Phare Project on Drug Information Systems Bridging Phase

National Report on the drugs situation in

2000 © European Commission 2000

This report been prepared within the framework of a Project undertaken by eesv MSDP. The findings, conclusions and interpretations expressed in this document are those of eesv MSDP alone and should in no way be taken to reflect the policies or opinions of the European Commission Phare Project on Drug Information Systems Bridging Phase

National Report on the drugs situation in Albania

2000 eesv MSDP WG Plein 65, NL - 1054 RB Amsterdam, The Netherlands Tel: +31.20.685.50.82, Fax: +31.20.612.57.91 ALBANIA : NATIONAL REPORT 2000 (THE STATE OF THE DRUGS PROBLEMS OVER THE PERIOD 1995-1999)

Tirana, April 2000

______

Prepared by

Eduard Z. Kakarriqi Institute of Public Health, Zihni Sulaj Toxicological Clinic of University Hospital Center, Tirana National Report 2000 Albania

Table of Contents

1. COUNTRY’S BACKGROUND 2

1.1. RECENT POLITICAL, SOCIAL AND ECONOMICAL BACKGROUND. 2 1.2. DEMOGRAPHIC CHARACTERISTICS : FACTS AND TRENDS . 2 1.3. HISTORY OF DRUGS PROBLEMS AND SOCIAL-ECONOMIC AND CULTURAL FEATURES RELATED TO DRUG PHENOMENON. 4

2. TRENDS AND NEW DEVELOPMENTS IN DRUG USE/MISUSE AND RESPONSES 5

2.1. FIRST TREATMENT DEMAND DATA. 5 2.2. DRUG RELATED DEATHS . 12 2.3. INFECTIOUS DISEASES RELATED TO IVDU. 12 2.4. NON-FATAL EMERGENCIES . 13 2.5. NEW DRUGS IN 1995-1998 VERSUS OLD DRUGS AT THE BEGINNING OF THE 1990S. 13 2.6. DEVELOPMENTS OF THE USE OF INDIVIDUAL DRUGS IN THE 1990S. 13 2.7. DRUG LEGISLATION AND POLICY 13

3. PATTERNS AND PREVALENCE OF DRUG USE AND RELATED PROBLEMS. 15

3.1. PATTERNS AND PREVALENCE RATES AMONG THE GENERAL POPULATION. 15 3.2. PREVALENCE RATES FROM SCHOOL SURVEYS . 15 3.3. LAW ENFORCEMENT INDICATORS . 16

4. SUBSTITUTION TREATMENT 18

5. CONCLUSION 18

Phare Project on Drug Information Systems 1 National Report 2000 Albania

This national report 2000 as the first EMCDDA annual report of Albania (not taking into account that preliminary one sent to Phare eesv MSDP in December 1999) aims at representing the state of the drugs problems in Albania not only for the years 1998-1999 but for all the period from 1995 to 1999 (the year 1995 being the beginning of data collection regarding to drug problem).

Which are trends and new developments in drug use and responses? Which are patterns and prevalence of drug use and related problems? What’s about treatment? What’s about law enforcement aspects? What’s about locally produced opiates and other “local” substances?

Answering such questions would require giving first of all a summary picture of Albania’s profile, highlighting thus its main specific historical, political, economical, demographic, and social-economic features.

1. COUNTRY’S BACKGROUND

1.1. RECENT POLITICAL, SOCIAL AND ECONOMICAL BACKGROUND.

Since the victory of democracy in 1992 Albania experienced rapid and in-depth political, social and economic changes. A total opening of the country and a free movement of ideas and people contrasted with the extreme international isolation under up-to-then communist dictatorship; the free market economy substituted the former centrally planned one. Though such changes Albania still remains the poorest country of Europe, (the human development indicator of an actual value of 0.656 places Albania 105th among 175 countries). Furthermore, the political and social situation remains fragile what does mean that further deterioration of any single condition could lead to unrest and possible turmoil (as it was just the case of the first mid-year 1997). The recent Kosovo war (mid-year 1999) had its greatest economical and social impact just on Albania where all but a half million Kosovo refugees found their temporary accommodation.

Into such a political, social and economical background a myriad of risk determinants concerning drug phenomenon is emerging. It is likely to affect especially the younger segment of the population.

1.2. DEMOGRAPHIC CHARACTERISTICS : FACTS AND TRENDS.

The Albania’s population age-structure either in 1989 (the last census) or 1999 (operative data) indicates of a young population, the youngest one in Europe : the age-groups of 12-30 years old, that is just those of the highest frequency of social deviance account in 1999 of all but 30% of the total country’s population. Concerning the population gender-structure the females account for 48.5% in 1989 and 51.0% in 1999. Such a gender ratio overturning is due to the selective emigration during the'90ies, (Table 1) Following a strict natalist policy of the communist regime the Albanian population increased during the last fifty years, but its growth rate slowed from 2.96 in the 1950s to 2.1 in 1980s. Meanwhile a sharp decrease of the population growth rate (1.5) results to be in the 1990s mainly because of a large people (e)migration.

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Table 1 Albania’s population structure in 1989 and 1999

Year 1989 Age group M F Total Total as Ratio M/F Female (years) number percentage (%) (in %) 0-14 547,611 502,977 1,050,588 33.01 109 47.8 15-19 167,368 153,639 321,007 10.09 109 47.8 20-24 156,070 146,149 302,219 9.50 107 48.3 25-29 153,496 144,149 297,645 9.35 106 48.4 30-34 130,079 122,053 252,132 7.92 106 48.4 35-39 101,116 90,452 191,568 6.10 111 47.2 40-44 76,328 68,729 145,057 4.55 111 47.4 45-49 76,559 70,285 146,844 4.61 109 47.8 50+ 231,107 244,250 475,357 14.93 94 51.4 TOTAL POPUL. 1,639,734 1,542,683 3,182,417 100.0 106 48.5

Year 1999 Age group M F Total Total as Ratio M/F Female (years) number percentage (%) (in %) 0-14 561,979 533,100 1,095,079 32.95 105 48.7 15-19 135,656 153,996 289,652 8.71 88 53.2 20-24 108,710 138,878 247,588 7.44 78 56.1 25-29 107,111 136,061 243,172 7.31 78 55.9 30-34 128,919 136,720 265,639 7.99 94 51.5 35-39 124,890 125,122 250,012 7.52 100 50.0 40-44 102,118 97,967 200,085 6.02 104 48.9 45-49 79,352 74,583 153,935 4.63 106 48.4 50+ 280,180 298,975 579,155 17.42 93 51.6 TOTAL POPUL. 1,628,915 1,695,402 3,324,317 100.0 96 51.0

Both crude birth rate (20.6 / 1000) and total fertility rate (2.6) are actually much higher than those of the rest of Europe, country’s demographic profile being thus closer to that of developing countries. But, on the other hand, enjoy a life expectancy at birth (LEo) above the average of countries of a similar level of economic development and wealth. LEo in Albania in 1998 was 69.2 years for men and 75.0 years for women, figures quite comparable with those of the European developed countries.

Around 52.1% of the estimated population of 1999 were living in rural areas compared to around 64.1% according to the 1989 census. Overall population density was around 110.2 inhabitants per square kilometer in 1993 with different density levels in various country’s areas. Population pressure was and still is noticeable in the cities and plains whereas the mountain areas are continuously scarcely populated. Therefore a very high rate of urbanization or internal migration, (beyond any expectation on the respective

Phare Project on Drug Information Systems 3 National Report 2000 Albania mathematical simulations), is going on to take place in Albania, conspicuously for the country’s capital – Tirana, (which actually, 1999, accounts for a population of around 800,000 inhabitants, compared with around 350,000 ones in 1994); as well as for other main cities as Shkodra and Lezha (Northwestern Albania), Durres (together with Kavaja and ) (Centralwestern Albania), and (), and Vlora (Southwestern Albania), Korça (Southeastern Albania), etc. Such an “over-free” and chaotic movement of people carries the establishment of various subcultures, thus creating an appropriate social environment to lifestyles deviance.

On the other hand, the people (especially youth) emigration, virtually non-existent in Albania until 1989, represents over the years 1990s a very remarkable phenomenon. The emigration rate (either illegal or legal one) remains to be too high : from 1991 onwards the number of Albanians emigrated abroad (mainly in Greece and Italy) and in other European and non-European countries as well might be considered of some 450,000-600,000 people, around 70% out of them being mainly males of age-groups of 16-30 years old.

Concerning demographic and epidemiological transition Albania shows the features of both a developing country and a developed one. The high fertility rates, high natality rates, still high infant mortality rates (around 20 / 1000 in 1998), and the population demographic pyramid shape are demographic indicators of a developing country. But, in the meanwhile, the low crude death rates (5 / 1000) and high life expectancy at birth (around 73 years) are demographic indicators of a developed country. On the other hand, the total morbidity patterns, with the communicable diseases at the first place, are epidemiological characteristics of a developing country. But, in the meanwhile, the total mortality patterns (communicable diseases at the fifth place after cardiovascular diseases, chronic pulmonary diseases, cancer, accidents) represent epidemiological patterns of a developed country.

1.3. HISTORY OF DRUGS PROBLEMS AND SOCIAL-ECONOMIC AND CULTURAL FEATURES RELATED TO DRUG PHENOMENON.

The very beginning of drugs use/misuse and drugs problems in Albania dates very recently, in 1993, that is just after the demolition of the 45-years communist dictatorship and a total country isolation. The victory of democracy in 1992, marking a total opening of Albania towards the Western civilized world, marked in the meantime the confrontation of the Albanian civil society with the social problems of that world. Consequently, criminality, drugs, AIDS, smuggling, prostitution have been emerged as new issues with which the youth subculture has had to come to terms. Just such new lifestyle subcultures were and still are going to be more and more evident. The actual high unemployment rate (especially amongst the youth) accounting for 36% in 1998 and the high educational breakdown rates (university 1.9%, secondary 46.7%, and primary 51.4% in 1998) should be taken into consideration as very potential risk factors concerning the drug trafficking and drug use/misuse.

On the other hand, the actual appeared organized crime bringing violence, uncertainty and fear, has too much aggravated the actual social-economic situation. This situation was taken advantage of by the new network of drug dealers (in close connection with Turkish, Bulgarian, Greek, Macedonian, and Italian Maffias), and an illicit drug market is already established in the country.

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2. TRENDS AND NEW DEVELOPMENTS IN DRUG USE/MISUSE AND RESPONSES

2.1. FIRST TREATMENT DEMAND DATA.

First of all it should be emphasized there is still only one drug specialized residential center in Albania, namely the Toxicological Clinic of Tirana University Hospital Center (TUHC), located in Tirana and responsible for all the country, dealing only with the detox and overdosis treatment, and serving both as a hospital inpatient and outpatient unit. Another specialised residential center, namely the Psychiatric Clinic of the same TUHC, also located in Tirana, doesn’t deal with drug treatment (subjective reasons), though potentially able to do it. There are not yet neither specialized non-residential centers (as day care centers, low threshold drop-in ones, etc) nor any rehabilitation center in Albania.

2.2.1 A statistically significant increase of first treatment demand results to be over the period 1995-1999. Such an increase of an exponential shape is a strong evidence on a current epidemic trend of drugs problems in Albania. Concretely, 1.7% (27/1,562) in 1995, 4.0% (63/1,562) in 1996, 21.4% (334/1,562) in 1997, 33.5% (523/1,562) in 1998, and 39.4% (615/1,562) are the respective yearly proportions out of the total number (1,562) of persons asking for the first treatment over this period of time. The above trend on the first treatment demand is graphically shown in Graph 1.1 (frequency in absolute numbers) and Graph 1.2 (proportions).

Graph 1.1

Each year first treatment demand data in 1995-1999 : Frequency in absolute numbers

700 615 600 523 500 334 400 300 200 63 100 27 0 1995 1996 1997 1998 1999

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Graph 1.2 Each year first treatment demand data in 1995-1999 : Proportions

1995 1996 1.7% 4.0%

1997 21.4% 1999 39.4%

1998 33.5%

2.1.2 The most predominating age groups over all the period 1995-1999 concerning the first treatment demand are those of 15-29 years old. Concretely, 22.9% of all persons asking for the first treatment belongs to age groups of 15-19 years, 50.6% to those of 20- 24 years, and 14.8% to those of 25-29 years, what does mean a figure of above 88% for the age groups of 15-29 years.

The overall Male/Female Ratio of the total treatment demands (1995-1999) results 15.3/1. Such a figure doesn’t show the reality based on the fact that the females are much more declined not to be presented in treatment centers because of the still existing people’s mentality. The detailed data on first treatment demand as regards age groups and gender are represented in Table 2 and Graphs 2.1 (frequency in absolute numbers) and 2.2.(proportions) .

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Table2 Albania : First treatment demand data in the years 1995, 1996, 1997, 1998, and 1999 according to : l Age Groups l Gender

Frequency in each year 1995-1999 in Total and according to Age-groups and Gender <15 15-19 20-24 25-29 30-34 35-39 40+ TOTAL M/F yrs yrs yrs yrs yrs yrs yrs ratio M 2 10 6 3 1 - - 22 F - 2 2 1 - - - 5 4.4/1

1995 T 2 12 8 4 1 - - 27 M 5 18 21 7 2 1 1 55 F 1 3 2 - 2 - - 8 6.8/1

1996 T 6 21 23 7 4 1 1 63 M 6 89 105 63 31 - 14 308 F 1 10 8 2 5 - - 26 11.8/1

1997 T 7 99 113 65 36 - 14 334 M 6 90 272 80 36 14 3 501 F - 14 8 - - - - 22 22.8/1

1998 T 6 104 280 80 36 14 3 523 M 8 114 343 72 29 13 1 580 F 1 8 23 2 1 - - 35 16.6/1

1999 T 9 122 366 74 30 13 1 615 1995- 1999 30 358 790 230 107 28 19 1,562 (freq) 15.3/1 1995- 1999 1.9 22.9 50.6 14.8 6.8 1.8 1.2 100 (%)

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Graphs 2.1 (frequency) and 2.2 (proportions)

First treatment demand data according to age groups over the period 1995-1999

800 700 600 500 400 300 200 100 0 <15 15-19 20-24 25-29 30-34 35-39 40+

First treatment demand data 1995-1999 : Proportions

35-39 40+ 2% 1% <15 30-34 2% 7% 15-19 23% 25-29 15%

20-24 50%

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2.1.3. Regarding to the type of illicit drug, OPIATES (mainly Heroin) account for more than 87% of all first treatment demands over the period 1995-1999, that is too much more than Cannabis (4.4%) and Cocaine (1.8%), (Table 3 and Graph 3). It reflects in the meanwhile a rapid rise in heroin use in 1998 and 1999 compared to the previous years.

Table 3

60708090 1020304050 NorthWest 0 Smoking I.V.Injecting Smoking&Sniffing Albania : First Treatment Demand data over the period 1995-1999 according to Type of Illicit Drug

M F TOT. as Freq. TOT as % Heroin 1,234 56 1,290 82.6 Cannabis 53 15 68 4.4 Heroin & Cocaine 52 5 57 3.6 Heroin & Cannabis 49 5 54 3.5 Cocaine 26 2 28 1.8 Cocaine & Cannabis 15 1 16 1.0 Pethidin 12 - 12 0.8 Morphin & Pethidin 8 - 8 0.5 Fentanyl 9 - 9 0.6 Dower 13 5 18 1.1 Diazepam 1 1 2 0.1 1.562 100.0

Graph 3

90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0%

Heroin Dower Cocaine Pethidin Fentanyl Cannabis Diazepam Her&Coca Mrph&Pet Her&Cann Coca&Cann

2.1.4. Smoking or chasing heroin seems to be more common than injecting, most probably because of the high level of purity of heroin available in the country. This could either reflect Albania’s proximity to the main heroin trafficking routes or the efforts of organised crime syndicates to create new markets.

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Anyhow. the intravenous (injecting) administration route of heroin highlights a feature of a great importance as regards its health and social consequences. It represents about 26.1% of the total first treatment demands over the period 1995-1998, with fluctuations from 29.6% in 1995 and 36.5% and 33.8% respectively in 1996 and 1997 to 19.5% in 1998 (a falling trend) and to 26.6% in 1999 (a re-raising trend). Such figures might give the perception of a tendency of the injecting administration route to predominate in the following years in the problem drug users undergoing treatment.

The detailed data concerning the route of administration of primary drug are represented in Table 4 and Graph 4.

Table 4 and Graph 4

Albania : First Treatment Demand data in the years 1995, 1996, 1997, and 1998 according to the Route of Administration of Primary Drug

Route of Frequency and proportion in each year over the period 1995-1999 Period administration according to the route of administration of primary drug from 1995 to 1995 1996 1997 1998 1999 1999 Freq % * Freq % * Freq % * Freq % * Freq % * Freq % Smoking 2 7.4 6 9.5 7 2.1 242 46.3 371 60.3 628 40.2

Heating & 1 3.7 1 1.6 100 29.9 147 28.1 45 7.3 294 18.8 Inhaling Smoking & 3 11.1 7 11.1 80 23.9 15 2.7 19 3.1 124 7.9 Sniffing Sniffing 12 44.4 21 33.3 29 8.7 17 3.2 17 2.7 96 6.1

I.V. Injecting 8 29.6 23 36.5 113 33.8 101 19.5 163 26.6 408 26.1

Eating & 1 3.7 1 1.6 1 0.3 1 0.2 - - 4 0.3 Drinking other unknown - - 4 6.3 4 1.2 - - - - 8 0.6

Total 27 100 63 100 334 100 523 100 615 100 1,562 100

* The proportions (percentages) correspond to the total number of the respective year.

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45.0 40.0 35.0 30.0 25.0 20.0 15.0 10.0 5.0 0.0 Smoking Inhaling Injecting Sniffing Smk&Snff Eat/Drink Other

2.1.5. Most of the cases demanding treatment are of a lifetime experience (career) in drug use of at maximum five years, the drug phenomenon being a recent one in Albania (as it was already mentioned). Anyhow this doesn’t at all mean an absence of cases with more than 5 years (even more than 10 years) of a career in drug use, though in low proportions, (Table 5). The highest lifetime prevalence rates concerning heroin and cocaine are 1-3 years (57% and 43% respectively) and up to 1 year (56%) as regards cannabis use.

Table 5

Albania 1998 : Treatment Demand data - Classification of Drug Users according to the “Career” in Drug Use/Misuse

Lifetime Heroin Cannabis Cocaine Benzodi- Combina- prevalence in (& pethidin, azepines tions of two drug morphin) drugs use/misuse Freq % Freq % Freq % Freq % Freq % <6 months 111 8.4 14 20.6 5 17.8 - 8 6.3 6-12 months 189 14.4 24 35.3 5 17.8 - 19 15.0 1-2 years 322 24.5 12 17.6 7 25.0 2 10.0 48 37.8 2-3 years 358 27.2 8 11.8 5 17.8 4 20.0 41 32.3 3-4 years 163 12.3 3 4.4 1 3.6 6 30.0 7 5.5 4-5 years 62 4.7 2 2.9 1 3.6 4 20.0 - 5-6 years 56 4.2 3 4.4 2 7.2 - - 6-7 years 33 2.5 1 1.5 1 3.6 - 1 0.8 7-10 years 15 1.1 1 1.5 - 2 10.0 3 2.3 >10 years 10 0.7 - 1 3.6 2 10.0 - TOT. Freq 1,319 68 28 20 127

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2.1.6. The first treatment demand data demonstrates a widespread of drugs use/misuse in all but the country in 1999 compared to the years 1995-1996, though still remaining a phenomenon mainly of urban-suburban areas. The capital Tirana always represents the highest prevalence : 72.7% of all demands for first treatment in 1999 belong to Tirana residents. Around 65% of drugs users/misusers are of a medium-high educational level. Around 92% of drugs users/misusers are officially unemployed or partially employed people. Around 93% of drugs users/misusers live in family microenvironment and with stable accommodation ; around 10% of them are married with children. Around 30% of cases demanding for treatment are both drugs traffickers and drugs users/misusers. 12-13% of cases results to be with psychopathologic problems.

2.2. DRUG RELATED DEATHS .

There are not yet reliable data. According to anectodal data some 25 cases are acute deaths related to drugs misuse (overdoses) over the period 1995-1999. Nevertheless the total number of drug-related deaths must be much higher than that of the above figure.

2.3. INFECTIOUS DISEASES RELATED TO IVDU.

2.3.1. HIV/AIDS. The cumulative number of HIV+ cases during the period from 1993 (the first HIV+ case diagnosed in Albania) till 1999 is 42 ones. 11 out of them represent the cumulative number of AIDS cases during the same period.

Epidemiological investigation on each diagnosed HIV+/AIDS case has demonstrated and confirmed the total absence of any relation to the IVDU. Nevertheless, all prerequisites are present for the rapid development of HIV epidemic in the country, namely the level of HIV risk behaviours (needle sharing, frontloading, unsafe sex) among intravenous drug users seems to be high whereas the knowledge about HIV and safer sex are low.

2.3.2. Viral hepatitis B and C. Sero-epidemiological cross-sectional surveys carried out by the National Institute of Public Health during the years 1990s have demonstrated : - The prevalence rates (seropositivity levels) in healthy population of HBsAg and HBeAg are respectively at 18% and 11%, and those of Anti-HCV at around 1.5%. Such levels are higher compared to all other European countries. - The prevalence rate of hepatitis C virus in the poly-blood-transfused subjects (haemophylics, thalacemics, etc) results to be at 63%, that is an extremely high level. - The etiologic agent in patients with viral hepatitis (acute and chronic forms) results to be the hepatitis B virus (65% of total cases), hepatitis A virus (27%), hepatitis C virus (1%), hepatitis D virus (1%), and hepatitis E virus (3%).

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This is the overall picture of viral hepatitis infections in Albania. But, concerning the aim of this item there are not yet confirmed data of hepatitis B and C related to IVDU, what for sure doesn’t represent the reality.

2.4. NON-FATAL EMERGENCIES .

There are not reliable data. Anyhow, according to anectodal informations (emergencies units of TUHC first of all) the number of non-fatal emergencies cases seems to be at high levels. The problem remains on the lack of a proper diagnosis and reporting.

2.5. NEW DRUGS IN 1995-1998 VERSUS OLD DRUGS AT THE BEGINNING OF THE 1990S.

Opium has been the main drug in use at the beginning of the 1990s. Over time it was substituted by new drugs. Actually (1996 on) Cannabis (marijuana, hashish), Heroin, and Cocaine represent the main used drugs. It should be stressed that Hallucinogens (LSD, others), Stimulants (amphetamines, MDMA, etc), and Volatile Inhalants are not yet in use in Albania (based at least on the official reliable data).

2.6. DEVELOPMENTS OF THE USE OF INDIVIDUAL DRUGS IN THE 1990S.

The general trend pattern, representing the development of current drugs use among the Albanian population over the years 1990s (that is till 1998), is different according to the individual drug. Thus, whereas the trend of Cannabis and Heroin use is overall upward, that of Cocaine (and crack) use seems to be more or less stable, and that of Opium (already “old” drug) is continuously downward.

2.7. DRUG LEGISLATION AND POLICY

2.7.1. Illicit drugs. In the new Penal Code of the Republic of Albania (1996) all kinds of activities concerning illicit drug traffic, production, sales, and possession, are considered as punishable penal acts and criminal offences against the public order and public security. There are several law items (namely the items 283, 284, 285, 286) where it is foreseen and determined the sentence to 5-15 years’ imprisonment for the production, preparation, distribution, transportation, possession, and sales of drugs and psychotropic substances of any kind, and the sentence to 10-20 years for organizing and/or financing such an activity (the item 283) ; the sentence to 3-10 years’ imprisonment for the narcotic plant cultivation and to 5-10 years for organizing and/or financing this activity (the item 284) ; the sentence up to 5 years’ imprisonment for the production and/or distribution of drugs precursor substances (the item 285); the sentence to 5-10 years’ imprisonment for the propaganda and incitement of drug use to the people (up to 10-15 years when the children are subjects of such an incitement) (the item 126).

Recently a review of these items is going to be undertaken, aiming at a further severity of the respective sentences.

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2.7.2. Licit Drugs. The recent “Law for narcotic medicaments” (law no. 7975, July 1995) details all of the rules for the licit drugs, namely their fabrication, dealing, and prescriptions concerning their use, maintenance, control, registration ; the administrative measures are also foreseen.

2.7.3. Drugs Policy Structure and Drugs Information System. In 1996 the National Committee for the Fight against Drugs, presided by the Deputy Prime Minister and composed by the ministers of all the ministries involved in the drugs fight, has been created, (Governmental Resolution No 412, May 20, 1996, signed by the Albanian Prime Minister). This Committee, a national intersectoral organism, supervising the activities of each governmental sector, represents the Albanian Policy-Maker concerning Drug Policy.

By the same Governmental Resolution the National Center of Drugs Information System has been created : this Center is equalized with the Department of Epidemiology and Biostatistics of the National Institute of Public Health and is presided by the Head of that Department. All the governmental sectors involved in the drugs problems should regularly send the respective data to that center.

In 1998 the National Interdisciplinary Technical Council on Drugs (a technical Task Force) has been set up and has requested its formal (official) recognition. The establishment of the Task Force was promoted by the PHARE Programme jointly with UNDCP. It represents the Albanian Policy-Planner, that is the technical body of the National Committee for the Fight against Drugs.

2.7.4. DRUG DEMAND REDUCTION POLICY AND STRATEGIES . In 1998-1999 Albania followed the EU Phare Programme on Primary Prevention which was mainly focused in the levels of primary and secondary schools, local community, and high-risk groups. Into such a frame the objectives and strategies of drug demand reduction were developed. Anyhow it should be stressed that more resources have been devoted and still are going to be devoted to supply reduction though the most effective and appropriate approach to the drug problem is to address both supply reduction and demand reduction in a comprehensive, balanced and coordinated way so these strategies can reinforce each other.

OBJECTIVES AND PRIORITIES . Objectives : - To create the national DDR strategy ; - To increase the position of DDR within a comprehensive drug policy ; - To further increase the awareness of the people towards drug phenomenon ; - To strengthen intersectoral drug-coordination approach. Priorities : - Prevention : initiation of structured school-based programmes, involving mass-media in awareness raising ; - Development of a treatment system in all its levels ; - Harm reduction ; - Innovative drug education and promotion ; - Wider involvement of NGOs ; - Basic training in prevention and treatment.

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2.7.5. POLICY ASPECTS. - Main objective of drug prevention = Do not use any drug at all. - Main objective of health intervention = Harm minimization. - Main focus of treatment measures = Low threshold projects. - Main focus of police activities = Drug law offences.

3. PATTERNS AND PREVALENCE OF DRUG USE AND RELATED PROBLEMS.

3.1. PATTERNS AND PREVALENCE RATES AMONG THE GENERAL POPULATION.

3.1.1. There have not been carried out yet population-based epidemiological surveys aiming at determining the prevalence rates of drugs use among the general population. A cross- sectional epidemiological survey carried out in 1998 aimed at the needs assessment among the general population, thus not being focused at drugs use/misuse.

3.1.2. Nevertheless, a general idea, though not scientifically based, might give the following figures : some 5,000 drugs users in 1995 and some 20,000 ones in 1998 throughout the country, (occasionally drugs users being included in such figures).

3.1.3. Estimated number of drug users in need of treatment accounts for 3,300 persons in 1999 what does mean the estimate of problem drug users undergoing treatment seems to be around 1/1,000 of the population.

3.1.4. Concerning drug type, the estimated rank order of prevalence among the general population, starting from the highest prevalence is as follows : - Cannabis : the highest prevalence - Heroin : the second in the rank order - Cocaine (and crack) in the third rank order.

3.1.5. The geography of drugs users. Actually (1999) all but the country’s districts represent the geography of drugs users though with conspicuous differences concerning the prevalence rates, whereas till 1997 the geography of drugs users was limited in the districts of Central and Central-West part of the country. The highest prevalence rates still remain in Tirana, Durres-Kavaje-Shijak, Shkodra, Vlora, and Berat.

3.2. PREVALENCE RATES FROM SCHOOL SURVEYS . Four school surveys have been carried out in the country during the years 1997-1998. The overall figure of prevalence rates of drugs use results to be 10-12%, what indicates a considerable level of drugs use (both regular and occasional users) amongst the school youth ( Concerning the type of drug, Cannabis (mainly Marijuana) accounts for 60-65% of cases, Heroin for 20-25%, and Cocaine for 10-12%.

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3.3. LAW ENFORCEMENT INDICATORS .

3.3.1. Drug seizures and Police arrests data. (Source : Ministry of Public Order) The data concerning seizures of drugs in Albania by quantity from 1993 to the 1st half of 1999 are given in Table 6. Table 7 and Graph 5 represent the data on cultivated narcotic plants of Cannabis sativa destroyed by the police during in 1997, 1998, and 1st half of 1999. The respective data on the local cultivation of Cannabis and local production of Marijuana highlights a conspicuous rising trend over years. Such a trend might only partly be explained by the quantitatively and qualitatively rising police activity, what does mean of a real trend in absolute figures. There are not yet data regarding locally produced opiates.

Table 6 Seizures of drugs in Albania by quantity from 1993 to the 1st half of 1999

Drug type 1993 1994 1995 1996 1997 1998 1st half of 1999 Cannabis (Marijuana) (kg) - - 150.0 198.0 944.0 2,307.5 2,584.1 Cannabis (Hashish oil) (liter) - - - - - 13.0 Heroin (kg) 0.002 1.0 40.5 5.75 0.061 0.161 7.106

Opium (kg) ------0.026

Cocaine (kg) - - - 0.002 0.006 7.512 0.0006

Amphetamines (kg) - - - - - 0.683 0.0093

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Table 7 and Graph 5

Albania : Cultivated Cannabis sativa plants destroyed by the police

1997 1998 1st half of 1999 807 roots 62,742 roots 52,000 roots

70000 60000 50000 40000 30000 20000 10000 0 1997 1998 1st half of 1999

Data on drug-related criminal offences from 1993 to 1997 (for 1998 the data were not available) are given in Table 8.

Table 8

Albania : Drug-related criminal offences (police arrests) from 1993 to 1997

Drug type 1993 1994 1995 1996 1997 1998

Cannabis cultivation 14 44 320 391 NA NA Cannabis traffic - - 35 64 87 NA Heroin 1 3 5 19 12 NA Cocaine - - - 5 2 NA others - - - - - NA

3.3.2. Purity and retail price of illicit drugs. Purity of seized heroin ranges between 50%-65% that is a high purity level. Its street (retail) price ranges between 20-25 USD per gram. Retail price of cocaine ranges between 50-60 USD per gram. Retail price of Marijuana is about 5-6 USD per pack. 3.3.3. There are not in our availability the data concerning Prosecution and Convictions for the period 1997-1999 because of the impossibility of getting them from the Ministry of Justice.

Phare Project on Drug Information Systems 17 National Report 2000 Albania

3.3.4. The above Law Enforcement Data show a conspicuous increase of both drugs trafficking and narcotic plants cultivation over the period 1993-1998 (1999). The very strategic geographical position of Albania into the passage East-West determines it as a very potential key point into the traffic of drugs.

4. SUBSTITUTION TREATMENT

Methadone substitution is not yet put into the practice of drug treatment (financial reasons).

5. CONCLUSION

THOUGH DRUGS PROBLEM IS A RECENT HEALTH/SOCIAL PHENOMENON IN ALBANIA (STARTING FROM THE YEARS 1992-1993), STATISTICALLY SIGNIFICANT INCREASING LEVELS OF HEALTH INDICATORS (DATA ON FIRST TREATMENT DEMAND AND TREATMENT DEMAND, NON-FATAL DRUG-RELATED EMERGENCIES , ETC) AND LAW ENFORCEMENT INDICATORS (QUANTITIES OF ILLICIT DRUGS SEIZED AND NUMBER OF DRUGS RELATED CRIMINAL OFFENCES ) OVER THE FOLLOWING YEARS (1995 ONWARDS), AS WELL AS THE DATA OF EPIDEMIOLOGICAL SURVEYS (INCREASED PREVALENCE RATES AS REGARDS THE TIME AND PLACE) BEAR WITNESS TO AN ACTUAL WIDESPREAD EPIDEMIC OF DRUGS USE/MISUSE IN THE COUNTRY. THUS THE DRUG CULTURE HAS ALREADY VERY WELL PENETRATED THE ALBANIAN SOCIETY AND THE RISK OF A COLOMBIAN -STYLE SYNDROME IS VERY REAL. SUCH A DANGEROUS SITUATION STRONGLY EMPHASIZES THE INDISPENSABILITY OF URGENT INTERVENTIONS AIMING AT SETTING-UP THE PROPER PREVENTION STRATEGIES . ______

Phare Project on Drug Information Systems 18 eesv MSDP WG Plein 65, NL - 1054 RB Amsterdam, The Netherlands Tel: +31.20.685.50.82, Fax: +31.20.612.57.91