Georgia Fighting Losing Battle Against Designer Drug

Forget about fighting corruption. Georgians now have a new battle on their hands: cracking down on a craze for subutex, a drug designed to fight opiate addictions that locals and international organizations say is taking the country by storm.

"When we're high, we all talk about quitting, that this is the last time," recounted one Tbilisi subutex user, who gave her name as Nino. "Then the next day, we call our friends to find out who has money for the next fix."

Nino's story is an increasingly common one for young Georgians. The International Narcotics Control Board (INCB), an independent body established by the United Nations to implement its international drug conventions, estimates that there has been an 80 per cent increase in drug abusers in Georgia since 2003. The organization's 2005 annual report attributes this increase to the import and illegal sale of subutex, the market name for a form of buprenorphine tablets.

Like methadone, buprenorphine is a synthetic opiate derivative developed for the treatment of opiate addiction. Considered a breakthrough in the treatment of drug addiction, buprenorphine, a tablet which dissolves under the tongue, is the only addiction therapy drug that can be administered at a doctors' office, thereby eliminating the need for travel to a methadone clinic.

The drug comes in two forms: Subutex, which is pure buprenorphine, and suboxone, which contains naloxone, an anti-abuse component that produces intense withdrawal symptoms when taken intravenously. Subutex, meant for the early stages of addiction treatment, is more vulnerable to abuse since it does not contain naloxone, and can be snorted or dissolved into water and injected without causing withdrawal symptoms.

While official numbers are hard to substantiate and largely based on estimates, subutex abuse is believed to be increasing at alarming rates in Georgia. According to some reports, 60 percent of Tbilisi residents between the ages of 16 and 27 years old have tried the drug at least once.

Some subutex habituates put the age for first-time users even younger. Notes one nine-year opiate addict, now undergoing treatment, who gave his name as Guram, "subutex is easier to find than heroin, which is why everybody is doing it. It's a shame. Fourteen-year-olds are starting to use it, even girls."

By Nino's accounts, most subutex users in Georgia believe the drug is less dangerous than heroin, which explains its growing popularity. She adds that though it is now easier to find heroin in Tbilisi than subutex, people still prefer the latter. "Nobody thinks they'll become addicted to subutex, [they think] that you can't overdose on it, like you can on heroin."

As a result, she said, "some people use subutex as self-treatment to get off heroin. Then they use heroin to get off subutex."

Georgian users usually snort subutex, although some dissolve it in water or mix it with other medication like suprostin, an antihistamine, and then inject it. All the materials are readily available at any pharmacy, Nino said. "When somebody walks in and asks for four small needles, one large one, some distilled water and suprostin, they know exactly what we are planning to do."

Unlike heroin, the distribution of which is linked to organized crime and reaches Georgia from Central Asia, the INCB report claims subutex trafficking is done largely by private individuals traveling from Europe. According to the 2005 annual report of the European Union's Lisbon-based European Monitoring Centre for Drugs and Drug Addiction, the ease of access to subutex in Estonia and France has led to an increase in the substance on the black market in Europe.

France, where buprenorphine was first authorized for sale in 1996, is believed to be the source of most of Georgia's subutex supplies. The drug, developed in the United States and United Kingdom, has since been put on the market in 24 countries. The drug was approved by the US Food and Drug Administration in 2002.

In France, subutex clients reportedly often obtain several prescriptions by "doctor shopping" – going from one doctor to another. The tablets are usually smuggled into Georgia by airline or across the border, often with shipments of used cars.

Traffickers can count on considerable profits from the Georgia trade. The price of an eight milligram tablet in France costs anywhere between one to four euros ($1.21 - $4.84), while the same tablet reportedly fetches a sales price of $120 in Tbilisi.

"One eight milligram tablet is enough for eight people, only you rarely get a full eight milligrams. You get two