Bogusława Bukowska, Dawid Chojecki, Piotr Jabło
ski, Łukasz Jdraszak, Agnieszka Kolbowska, Michał Kidawa, Artur Malczewski, Małgorzata Maresz, Elbieta Milczarek, Danuta Muszy
ska, Katarzyna Pacewicz, Klaudia Palczak, Anna Radomska, Jolanta Rogala-Obłkowska, Janusz Sierosławski

2006 NATIONAL REPORT (2005 data) TO THE EMCDDA by the Reitox National Focal Point

POLAND New Development, Trends and in-depth information on selected issues

REITOX

Table of Contents for National Reports

Page

Summary ...... 3

Part A: New Developments and Trends ...... 6

1. National policies and context ...... 6 2. Drug Use in the Population ...... 21 3. Prevention ...... 33 4. Problem Drug Use ...... 41 5. Drug-Related Treatment ...... 55 6. Health Correlates and Consequences ...... 59 7. Responses to Health Correlates and Consequences...... 71 8. Social Correlates and Consequences ...... 76 9. Responses to Social Correlates and Consequences...... 86 10. Drug Markets...... 89

Part B – Selected Issues ...... 100 11. Drug Use and Related Problems among Very Young People ...... 100 12. Cocaine and Crack – Situation and Responses ...... 108 13. Drugs and Driving ...... 124

Part C ...... 128 14. Bibliography o Alphabetic list of all bibliographic references used ...... 128 o Alphabetic list of relevant data bases ...... 131 o Alphabetic list of relevant Internet addresses ...... 131

15. Annexes ...... 132 o List of Standard Tables and Structured Questionnaires used in the text ...... 132 o List of Graphs used in the text ...... 133 o List of Abbreviations used in the text ...... 136

2 SUMMARY

Licit and illicit psychoactive substances and the related problems have been monitored in Poland for many years. Despite the methodological limitations connected with estimating the drug phenomenon as well as the availability and credibility of some data we are able to describe the phenomenon and portray the scope of the drug problem and its trends. The demand for drugs can be measured through the prevalence of use. There are several sources of information on this subject. One of them is the national survey audit on the use of alcohol and other drugs by school youth. The survey was conducted on a representative sample of pupils of third grades at lower secondary schools “gimnazja” and second grades at secondary schools according to the methodology of the European School Survey on Alcohol and Other Drugs (ESPAD). The aim of the survey of 2005 was to estimate the prevalence of substance use by school youth prior to coming into force of the National Programme for Counteracting Drug Addiction 2006-2010. The results indicate far higher prevalence of illicit substance use than licit one. The comparison of the results of the survey of 2005 with the results of the previous surveys points to the decline in the upward trend in the use of both licit and illicit psychoactive substances. Among the illicit substances the highest prevalence is noted in cannabis. The lifetime prevalence of cannabis use stood at 14.2% in the younger pupils and 31.5 in the older ones. Second comes amphetamine (3.6% of the younger pupils and 12.4% of the older pupils). Both experimenting with illicit substances and the occasional use are more prevalent in boys than girls. The majority of the adolescents are well-oriented in the health and social threats related to substance use. The degree of risk, according to the pupils, is more dependent on the frequency and the way of use rather than the type of substance. It must be noted that cannabis is viewed more liberally by than other illicit substances. Both 70% of third-graders of lower secondary schools and second-graders of secondary schools participated in preventive classes the year before. The majority of the respondents notice the influence of the classes, at least in the field of their own perception of drug use. Another source of information on drug use in our country is the survey conducted in 2002 on the national random sample of adult citizens of Poland. The survey called “Psychoactive substances – attitudes and behaviours” dealt with the prevalence of substance use and the attitudes of Poles to alcohol and drug-related problems. It was the first survey of such type carried out on a national scale. Its results showed that drugs in Poland ceased to the problem of young people. They are entering the world of adults.

Among the citizens of age, especially in big cities, the prevalence of illicit substance use does not deviate from the prevalence in schools. Poles regard drug addiction as a problem of public health rather than public security.

3 Trends in the development of drug addiction understood as a regular drug use that causes acute problems i.e. mental and behavioural disorders may be followed through statistical data of the residential psychiatric treatment system. The number of patients treated at specialist facilities and hospital wards due to addiction has been rising in recent years. In 2004 12 836 users were admitted to residential treatment. It was an increase of 9.0% compared to 2003, when 11 778 patients were admitted. The percentage of first-time patients did not change a lot and stood at 56.4%. The gender structure of patients admitted to residential treatment has been holding steady for many years. In 2004 the percentage of women was 23.6% (22% in 2000, 24% in 2003). The changes are also observed in the age structure, in 2004 the percentage of patients aged 16-24 fell to 48% (54.7% in 2000, over 51% in 2003) and the proportion of the oldest patients (over 45) rose to 12.7% (8% in 2000, 11.3% in 2003). A decrease in young patients may mark the beginning of the trend stabilization. The most numerous group still remains the group of opiate users (20%) then, in terms of numbers, came users of tranquilizers and sleeping pills (11%), amphetamines (9%), cannabis (3%) and inhalants (2%). The remaining categories of patients do not exceed 1%. It must be stressed that more than a half of patients falls in the category: mixed and undefined substances. In 2005, similarly to previous years, there were strong territorial variations in the prevalence of drug addiction. The territorial distribution of the phenomenon provides three areas of increased drug prevalence: western part of the country - regions of dolnoslaskie, lubuskie and zachodniopomorskie, northern part – warminsko-mazurskie region and central part – mazowieckie region.

The latest estimate of the number of drug addicts in Poland which included persons not covered by the reporting treatment system is based on the results of the study conducted in 2002. According to this estimate the number of drug addicts ranges from 35 000 – 75 000. One of the most serious drug-related health problems is infectious diseases. Injecting drug use poses a great risk of HBV, HCV or HIV infection. The data on drug-related HIV infections and AIDS cases as well as data on the incidence of infectious diseases in injecting drug users come from the National Health Institute. The number of new HIV infections in injecting drug users reported in standard statistics in recent years has been decreasing similarly to AIDS cases, which are reported with considerable delay.

The most dramatic consequences of using drugs are fatal overdoses. The source of information on this subject is the register of the Main Statistical Office. Drug-related deaths selected according to the national definition include ICD-10 codes: F 11-12, F 14-16, F19, X42, X44, X62, X64, Y12 and Y14. In recent years in Poland the trend has been stabilizing and since 2002 it has been falling. The data of 2002 reveal 324 drug-related deaths, 179 deaths in 2003 and 149 in 2004.

4 Pursuant to Article 26.5 of the Act of Law of 29 July 2005 on counteracting drug addiction benefits of treatment, rehabilitation and reintegration are provided free of charge for a drug addict regardless of his or her place of residence in Poland. Health services for drug addicts are provided through the network of ambulatory and residential public or non- public health care centres. The basic link of the first aid and psychological counselling are ambulatory clinics. The most popular ambulatory clinics include Prevention and Treatment Counselling Centres (Poradnie Profilaktyki i Leczenia Uzale
nie). In 7 years from 1998 to 2004 the number of counselling centres doubled and the number of patients increased sixfold (number of counselling centres rose from 34 in 1998 to 73 in 2004, number of patients at these centres rose from 4 991 in 1998 to 30 601 in 2004). The system of health care for drug addicts is still dominated by long-term and mid-term residential treatment. However, the trend of shortening the therapy is being observed. Residential treatment facilities are located outside urban areas and perform treatment and rehabilitation based on a therapeutic community model. In 2004 there were 52 residential treatment facilities in Poland housing 2 330 beds and 73 counselling centres. 26 out of the residential treatment facilities admitted underage patients. The other forms of assistance to drug addicts, available to a limited extent, are provided in Poland by detoxification wards, day care centres, drug treatment hospital wards, harm reduction programmes, therapeutic wards for drug addicts at penal institutions as well as social reintegration programmes. Selected centres provided services for patients with dual diagnosis. 750 opiate addicts (in 12 programmes) remained under substitution treatment. A serious problem is treating minors obliged to enter drug treatment by a court order.

5

Part A: New Developments and Trends

1. National policies and context

1.1. Legal framework o Laws, regulations, directives or guidelines in the field of drug issues (demand and supply)

- New Act of Law on counteracting drug addiction On 4 October 2006 a new Act of Law on counteracting drug addiction came into force. The laws of 1997 had to be modified in order to harmonise the Polish legislation with the EU acquits and to bridge the gaps in the existing regulations. Especially the latter was voiced by drug treatment specialists. The works on the new law were accompanied with selective approach of the public opinion and the media. The hot potato was possession of small amount of drugs for private use. This issue was the focal point of the media coverage and participants of the ‘social listening’, which is a form of social consultation organized by the Minister of Health. However, apart from penal provisions that eventually did not undergo major changes the Act introduces a number of vital changes to the field of counteracting drug addiction. This chapter deals with these changes (Bukowska 2005).

- National Programme for Counteracting Drug Addiction New provisions of the Act on counteracting drug addiction significantly influenced the National Programme for Counteracting Drug Addiction (NPCDA). The provision that the NPCDA is the basis for the activities in counteracting drug addiction remained in force, however, there were changes to the general aims of the document and its status. The NPCDA shall define only courses of action for self governments, leaving it to them to decide as to specific problems and ways of solving them. Regarding the governmental administration the general aims of the NPCDA did not change. The principle of detailed courses of action formulated by the ministries and ways of implementing them was upheld. The status of the document changed. Before the NPCDA was adopted by way of a resolution by the Council of Ministers, the existing Act binds the Council of Ministers to adopt a regulation on the NPCDA.

6

- Provincial and Communal Programmes for Counteracting Drug Addiction The necessity to take more systemic and structured actions in counteracting drug addiction at the level of communes and regions was raised by a number of communities. Responding to these expectations the Act introduces an obligation to adopt Provincial and Communal Programmes for Counteracting Drug Addiction by the provincial council and the commune council. The executive bodies of the provincial and communal government are responsible for developing adequate draft projects and may appoint a proxy for the implementation thereof. With reference to the commune the legislator listed a number of commune’s statutory tasks. The new Act on counteracting drug addiction, while amending the provisions on the Act on upbringing in sobriety and counteracting alcoholism, points to the sources of financing tasks listed in the Provincial and Communal Programme for Counteracting Drug Addiction. They include charges and revenues from permits for wholesale and retail trade in alcohol.

- Provincial expert The idea of appointing the provincial expert by the executive body of the region was sanctioned by the new Act. It was developed at the time when Poland was in the process of joining the EU and establishing the NFP. Provincial experts were intended to form a network of cooperation with the NFP at the region level. Then it seemed that if the Centre were to fulfil its function effectively it ought to have adequate counterparts at the level of regions – provinces. This way the marshals appointed regional experts (currently named provincial experts) cooperating closely with the National Focal Point at the region level. They are responsible for collecting data, exchanging information and documentation in the field of counteracting drug addiction to be covered by the public statistics research, initiating and conducting research on drug addiction as well as formulating conclusions for adequate anti- drug strategies at the level of a region. It seems that new legislative solutions provide local governments with a new instrument, which will contribute to more effective preventive activities and better quality thereof.

- Coordinating anti-drug policy at national level The new provisions on the Council for Counteracting Drug Addiction were influenced by the experiences with this body under the previous Act on counteracting drug addiction. Observing the inadequacies of the previous regulations the new Act expanded the powers of the new Council and changed its composition. The present powers bil down to advising the Prime Minister. However, it remains responsible for coordinating activities in counteracting drug addiction. The decision to amend the law in this respect stemmed from the fact that the previous solutions of superiority of specialist opinions and reports did not guarantee equal

7 opportunity to implement recommendations and decisions taken by the Council. Now the members of the Council comprise only secretaries and undersecretaries of state in relevant ministries. Considering the above composition of the Board, opportunities of effective coordination of activities in the field of drug addiction have been considerably expanded and strengthened. The advisory role shall be implemented through expert teams appointed by the Chairman of the Council.

- Drug treatment and rehabilitation The Act upheld the previous provisions on the drug treatment for addicts regardless of their place of residence in the country and the free-of-charge approach to treatment and rehabilitation. The principle of voluntary treatment and rehabilitation was also preserved with the exception of minors who can be referred to treatment by the court of law. Within the meaning of the new regulations more entities may conduct substitution treatment i.e. both public and non-public health care units upon approval and meeting requirements set out in the Regulation on substitution treatment. Moreover, provisions of the new Act define specialist qualifications allowing for performing rehabilitation of drug addicts. Drug rehabilitation may be performed by a doctor specializing in psychiatry and a person who graduated from a training course in drug addiction according to a curriculum selected by way of competition and approved by the Minister of Health. The certificate of drug therapy specialist may be obtained by any person with a university degree in medicine, psychology, pedagogy, social reintegration, sociology, family sciences or theology. The certificate of drug therapy instructor maybe obtained by a persons with at least secondary education who graduated from the abovementioned specialist training programme.

- Penal provisions Similarly to the previous years the hottest issue were provisions penalizing possession of small amount of drugs for private use. Amending the law of 1997 and tightening it in 2000 was proposed by the Minister of Health. New solutions were meant to stop sentencing drug users to imprisonment for possession of small amount of drugs for private use while upholding at the same time the criminal character of the same act. The proposition however did not meet with the understanding of the public opinion and the Parliament. Eventually Article 62 of the Act of 29 July 2005 received the following wording: “whoever possesses narcotic drugs or psychotropic substances is subject to three years’ imprisonment. If the object of the crime is (…) considerable amount of narcotic drugs or psychotropic substances the perpetrator is subject to a fine or the imprisonment of up to 5 years. In the case of the act of lesser gravity the perpetrator is subject to a fine, the penalty of limitation of liberty or imprisonment of up to one year”.

8 The new Act expanded the list of measures alternative to imprisonment. In the light of the new provisions the prosecutor may suspend the proceedings if the addict or the person using harmful substances who has been charged with an act subject to the penalty of imprisonment not exceeding 5 years of imprisonment enters treatment and rehabilitation or participates in a prevention and treatment programme. In this case the prosecutor upon completion of treatment considering the results thereof decides to continue proceedings or moves the court for conditional discontinuance of the proceedings. o Laws implementation The consequence of the new Act is the introduction of detailed provisions by way of regulations. First it is the National Programme for Counteracting Drug Addiction 2006-2010. As it has been mentioned it has changed its legal status. At present it is the regulation adopted by the Council of Ministers. It is developed by working teams composed of representatives of Ministries involved in counteracting drug addiction both in drug demand and supply reduction. In the Polish legal system it fulfils the role of a national strategy and an action plan. Due to its character it will be described in the section on anti-drug strategies and action plans (subchapter 1.2.). Then comes the regulation on conduct procedure for training purposes with narcotic drugs, psychotropic substances or preparations thereof and group I-R precursors as well the conditions for storing and ways of destroying thereof by organizational units of the governmental administration. The regulation specifies general principles, procedures and conditions for procuring, storing and using for training purposes narcotic drugs and group I-R precursors. The abovementioned activities are performed by units of governmental administration and higher education schools. Moreover, storing and destroying these substances shall be performed by the units of governmental administration in the process of operational and intelligence activities. The above regulation stipulates two ways of coming into possession of group I-R substances. One is through procuring them in pharmaceutical wholesale businesses upon an order containing the following: name of the unit, international name of the order, commercial name, pharmaceutical form and the amount, stipulation of the person entitled to pick it up as well as the date of the order and the stamp, signature, first and last name of the manager. Another possibility of coming into possession of group I substances is takeover. It may take place through a court order and the forfeiture for the benefit of the state treasury, through takeover from other units of governmental administration and higher education

9 school upon approval from their managers, as well as from other entities upon consent of the managers of governmental administration and higher education schools. Moreover the regulation specifies in detail the requirements as to keeping the documentation on these substances on premises of the authorized centres. According to the above rules every takeover or pick-up of the substances is recorded and contains information on the amount of the substance picked up or taken over as well as the information on the person picking it up. Additionally units of governmental administration and higher education schools are bound to destroy these substances in compliance with the procedures set out by the Provincial Pharmaceutical Inspectorate. They may take advantage of the services of companies performing business activity in recycling and neutralising waste material and holding relevant permits. The procedure for destroying these substances are set out in detail in the Act of Law of 29 July 2005 on counteracting drug addiction (Journal of Laws “Dz. U.” 2005.179.1485).

1.2. Institutional framework, strategies and policies o Coordination arrangements In Poland the problem of drugs and drug addiction is viewed from the perspective of public health. The institutional framework of counteracting drug addiction is laid out in the Act of Law of 29 July 2005 on Counteracting Drug Addiction (Journal of Laws 2005) and the National Programme for Counteracting Drug Addiction 2006-2010 – NPCDA (Journal of Laws 2006). Pursuant to Article 12 of the Act of Law competences and powers of the National Council for Counteracting Drug Addiction, as a coordinating and organizational body in counteracting drug addiction, were expanded (since March 2001 the Council used to operate as an opinion-making body).

However, it is the National Bureau for Drug Prevention – NBDP that is responsible for drafting the National Programme for Counteracting Drug Addiction and monitoring its complementation, in cooperation with other entities relevant to act thereupon; as well as producing and submitting to the Minister competent for health matters the report on the implementation of the National Programme for Counteracting Drug Addiction (Article 6.3)

Chapter 2 of the Act (Article 5-18) lists entities responsible for counteracting drug addiction and the NPCDA specifies ministers responsible for the implementation of individual courses of action. In the “Supply” area one of the five key courses of action is the improvement of coordination of combating drug-related crime.

10

o National plan and/or strategies In 2005 there were intensive works in progress on the Polish anti-drug strategy. The National Programme for Counteracting Drug Addiction 2006-2010 (Journal of Laws 2006) was being developed in working groups designated to individual thematic areas. During the document development objective oriented programme planning was applied. The National Programme 2006-2010 was being based on the following principles: realism, the context of other psychoactive substances, participation and building social acceptance. As the modern prevention strategies increasingly feature the notion of balanced approach, the national Programme shall be implemented in 5 key areas: prevention, broadly understood treatment, supply reduction, research and monitoring and for the first time international cooperation. The Programme sets out courses of action and implementation indicators as well as ministers and relevant entities responsible for the implementation thereof. A novel idea about the National Programme 2006-2010 is that it determines courses of action for the local government, which should contribute to better availability and diversity of the projects implemented.

The National Programme for Counteracting Drug Addiction is aligned with the EU Drugs Strategy 2005-2012 (Council of the European Union 2004) and the EU Drugs Action Plan 2005-2008 (Council of the European Union 2005).

The National Programme for Counteracting Drug Addiction 2006-2010 was adopted by the Council of Ministers on 27 June 2006 and it is an executive act to the Act of Law of 29 July 2005 on Counteracting Drug Addiction. Pursuant to Article 7 thereof, it provides for counteracting drug addiction in Poland. Compared to the previous programmes, the new Programme in the form of a regulation, has become far more binding.

In the field of prevention the National Programme aims at stopping the growth rate of demand for drugs through developing strategies and programmes for counteracting drug addiction at communal and provincial level and improving quality and effectiveness of prevention programmes. The following courses of action are of special importance in drug prevention: 1) Increasing involvement of local governments in counteracting drug addiction. 2) Raising quality of local, regional and ministerial anti-drug strategies. 3) Improving knowledge of society on drug-related problems and drug prevention options.

11 Improving health and social functioning of drug addicts and users is an objective in the area of treatment, rehabilitation, harm reduction and social reintegration. The following tasks call for urgent action: 1) Raising quality of health services in treatment and rehabilitation of persons addicted to psychoactive substances. 2) Increasing availability of health services provided.

The main objective of the area of supply reduction is limiting availability of drugs. The objective shall be achieved through activities in the following directions: 1) Stopping the growth rate of domestic illegal production of synthetic drugs, precursors and drugs produced from natural components.

2) Stopping growth rate of trafficking in narcotic drugs and precursors into the internal market. 3) Reducing retail trade in drugs. 4) Improving coordination process of combating drug-related crime.

5) Strengthening actions aimed at dismantling the financial structure of the drug business.

The international cooperation activities are aimed at supporting the implementation of the National Programme in shaping the international anti-drug policy-making. Main objectives include:

1) Increasing Polish involvement in planning, making and coordinating EU anti-drug policy.

2) Increasing Polish involvement in the operations of international institutions and organizations dealing with drug addiction.

3) Development of Polish international cooperation with neighbouring countries both in the context of combating illicit drug trafficking and health care programmes.

In the field of research and monitoring the National Programme emphasises providing incentives to concrete activities and clues to the evaluation thereof through informative support for the National Programme for Counteracting Drug Addiction. The key courses of action include: 1) Epidemiological monitoring of the problem of drugs and drug addiction in Poland in relation to the rest of Europe.

2) Monitoring social responses to the problem of drugs and drug addiction including monitoring and evaluation of the National Programme for Counteracting Drug Addiction.

3) Development and consolidation of the information system on drugs and drug addiction.

12

o Implementation of policies and strategies Upon coming into force in 2005 of the Act of Law on Counteracting Drug Addiction the executive bodies of provincial governments were bound to develop Provincial Programmes for Counteracting Drug Addiction (Article 9) including courses and types of actions stipulated in the National Programme and to appoint provincial experts in information on drugs and drug addiction. A provincial expert is responsible for performing the following tasks financed from the provincial government budget:

• collecting and exchanging information and documentation related to counteracting drug addiction, covered by statistical research of public statistics as well as developing and processing data collected; • conducting and initiating drug-related studies as well as developing and sharing results thereof; • collecting, storing and sharing drug-related databases; • formulating conclusions favouring adequate anti-drug strategies as well as collecting and sharing publications on drugs and drug addiction.

Pursuant to the provisions of the Act (Article 10) counteracting drug addiction is one of the statutory tasks of a commune. Executive bodies of provincial governments and communes are bound to produce annual reports on the implementation of Provincial and Communal Programmes and the results thereof and to provide information on the performance of the tasks in a given year resulting from a Provincial or a Communal Programme in accordance with the questionnaires developed by the National Bureau. o Impact of policies and strategies The outcome of the Polish anti-drug policy and the strategies for counteracting drug addiction can be evaluated on the basis of reports on the National Programme for Counteracting Drug Addiction implementation (NBDP unpublished report, 2006a; Minister of Health 2005). The year 2005 concluded the implementation of the National Programme for Counteracting Drug Addiction 2002-2005. The Programme covered a broad range of activities and was originally intended to integrate activities aimed at drug prevention. The analysis of annual reports on the implementation of the NPCDA showhs that the vast majority of National Programme activities were completed; however, some of them require further efforts in the coming years. Drug prevention offer is insufficient in terms of community programmes addressed to drug endangered persons and youth leader programmes. Such projects should involve local

13 authorities that up to now have been helpful especially in the case of school prevention programmes. In drug treatment and rehabilitation it is necessary to increase the availability of substitution treatment taking into the account that in Poland there is a long tradition based on a drug-free residential treatment model run by non-governmental organizations. Specialist therapeutic programmes in prisons as well as are scarce. The same refers to the programmes aimed for minors bound for drug treatment by order of Family Court. Moreover, ambulatory treatment with wider psychosocial interventions must be further developed. In supply reduction operational activities should limit the availability of drugs to individual drug users and, moreover, data collection systems of drug-related crime should be adapted to the needs of monitoring activities performed under the NPCDA and the international requirements. Regarding the drug research area it is vital to implement the database system of reporting to drug treatment in line with EMCDDA standards. Moreover, other fields should be subject to research e.g. cohort studies of drug-related deaths or qualitative studies in hidden populations (e.g. in cocaine users) The outcome of the National Programme for Counteracting Drug Addiction 2002-2005 are indicative of the necessity to continue the actions taken.

1.3. Budget and public expenditure o In law enforcement, social and health care, research, international actions, coordination, national strategies Detailed calculation of financial resources disbursed on counteracting drug addiction in 2005 is not feasible without conducting a study in this field. Below we provide expenditure incurred in connection with the implementation of the National Programme for Counteracting Drug Addiction in 2005 (NBDP unpublished report, 2006a). It should be mentioned that the institutions that were bound to perform the Programme activities did so within their own budgets as the National Programme for Counteracting Drug Addiction 2002-2005 was not allotted separate budget. The breakdown below is only estimation.

Based on the amounts provided by the reporting entities it may be estimated that the overall implementation cost of the National Programme for Counteracting Drug Addiction in 2005 increased by 32% compared to 2004 from EUR 52 135 698 to EUR 68 822 566.

The analysis of costs incurred by the central institutions due to the implementation of the National Programme for Counteracting Drug Addiction increased from EUR 38 473 169 in 2004 to EUR 50 371 401 in 2005. In the case of costs incurred by local authorities of all 14 tiers we observe an increase of 31% compared to 2004. In 2005 local authorities allocated EUR 18 451 165, i.e. 27% of all expenditure on the National Programme for Counteracting Drug Addiction.

Table 1. Expenditure on implementation of National Programme for Counteracting Drug Addiction (NPCDA) in 2005 in EUR1

Expenditure on implementation No Institution of NPCDA in EUR

1. Bureau for Chemical Substances and Preparations n.a.

2. Central Board of Prison Service 2 791 570

3. General Inspector of Financial Information n.a.

4. Main Pharmaceutical Inspectorate n.a.

5. Institute of Psychiatry and Neurology 53 944

6. Police Headquarters 35 139 949

7. Border Guard Headquarters 254 568

8. Ministry of National Defence, including: 687 023 a) Military Police Headquarters b) Management Board of Military Health Service

9. Ministry of National Education and Sport 40 244

Methodological Centre of Psychological 4 904 and Pedagogical Assistance

10. Ministry of Finance – Customs Service n.a.

11. Ministry of Interior and Administration 123 391

12. Ministry of Justice 28 059

13. Ministry of Health:

a) NBDP 2 760 051 b) Bureau of International Payments 2 367 749

14. Branches of National Health Fund 6 116 700

15. State Sanitary Inspection n.a.

1 Conversion based on average National Bank of Poland exchange rate of PLN to EUR as of 25 August 2006 EUR 1 = PLN 3.93 15 Expenditure on implementation No Institution of NPCDA in EUR

16. Communal (Local) Governments 11 553 638

17. County Governments 5 869 159

18. Provincial (Regional) Governments 1 028 368

19. Provincial Pharmaceutical Inspectorates 3 248

in total: 68 822 566

The analysis of the budget of the National Bureau for Drug Prevention 1999-2005 (NBDP 2000-2005, 2006b) shows the reduction of expenditure on drug prevention. Financial resources of the Ministry of Health allocated to the activities in this field are steadily being reduced. The reduction of the NBDP budget results from the fact that financing drug therapy and rehabilitation was first taken over by the National Health Fund and then reallocating financial resources assigned to the purchase of health services including health services for non-insured persons directly from the budget of the Ministry of Health. On the other hand during the implementation of the National Programme the National Bureau for Drug Prevention substantially extended the scope of the activities which were not allotted with additional resources.

Figure 1. Budget of National Bureau for Drug Prevention 1999-2005 in PLN (PLN 1 = EUR 0,255)

25 000 000

20 000 000

15 000 000

10 000 000

5 000 000

0 1999 2000 2001 2002 2003 2004 2005

16 o Funding arrangements In the case of the institutions bound to implement tasks of counteracting drug addiction the expenditures are included in annual budgets of these institutions or the resources on counteracting drug addiction are not distinguished as they are strongly integrated into the statutory activities serving purposes other than counteracting drug addiction. Regarding local authorities, the Act of Law of 29 July 2005 on counteracting drug addiction (Article 75) introducing amendments to the Act of Law of 26 October 1982 on upbringing in sobriety and counteracting alcoholism (Journal of Laws of 2002, No. 147, item 1231 as further amended) provides for obtaining resources at communal level through retail sales of alcohol and at provincial level through wholesale sales of alcohol. According to the legal provisions bodies of governmnetal administration and local authorities may finance actions of counteracting drug addiction performed by non- governmental organizations and other entities whose statutory activity covers public tasks suchas health care and promotion, charity, science, education, upbringing, physical culture, order and public security and social pathology prevention as well as promotion and orgranzation of voluntary work2.

1.4. Social and cultural context

In 2005 the National Bureau for Drug Prevention initiated and conducted a nationwide social campaign addressed to parents of school children entitled “Close to each other – further away from drugs”. The primary aim of the campaign was to make parents aware of drug-related problems, enhancing social knowledge in this field and underlining the upbringing role of parents in drug prevention with particular emphasis placed on good communication within a family. Another aim of the campaign was the promotion of anti-drug

2 Following documents are the legal basis for financing actions of counteracting drug addiction: 1) Act of Law of 29 July 2005 on counteracting drug addiction (Journal of Laws 2005.179.1485), 2) National Programme for Counteracting Drug Addiction 2006-2010 (Journal of Laws 2006.143.1033), 3) Regulation of the Minister of Health of 20 August 1996 on organizing and promoting mental health and preventing mental disorders (Journal of Laws 1996.112.537), 4) National Health Programme 1996-2005, Operational Goal No. 5, 5) Act of Law of 30 August 1991 on health care facilities (Journal of Laws of 1991 No 91 item 408 as further amended), 6) Act of Law of 27 August 2004 on health care benefits financed from public resources (Journal of Laws No. 210 of 2004, item 2135 as further amended), 7) Act of Law of 19 August 1994 on mental health care (Journal of Laws of 1994, No. 111, item 535 as further amended), 8) Regulation of the Council of Ministers of 20 December 2004 on way and mode of financing from the state budget health care benefits provided for non-insured beneficiaries (Journal of Laws No. 281, item 2789) 9) Act of Law of 26 November 1998 on public finances (Journal of Laws of 2003 No. 15 item 148 as further amended), 10) Regulation of the Minister of Health of 13 November 2000 on the National Bureau for Drug Prevention (Official Journal of the Ministry of Health of 2000, No. 2, item 44), 11) Act of Law of 24 April 2003 on public welfare and voluntary work (Journal of Laws No. 96 item 873).

17 hotline and online counselling centre as well as the promotion of institutions dealing with counselling and assistance in solving upbringing-related problems in a family. The campaign lasted 6 months and the implementing entities included media, local authorities and non- governmental organizations. The media part of the campaign was of a nationwide character thanks to the involvement of the media. It was conducted in cooperation with public TV, a number of radio stations, cinemas. It was launched in the press and on the Internet. The campaign was visible through the use of billboards, posters and city-lights. The campaign featured an anti-drug social video broadcast on TV and in cinemas. It was intended to make parents aware of the role of interpersonal communication, good relations, and real interest in matters important for a child. On the radio apart from a specially prepared social advert listeners had the opportunity to listed to a series of radio broadcasts dedicated to drug prevention. An important element of the campaign was also distribution of a high circulation of an educational brochure for parents.

The campaign evaluation results showed a very high visibility rate (61% of the target audience). According to the respondents who have seen the campaign the most effective media included TV (76%), press releases (46%) and billboard advertisements (41%). The survey indicated that almost every third parent that has had contact with the campaign message stated that he or she began to talk more with their children on important subjects. According to the respondents the advertisement made them aware of the risk of using drugs by their children and successfully promoted the anti-drug hotline. It is worth mentioning that the number of the hotline callers increased nearly twofold in the course of the campaign. The number of counsels provided through the online counselling centre increase substantially by 400%.

Moreover, the National Bureau for Drug Prevention monitors the press and every two months it publishes a selection of press excerpts on drug addiction. The information obtained through press releases reflects social perception of drug addiction. It is the way of getting more information on new trends and phenomena requiring intervention at management and planning level. Press articles usually supersede scientific research and constitute the first signals of new trends in drug use and new substances emerging on the drug scene.

The monitoring covers 190 press titles including national and regional dailies as well as other periodical press publications. The press information is analysed and the published in regular newsletters entitled “Selection of press excerpts on drugs and drug addiction”. As the press reports are dedicated to various aspects related to drug addiction they are divided into several thematic fields such as:

18 Figure 2. Subjects of press releases on drugs and drug addiction in 2005

Foreign affairs; 186; 6% Police actions; 1164; 41%

Other; 287; 11%

Studies, reports; 98; 3% Drug trafficking; 235; 8%

Drug outreach; 85; 3% Drug prevention; 328; 12%

Local initiatives; 72; 2%

State policy; 124; HIV/AIDS; 12; 0,4% 4% Social attitudes Youth, schools; 128; 1,8% 4%

Source: Newsletter of press excerpts based on bimonthly reports prepared by the NBDP

Figure 2 shows numerical and percentage breakdown of articles classified into the thematic fields. In 2005 the press featured mainly reports of supply reduction and the incidents of breaking the Act of Law on counteracting drug addiction. Police actions concerning detection of offences such as drug dealing, production, illegal cultivation of cannabis and drug trafficking constituted almost a half of the articles included in the breakdown, however, compared to 2004 there has been a decrease in the number of press releases in this thematic field. It is worth noting that compared to last year there has been an increase in the number of articles on drug prevention, state policy and “social attitudes”. The increase in the number of publications under the above thematic fields reflected the ongoing discussions in the press concerning the new Act of Law of 2005 on counteracting drug addiction. Other thematic fields did not feature so much press information and they are comparable with the previous period. The analysis of press excerpts was also conducted according to the names of individual psychoactive substances that emerged in the press (Figure 3). Out of all substances mentioned in press releases in 2005, similarly to previous years, number one was cannabis and then amphetamine. The third, though to a lesser degree, was ecstasy,

19 cocaine and opiates. The name “other” includes such substances as: GHB, anabolic steroids, mescaline, datura stramonium, methadone, methamphetamine. They were mentioned occasionally in the year.

Figure 3. Ranking scale of psychoactive substances mentioned in press publications on drug addiction in 2005

other 51 alcohol 97 hallucinogenic 19 psychotropic drugs 23 LSD 49 ecstasy 356 cocaine 347 opiates 322 amphetamine 689 1038 cannabis 0 200 400 600 800 1000 1200

Source: Newsletter of press excerpts based on bimonthly reports prepared by the NBDP

20

2. Drug Use in the Population

2.1. Drug Use in the general population There was no population survey implemented in 2005. Such a survey was conducted in 2006.

2.2. Drug Use in the school and youth population In October-November 2005 a school survey was conducted on a representative sample of third grade pupils of upper-primary schools (aged 15-16) and second grade pupils of secondary schools (aged 17-18) (Sierosławski 2006b). The survey was conducted in line with ESPAD methodology3. There were three ESPAD waves conducted in Poland - in 1995, 1999 and 2003. They allow not only for the estimation of the size of the problem but also keeping track of changes that have taken place in recent years.

The aim of the current study was measuring the prevalence of the use of psychoactive substances by young people. The survey was implemented with intention to provide initial assessment for evaluation of Drug Strategy and Action Plan for 2006-2010. The ESPAD schedule doe not fit in the schedule of Drug Strategies and Action Plans, hence we are not able to evaluate it using ESPAD data. The school survey 2005 provide us with the pictures of drug use among youth exactly at the moment before new Drug Strategy and Action Plan is implemented. Due to the purpose of the survey the implementation period fell in the autumn, differently from ESPAD which is conducted always in spring. This difference decreased the comparability of results of 2005 study and ESPAD due to seasonal variation of substance use (in spring slightly higher prevalence is expected) and several months younger population covered in autumn than in spring. This reservation should be taken into consideration when the trend is analyzed. The school survey has been planned for 2011, that means at the end of the implementation of National Drug Strategy and Action Plan. It will also be conducted in autumn. Meantime the ESPAD 2007 and 2009 will be conducted as usual in spring and after that the trend analysis will be more adequate.

The figures on prevalence of lifetime use of psychoactive substances other than alcohol and tobacco is presented in Table 2.

Table 2 figures show that among pupils of lower grades the first place in terms of prevalence is taken by tranquillizers and sleeping pills available without prescription (15%), then come marijuana and hashish (14%). Among pupils of higher grades the first place is

3 methodological information included in the ST02 21 occupied by marijuana and hashish (32%). Non-prescription tranquillizers and sleeping pills came second (19%). Among younger students inhalants ranked third (8%) and amphetamine (4%) fourth. In the older cohort the third place was taken by amphetamine (12%), the fourth by ecstasy (8%) and the fifth by inhalants (6%).

Among upper-primary school (‘gimnazjum’) pupils the threshold of 2% prevalence is even crossed by hallucinogenic mushrooms, cocaine, ecstasy and anabolic steroids. Among older pupils an analogous list of lifetime prevalence substances that have been used by more than 2% of the subjects is similar and covers LSD and other hallucinogens, hallucinogenic mushrooms, cocaine, and anabolic steroids. In the case of the majority of substances higher experimenting rates must be noted among older rather than younger groups. Only experiments with inhalants and Polish heroin are reported by upper-primary school pupils.

GHB, a new drug in Poland, had ever been used by less than 1% of the participants. A very low prevalence is also reported in terms of Polish heroin. These substances had ever been used by a similar percentage of participants, not far away from those who reported using a non-existent relevin.

Table 2. Lifetime prevalence of substances use

Grade level 1995 1999 2003 2005

Third grade at Marijuana or hashish 10.1 15.1 19.2 14.2 upper-primary Inhalants 10.4 9.1 9.3 7.5 schools Non-prescription tranquilizers or 18.5 18.3 17.3 15.1 sleeping pills Amphetamine 2.9 7.4 6.0 3.6

LSD or other hallucinogens 1.9 4.0 2.5 1.6

Crack 0.5 1.0 1.6 1.0

Cocaine 0.8 1.9 2.2 2.1

Relevin 0.4 1.0 0.7

Heroin 0.8 5.7 1.8 1.2

Ecstasy 0.8 2.8 2.8 2.5

Hallucinogenic mushrooms 3.5 2.9

GHB 0.8 0.8

Injecting drugs 1.2 0.8

Alcohol and pills 8.4 6.9 Alcohol and marijuana 11.3 7.7 Anabolic steroids 2.8 3.4 2.9 2.5 Polish heroin (kompot) 2.3 1.5

22

Grade level 1995 1999 2003 2005

Second grades Marijuana or hashish 17.1 22.4 36.7 31.5 at secondary Inhalants 7.9 5.4 6.3 5.6 schools Non-prescription tranquillizers or 20.8 20.8 20.1 19.0 sleeping pills Amphetamine 2.8 10.5 15.4 12.4 LSD or other hallucinogens 2.7 3.5 4.2 3.7 Crack 0.4 0.8 1.4 1.4 Cocaine 0.8 1.8 2.4 2.4 Relevin 0.3 0.6 0.6 Heroin 0.6 6.8 2.2 1.6 Ecstasy 0.6 2.7 5.8 8.3 Hallucinogenic mushrooms 4.9 4.3 GHB 0.6 0.8 Injecting drugs 0.7 0.6 Alcohol and pills 14.6 13.2 Alcohol and marijuana 23.4 19.9 Anabolic steroids 4.0 2.6 3.5 4.3 Polish heroin (compote) 1.2 1.3

Source: Sierosławski (2006b)

Attention must be paid to a very low prevalence (less than 1%) of injecting drug use. However, serious concern should be expressed at considerable percentages of youth experimenting with alcohol in connection with medical drugs (6.9% in younger cohort and 13.2% in the older one) or marijuana (7.7% in younger group and 19.9% in the older one).

Comparing the results of 2005 with the ones of 2003, 1999 and 1995 a decrease must be noted in the percentage of pupils experimenting with cannabis. In previous years the increasing trend was observed. In the younger group the increase between 1999 and 2003 was slightly lower than in the previous 4-year period although faltering of the increase was not too big. In the older group the percentages of pupils who had used cannabis at least once surged more significantly in the years 1999-2003 than in the years 1995-1999, so the decrease of lifetime prevalence noted in 2005 was not preceded by faltering of an upward trend as it happened in the case of the younger group.

The changes in experimentation with marijuana and hashish in the younger and older groups reflect similarities and dissimilarities in the ten-year trend. Similar situation occurs in several other substances. In 2003 the prevalence of amphetamine, LSD and anabolic steroids after an increase within both groups in the years 1995-1999, decreased slightly in 23 the younger group whereas in the older one the upward trend continued. In 2005 we noted a decrease or stabilization of indicators.

Prevalence of experimenting with ecstasy, after increase in the years 1995-1999 both among the younger and older pupils, in the following four years stabilized in the younger group and kept rising in the older one. In 2005 the upward trend among the older group continued and further stabilization in the younger group is noted.

The upward trend through the whole 8-year period of ESPAD surveys shows in both groups prevalence of experimenting with cocaine. In 2005 the share of students experimenting with cocaine have stabilized in both group and it remained at a very low level not exceeding 2.5%.

A separate comment should be made on the heroin use results. In both groups the percentages of participants taking this substance visibly rose in the years 1996-1999 and then fell in 2003 to a level slightly higher than the one of 1995. A rapid surge of the 1999 percentage can be explained with a change in the questionnaire introduced in 1999. In 1995 there were general questions about heroin use; however, in 1999 separate questions referred to ‘brown sugar’ and so called ‘white’ heroin. In 2003 the version of 1995 was re- introduced. ‘Brown sugar’ appeared on a larger scale in the second half of the 1990s. At the same time Polish drug scene witnessed emerging new types of cannabis called ‘skunk’ of higher THC concentration. Different myths surrounded this substance. It cannot be precluded that some young people reporting their experiences with drugs confused these substances. The fact enhancing the popularity of ‘brown sugar’ was the effect of the new. New trendy substance with a label of relatively safe could provoke young people into trying. It is hard to determine what contribution into the increase of percentage observed in 1999 was made by the changes in the questionnaire and what the real increase in prevalence was. In 2005 the percentage of students with heroin use experiences remained similar to 2003.

Last but not least one must point to a slight downward tend in prevalence of psychoactive substances other than alcohol in Poland, i.e. tranquillizers and sleeping pills taken without a doctor’s prescription as well as inhalants.

The prevalence of attempts at psychoactive substances other than alcohol or tobacco is gender dependent (Table 3). The relationship between substance use and gender appears at both school levels. Boys are more willing to declare attempts to use practically all substances except tranquillizers and sleeping pills. Experimenting with tranquillizers and sleeping pills is far more popular with girls. Also the experiments of combining alcohol with pills are observed more frequently among boys than girls.

24 Table 3. Lifetime prevalence of substances use by gender

Grade level 2003 2005 Boys Girls Boys Girls Third grades at Marijuana or hashish 24.7 13.9 16.0 12.3 upper-primary Inhalants 10.2 8.4 9.0 6.1 schools Non-prescription tranquillizers or 12.3 22.1 10.5 19.7 sleeping pills

Amphetamine 7.5 4.6 4.3 3.0

LSD or other hallucinogens 3.5 1.6 2.0 1.2 Crack 2.5 0.8 1.6 0.5 Cocaine 3.1 1.4 2.2 1.9 Relevin 1.4 0.6 1.0 0.4 Heroin 2.5 1.2 1.8 0.6 Ecstasy 3.7 2.1 2.4 2.6 Hallucinogenic mushrooms 5.3 1.9 4.7 1.1 GHB 1.3 0.4 1.1 0.4 Injecting drugs 1.8 0.6 1.1 0.4 Alcohol and pills 6.3 10.4 5.4 8.3 Alcohol and marijuana 14.9 7.9 9.4 6.1 Anabolic steroids 5.2 0.9 4.8 0.3 Polish heroin (kompot) 3.1 1.5 1.8 1.1

Second grades Marijuana or hashish 47.7 25.5 41.4 21.7 at secondary Inhalants 8.4 4.1 6.3 4.9 schools Non-prescription tranquillizers or 13.9 26.2 12.5 25.4 sleeping pills

Amphetamine 18.1 12.7 14.5 10.2

LSD or other hallucinogens 6.7 1.8 5.5 1.9

Crack 2.1 0.7 1.9 0.7 Cocaine 3.4 1.4 3.1 1.6 Relevin 1.1 0.1 0.6 0.6 Heroin 2.5 1.8 1.6 1.6 Ecstasy 8.0 3.5 10.8 5.7 Hallucinogenic mushrooms 7.5 2.2 6.8 1.6 GHB 1.1 0.1 0.9 0.6 Injecting drugs 1.0 0.3 0.7 0.5 Alcohol and pills 12.6 16.4 11.9 14.4 Alcohol and marijuana 31.4 15.2 27.6 12.1 Anabolic steroids 6.9 0.2 7.6 0.9 Polish heroin (kompot) 1.6 0.8 1.5 0.9

Source: Sierosławski (2006b)

25 Comparing results of surveys of 2005 and 2003 among the younger group we can observe deeper decrease of percentages of lifetime users among boys than girls with reference to cannabis and amphetamine. In results the differences between boys and girls narrowed.

The indicator of current substance use is usually defined as substance use in the last 12 months prior to survey. The figures of Table 4 show that the most popular substance within current use is cannabis. 10.0% of third-graders of upper-primary schools and 22.6% of second-graders of secondary schools use it. Within the younger group second comes tranquillizers and sleeping pills taken without prescription (6.6%) and in the older group it is tranquillizers and sleeping pills (9.0%) and amphetamine (6.8%).

Comparison of results of the current survey with previous ESPAD studies show a decrease of percentages of current users of most substances in question. A decrease of percentage of current cannabis users among 15-16 years old students is even deeper than decrease of lifetime users in the same group. The current prevalence is now lower than even in 1999. The only increase is recorded in ecstasy use in the older group.

Table 4. Substance use on the last 12 months

Grade level 1995 1999 2003 2005 Third grades at Marijuana or hashish 6.9 12.3 14.5 10.0 upper-primary Inhalants 4.3 4.3 4.1 3.5 schools Non-prescription tranquillizers 6.4 8.9 6.6 or sleeping pills

Amphetamine 6.8 3.5 2.1

LSD or other hallucinogens 3.0 1.4 0.6

Crack .9 0.5

Cocaine 1.6 1.4 1.3

Relevin .6 0.3

Heroin 1.7 1.0 0.7

Ecstasy 1.7 1.7

Hallucinogenic mushrooms 1.7 0.9

GHB 0.4 0.6

Injecting drugs 0.6 0.4

Alcohol and pills 4.9 3.6

Alcohol and marijuana 7.8 4.5

Anabolic steroids 2.5 1.8 1.7

Polish heroin (kompot) 1.1 0.6

26 Grade level 1995 1999 2003 2005 Second grades Marijuana or hashish 10.0 17.4 26.1 22.6 at secondary Inhalants 2.8 1.6 2.2 2.1 schools Non-prescription tranquillizers 5.8 9.4 9.0 or sleeping pills

Amphetamine 7.7 9.5 6.8

LSD or other hallucinogens 2.2 2.0 1.9

Crack 0.7 0.7

Cocaine 1.4 1.5 1.5

Relevin 0.4 0.4

Heroin 1.4 0.8 1.2

Ecstasy 3.5 5.2

Hallucinogenic mushrooms 2.5 2.0

GHB 0.5 0.4

Injecting drugs 0.4 0.3

Alcohol and pills 6.6 7.7

Alcohol and marijuana 13.7 11.6

Anabolic steroids 2.3 2.3 2.6

Polish heroin (kompot) 0.7 0.6

Source: Sierosławski (2006b)

It is also easy to observe the relationship between the current substance use and gender. Similarly to experimenting it occurs more often among boys rather than girls except tranquillizers and sleeping pills taken without a doctor’s prescription.

The period of the last 30 days prior to survey can be accepted as the indicator of relatively frequent and occasional use. Smoking marijuana or the use of other substances, similarly as drinking alcohol, in the majority of cases is not of regular character. Therefore one can hardly be sure that all the pupils who declared contact with a given substance in the last 30 days use it at least once a month. However, it can be assumed, with an approximation, that the proportions of those using it once a month among those who have not used it in the last month equal proportions of those who use it less often and confirm using in the last 30 days prior to survey. With such an assumption it can be concluded that 4.3% of third-graders at upper-primary schools and 10.5% of second-grader at secondary schools smoke marijuana or hashish at least once a month (Table 5).

27 Table 5. Substance use in the last 30 days

Grade level 1995 1999 2003 2005 Third grades at Marijuana or hashish 3.1 7.4 8.3 4.3 upper-primary Inhalants 1.8 1.9 2.5 1.7 schools Non-prescription tranquillizers 2.9 4.6 3.3 or sleeping pills Amphetamine 3.9 1.7 1.1

LSD or other hallucinogens 1.9 0.6 0.3

Crack 0.5 0.3

Cocaine 1.2 0.6 0.5

Relevin 0.3 0.2

Heroin 1.3 0.6 0.5

Ecstasy 1.0 1.1

Hallucinogenic mushrooms 0.8 0.4

GHB 0.2 0.5

Injecting drugs 0.3 0.2

Alcohol and pills 2.7 1.5 Alcohol and marijuana 3.7 1.6 Anabolic steroids 1.8 1.1 0.9 Polish heroin (kompot) 0.7 0.5 Second grades Marijuana or hashish 3.3 8.6 13.3 10.5 at secondary Inhalants 1.4 1.0 1.2 1.1 schools Non-prescription tranquillizers 2.1 4.7 4.4 or sleeping pills Amphetamine 3.6 5.1 2.8 LSD or other hallucinogens 1.5 0.6 0.8 Crack 0.4 0.4 Cocaine 0.6 0.8 0.7 Relevin 0.1 0.3 Heroin 0.7 0.4 0.6 Ecstasy 1.9 2.4 Hallucinogenic mushrooms 0.8 0.9 GHB 0.2 0.3 Injecting drugs 0.2 0.2 Alcohol and pills 2.9 3.3 Alcohol and marijuana 7.0 5.1 Anabolic steroids 2.2 1.1 1.3 Polish heroin (kompot) 0.2 0.5

Source: Sierosławski (2006b)

28 Similarly to use in the last 12 months in the younger group the second place in terms of frequent use is taken by tranquillizers and sleeping pills taken without prescription (4.6%) and in the older group it is amphetamine (5.1%) as well as tranquillizers and sleeping pills (4.7%). Inhalants ranked third in terms of prevalence among the younger pupils (2.5%) and in the case of the older ones it is ecstasy (1.9%).

Similarly as in the previous indicators vital differentiation is related to gender. More boys than girls frequently take each of the substances except tranquillizers and sleeping pills taken without a doctor’s prescription, which are preferred by girls. Amphetamine use ranks equally both among boys and girls. It should be noted that the percentages of frequent cannabis users among boys of third grades of upper-primary schools oscillate around 11% and in third grades of secondary schools reach the level of 20%.

The attempt at obtaining normative references to the use of psychoactive substances was the question about the assessment of the behavior of somebody who takes particular substances according to various patterns.

The subjects answered questions by means of categories in Table 5, i.e. “I don’t disapprove of”, “I disapprove of” and “I strongly disapprove of”. Evading a question was an option.

The list of the assessed substances included both legal substances (cigarettes, alcoholic beverages, inhalants, tranquillizers and sleeping pills taken without a doctor’s prescription) and illegal ones (marijuana, amphetamine, LSD, ecstasy, cocaine, crack, ‘kompot’). Additionally using alcohol, tobacco and cannabis was differentiated in terms of frequency. As it had been expected legal substances were generally more seldom disapproved of. It must be noted that the percentages of subjects disapproving of the use of substances such as amphetamine, cocaine or ‘kompot’ are not only high but also differ insignificantly from one another. The assessment of marijuana use is not so unequivocal any more. The percentages of pupils disapproving of using marijuana or hashish from time to time are similar as in the case of getting drunk once a week and considerably lower compared to the above-mentioned drugs. The survey results confirm a tendency to treat cannabis and so-called ‘hard’ drugs differently. It means that in the eyes of young people marijuana does not possess clearly the same ‘image’ as other drugs. The degree of disapproval of drinking alcoholic beverages is strongly differentiated from the frequency of drinking. The most lenient assessment relate to drinking twice a year at most, then drinking one or two drinks a few times a week, and getting drunk once a week is most disapproved of. Smoking cigarettes, if on a daily basis, is located between drinking a few times a week and getting drunk once a week.

29 Table 6. Disapproving of the use of individual substances

I don’t I I strongly I don’t disapprove disapprove disapprove know Grade level of of of Third grades at Smoking cigarettes from time to time 60.2 21.1 7.9 10.8 upper-primary schools Smoking 10 or more cigarettes a day 27.7 36.2 28.6 7.6 Drinking alcohol once or twice a year 88.2 4.8 2.6 4.5

Drinking one or two “cocktails” a few times 40.9 34.0 10.4 14.7 a week Getting drunk once a week 20.2 36.6 33.1 10.1

Trying marijuana or hashish once or twice 26.9 26.2 38.2 8.7 Smoking marijuana or hashish from time to 19.9 31.0 41.8 7.3 time Smoking marijuana or hashish from 10.1 25.0 59.7 5.1 regularly Trying LSD or some other hallucinogenic 15.4 31.3 44.6 8.8 drug once or twice Trying heroin once or twice 15.8 31.7 45.1 7.5

Trying tranquillizers or sleeping pills 30.4 30.3 27.3 12.0 (without doctor’s prescription) Trying amphetamine once or twice 17.5 32.4 42.7 7.4 Trying crack once or twice 15.2 32.0 44.4 8.3 Trying cocaine once or twice 15.7 32.4 44.4 7.5 Trying ecstasy once or twice 16.7 31.4 43.8 8.2 Trying inhalants once or twice 17.3 32.7 41.6 8.4 Trying Polish heroin (kompot) once or twice 14.9 32.2 43.5 9.5

Second grades Smoking cigarettes from time to time 69.7 16.9 5.7 7.7 at secondary schools Smoking 10 or more cigarettes a day 38.6 32.0 21.3 8.0 Drinking alcohol once or twice a year 92.3 3.6 1.5 2.6

Drinking one or two “cocktails” a few times 48.7 32.6 6.8 11.9 a week Getting drunk once a week 29.4 36.1 24.5 10.0

Trying marijuana or hashish once or twice 37.5 25.2 29.6 7.7 Smoking marijuana or hashish from time to 29.4 29.0 34.6 6.9 time Smoking marijuana or hashish from 13.5 29.0 52.9 4.6 regularly Trying LSD or some other hallucinogenic 18.1 30.9 42.9 8.1 drug once or twice Trying heroin once or twice 15.8 32.2 45.6 6.4

Trying tranquillizers or sleeping pills 30.2 30.9 26.4 12.4 (without doctor’s prescription) Trying amphetamine once or twice 22.4 31.5 40.2 6.0 Trying crack once or twice 15.2 32.5 44.2 8.2 Trying cocaine once or twice 15.9 32.9 44.7 6.4 Trying ecstasy once or twice 20.6 31.4 41.5 6.5 Trying inhalants once or twice 14.5 34.0 45.0 6.5 Trying Polish heroin (kompot) once or twice 14.2 32.0 46.8 7.0

Source: Sierosławski (2006b)

30 The comparison of the results of the younger and older grades indicates higher level of liberalism among the older pupils. In the majority of substances the secondary school pupils more often than the upper-primary pupils ticked the answer “I don’t disapprove of” and less often “I strongly disapprove of”.

The comparison of the 2005 results with the results of 2003 reveal a slight tendency to less frequent liberal attitude towards all three patterns of cannabis use, tobacco smoking and alcohol drinking.

The global effect of prevention activities performed in schools may be stated after comparing answers to the question about substance use among those who participated in prevention classes and those who did not attend them. The figures on this subject are presented in Table 7.

Table 7. Participation in prevention classes vs. cannabis use

Marijuana or hashish use Grade level in the last 30 days

Yes No Third grades at Drug use Yes 4.0 96.0 upper-primary

schools No 4.7 95.3 Second grades at Drug use Yes 10.4 89.6 secondary

schools No 9.8 90.2

Source: Sierosławski (2006b)

It comprises percentages of subjects who reported using individual substances in the last 30 days prior to survey among those who had ever attended classes on a given substance and among those who had never attended such classes. The reference point for smoking marijuana or hashish were the drug classes.

It must be noted that no statistical association between cannabis use and participation in school prevention classes on these substances was found. Regardless of whether the participants participated in prevention classes or not, their behaviors in terms of psychoactive substances did not differ significantly. On the other hand the majority of young people are well familiar with health harm and social risks of the use of psychoactive substances. According to the distribution of respondents’ opinions, the degree of risk is more dependent on the frequency of use rather than a type of substance although the type of substance seems to be also an important factor.

31

Conclusions The results of school survey of 2005 compared with the results of ESPAD 1995, 1999 and 2003 suggest at least the faltering of an upward trend in drug use among youth. The most indicators of drug use prevalence are lower in 2005 compared to 2003. Taking into consideration reservations regarding the comparability of 2005 school survey and ESPAD we cannot be sure about this conclusion. The results of ESPAD 2007 should allow us to control the impact of methodological differences between studies on their results.

2.3. Drug Use among specific groups: Conscripts, minorities, sex workers etc.

Cocaine users – see chapter 12. Other data not available.

32

3. Prevention

3.1. Universal prevention o School Main governmental institution is legally bound to systemically perform preventive activities in schools in the Ministry of Education and Science (as of 30 October 2005 the name was changed to the Ministry of National Education and Sport). In 2002 the school curriculum and the framework statutes of the school were introduced with the obligation to perform a school prevention programme for children and youth that would be coherent with the upbringing programme of a school. The year 2005 was another year of implementation and performance thereof. In 2005 the Methodological Centre of Psychological and Pedagogical Assistance of the Ministry of Education and Science began to implement the primary prevention programme addressed to preschool children (six-year-olds) entitled “Zippie’s Friends”. The programme was the Polish adaptation of the international programme called “Partnership for Children” aimed at shaping psychosocial skills in young children. The idea of the programme is that if young children have an opportunity to learn how to deal with problems then in adolescence and adulthood they will better cope with problems and crises.. Under the programme children learn how to express their own feelings, say what they wish to say, listen carefully, ask for help, make and keep friends, cope with loneliness and rejection, say sorry, deal with conflicts, manage loss, adapt to new situations and help others. The programme is implemented by teachers and preschool staff trained by the Methodological Centre of Psychological and Pedagogical Assistance. In 2005 101 teachers were trained, and by January 2006 20 instructors trained 121 more teachers . “Zippie’s Friends” programme is currently being implemented in 110 preschools. The analysis of the evaluation results of the first stage of pilot project shows that all the participating teachers in “Zippie’s Friends” programme consider it valuable and worth implementing in other facilities. The programme proved helpful in integration classes and to a large extent contributed to the improvement of functioning in children with emotional disorders4.

Moreover, in 2005 the Methodological Centre of Psychological and Pedagogical Assistance published a methodological guidebook for teachers entitled “School Prevention” edited by Bo
enna Kamiska-Buko and Joanna Szymaska at the circulation of 2 000 copies. The guidebook was provided for superintendents of schools exercising pedagogical

4 Information about the programme is available in Polish on: www.cmppp.edu.pl/zdrowie/zippi

33 supervision over preventive and educational activity of schools. It was also distributed to consultants at teacher improvement centres and staff of school counselling centres.

The website of the Methodological Centre of Psychological and Pedagogical Assistance features quality standards of school prevention programmes for children and youth edited by Joanna Szymaska (Kamiska-Buko, B., Szymaska J. et. al. 2005).

In 2005 the magazine “Hygiene and Epidemiology” published an overview of activities taken in the academic community under the programme of integrated drug prevention in academic communities “National Network of Drug-Free Colleges”. The article was dedicated to the possibilities of effective reduction of drug addiction in higher education schools through strengthening development potential of students, promotion of healthy lifestyle in the academic community as well as interventions towards problem-stricken youth. In order to work out technical, financial and organizational standards of prevention work at colleges “National Network of Drug-Free Colleges” was established. The article dealt with the issues of harmonising preventive actions in colleges, the structure of “National Network of Drug- Free Colleges”, general assumptions of the programme, standards of research and prevention, training prevention personnel, ways of financing college prevention programmes and the information flow between colleges covered by the network (Kalinowski, Niewiadomska 2005).

Moreover, in 2005 the National Bureau supported the development of prevention programmes addressed to the academic community: students, teaching staff and administrative personnel. 4 programmes were co-financed. They covered informative, educational, psycho-educational and counselling actions and aimed at improving knowledge of psychoactive substances, drug use-related threats and the drug outreach system. The programmes stimulated the community to work out systemic solutions of new actions in the field of drug prevention (NBDP unpublished report, 2006b, p. 21).

• School actions by local authorities The year 2005 was the last in the implementation of the National Programme for Counteracting Drug Addiction that bound local authorities to support primary schools, lower secondary and upper secondary schools in developing preventive activities especially in the scope of diagnosing drug problem in a school and the implementation of an adequate school prevention programme. In 2005 1163 communes (out of 2 478 in Poland) financed school preventive actions (997 in 2004). Communes co-financed 4 893 prevention programmes in 4 731 primary and lower secondary schools. 146 county governments co-financed 1 331 prevention programmes implemented in 1 857 in secondary schools. 13 out of 16 provincial governments supported

34 school prevention programmes addressed to pupils (NBDP unpublished report, 2006a, pp. 54-55). In the area of prevention, activities have been undertaken to encourage local communities to support and take part in counteracting drug addiction. As an effect of the policy, there has been a gradual increase in 2005 compared with the previous year, of number of local governments to include involvement in school programmes in their regional and local strategies of solving social problems. o Family Since 2000 the Methodological Centre of Psychological and Pedagogical Assistance has been coordinating the implementation of the programme called “School for Parents and Educators”. The programme was described in the 2005 Annual Report for the EMCDDA. In 2005 a vital organizational change was introduced to the programme: - the Methodological Centre of Psychological and Pedagogical Assistance: coordination, staff training: leaders (training courses, seminars), implementers (40-hour training courses in part I and II), supervision and consultation. In the programme the Methodological Centre of Psychological and Pedagogical Assistance is responsible for monitoring, keeping national database of implementers and producing an annual report of provincial leaders, evaluation, promotion, organizing conferences, managing a website and publishing activities. The Methodological Centre of Psychological and Pedagogical Assistance is also responsible for developing brochures, leaflets and methodological newsletters for implementers.

• Leaders: they are responsible for conducting training courses for counsellors and pedagogues on how to conduct upbringing workshops for parents and educators providing consultation and supervision for the above implementers as well as monitoring programme in a region. Moreover, they are responsible keeping information bank on implementers as well as monitoring the programme in a region. They provide professional support for persons and institutions dealing with upbringing issues. These actions were performed by 35 leaders in 2005.

• Implementers: they conduct training courses for parents/educators. In 2005 there were 443 implementers registered in the system5.

5 Review of 34 recommended by Methodological Centre of Psychological and Pedagogical Assistance prevention programmes is available in Polish on: http://www.cmppp.edu.pl/programy/przeglad

35 o Community

ACTIVITIES PERFORMED BY LOCAL GOVERNMENTS In 2005 local governments implemented tasks of grater involvement of local communities in drug prevention as set out in the National Programme for Counteracting Drug Addiction 2002-2005.

The above activities were implemented by 1 440 out of 2 478 communes and the drug problem was incorporated in 192 communal anti-drug programmes. 21 county anti-drug programmes were developed and the drug problem issues were incorporated in 143 county strategies of solving social problems or 159 county programmes of other type.

In 2005 almost all provincial governments, except podkarpackie region, developed strategies of solving social problems that would cover drug prevention issues (NBDP unpublished report, 2006a, pp. 53-54).

Under communal programmes community prevention programmes for children and youth were organised and financed by 789 out of 2 478 communes. 2 901 prevention programmes were co-financed and implemented in 3 744 facilities. 84 counties supported extra-school programmes. 771 programmes implemented in 916 facilities were co-financed. In 2005 11 provincial governments co-financed and organized extra-school community programmes including drug alternative forms of spending free time and activities performed in socio-therapeutic common rooms.

Local governments co-financed the following actions: - “Academy of Youth Prevention Initiatives” concerning peer education implemented in 5 regions and subsidised by the National Bureau for Drug Prevention aims at preparing 50 volunteers to work in youth community groups as coordinators and animators and improving their organizational skills in the form of workshops through participation in informative, educational, psycho-educational and in the course of consultation for volunteers. The aim of the programme is to create conditions for further development of peer prevention designed by youth leader groups. The evaluation of the programme was planned: formative – conducted in training and conclusive – as an evaluation of the completion stages of the goals set by the programme designers after one year since the implementation thereof, • drug alternative programmes and common room activities. Special attention was paid to support activities implemented in rural areas, former state collective farm areas characteristic of high unemployment rate.

36 • training courses raising qualifications of the charges (e.g. computer courses, foreign language courses). Such activities prevented exclusion of youth of disruptive families, of low income status and to some extent equalized chance of even access to different forms of development.

- “True or false – drug statements” programme addressed to children of disruptive families with behavioural disorders and having direct contact with drugs.

- “Backyard Educator” community prevention programme aimed at: • working out optimal, adaptable model of preventive and educational work in an open environment i.e. youth meeting spots (in the street, backyard, football pitch, park etc.), • modification of adverse youth behaviour, alleviating and eliminating conflicts inside groups, • teaching right functioning in a peer group through common sport practising and integration games. • a series of training courses in drug addiction and HIV/AIDS for members of Local Outreach Teams in the form of workshops and lectures on the overview of drug addiction, social, medical and ethical aspect of drug addiction and HIV/AIDS as well as principles of building local system of dealing with the abovementioned problem (NBDP unpublished report, 2006a, pp. 63-64).

The quality of local actions is shaped by local governments with the use of modern approach to drug prevention and promotion of local drug prevention strategies. In 2005 the National Bureau for Drug Prevention commissioned the following programmes:

• “Penal policy towards drug users” – seminar addressed to court judges, prosecutors and probation officers dedicated to law enforcement towards drug users and spreading knowledge of addictions and problems of drug addicts in the legal community. • “Be first before Prevention” training course addressed to the personnel of orphanages and care and upbringing facilities of mazowieckie region. The training course aimed at enhancing the participants’ knowledge of drug addiction, psychoactive substances, outreach system for drug endangered children and youth and preventive activities addressed to children and youth (NBDP unpublished report, 2006a, pp. 65-66).

ACTIVITIES PERFORMED BY THE NATIONAL BUREAU FOR DRUG PREVENTION The National Bureau in the process of supporting professional prevention programmes addressed to specific target groups, integrated with local and regional anti-drug strategies commissioned non-governmental organizations the implementation of 17 youth leader programmes aimed at peer health education.

37

3.2. Selective / indicated prevention o Recreational settings Prevention programmes for drug endangered children and youth conducted in recreational venues (dance clubs, backyards) aimed at preventing drug initiation and reducing risk related to occasional drug use. The National Bureau commissioned follow-up of 6 programmes and 2 new programmes in recreational venues where drug initiation often takes place i.e. dance clubs and backyards (described in annual report for the EMCDDA 2004) (NBDP unpublished report, 2006b, p. 20).

o At – risk groups In 2005 3 Polish programmes were introduced in the database of recommended EDDRA drug prevention programmes: 1) Programme of “Preventive intervention towards children using psychoactive substances”, 2) “Community Addiction Prevention”, 3) “Altum prevention workshop for children and youth” Description of above mentioned programmes are in the EDDRA database.

Drug prevalence in teenagers calls for constant improvement of existing diagnostic methods, preventive activities and treatment towards this group and placing special emphasis on improving professional skills of persons dealing with the youth i.e. teachers, pedagogues, school nurses etc. Since 2004 the National Bureau for Drug Prevention and the Institute of Psychiatry and Neurology have been conducting a study of screening tests addressed to teenagers using cannabis and other drugs as a new diagnostic method and a form of intervention. In 2005 under the above project a model of intervention activities towards teenagers using cannabis and/or other drugs was designed. A number of representatives of different occupational groups and facilities were prepared to carry out the tests. The first component of the model is diagnosis whose primary objective is to determine procedure for further handling a teenager using drugs including his or her needs and individual status. Then there is counselling that motivates the teenager to take part in further intervention activities. Further procedure is closely related to the diagnosis results, experience of the intervention specialist and the arrangements between him or her and the parents (guardians) of the teenager and the teenager himself. The general guidelines of the intervention model concern making an agreement that would enable the teenager to change his behaviour and monitor the contract performance. In 2005 under the project the following 38 representatives of occupational groups were trained: doctors, school nurses, counsellors, pedagogues working at school counselling centres, schools, counselling centres for mental health and drug therapists. Length of the training courses varied depending on the group (3-9 hours) and the content. All the groups dealt with the following topics: - test conditions (including making contact, gaining trust, providing discretion), - test results interpretation, - planning further activities for occasional and problem teenage drug users, - analysis of opportunities and threats related to testing by the course participants, - setting schedule for further cooperation with the course participants. Moreover, the training course participants were equipped with the basic package of materials containing testing manual, PUN and PUM test battery, information for teenagers under intervention on the study along with an acceptance form for the participation therein, intervention monitoring sheet. The evaluation of the tests in practice was performed in 2006 (Okulicz-Kozaryn 2005).

In 2005 the National Bureau supported the implementation of counselling programmes for drug endangered persons, those experimenting with drugs and their families. In the framework of this project the National Bureau commissioned programmes addressed to drug endangered children and youth of disruptive families including those with addiction problem and those who have had contacts with drugs. The programmes aimed at reducing consequences of growing up in an unfavourable family and peer conditions, improvement of their emotional and social functioning, modelling habits of spending free time without turning to drugs and supporting families in solving drug-related problems of their child. The programmes were attended by drug users and their families. The programmes aimed at changing behaviours of children, youth and adults in order to remain abstinent, improve emotional and social functioning and support families in supporting drug related problems of their child or another family member. The goals were reached through activities of educational, interventionist and psycho-correctional character. The above prevention programmes were conducted in 59 facilities operating in local communities – common socio-therapeutic rooms, upbringing centres, youth clubs, social prevention centres, consultation points, community counselling centres, addiction prevention and treatment counselling facilities. 39 non-governmental organizations were commissioned the above programmes (NBDP unpublished report, 2006b, pp. 14-16).

In 2005, similarly to the previous years, pursuant to the provisions on prevention tasks set out in the National Programme for Counteracting Drug Addiction 2002-2005 local governments performed the following activity: Supporting extra-school prevention programmes addressed to drug endangered children, youth and their parents.

39 Under this project the provincial governments in cooperation with communal governments co-financed new prevention programmes addressed to young people who upon graduation from high school become unemployed, come form former state collective farm areas and are under threat of getting addicted. Under the programme 10 new common socio- therapeutic rooms were opened. The guarding staff working there comprise young people who upon graduation from a high school become unemployed. The programme was based on the pilot governmental programme “Common room – job – internship”. Moreover, in a region with high unemployment rate among young people 11 social integration youth clubs were established and supervised by county governments, 1 social integration youth club supervised by a county government and 2 social integration youth clubs supervised by non- governmental organizations. These programmes are of high importance to local communities, especially in regions seriously endangered by drug addiction and unemployment.

Social integration youth clubs provide such services as: legal, psychological or other counselling, training courses, workshops aimed at reducing risky behaviour related to drugs and crime (NBDP unpublished report, 2006b, pp. 63-64).

o At risk families Continuation of previous year’s projects. No new initiative has been recorded.

40

4. Problem Drug Use

4.1. Prevalence and incidence estimates o By substance used

REGIONAL AND LOCAL ESTIMATES OF PROBLEM DRUG USERS IN POLAND IN 2003- 2005. NATIONAL DEFINITION OF PROBLEM DRUG USE (PDU) The basic problem in estimating hidden populations is the precise definition of the estimated group. It is to some extent dependent on the scope of available data and estimation methods. The estimates presented in this chapter are based on the national definition of problem drug use according to which it is understood as a long-term, regular drug consumption (illicit substances) that results in serious problems in the user. The Polish national definition covers problem users not only of opiates, amphetamine and cocaine, injecting drug users but also problem users of cannabis and other drugs. The national definition is broader than the definition adopted by the European Monitoring Centre for Drugs and Drug Addiction that specifies problem drug use as follows: “Injecting drug or long/regular use of opiates, cocaine and/or amphetamines”.

ESTIMATE OF PROBLEM DRUG USERS IN ŁÓDZKIE REGION IN 2003 The estimate in lodzkie region was conducted by multiplier method (Sierosławski 2004). The study conducted on 60 problem drug users of the street population provided data on reporting to treatment by problem drug users known to the participants. As a result of this procedure 314 nominated drug addicts were collected. In the case of 234 drug addicts it was possible to determine whether they entered residential treatment or not. Data on drug treatment of individuals nominated by the study respondents are presented in Table 8.

Table 8. Individuals reporting to residential treatment in relation to the overall nominated population

1. Number of nominees provided by study respondents 314 2. Number of individuals who were found to have entered residential 284 treatment in the last year 3. Number of individuals who have entered residential treatment in the last 59 year 4. Number of non-treated individuals in the last year 225 5. Percentage of residential patients (3. / 2. x 100) 20.8%

41 From the fact that 20.8%of the drug addicts enter residential treatment it may be calculated that there 4.8 times more drug addicts than drug patients. Multiplying the number of problem drug users entering drug treatment in lodzkie region (883 individuals in 2003) by the multiplier of community studies gave the number of 4 250 individuals.

ESTIMATE OF PROBLEM DRUG USERS IN MAŁOPOLSKIE REGION IN 2003 Drug prevalence estimates in malopolskie region in 2003 used the same multiplier method as in lodzkie region (BBS Obserwator 2005). The basis of the study was the data of the residential and ambulatory treatment in 2003 as well as the data of the study on a street sample of problem drug users. In the first stage the respondents were asked whether they had entered any drug treatment in 2003. 36%of the respondents replied that they had not made any drug treatment attempts in that period. The indicator was 2 777. Then treatment registers were analyzed and it was found out that 1280 problem drug users had entered any form of drug treatment. After multiplying the number of registered individuals in the treatment system by the number of individuals who declared that they entered drug treatment the estimate of 3 555 individuals was effected.

ESTIMATE OF PROBLEM DRUG USERS IN WARSAW IN 2003-2004 The multiplier method was also applied in estimating the number of problem drug users in Warsaw (Sierosławski 2005a). The information of community studies and statistical data of residential and ambulatory treatment were used. The estimated data are presented in Table 9.

Table 9. Breakdown of source data and estimate results Statistical Community Estimate Estimate data study multiplier percentages Residential treatment (2003) 1873 47,6 2,1 3935 Ambulatory treatment (2004) 5994 60,7 1,6 9875

Source: Sierosławski, J. (2005)

On the basis of the field research the percentage of treated drug users was determined. It was 47.6%. From the fact that 47.6% of drug addicts enter drug treatment it may be calculated that the number of all drug addicts is 2.1 times higher than the number of drug patients. As a result the estimate of 4 000 individuals was obtained. The analogous estimate produced on the basis of data on ambulatory treatment gave the result approaching 10 000 problem drug users.

42 To sum up, it may be concluded that the estimated number of problem drug users in Warsaw ranged from 4 000 to 10 000. ESTIMATE OF PROBLEM OPIATE USERS IN WARSAW IN 2005 Estimate of problem opiate users was obtained by applying capture-recapture method based on three different samples (Moskalewicz, Sieroslawski, Bujalski 2006). The first two consisted of detoxification ward patients: the Institute of Psychiatry and Neurology (206 individuals) and Psychiatric Hospital at Nowowiejska St. (481 individuals). The third group was made up by people from outside drug treatment system (street sample) and it was the object of a survey study (107 individuals). The overall number of the study respondents was 794. Table 3 shows the numerical breakdown of respondents in respective samples and their combinations.

Table 10. Respondents in respective samples Number of respondents only IP&N patients 165 only Nowowiejska St patients 424 only community study respondents 84 IP&N and Nowowiejska St patients 37 IP&N patients and community study respondents 3 Nowowiejska St patients and community study respondents 19 IP&N patients, Nowowiejska St patients and community study respondents 1 Total number 733

Source: Moskalewicz J., Sierosławski J., Bujalski M. (2006)

By means of regressive methods the size of hidden population was calculated. As it is stated in the report: “The estimate was conducted based on a logarithmic and linear model. In the first stage models of interactions between samples were tested, then the model of no interaction was selected (independent samples) as the most suitable for the data collected”. The estimate results and the parameters of the logarithmic and linear model build for this purpose are presented in Table 11.

43

Table 11. Basic estimate parameters Model df chi2 P Estimated Estimated constant size of hidden number of population problem opiate users

Number of problem opiate users 7,618 3 2,540 0,468 2034 2767 lower limit of 95% CI 1517 2250 upper limit of 95% CI 2725 3458

Source: Moskalewicz J., Sierosławski J., Bujalski M. (2006)

The estimate of hidden population of Warsaw problem opiate users was obtained. It equalled 2 034 users. Considering the margin of error, we can state with 95% accuracy that the real size of the hidden population ranges from 1 517 to 2 725. Estimating the number of all problem opiate users in Warsaw requires adding the number of 733 individuals identified during the study. As the last column of Table 11 shows the estimated number accounts for 2 767 individuals with 95% CI – 2 250 - 3 458 individuals.

o By injecting drug use (ever and current)

ESTIMATE OF INJECTING DRUG USERS IN WARSAW IN 2005 In estimating the number of problem injecting opiate users the previous estimate of problem IDUs was used. The information on injecting drug use was collected in community studies in relation to individuals nominated by the respondents. Moreover, such data were collected referring to lists of detoxification ward patients. The percentages of injecting drug users from three samples are presented in Table 12.

Table 12. Percentages of injecting drug users among problem drug users IP&N Detox Nowowiejska Detox Nominations Weighted 2005 2005 2006 mean Percentage of injecting 55,6% 76,4% 94,1% 80,5% drug users

44 The highest percentage of injecting drug users was recorded in persons nominated in community studies (94.1%), however, the lowest one in the patients of the Institute of Psychiatry and Neurology (55.6%). The weighted mean taken for the estimate basis was 80.5%. Assuming, in line with the capture-recapture estimates, that in Warsaw there are 2 760 problem opiate users, the number of injecting opiate users can be estimated at 2 222. It is the most likely number. Minimal estimate considering standard margin of error equals 1811 and the maximum 2 784. The number of injecting drug users in Warsaw was estimated with another approach called the multiplier method. Table 4 shows the input data and the results. The estimate was conducted on the basis of nominations of HIV positive users known to the respondents obtained in community studies. At first the percentage of HIV users among all nominees was determined (33.6%) and among those who were found by the respondents to be HIV positive (43.9%). Based on the percentage size two multipliers were calculated. They were multiplied by the number of HIV users obtained from the National Institute of Hygiene (PZH). The number of 652 users covers the residents of Warsaw who were HIV positive in relation to injecting drug use in 2005. Table 13 shows the results of the study.

Table 13. Sources and estimate values based on community studies and statistics of National Institute of Hygiene (PZH) PZH statistical Community Estimate Estimate data study indicator percentage

HIV users (Dec 2005) 652 43,9-33,6 2,3-3,0 1480-1940

Source: Moskalewicz J., Sierosławski J., Bujalski M. (2006)

Conclusions Figure 4 shows the results of the three estimates conducted in Warsaw in 2005. The first covers problem opiate users and was conducted with the capture-recapture method. The next two refer to injecting opiate users. One was based on the previous estimate results and the proportion of IDUs estimated according to the data collected among patients as well as from nominations obtained in community studies (IDUs – Estimate 1). The other estimate was conducted by applying multiplier method. It included community study nominations and data on HIV users from National Institute if Hygiene statistics (IDUs – Estimate 2).

45 Figure 4. Comparison of estimates of problem opiate users and injecting drug users in Warsaw

4000

3500

3000 2767,0 2500 2298,0 2000

1710,0 1500

1000 Upper estimate limit

Lower estimate limit 500 Average estimate

0

Problem opiate users IDUs - Estimate 1 IDUs - Estimate 2

The data above are indicative of relatively coherent estimate results. Estimating the number of injecting drug users with the multiplier method suggests that they might account for approx. 68% of opiate users. It is worth noting that the percentage falls within the percentages recorded in patients of detoxification wards (see Table 12). The weighted mean used for Estimate 1 was affected by the percentage of the community study nominations. It may be assumed that the real segment of injecting drug users in problem opiate users in Warsaw ranges from 68% to 81% (1 480 – 2 784 IDUs)

4.2. Profile of clients in treatment (characteristics, patterns of use) – TDI Data In Poland residential and ambulatory psychiatric treatment are covered by two separate statistical reporting systems. One is based on individual statistical questionnaires completed upon discharge of a patient and the other completed on 31 December every year. The questionnaire contains an identity code that makes it possible to collect data referring not only to cases but also to persons. The statistical system of ambulatory facilities is based on collective figures produced at the level of a counselling centre. The data of residential treatment are more accurate i.e. there is no double counting of patients admitted to two separate facilities in the same year. They better reflect epidemiological trends and allow, with certain restrictions, for following trends in the qualitative development of the phenomenon.

46 As in previous years the analysis of epidemiological trend of drug addiction in Poland will be presented on the basis of statistics of reporting to residential treatment. The data of residential treatment refer to patients of psychiatric wards, including patients of drug treatment facilities.

The data of 2004 will be compared against the data of previous years. Two indicators will be applied to assess epidemiological trends. One is the number of individuals admitted to treatment in a given year covering all persons who entered drug treatment in any residential treatment facility no matter whether they completed it the same year or continued through the next. The other indicator was the number of first-time patients defined as persons who entered drug treatment in a residential facility for the first time in their lives in a given year. The other indicator reflects more accurately the changes of the increasing number of new cases, not recorded in the treatment system before, thus being closer to the developments in population.

We begin the data analysis with the indicator of admissions to treatment. In 2004 12 838 drug users entered residential treatment. It means an increase of 9.0% compared to 2003, when 11 778 patients were admitted. On the basis of Figure 5 it may be calculated that the indicator of reporting to treatment since 1900 stands at 22% (Sierosławski 2006a, p. 18).

Figure 5. All patients admitted to residential treatment in 1990-1996 due to addiction or abuse of medical drugs and in 1997-2004 due to mental disorders and behavioural disorders caused by using psychoactive substances (per 100 000 residents)

35 33,6 31,2 30,8 30

25 23,5 22,2

20 17,7 15,8 15 13,8 12,4 10,7 10,9 9,4 9,7 9,8 10 7,3

5

0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004

Source: Institute of Psychiatry and Neurology in Warsaw

47

o By substance used Out of patients as to whom we know which drug posed the biggest problem the most numerous group were opiate users (Figure 6). In 2004 20% of patients admitted to residential treatment facilities were diagnosed with F11. Then came the patients using tranquilizers and sleeping pills – 10.5%, stimulants such as cocaine and amphetamines – 8.7%, cannabis – 3%, and inhalants – 2.1%. The remaining categories of patients do not exceed 1%. However, more than a half of users of psychoactive substances remain in the category ”mixed or undefined”. Drugs used by these patients can hardly be determined besides the fact that in the majority of patients there is more than one. The situation in 2004 corroborates the trend observed in previous years.

Figure 6. Patients admitted to residential treatment in 2004 due to mental and behavioural disorders caused by using psychoactive substances

Opiates 20,0%

Cannabis 3,0%

Tranquilizers and sleeping pills 10,5%

Cocaine 0,8%

Other stimulants Other and mixed 8,7% 54,5% Hallucinogens Inhalants 0,4% 2,1%

Source: Institute of Psychiatry and Neurology in Warsaw

The comparison of the structure of diagnoses in 1997-2004 (Table 15) demonstrates important changes. The biggest one is the continuation of the downward trend in opiate users from 43% in 1997 to 20% in 2004 as well as the rise in the category ‘mixed and undefined’. These changes can be interpreted as the result of polydrug use. We cannot state with certainty that the fall in opiate users reflects the fall in prevalence of opiates as we are

48 not able to determine how many users of the above substances fall into the category “mixed and undefined” and whether their proportion is steady. Other changes relate to a downward trends in inhalant users (10% in 1997; 2% in 2004) and a rise in amphetamine users from 4%in 1997 to 9% in 2004 as well as the proportion of users of tranquilizers and sleeping pills from 8.4% in 997 to 10.5% in 2004. In recent years we have been observing a decline in the trend of cannabis users, which in 1997-2002 was going up and has been holding steady lately. The percentage of cocaine users in 1997-2004 has been at a very low and steady level.

Table 15. Percentage of patients admitted to residential treatment in 1997-2004 due to mental and behavioural disorders caused by using psychoactive substances (ICD X: F11- F16, F18, F19); by substances

Opiates Cannabis Tranquilizers Cocaine Other Hallucinogens Inhalants Mixed Total & sleeping stimulants and pills undefined

1997 43.3 1.3 8.4 0.9 3.8 1.3 10.0 30.9 100.0 1998 42.3 1.8 8.3 0.7 6.0 1.2 9.2 30.5 100.0 1999 38.8 2.4 8.4 0.8 6.7 1.3 6.7 34.9 100.0 2000 39.4 2.9 9.0 0.6 5.8 0.7 5.2 36.4 100.0 2001 40.4 3.0 8.0 0.2 6.0 0.7 3.7 38.1 100.0 2002 30.3 3.4 9.0 0.8 8.1 0.5 3.3 44.5 100.0 2003 23.3 3.0 10.1 0.9 8.9 0.6 2.7 50.4 100.0 2004 20.0 3.0 10.5 0.8 8.7 0.4 2.1 54.5 100.0

Source: Institute Psychiatry and Neurology in Warsaw

As the data of Tables 15 and 16 show addiction to opiates is still a dominating problem – the number of patients in 2004 was 2 573. The numbers of amphetamine patients (1 115) and the patients using tranquilisers and sleeping pills (1 350) are also high.

49

Table 16. Patients admitted to residential treatment in 1997-2004 due to mental and behavioural disorders caused by using psychoactive substances (ICD X: F11-F16, F18, F19); by substances

Opiates Cannabis Tranquilizers Cocaine Other Hallucinogens Inhalants Mixed Total & sleeping stimulants and pills undefined

1997 2 313 70 449 46 204 70 535 1 649 5 336 1998 2 569 110 509 45 367 75 564 1 861 6 100 1999 2 652 164 573 52 459 91 455 2 381 6 827 2000 3 383 246 769 50 502 62 449 3 129 8 590 2001 3 674 269 724 19 544 61 340 3 465 9 096 2002 3 609 409 1 074 98 966 62 397 5 300 11 915 2003 2 745 356 1 187 107 1 054 74 321 5 934 11 778 2004 2 573 382 1 350 107 1 115 49 269 6 991 12 836

Source: Institute Psychiatry and Neurology in Warsaw

Figure 7. Patients admitted to residential treatment in 1990-1996 due to addiction to medical drugs or medical drug abuse (ICD IX: 304, 305.2-9) and in 1997-2004 due to mental and behavioural disorders caused by using psychoactive substances (ICD X: F11- F16, F18, F19) – selected drugs (no. of patients)

inhalants 1400 1300 tranquilizers & sleeping pills 1200 other stimulants 1100 cannabis 1000 900 cocaine 800 700 600 500 400 300 200 100 0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004

Source: Institute Psychiatry and Neurology in Warsaw

50 Figure 7 shows that the number of cannabis addicts admitted to residential treatment is higher than the number of cocaine users and at the same time lower than the number of patients addicted to amphetamine or tranquilizers and sleeping pills. Moreover, the figure demonstrates a clear decline in the number of inhalants addicts. However, the overall upward trend in the patients of each category / type of addiction seems alarming. o Injecting drug-users Statistical data of the treatment system do not contain information on the number of injecting drug users. In Poland there has been so far no estimate of injecting drug users. A nationwide data collection system on patients of residential and ambulatory facilities is due to be established in 2007. It will be coherent with the European TDI protocol and will cover information such as the route of administration. The system is going to be implemented under Transition Facility PL 2004/016-829.02.01 and it will generate detailed information on patients e.g. number of injecting drug users. o Other specific sub-populations Table 17 below presents the age and gender structure of residential treatment patients. It has been holding relatively steady for a number of years. The percentage of women was rising slowly though steadily from the level of 22% in 2000 to 24% in 2003. In 2004 we the trend levelled off and the percentage of women stood at 23.6% (Sierosławski 2006a, p. 19).

Table 17. Patients admitted to residential treatment in 1997-2004 due to mental and behavioural disorders caused by using psychoactive substances (ICD X: F11-F16, F18, F19); by gender

Men Women

N % N %

1997 3 936 73.8 1 400 26.2 1998 4 519 74.1 1 581 25.9

1999 5 209 76.3 1 618 23.7

2000 6 702 78.0 1 888 22.0 2001 7 006 77.0 2 090 23.0

2002 8 633 76.8 2 608 23.2

2003 8 952 76.0 2 826 24.0 2004 9 808 76.4 3 028 23.6

Source: Institute Psychiatry and Neurology in Warsaw

51 Far wider discrepancies are observed in the age structure (Figure 8). In 1997-2001 the percentage of patients aged 16-24 was consistently rising while the percentage of patients aged 25-34 was falling. In the following years there was a decrease in the patients aged 16- 24 and an increase in patients aged 25-34 and 35-44. In 2004 the percentage of patients aged 16-24 fell to 48% and the percentage of the oldest patients (aged 44 and older) rose to 13% (Sierosławski 2006a, p. 20).

Figure 8. Patients admitted to residential treatment in 1997-2004 due to mental and behavioural disorders caused by using psychoactive substances; by age

10 0% 7 7 7 8 8 10 11 13

17 15 14 12 11 10 45 + 8 0% 11 11 22 22 23 24 24 35-44 29 60% 33 26

25-34 4 0% 16-24 55 57 55 46 52 51 48 2 0% 40 -15

0% 4 4 3 3 3 2 3 2

1997 1998 1999 2000 2001 2002 2003 2004

Source: Institute Psychiatry and Neurology in Warsaw

4.3. Main characteristics and patterns of use from non-treatment sources The information on patterns of drug use among problem drug users is obtained through qualitative research conducted in 2005 in Pozna and Warsaw. The surveys were carried out by means of in-depth interviews with problem injecting drug users. The interviewees were selected in their community according to the snowball method (Sierosławski unpublished report 2005b). The respondents declared that their first contacts with drugs occurred when they were 15-16 years old. Drug use was frequently initiated with cannabis as well as inhalants, tranquilizers and sleeping pills, amphetamine or LSD. The users were usually attracted by curiosity. Sometimes it was hard to determine the motive – the first use is often accidental and dependent on a number of situational factors, without clear reflection of the person taking a drug. Both drug initiation and further use was facilitated by a substantial amount of

52 free time uncontrolled by adults. An important factor was also the lack of understanding on the part of close relatives, parental love and interest in a child. The other factor seems to play a more important role in the process of continuing drug experience. o By substance used On the basis of the information obtained from the respondents four patterns of problem drug use may be differentiated according to a type of substance. The first pattern is opiates as the primary drug. They might be accompanied by other substances such as tranquilizers, sleeping pills of the morphine family, amphetamine and cannabis. Two subtypes may be differentiated here. One is based on homemade opiates so- called Polish heroin or ’kompot’ taken intravenously. The other is ‘brown sugar’, sometimes taken intravenously. The second pattern is stimulants – most often amphetamine. This pattern includes the use of other stimulants such as methamphetamine, ecstasy and occasionally cocaine. Ecstasy usually fulfils a role of a secondary drug. Cannabis or hallucinogens tend to be frequently added. For the third pattern of use the basic drug is cannabis. It is accompanied by substances such as amphetamine or hallucinogens, but only occasionally. Cannabis is used on a daily basis, even several times a day. The cannabis is often genetically modified with higher THC concentration (so called sinsemilla or skunk). The fourth and last pattern involves combination of different substances such as amphetamine, hallucinogens, tranquilizers, sleeping pills, cannabis, less often cocaine or heroin. These combinations sometimes include only some of these substances. The primary drug is usually difficult to determine. A special case of this pattern is combining heroin and amphetamine or their alternate use. o Injecting drug users Injecting drugs is characteristic of the first pattern, it might occur in the second and fourth pattern and it never appear in the third pattern. The start of injecting drug use marks a special moment in a drug user’s life. The change to a pattern of use into injection is related to a clear acceleration of psychosocial degradation. This threshold is crossed without reflection and the drug user does even remember it . The most common reasons for injecting drugs include: − increasing the potency of a drug, − yielding to dominating pattern of use in a given community, − reducing costs as the same effect is reached with the smaller amount of the drug. Drug injecting initiations often take place in the context of intensive process of social exclusion. No money for drugs in a situation of increased body tolerance for drugs and the 53 resulting necessity to increase doses on the one hand lead to attempts of obtaining financial resources in a socially unacceptable way and often against the law. On the other hand injecting drug use is simply cheaper Injecting drug use is relatively seldom related to sharing needles and syringes. The interviewees are well aware of the risk of infection although the risk becomes meaningless when it comes to drug craving. o Other specific sub-populations The above issue has been described in „By substance used” where patterns of use were presented.

54 5. Drug-Related Treatment

5.1. Treatment system Drug treatment system is based on a network of inpatient and outpatient drug clinics, detoxification wards, day care centres, drug treatment wards in hospitals, mid-term and long- term drug rehabilitation facilities and drug wards in prisons. These facilities have the status of public and non-public health care units. Under the system the following drug-related services are provided: diagnosis, counselling, psycho- education, pharmacological therapy, substitution treatment, individual and group psychotherapy, therapeutic community model. In Poland the most prevalent treatment model is a drug-free therapeutic community. In 2005 as in previous years mid-term and long-term programmes dominated, however due to economic changes and a different profile of patients, the programmes are getting shorter. The changes are dictated by financial limitations imposed by the National Health Fund – NHF. In 2005 neither sources of financing drug-related health benefits (mainly NHF) nor distribution criteria thereof changed. The implementers were health care units run by non- governmental organizations (societies, association, foundations). Substitution treatment, for formal reasons run so far by public health care units, was the exception. However the new Act of Law of 29 July 2005 on counteracting drug addiction made it possible for non-public health care facilities to run such type of treatment, which will hopefully lead to the broadening of this deficient treatment service in Poland.

5.2. “Drug Free” treatment o Inpatient treatments Residential treatment centres are often located outside cities as it is expected that it provides natural isolation of patients from the drug community. The latest data on the number of residential treatment centres come form 2004. In 2004 there were 54 facilities of such type in Poland (including facilities admitting patients with dual diagnosis. In 2004 residential wards housed 2 330 beds (Pietrzykowska 2005, p. 69). We observe a slight increase of a number of patients, especially first-timers, under such type of treatment. In 2005 12 836 drug users reported to residential treatment (11 778 in 2003). Out of these group 6 947 were first-timers (5 934 in the previous year) (Pietrzykowska 2006, p. 121). The above data do not include psychiatric hospitals, where problem drug users receive treatment after being referred there due to symptoms of psychotic disorders. 55 o Outpatient treatments Ambulatory assistance to users of illicit psychoactive substances is provided in Poland through drug counselling centres, mental health counselling centres and in special cases, if there is no centres of the type mentioned before, abstinence counselling centres (more numerous network) which must often adapt their service offer to the needs of problem drug users.

In 2003-2004 there was a fall in the number of drug counselling centres. In 2004 there were 73 centres for drug treatment (90 in the previous year) (Pietrzykowska 2005, p. 79). They registered 30 601 patients including 13 214 first-timers (Pietrzykowska 2005, p. 121).

However the network of ambulatory treatment centres is still insufficient and the service offer is not diverse enough. Despite the fact that for drug addicts the ambulatory form of treatment (especially day care centres located in large cities) seems to be more adequate than residential and long-term one it is clearly underinvested.

In order to raise the effectiveness of therapeutic interventions towards drug users in counselling centres and consultation points activities for parents and close relatives of drug users are organized. The counselling centre rooms are used for sessions of drug anonymous groups. Figure 9 shows the development trend of ambulatory and residential drug centres along with the number of beds in 1998 – 2004.

Figure 9. Development trend of number of ambulatory and residential drug centres along with number of beds in 1998 - 2004 (1998 = 100)

280 260 Ambulatory centres 240 Residential centres 220 Beds 200 180

160 140 120 100

1998 1999 2000 2001 2002 2003 2004

Source: : Institute Psychiatry and Neurology in Warsaw

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5.3. Medically assisted treatment o Withdrawal treatment The latest data on detoxification come from 2004. Then there were 40 public detoxification wards (no data on the number of beds available) (Zakrzewski 2004) addressed mainly to opioid withdrawal symptoms. The basic forms of treatment at detoxification wards is symptom treatment, administering painkillers and tranquilizers, antiemetics etc. and causal treatment (clonidine, methadone or buprenorphine). At hospital detoxification usually lasts 8-21 days. Detoxification from psychoactive substances includes: - fluid transfusion, - alleviating withdrawal symptoms, - motivating to enter treatment, - support, - education on infectious diseases, - counselling, psycho-education, - treating coexisting diseases, - crisis interventions, - cooperation with family members.

Data collection system does not cover private facilities / medical practices conducting detoxification from psychoactive substances. It is known that a method commonly applied is so-called “rapid detoxification”, which is not conducted in public centres. o Substitution treatment Polish drug treatment system allows substitution treatment as a ambulatory form to drug addicts when other forms of treatment failed. Such programmes are addressed to opiate addicts aged 18 and older. Under substitution treatment programmes patients are provided with psychological and social assistance. In 2005 one new methadone maintenance programme was launched (Łód Methadone Maintenance Centre by Detoxification Ward of J. Babiski Hospital in Specialist Psychiatric Health Care Group) and another one started operating in wiecie in 2006. In 2005 there were 11 substitution treatment programmes in Poland. They were run in public health care units (NBDP unpublished report 2006a p. 26; Zakrzewski 2004) 3 programmes run in remand centres (5 facilities) where 36 patients had been treated since their establishment. The

57 information collected by the National Focal Point shows that the methadone maintenance programmes outside the prison system provided treatment for 969 patients in 2005 (801 in the previous year)6. The key criterion for admitting drug users to substitution treatment programmes run in prison is the possibility to continue therapy upon serving a sentence. For that reason few inmates enter methadone programmes. That is why substitution treatment within the prison system must be coordinated with the one outside. The development of substitution treatment in 2005 was co-finance by local governments in 4 regions (out of 16 existing in Poland): dolnolskie, kujawsko-pomorskie, łódzkie and zachodniopomorskie (in 2003 – 3 regions) (NBDP unpublished report, 2006a, p. 104). o Other medically assisted treatment

In special cases drug addicts take psychotropic medication. It is the case when a patient is diagnosed with drug-related psychotic or mood disorders.

6 Data reported by substitution programmes, available in NBDP in Warsaw. 58

6. Health Correlates and Consequences

6.1. Drug-related deaths and mortality of drug users The basic source of information on deaths due to drug overdose is data of the Central Statistical Office – CSO. Every case is registered in the system. The database of the CSO database contains socio-demographic data and information on the cause of death. Up to 1999 ICD 9 was used, since 1997 the data have been encoded according to ICD 10. The main obstacle in collecting data on cases of fatal drug overdose is putting in the system only one primary cause of death. The CSO is in the process of developing the database into secondary and tertiary cause of death, which will adapt the Polish system to Eurostat requirements. Using one code may have effect on underestimation of the number of death cases. In 2005 the codes that make up the national definition of cause of death due to drug overdose. The following ICD codes were selected out of the general database: F11-12, F14- 16, F19, X42, X62, Y12, X44, X64, Y14. The data of Table 1 show a stable long-term trend of death cases. In 1997 we recorded a sharp increase compared to 1996. ICD 10 went into circulation at that time. The changes in encoding might have raised the number of death cases in the database. In 1997-2004 the number of deaths fluctuated. The data of 2002-2004 show a downward trend, however, it is hard to state whether we deal with a new trend or just the sign of prior fluctuations.

Table 18. Deaths due to drug overdose in 1987-2004

Year Number Rate per 100 thousand residents 1987 156 0.41 1988 145 0.38 1989 181 0.48 1990 155 0.41 1991 213 0.56 1992 199 0.52 1993 211 0.55 1994 185 0.48 1995 175 0.45 1996 179 0.46 1997 253 0.65 1998 235 0.61

59 Year Number Rate per 100 thousand residents 1999 292 0.76 2000 310 0.81 2001 294 0.77 2002 324 0.85 2003 277 0.73 2004 231 0.61

Source: Central Statistical Office

As men are more frequent drug users than women, drugs contribute to more death cases among men than women. In 2004 38% of fatal drug overdose victims were female, in 2003 – 32% and in 2002 – 42%.

6.2. Drug related infectious diseases o HIV/AIDS, viral hepatitis, STD, tuberculosis, other infectious morbidity

2005 CROSS-SECTIONAL STUDY RESULTS The data below come from a research project called “Estimation of infectious diseases prevalence (HCV, HBV and HIV) among injecting drug users” that was conducted in 2005 upon commission of the National Bureau for Drug Prevention by the State Institute of Hygiene (Rosiska 2006).

• Methodology The study was conducted in the 4th quarter of 2005 in Wroclaw (dolnoslaskie region), Lublin and Pulawy (lubelskie region) and Elblag and Olsztyn (warminsko-mazurskie region). 2 criteria for inclusion into sample were applied: drug injection at least once in a lifetime and permanent residence in a given area (not shorter than 3 months). The recruitment was performed in the street and 8 low-threshold programmes, methadone maintenance programmes and remand centres. The study included 353 participants – 178 in Wroclaw , 92 in lubelskie region and 83 in warminsko-mazurskie region. Almost 30% of the participants were female (105). The participants’ age ranged from 17 to 56 (30 on average). The project was implemented according to cross-sectional model covering serum tests for HIV, HCV and HBV, syphilis and completing an anonymous closed question questionnaire.

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• Drug use history The average age of participants at first injection was 19.7. The estimated average period of injecting a drug (counted from first till last injection) was more than 8.5 years (range of 0-30 years). 64.9% of the participants confirm that they used needles and syringes along with another person or needles and syringes that had been shared by another user. More than 85% of the participants had periods of daily drug use. The average number of injections in that period was 3.3 per day and ranged from 1 to 15 times in a day. The period of daily drug use lasted 17.9 months on average. The most common drug were opiates (210 participants – 59.5%) including heroin (116 = 32.9%) and homemade opiates (so called ‘Polish heroin’ or ‘kompot’). Next was amphetamine, used by 82 participants (23.2%). However, there were large discrepancies between the regions in this respect. While for 42.1% of the participants of dolnoslaskie region ‘kompot’ was the primary drug in the two other regions only 3% of the participants used it. In lubelskie and warminsko-mazurksie regions the most prevalent drug was amphetamine used by 31 (33.7%) and 36 (43.4%) users respectively. Next came heroin, lubelskie region – 21 users (23.9%) and warminsko-mazurskie region – 33 users (39.9%). 76.7% of the street and low threshold facility participants reported that they were being treated for drug addiction. 63.6% of the participants underwent detoxification. 216 drug users entered outpatient treatment, which constitutes 67.3% of the total number of participants. 23 persons – 7.4% of the participants who answered this question entered methadone maintenance programmes. The majority of the participants were aware of the existence of needle and syringe exchange programmes (86.7%). 178 users (53%) entered such programmes, 40 persons (11.9%) would like to enter them and 118 persons (35.1%) did not show any interest in these programmes. The percentages vary from city to city. In dolnoslaskie region 23% of the participants were not interested in needle and syringe exchange programmes, 32.5% in lubelskie region and 63.4% in warminsko-mazurksie region. 62% of the participants declared that they had undergone HIV tests.

• HIV prevalence As a result of immunoenzymatic tests HIV antibodies were detected in 84 persons (24.1%). Positive results were obtained in 56 persons (31%) in Wroclaw, 88 (30%) in lubelskie region and 2 users (0.02%) in warminsko-mazurskie region. Risk factors most often to correlated with HIV infections were injecting-related behaviours: sharing needles with HBV and HCV users (77.3%), sharing needles with HIV users (62.5%) and injecting in the last 30 days (38.1%) as well as homelessness (42.3%) and unemployment (34.8%). 61

• HCV prevalence In the study sample HCV antibodies were detected in 201 users (57.9%) and in 6 cases there were no decisive results. In 201 positive participants only 70 were aware of their status. HCV antibodies were detected in 114 persons (64%) in Wroclaw, 38 (44%) in lubelskie region and 49 (60%)in warminsko-mazurskie region. HCV infections were boosted by injecting behaviours such as sharing needles with HBV and HCV users (88.6%), sharing needles with HIV users (83.9%) and injecting a drug in the last 30 days (71%).

• HBV prevalence The study participants were screened for two HBV markers, antibodies to HBV core antigen (HBc-Ab) indicative of HBV history and surface antigen (HB-Ag) indicative of active HBV. 157 participants (45%) were identified with HBc-Ab antibodies and 21 (6.1%) were identified with HB-Ag antigen. In the case of 27 participants no presence of HBc-Ab or HBs- Ag was detected. Concerning antibodies to HBV core antigen 97 participants (55.7%) obtained positive results in dolnoslaskie region, 40 (46%) in lubelskie region and 82 (24.4%) in warminsko-mazurskie region. In the case of surface antigen the following prevalence figures were recorded: 13 participants (7.3%) in dolnoslaskie region, 1 person (1.1%) in lubelskie region and 21 persons (6.1%) in warminsko-mazurskie region. Apart from injecting behaviour another risk factor correlating with HBV infections was having sex with more than 5 partners in the last year (63.3%).

• Syphilis prevalence Only Wroclaw participants tested positive for syphilis. HIV cases were more frequent in this group. There is a strong relationship between the frequency of HIV detection and the frequency of VDRL results (61.5% of HIV positive users tested positive for VDRL) and the frequency of STD diagnosis (47% of HIV positive users). HCV antibody prevalence among VDRL positive participants was 88.5%. The correlation between syphilis test results and HCV tests may point to the role sexual contacts as a risk factor in HCV infections, though they might not be behaviours in the traditional sense of risky sexual behaviours. Sexual contacts had an important influence on HBV infections, which is indicated by the correlation of HCc-Ab tests with VDRL test results (76%).

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• Conclusions: - In dolnoslaskie and lubelskie regions high HIV rates were detected (31.5% and 29.5% respectively) compared to the majority of regions surveyed in the previous years (2004: Warsaw - 16%, lubuskie region – 7,5%, slaskie – 13,3%, 2002: Gdansk - 29%). HIV prevalence in warminsko-mazurskie region was far lower (2.4%). The percentages recorded are higher than the European data. - HCV antibody prevalence differed to a lesser extent than HIV prevalence both in the areas covered by the study (Wroclaw – 64%, lubelskie region – 43.7%, warminsko- mazurskie region – 59.8%) and in the areas studied in the previous years (2004: slaskie region – 68,3%, Warsaw 60,0%, lubuskie region– 55,6%). This level is also comparable with the data recorded in the European Union. In Polish population there is a high prevalence of HCV antibodies in persons aged 25 and younger (54.7% in this study, 46.6% in 2004). In EU countries the prevalence rates stand at 30%. This situation calls for preventive actions among young people. - The prevalence of antibodies to HBV core antigen, similarly to HIV prevalence, varies depending on a region: Wroclaw – 55.7%, lubelskie region – 46%, warminsko-mazurskie region – 24.4% (2004: Warsaw – 40,0%, slaskie region – 61,7%, lubuskie region – 23,3%). Considering wide availability of vaccinations as an effective prevention method these percentages are far too high. - HBV reached high prevalence already in the age group 20-25 (28.6% in lubelskie region, 23.1% in warminsko-mazurskie region and as high as 52% in dolnoslaskie region). Protective vaccinations should be provided for young people. The offer of HBV vaccinations even for the age group 14, which should receive such vaccinations on a routine basis, is also insufficient. - At an individual level risk factors connected with infections transmitted through injecting were the factors related to increased exposure to blood, period of injecting, periods of daily injecting, frequency of injecting (measured by injecting in the last month). Sharing needles/syringes mattered only in the case of HIV and HCV. Infection factors seems to be the factors related to socio-economic status, especially unemployment, homelessness and prison sentences in the case of HCV. These dependencies, except prison sentences, were stronger in the case of HIV. Then preventive actions should be addressed to mainly potential HIV users. - An important infection risk factor was sharing needles/syringes with users that were infected with HIV or jaundice. HIV users should be reminded that since there is a strong coexistence of HIV and hepatitis sharing needles with another HIV positive user they may also get infected with hepatitis.

63 - Frequent positive VDRL results of Wroclaw participants may indicate the focus of the disease among injecting drug users. This may contribute to the spread of HIV, which is corroborated by the frequency correlation of HIV and positive VDRL results. - Since the prevalence is dependent on the lifetime exposure to potentially infected blood, it raises with age. The alarming trend is the reversal of age correlation (higher prevalence of antibodies in younger age group) in the group of Wroclaw participants, especially among women. It refers to all the diseases (HIV, HBV and HCV) and may point to the faster spread of these diseases now compared to the previous years. It also must be noted that the prevalence in older age groups recorded in Wroclaw is one of the higher in Poland. In warminsko-mazurskie region the highest prevalence of HCV antibodies is recorded in the age group 25-29, which once again suggests the focal of the disease in this age group. - Local discrepancies in the prevalence HIV and hepatitis in Poland to a great extent depend on risky behaviours. - The persons diagnosed with HIV and/or hepatitis were often not aware of their serological status. It mainly refers to hepatitis infections and may lead to further transmission of the viruses. There must be wider availability of research in the field for injecting drug users.

STATISTICAL DATA OF PUBLIC LABORATORIES The national data on HIV and AIDS in relation to drug use are collected by the National Institute of Hygiene7 from Provincial Sanitary and Epidemiological Stations (SANEPIDs). According to Figure 2 the number of new HIV infections in injecting drug users recorded in routine statistics in recent years has been decreasing.

In 2005, there were 645 new HIV infections detected, out of which 129 (20%) accounted for injecting drug users. It must be stressed that in the case of 69% of reported cases of new HIV infections no likely route of infection was given, which prevents an adequate assessment of the epidemiological situation. Since the implementation of routine tests in 1985 up to 31 December 2005 9 798 Polish citizens were diagnosed with HIV out of whom 5 293 were infected due to drug use. AIDS trend in relation to injecting drug use cases in 1999-2005 shows an upward tendency, however, it is a less dramatic increase compared to all cases of AIDS. In 2005 out of 190 recorted AIDS cases 98 (51.6%) were related to injecting drug use. Due to AIDS 74 people died including 45 (60.8%) injecting drug users.

7 Data is available in Polish on: http://www.pzh.gov.pl/epimeld/hiv_aids/index.htm 64 Figure 10. New HIV infections, including injecting drug users in 1999-2005, according to date of reporting

700

600

500

400

300

200 Drug addicts

100 All

0 1999 2000 2001 2002 2003 2004 2005

Source: Epidemiology Department of the National Institute of Hygiene

Figure 11. AIDS cases, including injecting drug users in 1999 – 2005, according to year of AIDS diagnose

200

180

160

140

120

100

80

60 Drug users 40 All 20

0 1999 2000 2001 2002 2003 2004 2005

Source: Epidemiology Department of the National Institute of Hygiene

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6.3. Psychiatric co-morbidity (dual diagnosis) o Personality disorders, depression, anxiety, affective disorders, etc. In Poland, as in other countries, patients with dual diagnosis are treated in two separate treatment systems: addiction treatment system based on re-entry model and psychiatric treatment system based on mental health improvement model. The scale of coexistence of drug-related behavioural disorders (ICD 10: F11-F16, F-18, F19) with other mental disorders may be determined upon statistical data on patients reported to residential psychiatric treatment system in a given year. The data will be incomplete for different reasons. Firstly, they come from residential treatment centres. Secondly, co-morbidity still remains hard to diagnose. Symptoms and problems caused by mental disorders in drug users are often attributed to psychoactive substances they use, which results in underestimation of the phenomenon. What is more medical doctors sometimes do not report the second diagnosis (which is the mental disorders) or the patient has three diagnoses but in the form place only for two of them is foreseen (so one diagnose is missed). Data of residential psychiatric treatment system indicate that in 1997-2004 the percentage of injecting drug users with other mental disorders increased steadily. In 1997 patients with dual diagnosis accounted for 3.2% of the overall number of drug users admitted to residential psychiatric treatment, in 2000 – 4%, in 2003 – 5.9%, whereas in 2004 – 6.3% (Figure 12), i.e. 809 out of 12 027 patients.

Figure 12. Upward trends in the percentage of patients with dual diagnosis in all patients admitted to residential psychiatric treatment due to drug use in 1997- 2004

7 6 5 4 3 2 1 0 1997 1999 2001 2003

Source: Institute of Psychiatry and Neurology in Warsaw

66 Patients with dual diagnosis treated in residential psychiatric treatment facilities most often demonstrated symptoms of personality disorders (39% in 2004), depression and anxiety disorders, including phobias and panic disorders (each 6% in 2004). The remaining disorders frequent in drug users were psychotic disorders (45% in 2004) including hallucinations, delusions or schizophrenia and also behavioural disorders. As table 19 shows in the case of drug-related patients, despite the increase in the overall number of such patients, the percentage of second diagnoses has been holding steady since 1997.

Table 19. Patients admitted to residential treatment due to drug use in 1997 – 2004, in second diagnose breakdown

Second diagnose 1997 1998 1999 2000 2001 2002 2003 2004 Total number of patients: 171 229 271 343 378 645 693 809 Personality disorders 46% 32% 48% 37% 39% 50% 39% 39% Depression 7% 7% 7% 9% 5% 4% 5% 7% Other affective disorders 5% 5% 0 2% 1% 2% 2% 2% Anxiety disorders 0 5% 8% 6% 5% 6% 7% 7% Other disorders (psychotic and behavioural) 42% 51% 37% 46% 50% 38% 47% 45% In total: 100% 100% 100% 100% 100% 100% 100% 100%

Source: Institute of Psychiatry and Neurology in Warsaw

6.4. Other drug-related health correlates and consequences: o Somatic co-morbidity (as abscesses, sepses, endocarditis, dental health etc.), non-fatal drug emergencies, other health consequences No data available. o Driving and other accidents Issue of driving under the influence of drugs is described in detail in Part B – Selected Issues.

67 o Pregnancies and children born to drug users In 2005 upon the commission of the National Bureau for Drug Prevention the Obstetrics and Gynaecology Clinic of the Mother and Child Institute conducted a research project “Prenatal care for a pregnant drug user receiving methadone” (Niemiec and Kowalska 2005). The information presented below comes from an article on the above research subject.

• Purpose of study The project aimed at assessing the risk of pregnancy and birth complications in women addicted to psychoactive substances; development of the child; the assessment of women’s socio-economic status; an psychological and sociological analysis of attitudes, including attitude to maternity, of addicted pregnant women; vision of the future in the context of a mother. Moreover assessment of usefulness and implementation chances of a proposed medical care model was performed.

• Methodology It was assumed that the study would cover women addicted to psychoactive substances with confirmed pregnancy of more than six weeks. The women were provided interdisciplinary care (gynaecologist – obstetrician, infectious diseases specialist, liver specialist, psychiatrist, addiction specialist, clinical psychologist, social worker, certified midwife). The women underwent laboratory tests (e.g. liver functioning) and were asked to fill in a questionnaire. The analysis was carried out on the questionnaire or interview data obtained from addicted women.

• Sample 13 patients with single pregnancies aged 22 to 35 (mean 26) participated in the study. 7 women were HIV positive due to injecting drug use (54%); 10 were HCV positive (77%) also intravenously; 2 women were diagnosed with liver malfunction. All HIV patients were HCV positive. The participants were mainly addicted to opiates. Substitution treatment with methadone was provided for 6 women (46%), other 6 patients reported addiction to psychoactive substances, however, remained drug free while pregnant. 3 patients (23%) used heroin while pregnant.

• Programme In the sample 3 women (23%) declared that they planned their pregnancy and the moment they found out about it was a source of joy. The other women were pleased to find out they were pregnant, however, they felt fear and anxiety before the coming changes. The

68 HIV addicted women stressed their concerns for the health of their babies and the likelihood of infecting them with the fatal disease. At the same time they were concerned about how the pregnancy would affect their lives. They felt prepared neither physically nor mentally.

In pregnancy each patient had one sexual partner, however, in their lifetime the number of partners ranged from 3 to 10. In the study group 9 women (69%) were first-timers, 4 had already had children, including 2 through C-section. 3 patients (23%) had previously miscarried. 11 participants gave birth between 37th and 40th week, the remaining two decided to give birth in another hospital. 4 births (36%) were natural. In three cases (27%) HIV patients underwent C-section to prevent mother-to-child infection transmission. 4 women (36%) underwent rapid C-section, including 2 women due to symptoms of threat to the foetus. All HIV women during labour were provided with antiretroviral medication and the women under methadone maintenance programme received methadone during labour. The postpartum period ran an uncomplicated course in 9 women (82%) and 2 were diagnosed with inflammation. All HIV and the majority of HCV mothers did not breastfeed. Only one HCV mother decided to breastfeed. Receiving methadone was not contraindications to breastfeeding. 3 patients asked to be discharged from hospital without their children, including 2 women who decided to leave their children ready for adoption. 3 women left the clinic upon request and took their children, discontinuing in 2 cases treatment of neonatal abstinence syndrome. One of them in postpartum period relapsed into drug use. The women under study gave birth to 8 boys and 3 girls. The infants’ weight ranged from 1900 to 3800 g, with mean values of 3 kg. 10 infants (91%) were born in good condition, 1 baby in the first minute scored 5 points in the Apgar scale with fast recovery in the 5th minute of life. 4 out of 5 newborn children borne by mothers receiving methadone or heroin (80%) demonstrated symptoms of neonatal abstinence syndrome (NAS) of different intensity levels requiring Phenobarbital treatment. One infant was diagnosed with foetal heart defect in the form of atrial septal defect – his mother was an injecting drug user and reported to medical treatment at the end of her pregnancy. She had two appointments. One infant had low birth weight (less than 2500 g). His HIV and HCV mother demonstrated first symptoms of AIDS (C3) with left hemiplegia, AIDS dementia and epilepsy due to CNS toxoplasmosis. She reported addiction to narcotic drugs in an interview, however, she remained abstinent during pregnancy. Since HIV and HCV antibodies may be detected after 6 months since birth the diagnostic tests have not been completed yet. By the time this report was finished no final data on mother-to-child transmission were obtained.

69 • Conclusions Upon analysis of the results of the study conducted on addicted pregnant mothers at the Institute of Mother and Child a relatively low percentage of pregnancy complications were recorded, which may be explained by close medical supervision over the patients, rapid identification of threats and pathology prevention. The fact that individual cases of syphilis infection, trichomoniasis or human papilloma virus (HPV) and no cases of chlamydia trachomatis infection were recorded is likely to be related to patients’ lifestyle (permanent sexual partner). Despite a great number of HIV patients colposcopic and cytological tests did not provide any cases of cervical cancer or precancer states requiring surgical intervention. Moreover, it was determined that the risk of pregnancy pathology diminishes thanks to substitution treatment. During the course of the project the majority of the patients of the Institute of Mother and Child experience changes for better in their lives. If the socio-economic situation permitted, the pregnancy motivated and stimulated the women to fight the addiction and re- enter society as well as raised their self-esteem. Remaining abstinent or receiving only substitution treatment was successful in the case of 10 out of 13 patients (77%). The majority of young women reported willingness to return to school, gain education and pursue self- development. Additional duties and higher responsibility related to motherhood made them raise their qualifications, which may result in finding a good job in the future.

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7. Response to Health Correlates and Consequences

7.1. Prevention of drug related deaths Harm reduction programmes were conducted mainly by non-governmental organizations in large cities, the streets, homeless shelters, meeting spots of drug users (dealers’ dens, railway stations), sexual service points and points of needle and syringe exchange points. In 2005 the National Bureau co-financed 18 harm reduction programmes (NBDP unpublished report, 2006a, p. 27). Harm reduction and risk reduction programmes are addressed to persons addicted to psychoactive substances and demotivated to enter treatment. Such programmes are intended to minimize drug-related health harm (mainly due to opiates and synthetic drugs) as well as the risk of HIV, HBV and HCV infection. The most prevalent form of outreach is the distribution of sterile injecting equipment (needles, syringes), cleaning stuff and condoms. Drug addicts are motivated by the staff harm reduction programmes to enter drug treatment. They provide information on relevant facilities and in case of some programmes also encourage drug users to sign up for “safer drug taking” courses that aim at limiting cases of overdose and infection. Another important component of harm reduction programmes is education on safe sex behaviour and first aid training sessions. In 2005 the National Bureau sponsored distribution of about 474 000 needles and 372 000 syringes. The programmes covered 6 715 drug users (NBDP unpublished report, 2006a, p. 104). In 2005, as in the previous years, the National Bureau co-financed “Monar na bajzlu” magazine addressed to drug users and treatment programme operators, especially harm reduction programmes. Apart from the National Bureau such programme are also supported by some local governments. UNDP Poland has ceased supporting those programmes in 2004. The analysis of the 2005 questionnaire reports on the implementation of the National Programme for Counteracting Drug Addiction sent by provincial governments shows that harm reduction activities were financed by 7 provincial governments (out of 16 existing in Poland): dolnoslaskie, lodzkie, podkarpackie, pomorskie, warminsko-mazurskie, wielkopolskie oraz zachodniopomorskie. In 2005 provincial governments participated in 8 programmes of this type compared to 14 in 2004. The programmes concentrated on needle and syringe exchange for active drug users and community activities including recreational venues.

71 Harm reduction programmes in Poland were conducted in 12 counties (out of 373 counties existing in Poland). The programmes were allocated with EUR 82 4348. One county allocated EUR 6 869 to the above purpose. Harm reduction tasks were also performed by 18 communes which allocated an average of EUR 6 813 to each programme. Half of the communes disbursed more than EUR 2 322. Communed spend the total of EUR 122 641on the task implementation. o Overdose prevention

- safer use training, first aid training

Due to the increased popularity of synthetic drugs in Poland there are risk reduction programmes aimed at occasional, recreational drug users. Such programmes are conducted in recreational venues (dance clubs, concerts, open air events etc.) and focus mainly on negative consequences of drug use, especially overdoses. There were 8 programmes of this type operating in 2005 and they were co-financed by the National Bureau. They were conducted in 6 big cities and at the annual rock festival “Woodstock Stop” (NBDP unpublished report, 2006b, pp. 20-21). The programmes consisted of the following components: - education and information on psychoactive substances, drug addiction and consequences of drug use and drug treatment options. The above goals were being performed through distribution of leaflets and brochures and talks with drug users, - motivating to change attitude and behaviour, - first aid in case of overdose training sessions, - condom distribution, - crisis interventions.

- consumption rooms No safe injecting rooms exist in Poland.

- antagonists In Poland the following are used: • naloxon, in case of acute opiate poisoning • naltrexon, in maintaining abstinence or preventing relapse. The drug is registered for support opioid treatment for persons upon detoxification. The drug is used by doctors in drug treatment centres. A number of drug treatment facilities administer this drug.

8 Conversion based on average National Bank of Poland exchange rate of PLN to EUR as of 25 August 2006 EUR 1 = PLN 3.93 72 Both drugs are used by doctors working with opiate addicts. Naloxon should be part of ambulance equipment. Both drugs are not available on prescription and they are not distributed through pharmacies.

7.2. Prevention and treatment of drug-related infectious diseases o Prevention - vaccination Injecting drug users are not covered by special infectious disease vaccination programmes. There are no specific programmes for treating infectious diseases in drug users either. The exception is the programme addressed to infectious disease patients addicted to psychoactive substances, not covered by other forms of treatment, conducted at Warsaw hospital for infectious diseases. o Counselling and testing In Poland non-insured drug addicts have an option of taking a free-of-charge HIV test. Test centres are bound to provide counselling before and after the test. o Infectious disease treatment

Similarly to HIV testing, infectious disease treatment of drug users/addicts is performed according to the general rules of infectious disease treatment. Before 2005 active drug users infected with infectious disease or HIV/AIDS were often excluded from anti-retroviral treatment (the exception is methadone users under substitution treatment programmes and addicted pregnant women). It was caused by the common conviction that discontinuance of such treatment causes more serious consequences for health than not entering treatment at all. It is drug addicts who discontinue treatment more often than others. Additionally, some anti-retroviral drugs should not be administered in case of using specific narcotic drugs. On the other hand it is more commonly believed that every discontinued anti-retroviral treatment even a discontinued one benefits a patient and drug users should not be discriminated against and excluded form anti-retroviral treatment system. Therefore the notes from the Ministry of Health programme of “Anti-retroviral treatment of people living with HIV virus in Poland for years 2005-2006” recommend the physicians provide this kind of treatment to active drug users. In 2005 law changes were introduced in relation to anti-retroviral treatment for drug addicts. Now the decision whether an active drug user infected with HIV/AIDS should enter anti-retroviral treatment is made by a doctor (Ministry of Health 2004).

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7.3. Interventions related to psychiatric co-morbidity Generally addiction treatment centres are not ready for treating patients with dual diagnosis. Such patients are referred to mental health counselling centres and in the case of acute psychotic disorders to psychiatric hospitals. The majority of residential addiction treatment centres accept such patients upon prior stabilization of mental state in a psychiatric unit. However the centers stress that such patients should constitute a substantial minority so that their additional problems will not destabilize the functioning of a therapeutic community. In 2005 there were residential drug treatment centres in Poland specializing in professional assistance to drug addicts with mental disorders.

If a mental health counselling centre patient reveals that he or she has a drug problem – upon stabilization of his or her mental state the patient is referred to a addiction treatment counselling centre and the other way round. So ambulatory centres cooperate with one another.

7.4. Interventions related to other health correlates and consequences o Somatic co-morbidity No data available. o Non-fatal emergencies and general health-related treatment No data available. o Prevention and reduction of driving accidents related to drug use See the chapter 13. o Other health consequences reduction activities No data available. o Interventions concerning pregnancies and children born to drug users

In 2005 the National Bureau for Drug Prevention commissioned the Institute of Mother and Child to conduct a study called “Prenatal care for a pregnant drug user receiving methadone” (Niemiec and Kowalska 2005). The project is presented in part 6. Health Correlates and Consequences, point: Pregnancies and children born to drug users. One of

74 the study objective was working out an optimal model of medical care over a pregnant drug addict in a methadone maintenance programme. The basic recommendation emerging from the above study concerned the need of providing in one centre specialist medical care in obstetrics, infectious diseases and addiction treatment (gynaecologist – obstetrician, infectious diseases specialist, liver diseases specialist, psychiatrist, addiction treatment specialist, paediatrician, neonatologist, clinical psychologist, social worker, certified midwife). The option of establishing a separate methadone maintenance programme exclusively for pregnant patients should be seriously considered. It should be located in a centre with professional backup in case of any threat to pregnancy and specialist pediatric care for children of addicted mothers. At the same time under substitution treatment programme addiction specialists and therapists will perform drug withdrawal plan.

While developing standards of medical care of a pregnant addicted postnatal period should not be forgotten.

Moreover, it is of vital importance to provide easy access to an adequate procedure or a doctor since addicted persons are reluctant to seek help and are easily discouraged from it in case of any problems.

Programmes addressed to addicted mother were presented in the previous report for the EMCDDA in section on Key issue on gender study.

75 8. Social Correlates and Consequences

8.1. Social Exclusion: o Homelessness and unemployment Data on homelessness and unemployment in injecting drug users come from the study “Estimation of infectious diseases prevalence (HCV, HBV and HIV) among injecting drug users”. The study was conducted in 2005 by the National Institute of Hygiene upon commission of the National Bureau for Drug Prevention. The sample included 353 injecting drug users. The respondents came from 3 regions: dolnoslaskie, lubelskie and warminsko- mazurskie. The methodology description and the study group profile are presented in Chapter 6.2. The results of the survey on homelessness and unemployment in injecting drug users were as follows: Almost half of the respondents (169 = 49.6%) at the time of the survey were unemployed (12 respondents did not report their primary occupation). 113 (32%) respondents had ever been homeless in their lives, including 28 (7.9%) persons who did not have a job at the time of completing the questionnaire (Rosiska 2006, p. 6). o School drop out No data available. o Financial problems No data available. o Social network, etc. Injecting drug users relatively rarely benefit from welfare assistance. Such persons rarely turn for help and due to their poor awareness and knowledge on the options of getting this type of assistance (both in terms of welfare laws and locations of welfare services). Moreover, welfare centres are reluctant to take care of such clients as they do not comply with the procedures for the assistance. They fail to submit necessary documents or come to appointments etc. They are socially branded and raise suspicions of using the welfare resources for buying drugs.

In 2005 welfare centres in Poland provided assistance due to drug use for 3 922 families ( 7 856 persons in total, including 545 in rural areas) (Ministry of Labour 2006, p. 6). In the previous year 3 970 families benefited from the welfare assistance (8 312 persons in total, including 470 in rural areas) (Ministry of Labour 2006, p. 8).

76

8.2. Drug-related Crime (based on Police data)

The following police units are responsible for combating drug-related crime (Stochmal 2002): - Central Investigation Bureau (CBS) of the Police Headquarters (KGP) deals mainly with combating organized crime syndicates that manufacture and traffic in drugs on a large scale , also in the international context. CBS fulfils a leading role in the training area as well as strategic and conceptual planning. - Criminal Service departments of local police units are responsible for intelligence, operational activities and prosecution proceedings in a given area. The above units combat local productions of drugs, their distribution and possession. - Prevention Service Departments of local police units deal with basic intelligence and law enforcement in the course of routine preventive activities. They also perform preventive actions under their own programmes and contacts with society.

It must be stressed that combating drug-related crime, especially in the framework of operational activities and intelligence, is performed not only by the Police but also by other state services: the Internal Security Agency, Border Guard, General Customs Inspectorate and Military Police. While analyzing the data on drug-related crime one must remember that the official statistics do not reflect the full picture of illegal drug market. A number of offences are not revealed. The research shows that the percentage of reporting drug-related crime cases does not exceed 10% (Hołyst 1994). It may be expected that the percentage of non-reported drug- related offences stands at the same level. Another important issue in data analysis is the influence of policy activity on the number of reported offences. The dynamics of numbers of specific offences shows changes both in scope of activity of organized crime world and the extent of actions of institutions responsible for combating drug supply. In the case of active performance of law enforcement agencies numbers of reported offence go up, which does not necessarily have to mean an increase in the production of drugs or increased activity of organized crime syndicates.

77 RECORDED OFFENCES Police data on drug-related offences come mainly from the TEMIDA – Police data base system. The basic statistical units that the police use include suspects, proceedings instigated and recorded offences. The data shown in Table 20 and Figure 13 cover crimes detected by the police and committed against the Act of Law of 1985 on drug prevention and the Acts of Law of 1997 and 2005 on counteracting drug addiction. According to these data we noted an upward trend in the number of offences of illegal introducing to trade of narcotic drugs; sharing and inciting to use drugs. In the case of offences of illegal import, export or transit of drugs i.e. drug trafficking in 1990-1999 there is a noticeable upward trend. In the next two years (2000 and 2001) we observed a decline in these crimes. The last four years demonstrate an increase, except previous year when a fall occurred. However, the number of offences recorded that year is far higher compared to the years 1990-2003.

Figure 13. Recorded offences in 1999-2005 against Act of Law of 1997 and 2005 on counteracting drug addiction

90000 Cultivation of poppy and 80000 cannabis

70000 Drug manufacture

60000 Manufacture of 50000 drug production instruments 40000 Drug trafficking 30000

20000 Selling drugs

10000

0 Sharing and inciting to use 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 9 9 9 9 9 9 9 9 9 9 0 0 0 0 0 0 9 9 9 9 9 9 9 9 9 9 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 drugs

Source: Police Headquarters in Warsaw

78 Table 20. Recorded offences against Act of Law on drug prevention and Act of Law on counteracting drug addiction in 1990-2005

Legal qualification Years 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 Illegal cultivation 382 1712 1631 3577 3040 2780 2634 2518 1195 615 814 663 653 687 886 875 (Art. 26; Art. 49.1; Art.63.1) Illegal manufacture 557 589 521 1280 387 392 459 701 574 361 400 408 319 297 350 456 (Art. 27; Art. 40. 1 & 2; Art. 53) Manufacture, 34 60 94 123 85 97 135 116 190 143 152 292 230 230 220 144 storing instruments (Art. 28; Art. 41; Art.54) Illegal import, 1 6 23 21 20 69 97 148 252 406 383 295 336 354 795 643 export or transit (Art. 29; Art. 42; Art.55) Illegal introducing 10 24 45 207 107 215 397 847 1957 1714 1417 1809 1931 2064 2323 2814 to trade (Art. 30; Art. 43; Art.56) Illegal sharing or 121 77 128 249 361 731 3058 3507 10762 10305 13278 18873 20482 25036 28351 31332 inciting to use (Art. 31; Art. 45 & Art. 46; Art. 58 & Art. 59) Production, 11 88 61 66 115 104 159 178 151 trafficking, trade in precursors (Art. 47; Art. 61) Possession of 32 1380 1896 2815 6651 11960 18681 26163 30899 narcotic drugs (Art. 48; Art. 62) Illegal harvest of 26 112 113 83 78 73 69 42 49 poppy milk, opium, poppy straw, cannabis resin or cannabis plant (Art. 49. 2; Art. 63.2) Appropriation of 9 22 14 241 24 14 17 15 31 poppy milk, straw, cannabis resin or plant (Art. 50; Art. 64) Non-reporting an 22 76 11 33 163 offence (Art. 46a; Art. 60) Promoting and 3 advertising (Art. 68) Total 1105 2468 2442 5457 4000 4284 6780 7915 16532 15628 19649 29230 36178 47605 59356 67560

Source: Police Headquarters in Warsaw

79 The most offences were recorded due to illegal drug possession as well as sharing and inciting to use drugs. In the case of the latter in 1996 we recorded the highest number of punishable acts- 3 051 (45.1% of all crimes against the Act of Law). In 1997 a new Act of Law on counteracting drug addiction was adopted thus tightening the drug law. Let us remember that the Act of 1997 was meant to be an effective tool in combating the illegal market and the improvement in law enforcement had taken place before. The reason for an increase in punishable acts before 1997 might have been establishing in 1996 departments dealing with drug-related crime in the Police Headquarters and some police stations. (Krajewski 2005). Due to organizational changes within the Police the units started to show more activity, which translated into a rise in the number of recorded offences against the Act. It must be stressed that illegal sharing a narcotic drug is a major offence within the structure of drug-related offences. In 1997 the number of such acts stood at 3 507 (44.3% of all crimes) and in 2005 it rose to 31 332 (45.8%) i.e. more than nine fold. Another offence whose upward trend is equally dynamic is Article 49 of the Act of Law of 1997 (Article 62 of the Act of 2005) – punishing for drug possession (Figure 14). The crimes against this article in 1998 accounted for 8.4% (1 380 cases) of all incidents against the Act and in 2005 – 45.2% (30 899 cases). It is clearly seen that the three articles of the Act of Law of 1997: 45, 46 and 48 (in the Act of 2005: 58, 59 and 62) constituted 90.9% of all the offences in 2005. In the first year of the Act of 1997 in force this percentage was slightly lower and stood at 85.3%. The offence whose small numbers were recorded by the police is illegal cultivation of poppy and cannabis. Upon coming into force of the Act of 1997 the recorded cases of illegal cultivations accounted for one of the most frequent offences. In 1994 every fourth crime against the Act was illegal poppy or cannabis cultivation. From that year to 2002 we observe a downward trend in the number of offences with a momentary decline in 2000. Despite that fact in the structure of all crimes illegal cultivations constitute a tiny percentage of all punishable acts and even the rise in 2003-2005 did not change the structure of all recorded drug-related offences. In 2003 and 2004 the cultivation crimes accounted for 1.5% of all the punishable acts and in 2005 – 1.4%. The decrease in the number of offences of illegal poppy or cannabis cultivation in 2000 was caused among other things by new varieties of low- morphine poppy of altered morphology and characteristic of different colour and shape of petals. The new solution contributed substantially to the reduction of the old cultivation of poppy that was used for ‘kompot’ manufacture. For two years the police have been collecting data on the offences with breakdown into different types of narcotic drugs. The most offences were related to Indian hemp, in 2004 – 35 873 and in 2005 – 36 899. Then came offences in connection with amphetamine, in 2004 – 13 414, in 2005 – 16 974. Such results are not surprising as the most prevalent illicit drug in Poland is cannabis, then comes amphetamine (Sierosławski 2002).

80 Figure 14. Recorded offences in 1998-2005 against the Act of Law of 1997 and 2005 on counteracting drug addiction (index 1998 = 100)

2500 Cultivation of poppy and cannabis

2300 Drug manufacture

2100 Production of drug manufacture instruments 1900 Drug trafficking Selling drugs 1700 Sharing and facilitiating use 1500 Drug possession 1300

1100

900

700

500

300

100

-100 1998 1999 2000 2001 2002 2003 2004 2005

Source: Police Headquarters in Warsaw

SUSPECTS

Along with the number of recorded offences the number of suspects against the Act of 1997 and 2005 on counteracting drug addiction is also rising. Figure 15 illustrates stable growth. In the structure of all suspects the dominating segment are individuals suspected of violating Article 48 of the Act of 1997 (Article 62 of 2005) related to the possession of narcotic drugs. In 2005 there were as many as 19 215 in connection with this article (67% of all suspects under the Act). The data of previous years show how the structure of suspects was changing and how the individuals under Article 48 became to dominate: in 1999 – 1 146 suspects (23.9%); in 2000 – 1 799 suspects (27%); in 2001 0 4 358 suspects (43.7%); in 2002 – 7 285 suspects (54.1%); in 2003 – 10 529 (62.2%); in 2004 – 14 914 (65%). There was a twofold increase in the number of suspects in 2001 (the first year of the Act of 1997 in force) compared to 2000. An important amendment was deleting Article 48.4 that prevented a person who possessed a small amount of a drug for private use from being punished. Since 2000 the police have been able to perform “controlled purchase”, which led to an increase in drug-related crime detection.

81

Figure 15. Suspects In 199-2005 under the Act of 1997 and 2005 on counteracting drug addiction

30 000 28170

25 000 22 969

20 000 16 914

15 000 13 461 9 952 10 000 6 639 4 777 5 000

0 1999 2000 2001 2002 2003 2004 2005

Source: Police Headquarters in Warsaw

CUSTODIAL SENTENCES

Figure 16. Individuals sentenced to penalty of deprivation of liberty under the Act of Law on counteracting drug addiction 1989-2004

1 4000

suspended sentence

1 2000 custodial sentence 1 0000

8000

6000

4000

2000

0

9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 8 9 9 9 9 9 9 9 9 9 9 0 0 0 0 0 9 9 9 9 9 9 9 9 9 9 9 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2

Source: Ministry of Justice

82 Criminal proceedings under the Act are heard in district courts relevant to the place of committing a crime. The breakdown of final custodial sentences in 1998-2004 is shown in Table 21. The trend increased steadily from 1993 and then declined as of 1997. From 1998 we observe a rise in the number of convicts resulting from adopting a new Act of 1997 on counteracting drug addiction. In 2001 there was another increase of 49% in the number of convicts compared to 2000. In 2000 the Act on counteracting drug addiction was amended. The amendments are reflected in the statistics. The upward trend was continuing to 2004 – the yearof the most recent data. Comparing the last two years we can observe a large increase in the number of convicts under the Act (Figure 16).

Table 21. Convictions by courts in general and convictions under the Acts on counteracting drug addiction

Years Convictions in Convictions under the % of convictions general Act under the Act 1989 93 373 591 0.,63

1990 106 464 231 0.22

1991 152 333 421 0.28

1992 160 703 993 0.62

1993 171 622 2 235 1.30

1994 185 065 1 862 1.01

1995 195 455 1 864 0.95

1996 227 731 1 739 0.76

1997 210 600 1 457 0.69

1998 219 064 1 662 0.76

1999 207607 2 264 1.09

2000 222 815 2 878 1.29

2001 315 013 4 300 1.36

2002 365 326 6 407 1.75

2003 415 533 9 815 2.36

2004 512 969 16 608 3.30

Source: Ministry of Justice

83

Table 22 presents data on the number of convicts sentenced to imprisonment. Although in the case of all convictions under the Act (Table 21) the upward trend demonstrates certain deviations and the number of convicts tends to fall at times the number of convicts sentenced to imprisonment has been rising since 1990. The increase has gathered momentum in the last two years because, as it has been mentioned, the anti-drug law was tightened in 2000. Comparing the last two years a large increase in the number of convicts is seen (Figure 16).

Table 22. Convicts sentenced finally to imprisonment under Acts on drug prevention and counteracting drug addiction

Lata Convicts sentenced to imprisonment In general Without suspension With suspension 1989 236 76 160

1990 92 30 62

1991 143 32 111

1992 282 72 210

1993 347 97 250

1994 346 97 249

1995 368 100 268

1996 520 141 379

1997 629 165 464

1998 1 173 252 921

1999 1 865 420 1 445

2000 2 428 572 1 856

2001 3 802 1 024 2 778

2002 5 417 1 282 4 133

2003 7 785 1 489 6 296

2004 12 417 2 308 10 109

Source: Ministry of Justice

84

8.3. Drug Use in Prison: No new data available.

8.4. Social Costs: No new data available.

85

9. Responses to Social correlates and Consequences

9.1. Social Reintegration o Housing; education, training; employment; basic social assistance, etc. Post-rehabilitation programme for drug therapy graduates are conducted in hostels, re- entry flats, inpatient and outpatient clinics. Apart form therapeutic actions aimed at “preventing” a patient from relapse the programmes feature vocational training, skill improvement courses, assistance in graduating from a school. Post-rehabilitation programmes in the first place include: - counselling on solving everyday problems, - informative and educational group sessions, - personal development groups (coaching, training courses, workshops) aimed at raising self-esteem, improvement of functioning in social roles, - relapse prevention groups, - crisis interventions, - group and individual psycho-educational classes for families aimed at changing behaviour and habits related to living with a drug addict. These activities help to remain abstinent and re-enter society by drug addicts. In 2005 the National Bureau for Drug Prevention subsidised 45 social reintegration programmes conducted in outpatient clinics (18), hostels (21) and re-entry flats (16). Among residential social reintegration programmes there were 153 persons who studied and worked, 134 persons who studied only, 268 who worked and 127 participants who neither studied nor worked. In 2005 there were 77 children (up to 14) in programmes. Local governments and social care centres are bound by the Act of Law on social employment and the Act of Law on social care to conduct social reintegration programmes for addicts under strategy of integration and social policy. In 2005 the task of post-rehabilitation was performed by communes (gminy) and counties (powiaty). The reports on the implementation of the National Programme for Counteracting Drug Addiction show that in 2005 7 communes (out of 2 478 existing in Poland) financed 108 vacancies in 9 hostels and 15 re-entry flats.

County governments co-financed 5 hostels allocating to this purpose EUR 17 0289 and 7 re-entry flats at the amount of EUR 20 910 (NBDP unpublished report, 2006a, pp. 106- 107).

9 Conversion based on average National Bank of Poland exchange rate of PLN to EUR as of 25 August 2006 EUR 1 = PLN 3.93 86

9.2. Prevention of drug related Crime Activities in this field are performed mainly under “Governmental programme of preventing social inadequacy and crime in children and youth” that has been in use since 2004. One of the programme components is the conduct procedures for teachers and methods of cooperation with the police in cases where children or youth are endangered by crime or demoralization, especially drug addiction, alcoholism and prostitution. These procedures aim at improving and increasing adequacy and effectiveness of school interventions towards drug endangered children and youth. In 2005 the Ministry of National Education in cooperation with the Police Headquarters in the framework of implementing procedures placed special emphasis on shaping the ability to practically take advantage of procedures in cases of seriously threatening behaviour of pupils at school. Policemen dealing with juvenile issues and pathologies held meetings with school headmasters, pedagogues and teachers. These meetings were aimed at gaining skills of solving specific problems posing a threat to a given school. The superintendents offices also participated in disseminating the procedures (MSWiA 2006). o Assistance to drug users in prisons - treatment In 2005 prison system facilities provided: - 12 specialist drug-free therapeutic programmes,

- 3 substitution treatment programmes (run in 5 facilities),

- 56 addiction prevention programmes.

In 2005 the number of inmates in drug treatment serving sentences in penal institutions and remand centres was 1 325, compared to 1 157 in 2004 (increase of 12.7%). Still it is difficult to talk of the increase in the availability of benefits since the number of inmates requiring drug treatment is rising much faster. In 2005 the time of waiting for the admission to a drug treatment ward for inmates addicted to narcotic drugs and psychotropic substances lengthened by another 2 months (from 11 months in 2004 to 13 months in 2005)10. The existing system of drug treatment for inmates addicted to psychoactive substances still remains inadequate in relation to the real needs. Inmates wait for a vacancy in a therapeutic ward for several months and some of them are released from prison without proper drug therapy.

10 Data provided by the Bureau of Health Service at the Central Management Board of Prison Service. 87 o Other interventions for prevention of drug related crime, in particular : Urban security policies in the prevention of drug related crime (i.e. citizen participation, multi-agency collaboration, victims support interventions) No data available.

88 10. Drug Markets

10.1. Availability and supply o Availability of drugs (perceived availability/access in population, other indicators) The data on the availability of drugs among young people are obtained through ESPAD studies of 1995, 1999 and 2003. In 2005 school survey, according to the ESPAD methodology, was conducted. Thanks to the last year’s study we are able to track changes in the last 10 years. Comparison of the results may affect another period of the latest study. In 2005 the study was conducted in October and November, not in May and June as it was the case in 1995, 1999 and 2003. Trends of access to specific narcotic drugs may be analyzed with the data of subject to restrictions listed in Chapter 2.2. As in previous years, in 2005 the pupils answered the same question: “How hard would it be for you to obtain any of the following substances, if you wanted to?”. Table 1 contains percentages of the study participants who ticked the answer ‘very easy’. The participants were asked to assess the availability of tranquilizers and sleeping pills, inhalants and other illicit drugs.

In the last two surveys (2003 and 2005) there was a decrease in the respondents of younger age group who found it very easy to get the respective substances. Only in the case of tranquilizers was there an upward trend. Inhalants were also recorded to be on the rise in terms of availability 2005. The availability trend regarding this substance has been fluctuating for the past10 years. The older age group notes a decline in the availability of cannabis and amphetamine i.e. the most prevalent illicit drugs. In the same group the substances such as LSD, crack, heroin, hallucinogenic mushrooms and anabolic steroids were holding steady. In the case of tranquilizers, ‘kompot’, ecstasy, GHB and inhalants the upward trend is continuing. It is worth noting that although the respondents considered these substances to be more available, the increase was not so dynamic compared to the previous years.

89 Table 23. Substance availability (very easy to obtain)

Grades 1995 1999 2003 2005 Third grades of Cannabis 6.3 11.5 15.7 12.3 lower LSD or another hallucinogenic drug 3.3 7.3 8.6 5.3 secondary school Amphetamine 4.7 10.4 11.8 8.5 (gimnazjum) Tranquilizers or sleeping pills 16.5 17.4 19.6 22.9 Crack 2.1 4.7 7.4 5.3 Cocaine 2.6 5.8 8.3 6.2 Ecstasy 2.4 7.2 9.6 8.1 Heroin 3.8 6.0 8.5 6.7 Hallucinogenic mushrooms X 9.9 10.8 8.5 GHB X X 6.9 5.4 Inhalants 25.7 30.7 28.6 31.6 Anabolic steroids 6.1 11.8 13.8 12.2 Polish heroin (kompot) 6.6 X 10.5 8.5 Second grades Cannabis 9.6 11.9 23.1 21.0 of secondary LSD or another hallucinogenic drug 4.7 5.9 9.8 9.1 schools Amphetamine 6.5 10.5 17.5 15.5 Tranquilizers or sleeping pills 19.8 17.0 21.7 24.2 Crack 2.4 3.4 6.0 6.2 Cocaine 3.0 4.1 7.4 8.1 Ecstasy 2.5 6.7 11.9 13.2 Heroin 4.9 4.4 7.9 7.9 Hallucinogenic mushrooms X 8.9 12.3 12.5 GHB X X 5.7 6.4 Inhalants 27.5 29.8 35.1 36.6 Anabolic steroids 9.5 14.1 19.8 19.6 Polish heroin (kompot) 6.9 X 8.4 9.7

Source: Sierosławski J. (2006b)

Another indicator of drug availability was the question whether the respondent had been offered psychoactive substances. The respondents were provided with a list of licit and illicit substances and were asked to tick those who had been offered to them in the last 12 months. Table 2 demonstrates the same patterns as in the case of drug use in the survey of 2005.

The most prevalent drug offered to the youth was cannabis. 20.7% of the younger age group pupils and 36.8% of the older age group pupils had been offered a drug at least once in the last 12 months. The percentages of the pupils who had been offered amphetamine were 7.2% in 15-16-year-olds and 15% in 17-18-year-olds, in the case of ecstasy it was 5.8%and 11.8% respectively. Crack. LSD and heroin had been hardly offered. The younger age group demonstrated a decline in cannabis use. However, in 2005 there were higher rates of respondents who had been offered tranquilizers, sleeping pills, cocaine, ecstasy and

90 Polish heroin. The trend of amphetamine and anabolic steroids had been on the decrease since 2003. Teenagers in the older age group had been offered drugs more frequently than their younger mates. In this age group offer rates fell only for amphetamine.

Table 24. Exposure to drug offers

Grades 1995 1999 2003 2005 Third grades of lower Cannabis 11.4 17.3 21.6 20.7 secondary school LSD 3.8 5.0 3.4 3.7 (gimnazjum) Amphetamine 4.8 10.3 8.6 7.2 Tranquilizers or sleeping pills 8.1 6.9 5.7 7.1

Cocaine 1.7 3.5 3.8 4.5 Ecstasy 1.4 5.0 4.9 5.8 Heroin 2.0 3.4 3.6 3.8 Anabolic steroids 3.6 6.2 5.3 5.0 Polish heroin (kompot) 2.7 3.5 3.4 5.0 Second grades of Cannabis 17.3 23.6 34.8 36.8 secondary schools LSD 5.3 4.9 4.6 5.6

Amphetamine 6.0 14.0 16.8 15.4 Tranquilizers or sleeping pills 8.8 5.5 6.6 8.1

Cocaine 1.2 1.7 2.1 3.0 Ecstasy 1.9 2.7 3.5 5.2 Heroin 1.7 5.2 8.1 11.8 Anabolic steroids 2.2 2.3 3.4 4.6 Polish heroin (kompot) 5.4 7.1 8.7 8.9 Cannabis 2.1 1.5 2.2 8.6 Moonshine (Bimber) 16.8 14.9 25.4 3.3

Source: Sierosławski J. (2006b)

Another indicator of the availability of psychoactive substances on the illegal market was the answer to the question: “How much time do you think you would need to obtain a drug?”. The respondents could choose between the answers ranging from ”one hour or less” to “a few days or more”. The respondents could also tick the options “impossible” or “I don’t know”. Table 25 presents percentages for the two age groups.

91 Table 25. Drug availability assessment: ’How much time to do you need to get the following drugs?’

A few An hour A few Impossible to Don’t A day days or or less hours get know more Third grades Cannabis 14.2 10.9 8.4 13.7 16.3 36.5 of lower secondary Amphetamine 6.9 7.2 6.7 13.6 20.0 45.6 school (gimnazjum) Ecstasy 6.0 6.9 5.0 12.8 20.5 48.9

Heroin 4.5 5.7 5.4 12.4 22.1 49.9

Second Cannabis 23.7 14.0 10.4 12.9 10.7 28.3 grades of Amphetamine 13.4 10.8 7.6 12.9 13.2 42.0 secondary schools Ecstasy 10.6 8.8 6.8 12.9 14.9 46.1

Heroin 5.3 6.2 5.9 12.9 17.8 51.9

Source: Sierosławski J. (2006b)

The above data indicate that the considerable number of the respondents would be able to get cannabis in less than a day (35% of ‘gimnazjum’ pupils, 48.1% of secondary school pupils). For 14.2% of the younger age group pupils and 23.7% of the older age group obtaining cannabis would take no more than an hour. On the other hand 16.3% of ‘gimnazjum’ pupils and 10.7% of secondary school pupils considered getting hold of cannabis impossible.

The other drugs take longer to get. For example, only 20.8% of the surveyed lower secondary school pupils and 31.8% of secondary school pupils would get hold of amphetamine, which ranked second in terms of availability, in less than a day. 6.9% and 13.4% of the pupils respectively would get it in less than an hour. 20% of pupils of the younger age group and 13.2% of the old group considered it impossible to get hold of the drug.

Results for ecstasy are not different from the results for amphetamine. In the case of heroin they are indicative of slightly lower availability.

92 o Production, sources of supply and trafficking patterns within country as well as from and towards other countries Poland is a leading producer of amphetamine In Europe. Between 1995 and 2005 127 clandestine laboratories were seized (Krawczyk 2006). In 2005 police seized 20 amphetamine and 1 GHB labs. Polish labs apply the Leuckart synthesis in amphetamine production. The basic precursors include BMK and ammonium formate. A considerable quantity of this production is destined for Western European markets, particularly Germany and the Scandinavian countries. Two major drug trafficking routes go through the territory of Poland. Drugs are trafficked through the Polish territory in transit or find their way directly into the Western European markets. Crime syndicates might also store drugs, repack and ship them in smaller quantities to European countries and North America. Routes and methods of trafficking of drugs into Poland depend on their type, quantity and country of origin. − Sea and air routes are used for trafficking of cocaine from South America and cannabis from Africa. − Heroin and cannabis of Asian origin (South East Asia) are trafficked by land. − Heroin coming from the Golden Crescent (Afghanistan, Pakistan, Iran) is trafficked through the Balkan route (Turkey – Bulgaria – Romania – Hungary) or through the territory of the former Soviet Union. The largest quantities of heroin are smuggled to Poland from Afghanistan. − The same drug trafficking route is used for heroin from the Golden Triangle (Burma, Laos, Thailand) with smaller quantities trafficked by air. − Cannabis is trafficked by land into Poland through Germany from the Netherlands.

10.2. Seizures In Poland drug seizures are revealed by the Police, Customs Service (by the Ministry of Finance), Border guard, Military Police, Internal Security Agency and Prison Service in penal institutions. The three last institutions do not provide any data on seizures. All the above institutions have not developed a single data collection system, which makes it difficult to estimate the quantity of drugs seized in the whole country. As in some case there are at least two institutions who are involved in revealing data double counting occurs. Since 1996 the Police have been publishing data regarding the quantities of drugs seized and not the number of seizures. These data are reported by the Customs Service. Due to high discrepancies in the quantities of drug seizures and the role of the random factor the trend analysis is hampered. It must be remembered that part of drugs secured by the Polish services was destined for foreign markets. The largest quantities of drugs are revealed by the Police. The Central Investigation Bureau deals with organized crime and the department of criminal police combats retail trade in drugs. The analysis of Table 6 regarding police drug 93 seizures provides certain trends in this field. The police data reveal an upward trend in the quantity of amphetamine and ecstasy seized in 2002-2005. The highest number of seizures was recorded in 2005. In the case of cannabis the record year was 2002. After that year the number of marijuana seizures stabilised and the number of hashish seizures fluctuated. Cocaine seizures have been rising since 2002. In the last two years there has been a downward trend and the amounts of cocaine secured were smaller compared to the previous period. The biggest amount of heroin seized was reported in 2002, the same held for LSD in 2004. In 2005 compared to the previous years the department of criminal police secured larger quantities of the following substances: Polish heroin, poppy straw, Indian hemp, marijuana, amphetamine, cocaine and ecstasy (Minister of Health 2006). It may be indicative of increased intensity of actions against retail trade in drugs. In 2002 the Customs Service reported large quantities of marijuana, heroin, ecstasy and hallucinogenic mushrooms. In the next year there were record seizures of hashish, cocaine and amphetamine. Apart from ecstasy tablets, whose highest number was revealed by customs officers in 2005, the quantities of narcotic drugs seized are smaller than in previous years. The Border Guard, similarly to the Police, confiscated the largest quantities of marijuana and hashish in 2002. The same happened in the case of amphetamine. Both services reported the biggest seizures of this drug in 2005. The data analysis is hindered by the measurement units used by the Border Guard when they revealed a seizure of 0.25 kg of LSD. This unit is not used in any other statistics. It might be the weight of LSD paper and not the active substance itself. Such reporting makes it impossible to take this figure into consideration. If this fact had been reported in terms of the number of tabs it would have been a record year. The first seizure of GHB, called rape date drug, by the Police in 2005 is worth noting. It has so far been the only case of such seizure.

Table 28. Border Guard seizures 2002 – 2005

Drug Unit 2002 2003 2004 2005

Hashish Kg 18.389 0.314 2.521 0.774 Marijuana kg 56.679 24.106 28.631 25.502 Heroin Kg 12.250 0.003 46.269 0.022 Cocaine Kg 0.050 1.145 7.943 4.071 Amphetamin 6.034 13.341 1.727 34.776 Kg e Ecstasy tablets 250 194 13117 4655 LSD tabs 0 0 0.25kg 69

Source: Border Guard

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Table 26. Police seizures 2001-2005

Drug 2001 2002 2003 2004 2005

Amphetamine 195 kg 118 kg 134 g 192 kg 95 g 236 kg 348 g 308 kg 600 g

Ecstasy 232 735 pieces 24 883 pieces 95 148 pieces 269 377 pieces 487 268 pieces 1 kg 274 g

Marijuana 74kg 3 g 440 kg 001 g 198 kg 152 g 205 kg 735 g 201 kg 400 g

Cannabis; 32 388 pieces 86 163 plants 15 440 pieces 34 916 pieces plants/ 765 plants +15 tonnes 258 pot plants pot plants

Hashish 9 kg 500 g 114 kg 410 g 33 kg 640 g 41 kg 52 g 18 kg 500 g

Cocaine 45 kg 300g 397 kg 561 g 401 kg 225 g 21 kg 721 g 12 kg 800 g

Heroin 208 kg 100 g 6 kg 502 g 6 kg 913 g 65 kg 587 g 41 kg 130 g

Poppy straw 100 kg 3 t 300 g 4 t 398 kg N 1210 kg

Polish heroin 10 litres + 45 g 193 litres 155 litres 11 litres 11.493 litres

LSD 672 pieces 797 pieces 20 602 pieces 34 288 pieces 2 157 pieces

Psychotropic - 5 132 tablets 36 818 pieces 50 039 pieces - drugs / anabolic steroids Hallucinogenic - 3 kg 727 g 5 kg 943 g 11 kg 500 g 2 kg 580 g mushrooms

Source: Police Headquarters

95 Table 27.Customs Service seizures 1998 – 2005

1998 1999 2000 2001 2002 2003 2004 2005 iloş No. Quanti- No. Quanti- No. Quanti- No. Quanti- No. Quanti- No. Quanti- No. Quantity No. Quanti- Measure repor- ty repor- ty repor- ty repor- ty repor- ty repor- ty repor- repor- ty Drug ment unit ted ted ted ted ted ted ted ted Hashish kg 12 844 24 4.055 13 2.350 17 3.536 37 3.388 43 12,928 82 0.443 104 1.438 Marihuana kg 47 8.057 59 37.980 58 22.513 87 17.278 147 75.360 152 35.012 209 26.910 357 17.066 Hemp plants 8 807 8 3017 0 0 2 240 0 0 0 0 0 0 0 0 Heroin kg 5 23.081 1 10.500 1 96.718 3 180.560 4 292.835 0 0 7 189.627 4 0.017 Cocaine kg 2 8.136 6 5.766 1 75 4 5.249 6 1.480 4 399,333 6 6.308 8 7.224 Amphetami 2 2.684 9 0.718 6 0.865 14 0.651 28 10.548 20 11.204 32 5.686 101 3.008 kg ne Ecstasy tablets 3 1054 5 444 8 5171 22 6389 9 12138 4 6382 18 2821 59 9269 LSD tabs 6 4898 1 190 1 150 0 0 0 0 0 0 0 0 2 29 hallucinoge 4 81 3 93 0 0 5 38g 7 203g 3 15g 14 41g 4 99g nic pieces/g pieces pieces mushrooms

Source: Customs Service of Ministry of Finance

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10.3. Prices / Purity

o Price of drugs at street level Information on the prices of drugs is provided by the institutions dealing with the illegal market. The key institution in collecting such data is the Police as they conduct operational activities against wholesale and retail trade in drugs. Retail prices hale to follow developments on the drug scene. Their rise or fall may indicate rise or fall in supply. It is worth noting that the price of a drug is affected by a number of factors: area, drug purity, intensity of police actions as well as the international situation. In order to obtain credible data and eliminate distractors that would affect their credibility the information on the prices should be collected according to a specific methodology from as many sources as possible. The police system of data collection does not provide data reflecting exact retail prices of drugs. These data must be treated as estimates. Despite these restrictions the data could be interpreted, however, the information provided in the table must be regarded as approximate. Table 29 shows that the amphetamine prices have been falling since 2001. Prices of cocaine and ecstasy have also been decreasing since 2004. Prices of heroin (brown sugar), hashish and LSD are holding steady, however, the biggest fluctuations concern heroin. Prices of ecstasy, amphetamine and cocaine fell in 2005 compared to 2004. There has been a slight increase in the case of hashish, LSD and heroin. In 2005 the Information Centre developed a system of collecting police data. However, it proved impossible to implement it that year.

Table 29. Retail prices11 on illegal market 1999-2005 in EURO

Amphetamine Ecstasy Cocaine Heroin Hashish LSD „Brown Sugar” unit gram tablet gram gram gram tab 1999 Lowest and 20.36 - 30.53 6.36 -12.72 63.61 -76.33 50.89 - 63.61 8.91 - 11.45 5.09 - 10.18 highest prices Average price 20.36 8.91 63.61 50.89 10.18 7.63 2000 Lowest and 10.18 - 30.53 3.82 - 7.63 50.89 50.89 - 63.61 8.91 - 11.45 5.09-10.18 highest prices Average price 20.36 8.91 63.61 50.89 10.18 7.63 2001 Lowest and 5.09 3.82– 10.18 38.17-76.33 38.17 - 61.07 6.36- 8.91 5.09-10.18 highest prices Average price 16.54 6.62 53.18 48.09 7.63 7.89 2002 Lowest and 5.09 - 20.36 7.63 – 2.54 38.17 -76.33 50.89 - 76.34 5.09 -10.18 2.80-8.91 highest prices 12.72 6.36 50.89 40.71 7.63 8.65 Average price

11 Conversion based on average National Bank of Poland exchange rate of PLN to EUR as of 25 August 2006 EUR 1 = PLN 3.93 Amphetamine Ecstasy Cocaine Heroin Hashish LSD „Brown Sugar” unit gram tablet gram gram gram tab

2003 Lowest and 7.63 - 12.72 5.09 – 12.72 63.61 -76.33 40.71 - 50.89 7.63 6.36 highest prices Average price 10.18 8.91 69.97 45.80 7.63 6.36 2004 Lowest and 3.82 - 15.27 1.02 – 6.36 30.53 -76.33 25.45 - 50.89 3.82 - 10.18 3.05-7.63 highest prices Average price 9.67 3.82 53.44 38.17 7.63 5.34 2005 Lowest and 5.09 - 12.72 2.04 – 3.82 20.36- 76.33 38.17 - 50.89 6.36- 11.45 5.09-10.18 highest prices Average price 7.63 2.54 38.17 41.98 8.91 6.36

Source: Police Headquarters in Warsaw

o Purity Based on Police data and qualitative research conducted in drug users we know that the purity of drugs sold on the illegal market varies. No single system in this field hampers the interpretation of data. Average purity of cocaine in 2005 was 77% and 55% the case of amphetamine. As Table 5 shows the purity of substances, especially heroin and cocaine, has been determined on the basis of few analyses and the outcome may be highly accidental. THC concentration in Polish marihuana is lower than in European countries where it ranges from 6% to 8% (King 2004). The data of 2005 on Poland show that the average concentration of THC in marijuana was as low as 1%. The purity of amphetamine in 2005 and the purity of cocaine in the last three years might be overestimated. The qualitative research on drug users indicates that the quality of Polish cocaine is considerably lower than the foreign one. The average amphetamine is also poorer quality. In 2005 apart from the lowest and the highest purity of drugs we have the modal value i.e. the most prevalent. For marijuana it was 0.75%, cocaine 78% and amphetamine 84%. Data listed in Table 30 come from the Central Forensic Science Laboratory, which mainly deals with the analysis of large seizures. Under the protocol of adapting data collection to EMCDDA standards a system of broader and more credible data was developed. The next year’s report is going to be based on the information obtained from provincial forensic science laboratories according to the single methodology.

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Table 30. Purity of drugs and THC concentration in cannabis on illegal market

2003 2004 2005

No. of No. of No. of Modal Lowest Highest Aver. Lowest Highest Aver. Lowest Highest Aver. samples samples samples value THC concentration in marijuana % 86 0.06 3.88 0.6 66 0.22 4.19 1.01 0.75 Heroin % 14 0.21 33.9 Cocaine % 6 20 88 83 3 23 96 80 6 20 88 77 78 Amphetamine 30 - 30- % 701 2 99 50 256 10 98 40 56 6 85 53.1 84

Source: Central Forensic Science Laboratory

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Part B – Selected Issues

11. Drug Use and Related Problems among Very Young People

Author: prof. Jolanta Rogala-Obłkowska, PhD. Institute of Applied Social Sciences, Warsaw University.

Research background Polish and international research corroborate the belief that early experiments with drugs are usually preceded by using other psychoactive substances. That is why the object of this study was determining preferences of young people in relation to drugs, alcohol, tobacco. Such tackling the problem aims at verifying the hypothesis of the probabilities or discrepancies in risk factors in relation to different substances. The study was conducted in a school setting and involved participants whose contacts with drugs had been sporadic enough not to result in dropping out of the school system. The study did not focus on the adolescents who due to their advanced drugs use require professional assistance. In presenting the results we refer to the basic studies carried out in 2000 on a representative sample of 1 109 participants – adolescents of ‘gimnazjum’ (lower secondary school) aged 13-14. The study included territorial variable of the adolescents living in villages and cities as well as gender variable12. The study of 2005 was conducted on a far lower number of ‘gimnazjum’ respondents aged 13-1513. The overall number of 151 participants in this age group were surveyed. It must be added that it was not a representative sample. The study included territorial variable (division into village, small town of up to 30 thousand residents, big city of more than 500 thousand residents).

Availability of psychoactive drugs. Trends in recent years. In the last 20 years there have been vital social changes in the socio-demographic image of availability and drug attempts in Poland. At the beginning of the 1980s drugs were available and popular among the adolescents of cities of more than 200 thousand residents, especially Warsaw, Gdansk, Krakow and Wroclaw. At the end of the 1980s this problem started to concern medium-sized towns. Even a few years ago drugs in the country were

12 Fatyga B., Rogala-Obłkowska J. (2002). Life Styles and drugs. CBOS, Warsaw. 13 The study quoted in this paper were conducted by the students of the Institute of Applied Social Sciences of Warsaw University, Higher Pedagogical School TWP and Higher School of Economics and Humanities in Skierniewice in the framework of research seminars conducted by J. Rogala- Obłkowska.

100 little popular and hardly available. It does not mean that the rural areas were ‘healthier’ environment for the adolescents. It had more to do with a choice of a preferred psychoactive substance, which was connected with a socially accepted model of drinking alcohol in the country. The ESPAD studies show that in assessment of the adolescents in recent years there has been a sharp rise in the availability of drugs. The knowledge of drugs and their availability are becoming similar in the city and the country. Country discotheques are increasingly frequented by drug dealers offering ecstasy of amphetamine. This trend is corroborated by the results of our research, which indicate that the availability of drugs is only slightly higher in cities compared to the country. The study of 200514 showed that the access to drugs in the school setting is easy according to the adolescents aged 15 and younger (68.1%of the surveyed adolescents). It is the easiest in big and small towns (68.3% and 84%) and a little harder in the country (52%). The knowledge where to buy drugs may come from a number of sources – autopsy, other buyers or the word of mouth. The survey on older adolescents conducted in 200515 reveals that only 25% of the adolescents would not be able to get hold of psychoactive substances if they wanted to. This trend is getting clearer as the study of 200516 on a sample of 60 ‘gimnazjum’ pupils aged 15 and younger of a medium-sized town (Wyszkow) shows only 10% of the participants did not know where and from whom to buy drugs; 90% of boys and 36.7% of girls had friends who used drugs.

Personal experience with psychoactive substances KNOWLEDGE OF DRUGS The knowledge of adolescents on the composition, properties or the impact of psychoactive substances on a human body is extensive. The adolescents, regardless of their place of residence, are aware of the threats as well as fleeting pleasures of drug taking. They are aware of the effects of marijuana 69.2%, amphetamine 28.6%, glues 27.5% or brown sugar11.0%. The more available a given drug is and the more likely it is that the drug has been used the higher the number of correct answers. Needless to say the adolescents living in the age of of the press, television and the Internet do not have to take drugs to know what they look like and what threats are related to using them. However, what may be surprising is

14 Szpadkiewicz, M. (unpublished MA thesis 2006). Addiction prevention is upper primary schools and its effect on the growing youth. Warsaw. 15 Sierosławski, J (2006). Alcohol and drug use in school youth – report on national questionnaire survey of 2005. Institute of Psychiatry and Neurology, Warsaw. 16 Salwin, E. (unpublished MA thesis 2006). Attitude of youth to addictive substances on a city sample. Warsaw.

101 the detailed nature of this knowledge, which points to direct accounts of the persons who have tried these substances.

AWARENESS OF THREATS The majority of young people ( 69.2%) living both in a city and in the country are aware of the social harm that may result from drug use. The answers referring to the effects of marijuana are characteristic here. Although the majority see the threats related to drug use and the negative impact of smoking on a human body and its mental condition some young people (31%) regard marijuana as a ‘light’ drug which does not cause any damage and its effects are similar to those of a cigarette. While characterising a group of experimenting drug users we found out that they see more positive than negative consequences of using drugs, which are conducive to enjoyment and social contacts, relaxation and problem-forgetting. The surveyed adolescents depreciate the importance of both direct health consequences of poor mental state after the drug ceases to take effect as well as long-term negative health consequences of drug use. This trend was shown by the study of 2000, which indicates the drug experimenting adolescents see more positive than negative consequences related to drug use. It may mean that the user is in so-called “run on taking” because the motivation to take drugs is strong enough to dismiss any arguments against taking ranging from fear for health through parent or school pressure to fear for the police.

PERSONAL CONTACTS WITH DRUGS The majority of school pupils aged 15 and younger had never tried drugs. However, on average every fourth study participant had smoked marijuana. The second most prevalent drug was ecstasy, which was used by 8.8% of the pupils. No one had tried either heroin or cocaine. Inhalants were not popular among the adolescents surveyed. 8.0% of the village dwellers and no city resident admitted to using inhalants. However, compared to the study of 2000 we can observe a significant rise in young people smoking marijuana (25% compared to 10%). It turned out that the majority of ‘gimnazjum’ pupils occasionally smoke cigarettes, drink alcohol or take drugs. In general, in the studied population of ‘gimnazjum’ pupils who declared contacts with psychoactive substances there is a “trying’ model, which points to early age of experimenting with addictive substances as out of the ones who had tried only 3.3% use drugs at least once a month and 13.3% less often than one time every two months. The general conclusion from the survey is that we observe certain increase in the interest in drugs in adolescents aged 15 and younger compared to previous years. However, the results clearly indicate that in this age group the occasional drug and alcohol use model

102 is prevalent and using psychoactive substances is treated as one of the ways of spending leisure time – mainly attribute of entertainment and recreations.

Drug use and place of residence There are two significant differences in place of residence. The rural adolescents are the most infrequent to admit to trying marijuana (12%), in small towns it is 32% and in big cities it is 29.3%. There was a clear rise compared to 2000, when every sixth city dweller declared ever smoking marijuana. The study of 2006 shows that in a medium-sized town (Wyszkow)17, 83.4% of boys had ever tried drugs and 46.7% had tried them at least several times. In comparison to the previous studies the relationship between a place of residence and the declared contact with drugs is changing and more and more young people, especially boys of rural areas are trying drugs. However, drugs are still more prevalent in urban areas than in rural ones. If we considered the variable of intensity of contacts with psychoactive substances there are no significant gaps between rural and urban adolescents (except for girls from the country).

Drug use and gender Currently we observe a narrowing of a gap between girls and boys compared to trends occurring 20-30 years ago. Studies of the 1970s and 1980s showed that there four times as many boys as girls took drugs. In the 1990s the gap began to narrow. Now the group that uses psychoactive substances (tobacco, alcohol, drugs) the least often is girls of rural areas. In big cities as many girls as boys experiment with drugs and girls more frequently than boys admit to smoking marijuana. Even in the group of pupils who report multiple drug use the number of boys and girls is more or less equal.

Age of initiation Nearly 50% of the adolescents who admit to trying drugs, start experimenting between 10 and 13 years of age. There are discrepancies related to place of residence. As many as 74.1% of the urban adolescents started experimenting with drugs at the age of 10-13. 33% of rural adolescents and 14.3% of small town adolescents tried drugs at this age. Due to the limited scope of the study it is hard to draw general conclusions. It must be noted that if the study of 2000 revealed that the adolescents started to smoke cigarettes and drink alcohol far earlier than use drugs then now a similar number of young people are experimenting with drugs, tobacco and alcohol at the age 10-13.

17 Study conducted on a sample of 60 ‘gimnazjum’ pupils does not meet requirements of representativeness and may indicate certain trends only.

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Reasons for taking drugs It often happens that direct reasons for taking drugs are not well-thought conscious plans but result from inability to refuse. At this age young people are extremely vulnerable to pressure and in order to impress or enter a given group they are ready to act against their own norms of behaviour. The research so far conducted both in Poland and internationally have shown that the reasons for taking psychoactive substances most often stated by young people include curiosity, fashion, peer pressure. Similar conclusions are drawn from our research. In urban and rural areas another frequently mentioned reason was boredom. It is mentioned by more than a half of the adolescents that smoke cigarettes, drink alcohol or take drugs. It may be indicative of the shortages of the socially acceptable adolescents leisure activities e.g. interesting extracurricular classes.

Alcohol and cigarettes The adolescents age 15 and younger are through alcohol and tobacco initiation. It proves that almost all have drunk beer, 83.5% have tried wine and 74.7% have drunk vodka. 61.5% of the adolescents started smoking cigarettes below 15 years of age. There no clear difference between the city and the country. More and more young people are smoking cigarettes and drinking alcohol in a more systematic way. As many as 19.8% of the adolescents aged 15 and younger smoke cigarettes on a regular basis. The differences between a big city (29.3%), a small town (8%) and the country (16%) are statistically significant. Alcohol use is not so sporadic as it might be expected since 58% of the adolescents drink at least one time a month. It turned out that the number of girls declaring fairly frequent cigarette smoking, beer and hard liquor drinking did not differ from the number of boys. The most frequent reason for smoking tobacco and drinking alcohol is peer pressure and for the half of the adolescents of rural areas and small towns also boredom. Alcohol is most often drunk at parties (42.8%), second came the group of pupils who pointed to home as the place of first contact with alcohol (26.4%). Compared to the study of 2000 we observe a significant increase in the number of adolescents declaring contacts with tobacco and alcohol and substantial increase in the frequency of drinking and smoking.

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Conditions and consequences of taking drugs

DRUGS AND OTHER SUBSTANCES Young people experimenting with substances no matter if these are drugs, alcohol or cigarettes demonstrate a similar degree of disorders in interpersonal contacts with parents or teachers. They share similar patterns of spending leisure time and contacts with peers as well as similar personal problems. It may mean similarity of community and individual factors making the adolescents take different addictive substances, not only drugs but also cigarettes or alcohol. This strong coherence of results in relation to all substances could indicate that experiments with various substances at young age have similar reasons.

FAMILY The adolescents who take drugs grow up predominantly in two-parent families. Parents are slightly higher educated than national average. The results demonstrate tensions within families stemming from broken emotional ties between parents and their children. According to children the reason for such a situation is the lack of understanding and acceptance on the part of parents. The adolescents taking drugs very rarely turn with their problems to their fathers. Mothers are more trusted, however, far less often than by ‘other’ ‘gimnazjum’ pupils.

SCHOOL ENVIRONMENT School should transfer values flowing from the global society to an individual. The modern school is becoming mainly a transmitter of knowledge. It does not fulfil its upbringing role properly. Contacts between adolescents trying drugs and their teachers are very formal. Young people feel rejected and misunderstood by teachers. That is why they very rarely turn to them for advice or assistance in problematic situations, which points to unfavourable psychological situation in terms of upbringing for ‘gimnazjum’ pupils resulting from the lack of support in the world of adults, who should help to get over the problems of adolescence. Adolescents who try drugs score poorly at school, which is not the effect of low intellectual performance but the lack of interest in learning.

PEERS Young people who take drugs and other substances feel misunderstood and unaccepted by parents, teachers and adults so the only community where they can satisfy their mental needs is peers. The results show that they keep strong direct ties with peers. They know their problems, feel understood and accepted.

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What is a peer group like? Boys are impressed by material things, sport abilities as well as drinking, smoking and taking drugs. However, values such as intellect, personal manners are less appreciated. It must be stressed that the peer community of adolescents who try drugs have a favourable attitude towards drugs and other substances than the rest of young people. They are more tolerant of drug dealing, which supports the point that belonging to this group may be considered a vital risk element.

LEISURE TIME Young people taking drugs are keen on spending time outside their homes at parties, discotheques or cafes, less often at cultural settings even if the were asked questions about the cinema, which is most favoured by young people. The favourite way of spending free time is entertainment, sport activities. Extracurricular classes, spending time in a library are not frequent. They spend their time outdoor with their company, outside home, which means that parents have fewer opportunities to get to know their children’s friends and ways of exercising control. We must remember that it is the group of young people who are not habitual drug users. They have tried drugs several times thus making the first step on their way to drug addiction. Their psychological situation at family, school as well as their lifestyle in a peer group along with the values passes therein show that this group of adolescents must be regarded as the very high risk group.

Adolescents at upbringing institutions Orphanage graduates take drugs more often than the general population at this age. Random survey on a group of 73 participants aged 15and younger conducted at the turn of 2004 and 2005 in three orphanage houses in a big and a medium-sized city (Warsaw and Skierniewice) shows that 32.8% of the adolescents had tried psychoactive substances. The most prevalent drugs in that group were inhalants and marijuana. None of the participants had tried cocaine or heroin. In a big city orphanage house the same number of boys and girls took drugs (31.8% and 33.3%). However, in a medium-sized city boys did it more often than girls (35.2% and 28.5%).

Prevention Addiction prevention in Poland is financed mainly by local governments. Pursuant to the Regulation of the Minister of National Education and Sport (Journal of Laws “Dz. U.” 2002.10.96.) prevention programmes should be implemented in all ‘gimnazjum’ schools. The

106 study of 2005 reveals that 83.5% of the pupils took part in addiction prevention classes. The least prevention programmes were implemented in towns (44%). However, prevention classes were rare. According to 55.2% of the adolescents once a year or less often. Almost all ‘gimnazjum’ pupils assess as very positive both the content and the implementation of the programmes. However, only 11.8% of ‘gimnazjum’ pupils knew the name of the programme in which they took part. According to the descriptions they gave, they were standard programmes, designed bys specialists. However, it is a positive change compared to the study of 2000, when only 2% of the ‘gimnazjum’ pupils knew the name of the programme in which they participated. We were interested in the adolescents’ opinions on who should deal with addiction prevention and who would be more effective in these activities. The results obtained proved to be very interesting. In the opinion of young people addiction prevention should be implemented by a number of actors ranging from parents, schools, health service, non- governmental organizations to the police but the most successful might be the adolescents themselves. It may be stated that the message from peers has greater impact on the young people. It provides an opportunity for more active participation of the young people in the implementation of the prevention. Peer education model should be viewed not as an assistance to teachers but an independent initiative.

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12. Cocaine and Crack – Situation and Responses

12.1. Prevalence, patterns and trends of cocaine and crack use o General Population Survey The analysis of cocaine prevalence of cocaine use in the general Polish population may be carried out on the basis of the data of the first national survey of 2002 on a representative sample of Polish citizens aged 16 and older. The results indicate low prevalence of cocaine and crack use in adults. Figure 17 shows prevalence of drugs in a lifetime and in the last 12 months and 30 days. As the data show the prevalence of crack and cocaine does not exceed 1% and in the case of the last 12 months and 30 days the use of both drugs is equal and almost equal to zero. It does not mean that there are no cocaine users in Poland but they are hard to detect even in surveys on a large sample.

Figure 17. Lifetime prevalence of psychoactive substances, in the last 12 months and 30 days

7 6 5 4 3 2 lifetime 1 0 last 12

y months is e k e in n s c n . b i a a i o . a t r a r . n m s c c e m last 30 n a c o h t c a e e c i days c h n p e g m o a in c u ll a h

Source: Sierosławski J. (2002)

If we analyze cocaine and crack use in terms of gender (Table 31) we can see that men use these substances more often than women. In the case of crack no single female respondent who had ever used this drug was recorded.

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Table 31. Lifetime prevalence of psychoactive substances by gender

Men Women Marihuana or hashish 10.0 3.4 LSD 1.4 0.6 Amphetamine 2.7 0.7 Hallucinogenic mushrooms 1.0 0.4 Ecstasy 1.0 0.2 Crack 0.3 0.0 Cocaine 0.6 0.2 Astrolit 0.1 0.0 Heroin 0.5 0.0 Methadone 0.3 0.0 "Kompot" 0.3 0.0 Anabolic steroids 0.5 0.1 Inhalants 1.0 0.2 Other 1.5 0.4

Source: Sierosławski J. (2002)

The age analysis shows that similarly to other drugs, experiences with crack and cocaine are reported by 16-24-year-olds. In older age groups we record 0.2% and 0.3% of cocaine and crack users. If we expand the analysis by gender then we will see that crack is mainly used by men aged 16-24 (0.6%) and 25-34 (0.4%) while women only in the age group 16-24 (0.2%). No older female respondents who had used the drug were recorded. In the case of cocaine the situation looked similar. Women aged 16-24 who had used cocaine constitute 0.9% while men aged 16-24 – 1.6% and 25-34 – 0.3%. Men older than 35 years accounted for 0.3%.

Table 32. Lifetime prevalence of psychoactive substances by age

16-24 25-34 35-44 45-54 55+ Marihuana or hashish 18.6 10.3 3.4 1.7 0.8 LSD 3.5 1.3 0.4 0.0 0.1 Amphetamine 5.2 2.9 0.6 0.2 0.0 Hallucinogenic mushrooms 2.1 1.0 0.4 0.0 0.0 Ecstasy 2.2 0.6 0.2 - 0.0

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Crack 0.4 0.2 0.2 - 0.0 Cocaine 1.3 0.3 0.3 - 0.1 Astrolit 0.0 0.2 0.2 - 0.0 Heroin 0.3 0.7 0.2 - 0.0 Methadone 0.2 0.2 0.4 - 0.0 "Kompot" 0.2 0.3 0.2 0.1 0.0 Anabolic steroids 0.6 0.5 0.5 0.0 0.0 Inhalants 1.5 0.6 0.7 0.2 0.1 Other 1.5 0.9 1.3 0.7 0.3

Source: Sierosławski J. (2002)

o School Survey Cocaine and crack analysis in secondary school pupils is based on ESPAD survey results of 1995, 1999 and 2000 as well as the study of 2005 conducted on a representative sample in line with ESPAD methodology (see Chapter 2 for more information). The data of the previous years make it possible to observe the phenomenon in time. Taking into account reservation from Chapter 2. Lifetime prevalence of cocaine use in the younger age group was rising trend in 1995- 2003 and then fell in 2005. In the case of the older group we deal with an increase in 1995-2003 and then stabilization of the trend in 2005. Indicators of lifetime prevalence of cocaine and crack use in the young people are higher than those observed in the general population. Cocaine and crack use is far less prevalent than the use of cannabis, tranquilizers, sleeping pills or amphetamine. The gaps are a lot wider in the older age group.

Table 33. Lifetime prevalence of crack and cocaine use

Grade level 1995 1999 2003 2005 Third grades at Crack 0.5 1.0 1.6 1.0 lower Cocaine 0.8 1.9 2.2 2.1 secondary schools Second grades Crack 0.4 0.8 1.4 1.4 at secondary Cocaine 0.8 1.8 2.4 2.4 schools

Source: Sierosławski J.

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The trend of current cocaine use can be observed based on the surveys of 1995-2005. As the data show in the younger age group there was a decrease in cocaine use in 2003 and then again in 2005. In the case of the older age group the indicators fell in 2005 and stabilized in 2005. Both in crack and cocaine in the younger age group there was a fall from 0.9%in 2003 to 0.5% in 2005. In the older age group we deal with the trend stabilization.

Table 34. Substance use in the last 12 months

Grade level 1995 1999 2003 2005 Third grades at Crack 0.9 0.5 lower Cocaine 1.6 1.4 1.3 secondary schools Second grades Crack 0.7 0.7 at secondary Cocaine 1.4 1.5 1.5 schools

Source: Sierosławski J.

In the case of regular use of crack there was a fall in the younger age group and stabilization on the older one. In the case of cocaine use there was a decrease in the younger age group and a slight increase in the older group in 2003 and then decrease in 2005.

Table 35. Substance use in the last 30 days

Grade level 1995 1999 2003 2005 Third grades at Crack 0.5 0.3 lower Cocaine 1.2 0.6 0.5 secondary schools Second grades Crack 0.4 0.4 at secondary Cocaine 0.6 0.8 0.7 schools

Source: Sierosławski J.

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Cocaine and crack analysis by gender points to higher prevalence of both drugs in boys. In some cases we notice a twofold and threefold increase in the prevalence of use of these two drugs in boys.

Table 36. Lifetime prevalence of substances use by gender

Grade level 2003 2005 Boys Girls Boys Girls Third grades at Crack 2.5 0.8 1.6 0.5 lower Cocaine 3.1 1.4 2.2 1.9 secondary schools Second grades Crack 2.1 0.7 1.9 0.7 at secondary Cocaine 3.4 1.4 3.1 1.6 schools

Source: Sierosławski J.

There are a few reasons for low prevalence of cocaine and crack use in the general population and young people. One is the low availability caused by the high price of cocaine. An alternative to these drugs can be cheap and easily available amphetamine.

12.2. Problems related to cocaine and crack use Statistical data of 2002 of psychiatric residential treatment on mental and behavioural disorders caused by using psychoactive substances other than alcohol and tobacco show that the number of cocaine users was holding steady. By 1996 there had been only a few cases of cocaine abuse. In 1997 the number increased sharply. Then in 1998 the trend levelled off. It decreased in 2001 and increased in 2002. In 2003 the trend was stable, however, at a higher level compared to the end of the 1990s (Table 37). In 2004 cocaine users constituted 0.8% of all residential treatment patients (Figure 18).

The analysis of the data on first-time patients in 2004 shows that cocaine addicts accounted for 1.1% of all first-time patients (Table 38). The gender analysis revealed that there was an equal number of male and female cocaine patients.

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Table 37. First-time and returning patients admitted to residential treatment in 2004 due to mental and behavioural disorders caused by using psychoactive substances (ICD X: F11-F16, F18, F19) by substances (in percent) First0time patients Returning patients Opiates 16.2 24..7 Cannabis 4.2 1.4 Tranquilizers and sleeping pills 9.9 11.3 Cocaine 1.1 0.6 Amphetamine 11.7 5.0 Hallucinogens 0.5 0.1 Inhalants 2.1 2.1 Mixed and undefined 54.3 54.7

Source: Sierosławski J. (2004)

Figure 18. Patients of residential treatment admitted in 2004 due to mental and behavioural disorders caused by using psychoactive substances, by substance

Opiates 20,0%

Cannabis 3,0%

Tranquilizers and sleeping pills 10,5%

Cocaine 0,8% Other stimulants Other and mixed 8,7% 54,5% Hallucinogens Inhalants 0,4% 2,1%

Source: Sierosławski J. (2004)

o Other problems related to cocaine use

Data on the number of drug-related deaths come from the Main Statistical Office. In 2003 out of 277 drug-related deaths 2 were caused by cocaine use. In 2004 out of 231 drug- related deaths only one was caused by cocaine use. The data show that deaths due to cocaine use account for an insignificant proportion of all drug-related deaths. However, it

113 must be added that data collection system in this field does not cover all fatal overdose- related as only the primary cause of death is taken into consideration.

12.3. Responses and interventions to cocaine and crack use o Treatment for cocaine Drug treatment system in Poland is based on ambulatory and residential facilities. There are practically no separate cocaine-oriented treatment programmes. Cocaine users attend therapy alongside other users. Specific profiles of cocaine users i.e. higher financial status that help seekers do not enter programmes conducted by public health system but they are treated at private drug treatment centres. o Harm reduction responses to cocaine

The statistics of the national anti-drug hotline reveal that cocaine users account for a low percentage of the overall number of all beneficiaries of this form of assistance. In the years 2002 and 2006 the number of such persons decreased compared to the years 2002- 2004. The materials on the harmfulness of cocaine addressed exclusively to cocaine users are non-existent. Leaflets on psychoactive substances contain information on cocaine as one of a few drugs. The exception are leaflets on cocaine distributed under party working programmes. Harm reduction activities are addressed mainly to opiate users as a part of street working programmes and to synthetic drug users as a part of party working programmes. In recreational settings there are no paraphernalia for safe cocaine use. o Law enforcement activities in response to cocaine use While analyzing data of cocaine seizures performed by drug combating services such as the Police, Customs Service and Border Guard we record a decrease in the number of the seizures. The biggest cocaine seizure in the last 8 years took place in 2003 – 401.225 kg (Table 39). In the following years the quantity of the drug seized fell dramatically to 21.721 kg in 2004 and 12.800 kg in 2005. A similar trend is recorded in the case of Border Guard operations – 399.333 kg in 2003, 6.308 kg in 2004 and 7.224 kg in 2005 (Table 40). However, the number of seizures is rising every year: 4 cases in 2003, 6 cases in 2004 and 8 cases in 2005. However, comparing 8 seizures of cocaine by the Border guard to 357 seizures of marijuana or 101 seizures of amphetamine we clearly see a very low proportion of cocaine

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seizures in the overall number of drugs seized. The Border Guard (Table 41) reports insignificant amounts of cocaine compared to other services and the overall quantity of drugs seized at border crossings. Comparing the last two years we notice a fall in 2005 compared to 2004 (from 7.943 to 4.0071). The services dealing with supply reduction do not differentiate between cocaine and crack seizures.

Table 39. Cocaine seizures by police in 2001- 2005

1998 1999 2000 2001 2002 2003 2004 2005 Unit of Drug measur No. quant No. quant No. qua No. qua No. qua No. quant No. qua No. quant ement ity ity ntit ntit ntit ity ntit ity y y y y 5.2 1.4 399.3 6.0 7.224 Cocaine kg 2 8.136 6 5.766 1 75 4 6 4 6 8 49 80 33 8

Source: Police Headquarters

Table 40. Cocaine seizures by Customs Service in 1998-2005

Unit of Drug measure 2002 2003 2004 2005 ment Cocaine kg 0.050 1.145 7.943 4.071

Source: Customs Service – Ministry of Finance

Table 41. Cocaine seizures by Border Guard in 2002-2005

Unit of Drug measureme 2001 2002 2003 2004 2005 nt 45.300 397.561 401.225 21.721 12.800 Cocaine kg

Source: Border Guard

o Policies and strategies in response to cocaine use

No data or strategies aimed at cocaine users exists.

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12.4. Cocaine- related crime and cocaine and crack markets o Cocaine-related crime The police have been collecting data on the number of drug-related crime with breakdown into substances. In 2004 the number of recorded offences stood at 59 356, including 182 involving cocaine. In 2005 there were 67 560 recorded offences, including 145 involving cocaine. There was a decrease in the number of cocaine-related offences both in the structure of the crime and the absolute numbers. Figure 19 presents the proportions of cocaine-related crimes in 2005. 0.5% of all crimes were committed in relation to cocaine.

Figure 19. Crimes against Act of Law on counteracting drug addiction in 2005, by substance

Polish herposinychotropic drugs cocaine, crack LSD 1,50% 2,87% 0,49% heroin 0,06% 2,01% other drug ecstasy 3,59% 4,27%

cannabis amphetamine 25,12% 60,08%

o Cocaine markets The cocaine analysis shows that in the last two years there has been a fall in its price. However, compared to other drugs the price of cocaine still remains the highest. The police data of Table 42 probably do not refer to a gram, as it is shown in the table, but to the basic dosage unit used by dealers - the so-called “bag”, which contains from 0.4 to 0.6 g of the substance.

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Table 42. Cocaine prices18 on illegal market in EURO

2003 2004 2005

No. of No. of Most No. of sampl Min. Max. Mean Min. Max. Mean sampl Min. Max. Mean prevale samples es es nt

Cocaine 6 20 88 83 3 23 96 80 6 20 88 77 78 %

Source: Police Headquarters

The data of Table 43 come from the Central Forensic Laboratory that deals with the analysis of substantial seizures. According to the data cocaine is relatively pure in Poland. However, the research shows that the drug purity is changing with every year. The data presented in the table can hardly be considered representative for the illegal market as few cocaine samples were tested. The interviews with cocaine users reveal that cocaine purity is much lower than reported by the Central Forensic Laboratory. The quality of Polish cocaine is poorer compared to cocaine bought abroad.

Table 43. Cocaine purity on illegal market in 2003 – 2005

Drug 1999 2000 2001 2002 2003 2004 2005

Cocaine 63.61 -76.33 50.89 38.17-76.33 38.17 -76.33 63.61 -76.33 30.53 -76.33 20.36- 76.33 (prices per 63.61 63.61 53.18 50.89 69.97 53.44 38.17 gram)

Source: Central Forensic Laboratory

The source of data on the availability of drugs among young people is the ESPAD surveys of 1995, 1999 and 2003. In 2005 the Polish edition of the survey was conducted with the use of ESPAD methodology and questionnaire. The data of Table 5 help to find the availability trends. It contains percentages of respondents who answered the question: “How hard would it be for you to get hold of the following substances, if you wanted to?”. The analysis included the “very easy” answers. As it is shown very few respondents believe that cocaine is easily available. In the younger age group we note a slight decrease in the availability and in the older one a slight decrease.

18 Conversion based on average National Bank of Poland exchange rate of PLN to EUR as of 25 August 2006 EUR 1 = PLN 3.93

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Table 44. Assessment of availability of drugs (drugs very easy to obtain)

Grade level 1995 1999 2003 2005

Third grades of Crack 2.1 4.7 7.4 5.3 lower secondary school Cocaine 2.6 5.8 8.3 6.2 Second grades of Crack 2.4 3.4 6.0 6.2 secondary schools Cocaine 3.0 4.1 7.4 8.1

Source: Sierosławki (2005)

The answers to the question whether the respondent had ever been offered any psychoactive substances provided another availability indicator. The respondents were shown a list of substances and asked to tick the ones that they had been offered in the last 12 months. The distribution of answers presented in Table 2 indicates an upward trend in both age groups. Only in the case of crack in 2003-2005 in the younger age group was the rend stabilization recorded.

However, in comparison with the percentages of the most prevalent substance i.e. cannabis which had been offered at least once in the last12 months to 20.7% of the younger pupils and 36.8% of the older ones it is seen that cocaine is a substance offered much less often.

Table 45. Exposure to drug offers Grade level 1995 1999 2003 2005

Third grades of lower Crack 0.8 2.1 2.7 2.6 secondary school Cocaine 1.7 3.5 3.8 4.5 Second grades of Crack 1.2 1.7 2.1 3.0 secondary schools Cocaine 1.9 2.7 3.5 5.2

Source: Sierosławki (2005)

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12.5. 2006 qualitative study on cocaine users

In 2006 the National Focal Point conducted a research project which aimed at collecting in-depth information on lifestyle of cocaine users in Warsaw. The research conducted so far in Warsaw had focused on young adults and used qualitative research methods. The research shows that cocaine use is of niche character. So far there is no information on the patterns of cocaine use and the preferred lifestyle of this group. The motivation of cocaine users has also not been studied. The system of information on drugs and drug addiction besides the abovementioned quantitative studies uses police and treatment system statistics. Due to their high income status some cocaine users might not have had contacts with the police or the drug treatment system. The information on such persons is not included in the existing statistical systems. Considering the above facts the following objectives of the study were set: • Socio-demographic profile and the social status of cocaine users. • Collecting information on ways of spending leisure time and lifestyles of cocaine users in Warsaw. • Finding out about the motivation to take cocaine. • Collecting information on patterns of drug use. • Collecting information on the impact of cocaine use on health and social functioning of cocaine users • Collecting information on contacts with the police and the drug treatment system. • Validation of data collected from other sources (purity, price of cocaine) • Formulating conclusions and guidelines for preventive actions and treatment addressed to cocaine users. o Research methods The project aimed at using qualitative methods to describe the phenomenon and profile cocaine users as well as routes of administration. The study included respondents who at least 6 times in the last 12 months had used cocaine. The sample was selected according to the snowball method whereby the new respondents were contacted through the directions given by the previous respondents. The starting point were the persons identified as cocaine users. Then upon interview they were asked to provide the name of another person, a friend who had used cocaine minimum 6 times in the last year.

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The survey utilized unstructured (easy) individual in-depth interviews. The interviews mainly concerned the issues of lifestyle, motivation to take cocaine, routes of administration and user profiles. 20 individual interviews were planned to be conducted during the survey. o Preliminary survey results The presented results are of preliminary character (report due to be published early next year). It is the outcome of initial analysis and it should be treated with care. It is the presentation of general profiles of a given group. It might be a trap to extrapolate these results to the overall population of cocaine users in Warsaw. It must be remembered that under our project we managed to collect data on a few groups of cocaine users and any conclusions must refer to these groups. However, the observations and opinions of the respondents provide use with some idea of the phenomenon, which should be subject to further analysis. o Sample The basic problem was not reaching the respondents, as we expected, and which did not pose major difficulties but making the persons we reached to record the interview. Out of 35 individuals we reached 60% agreed to being recorded. The reason might have been the legal status of the drug on the one hand and the high social status of the interviewees and fear for publishing the recordings on the other. The group that we managed to reach comprised 25-40-year-olds i.e. young adults and adults that performed freelance jobs, worked in the media, advertising, real estate or fashion business. In terms of material status it was a group with a high financial income (over 857 Euro gross monthly income, which is an average monthly pay for Warsaw) (GUS 2005) or in a few cases a very high income for the national reality of more than 2 544 Euro a month. The respondents did not brag about their cocaine use and were reluctant to be identified this way. Cocaine use was limited to a closed circle of friends. They were afraid that the recording might be used against them e.g. at work or for the purposes of law enforcement agencies or for tarnishing (in a few case) their public image. The study group was not coherent. The age and income criteria were differentiating factors and were indicative of belonging to various social groups. Despite these differences certain common features e.g. behavioural patterns, ways of spending leisure time were identified.

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o Work and leisure The whole study group considered work a priority. The decisive majority of the respondents considered it interesting and satisfying even in financial terms. Leisure and entertainment time conformed to the working week schedule. Meetings with friends took place at weekends, most often on Saturdays. Especially the younger respondents (aged 28- 35) stressed that such a rhythm is a big change compared to the way of life they had led a few years before when meetings with friends occurred not only at weekends. At weekends the entertainment settings were Warsaw dance clubs. The respondents got together at pubs and then went clubbing (several clubs a night). It must be underlined that despite the income and age gaps the names of several Warsaw dance clubs came up in virtually all interviews. The above way of spending leisure time is not different from the general way of spending free time by young people and it is not this group specific. What makes it specific though is the recreational venues they frequent. They are the clubs with the so-called ‘door selection’, where the access is limited. They are different selection criteria depending on the club. The respondents took part in exclusive access parties to which invitations were distributed in a closed circle. o Patterns of use The respondents had had contacts with different drugs. They had experimented with substances ranging from cannabis to such exotic drugs in Polish reality as ketamine, GHB or peyote cactus (containing mescaline) brought from Mexico. 2 persons had problems with addiction - one to heroin and one to amphetamine. In the first case it was heroin in the other amphetamine. One person had entered treatment due to cocaine addiction. Besides, the rest of the group did not have any experience with drug treatment. Strangely enough, for the vast majority of the respondents cocaine was not the only drug they used at the time of the study (in some case respondents reported using cannabis). Cocaine was most often combined with alcohol. The respondents pointed to a number of advantages of this combination. They believed that cocaine prolongs good entertainment and helps to stay in the game longer, especially in terms of alcohol, which reduces ‘nervousness’ that occurs upon intake of cocaine. The most prevalent plan for the night starts with alcohol and later cocaine is added. All the respondents snorted cocaine and when it was not possible diluted it in a drink. There was only one respondent who knew somebody who used crack. Crack, similarly to heroin, is considered a ‘dirty’ drug. The majority of the respondents listed it as one of the few drugs they would never try.

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The respondents used one ‘bag’ during the night i.e. 0.4-0.5 gram. Needless to say, there were users who consumed much more. Cocaine use was limited to weekends. Cocaine was almost never used at work. o Buying, prices, availability and quality of cocaine Cocaine is sold in ‘bags’, each containing 0.4-0.5 gram. Prices vary depending on the source and connections, as some respondents stressed, ranging from Euro 25 to Euro 5119. The majority of persons considered cocaine relatively readily available. However, there are some regional discrepancies. Some respondents indicated that there are cities in Poland with limited access to cocaine. In Warsaw clubs there are no problems with supply. However, the quality of cocaine sold in such settings is not high. Respondents avoided buying cocaine in clubs. The most prevalent form of buying is placing a telephone order with a familiar drug dealer. In this case cocaine is supplied in any place (e.g. to the club, house or flat). It is characteristic of cocaine. If you order other drugs there must be personal pick-up. The quality of cocaine is dependent on the source of purchase. Generally all respondents regarded the quality of cocaine as poor. Compared to the cocaine that the users tried abroad it is considered far worse. It is contrary to police reports based on a low number of seizures, according to which Polish cocaine is one of the purest in Europe. o Conclusions While drawing conclusions from qualitative research one must be very cautious. It is easy to overinterpret or misinterpret the results. The situation is additionally hampered by the fact that these are preliminary results of the study. Any conclusions will refer exclusively to this group and certain generalizations should be treated as hypotheses. Cocaine is a specific drug. Even upon preliminary analysis it is clear that it fulfils a role of some type of status indicator and is connected with certain types of behaviour closely associated with the wish to underline one’s status. The very fact that cocaine is supplied directly to the recipient’s place and the rituals of snorting cocaine with a golden or silver pipe or a rolled-up high value banknote seem to support it. Additionally this high-profile status of cocaine is enhanced by the stories e.g. of a famous American rapper who once organized the biggest cocaine party in Warsaw.

19 Conversion based on average National Bank of Poland exchange rate of PLN to EUR as of 25 August 2006 EUR 1 = PLN 3.93

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Our research seems to corroborate it. The sample that we reached constitutes a sort of social elite of Warsaw if we consider their professions and upper class status. Elite nature of cocaine is strengthened by market prices which are far higher compared to other drugs. However, in the interviews there were a few reports that cocaine is also existent in Warsaw residential urban quarters. This elite character of cocaine may become a magnet for young people from working class quarters, some sort of pass for seeming improvement of one’s social status. However, it is just a hypothesis and this is how it should be viewed.

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13. Drugs and Driving 20

1. Policy The matters of blood or urine tests for the presence of substances acting similarly to alcohol are regulated by Article 11 of the Order of 25 May 2004 No. 496 of the Chief of the Police on “In matters of tests for the presence of alcohol or a substance acting similarly to alcohol” It provides that such a test is performed in a driver, who took part in a road accident with fatalities. At present the final version of the algorithm is being developed that would regulate the conduct of a policeman with a driver suspected of consuming a substance acting similarly to alcohol. Under PHARE project – Twinning 2001 along with the German partners 50 policemen of provincial police stations (Police Station of the capital city of Warsaw) were trained in drug-related issues. Under the same project in 2003 in the Police Training Centre in Legionowo (Legionowo PTC) a training seminar was held on the above subject. Practical classes were followed with an instruction movie, which was later distributed to all Provincial Police Stations and the Police Station of the capital city of Warsaw. In June 2006 in Legionowo Police Training Centre a workshop was organized for leaders of Provincial Police Stations that would take part in DRUID programme. In 2004 the Police Headquarters expressed its readiness to take part in the 6th Framework Programme for Research Studies in the European Union whose one of the components is the DRIUD research programme – “Driving under the influence of drugs, alcohol and medicine”. It is the programme aimed at determining the influence of drugs acting similarly to alcohol on drivers. Moreover, one of the courses of action in this field is implementing the system of collecting data on drugs in road traffic as stipulated in the National Programme for Counteracting Drug Addiction (NPCDA). The system will be dedicated to the analysis of the phenomenon based on the data received annually from the police bound to collect these data (see point 2 for more information on data collected by the police). The Police Headquarters (PH) as an institution dealing directly with the drugs problem in road traffic took up an number of initiatives in order to prepare the traffic policemen to adequately respond in situations when there is a suspicion that the driver of a vehicle is under the influence of narcotic drugs.

20 Information on points 1, 2 and 3 were obtained from the Bureau for Prevention and Road Traffic of the Police Headquarters in Warsaw.

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2. Prevalence levels and epidemiological methodology In 2005 the traffic police submitted for testing 1 165 blood samples for the presence of substances acting similarly to alcohol. Consequently in the previous year 280 adults and 3 minors were found to have been driving vehicles under the influence of drugs (Temida system data of the Police Headquarters). Unfortunately, there are no nationwide police statistics in place profiling in detail (age group, gender, criminal record) the drivers detained for driving under the influence of substances acting similarly to drugs. However, according to the new Programme for Counteracting Drug Addiction (NPCDA) the police have been bound to collect and annually update data on the drugs problem in road traffic i.e. number of tests for the presence of drugs, including test with positive results as well as the number of road accidents caused by drivers under the influence of drugs, including accidents with fatalities. The national survey of 2002 on the general population contained questions about driving mechanical vehicles under the influence of drugs. Based on the answers of the respondents an attempt was made to estimate the number of drivers who drive mechanical vehicles under the influence of drugs. According to the results the percentage of drivers driving vehicles under the influence of drugs stood at 1.2%. It means that every 80th driver of a car or another vehicle at least once a year sits behind the wheel under the influence of drugs.

3. Measure aimed at detecting prohibited substances and law enforcement According to the existing law it is prohibited for a person in the state of insobriety, upon consuming alcohol or a substance acting similarly to alcohol to drive a vehicle, lead a column of pedestrians, ride horses or drive cattle (Article 45.1 of the Act of Law of 30 June 1997 – Law on road traffic. Journal of Laws of 2005, No. 108, item 908 as further amended). Article 178a.1 of the Penal Code provides that whoever being unsober or under the influence of a narcotic drug is found to be driving a mechanical vehicle in road, water or air traffic is subject to a fine, penalty of limitation of liberty or imprisonment of up to two years. The effective execution of the above provisions cannot do without proper equipment therefore traffic policemen are equipped with drug testers which possess, pursuant to Article 4.5 of the regulation of the Minister of Health of 11 June 2003 on the list of substances acting similarly to alcohol and conditions and procedure for performing tests for the presence thereof in the body (Journal of Laws No. 116, item 1104 as further amended), certificates of use issued by Dr J. Sehn Institute of Court Examinations in Krakow. These instruments include multi-panel devices, testing a driver in terms of presence of all substances acting similarly to alcohol that were listed in the regulation. It must be stressed that the positive result of the test with the drug tester must be corroborated in a laboratory.

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Next stage of the training programme for the traffic policemen was the training course in detecting substances acting similarly to alcohol, which was held in June and October of 2005. Every time training materials included CD-ROM presentations which were subsequently used in further training in regional units of the police.

4. Prevention It is worth noting that the drugs problem in road traffic, contrary to driving under the influence of alcohol, is not a frequent subject of the media coverage. Reports on driving vehicles under the influence of drugs are sporadic. There is no public debate on this subject. Despite this fact in some regions of Poland actions are taken with a view to counteracting this phenomenon. In October 2004 methods of combating drug addiction in road traffic were designed. Based on these materials the Provincial Police Station in Szczecin developed an instruction manual for policemen that was subsequently distributed in the whole country. The Marshal’s Office handed over 330 drug testers to the Provincial Police Headquarters and Toxicology Department of the Pomeranian Medical School trained policemen in detecting drivers under the influence of psychoactive substances. The first benefit of the action was revealing 41 drivers in 2005 in whom blood tests corroborated the presence of narcotic drugs acting similarly to alcohol. In 2005-2006 the police of Zachodniopomorskie Region held 731 drug testers and revealed 93 drivers under the influence of psychoactive substances acting similarly to alcohol. In this field 13 campaigns were launched in Zachodniopomorskie Region addressed to young drivers in large transportation companies and among professional drivers. 123 talks with secondary school pupils and their parents were organized. The above actions were financed from the resources of the police and the Marshal’s Office. The additional drug testers were purchased from the resources of the communes and organizations acting for public security21. The threats related to the drug phenomenon in road traffic should be highlighted to young drivers already at the stage of being trained at Driving Training Centres. Therefore, according to the Regulation of the Minister of Infrastructure of 27 October 2005 on training, examining and obtaining qualifications by drivers, instructors and examiners the classes at

21 Information on this point has been obtained from the Department of Social Policy of the Zachodniopomorskie Provincial Government Office.

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Driving Training Centres should cover familiarising the student with the influence of alcohol and other substances acting similarly to alcohol on the ability to drive a vehicle22. Actions aimed at preventing drivers from driving vehicles under the influence of narcotic drugs were also performed among doctors and pharmacists. Their task is to provide the patient with the information on the influence of a medical drug on the ability to drive mechanical vehicles. Producers and distributors of medical drugs are not bound to place on the drug box a clear notice on the influence of that drug on the ability to drive mechanical vehicles. This information is appended to a leaflet inside the box.

22 Information obtained from Mr. Andrzej Szulc - Head of the Provincial Centre for Road Traffic in Warsaw.

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Part C

14. Bibliography o Alphabetic list of all bibliographic references used (Harvard System)

1) Annual report on welfare benefits provided from 1 January to December 2005 (2006). Ministry of Labour, Department of Welfare and Social Integration, Warsaw. 2) BBS Obserwator (2005). Opinions of drug addicts of malopolskie region on psychoactive substances – study report. Malopolskie Region Management Board, Krakow. 3) Bukowska, B. (2005). New act of law on counteracting drug addiction. Remedium monthly – special issue: January. 4) Council of the European Union (2004). EU Drugs Strategy 2005-2012, 15074/04. Available in English and Polish: http://www.narkomania.gov.pl [accessed 9.10.06] 5) Council of the European Union (2005). EU Drugs Action Plan 2005-2008, 8652/1/05. Available in English and Polish: http://www.narkomania.gov.pl [accessed 9.10.06] 6) General Statistical Office (2003). Available in Polish: http://www.stat.gov.pl/urzedy/warsz/publikacje/rocznik_stolicy_woj/rynek_pracy_wynagr odzenia_warunki_pracy/144_03.pdf [accessed 9.10.06] 7) Hołyst, B. (1994). Criminology. PWN, Warsaw. 8) Journal of Laws 2005.179.1485 (2005). Act of Law of 29 July 2005 on Counteracting Drug Addiction. Available in English and Polish: http://www.narkomania.gov.pl [accessed 9.10.06] 9) Journal of Laws 2006.143.1033 (2005). Regulation of the Council of Ministers of 27 June 2006 on the National Programme for Counteracting Drug Addiction 2006-2010. Available in Polish: http://www.narkomania.gov.pl [accessed 9.10.06] 10) Journal of Laws 1997.24.198 (1997) Act of Law of 24 June 1997 on Counteracting Drug Addiction as further amended. 11) Kalinowski, M., Niewiadomska I. (2005). National Network of Drug-Free Colleges – integrated drug prevention programme in the academic community. Hygiene and Epidemiology 86 (2) pp. 133-140. 12) Kamiska-Buko, B., Szymaska J. et. al. (2005). Manual: School prevention, pp.100. CMPPP, Warsaw.

13) Krajewski, K. (2005). Law on drugs and drug addiction. Unintentional consequences:

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Anti-drug policy and human rights, (ed.) Malinowska-Semprucha, K. International Debate Education Association, Warsaw. 14) Minister of Health (2005). Report on the implementation of the National Programme for Counteracting Drug Addiction in 2004. Warsaw. Available in Polish: http://www.sejm.gov.pl [accessed 9.10.06] 15) Ministry of Health (2004). Programme of Health Policy. Antiretroviral therapy for people living with HIV 2005-2006. National AIDS Centre, Warsaw. Available in Polish: http://www.mz.gov.pl/wwwfiles/ma_struktura/docs/program_pz_hiv_2005_2006.pdf [accessed 9.10.06] 16) Moskalewicz, J., Sierosławski, J., Bujalski, M. (2006). Availability of substitution treatment programmes in Warsaw – the research project report. Multicipal Office of the Capital City of Warsaw, Warsaw. 17) MSWiA (Ministry of Interior and Administration) (2006). Draft Report on the implementation of 2005 Governmental programme of preventing social inadequacy and crime in children and youth, p. 2. Available in Polish: http://www2.mswia.gov.pl/portal.php?serwis=pl&dzial=199&id=4203&search=7292 [accessed 9.10.06] 18) NBDP (National Bureau for Drug Prevention) (unpublished report 2006a). Draft Report on the implementation of the National Programme for Counteracting Drug Addiction in 2005. Warsaw. 19) NBDP (National Bureau for Drug Prevention) (unpublished report 2006b). Report of the National Bureau for Drug Prevention to the Ministry of Health on the budget implementation and tasks commissioned in 2005. Warsaw. 20) NBDP (National Bureau for Drug Prevention) (unpublished reports 2000-2005). Annual reports of National Bureau for Drug Prevention to the Ministry of Health on the budget implementation and tasks commissioned in 1999-2004. Warsaw. 21) Niemiec K., Kowalska A. (2005). Prenatal care for pregnant women addicted to psychoactive substances. Obstetrics and Gynaecology Clinic of Mother and Child Institute, Warsaw. Available in Polish: http://www.narkomania.gov.pl [accessed 9.10.06] 22) Okulicz-Kozaryn, K. (2005). Report on the project performance: Pilot implementation and evaluation of screening tests functioning in the intervention process towards teenagers using cannabis and other drugs in 2005. Available in Polish: http://www.narkomania.org.pl [accessed 9.10.06] 23) (ed.) Pietrzykowska, B., Boguszewska, L., Karolak, H., Szirkowiec, W. and Skiba, K. (2005) Psychiatric and Neurological Health Care Facilities – Statistical Yearbooks 2004. Institute of Psychiatry and Neurology – Unit of Health Protection Organizing, Warsaw.

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24) Sierosławski, J. (2002). Psychoactive substances – attitudes and behaviours. National Bureau for Drug Prevention, Warsaw. Available in Polish: http://www.narkomania.gov.pl [accessed 9.10.06] 25) Sierosławski, J. (2004). Estimate of drug addicts in lodzkie region. Report on combining substances in drug patterns in lodzkie region (ed. J. Sierosławski and P. Jabłoski). Institute of Psychiatry and Neurology, Warsaw. 26) Sierosławski, J. (2005a). Estimate of problem drug users and scale of drug-related problems in Warsaw" – the research project report. Multicipal Office of the Capital City of Warsaw, Warsaw. 27) Sierosławski, J., (unpublished report 2005b). Drug injecting use and other risk behaviour – report on qualitative research project in problem drug users. Institute of Psychiatry and Neurology, Warsaw. 28) Sierosławski, J. (2006a). Drug use in Poland 2004 – Data from residential treatment services. Drug Addiction Newsletter, 1 (32). Available in Polish: http://www.narkomania.gov.pl [accessed 9.10.06] 29) Sierosławski, J. (2006b). Alcohol and drug use in school youth – report on national questionnaire survey of 2005. Institute of Psychiatry and Neurology, Warsaw. Available in Polish: http://www.narkomania.gov.pl [accessed 9.10.06] 30) Stochmal, S., Borkowski, M., Sabatowski, S., Krawczyk, W., Woş, L. (2002). Drug- related crime in Poland in 2001. Police Headquarters, Warsaw. 31) (ed.) Zakrzewski, T. (2004). Drug Addiction – Information booklet on drug treatment centres – Where to look for help?. National Bureau for Drug Prevention, Warsaw. Available in Polish: http://www.narkomania.gov.pl [accessed 9.10.06]

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o Alphabetic list of relevant data bases 1) Data base on deaths cases. Central Statistical Office in Warsaw. 2) Data base on offences (Temida System). Polish National Police. 3) Data base on patients admitted to residential psychiatric treatment due to drug use. Institute of Psychiatry and Neurology in Warsaw. 4) Data base on reported cases of infectious diseases. Epidemiology Department of the Institute of Hygiene in Warsaw.

o Alphabetic list of relevant Internet addresses 1) General Statistical Office http://www.stat.gov.pl 2) Methodological Centre of Psychological and Pedagogical Assistance http://www.cmppp.edu.pl 3) Ministry of Health http://www.mz.gov.pl 4) Ministry of National Education http://www.men.gov.pl 5) Ministry of Interior and Administration http://www.mswia.gov.pl 6) National Bureau for Drug Prevention http://www.narkomania.gov.pl 7) National Institute of Hygiene http://www.pzh.gov.pl 8) Nationwide Internet Counselling Centre for Drug Addiction http://www.narkomania.org.pl 9) Seym – lower house of the Polish Parliament http://www.sejm.gov.pl

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15. Annexes o List of Standard Tables and Structured Questionnaires used in the text 2) Standard Table 02: Methodology and results of school surveys on drug use 9) Standard Table 09: Prevalence of hepatitis B/C and HIV infection among injecting drug users 11) Standard Table 11: Arrests/Reports for drug law offences 13) Standard Table 13: Number and quantity of seizures of illicit drugs 14) Standard Table 14: Purity at street level of illicit drugs 15) Standard Table 15: Composition of tablets sold as illicit drugs 16) Standard Table 16: Price in Euros at street level of illicit drugs

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o List of Graphs and Tables used in the text 1) Figure 1. Budget of National Bureau for Drug Prevention 1999-2005 in PLN

2) Figure 2. Subjects of press releases on drugs and drug addiction in 2005 3) Figure 3. Ranking scale of psychoactive substances mentioned in press publications on drug addiction in 2005 4) Figure 4. Comparison of estimates of problem opiate users and injecting drug users in Warsaw 5) Figure 5. All patients admitted to residential treatment in 1990-1996 due to addiction or abuse of medical drugs and in 1997-2004 due to mental disorders and behavioural disorders caused by using psychoactive substances (per 100 000 residents) 6) Figure 6. Patients admitted to residential treatment in 2004 due to mental and behavioural disorders caused by using psychoactive substances 7) Figure 7. Patients admitted to residential treatment in 1990-1996 due to addiction to medical drugs or medical drug abuse (ICD IX: 304, 305.2-9) and in 1997-2004 due to mental and behavioural disorders caused by using psychoactive substances (ICD X: F11-F16, F18, F19) – selected drugs (no. of patients) 8) Figure 8. Patients admitted to residential treatment in 1997-2004 due to mental and behavioural disorders caused by using psychoactive substances; by age 9) Figure 9. Development rend of number of ambulatory and residential drug centres along with number of beds in 1998 - 2004 (1998 = 100) 10) Figure 10. New HIV infections, including injecting drug users in 1999-2005, according to date of reporting 11) Figure 11. AIDS cases, including injecting drug users in 1999 – 2005, according to year of AIDS diagnose 12) Figure 12. Upward trends in the percentage of patients with double diagnosis in all patients admitted to residential psychiatric treatment due to drug use in 1997 – 2004 13) Figure 13. Recorded offences in 1999-2005 against Act of Law of 1997 and 2005 on counteracting drug addiction 14) Figure 14. Recorded offences in 1998 – 2005 against the Act of Law of 1997 and 2005 on counteracting drug addiction (index 1998 = 100) 15) Figure 15. Suspects In 199-2005 under the Act of 1997 and 2005 on counteracting drug addiction 16) Figure 16. Individuals sentenced to penalty of deprivation of liberty under the Act of Law on counteracting drug addiction 1989-2004

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17) Figure 17. Cocaine: Lifetime prevalence of psychoactive substances, in the last 12 months and 30 days 18) Figure 18. Cocaine: Patients of residential treatment admitted in 2004 due to mental and behavioural disorders caused by using psychoactive substances, by substance 19) Figure 19. Cocaine: Crimes against Act of Law on counteracting drug addiction in 2005, by substance.

20) Table 1. Expenditure on implementation of National Programme for Counteracting Drug Addiction (NPCDA) in 2005 in EUR 21) Table 2. Lifetime prevalence of substances use 22) Table 3. Lifetime prevalence of substances use by gender 23) Table 4. Substance use on the last 12 months 24) Table 5. Substance use in the last 30 days 25) Table 6. Disapproving of the use of individual substances 26) Table 7. Participation in prevention classes vs. cannabis use 27) Table 8. Individuals reporting to residential treatment in relation to the overall nominated population 28) Table 9. Breakdown of source data and estimate results 29) Table 10. Respondents in respective samples 30) Table 11. Basic estimate parameters 31) Table 12. Percentages of injecting drug users among problem drug users 32) Table 13. Sources and estimate values based on community studies and statistics of National Institute of Hygiene (PZH) 33) Table 15. Percentage of patients admitted to residential treatment in 1997-2004 due to mental and behavioural disorders caused by using psychoactive substances (ICD X: F11-F16, F18, F19); by substances 34) Table 16. Patients admitted to residential treatment in 1997-2004 due to mental and behavioural disorders caused by using psychoactive substances (ICD X: F11-F16, F18, F19); by substances 35) Table 17. Patients admitted to residential treatment in 1997-2004 due to mental and behavioural disorders caused by using psychoactive substances (ICD X: F11-F16, F18, F19); by gender 36) Table 18. Deaths due to drug overdose in 1987-2004 37) Table 19. Patients admitted to residential treatment due to drug use in 1997 – 2004, in second diagnose breakdown

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38) Table 20. Recorded offences against Act of Law on drug prevention and Act of Law on counteracting drug addiction in 1990 – 2005 39) Table 21. Convictions by courts in general and convictions under the Acts on counteracting drug addiction 40) Table 22. Convicts sentenced finally to imprisonment under Acts on drug prevention and counteracting drug addiction 41) Table 23. Substance availability (very easy to obtain) 42) Table 24. Exposure to drug offers 43) Table 25. Drug availability assessment: ’How much time to do you need to get the following drugs?’ 44) Table 26. Police seizures 2001-2005 45) Table 27.Customs Service seizures 1998-2005 46) Table 28. Border Guard seizures 2002-2005 47) Table 29. Retail prices on illegal market 1999-2005 48) Table 30. Purity of drugs and THC concentration in cannabis on illegal market 49) Table 31. Cocaine: Lifetime prevalence of psychoactive substances by gender 50) Table 32. Cocaine: Lifetime prevalence of psychoactive substances by age 51) Table 33. Lifetime prevalence of crack and cocaine use 52) Table 34. Cocaine: Substance use in the last 12 months 53) Table 35. Cocaine: Substance use in the last 30 days 54) Table 36. Cocaine: Lifetime prevalence of substances use by gender 55) Table 37. Cocaine: Patients admitted to residential treatment in 1990-1996 due to addiction or abuse of medical drugs (ICD IX: 304, 305.2-9) and in 1997-2004 due to mental and behavioural disorders caused by using psychoactive substances (ICD X: F11-F16, F18, F19) 56) Table 38. Cocaine: First-time and returning patients admitted to residential treatment in 2004 due to mental and behavioural disorders caused by using psychoactive substances (ICD X: F11-F16, F18, F19) by substances (in percent) 57) Table 39. Cocaine seizures by police in 2001-2005 58) Table 40. Cocaine seizures by Customs Service in 1998-2005 59) Table 41. Cocaine seizures by Border Guard in 2002-2005 60) Table 42. Cocaine prices on illegal market. 61) Table 43. Cocaine purity on illegal market in 2003-2005 62) Table 44. Cocaine: Assessment of availability of drugs (drugs very easy to obtain) 63) Table 45. Cocaine: Exposure to drug offers

135 o List of abbreviations used in the text

1) CSO – Central Statistical Office 2) ESPAD – European School Survey Project on Alcohol and other Drugs 3) ICD – International Classification of Diseases 4) NBDP – National Bureau for Drug Prevention 5) NPCDA – National Programme for Counteracting Drug Addiction

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