Phare Project on Drug Information Systems Bridging Phase National Report on the drugs situation in Albania 2000 © European Commission 2000 This report has been prepared within the framework of a Project undertaken by eesv MSDP. The findings, conclusions and interpretations expressed in this document are those of eesv MSDP alone and should in no way be taken to reflect the policies or opinions of the European Commission Phare Project on Drug Information Systems Bridging Phase National Report on the drugs situation in Albania 2000 eesv MSDP WG Plein 65, NL - 1054 RB Amsterdam, The Netherlands Tel: +31.20.685.50.82, Fax: +31.20.612.57.91 ALBANIA : NATIONAL REPORT 2000 (THE STATE OF THE DRUGS PROBLEMS OVER THE PERIOD 1995-1999) Tirana, April 2000 ______________________________________________________________________________ Prepared by Eduard Z. Kakarriqi Institute of Public Health, Tirana Zihni Sulaj Toxicological Clinic of University Hospital Center, Tirana National Report 2000 Albania Table of Contents 1. COUNTRY’S BACKGROUND 2 1.1. RECENT POLITICAL, SOCIAL AND ECONOMICAL BACKGROUND. 2 1.2. DEMOGRAPHIC CHARACTERISTICS : FACTS AND TRENDS . 2 1.3. HISTORY OF DRUGS PROBLEMS AND SOCIAL-ECONOMIC AND CULTURAL FEATURES RELATED TO DRUG PHENOMENON. 4 2. TRENDS AND NEW DEVELOPMENTS IN DRUG USE/MISUSE AND RESPONSES 5 2.1. FIRST TREATMENT DEMAND DATA. 5 2.2. DRUG RELATED DEATHS . 12 2.3. INFECTIOUS DISEASES RELATED TO IVDU. 12 2.4. NON-FATAL EMERGENCIES . 13 2.5. NEW DRUGS IN 1995-1998 VERSUS OLD DRUGS AT THE BEGINNING OF THE 1990S. 13 2.6. DEVELOPMENTS OF THE USE OF INDIVIDUAL DRUGS IN THE 1990S. 13 2.7. DRUG LEGISLATION AND POLICY 13 3. PATTERNS AND PREVALENCE OF DRUG USE AND RELATED PROBLEMS. 15 3.1. PATTERNS AND PREVALENCE RATES AMONG THE GENERAL POPULATION. 15 3.2. PREVALENCE RATES FROM SCHOOL SURVEYS . 15 3.3. LAW ENFORCEMENT INDICATORS . 16 4. SUBSTITUTION TREATMENT 18 5. CONCLUSION 18 Phare Project on Drug Information Systems 1 National Report 2000 Albania This national report 2000 as the first EMCDDA annual report of Albania (not taking into account that preliminary one sent to Phare eesv MSDP in December 1999) aims at representing the state of the drugs problems in Albania not only for the years 1998-1999 but for all the period from 1995 to 1999 (the year 1995 being the beginning of data collection regarding to drug problem). Which are trends and new developments in drug use and responses? Which are patterns and prevalence of drug use and related problems? What’s about treatment? What’s about law enforcement aspects? What’s about locally produced opiates and other “local” substances? Answering such questions would require giving first of all a summary picture of Albania’s profile, highlighting thus its main specific historical, political, economical, demographic, and social-economic features. 1. COUNTRY’S BACKGROUND 1.1. RECENT POLITICAL, SOCIAL AND ECONOMICAL BACKGROUND. Since the victory of democracy in 1992 Albania experienced rapid and in-depth political, social and economic changes. A total opening of the country and a free movement of ideas and people contrasted with the extreme international isolation under up-to-then communist dictatorship; the free market economy substituted the former centrally planned one. Though such changes Albania still remains the poorest country of Europe, (the human development indicator of an actual value of 0.656 places Albania 105th among 175 countries). Furthermore, the political and social situation remains fragile what does mean that further deterioration of any single condition could lead to unrest and possible turmoil (as it was just the case of the first mid-year 1997). The recent Kosovo war (mid-year 1999) had its greatest economical and social impact just on Albania where all but a half million Kosovo refugees found their temporary accommodation. Into such a political, social and economical background a myriad of risk determinants concerning drug phenomenon is emerging. It is likely to affect especially the younger segment of the population. 1.2. DEMOGRAPHIC CHARACTERISTICS : FACTS AND TRENDS. The Albania’s population age-structure either in 1989 (the last census) or 1999 (operative data) indicates of a young population, the youngest one in Europe : the age-groups of 12-30 years old, that is just those of the highest frequency of social deviance account in 1999 of all but 30% of the total country’s population. Concerning the population gender-structure the females account for 48.5% in 1989 and 51.0% in 1999. Such a gender ratio overturning is due to the selective emigration during the'90ies, (Table 1) Following a strict natalist policy of the communist regime the Albanian population increased during the last fifty years, but its growth rate slowed from 2.96 in the 1950s to 2.1 in 1980s. Meanwhile a sharp decrease of the population growth rate (1.5) results to be in the 1990s mainly because of a large people (e)migration. Phare Project on Drug Information Systems 2 National Report 2000 Albania Table 1 Albania’s population structure in 1989 and 1999 Year 1989 Age group M F Total Total as Ratio M/F Female (years) number percentage (%) (in %) 0-14 547,611 502,977 1,050,588 33.01 109 47.8 15-19 167,368 153,639 321,007 10.09 109 47.8 20-24 156,070 146,149 302,219 9.50 107 48.3 25-29 153,496 144,149 297,645 9.35 106 48.4 30-34 130,079 122,053 252,132 7.92 106 48.4 35-39 101,116 90,452 191,568 6.10 111 47.2 40-44 76,328 68,729 145,057 4.55 111 47.4 45-49 76,559 70,285 146,844 4.61 109 47.8 50+ 231,107 244,250 475,357 14.93 94 51.4 TOTAL POPUL. 1,639,734 1,542,683 3,182,417 100.0 106 48.5 Year 1999 Age group M F Total Total as Ratio M/F Female (years) number percentage (%) (in %) 0-14 561,979 533,100 1,095,079 32.95 105 48.7 15-19 135,656 153,996 289,652 8.71 88 53.2 20-24 108,710 138,878 247,588 7.44 78 56.1 25-29 107,111 136,061 243,172 7.31 78 55.9 30-34 128,919 136,720 265,639 7.99 94 51.5 35-39 124,890 125,122 250,012 7.52 100 50.0 40-44 102,118 97,967 200,085 6.02 104 48.9 45-49 79,352 74,583 153,935 4.63 106 48.4 50+ 280,180 298,975 579,155 17.42 93 51.6 TOTAL POPUL. 1,628,915 1,695,402 3,324,317 100.0 96 51.0 Both crude birth rate (20.6 / 1000) and total fertility rate (2.6) are actually much higher than those of the rest of Europe, country’s demographic profile being thus closer to that of developing countries. But, on the other hand, Albanians enjoy a life expectancy at birth (LEo) above the average of countries of a similar level of economic development and wealth. LEo in Albania in 1998 was 69.2 years for men and 75.0 years for women, figures quite comparable with those of the European developed countries. Around 52.1% of the estimated population of 1999 were living in rural areas compared to around 64.1% according to the 1989 census. Overall population density was around 110.2 inhabitants per square kilometer in 1993 with different density levels in various country’s areas. Population pressure was and still is noticeable in the cities and plains whereas the mountain areas are continuously scarcely populated. Therefore a very high rate of urbanization or internal migration, (beyond any expectation on the respective Phare Project on Drug Information Systems 3 National Report 2000 Albania mathematical simulations), is going on to take place in Albania, conspicuously for the country’s capital – Tirana, (which actually, 1999, accounts for a population of around 800,000 inhabitants, compared with around 350,000 ones in 1994); as well as for other main cities as Shkodra and Lezha (Northwestern Albania), Durres (together with Kavaja and Shijak) (Centralwestern Albania), Elbasan and Berat (Central Albania), Fier and Vlora (Southwestern Albania), Korça (Southeastern Albania), etc. Such an “over-free” and chaotic movement of people carries the establishment of various subcultures, thus creating an appropriate social environment to lifestyles deviance. On the other hand, the people (especially youth) emigration, virtually non-existent in Albania until 1989, represents over the years 1990s a very remarkable phenomenon. The emigration rate (either illegal or legal one) remains to be too high : from 1991 onwards the number of Albanians emigrated abroad (mainly in Greece and Italy) and in other European and non-European countries as well might be considered of some 450,000-600,000 people, around 70% out of them being mainly males of age-groups of 16-30 years old. Concerning demographic and epidemiological transition Albania shows the features of both a developing country and a developed one. The high fertility rates, high natality rates, still high infant mortality rates (around 20 / 1000 in 1998), and the population demographic pyramid shape are demographic indicators of a developing country. But, in the meanwhile, the low crude death rates (5 / 1000) and high life expectancy at birth (around 73 years) are demographic indicators of a developed country. On the other hand, the total morbidity patterns, with the communicable diseases at the first place, are epidemiological characteristics of a developing country. But, in the meanwhile, the total mortality patterns (communicable diseases at the fifth place after cardiovascular diseases, chronic pulmonary diseases, cancer, accidents) represent epidemiological patterns of a developed country.