ROMANIA - National Report on Drugs 2000

FOREWORD Although late, this national report is the result of the hard work of a small group of people to whom I want to thank from the bottom of my heart: - Ms Denise Ezechil, MD – Ministry of Health and Family, - Mr Florin Sologiuc, MD – Ministry of Health and Family, - Mrs Angela Pantea, Ph.D in Pharmacy, Ministry of Interior. It may not be the best report ever made on the drugs situation, but it is the fruit of our endeavor. The establishment of the National Focal Point on drugs this year, 2002, makes me confident that the next report will raise to the expectations of all interested parties, and I want to wish the people selected to work in this institution good luck and perseverance in accomplishing their tasks. Adrian Bumbac Phare National Drugs CoordinatorSUMMARY Major trends Drug use represents a problem for Romania in the opinion of the majority of the population (86.3%). Should it be about younger or elder people, should it be about urban or rural environment, the opinions show that drugs are a problem for the Romanian society. The answers of this type are more frequent in the 18-25 years age group. Although drug problem is perceived as a serious one, it is to be noted the fact that a high percentage of the population that does that (40%) does not know the meaning of “ideal drug”. Three of the drugs are highlighted, by the high percentage in what concerns the number of persons that heard of them: cocaine (50%), marijuana (42%) and heroine (42%). These three drugs, to which we might add hashish (30%), have scored high percentages, much higher than the next in line. Although at national level, drug abuse represents a problem in the opinion of 86% of the respondents, 64% of the subjects cannot assess the drug abuse in their 2 ROMANIA - National Report on Drugs – 2000 hometown. This is even more obvious in rural area (76% of the rural area cannot assess drug abuse in their area) and gets minimum in Bucharest with 29% of non-answers. Talking of the tendency to use drugs, the number of those who used or are tempted to, overpass in Bucharest the expected values. From the regional point of view, we can determine that also the level observed in Dobrogea overpasses the expected level. In what concerns the potential users, Bucharest is a leader without any doubt, totally different than the situation in Transilvania and the other regions. During 2000 there were investigated 270 cases of illicit drugs trafficking out of which 243 cases were carried out by organized crime services; there were investigated a total number of 426 persons, out of which 399 persons by the organized crime services. 188 final sentences on drugs were given during 2000, but the number is strongly influenced by the lack of legislation. The fact that the antidrug law was enacted in 2000, didn’t immediately lead to convictions. Heroine continued to be the most trafficked and abused drug on the market especially by way of injection. However, a serious increase of the synthetic drug use on the market was also noticed. Cannabis use grew, and cultivations of Cannabis sativa were discovered in Romania. Medicines abuse (codeine, methadone, pentazocine, diazepam) reached a worrying level, as they are mostly abused by heroine addicts. The most abused drug in Romania was heroin. The purity of street heroin was around 30%. The amphetamine derivatives (especially Ecstasy) were on the second place in the preferences of the drugs abusers. The percentage of this drug in the pills was around 30%. The abuse of heroin is more extended than in 1999, and it became a real health problem. The public opinion is very disoriented in connection with the topic of drugs. The level of information in this field is very low, and in another opinion survey carried out during a TV show, more than 70% of the viewers called agreed with the punishment of drug users, considering them as common criminals.New developmentsThe improvement of the activity of the Interministerial Committee for Fighting against Drugs (ICFAD) was taken under consideration, by: 3 ROMANIA - National Report on Drugs – 2000- the drafting of a national drug strategy - the enacting of the law regarding the countering of illicit drug trafficking and abuse (Law 143/2000) With regard to the Law No 143 of July 26, 2000, we may stress out the following: - Article 6,1 stipulates imprisonment for doctors who prescribe „high risk drugs“ if „not necessary from the medical point of view“. This creates considerable risks for doctors who engage in substitution treatment for heroin addicts, as methadone may be labelled as a high-risk drug (being an opiate), and as the indication for maintenance on a substitution medication is not defined on a consensus basis, neither nationally nor internationally. The same risk exists for pharmacists involved in substitution treatment according to article 6,2. - According to Article 5, toleration of drug consumption in places, where the public has access, is punishable by imprisonment. This may create risks for implementing a policy to prevent HIV- and Hepatitis Infections through needle and syringe exchange programmes, to promote the use of clean syringes and needles for the injection of illegal drugs, and to tolerate such use in supervised places and low- threshold facilities, while a zero-tolerance policy in such facilities would exclude most of the potential clients in need of professional contact and counselling. - The structure of the national drug unit from the Ministry of Interior was changed to include a compartment dealing in the licit circuit of drugs and precursors, and other structures within the Ministry of Health and Ministry of Finance, General Customs Directorate were modified in view of increasing the efficiency of the prevention and countering of illicit drug trafficking and abuse; Health programmes for DDR were set up. New structures were created within some state institutions (Ministry of Health, General Customs Directorate, etc) in view of increasing the efficiency of the prevention and countering of illicit drugs trafficking and abuse; There were set the basis of a health policy and of an educational system to ensure concrete prevention activities of drug abuse and recovery of drug addicts through proper treatment. Through the Government Decision no. 1359/2000 regarding the enforcement of Law 143/2000 the approach of the issues related to Drug Demand Reduction was set on a basis in accordance with the European Drug policy. The most important developments in the field of DDR were: 4 ROMANIA - National Report on Drugs – 2000- a national programme for education in schools was initiated in accordance with the WHO methodology, including all urban area schools in Romania; - the two detoxification sections in Bucharest and Iasi were opened; - the methadone substitution programme was developed in Bucharest - the first post cure and rehabilitation center was opened in Balaceanca, next to Bucharest: the first syringe exchange centers started to function in Bucharest, within some NGO’s. 5 ROMANIA - National Report on Drugs – 2000PART 1 NATIONAL STRATEGIES INSTITUTIONAL & LEGAL FRAMEWORKS 1. Developments in Drug Policy and Responses1.1. Political framework in the drug field a) Objective and priorities of the national drug policy The priorities of the national drug policy were: - the improvement of the legal framework in the field of drugs and precursors by promoting two pieces of legislation - the improvement of the prevention activity - the development of a therapeutic network for drug users b) Basic elements of drug policy at national, regional, local level The improvement of the activity of the Interministerial Committee for Fighting against Drugs (ICFAD) was taken under consideration. - the drafting of a national drug strategy - the enacting of the law regarding the countering of illicit drug trafficking and abuse (Law 143/2000) - the enacting of the regulation of the Law 143/2000 - the structure of the national drug unit was changed to include a compartment dealing in the licit circuit of drugs and precursors, and other structures within the Ministry of Health and Ministry of Finance, General Customs Directorate were modified in view of increasing the efficiency of the prevention and countering of illicit drug trafficking and abuse; - the setting up of health programmes for DDR - new structures were created within some state institutions (Ministry of Interior, Ministry of Health, General Customs Directorate, etc) in view of increasing the efficiency of the prevention and countering of illicit drugs trafficking and abuse; 6 ROMANIA - National Report on Drugs – 2000- there were set the basis of a health policy and of an educational system to ensure concrete prevention activities of drug abuse and recovery of drug addicts through proper treatment;1.2. Policy implementation, legal framework and prosecution a) Law and regulations (drug-related issues about health, social affairs, youth, justice, drug control, etc.) Romania has signed the following international conventions: - The Opium Convention and Protocol, concluded in Geneva on February 19, 1925, during the Second Opium Conference, promulgated by Romania through the Decree No 1578 of June 5, 1928; - the Convention for the repression of illicit drug trafficking, signed in Geneva on June 26, 1936, and ratified by Romania through the Law-Decree No 169 of May 27, 1938; - The Single Convention on narcotic drugs, concluded in New York on March 30, 1961, amended by the Geneva Protocol on March 25, 1972, to which Romania adhered through the Decree No 626/1973, published in the Official Bulletin, Part I, No 213/1973; - The UN Convention of 1971, concerning psychotropic substances; - The UN Convention Against Illicit Traffic in Narcotic Drugs and Psychotropic Substances (Vienna 1988) Romania adhered to the UN Conventions of 1971 and 1988 through the Law 118/1992. The internal legal framework: - the Law No 73/1969 concerning the regime of the narcotic substances and products and the Instructions of the minister of health no 103/1970 for putting into practice the provisions of Law No 73/1969. The two acts regulate the fabrication, extraction, conditioning, preparing, storing, administration, distribution and transport of certain narcotic products and substances, provided for in the annex of this law; - Decree No 466/1979 regarding the regime of the toxic substances, category in which enter some of the essential chemical substances and precursors (lysergic acid, ephedrine, ergotamine, ergometrine); the annex list of this decree must be up- dated, as certain toxic substances that transit our country lately are not controlled by this decree (the bee venom, snake venom, and others); 7 ROMANIA - National Report on Drugs – 2000- Order 317/1987 issued by the minister of health regarding the list of narcotic products and substances placed under control, given for the enforcement of Law no 73/1969; - the Government Decision No 75/1991 regarding the defining and the sanctioning of felonies to the regime of the narcotic substances and products; - the Order of the minister of industry and commerce no 36C/1999 regarding the issuing of import-export licenses for some chemical substances placed under international control (22 substances are placed under the control of the 1988 Vienna Convention, modified following to the recommendations made during the 35th Session of the Commission on Narcotics, according to Regulation No 3677/1990); - The Emergency Ordinance No 152/1999 regarding the medical drugs for human use, that has special provisions on the import, export and transport inside the country of the toxic substances, narcotics and medical drugs; - the Law No 100/1998 concerning the public health care. In the annex no 1 of the law, there are mentioned the national public health programmes, organized and financed by the Ministry of Health; the National Programme for the Prevention and Control of Drug Addiction and the Induced Pathology is included in this law; - The order of the minister of health no 415/2000 regarding the organizing and the financing of the National Health Programmes, that are revised yearly. These Programmes include the National Programme for Prevention and Control of Drug Addiction and Induced Pathology - adults and children. - The Order of the minister of health no 963/1998, regarding the approval of the general methodological norms of organization and offering of medical assistance, treatment, medical care and hotel services (meals and bed in hospital) to the addicts by abuse of narcotic and psychoactive substances. This order also regulates the information circuit regarding the drug addicts, as the steps of the centralization of the data regarding the number of persons hospitalized for drug addiction as well as of the centers they are coming from (their territorial distribution) are provided for. An annex of this order contains the Reporting fiche of the cases that are fed into the informational system of the Ministry of Health through its Computer Center, Sanitary Statistics and Medical Documentation, where there is a special software financed by the World Bank; - the Criminal Code of Romania, that represents the basic law through which the criminal deeds related to the regime of drugs are incriminated. Thus, according to the provisions of Article 312, it represents the crime of narcotic drugs trafficking, the following deeds: 8 ROMANIA - National Report on Drugs – 2000- the production, the possession or any other operation regarding the circulation of the narcotic or toxic substances and products, the cultivation for procession of plants that contain such substances, or the experimenting of toxic products or substances, all these without right, shall be punished with prison from 3 to 15 years and the forbidding of certain rights; - the committing of the above deeds in an organized manner, shall be punished with life imprisonment or prison from 15 to 25 years and the forbidding of certain rights; - the prescription by a physician, without being necessary, of narcotic substances or products shall be punished with prison from 1 to 5 years; - the organizing or the allowing of consumption of such substances or products in special places, shall be punished with prison from 3 to 15 years and the forbidding of some rights. The regime of the safety measures of the Criminal Code, Article 113 and Article 114 regulate the obligation to medical treatment and hospitalisation of the persons that represent a danger for the society because of drug addiction. Once the special law on drugs (Law 143/2000 see bellow) was officially published it was immediately enforced. - Law no 21/1999 for the prevention and the sanctioning of money laundering; according to Article 23 it is incriminated as money laundering the deed of changing or transferring values knowing that they are the result of drug trafficking crime; Article 25 provides that in case of the crimes provided for in Article 23, the confiscation of the assets that make the object of the crime, will be ordered according to Article 118 Criminal Code, and if they are not found, the criminal is forced to the payment of their equivalent in money. - the Customs Code incriminates as smuggling in Article 176, and punishes the crossing of the border, without authorization, of narcotic drugs and psychotropic substances, of precursors and essential chemical substances with prison from 2 to 7 years. - the Government Decision no 534/1999, regarding the establishment of the Interministerial Committee for Fighting Against Drugs. - the Order of the minister of health no 9/1999 regarding the nomination of the national coordinators of the Programmes for the Promotion of Health and Health Education; it nominates the National Drug Demand Reduction Coordinator. Also there have been nominated the persons responsible of the National Programme for the Prevention and Control of Drug Addiction and Induced Pathology (adults and children). 9 ROMANIA - National Report on Drugs – 2000- the Order of the minister of health no 332/1999 regarding the establishment of the Resources and Documentation Center for the prevention of drugs abuse in the Institute of Health Services Management Bucharest with Phare support. This order helps to increase the quality of the information regarding the prevention of drug abuse. - the Law 143/2000 regarding the countering of illicit drugs trafficking and abuse, a major accomplishment of the year 2000. The novelties the law brings are: - a national specialized unit for fighting drugs trafficking within the National Police - the use of undercover officers - the use of controlled deliveries - sentence reduction for cooperating offenders - the legal frame for development of the treatment services for drug addicts The decision to take part in the Early Warning System was taken, and the steps in this respect were made. - the regulation of Law 143/2000 which specifies rules of procedure for the enforcement of this law approved by the Governmental Decision 1359/2000. The legislation in the field of health education in the educational units: - the joint Order of the minister of health and minister of national education of 28.01.1999, “for the purpose of health promotion and the increase of the level of education for health according to international standards, starting from the study year 1999/2000 health education classes will be introduced both in the compulsory and optional school curricula. These classes will be held by specially trained teachers, with competency in the health education, so that the pupils and the students are offered information and education programmes for health at international standards”. Health education classes include specific for drugs. - the Order of the minister of national education no 3281/1999 regarding the counseling and orienting activity in pre-university education for the school year 1999/2000; this order defines the content of the counseling and orienting activities, others than the tutor hour, as follows: a) psychological and pedagogic counseling of the pupils; b) the counseling of the over-gifted pupils; c) the counseling of the pupils with disciplinary or learning problems; d) school and professional orienting of the pupils; 10 ROMANIA - National Report on Drugs – 2000- the Order of the minister of national education no 3449/1999 regarding the regime of the optional disciplines in the perspective of enforcing the new training plans starting with the school year 1999/2000. It is provided in this order that the optional disciplines are indicated by the Ministry of National Education only as orientation, for all fields; the schools may also propose to the pupils disciplines and optional themes; both optional disciplines may be included in the timetable, from the offer of the Ministry of National Education as well as optional ones from the local offer. - the Protocol signed by the Ministry of Education and the Ministry of Health regarding the national drug prevention programme, according to WHO methodology; Legislative initiatives: - the law draft for the modification and completion of the Criminal Procedure Code for the establishment of the juridical institutions regarding the witness protection and the undercover investigator; - the law draft for the modification and the completion of the Criminal Code regarding the establishment of the juridical institution of the criminal liability of a juridical person. - the law draft regarding the legal regime of the precursors b) Prosecution policy, priorities and objectives in relation to drug addicts, occasional users, drug related crime Drug abuse is punished according to the Law 143/2000. If proof is provided that the person caught with drugs is an abuser of drugs, the quantity found on him is small and he claims it is for his personal use, an alternative is given him to undertake treatment versus prison, although the law does not explicitly mention this possibility. There have been preoccupations in drafting and promoting the law concerning the legal regime of precursors.1.3. Developments in public attitudes and debates The media organized meetings, round tables, talk shows on the issue of illegal drug trafficking and abuse, but everything was done randomly. At regional level, various local authorities printed booklets and leaflets regarding the harmful effects of drug abuse. 11 ROMANIA - National Report on Drugs – 20001.4. Budget and funding arrangements No special funding was made available for DSR. DDR activities of the Ministry of Health were financed from the national budget within the National Programme for prevention of drug addiction, in value of 17 billion ROL (approx. 850,000 Euro). 12 ROMANIA - National Report on Drugs – 2000PART 2EPIDEMIOLOGICAL SITUATION 2. Prevalence, Patterns and Developments in Drug Use Based on statistical indicators, research results, qualitative data and literature 2.1. Main developments and emerging trends a)Overview of most important characteristics and developments of drug situation The number of drug addicts increased, adding the abusers of synthetic drugs. b) Emerging trends (changing patterns or modes of use, new user groups, new drugs, new problems) The number of persons abusing medical drugs increased (ephedrine, codeine, barbiturates and benzodiazepines) according to statistics of the Bucharest Emergency Hospital. The number of persons abusing heroine by way of injection also increased according to the information provided by the treatment centres. The abuse of ketamine was recorded following to reports of the veterinary pharmacies. c) Analysis of drug trends in wider social context (youth culture, economic or demographic changes, social attitudes, supply …) This analysis is based on the information gathered within the national study carried out in December 2000. Thus, drug use represents a problem for Romania in the opinion of the majority of the population (86.3%). Should it be about younger or elder people, should it be about urban or rural environment, the opinions show that drugs are a problem for the Romanian society. The answers of this type are more frequent in the 18-25 years age group. Although drug problem is perceived as a serious one, it is to be noted the fact that a high percentage of the population that does that (40%) does not know the meaning of “ideal drug”. 13 ROMANIA - National Report on Drugs – 2000Three of the drugs are highlighted, by the high percentage in what concerns the number of persons that heard of them: cocaine (50%), marijuana (42%) and heroine (42%). These three drugs, to which we might add hashish (30%), have scored high percentages, much higher than the next in line. Although at national level, drug abuse represents a problem in the opinion of 86% of the respondents, 64% of the subjects cannot assess the drug abuse in their hometown. This is even more obvious in rural area (76% of the rural area cannot assess drug abuse in their area) and gets minimum in Bucharest with 29% of non-answers. Talking of the tendency to use drugs, the number of those who used or are tempted to, overpass in Bucharest the expected values. From the regional point of view, we can determine that also the level observed in Dobrogea overpasses the expected level. In what concerns the potential users, Bucharest is a leader without any doubt, totally different than the situation in Transilvania and the other regions.2.2. Drug use in the population a) Main results of surveys and studies (prevalence, incidence, patterns of use, characteristics of users, geographical differences) with indication of trends and possible reasons/associated factors: “NO INFORMATION AVAILABLE” b) General population Drug use in Romania – quantitative survey carried out by the Survey Centre of the Public Opinion (SCPO) at the request of the Ministry of Health – December 2000 Obviously there are reasons of satisfaction and dissatisfaction in each person’s life. If we consider the population of Romania as a whole, or to be more precise, the population between 12-45, we can conclude that the number of satisfactions overpasses the one of dissatisfactions. On a 1 to 4 scale of satisfaction where 1 means, “Very satisfied” and 4 means, “Totally dissatisfied”, the average satisfaction degree is 2.3. From the point of view of age, a slight increase of dissatisfaction with age growth could be noticed. From the point of view of the region and of the domicile, Bucharest is totally different than the other areas of the country. The people that live in Bucharest have a comparatively better opinion about the degree of satisfaction in comparison with the rest of the country. This distribution confirms the existence of higher opportunities in the capital, situation that also influences the volume and the repartition of the benefits. The average degree of satisfaction has here the value of 2.03, the recorded values being considerable different than the expected ones. 14 ROMANIA - National Report on Drugs – 2000Drug abuse represents a problem for Romania in the opinion of the majority of respondents (86.3%). It either concerns younger or elder persons, or it’s about urban or rural areas, the opinions of the respondents show that drugs represent a problem for the Romanian society. The answers of this kind are more frequent with the 18-25 year age group. Drugs do not represent just an ordinary problem for Romania, but a very serious one we might say, the general opinion in what concerns its gravity being of 1.28, where 1 represents a “very serious problem” and 4, “there is no problem”. Although the drug problem is perceived as a serious one, it is worth mentioning the fact that a very high percentage of the population, which appreciates drug abuse as a problem for Romania (40%), does not understand the significance of the words “legal drugs”.How do you assess the drug problem in Romania Sam ple: The persons who consider drugs a problem 100% 27% 80% 40% 39% 40% 67% 60%40% 73% 60% 61% 60% 20% 33% 0% Serious Average Minor problem There is no Total problem Do not know what the word DRUG m eans Know what the word DRUG m eans The assessment of the knowledge on drugs may be done with the variables: the knowing of the words “legal drugs”, the number of drugs known, types of known drugs. From demographic point of view it is worth highlighting the situation of the young people. The 12-17 years age group, of those still in elementary schools or in the first grades of high schools differs significantly from the other age groups in what concerns the understanding of the word “drug”. According to the number of drugs a person knows the knowledge that person has on drugs may be assessed. As per the above, the 12-17 years age group is over- represented for “I don’t know” The number of known drugs answers, and underrepresented for 1 type of 2 types of the alternative “4 and over known drug drugs drugs”. 15% 27% If 42 % of questioned subjects do not know what “illegal I don't know /No drug” is, yet the names of the drugs answ er 18% 3 types of 4 types of drugs drugs 24% 16% 15 ROMANIA - National Report on Drugs – 2000 are much better known, and “I don’t know” is the answer only in 18% of the sample. Three of the drugs are highlighted, by the high percentage in what concerns the number of persons knowing them: cocaine (50%), marijuana (42%) and heroine (42%). These three drugs, to which we might add hashish (30%), have scored high percentages, much higher than the next in line. In the table below are given the Somers’d asymmetric correlation coefficients of the number of known drugs and the knowledge of each drug:Name of drug Somers’d CoefficientLSD 0.797 EXTASY 0.622 OPIUM 0.617 CANNABIS 0.592 HASHISH 0.59 MARIJUANA 0.578 COCAINE 0.577 HEROINE 0.567 SOLVENT *insignificantThree of the drugs are more significantly represented. LSD, Ecstasy and Opium, whose correlation coefficients and residual adjusted values show a strong link with the number of known drugs, these names of drugs appear with the respondents that know at least two drugs, but, the highest percentages are recorded for persons that know 4 or more drugs. The possible reasons for the persons that use drugs were expressed differently by respondents and comprised material, emotional, exhibitionism, curiosity issues, such as are presented in the next graph.40% Main reasons for using drugs 31% 30% 28% 19% 20% 17% 13% 13% 9% 10% 7% 7% 7%0% f f d d r y g l s y i e y t o o t o t t e i n a r i a g m m i l z o e s i e n e i e a o p k e g g l o s r s b v o t n s i n d e r i i i l i b r u u u t a o a e e h o f t e h f D o t u a o a r g i P t m s F r o t l e r c c o f C t n p n E i o e e b o e o s B B i N T D 16 ROMANIA - National Report on Drugs – 2000Although at national level, drug abuse represents a problem in the opinion of 86% of the respondents, 64% of the subjects cannot assess the drug abuse in their hometown. This is even more obvious in rural area (76% of the rural area cannot assess drug abuse in their area) and gets minimum in Bucharest with 29% of non-answers. There is a tight relationship between the number of non-answers and the dimension of the town, the Kendall correlation coefficient has a value of 0.264 at a level of meaning of 99%). If we refer only to the group of respondents that have made an assessment on drug abuse in their hometown there are differences in respect to how they perceive the situation at national level. Only 5.4% of the subjects consider the abuse as very high and 20.5% as high. From the residential point of view, drug abuse is considered higher in big towns and cities and Bucharest. The correlation coefficient between the dimension of abuse and the residential area has a value of 0.623.Adjusted Residence residual values Rural Small town Big town Bucharest Very big -2.6 -1.0 -1.7 5.7 Big -5.7 -3.8 2.2 7.9 Small -5.5 -.6 6.9 -.6 Very small 10.7 4.1 -7.3 -8.4The residual adjusted values are given in the above table calculated for the association table “Drug abuse in localities and residential areas”. Discussing on the trend to use drugs, the number of those that have used or are inclined to use drugs overpass the expectations in Bucharest.Adjusted residual Residence Region values s e r u a n i t t a m a a n s s n i e a w a e t e v l a i r n w g o r r a a o v a t e n o a a o r l t n d t e i l r h h l u t a l n M s l b c c g o - a u R n B i o u u a O a m M B n r M D B B S a T s i r C 17 ROMANIA - National Report on Drugs – 2000Yes, I was tempted -3.3 1.3 .9 2.3 -1.2 -1.9 4.3 -1.1 -.9 1.3 -.8 2.3 and I tried Yes, I was tempted -2.7 -.7 .4 4.8 -1.8 -2.6 1.8 -2.8 2.3 .3 -.8 4.8 but I never tried No, I was never 4.0 .0 -.8 -5.4 2.1 3.2 -3.7 3.0 -1.7 -.9 1.1 -5.4 tempedFrom the point of view of the region we may see that even in Dobrogea the recorded level is higher than expected. Transilvania is different from the other regions in this respect. c) School and youth population The European Survey Programme for Alcohol and Drugs (ESPAD) was conducted during 1999, and it represents a request conducted at national level regarding alcohol, tobacco and drugs abuse among the IXth grade students from all European countries. The study was conducted on basis of questionnaires filled in by a national sample of 2,394 subjects, students in the IXth grade from all over the country. The computer thus choosing both urban and rural high schools, allowing for the extrapolation of data, did their selection randomly. This type of research and the working methodology are similar to those made in European Union countries in the same period of time. The results of the research will allow us to evaluate the importance of the phenomenon of alcohol, tobacco and drug abuse among the young people in Romania. The analysis and the processing of data was finalized in this stage, and their sending to the programme coordinators that are going to publish them, setting in the same time a hierarchy of the countries in the abuse of alcohol and drugs. The Institute of Health Services Management and the County Departments for Health Promotion and Health Education made this survey. The survey has shown the following: - - 95.2% of the male population and 96.5% of the female population that answered declared that they have never used any drug; - 85,5% from the students, declared that they used alcohol and 43,2% experienced ebriety; - 57,3% from all have smoked; - 9,5% of all students declared that they use ilegal drugs at least once; 18 ROMANIA - National Report on Drugs – 2000- out of those that have declared the use, the drug used by boys were marijuana and hashish and by the girls – tranquilizers and sedatives; - the main source to obtain drugs is the group of friends (entourage) that offer or sell these substances; 1.2% of the boys have shared the drug when first using it; - the main reason for the young people (both girls and boys) to want to use drugs is the curiosity; 0.9% of the boys that have used drugs, have declared their reason to have been “to feel high” and the girls said “the wish to forget their problems”; - the most part of the young people self evaluated themselves to have good and medium school results; - in respect to the relation with their parents, most of the young people said (80% of the boys and 75% of the girls) that they are content and very content; - most of the young people declared that they didn’t have an aggressive behavior towards other persons; generally they complain of the uncertainty of the future and do not pay much attention to the generally accepted social rules. The total of non-respondents is under 7% from the entire sample. There is not a systematic lack of data and there is no core or question module to be constantly ignored by the pupils. The survey was conducted on a random sample. Before the actual use of the questionnaires it was tested on a qualitative group of 30 people, when some of the questions were adapted without changing their content and their role.The Phare project “Technical Assistance for Drug Demand Reduction” in which Romania participated next to Hungary and Slovakia in the project “Innovative Techniques for Drug Demand Reduction” in three pilot counties (Galati, Dolj, Timisoara), ended in 1999. This is the first project that sets for it as goals, the analysis of the situation regarding the information needs of the population on the issue of drugs. The study made showed that the age group most exposed to the risk of using drugs is 15-24. Although different through geographical particularities, the percentage of those declaring to have used drugs is pretty much the same in Galati and Timisoara, 3,5% in average. Both the young people and the rest of the community (parents, teachers, police, local authorities) consider necessary to be informed on the drugs issue and wish to cooperate for the enforcement of information-education-communication programmes on drugs. The ways they want to receive this information are yet different depending on the county and the target group. These general conclusions have been the base for the formulation of the programme strategies that are to be used in the future in the three pilot counties. The strategies mean the orienting of the actions in three main directions: 19 ROMANIA - National Report on Drugs – 2000- towards young people and their families; - towards teachers; - towards the community d) Specific groups (e.g. conscripts, minorities, workers, arrests, prisoners, sex workers, etc.) “ NO INFORMATION AVAILABLE”2.3. Problem drug use a) National and local estimates, trends in prevalence and incidence, characteristics of users and groups involved, risk factors, possible reasons for trends “ NO INFORMATION AVAILABLE” b) Risk behaviours (injecting, sharing, sex … ) and trends According to the regulation of enforcement of Law 143/2000, the issues related to syringe exchange are considered legal. Within hospitals and all medical units unique use needles and syringes are used; disinfectant materials are provided in every therapeutic stage involving injection. Unique use syringes may be bought in Romania, without medical prescription, and their price is quite low. With the financial support of the Foundation for an open society, a number of NGO’s started to function in the last period of the year in the field of syringes exchange.3. Health Consequences 3.1. Drug treatment demand a) Characteristics of clients, patterns of use and trends (especially in new client sub-group) Most of the clients were persons between 15 and 29 years old, the major part of them being heroine users. b) Comments on different client profiles in different types of treatment In a ratio of 10/1 the clients were males, and over 60% of them were recorded as new cases during 2000. 20 ROMANIA - National Report on Drugs – 2000 c) Comments on treatment demand for different drugs, including cannabis, cocaine, synthetic drugs … The number of clients who requested the support from the medical units doubled in 2000 in comparison with 1999.3.2. Drug-related mortality a) Drug-related deaths, direct and indirect, characteristics and trends, possible reasons for changes “ NO INFORMATION AVAILABLE” b) Mortality and causes of death in drug-users, trends “ NO INFORMATION AVAILABLE” There were 44 drug related suspected deaths during 2000. Out of these, 22 were positive, as follows: - 10 deaths related to heroine - 3 deaths related to diazepam - 2 deaths related to oxazepam - 2 deaths related to gluthetimide - 1 death related to fenobarbital - 1 death related to amphetamine - 1 death related to codeine - 2 deaths related to carbamazepină3.3. Drug-related infectious diseases “ NO INFORMATION AVAILABLE” a) HIV and AIDS b) Hepatitis B and C c) Other (e.g. TB)3.4. Other drug-related morbidity “ NO INFORMATION AVAILABLE” 21 ROMANIA - National Report on Drugs – 2000 a) Non-fatal drug emergencies b) Psychiatric co-morbidity c) Other important health consequences (e.g. drugs and driving, acute and chronic drug effects .. )4. Social and Legal Correlates and Consequences4.1. Social problems “ NO INFORMATION AVAILABLE” a) Social exclusion (e.g. housing, unemployment, minorities, education) “ NO INFORMATION AVAILABLE” b) Public nuisance, community problems, “ NO INFORMATION AVAILABLE”4.2. Drug offences and drug-related crime a) ‘Arrests’ for use/possession/traffic (distinguish police and customs if possible) and trends During 2000 there were investigated 270 cases of illicit drugs trafficking out of which 243 cases were carried out by organized crime services; there were investigated a total number of 426 persons, out of which 399 persons by the organized crime services. The Law 143/2000 doesn’t make any clear distinction between the penalties for drug traffickers and abusers. It is difficult to separate the data concerning the arrests for use (possession) apart for these for trafficking. b) Convictions and court sentences for drug offences. Imprisonment for drug law offences 22 ROMANIA - National Report on Drugs – 2000188 final sentences on drugs were given during 2000, but the number is strongly influenced by the lack of legislation. The fact that the antidrug law was enacted in 2000, didn’t immediately lead to convictions. In the penitentiary system, 139 convicts declared that they are drug abusers. There was no case to require treatment, but if it were, this couldn’t have been done within the penitentiary system, but in the civilian treatment network. c) Drug-related crime (theft, violence, …) “ NO INFORMATION AVAILABLE”4.3. Social and economic costs of drug consumption a) Studies and estimates of health care costs, other social costs “ NO INFORMATION AVAILABLE” b) Estimates of total consumption/demand/expenditure on drugs “ NO INFORMATION AVAILABLE” There are no real data concerning the total number of drugs abusers, The concrete number of the drug users asking for detoxification services is the only number that we can take into consideration.5. Drug Markets5.1. Availability and supply a) Availability of different drugs, trends and possible reasons Heroine continued to be the most trafficked and abused drug on the market especially by way of injection, mainly because of the development of the illegal trafficking on the Balkan route. However, a serious increase of the synthetic drug use on the market was also noticed. One of the reasons of the abuse of synthetic drugs lies in the reduced risk they pose regarding overdoses, and withdrawal. 23 ROMANIA - National Report on Drugs – 2000Cannabis use grew, and cultivations of Cannabis sativa were discovered in Romania. Cannabis is not considered by many people as a drug; the fact that some countries allow the public use of cannabis, only makes it more attractive. Medicines abuse (codeine, methadone, pentazocine, diazepam) reached a worrying level, as they are mostly abused by heroine addicts. b) Sources of supply and trafficking patterns within country The main sources of supply are: - heroine – Turkey, Afghanistan - amphetamines and ATS – various countries - cannabis – various countries - methadone, codeine and pentazocine – diverted from the legal circuit. Most of the drugs were trafficked with TIR trucks, containers and people, using various concealment places.5.2. Seizures Trends in quantities and numbers of seizures (If possible, distinguish police and customs) Police seizures: - hashish and cannabis – 340.81 kg - cocaine – 13.14 kg - ecstasy, and other ATS – 15,670 tablets - heroine – 52.94 kg - various medicines with narcotic and psychotropic content – 187 ampoules, 0.112 kg and 387 tablets. Customs seizures: - BMK – 137.6 kg - cannabis – 3 seizures of 309.3616 kg - cocaine – 2 seizures of 13.14 kg - ecstasy tablets – 1 seizure 10,115 tablets - hashish – 1 seizure of two sticks 24 ROMANIA - National Report on Drugs – 2000- heroine – 4 seizures of 6.036 kg and 1 ml - marijuana – 3 cases of cigarettes, and 1.74 gr. - Various medicines with narcotic and psychotropic content – 97,335 tablets5.3. Price, purity Distinguish trends at retail (street) level and trafficking level if possible The most abused drug in Romania was heroin. The purity of street heroin was around 30%. The amphetamine derivatives (especially Ecstasy) were on the second place in the preferences of the drugs abusers. The percentage of this drug in the pills was around 30%. The abuse of heroin is more extended than in 1999, and it became a real health problem. Cannabis, hashish and opium were on the third place. Heroin powder was brown, beige or grey and it was trafficked in small packages (“balls”) weighing from 0.01 grams to 5 grams (a one dose ball and a multiple dose ball that requires portioning). The price for one “ball” can vary from 5 to 10 USD. Amphetamine and the derivatives of amphetamine (MDMA, MDEA, MDA, DOB) could be found on the market as powder (amphetamine) and tablets (amphetamine and ATS). The tablets had different logos, colour and sizes. They might have contained besides amphetamines, caffeine and lactose. The price for one tablet was between 7 – 15 USD. Cannabis was mostly used rolled in joints, the price for one such joint varying around 7 USD. The hashish was used mostly in combination with tobacco, in rolled cigarettes. The price for one such cigarette was around 10 USD. Smokers sometimes abused opium by using special pipes.6. Trends per Drug a) Information from different indicators and other sources plus comments on possible reasons and factors that may be associated to reported trends for each substance b) Analysis for the following substances: - Cannabis - Synthetic drugs (amphetamine, ecstasy, LSD, other/new) 25 ROMANIA - National Report on Drugs – 2000- Heroin/opiates - Cocaine/crack Multiple use (including alcohol, pharmaceutical products, solvents) From the study of the data obtained from the institutions directly involved in the drug supply and demand reduction (Ministry of Interior, Ministry of Health, General Customs Directorate, Ministry of National Education) it can be stated that, during 2000, Romania developed the transiting, storing and drug abuse features. The growth of the seized drugs quantities by the police represents a clue of the aggravation of the phenomenon. The cannabis, the hashish, the heroine and the synthetic drugs (amphetamines, MDMA, benzodiazepines, barbiturates) are the type of drugs that were frequently captured by the Romanian Police. Cases of methadone on the illicit market were also reported. The ketamine was also a problem. Samples of heroin mixed with ketamine were found on the illicit market. The data supplied by the police prove the existence of the distributors and consumers of drugs all over the country (Moldova, Transilvania, Banat, Muntenia). An increase of the number of Romanian drug possessors and traffickers was witnessed during 2000. From the police statistics it results an aggravation of the drug use among Romanian young people coming from various environments (students, pupils, people without occupation, business people). If till the end of 1998 the number of possessors was higher in the border counties (Bihor, Timis, Constanta), in 2000 their number was reported to be increased in the counties from the center and South (Cluj, Dolj, Dâmbovita). The essential chemical substances and the precursors have become lately priority objectives in the preoccupation sphere of the Romanian and foreign traffickers from Romania. The analysis of some aspects related to the chemical profile of the trafficked drugs, seized and used in the country and the range of some commercial activities conducted by foreign citizens with respect to certain chemical substances, made the object of analysis activities at the level of the institutions responsible with the combating of the phenomenon.6.1. Cannabis The trafficking and the use of cannabis, obtained by the processing of the hemp grown for this purpose in special areas of Romania or other countries, continued to be a problem during 2000 with multiple causes: - the growing of the plant cannabis (cannabis sativa) is done without special authorization; 26 ROMANIA - National Report on Drugs – 2000- the legislative gaps – Law 73/1969 was not amended following to the adhering of Romania to the 1971 and 1998 international conventions; - the accessible price of the distributed forms of cannabis; - the insufficient knowing of the harmful effects of the drug by the users; - the placing of this drug in the “light drugs” category in some western countries.6.2. Synthetic drugs (amphetamine, ecstasy, LSD) The amphetamines and their derivates are the synthetic drugs more frequently encountered on the illicit market and among the users of 2000 comparatively with the previous years. The police made seizures of amphetamines and amphetamine derivates (Ecstasy, Adam) and have reported the increase of the use of these drugs in a number of areas of the country. This phenomenon developed due to certain causes: - the amphetamine derivatives were not included in the tables attached to the national law regarding the regime of the products and narcotic substances until the enacting of Law 143/2000; - the lack of knowledge among the young people regarding the harmful effects of these drugs.6.3. Heroin/Opiates In the reference year, the trafficking and abuse of heroine had an ascending evolution. Coming from different routes of trafficking, the heroine was seized by the Romanian Police in different areas of the country, near the border or not. Its purity varied very much, between 0.2% and 60%. Most of the heroine seized in 2000 was characterized by an incomplete synthesizing; the active substance, diacetylmorphine (heroine), represented a small percentage in the final product next to the other reaction products and impurities. The dilution of the trafficked heroine with various substances with own pharmaceutical properties (paracetamol, caffeine, phenobarbital, diazepam, lactose, manitol) was another specific feature. Heroine abuse had an ascending evolution in 2000. The most used way of administering was by injection, increasing thus the risk of spreading some diseases (AIDS, hepatitis). The lack of a complete therapeutic chain in the treatment of heroine addiction led to an increased number of relapses, their recovery being most of the times impossible. The methadone substitution treatment and the alternative therapy to this, 27 ROMANIA - National Report on Drugs – 2000 was done aleatory according to the experience and own criteria of the psychiatrists as there is not yet personnel specialized in this field. There have also been reported cases of diversion of medical drugs with narcotic content from the legal circuit (petidine, hidromorphon, piritramide).6.4. Cocaine The trafficking and abuse of cocaine was relatively small. The high purity of the cocaine seized from the illicit trafficking (70%) and the high price of the doses distributed for abuse are reasons enough to keep a low profile in the abuse of this drug.6.5. Medicines The incomplete legislation of the current pharmaceutical system makes possible the release of certain medicines containing psychotropic active principles or acting on the body through mechanisms similar to those the drugs do, without medical prescription. No measures have been taken to reduce the access of the population to certain medicines that, in over dosage may induce serious intoxications and even death. Subsequently, the number of the people that use, without medical motivation, medicines that may induce the psychical addiction (benzodiazepines, barbiturates), may endanger the functioning of some vital organs, may put the life at risk.6.6. Multiple use (including alcohol) In certain moments, in a group or in solitude, occasional, recreational users or addicts use more substances that, by synergic action or not, may induce addiction. From the samples picked up from the illegal possessors, it was ascertained: - the administering of the heroine together with large doses of codeine; - the administering of the trihexifenidil (Trihexiphenidyl) mixed with alcohol; - the mixing of cocaine distributed for use with caffeine; - the administering of amphetamines with alcohol.6.7. Solvents A serious problem of the society is represented by the inhaling of the solvents existing in the composition of many products distributed unrestrictedly in Romania 28 ROMANIA - National Report on Drugs – 2000(paints, varnishes) by certain users, mostly underage. These volatile solvents (the major component is toluene) induce after inhaling, reversible psychic addiction. The number of users is increasing continuously without being really known. The highest risk is their possible turning towards certain abuse drugs after the inhaling of solvents, drugs that produce sometimes, irreversible forms of addiction.6.8. Doping. The anabolisant substances are not subjected to a special control in Romania. Among the performance sportsmen there have been reported cases of doping with anabolisant substances, sanctioned by the sports federations they were belonging to. The possession of such substances in view of distribution or abuse is not punished according to the Romanian legislation in force, because the substances used for doping are not part of the narcotic and psychotropic substances group.7. Conclusions This chapter should draw together and highlight the main points and implications of the trends, patterns and social context Main trends and new developments in drug use and consequences In the reference year the drug abuse extended in the entire country, comprising various segments of the population; the used drugs were covering a large range: cannabis, amphetamines, heroine, opium and cocaine. The way drugs were administered differed according to the drug and to the targeted effect by the abuser. It resulted from indirect indicators that the number of the possessors and of the abusers increased in 1999, and sometimes, even from the first dose the users directly injected the drugs. The use of certain medicines with psychotropic content, benzodiazepines and barbiturates administered or not with alcohol extended. It resulted from the drug supply reduction data that the smoking of cigarettes containing cannabis or marijuana extended among the pupils. The incipient coordination at national level of the entire multidisciplinary activity of fighting against drugs didn’t allow so far the elaboration of a national strategy for the drug demand and supply reduction; also, it was not set up a unitary methodology for the collection and procession of data referring to drug abuse in Romania. Furthermore, the information and the statistics that have stayed at the basis of this phenomenon are still incomplete, following to: - the relatively low degree of knowing the legislation in the field; 29 ROMANIA - National Report on Drugs – 2000- the lack of specific training of the people involved in filling the reporting fiches of the cases; - some deficiencies in filling in the reporting fiche contained in the annex of the Order of the minister of health no 963/1998; - the lack of performance of the centralizing and data processing computer system; - the inexistence of a national reporting system, based on an appropriate infrastructure to allow a collection and automated procession of data. The consequence of the above is of concern. Extended on multiple coordinates, the drugs phenomenon aggravated during 2000; the dimensions of this aggravation are not exactly known due to the inexistence of a real national system for reporting and statistic data procession.7.1. Consistency between indicators Analysis of relationship between different indicators (consistencies and inconsistencies) on major trends “ NO INFORMATION AVAILABLE”7.2. Implications for policy and interventions a) Possible reasons or hypotheses for major trends observed The extending of drug abuse on the territory of Romania in the last period of time is based on multiple causes, the most important of which were: - the lack of knowledge of the harmful effects of drugs by certain segments of the population (young people, parents, teachers); - relatively low impact of the messages expressed in some educational campaigns; - some legislative gaps regarding the abuse and possession of drugs; - the inexistence of a complete therapeutic system appropriate for the treatment of addicts; - the insufficient number of specialized personnel at national level. In Romania there is not yet a monitoring system of the users and/or addicts. In 1999 it started to operate a system for the monitoring of drug addicts that have required medical services. 30 ROMANIA - National Report on Drugs – 2000The level of requiring assistance from the medical institutions meant to do their treatment did not increase, either by lack of trust in the treatment they would have received or from fear of the police. In our country the treatment of addiction is done in one of the following cases: - out of the person’s own initiative; - in the emergency given by withdrawal because of the missing of the narcotic or psychotropic substance; - compulsory hospitalization set by a medical commission or ordered by prosecutor’s ordinance or ruled by court ruling; c) Relevance to policy issues or interventions for policy makers and professionals With regard to the Law No 143 of July 26, 2000, we may stress out the following: Article 6,1 stipulates imprisonment for doctors who prescribe „high risk drugs“ if „not necessary from the medical point of view“. This creates considerable risks for doctors who engage in substitution treatment for heroin addicts, as methadone may be labelled as a high-risk drug (being an opiate), and as the indication for maintenance on a substitution medication is not defined on a consensus basis, neither nationally nor internationally. The same risk exists for pharmacists involved in substitution treatment according to article 6,2. According to Article 5, toleration of drug consumption in places, where the public has access, is punishable by imprisonment. This may create risks for implementing a policy to prevent HIV- and Hepatitis-Infections through needle and syringe exchange programmes, to promote the use of clean syringes and needles for the injection of illegal drugs, and to tolerate such use in supervised places and low- threshold facilities, while a zero-tolerance policy in such facilities would exclude most of the potential clients in need of professional contact and counselling. 7.3. Methodological limitations and data quality The data related to the number of abusers were obtained only by: - interpretation of the medical records of the people that required medical services. - interpretation of the number of the seizures made by the police and the customs; - the results of the laboratory analysis of the samples; 31 ROMANIA - National Report on Drugs – 2000- the conclusions of the ESPAD and of the Project “Innovative Techniques for Drug Demand Reduction”. The limiting of the sources of data only to those mentioned above made that also their evaluation was limited and incomplete.PART 3 DEMAND REDUCTION INTERVENTIONS8. Strategies in Demand Reduction at National Level Description of national framework of demand reduction emphasising new trend and developments at organisational level8.1. Major strategies and activities Synthetic description of major national strategies in demand reduction and new developments. The main strategic lines expressed in the year 2000 are: - the adoption of legislation - primary prevention of drug use: - data collection, research and youth attitudes towards drugs, assessment of information needs of the public - public information - education for health - training programmes for the personnel that carries out education for health activities - drug addiction treatment activities: - training of specialized personnel in the treatment of drug addictions - training programmes - the establishment and setting up of the treatment and psychosocial rehabilitation centres - the establishment and development of the counselling centres and of the Help Line type telephone lines. 32 ROMANIA - National Report on Drugs – 2000- the establishment of centres for the prevention of the transmission of infectious diseases in sanguine way among users of injecting drugs8.2. Approaches and New Developments a) New and innovative approaches Through the Government Decision 1359/2000 regarding the enforcement of Law 143/2000 the approach of the issues related to Drug Demand Reduction was set on a basis in accordance with the European Drug policy. Thus: - a national programme for education in schools was initiated in accordance with the WHO methodology, including all urban area schools in Romania; - the two detoxification sections in Bucharest and Iasi were opened; - the methadone substitution programme was developed in Bucharest - the first post cure and rehabilitation centre was opened in Balaceanca, next to Bucharest: the first syringe exchange centres started to function in Bucharest, within some NGO’s. b) Socio-cultural developments relevant to demand reduction Synthetic drugs were reported to be used by young people in discotheques during 2000. c) Developments in public opinion The public opinion is very disoriented in connection with the topic of drugs. The level of information in this field is very low, and in another opinion survey carried out during a TV show, more than 70% of the viewers called agreed with the punishment of drug users, considering them as common criminals. d) New research findings The survey “Drug use in Romania” – quantitative research made by the Public Opinion Survey Centre was done during 2000 at the request of the Ministry of Health. The conclusions of this survey were presented in §2.2.b) above. 33 ROMANIA - National Report on Drugs – 2000 e) Specific events during the reporting year - On June 26th the Romanian Parliament celebrated the World Day for Fighting against Drugs. - Study visit in Poland for Romanian Specialists in the field of Methadone Maintenance Programs organised by Open Society Foundation and Ministry of Health. f) Dissemination of information on demand reduction among professionals (networks, Internet, etc.) Within the DRSTP II Project of Group Pompidou, a team of Romanian specialists was organized, with the assistance of an European expert, to start developing the first Drug Addiction Treatment Guide in Romania.9. Intervention Areas a) Typologies of interventions with synthetic description of: - Objectives: - development of primary, secondary and tertiary prevention - analysis of epidemiological situation - correct evaluation of the number of drug addicts and their monitoring - the limiting of the number of drug addicts - the development of specific medical services according to those in the European Union - harmonization of the legislation with the respective one of the European Union. - Target groups: - the personnel carrying out education for health activities - all categories of specialists involved in the treatment of drug addiction - user persons and drug addicts - youths at risk of using drugs - Settings 34 ROMANIA - National Report on Drugs – 2000- the establishment of a network of educators and councillors in the field of drugs at national level; - the establishment in Bucharest of some complete addiction treatment circuits - Results - the National Education Programme in Schools - the establishment of a proper legislative framework for the development of treatment services for addicts; - the opening of two detoxification centres in Bucharest and Iasi - the development of the methadone maintenance Programme in Bucharest - the opening of the first psychosocial rehabilitation section in Balaceanca, near Bucharest - the initiation of the opening of a methadone maintenance Program and of a detoxification section in Constanţa - the equipping of these treatment units with the proper equipment for ambulatory investigations - the financing of the prevention and treatment structures from the funds of the Ministry of Health - the softening of the media and the public opinion regarding the existence of a drug problem in Romania.9.1. Primary prevention Description of news developments in prevention strategies (drug specific and/or drug-non-specific) 9.1.1. Infancy and Family a) First childhood interventions There were no programmes during 2000 to include interventions in the period of first childhood. b) Prevention within the family - Within the Phare Project “New Education Techniques for Drug Demand Reduction”, which was carried out in three pilot counties: Timiş, Dolj and Galaţi, although the purpose of the project was to make a situation analysis regarding the information needs of the population, one of the target groups taken into study is the one of the parents. Following to this study it resulted that they consider that the 35 ROMANIA - National Report on Drugs – 2000 phenomenon of drugs is a public health problem of the community they are member of. They also consider necessary their informing on drug issues and want to cooperate in view of carrying out information, education and communication programmes on the drug issue. - A guide approaching drug topics for parents was edited in 5000 copies.9.1.2. School programmes The Ministry of National Education created the necessary framework for the carrying out of certain educational preventive activities. The School Curricula The optional school curricula (at the choice of the school) have approached themes related to the prevention of drug abuse in the tutorial, school counselling, biology, chemistry, and civic education classes. During the tutorial and the school counselling classes, the tutoring teachers or the other teachers requested the assistance of medical doctors, medical nurses, psychologists, lawyers, representatives of the Ministry of Interior to present documented drug related topics (themes: ”The main categories of drugs and their effects”, “The causes that lead young people to use drugs”, etc.). Teaching materials The manual of the World Health Organization “Young people and drug use” was edited and printed in 17,000 copies which will cover all schools from the urban area. Training programmes for the users of this manual, most of them teachers, are being carried out in parallel. Besides the WHO manual, the main materials used for teaching are leaflets, posters and video cassettes supplied by the County Directorates for Public Health through the Health Promotion Services, the National Centre for Health Promotion and Programmes within the Institute for Health Services Management, County Police Inspectorates and NGO’s. Guidelines for school strategy - Post graduation training courses in health education were also addressed to teachers; - drafting of the themes of the education for health classes; 36 ROMANIA - National Report on Drugs – 2000- drafting of education for health manuals; - the keeping and the development of the partnerships with other governmental and nongovernmental bodies for the development of programmes and activities in this field. The training of the teachers Although there were no training courses at national level in an institutional framework, such activities were organized at local level (county) by the County School Inspectorates together with governmental and nongovernmental structures. There were conducted two training programmes for teachers covering the Muntenia and Moldova regions, in the use of the WHO manual. Briefing meetings were held with teachers and various specialists in the field (medical doctors, lawyers, psychologists, officers, etc.) Lectures with parents: Most schools have organized lectures with the parents, within which the teachers have approached a topics related to drugs abuse (the influence over health, addiction, social issues, legal issues). School partners The schools cooperated with: - County Public Health Departments, especially through the County Services for Health Promotion and Health Education Programmes (that supply educational materials, organize county seminaries on drug abuse), also involving the school medical facilities, hospitals, family planning offices. - The County Police Inspectorates that supply informational materials and organize workshops with pupils and teachers; - The County Departments for Youth and Sports; - The County Departments for Child Protection - Local TV and Radio stations - The Church - The Office for the Protection of the Consumer The school and implicitly the county school inspectorates have developed partnerships with various Nongovernmental organizations for various actions connected with the topics of discussion (obtaining of informational materials, organizing of workshops with pupils, training courses for teachers). Some of the involved NGOs are: 37 ROMANIA - National Report on Drugs – 2000- the “Red Cross” Society (in the counties Teleorman, Tulcea) - UNICEF (in the county of Arges) - Save the Children (in the counties of Arges, Mures) - Young people for young people (in the counties of Botosani, Maramures, Mehedinti, Mures, Sibiu) - GRADO (in the counties of Arges, Botosani) - The Trust (in the county of Bihor) - Catharsis (in the county of Brasov) - The Romanian Association for the Fight Against Drugs (in the county of Brasov) - The Romanian Association for Health Education (in the county of Cluj) - The Ecological Foundation “New Alliance” (in the county of Giurgiu) - The Society for Contraceptive and Sexual Education (SECS) ( in the counties of Mehedinti and Mures) - OASIS (in the county of Mures) - SOROS Foundation (in the county of Satu Mare) - The International Federation of Educational Communities – Romanian Section (in Bucharest and a number of counties) Partnership programmes carried out in the educational units A Protocol was concluded in November 2000 between the Ministry of Health and the Ministry of National Education regarding the including of the WHO manual in the education for health curricula. The Institute for Crime Research and Prevention within the General Inspectorate of Police initiated or was invited to participate in the development of drug abuse prevention programmes in educational institutions. With all efforts of the Ministry of Health that allocated money this year for these activities, unfortunately, the lack of funds, absolutely necessary to carry out some concerted prevention actions at national level, seriously affected the number of the programmes and their quality. Thus, there have been used the same materials as in the previous years and the expenses (trips, accommodation, transport, printing of materials, office materials, etc.) have been covered by partners. Unfortunately they, being either governmental or nongovernmental institutions or organizations, are less and less willing to bear the entire financial responsibilities of the programmes. 38 ROMANIA - National Report on Drugs – 2000The activities carried on were mainly interactive meetings with pupils, teachers, parents and NGOs for youth. The discussions wanted to emphasize the involvement of the pupils in the criminal phenomenon and the major risks of drug abuse. There were thus presented the general causes of drug abuse, different types of narcotic substances and their effects as well as ways to prevent the abuse. The main idea was to offer as correct and complete as possible information to the young people, in order to adopt a rejection attitude when they are confronted with the temptation of using such substances. Within the interactive meetings with target groups of pupils or with pupils, teachers and parents there was presented information regarding the danger of drug abuse, prevention means and recommendations for parents and teachers in the case they are confronted with drug abuse among children. These programmes targeted to stimulate the dialogue between the addressees and the specialists as well as to increase the awareness of the teachers on their role in drug abuse prevention.9.1.3. Youth programmes outside schools There were organized meetings between pupils, medical doctors, psychologists, lawyers, and representatives of the Ministry of Interior, during which informational materials were presented (leaflets, movies) and discussions related to drug abuse prevention were held. The school and its partners have organized seminaries, lectures, round tables (e.g. “The crafty sanitary workers”), exhibitions with thematic drawings, thematic campuses.9.1.4. Community programmes a) Drug-specific/drug non-specific b) Cities/rural area c) Cooperation structures d) Statistics and evaluation results Specific training Territorially there existed an attempt of inter-sector approach, through the participation or involvement of the local health promotion services in such activities, of the police units, of the factors from the educational system and of the local authorities. 39 ROMANIA - National Report on Drugs – 2000With the occasion of the International Day for Fighting Drugs 2000, the Ministry of Health initiated a national campaign through the national network for health promotion. The following types of actions were accomplished: - the production and distribution of the video – TV clips; - the production and distribution of the radio – audio clips - the production and lunching of singles in discotheques - TV and radio shows - interviews with the local TV and radio stations - press conferences - press releases - banners positioning - editing and distribution of leaflets, posters, brochures - multimedia CD making with drug related information - studies regarding the demand and abuse of drugs, public opinion on these matters - seminaries, discussions with students/pupils - antidrug courses - exhibitions with students’ works - exhibitions of sketches - radio contests - poster contests - epigrams contests - scientific publications - training of trainers courses - student theatre - T shirt printing - round table activities - workshops, games, open discussions with the public - video film presentation, video clips - documentation point in the NGO “The Youths for the Youths” 40 ROMANIA - National Report on Drugs – 2000- the work “Drugs and their bio-social impact on the youths” - county programme “Know and decide” - antidrug marches9.1.5. Telephone help lines There were three telephone lines type Help Line in Bucharest during 2000, but they were not specific for the issue of drugs. “ TOXAPEL” is a telephone emergency service created by the Toxicology Department of the Central Children Clinic Hospital “Grigore Alexandrescu” – Bucharest, destined to the information of the population on the way first aid must be provided to an intoxicated child until the arrival of the Ambulance or going to the hospital. “TOXAPEL” functions non-stop and covers the entire country; it can be called from home, from any public or mobile phone. The second Help Line type telephone service operates within the Laboratory for Mental Health, Sector 3, at the Crisis Centre for Teenagers and Youths. It functions only between 9 and 18 and offers counselling including on the issue of drugs to the persons willing to inform themselves, to abusers or to persons that have already been hospitalised for addiction. The Romanian Anti-Aids Association established a Help Line type telephone line in Bucharest, Constanţa and Iaşi on AIDS related issues, which also approaches drug abuse issues, as it is known that one of the risk behaviours frequently associated with drug abuse is unprotected sex. A specialist was trained within the Ministry of Health on the topics “help telephone lines in the field of drugs”, by the European Foundation of the Help Telephone Lines in the field of drugs. Following to this training it was possible to obtain the financing from the Foundation for an Open Society (former Soros) through a competent project proposal, for a first specialized help-line centre in the issue of drugs. This centre will be opened in Bucharest in 2001 as a pilot centre others following to be opened based on this experience.9.1.6. Mass media campaigns With the occasion of the International Day for Fighting Against Drugs, there were carried out media campaigns against drugs at national level. They were organized in the territory by the County Services for Health Promotion in cooperation with the local authorities, NGO’s. 41 ROMANIA - National Report on Drugs – 2000The campaign for fighting against drug abuse was carried out at national level, which was awarded first prize of the magazine “The Media and Image Projection Universe”, a magazine specialized in sending advertisement material. A Press Conference was organized at the Parliament Palace in cooperation with the European Integration Commission of the Parliament, when the importance of the approach with a special attention on the drug topics was highlighted and firm position was expressed against the adoption of some articles of the Law draft regarding the combat of illicit drugs trafficking and abuse. The messages comprised in the media campaigns have the role of growing the awareness of the population on the risks involved by drug abuse. At territorial level (county level), the cooperation with the local radio and TV stations as well as with the local media is good, in most of the cases the media offered free publicity and show space. In many occasions the media presented articles and shows on drugs. The media had in mind the phenomenon in its whole, its damaging effects over the lives of the youths and their families but also some events or manifestations occasioned by nationally or internationally dedicated days to information and prevention. The television and radio stations constantly organized shows on health issues, during which drug but mostly alcohol and tobacco abuse issues were referred to. Unfortunately, due to the lack of information on drugs of the newspapermen, in the last part of the year, a denigration and minimization campaign of the actions of the Ministry of Health was conducted. This campaign targeted both the prevention activities as well as the treatment ones, and originated in the lack of knowledge of both the efficient educational ways of prevention and of the complete and proper therapeutic approaches of drug addicts as well as the lack of knowledge regarding the concrete actions carried out by the Ministry of Health in this field.9.1.7 Internet ) Use of Internet for: - prevention (type of intervention, target, other relevant characteristics) - dissemination of prevention know-how among professional b) Statistics and evaluation results There were no Internet services in the field of drugs during 2000. 42 ROMANIA - National Report on Drugs – 20009.2. Reduction of drug related harm See 9.2.2. below. 9.2.1. Outreach work There was no outreach work in the field of drugs during 2000.9.2.2. Low threshold services As a reaction to the HIV epidemic, syringe and needle exchange programmes have been established, with funding through the Open Society Foundation. HIV testing was offered in various places, professional competence and funding being available, but the offer was rarely used.9.2.3. Prevention of infectious diseases Legislation - The Order of the minister of health no 415/2000 regarding the organizing and the financing of the national health programmes; - The National Programme for the Monitoring and Control of the Infectious Diseases including the prevention of hepatitis - The National Programme for the Monitoring and Control of the Tuberculosis - The National Programme for the Monitoring and Control of HIV/AIDS infection Organization and strategies: The Ministry of Health, through: - The General Directorate for Public Health - The General Directorate for Medical Assistance The National House of Medical Insurances Within the strategies of approaching the infectious diseases associated to drug abuse, the following are targeted: - the promotion of a healthy reproductive style (for the prevention of HIV and Hepatitis B) and of a healthy life style in which an important role plays the education for health, includes information-education- communication activities for the population; - the epidemiological survey which includes monitoring of the existing cases and the identification of new ones - in the case of HIV infection, the avoiding of parent transmission of the infection 43 ROMANIA - National Report on Drugs – 2000The identification of the new cases of TBC is done by running IDR tests or X rays in the following cases: - at employment - for students and drafted soldiers (free of charge) - for the release of the prenuptial certificate (before marriage) - the periodic check up of the personnel which fulfils certain services in the food production and distribution units; - the periodic check up of the personnel working in environments involving young children (nurseries, kindergartens, homes) or in schools - the periodic check up of the personnel working in TBC units (hospitals, sanatoriums) free of charge; - at request - with the occasion of any medical investigation which raises the suspicion of TBC (free of charge) The identification of new cases of HIV infection is done by doing tests in the following cases, according to the Order of the minister of health no 889/1998: - at request - within the population groups at risk - to the medical personnel (free of charge) - to the people who spend a longer then 6 months period of time abroad - to sailors - to long drive drivers - to pregnant women once with the registering of their condition (free of charge) - to sexual minorities (homosexuals, prostitutes) - to the people brought to homes, at the time of their entry (free of charge) - to the blood donors (free of charge)Education for health These activities are carried out planned within the National Education Programme for Health, of the National Programme of Monitoring and Control of Infectious Diseases (which includes the prevention of hepatitis), of the National Programme for Monitoring and Control of Tuberculosis and of the National Programme for Monitoring and Control of HIV/AIDS Infection. They are financed mostly from the state budget and by some of the NGO’s in the field. It is done through: - information-education-communication campaigns - the printing and distribution of counselling guides regarding the prevention of HIV infection - the setting up of counselling centres on the HIV/AIDS topics 44 ROMANIA - National Report on Drugs – 2000- the printing and distribution of informative materials: leaflets, brochures, posters, etc. The school curricula comprised health education classes in which special topics regarding the prevention of infectious diseases were included. Also the Foundation “Save the Children” participate next to the UNICEF representative office in Romania to the organizing of the seminar for the training of the school councillors, a seminar on the theme: “Knowledge and aptitudes regarding the HIV/AIDS infection, sexually transmitted diseases and the use of drugs”The supply of equipment Unique use needles and syringes are used in hospitals and all medical units and disinfectant materials are provided for any therapeutic acts involving injecting. Also, unique use syringes can be purchased freely from pharmacies, without medical prescription, their cost being relatively small.Actors The institutions involved in the carrying out of the infectious diseases prevention activities are: - - the Ministry of Health through: - the General Directorate for Public Health with its 2 directorates: - the Directorate for Health Promotion and Community Health; - the Directorate for Preventive Medicine - The Institute of Health Services Management and the National Center for the Promotion of Health and Programmes; At national level action is taken through three programmes: - The National Programme for the Surveillance and Control of Infectious Diseases – PN1; - Coordination institutions: - The Preventive Medical Science Department from the Ministry of Health; - The Institute for Infectious Diseases “Matei Bals” - The Public Health Institute, Bucharest - Institutions with responsibilities in carrying out the programme: - The Bucharest and County Directorates for Public Health; - The Public Health Institutes and the Public Health Centres; - The National Programme for the Surveillance and Control of the TBC: 45 ROMANIA - National Report on Drugs – 2000- Coordination institutions: - The Department for Preventive Medical Science from the Ministry of Health - The Pneumoftiziology Institute “Prof. Dr. Marius Nasta” - The Institute of Health Services Management through the National Center for Health Promotion and Programmes; - Institutions with responsibilities in carrying out the programme: - The Pneumoftiziology Institute “Prof. Dr. Marius Nasta” - The pneumoftiziology network (TBC hospitals, TBC clinics, TBC sanatoriums) - The Bucharest and County Directorates for Public Health - The National Programme for Surveillance and control of HIV/AIDS infection - Coordinating institutions: - The General Department for Public Health from the Minister of Health - Institutions responsible in accomplishing the programme: - The Institute for Health Services Management trough the National Centre for the Promotion of Health Programmes - The Bucharest and County Directorates for Public Health.Statistics In Romania there is no obligation for the persons addicted to injecting drugs to be tested for HIV/AIDS. Therefore, their discovery is by chance. From the medical data existing so far, only 2 persons addicted to injecting drugs were recorded HIV positive.Training There is no special training module for the prevention of the drug related infectious diseases both at the level of the university training of the medical doctors, as well as at the level of medium training for medical nurses. School counsellors started to be trained since 1999 (psycho pedagogic counselling) through the training system master in psycho pedagogic counselling. Basically they are psychologists, psycho pedagogy specialists or social workers. Within 46 ROMANIA - National Report on Drugs – 2000 the psycho pedagogic counselling master training specific themes for the prevention of the drug related infectious diseases are discussed.9.3. Treatment Description of new developments in treatment strategies9.3.1. Treatments and health care at National level a) Services offered and their characteristics (typology, staffing, monitoring and other relevant aspects) Establishment and setting up of treatment and post cure centres Detoxification centres for drug addicts existed during 2000 in Iasi and Bucharest (treatment of physical addiction), while at the level of the other counties the treatment was covered within the psychiatric sections. A post cure and psychosocial rehabilitation centre started working last year in Bălăceanca. There is no therapeutic community created yet. The emergency treatment of overdoses was conducted at the level of the intensive care sections of the hospitals. Both the detoxification centres and the post cure ones are centrally coordinated by the Ministry of Health through the two departments: the Directorate for Health and Community Health Promotion and the General Directorate for Medical Care. The National and the County Houses for Health Insurances covered the payment of the treatment services. Both the detoxification and the post cure centres will become efficient when there will be a sufficient number of specialized persons in the treatment of drug addictions. Currently their number is very small. Therapeutic notes 1. The treatment of drug addicts is mainly a biologic approach, as: - there was not sufficient specialized personnel in the treatment of addictions, nor with university training (psychiatrists, psychologists, social workers), nor with average training (medical nurses); there was also a lack of certain needed specialities in the therapeutic team (occupational therapist). - although the Order of the minister of health 973/1998 includes specific psychotherapeutic practices within the methadone therapeutic programme 47 ROMANIA - National Report on Drugs – 2000– occupational therapy and recovery treatment (physiotherapy, medical gymnastics, etc.), this provision could not be obeyed (counselling in the same time with substitution therapy), because there is no specialized personnel in Romania at this time in psycho-social specialized treatment of the drug addicts. Usually the treatment was done by a therapeutic team formed of just a psychiatrist and a medical nurse, lacking other categories of specialists, which should have been part of this team: psychologists, social workers, occupational therapists, due to the lack of such specialized personnel. The methadone substitution treatment was done with tablets of methadone. Offered services The following services are offered within the units in which drug addicts are being hospitalised (detoxification centres, psychiatric sections, intensive therapy sections, emergency rooms, post cure centres): - biological treatment (with medicines) for the detoxification cure - medical assistance (medical monitoring and general physical monitoring) - hospitalisation: 3 meals and hotel type services. Duration The average duration for the detoxification stage is 14 days, and it can vary depending on the physical state of the person, the type of drug used, the daily used quantity, the administration method, drug abuse duration. For the post cure stage, psychosocial rehabilitation, the average duration is of 6 months, but it can vary. In this moment we do not possess enough expertise to allow us to assess which is the average post cure duration in our country (the only post cure centre was inaugurated in November 1999). Personnel The therapeutic team was formed in 2000 of only one psychiatrist doctor and a medical nurse, with the aim to form the personnel specialized in drug addiction in 2001, including all categories of personnel that form a therapeutic team specific to any treatment stage. b) Objectives: drug-free treatment, not drug free treatments The detoxification treatment and the setting up of the substitution treatment are done in the following conditions, provided for in Law 143/2000: 48 ROMANIA - National Report on Drugs – 2000- out of free will; - in emergency given by withdrawal from lack of psychoactive substance of used drugs; - compulsory hospitalisation ordered by a medical commission or by a prosecutor’s ordinance or by court ruling. c) Criteria of admission All persons requesting such services are admitted within the limit of the available places. d) Involvement of public health services and GPs The treatment of addicts is done only in public services. e) Co-ordination between public health services and other community drug services “ NO INFORMATION AVAILABLE” f) Special services “ NO INFORMATION AVAILABLE” g) Financing The National and the County Houses for Health Insurances fund all medical services connected to treatment, from their own budget. Specific treatment with methadone is financed from the budget of the Ministry of Health. h) Statistics and evaluation results Statistics The statistics are based on the records of the persons that requested medical services (treatment).Drug addicts on age and gender groups 49 ROMANIA - National Report on Drugs – 2000Drug No of cases Male Female New Relapses New Relapses Total cases cases 0-14 7 1 - 1 9 15 - 19 142 57 28 3 230 20 – 24 256 167 41 22 486 25 – 29 102 67 17 10 196 30 – 34 34 20 6 6 66 35 – 39 12 9 3 3 27 40 – 44 6 7 3 4 20 45 – 49 3 3 2 8 16 50 – 54 2 3 2 3 10 55 – 59 2 1 1 2 6 60 – 64 2 2 1 1 6 75 - 79 1 - - 2 3 Total 569 337 104 65 1075Drug addicts depending on the used drug A. Age group 0-14 yearsDrug No of cases Male Female New Relapses New Relapses Total cases cases Heroine - - - - - Tetrahydrocannabinol - - - - - Hashish - - - - - Marijuana 1 - - - 1 Acetamynophen - - - - - Cocaine - - - - - Codeine - - - - - Morphine - - - - - Opium - - - - - Pentazocine - - - - - 50 ROMANIA - National Report on Drugs – 2000Alprazolam - - - - - Diazepam - - - - - Trihexiphenidyl - - - - - Regenon - - - - - Solvents 5 1 - - 6 Alcohol 1 - - 1 2 Total 7 1 - 1 9B. Age group 15-19 yearsDrug No of cases Male Female New Relapses New Relapses Total cases cases Heroine 115 49 22 3 189 Tetrahydrocannabinol - - - - - Hashish - - - - - Marijuana 2 1 1 - 4 Acetamynophen - - - - - Cocaine 1 - - - 1 Codeine - - - - - Morphine - - - - - Opium - - - - - Pentazocine 6 - - - 6 Alprazolam - - - - - Diazepam - - 1 - 1 Trihexiphenidyl 2 - 1 - 2 Regenon - - - - - Solvents 15 4 2 - 21 Alcohol 1 3 1 - 6 Total 142 57 28 3 230C. Age group 20-24 yearsDrug No of cases 51 ROMANIA - National Report on Drugs – 2000Male Female New Relapses New Relapses Total cases cases Heroine 243 161 37 21 462 Tetrahydrocannabinol - - - - - Hashish - - 1 - 1 Marijuana 4 - 1 - 5 Acetamynophen - - - - - Cocaine - - - - - Codeine 1 - - - 1 Morphine - - - - - Opium 1 1 - - 2 Pentazocine 5 3 1 1 10 Alprazolam - - - - - Diazepam - 2 1 - 3 Trihexiphenidyl - - - - - Regenon 1 - - - 1 Solvents 1 - - - 1 Alcohol - - - - - Total 256 167 41 22 486D. Age group 25-29 yearsDrug No of cases Male Female New Relapses New Relapses Total cases cases Heroine 98 65 14 6 183 Tetrahydrocannabinol - - - - - Hashish - - - 1 1 Marijuana 1 - - - 1 Acetamynophen - - - - - Cocaine 1 - - - 1 Codeine - - - - - Morphine - - - - - Opium - - - - - 52 ROMANIA - National Report on Drugs – 2000Pentazocine 1 - 2 3 6 Alprazolam - - - - - Diazepam - - 1 - 1 Trihexiphenidyl - 1 - - 1 Regenon - - - - - Solvents 1 1 - - 2 Alcohol - - - - - Total 102 67 17 10 196E. Age group 30-34 yearsDrug No of cases Male Female New Relapses New Relapses Total cases cases Heroine 32 17 5 6 60 Tetrahydrocannabinol - - - - - Hashish 1 - - - 1 Marijuana - - - - - Acetamynophen - - - - - Cocaine - - - - - Codeine - - - - - Morphine - - - - - Opium - - - - - Pentazocine - 2 - - 2 Alprazolam - - - - - Diazepam 1 - - - 1 Meprobamate - 1 1 - 2 Trihexiphenidyl - - - - - Regenon - - - - - Solvents - - - - - Alcohol - - - - - Total 34 20 6 6 66F. Age group 35-39 years 53 ROMANIA - National Report on Drugs – 2000Drug No of cases Male Female New Relapses New Relapses Total cases cases Heroine 9 2 1 1 13 Tetrahydrocannabinol - - - - - Hashish - - - - - Marijuana - - - - - Acetamynophen - - - - - Cocaine - - - - - Codeine - - - - - Morphine 1 - - - 1 Opium - - - - - Pentazocine 2 2 - - 4 Cyclobarbital - 2 1 - 3 Diazepam - 1 1 2 4 Meprobamate - - - - - Trihexiphenidyl - 1 - - 1 Amitriptilina - 1 - - 1 Solvents - - - - - Alcohol - - - - - Total 12 9 3 3 27G. Age group 40-44 yearsDrug No of cases Male Female New Relapses New Relapses Total cases cases Heroine 2 - - - 2 Tetrahydrocannabinol 1 - - - 1 Hashish - - - - - Marijuana - - - - - Acetamynophen - - - - - Codamine - 2 - - 2 Cocaine - - - - - Codeina - - - - - 54 ROMANIA - National Report on Drugs – 2000Morphine - - - - - Opium - - - - - Pentazocine 2 - - 1 3 Cyclobarbital - - - - - Diazepam - 2 1 - 3 Meprobamate - 1 - 1 2 Trihexiphenidyl - 1 - - 1 Amitriptilina - - - - - Other medical drugs 1 1 2 2 6 Solvents - - - - - Alcohol - - - - - Total 6 7 3 4 20H. Age group over 45 yearsDrug No of cases Male Female New Relapses New Relapses Total cases cases Heroine 1 - - - 1 Tetrahydrocannabinol - - - - - Hashish - - - - - Marijuana - - - - - Acetamynophen - - - - - Codamine - - - - - Cocaine - - - - - Codeine - - - - - Morphine - - - - - Opium 1 - - - 1 Pentazocine 3 1 1 3 8 Cyclobarbital - - - 1 1 Diazepam 3 4 2 5 14 Meprobamate - 3 3 2 8 Trihexiphenidyl - - - - - Amitriptilina - - - - - Other medical drugs 2 1 - 5 8 Solvents - - - - - 55 ROMANIA - National Report on Drugs – 2000Alcohol - - - - - Total 10 9 6 15 41Drug addicts on type of drug and genderDrug No of cases Male Female New Relapses New Relapses Total cases cases Heroine 500 294 79 37 910 Tetrahydrocannabinol 1 - - - 1 Hashish 1 - 1 1 3 Marijuana 8 1 2 - 11 Acetamynophen 1 - - - 1 Codamine - 1 - - 1 Cocainae 2 - - - 2 Codeine 1 - - - 1 Morphine 1 - 1 1 3 Opium 2 - - - 2 Pentazocine 19 7 6 8 40 Cyclobarbital - 3 - 1 4 Diazepam 4 8 6 5 23 Meprobamate - 5 3 - 8 Trihexiphenidyl 2 2 1 5 10 Amitriptilina - - - - - Other medical drugs 3 10 2 3 16 Solvents 23 6 2 1 32 Alcohol 1 - 1 1 3 Total 569 337 104 65 1075Type of treatment usedDrug 1 2 3 4 5 6 7 8 Heroine 723 137 10 14 5 2 16 3 Tetrahydrocann 1 ------56 ROMANIA - National Report on Drugs – 2000 abinol Hashish 3 ------Marijuana 6 - 3 - - - - - Acetamynophen 1 ------Codamin 1 ------Cocaina 1 ------Codeina 2 ------Morphine 2 ------Opium 3 ------Pentazocine 29 - 3 1 - 3 1 3 Cyclobarbital 4 ------Diazepam 12 - 7 1 - - 1 2 Meprobamate 11 - 1 - - - - 1 Trihexiphenidyl 3 - - 1 - - - 1 Amitriptilina 1 ------Other medical 13 1 2 2 - - - 3 drugs Solvents 10 - - 1 - - 1 19 Alcohol 1 3 ------Total 827 141 26 20 5 5 19 32Legend: 1. Detoxification cure 2. Substitution treatment 3. Psycho-social rehabilitation 4. Counselling 5. Transfer to other centres 6. No treatment 7. Other 8. Unspecified To these data can be added 208 cases of patients hospitalised in the Emergency Hospital Floreasca, which were never reported to the Statistics Centre of the Ministry of Health, nor were they classified according to the standard classification. The clients of the Emergency Hospital Floreasca in the year 2000 57 ROMANIA - National Report on Drugs – 2000Drug No of casesMale Female Total Opiates 141 41 182 Withdrawal 25 1 26 sindrome Total 166 42 208 i) Specific training Training The treatment of the drug addicts was done accordingly to the knowledge included in the training curricula of the psychiatric doctors, containing general information regarding this chapter, targeting only the biological approach. The knowledge regarding the treatment of drug addicts of other categories of personnel with university training that should be a part of the therapeutic team – psychologists, social workers – are included only under the form of optional modules and contain general notions. According to the Order of the minister of health no 916/1999, regarding the approval of the medical and pharmaceutical specialities, overspecialisations and competencies for the medical care network, the overspecialisation in drug addiction treatment, destined to psychiatric doctors, was included. The training of the personnel is done simultaneously with the organization of the specific treatment centres. Training activities for the forming of the specialists in the treatment of drug addiction - Romania was invited to participate as member in the Managerial Committee for Training the Trainers in the field of Drug Demand Reduction – part II (Drug Reduction Staff Training Project DRSTP II), programme conducted with the assistance of the Pompidou Group attached to the Council of Europe. The unfolding of a project for the issuing of a treatment guide for drug addictions started in cooperation with experts of the European Union, and with the support of the Pompidou Group; - Within the European integration policy the Health Ministry participates starting from 2000 in the conducting of the communitarian programmes in 58 ROMANIA - National Report on Drugs – 2000 the field of public health, according to the Additional Protocol to the Accession Agreement of Romania to the European Community, of the Parliament and Council of Europe decisions no 645/96/EC, 646/96/EC and 102/97/EC. One of the themes of these programmes is the one regarding the Prevention of Drug Use. Within this theme was approved the project destined to the training of the Romanian specialists: “Training Programme for the Romanian specialists in the field of drug addiction post cure drug addictions”. j) Other national specifications Assessment and results Due to the lack of all therapeutic rings as well as to the specialized personnel, and to the lack of a unanimously nationally accepted treatment guide, one cannot say that until 2000 drug addicts could have benefited of a complete and proper treatment. The results of the treatment given were not satisfactory as a great number of relapses was recorded and in the same time therapeutic mistakes were made.9.3.2. Substitution and maintenance programmes a) Organisation and delivery of substitution drugs: The Government Decision regarding the approval of the regulation of the Law 143/2000 provides in Chapter V, section 3 article 25 the way to organise and carry out the ambulatory substitution programmes. The only substitution drug used in Romania is methadone, in the form of tablets, traded under the name of SINTALGON (it was an attempt to import liquid methadone from U.K, but with no success.). According to the domestic and international legislation, methadone is part of the narcotic substances category. Law no 73/1969 regarding the regime of the narcotic products and substances, through the instructions of the minister of health no 103/1970, regulate the legal circuit of methadone. The storing of the product in the pharmacies is done in the specific cabinets for narcotics, sealed (labelled VENENA) 59 ROMANIA - National Report on Drugs – 2000 b) Criteria of admission Admission criteria The admission in the ambulatory substitution programme is done based on the following criteria: 1) positive diagnosis of addiction of psychoactive substances syndrome according to ICD 10 (mental and behavioural disorders due to the use of psychoactive substances F10-19) 2) over 18 years of age; people under 18 years of age who fulfil the criteria may be included in the programme with the approval of the parents or legal representative; 3) biologic evidence of addiction (positive exam of urine) 4) minimum 2 years of addiction, medically proven 5) 3 non-substitution detoxification failed attempts 6) addiction associated diseases (HIV/AIDS infection, TBC, cardiac insufficiency, B and C hepatitis, major psychic illnesses); 7) pregnant opium addicted women; 8) addiction of multiple drugs 9) drug addicts that have minors in keeping The person in charge of the programme may give a certain interpretation to these criteria and will elaborate the final decision to admit or exclude the addict in the programme. c) Mode of prescription The prescribing of the product is done on basis of a specially stamped form, in 3 copies, on basis of the authorization issued to the respective patient by the County Directorate for Public Health and of Bucharest. The hospital pharmacy releases the product on basis of a special record book for narcotics signed by the chief of section. The release of the product from the public pharmacy is done keeping a copy of the specially stamped form on basis of the authorization for narcotic possession. The patient or the belonging of such have the duty to return the left over tablets after the completion of the treatment or its exchange to the releasing pharmacy, on basis of a statement 60 ROMANIA - National Report on Drugs – 2000 d) Objective (gradual detoxification, maintenance) The substitution treatment is done to reduce the consequences associated to drug abuse. e) Substitution drug/s, mode of application During 2000 the substitution treatment was done using methadone tablets, SINTALGON. But just for three months liquid methadone was used in the Obregia Hospital in Bucharest. Other medical drugs used in the detoxification treatment were: clonidine, classical and atypical neuroleptics, tranquillisers, carbamazepine. f) Psycho-social counselling (requirements and practice) The Government decision regarding the approval of the regulation for the enforcement of the Law 143/2000 provides in Chapter V, Section III, Article 25, the organization and carrying out of ambulatory substitution programmes. Three psychosocial counselling centres functioned in Bucharest during 2000: “The Crisis Centre for Children and Teenagers” from within the Mental Health Laboratory of Bucharest Sector 3, the Counselling Centre for Teenagers and Youths, belonging to the “Save the Children” organization and the Counselling Centre organized by the Ministry of Youth and Sport in the Polivalent Hall. g) Drug testing The beginning of the methadone treatment is done after the detection of the psychoactive substance or the narcotics used by the addict, and is continued under periodic checking through specific identification methods (according to the provisions of the Government Decision regarding the enforcement of the Law 143/2000). This provision is respected only at the level of the detoxification centre of Bucharest and of the post cure centre from Bălăceanca Hospital, as well as at the level of the toxicology section of the Floreasca Emergency Hospital from Bucharest and the Toxicology Department of the Central Children’s Clinical Hospital “Grigore Alexandrescu” – Bucharest. These centres are equipped with drug testing analysers and their metabolites in blood and urine. Such equipment is missing at the level of the psychiatric sections and of the intensive therapy sections from the entire country, where drug addicts and overdoses emergencies are hospitalised, but the above provision is not respected. 61 ROMANIA - National Report on Drugs – 2000 h) Diversion of substitution drugs In order to prevent the diversion of methadone tablets from the detoxification centres, liquid methadone was used only for three months because of lack of finance. No quantitative data available. i) Statistics (measure point) Type of treatment usedDrug 1 2 3 4 5 6 7 8 Heroine 723 137 10 14 5 2 16 3 Tetrahydrocann 1 ------abinol Hashish 3 ------Marijuana 6 - 3 - - - - - Acetamynophen 1 ------Codamin 1 ------Cocaina 1 ------Codeina 2 ------Morphine 2 ------Opium 3 ------Pentazocine 29 - 3 1 - 3 1 3 Cyclobarbital 4 ------Diazepam 12 - 7 1 - - 1 2 Meprobamate 11 - 1 - - - - 1 Trihexiphenidyl 3 - - 1 - - - 1 Amitriptilina 1 ------Other medical 13 1 2 2 - - - 3 drugs Solvents 10 - - 1 - - 1 19 Alcohol 1 3 ------Total 827 141 26 20 5 5 19 32Legend: 9. Detoxification cure 10.Substitution treatment 11.Psycho-social rehabilitation 62 ROMANIA - National Report on Drugs – 200012.Counselling 13.Transfer to other centres 14.No treatment 15.Other 16.Unspecified k) Specific research results NO DATA AVAILABLE l) Evaluation results Due to the lack of all therapeutic rings as well as to the specialized personnel, a proper and complete treatment could not have been offered to all drug addicts. The results of the treatment given were not satisfactory as a great number of relapses was recorded and in the same time therapeutic mistakes were made The extended methadone treatment was done randomly, according to the expertise and own criteria of some psychiatrists, as there is no unanimously accepted treatment guide and a proper programme for this therapy in Romania.9.4. After-care and re-integration a) Organisation Drug-free residential rehabilitation is offered in specialised rehabilitation centre in Balaceanca Psychiatric Hospital, 30 km far from Bucharest Others are in preparation for Timisoara, Cluj and Iasi. The center Balaceanca was recently completely renovated and has 25 beds in a closed ward. Other 4 post cure centres are in the course of being set up in Timişoara, Cluj, Iaşi and Constanta. No therapeutic community was set up yet. For the post cure stage, psychosocial rehabilitation, the average duration is of 6 months, but it can vary. We do not have enough experience at the time being to allow us to estimate the average duration of the post cure in our country (the only post cure centre was opened only in December 2000). b) Accessibility for different target groups (after treatment, after prison, for long-term substitution clients) 63 ROMANIA - National Report on Drugs – 2000Admissions are voluntary. As a rule, patients are high school students and have problems with heroin, other narcotics or benzodiazepines. Aggressiveness and a strong desire to go home are frequent, especially after admission, while the patient’s families urge staff to keep the patients. c) Education and training Many of the personnel have no training regarding substance dependence and seem to prefer some other job. d) Employment The personnel have a low opinion of patient’s motivation to change, while little efforts are made to activate the patients. e) Housing Their daily activities are monotonous; they watch television and can engage in some physical exercise f) Other national specifications “ NO INFORMATION AVAILABLE” g) Statistics and evaluation results “ NO INFORMATION AVAILABLE” h) Specific training 9.4.1 Education and training NO SPECIFIC TRAINING9.4.2 Employment NO SPECIFIC TRAINING9.4.3 Housing NO SPECIFIC TRAINING 64 ROMANIA - National Report on Drugs – 20009.5 Interventions in the Criminal Justice System a) Interventions: - medical (detoxification, drug substitution) In the Romanian prisons there was no methadone substitution treatment used. - drug-free programmes No such programmes were carried out in the Romanian Penitentiary system. - self-help groups No such programmes were carried out in the Romanian Penitentiary system. - relapse prevention The general medical treatment system in prisons did not include the treatment of relapses. No preventive system (including its links) functions in prisons. - HIV/Hepatitis prevention (needles and syringe exchange) Any medical treatment involving injecting in the penitentiary hospital is done by employing unique use syringes. b) Drug testing The prisons do not have yet drug analysers to find out the drug metabolites in the blood of certain convicts assumed to have used drugs. c) Release: referral to treatment, aftercare, probation The release of the persons that have been imprisoned for illicit drug possession is done according to the general procedures for the serving of a sentence, without specific regulations for this type of criminals. d) Statistics and evaluation results No such specific statistics were conducted during the analysed period. e) Specific training No training system of the people dealing with the addicts in prisons was set up.9.6 Specific targets and settings a) Description of new trends and developments b) Specific services and intervention (prevention, treatment, programmes, etc.) c) Statistics and evaluation results 65 ROMANIA - National Report on Drugs – 2000 d) Specific training For the following targets: - Gender-specific issues (prostitution, pregnancy/mother, programmes for men, …) No such programmes were developed in 2000- Children of drug users No such programmes were developed in 2000- Parents of drug users (involvement in treatment, self-help groups, …) - The Association of Parents with Drug Addicted Children was established in the second half of the year 2000; on basis of some legislation gaps regarding the therapeutic approach of drug addicts, the association incited the Romanian media against Ministry of Health. After a number of negotiation sessions an agreement was reached between this organization and the ministry, which set the basis for the signing of an official cooperation protocol between the two parties. - Drug use at the workplace (policy, rehabilitation, …) No such programmes were developed in 2000- Ethnic minorities (population from former colonies, refugees, work migrants, indigenous ethnic minorities, …) No such programmes were developed in 2000- Self-help groups (groups at risk, experimenting groups, …) There are no outreach services, no low threshold services, no Therapeutic Communities, no involvement of family doctors, no self-help groups. Aftercare is not developed. No therapeutic approaches for drug dependents are available within the penitentiary system, nor are there provisions for a referral to drug services.Alternatives to prison and prosecution (admission criteria, …) If proof is provided that the person caught with drugs is an abuser of drugs and the quantity found on him is small and he claims it is for his personal use, he is given the alternative to undertake treatment versus prison although this possibility is not mentioned by the low. 66 ROMANIA - National Report on Drugs – 200010. Quality Assurance Description of new trends and developments “ NO INFORMATION AVAILABLE”10.1 Quality assurance procedures “ NO INFORMATION AVAILABLE”10.2 Evaluation “ NO INFORMATION AVAILABLE”10.3 Research a) Demand reduction research projects: objectives, structure and organisation The survey “Drug use in Romania – Quantitative Research carried out by the Survey Centre of the Public Opinion” was carried out in 2000 at the request of the Minister of Health – December 2000. This survey had as objectives: - the determining of the magnitude of the drug phenomenon at national level - the identification of the perception of the general population on the drug issue - the identification of the needs of information and education of the general population in respect to drug use. b) Relations between research and drug services “ NO INFORMATION AVAILABLE” c) Funding of demand reduction research Study funded by Ministry of Health. d) Training in demand reduction research “ NO INFORMATION AVAILABLE” 67 ROMANIA - National Report on Drugs – 200010.4 Training for professionals a) Training in quality assurance and evaluation: type and structures “ NO INFORMATION AVAILABLE” b) University training, non-university vocational training, in-service training The treatment of drug addicts is done according to the knowledge included in the training curricula of the psychiatrists, which contains general information regarding this chapter, focused on the biologic approach. Also, in the other categories of personnel with university training, which should be part of the therapeutic team – psychologists, social workers – the knowledge regarding the treatment of drug addicts is included only as optional modules and contain generalities. According the Order of the minister of health no 916/1999, regarding the approval of the medical and pharmaceutical specialities and competencies for the network of medical nurses, was also included the overspecialisation in the treatment of addictions, destined to the psychiatrist doctors. The personnel training activities are carried out simultaneously with the organization of the specific treatment centres. Romania was invited to participate as member of the Managerial Committee of the Drug Reduction Staff Training Project – part II, programme carried out with the support of the Pompidou Group attached to the Council of Europe. In cooperation with experts of the European Union, and with the support of the Pompidou Group a project for the drafting of the guide for drug addiction treatment was initiated. Starting with the year 2000, the Ministry of Health participates in the carrying out of community programmes in the field of public health within the framework of the European integration policy, according to the Additional Protocol to the Accession Agreement of Romania to the European Community, of the Parliament and Council of Europe decisions no 645/96/EC, 646/96/EC and 102/97/EC. One of the themes of these programmes is the one regarding the Prevention of Drug Use. Within this theme was approved the project destined to the training of the Romanian specialists: “Training Programme for the Romanian specialists in the field of drug addiction post cure drug addictions”. c) Statistics and evaluation results “ NO INFORMATION AVAILABLE”

ROMANIA - National Report on Drugs 2000

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