EXPLORING CENTRAL ASIA’S DRUG DANGER
Q & A with Nina Kerimi: 4/12/01

Central Asia’s emergence as a drug trafficking hub has helped cause a dramatic rise in narcotics use among residents of the region. The increase of drug use has, in turn, helped fuel potentially destabilizing social trends, including crime and health issues. Dr. Nina Kerimi, an expert affiliated with the World Health Organization’s office for Europe, based in Copenhagen, Denmark, has been tracking drug-use patterns and the possible consequences in Central Asia. On April 6 she presented a paper at the 6^th annual convention of the Association for the Study of Nationalities, held at Columbia University in New York. [Click here to see Dr. Kerimi’s convention paper]. Kerimi, who has served in a variety of advisory roles at Turkmenistan’s Ministry of Health, took time out during the ASN gathering to talk to EurasiaNet about drug use in Central Asia.

EurasiaNet: You maintain there are some differences in the characteristics of narcotics use today compared with that during the pre-Soviet times. Can you explain these differences as they pertain to Central Asia?

Kerimi: In the old days, opium – I will be talking about opium, because this is the main problematic drug – was used mostly as a folk remedy, as a panacea for illnesses, mental disorders, and physical diseases. It was ingested, and later – approximately in the 18^th century – it started to be smoked. And at that time, the recreational meaning of its use became clearly visible. Since the late 18^th century, opium use became a social phenomenon, in the sense that it created a lot of problems; the social response from the government at that time was just to destroy [opium] dens – the places where people used to smoke it – trying to prohibit consumption of the drug. It didn’t work, and the smoking continued. Under Russian administration, officials also tried to prohibit the spread of opium. Then, in the late 19^th century, they tried to prohibit the importation of opium. At that time, official imports, as well as smuggled opium from Persia, was flourishing and the flow of opium was very heavy, and it spread into all of Central Asia.

EurasiaNet: So what’s the main difference between narcotics use today and narcotics use then?

Kerimi: I would focus on three features: First of all, there is the mode of use. Now, more and more, people inject opiates. Secondly, the characteristics of the opiate itself. Now it’s heroin, which is processed opium. And thirdly, it is no longer used as a remedy, it is just used for recreational purposes. These are the main characteristics of the patterns.

Of course, the consequences are also different. In the past, the most serious consequence was overdose, or drug dependence itself. This encouraged the impoverishment of addicts because people many could not afford opium. Nowadays, there are some other very serious consequences which should be added to these two, like HIV infection, hepatitis, and sexually transmitted diseases, which are flourishing among drug users. There are some other diseases which accompany this. They are not the direct consequence of drug use, but they are there. I am talking mainly about tuberculosis. Patients with tuberculosis are over-represented among drug users, and vice versa. If you go to a tuberculosis clinic, you can see – up to 90 percent of them are drug users, in Kyrgyzstan for example. In Turkmenistan it was approximately 30 percent.

So the cluster of disorders linked to the use itself – and I have to add some social characteristics to that: a very high rate of unemployment; a tendency towards criminal activity; and a history of family problems. It is interesting to note that the family problems are specific to Central Asia, because in our culture people get married at a young age. When we investigated the social and marital status of drug users, we found that some of them have never been married at all, just because they started to use drugs. So there are two kinds of family problems – they can’t be married and they can’t have normal family lives because they have started to use drugs; and vice versa – when they begin using drugs, they caused a divorce. There are big problems with their children, especially now, because these children are not receiving care, and in a sort of social inheritance, they are acquiring deviant behavior.

EurasiaNet: From your research, what are the trends – at what rate is drug use growing, as best you can estimate?

Kerimi: According to statistics … the incidence of drug use is going up very quickly. It’s a very high rate. Between 1991 and 1999, the rate absolutely skyrocketed. Somehow we forget that the main reason for the number of drug users is the availability of the drug. And it is available, and it is relatively cheap, and it is promoted by the dealers, because it’s in their interest to have more and more people involved. So now we’re having the situation where it’s a real commodity – it’s an economic commodity.

Also important to note is the social context in which this phenomenon is going on. And this is unemployment, it is poverty, it is this search for a new identity - because we lost the Soviet identity, and now the nations are trying to build up something new. If people don’t have jobs, and they have to earn money and they can do it through trafficking or dealing drugs, they’ll do that. If they want to get out from poverty, they will try to do anything – including an activity that’s criminal or on the edge of criminal.

EurasiaNet: Do you believe that the statistics that you read are accurate, or do you think that governments are not accurately reporting the situation, and if they’re not accurately reporting the situation, what are the factors behind the inaccuracy?

Kerimi: My absolutely sincere belief is that the governments don’t do any cheating. They just get the numbers which are supplied by registration – taken from narcological surveys, police surveys, and so forth. And in terms of the healthcare system, there are numbers and referrals. So they have registered cases. And police also have seizure numbers and arrests. Of course all this does not provide a whole picture, but I am not so inclined to only stick to the exact figures, because first of all you can always make some estimate – some rapid assessment – and secondly, what is more important is the dynamics within the group of drug users. I’m talking about age of onset, I’m talking about demographic indicators, I’m talking about many other things which are much more important than just the number itself; and there are techniques which allow us to estimate these things.

EurasiaNet: Does the new pattern of drug use, specifically the injecting of drugs, have social consequences? Does it create problems between generations?

Kerimi: This is a very interesting question, and it is a complicated one. I can talk about my country [Turkmenistan]. Here we have two distinct sub-populations of drug users. One, which I call "classical," people with traditional use – they smoke raw opium or they ingest it – and they have rather mild consequences. I can’t say that it is absolutely harmless, there are a range of consequences, but in comparison with what is going on now with injection drugs, it is not as serious. On the other hand there is a group of people who are injecting drugs. These two groups clearly understand that they are different. Those traditional users look with some contempt and disgust at the intravenous users, and the intravenous users have a very deep feeling of guilt and shame because they know that they violate social norms. Smoking and eating opium is a quasi-tolerated behavior: it’s not encouraged, it’s not praised, but somehow it has a tradition. But injecting is very new, and if you are injecting drugs it’s almost equivalent to being a criminal – I might be exaggerating, but it’s very dangerous, it’s very bad, if people learn that you are an injection drug user, it’s very difficult for you to be treated well.

EurasiaNet: Does this new development in narcotics use threaten to have a very significant destabilizing impact on Central Asian society?

Kerimi: It is difficult for me to judge this in terms of political stability, because I am not a specialist in assessing the whole situation from an economic and political point of view, but I think yes. From the reports which are available from the republics, it seems like it has a serious impact on the economic situation, so it is worsening the situation. Again, because crime is going up, because of economic loss.

EurasiaNet: Where do you see the drug use trend heading? Do you see it leveling off or even decreasing, or will it increase, and at what rate?

Kerimi: Well, I think it will depend on the efforts made by the countries. And it is in our hands, whatever pessimistic picture we can see now. It is in our hands. Because if we know that there are some levers for influencing the situation, like availability, the social context, we can do something. If nothing is done, it will get worse.

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Posted April 5, 2001 © Eurasianet
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