. In an attempt to establish coordination mechanism for drug related activities the Inter-Agency Coordinating Council to Combat Drug Abuse was established by decree of the President. The Council was mandated to elaborate and coordinate the implementation of the national drug strategy and action plan \[ 27 \]. In with the new government in power, the National anti Drug Strategy and Action Plan were developed and approved by the Interagency Coordinating Council. However, clear mechanisms of implementation and monitoring have not been established \[ 17 \]. In the same year, a new wave of massive street drug testing was launched with a record of 60, episodes of drug testing performed Fig. In contrast, there were 5, individuals admitted for treatment both drug free detoxification and opioid agonist maintenance treatment for substance use related problems in the same year Fig. The drug control regime in Georgia has been focusing primarily on law enforcement measures to target supply and availability of particular drugs and to reduce demand through imposing harsh punishment on drug users. Reactive in its nature, the simplistic, repressive response heavily relied on consumer sanctions and stimulated shifts in drug markets and users behavior. In most cases these shifts were associated with the introduction and use of new toxic preparations and subsequent harm to the physical and mental health of individuals. The heroin shortage in Australia in — provided a useful example of drug market shock in which the abrupt reduction in supply of heroin, with consequent increase in its price and decrease in purity and availability, resulted in a clear reduction in heroin use and increase in use of other drugs. The majority of heroin users reported a compensatory increase in consumption of cocaine, cannabis, benzodiazepines and methamphetamines \[ 3 , 29 — 31 \]. Where illicit drug markets and distribution schemes are concerned, both traditional and novel control measures have been met with rapid countermeasures and technological innovations \[ 33 — 35 \]. Recently, the rapid increase in use of new psychoactive substances NPS has brought a global change in drug markets, with the number of NPS already exceeding the number of psychoactive substances controlled at the international level \[ 36 , 37 \]. More than this, the Internet has shown to make an impact on the drug markets dramatically and has allowed information on drug use and production to spread rapidly, effectively facilitating the diffusion of new trends \[ 6 , 38 \]. Consistent with these findings, our research suggests that Georgian drug markets and drug users have shown a considerable capacity and innovation to adapt to new regulatory measures and increased scrutiny by law enforcement. Reduction in availability of traditional drugs led to the exploration and rapid growth in use of new drugs, mostly domestically manufactured substances. Describing and understanding organized drug distribution networks falls beyond the scope of this report. It is to be investigated to what extent the Internet for example, online recipes for self-production has been influencing the development of Georgian drug markets. This policy review provides unique example of a small country in which multiple specific policy interventions resulted in prompt and dramatic changes in drug consumption patterns. The scale and dynamics of these changes were impressive. As argued in the following sections, the ultimate result of these changes did not seem to have led to any improvement in individual or public health. Rather, vice versa. Drug users switched to more toxic preparations and exercised more risky behaviour. However, the sensitivity and responsiveness of market players, seemingly very effective and rapid diffusion of information and new trends in the Georgian drug user setting can, and should, provide a window of opportunity and become a focus of future research endeavours for innovative approaches to educate and support behavioural changes aiming at reduction of negative consequences of substance use. Development in substance use patterns is driven by a complex set of factors and socio-economic context. In many cases, drug use patterns in Georgia were largely shaped by policy response and law enforcement practices implemented at particular periods of time. This lack of detectability obviously contributed to the spread of home-made ATS injection as well. As in case with buprenorphine, standard urine testing kits used by police did not include amphetamine and methamphetamine at least at the initial stages , thus allowing users of vint and jeff to pass testing undetected. In addition, the risk of arrest was reduced since all the ingredients for kitchen production were obtained via pharmacy and convenience stores and there was no need to engage with drug dealers. In Georgia politicians have argued that law enforcement massive drug testing reduces the demand by increasing the probability to get punished and thus coerces drug users to stop using drugs. In reality, the risk of detection is fairly limited and the improvement of detection rates is unrealistically expensive \[ 28 \]. In the United States, cannabis users had a tiny 1 in 3, risk of being arrested for any given incident of cannabis use \[ 4 \]. Simple calculations 45, problem injection users; roughly one injection per day; 20, positive results of the rapid urine toxicological testing in — see Fig. However low the risks of detection and arrest may be, it seems that Georgian drug consumers still did not ignore those risks. For example, possession of heroin in the amount of more than 1 gram, regardless of the purpose, is punished with 8 to 20 years of imprisonment or lifetime term Art. According to the same code, rape is punished with 4—6 years of imprisonment Art. On a positive note, reduction in overdose deaths and a possible reduction in injection drug use and hepatitis C infections were suggested to be potential public health benefits as a result of the Australian heroin shortage \[ 3 \]. Switching to new drugs in Georgia was in many cases associated with increased risks for blood-borne infections and other harms often related to the toxic nature of ingredients used for preparation of self-manufactured injection solutions. Buprenorphine, home-made stimulants and home-made opioids all were obtained, processed and used in a way that required a group of injectors to collaborate. In all these instances injection happened within a group of 3—5 drug injectors with apparently little direct sharing, but frequent indirect sharing via common container, cotton filters, and large volume syringe for division front or back loading of the produced substance \[ 9 , 40 \]. Addiction clinics and harm reduction programs reported numerous physical, neurological and psychiatric complications among consumers of home-made preparations, both stimulants and opioids, which were apparently linked to the toxicity of precursors used for processing — phosphorus, iodine, potassium permanganate, gasoline, strong acids and so on \[ 41 \]. Soft tissue damages, necrosis, gangrene, osteomalacia and other severe impairments have been reported elsewhere in connection to injection use of krokodil and self-produced ATS \[ 42 — 44 \]. Harm reduction services in Georgia have also reported increased demand for naloxone among krokodil injectors. Attempts to self-medicate and substitute traditional drugs of abuse have resulted in majority of drug injectors switching to unstructured poly-substance use. Nine out of ten respondents in one survey clients of needle and syringe exchange programmes reported injecting at least two drugs, and two-thirds reported injecting three or more drugs during the last month \[ 15 \]. This has apparently resulted in the rise in the number of overdose since most overdoses occur among individuals who consume multiple substances \[ 45 \]. However, overdose cases are not properly documented in Georgia and we are lacking the data to support this assumption. In Georgia, tens of thousands of people are subject to administrative and criminal proceedings including sentencing to prison terms as a consequence of positive rapid immunoassay test results. To the best of our knowledge, no other jurisdiction uses the results of rapid screening as irrecusably final evidence of drug use because of the issues related to the often-low specificity of the tests, cross-reactivity, and the stability of these devices their ability to resist certain conditions, such as temperature and humidity. Elsewhere, these results are considered preliminary and indicative, and advanced confirmatory laboratory tests are required for legal proceedings both in criminal justice and workplace settings \[ 46 — 49 \]. In Georgia, the results of these rapid tests are used as one single source of evidence in court, leading to heavy fines or imprisonment. We believe that this practice contradicts established international standards for a fair trial where sufficient evidence should be required for conviction beyond reasonable doubt of proof \[ 50 \]. However, it is obvious that confirmatory testing of those who tested positive using initial on-site tests would increase the cost and expenditures of the testing intervention immensely. We estimated that 1 in 20 men residing in the country was tested for drugs in 60, testing episodes among 1. Punitive measures, including massive street drug testing, that have no analogue in developed countries did not result in any measurable reduction in drug use in Georgia. Instead, such measures caused the harmful criminalization of thousands of otherwise law-abiding individuals. Importantly, these punitive measures had little or no influence on individual decisions to cease or to continue using drugs. Punishment did result in a change in user behaviour — study participants reported adapting variety of strategies to avoid being identified by police injecting alone, injecting and staying at home, avoiding traveling by taxi and so on. Finally, it is reasonable to state that massive drug testing, with the majority of the test results being negative, raises an ethical question. Subjecting tens of thousands of people to humiliating and lengthy drug-testing procedure infringes upon the dignity of citizens and undermines the public perception of a just and sound policy. Figure 5 presents a schematic description of drug policy interventions and relevant health and social implications in Georgia. In our analysis we focused on associations between specific law enforcement interventions and changes in illicit drug markets and substance use patterns. However, shifts in drug trends are obviously not only a function of enforcement. Drug markets are responsive to different political, socio-economic and cultural forces. Nevertheless, analysing those factors, whatever the importance, was beyond the scope of current review. Secondly, due to lack or complete absence of data, we were unable to assess the effect of drug enforcement measures on initiation of drug use by new users. We believe that the reliability of drug use data analysed for this report was satisfactory. Differences in the prevalence of current use of specific drugs in two samples might suggest that these were somehow different drug using populations with distinct characteristics and behaviours. It is hard to estimate to what extend samples for two surveys overlap. Between 3. Our general concerns relate to the overall fragmented character and limited scope of the data available in the country. Absence of comprehensive drug monitoring system in Georgia that would provide valid, relevant and continuous data was the major limitation. In order to measure changes in drug consumption, we focused on four major injection substances and relied on data provided by GHRN annual client survey and periodic BBSS. Supposedly, both surveys deal with problematic drug users, whom of which do not necessarily represent the entire substance-using population in the country. These problematic poly-substance users can respond to changes in a specific way, simply saying — consume whatever is available and rapidly switch to new drugs. Other groups recreational, experimental users may have responded differently to the changes in the legal environment, but there are no data to explore that. For example, as is the case with other countries \[ 36 \], it is possible that new psychoactive substances, in fact, attracted new cohorts of users and they exercised responses and behaviours different from those of systematic injection users of drugs. Again, given the data available, we were unable to examine trends in NPS consumption and intentionally focused on four most prevalent injection drugs. This is particularly true for prohibitively expensive drug free treatment and, to a lesser extent, to more affordable opioid substitution treatment. Finally, due to the lack of data, we did not discuss the price and purity of illicit drugs and did not cover the numbers of negative health and social consequences, including overdose death, morbidity due to toxic nature of home-produced injection preparations, criminal justice costs, social marginalization of users and their families. Some economic implications of massive street drug testing were reported earlier \[ 12 \]. This study highlights the need to re-examine national drug policy in Georgia. Intensive harassment of drug users and exclusive focus on reducing availability of specific drug s , with no adequate emphases on health interventions, resulted in drug injectors in Georgia exploring new substances and switching to unstructured poly-substance use. The toxicity of new alternatives home-made injection preparations , chaotic nature of mixing different substances, and the group character of consumption could be associated with a number of negative consequences and increased individual and public health risks. Development in the drug scene and correlating drug markets is a dynamic process that requires thoughtful monitoring. Continuous documentation and analysis of policy interventions and subsequent changes in patterns of drug use and associated consequences is warranted in order to inform decision makers and allow for the formulation of rationale and effective policy responses. There is a need to establish a comprehensive drug monitoring system in Georgia that would provide professional community and policy makers with reliable, valid and systematic data on drug markets and drug use trends and patterns. This research had no financial support. Authors are thankful to Dr. Alisher Latypov for reviewing the manuscript and providing useful suggestions for improvement. All authors participated in data collection and revision of literature and policy documents. DO wrote the first draft of the manuscript. All authors discussed the results and implications and commented on the manuscript at all stages. All authors have approved the final manuscript. As a library, NLM provides access to scientific literature. Subst Abuse Treat Prev Policy. Find articles by David Otiashvili. Find articles by Mzia Tabatadze. Find articles by Nino Balanchivadze. Find articles by Irma Kirtadze. Received Jul 19; Accepted Jan 10; Collection date Open in a new tab. Competing interest The authors declare that they have no competing interests. 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.

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