EurasiaNet Eurasia Insight - Georgia Fighting Losing Battle Against Designer Drug

EURASIA INSIGHT

GEORGIA FIGHTING LOSING BATTLE AGAINST DESIGNER DRUG
Paul Rimple 4/12/06

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 �near’ halves, because the dealer is always taking a bit for himself," Nino told EurasiaNet. The only problem in getting subutex, she said, is waiting for a delivery, which can take anywhere from five minutes to five hours. "But if one person’s dealer doesn’t have anything, somebody else always knows another dealer."

Nino’s habit costs her 30 lari (about $16.48) a day. A single mother on a monthly salary of $300, Nino says that she barely manages to scrape together the necessary money. She tells stories of how friends have turned to stealing -- even from other friends -- to maintain their habits. "When I have money, I can buy shoes for my child, or subutex�and I buy subutex."

Abuse of the drug can prove devastating. While it is far easier to overdose on heroin and methadone, makers of buprenorphine warn that the drug can cause death when injected, particularly when mixed with tranquilizers, a popular recreational drug in Georgia. When injected, users also face the obvious risk of HIV, although in Georgia, needles are available at pharmacies for a mere 25 tetri (about 14 cents).

For now, government plans for blocking subutex traffickers appear to rest largely on arresting users. But the fact that subutex cannot be detected in urine makes that task a challenge for police. Possession of the drug, however, is punishable by six-12 years in prison. "I know a girl who tried to smuggle two tablets under her bra to her husband in prison. She was caught and is now doing six years," Nino said.

Despite repeated attempts by EurasiaNet, responsible officials at the Ministry of Internal Affairs could not be reached for additional comment.

For users like Nino who say they want to kick the habit, the options are few. There are currently four drug addiction therapy centers in Tbilisi and one in Batumi, which treat withdrawal by chemical means. None of these provide psychological counseling for post-withdrawal.

Afraid of the stigma of attending a clinic to help quit her addiction, particularly as nobody in her family knows she is using, Nino is trying to stop by herself and is currently reducing her doses. Once a person becomes dependent on subutex, however, they suffer from withdrawal symptoms if they stop too suddenly.

"It has changed me," Nino recounted. "I used to go out clubbing and dancing. I never feel like doing that any more. I don’t even get high any more, I just take it to feel normal."

"Nobody can help me, no medicine. I have to help myself," she continued. "Physically I feel fine. Mentally, it’s difficult. But I have the desire to quit. Really."

Editor�s Note: Paul Rimple is a freelance writer based in Tbilisi.

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