Journal papers: Central Asia and its drug problem

 

ResAd and its staff have been active in Central Asian countries in the framework of several projects (most notably, CADAP since its second through recent sixth phase. In addition to standard project outputs and reports, we strive to publish our findings also in peer.reviewed scientific journals. Here, abstracts of the journal papers and links to fulltexts are posted.

 

For annual reports and the regional report prepared in CADAP 5 go to Documents.

Post-Soviet Central Asia:A summary of the drug situation

Tomas Zabransky, Viktor Mravcik, Ave Talu, Ernestas Jasaitis

 
Highlights 
  • A system for ongoing monitoring, analysis and reporting is being built in Central Asia.

  • The level of drug use in the school population is low when compared to developed countries.

  • Despite that, levels of injecting drug use in young people and adults are very high.

  • HIV and viral hepatitis C are driven by injecting drug use and high.

  • Treatment for drug users has low availability and mostly does not reflect modern standards.

  • Seizures of opiates have decreased in the last few years; seizures of cannabis have increased.

 

Abstract

Background:The paper aims to provide a snapshot of the drug situation in Kazakhstan, Kyrgyzstan, Tajikistan, and Uzbekistan using the EU methodology of “harmonised indicators of drug epidemiology.” Methods:Most of the data reported here were gathered and analysed within the framework of the EU-funded CADAP project in 2012. Together with members of CADAP national teams, we conducted extraction from the databases of national institutions in the field of (public) health and law enforcement, issued formal requests for the provision of specific information to national governmental authorities, and obtained national grey literature in Russian. In specific cases, we leaned on the expert opinions of the national experts, gathered by means of simple online questionnaires or focus group. In the rather scarce cases where peer-reviewed sources on the specific topics exist, it is used for comparisons and discussion.Results: All the post-Soviet Central Asian countries lack information on drug use in the general population. School surveys are relatively well developed in Kazakhstan, and Kyrgyzstan benefited from an international survey project on health in schools organised by private donors in 2009. For Tajikistan and Uzbekistan, the most recent available data on drug use in the school population are from 2006 and as such are of little relevance. Problem drug use is widespread in Central Asia and estimates of its prevalence are available for all four countries. All the post-Soviet Central Asian countries use a rather outdated system of narcological registers as the only source of data on drug users who are treated (and those investigated by the police), which was inherited from Soviet times. The availability of treatment is very low in all the countries reported on here except Kyrgyzstan; opioid substitution treatment (OST) was introduced first in Kyrgyzstan; Kazakhstan and Tajikistan are piloting their OST programmes but the coverage is extremely low, and in Uzbekistan the OST pilot programme has been abolished. HIV and hepatitis C virus (HCV) infections are concentrated in injecting drug users (IDUs) in Central Asia, with the situation in Kazakhstan having stabilised; HIV is on the increase among Kyrgyz IDUs. The sharp decrease in HIV and VHC seroprevalence among IDUs in Uzbekistan and Tajikistan still awaits an explanation. The system for monitoring of fatal drug overdoses needs substantial improvement in all the countries reported on here. Overall mortality studies of drug users registered in the narcological registers were performed in Uzbekistan, Kazakhstan, and Tajikistan; the highest excess mortality among registered drug users was found in Uzbekistan, and in all three countries, it was substantially higher for women than men. The seizures of illegal drugs are by far the highest in Kazakhstan; however, wild-growing cannabis represents 90% of these seizures. Uzbekistan was the country with the highest number of drug arrests. In Kazakhstan, after the decriminalisation of drug use in 2011, the number of reported drug-related offences dropped to below 50% of the figure for the previous year. Conclusion:The drug situation monitoring system in the four post-Soviet countries of Central Asia still needs substantial improvement. However, in its current state it is already able to generate evidence that is useful for the planning of effective national and regional drug policies, which would be of the utmost importance in the forthcoming years of the withdrawal of the International Security Assistance Force from Afghanistan.

 

Reference: ZABRANSKY, T., MRAVČÍK, V., TALU, A. & JASAITIS, E. 2014. Post-Soviet Central Asia: a summary of the drug situation International Journal of Drug Policy, In Press.

 

Fulltext and other tools

Mortality of registered drug users in Central Asia

Viktor Mravcik,Tomas Zabransky, Ave Talu, Ernestas Jasaitisa, Nuriya Gafarova, Zhannat Musabekova, Luiza Baymirova, Makhsut Makhsutovh, Furkat Ganievi

 

Highlights
  • Retrospective cohort study on mortality of registered drug users was performed in the post-Soviet countries of Central Asia, results from Kazakhstan and Uzbekistan are presented in details.

  • Crude mortality rates of drug users in this region were found to be higher than in European countries.

  • Excess mortality was found particularly in registered females as compared to their peers in general population.

  • Under-reporting of deaths in the narcological registers represents the main methodological limitation.

 

Abstract

Background: Within the fifth phase of the Central Asia Drug Action Programme (CADAP) covering five post-Soviet Central Asian countries, an analysis of the mortality of drug users was performed. The results for Kazakhstan and Uzbekistan are presented in detail in this paper since results from Kyrgyzstan and Tajikistan are not considered valid and Turkmenistan did not provide data at all. Methods: A system of registration of all users of illegal drugs known to the health and/or law enforcement authorities (“narcological registers”) exists in Central Asian countries inherited from the system of Soviet “narcology”. According to the legal norms, the death of a registered person should be recorded. We conducted indirect standardisation of crude mortality rates and computed the standardised mortality ratio (SMR) comparing observed number of deaths with expected number of deaths according to age and gender specific mortality rates in the general population of the same country. Results: The results show excess mortality in registered drug users, particularly in registered females, in Uzbekistan (the latest available SMR for all those registered is 7.4; the SMR in females is 16.3) and Kazakhstan (4.0 and 12.9). The excess mortality is highest among young adults (18–34) in all the studies.ConclusionTaking into account the limited quality and reliability of the data – first of all, the likely under-reporting of deaths in the narcological registers – the crude mortality rate among registered drug users is quite high when compared to EU countries. The SMR in total is comparably lower as a result of the high background mortality in the general population. This excess mortality is preventable and should be targeted by the national drug policies. Specifically, the programmes should target registered and unregistered female drug users.

 

Keywords: Central Asia; Mortality; Drug users; Heroin; Standardised mortality ratio; Narcological register

 

Reference: MRAVCIK, V., ZABRANSKY, T., TALU, A., JASAITIS , E., GAFAROVA, N., MUSABEKOVA, Z., BAYMIROVA, L., MAKHSUTOV, M. & GANIEV, F. 2014. Mortality of registered drug users in Central Asia. International Journal of Drug Policy, In Press.

 

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