Regional Overview Eurasia AVAILABILITY OF NEEDLE AND SYRINGE EXCHANGE PROGRAMMES AND OPIOID SUBSTITUTION THERAPY Both NSP and OST available OST only NSP only Neither available Not Known 33 HARM REDUCTION IN EURASIA Adult HIV Adult HCV Harm reduction response Country/territory with prevalence People who prevalence reported injecting amongst inject drugs1 amongst people drug usea people who HIV and HCV programmes targeted who inject drugs3 NSP OST inject drugs2 towards people who inject drugs* Albania 10,0004 nk 26– 65%4 ¸¸ Armenia 2,0005 6.78%6 nk ¸ x Azerbaijan 80,00020 19–24%7 57%17 ¸¸ Belarus 49,8968 16.7%9 39%9 ¸¸ Bosnia and Herzegovina 11,458 nk 30–35%10 ¸¸ Bulgaria 20,000–30,000 †,11 3.43%12 nk ¸¸ Croatia 20,942 0.5–1.93% 58.3–68.6% ¸¸ Czech Republic 27,00013 0–2.7%14 21–59% ¸¸ Estonia 13,80015 54.3–89.9% ‡ circa 90% ¸¸ Georgia 80,00016 0.4%17 64.6%17 ¸¸ Hungary 15,00018 <1.0%14 14–24%19 ¸¸ Kazakhstan 186,00020 3.9%21 65.7%21 ¸ x Kosovo nk 022 13–27%22 xx While there are some targeted HIV Kyrgyzstan 44,00023 3–9%33 28–43%33 ¸¸programmes reaching people who inject drugs in the region, coverage remains very Latvia 18,725 22%14 nk ¸¸ low Lithuania 8,500 2.9%14 79–95.9% ¸¸HCV services in the region are minimal Former Yugoslav Republic nk 24 25 of Macedonia <1% 85.6% ¸¸ Moldova 34,000–52,00026 21%27 nk ¸¸ Montenegro 400–50028 nk nk ¸¸ Poland 96,514 8.9–16%14 55–68%38 ¸¸ Romania 13,694–34,31829 0–0.81% 44–80%38 ¸¸ Russia 2,000,00030 12–30%30 90%31 ¸ x Serbia nk nk nk ¸¸ Slovakia 13,497 <1%14 circa 45%38 ¸¸ Slovenia 5,00032 <1%19 40%38 ¸¸ Tajikistan 15,00033 23.5%34 43.4%25 ¸ x Turkmenistan 11,148 nk nk x nk Ukraine 325,000–435,00036 41.8%37 70–90%38 ¸¸ Uzbekistan 80,00033 15.33%33 5%33 ¸¸ nk = not known * These services include, among others, voluntary HIV testing and counselling; HIV prevention, treatment and care; hepatitis C testing and treatment; STI prevention and treatment; information, education and communication. † Estimate of numbers who use drugs problematically, including those that inject drugs. ‡ Non-national estimate – from two sites. 34 There are over 400 million people living in the twenty-nine The general trend is that illicit drug use has increased in this region countries that comprise Eurasia (Central and Eastern Europe and since the end of the Cold War and during periods of con"ict (in the Central Asia),39 with over one-third residing in Russia. The region Balkans and parts of Central Asia and Caucasus).43 Throughout the can be divided into the six diverse sub-regions of the Balkans, the region, countries report poly-drug use, for example combining Baltics, Caucasus, Central Asia, Central Europe, and the European opiates and stimulants, although the capacity to monitor the countries of the Commonwealth of Independent States (CIS). drug use situation is limited and, with some exceptions, data are scarce. The Eurasian countries that rank lowest on the human poverty index are Tajikistan, Kyrgyzstan, Uzbekistan and Moldova. The Alcohol wealthiest countries in the region are Slovenia and the Czech Alcohol consumption is relatively high across the region, with o!cial per capita levels in seven countries (Croatia, the Czech Republic.40 Many Eurasian countries have experienced huge Republic, Hungary, Lithuania, Moldova, Russia and Slovakia) among political, social and economic changes since the 1990s, following the highest twenty in the world. The Czech Republic, in particular, the fall of the Soviet bloc and the Berlin Wall. Several countries has the third highest level of o!cial alcohol consumption in the have experienced the rapid expansion of drug use, HIV, hepatitis world at 16.21 litres of pure alcohol per capita per year. C and tuberculosis epidemics in recent years. In addition, ten of the top twenty spirit-consuming countries are DRUGS IN THE REGION in Eurasia, including the country with the highest o!cial levels (Moldova) and the country with the highest levels of o!cial beer Cultivation, production and transhipment consumption (the Czech Republic). Across most of the region, Production of amphetamine-type stimulants (ATS) occurs in alcohol is very accessible, with beer cheaper than soft drinks a number of Eurasian countries. Poland, and to a lesser extent in Belarus, Bulgaria, Croatia, the Czech Republic, Hungary and 44 Estonia and Lithuania, are the major amphetamine producers, Romania. and much of the European amphetamine market is supplied by In addition to the o!cial recorded data, ‘certain countries in Eastern these three countries. During 2005, a number of amphetamine Europe and some of the former Soviet Union republics have a manufacturing laboratories were dismantled in Bulgaria, Estonia, sizeable estimated unrecorded alcohol consumption’ ranging from Lithuania and Poland. 4.5 litres in Croatia to 12 litres in Moldova.44 In Russia, unrecorded alcohol consumption includes ‘samogon’ and counterfeit vodka Ecstasy is also produced in Poland, although not to the same (which is associated with high rates of alcohol poisoning),45 and ‘a extent as in some Western European countries. Methamphetamine signi#cant number of Russian men are drinking products that have manufacturing is predominantly limited to the Czech Republic either very high concentrations of ethanol or contaminants known (where it is known as ‘pervitin’), although some production is to be toxic’.46 In Moldova and Uzbekistan, alcohol consumption 41 reported in Lithuania, Moldova, Russia, Slovakia and Ukraine. has been identi#ed as an important factor in HIV transmission due Cannabis is also cultivated in the region, both naturally and to increased sexual risk behaviour.47 hydroponically. Amphetamine-type stimulants (ATS) Opioid production is limited to relatively low-quality poppy straw ATS are used in many countries in the region. Signi#cant and poppy concentrate for local consumption in Latvia, Lithuania methamphetamine use is reported in the Czech Republic and and Poland, as well as Belarus, Russia and Ukraine, where an opiate Slovakia; as well as in Belarus and Georgia, where homemade ATS extract known as ‘kompot’ or ‘shirka’ is produced from poppy known as ‘vint’ or ‘je$’ are often ephedrine and methamphetamine- straw. based. Amphetamine is commonly used in Ukraine and Russia, and substantial use of ecstasy is reported in Moldova. There has also Most countries in the region form part of one of two major heroin been a marked increase in amphetamine usage in south-eastern 43 tra!cking routes from Afghanistan to Western Europe. Countries Europe. that form part of the ‘Balkan route’ include the Former Yugoslav Republic of (FYR) Macedonia, Albania, Kosovo, Serbia, Montenegro The quality of ATS varies signi#cantly and, even in production and Bosnia and Herzegovina or Bulgaria, Romania and Hungary. countries such as Lithuania, people who use drugs report major "uctuations in the composition and strength of locally produced The ‘Silk route’ involves Afghanistan’s neighbouring countries in and sold amphetamine. In Ukraine, manganese is usually used for Central Asia and Russia, as well as Belarus, Ukraine, Estonia, Latvia producing methamphetamine, which includes very toxic chemical and sometimes Bulgaria.42 by-products. Although ATS injecting is reported in several countries, data are much scarcer than for opiate injecting. Some Eastern European countries are also beginning to play a role in cocaine transhipment routes. Opiates Opiate use in general is reported to be rising, particularly in Drug use countries along the Balkan trade route and in Russia. Heroin, The main psychoactive substances used are alcohol, tobacco, opium, pharmaceutical opiates and various homemade opiates are cannabis and opiates (including heroin and locally produced poppy used throughout the region. For example, ‘kompot’, a homemade derivatives). Problematic and recreational use of ATS, (including opiate derivative of the pod and straw of the poppy, became homemade stimulants, for example in Georgia) is increasing. Use widely used after the fall of the Soviet Union, when the region saw of cocaine is reported in several countries; as is the use of non- an in"ux of opiates from neighbouring countries. As with ATS, the quality of opiates and the purity of heroin vary substantially, with prescribed medications like sedatives and tranquilisers. Use of better-quality substances reported closer to Afghanistan and to ecstasy and hallucinogens, although at a low level compared to heroin tra!cking routes. other regions, has also been increasing in recent years. 35 Injecting of ATS, such as methamphetamine and ephedrine, is reported in an increasing number of countries including Belarus, Georgia, Moldova and Ukraine. As stimulant injecting requires a greater number of injections than opiate injecting in order to retain the drug’s e$ect, it may be associated with the sharing of injecting equipment. Cocaine, which is more expensive in relation to other drugs in the region, is injected in countries such as Croatia, Kosovo and Poland, although to a lesser extent. In Armenia and Russia, there are reports of people injecting ‘whatever they can get’, such as prescription drugs like Coaxial (an antidepressant).47 The average age of people injecting drugs in this region is very low. For example, in Kosovo in 2005, the average age was below 20 years.47 In Romania, it is estimated that 80% of people injecting are aged under 29 years, and in 2004 the average age for initiating injecting drug use was between 17 and 19 years.48 In FYR Macedonia, a 2002 UNICEF rapid assessment among young people who inject drugs found the age for drug use to be decreasing, NUMBERS OF PEOPLE with a growing number of 12 and 13 year olds using drugs.25 In WHO INJECT DRUGS Lithuania, according to the Drug Control Department, more than half of the injecting population begin injecting opiates between 49 Less than 5000 the ages of 15 and 19 years.