SUMMARY OF FACT FINDING MISSION TO KYRGYZSTAN
Maitland J. "Aaron" Peak – Peak Options Consulting
For Soros Foundation – Open Society Institute,
International Harm Reduction Development Program
printer-friendly version | page 2 | page 3

The fact finding mission, which ran from August 9-19, 2000, did its work in Bishkek and Osh. The majority of the meetings and site visits were held in Bishkek.

How Illicit Drug Use Affects the Lives of People in Kyrgyzstan

Trafficked drugs travel into Kyrgyzstan from Tajikistan and out to neighboring countries. The number of drug users may be seven times those registered, 3,791. While the official number has dropped, all other signs show an increase, especially in injecting drug users. The government will only allocate funds based on the official number. The State Commission on Drug Control held a conference recently where a national strategic program of drug control was discussed. As a result, laws were established to address drug users’ needs for medical attention, education, employment, and higher living standards.

The current policy [probably the government’s but not clear how written] has these three elements: primary prevention to make all youth aware of the dangers of drugs and discourage them from its use or trafficking; drug treatment and rehabilitation, for which there is a low level of commitment at present; and harm reduction, since other treatment options for infectious diseases are lacking. Representation of the drug using community is included in all three sectors. At least 40% of what is needed in comprehensive harm reduction must be supported in order to have a "real" impact. (Ref. 11)

Once a representative body to coordinate efforts is established, work can advance in providing comprehensive harm reduction. A successful study tour to Krakow, sponsored by the Soros Foundation, changed the attitude of the law enforcement community to support any initiative that yields a healthy society. (Ref. 11)

To bring the government into the effort alongside the NGOs, seminars on preventing infectious diseases need to be offered to top-level authorities. Some official representatives are concerned that harm reduction contradicts Kyrgyzstan laws, which make possession of drugs, but not use of them, illegal. But most accept the necessity of implementation. Front-line police who sometimes still beat, arrest, and incarcerate drug users without provocation or proof of illegal activities, need to be constantly oriented, especially because of turn-over in the ranks. In many cases, police demand payment from the drug users or plant drugs on them. There is frightening sexual abuse of girls by police, as well. The Children’s Welfare Foundation is gathering such accounts with which to approach the Ministry of Internal Affairs. (Ref. 15)

Continual harassment by police officers, therefore, is the primary obstacle to needle exchange programs. As a result few IDUs participate in them and there is a high level of relapse. Many drug users fear the police will arrest them when they access the trust points even if they do not have drugs.

The second barrier to the programs is the lack of employment and methods to build marketable skills. Assistance was requested for a plan of action to address the issue. (Ref. 10)

The third barrier is the lack of information on and understanding of the medical consequences of drug use. While the National AIDS Center provides information on HIV, more information is needed on TB, hepatitis B and C, safer injecting, nutrition, primary health care, and overdose. (Ref. 10) Although it is required by law, some drug users refuse treatment for TB since continuing to have TB gives them the status of "invalid," eligible for a pension. As a consequence, many have drug-resistant TB and will inevitably die from it. Ninety percent of the patients who died from TB in the hospital were drug users or alcoholics.

In the hospitals, it is encouraged for patients to be treated as in-patients so that they can get full care of medications, food, and oversight. Much of the hospital staff, who are afraid to work at night since thieves and strangers lurk about with drugs, favor substitution drug therapy as it would make their jobs easier. (Ref. 7) At the Infectious Disease Hospital, drug users are not categorized as such and are given proper treatment like everyone else. (Ref. 8)

The fourth barrier to the harm reduction programs is the lack of primary health care. It is achievable and the staff are interested in it, but they have not received training or equipment. Overdose is a major problem. Overdose mortality rates in 1998 were 38% and mortality from drug related diseases was 14%. Overdose can occur from taking too much of the drug or by the potency of heroin, which is sometimes difficult to discern. (Refs. 5, 10) The equipment to deal with patients in a coma is old and inadequate. There is only one doctor in the country who has received credentials in toxicology. (Ref. 12) The majority of hospital patients are indigent and uninsured. In the hospital, 25-27% of patients are insured, while in the toxicology unit only 6-7% are insured. (Ref. 12)

The fifth barrier to the drug using community is the lack of affordable, appropriate, and sustainable drug treatment. Most users cannot afford the USD $200-300 for a ten day treatment. There are no rehabilitation programs or reintegration initiatives even though government officials and drug users alike would like it to be available. (Ref. 10) The extended periods patients were kept in dispensaries during Soviet times has shortened due to a lack of funds. There are some in-patient psychology/narcology departments. A reform initiative (MANAS) was developed by the Ministry of Health and funded by the World Bank, to reduce bed allotments for drug users. [sic] The number of beds in Bishkek’s narcology dispensary, for instance, went from 1000 in 1991 to 300 in 1999. Presently, the state budget for medication for the narcology centers is an inadequate USD $25,000 annually. (Ref. 3)

The sixth barrier to comprehensive harm reduction programs is the lack of supplies, such as needles, syringes, condoms, cotton, and alcohol. Workers are frustrated by diminishing supplies and increasing clients.

Children of drug users suffer. Many of the children of drug users who are incarcerated, whether justly or framed by the police, turn to drug use and prostitution for survival and do not attend school. Right now 850 children have parents in jail on drug use charges; 350 children are in jail themselves with the parents. (Ref. 10) A survey in 1998 of 1,600 children found that half were eligible for assistance from the Children’s Welfare Foundation, an NGO. Often these children are beaten by the police, who treat them as they do the parents, and sent to labor camps. Some girls turn to sex work to earn money. (Ref. 15)

The estimated 25,000 sex workers in Bishkek are in danger of infectious diseases, although 80% now use condoms, up from 13%. (Ref. 9) The Gender in Development initiative is a crucial response right now to the increase of women using drugs. Its purpose is to train women to create small businesses in lieu of participating in the drug trade.

In spite of barriers, HIV prevention is advancing and the quality of life has improved for drug users. Needle exchange was looked on unfavorably, especially by the International Committee of Drug Control, and thought to provoke the use of illicit drugs. But with the help of the director of the National AIDS Center and the general director of the State Commission of Drug Control, needle exchange has proceeded. (Ref. 11) Funds previously marked for the AIDS program and the Ministry of Health, however, have been diverted to the security forces for the border wars and to fight international terrorism. (Ref. 13)

Because of the Muslim culture in Osh, many families are afraid to approach hospitals for their son or daughter drug user and prefer to use a private doctor. There is no HIV testing and patients are not categorized as drug users. Many families try to deal with overdoses themselves and therefore bring the patient into the hospital too late. Most overdoses go to the narcology dispensary. Some are suicides. Harm reduction programs should include education on coping skills. (Ref. 17) A rehabilitation center is needed for proper treatment; but users need to want to stop. WHO estimates that 95% of detoxification patients relapse. (Ref. 19) Some parents who have difficulty with their children selling off the household goods even asked for the "golden dose" for their son or daughter. (Ref. 21) The success of overdose management depends on when the patient is admitted to the hospital. The Soros Foundation’s donation of USD $25,000 for equipment and literature has been very helpful and the hospital hopes that it will continue. (Ref. 22).

The laws against commercial sex workers, drug users, and HIV infected individuals are strict in Osh and so more needs to be done from the top-down. The strong laws will be enforced since the deputy director of Internal Affairs was formerly part of the KGB and many in that office still have the old Soviet mentality. (Ref. 23)

Illicit Drug Prevalence and Consumption

The drugs most widely available in Kyrgyzstan are cannabis and opium extracts, including heroin. The number of new drug users increased six times from 1991 to 2000. No records are provided to the government, which figured the number of drug users at 4,500. Drug use among youth under the age of 25 is estimated to have risen from 10% to 30%. Drug use among women has risen from 10% to 35%. There is no methodology to determine the exact number of drug users, but the best realistic estimate comes from multiplying the official number eight to ten times. Regardless, all professionals in the field agree that drug use has increased dramatically.

The cannabis that is cultivated over approximately 300,000 hectares has a 5% content level of THC, much higher than the usual 0.5% in other areas. The purity of heroin in Bishkek is high and the price is approximately 150-250 soms. (Refs. 3, 5)

Use of heroin among sex workers has risen to about 10%. The NGO "Tais Plus" that works with sex workers on HIV prevention distributes condoms but had difficulty distributing needles without encouraging discrimination between sex workers who inject drugs and those who do not. Users are now referred to existing harm reduction program sites instead. (Ref. 9) While women drug users make up 10% of the total, they represent 35% of those using the OSI harm reduction services. Of those women, 40 are sex workers, thus there is a good linkage with "Tais Plus." (Ref. 4) Medecins Sans Frontieres in Osh revealed that there are quite a few migrant sex workers who are young females with children.

Children’s Welfare Foundation conducted a survey of children and found some astonishing results. Sixty percent knew about injecting drugs; 57% said they know how to inject; 66% said they had tried drugs. (Ref. 15)

Alcohol and psychosis patients represent 80% of the intakes at the narcology dispensary, whereas drug users represent only 20%. There is a trend moving from alcohol to drug use, especially since drugs are cheaper, but alcoholism is still a problem and needs better techniques of monitoring. (Ref. 3)

After the demise of opium on the market, heroin became the drug of choice. Overdoses have been common when transferring from dosages of one to the other. Generally, the heroin that is sold is so pure that it does not need to be cooked, only dissolved with water. Sometimes Dimidrol is added to avoid vomiting and Diazepam is added to prolong the high. The average number of injections per day is three. To avoid being detected by the police, many inject into their groin, making the user more susceptible to infection. Veins are apt to collapse when using Dimidrol. Users who have no more proper veins inject under their tongue or resort to skin popping.

The central narcology dispensary for detoxification uses burprenorphine and morphine, but the government has refused to supply these drugs to other dispensaries in the country. Procuring licit drugs is complicated as it is done through two pharmaceutical companies that trade in imported medicines. Stocks of burprenorphine are depleted and consequently expensive, therefore few patients receive it. The first patients who are eligible for it are those who can pay for it. Other patients receive obsolete treatments, such as tranquilizers and vitamins. Non-medical avenues, such as Narcotics Anonymous, are tried by the NGOs. (Ref. 10)

The OSI needle exchange programs offer syringes made in India, which are preferred by users to those made in Russia. No company in Kyrgyzstan manufactures syringes or needles. As drug users switch to heroin from opium they request smaller syringes. (Ref. 4)

The town of Osh is a drug trafficking crossroad as it is close to the borders of Uzbekistan, Tajikistan, and Afghanistan. Afghani soldiers come over the border with their drugs when the cannabis harvest peaks, as well as with heroin. The Osh narcology dispensary registered 500 drug users, but the figure for the Oblast is assessed at 10 to 15 times higher, 85% of which are injecting. (Ref. 17) The situation of illicit drugs has changed dramatically, especially in the rural areas, from five years ago when there were no serious problems. A survey of the 100 patients released last year from the narcology dispensary in Osh showed that 50 were in prison, 20 had died, and 30 had left the oblast. The dispensary receives 100-120 admissions per year. Some drug users return to using the week they are released from treatment. (Ref. 19)

Infectious Diseases Associated with Drug Use

Of the 47 people identified as HIV infected, 37 have been foreigners. The most prevalent route of transmission was through injecting drug use. In spite of the low numbers, 400,000-800,000 HIV tests are provided each year. (Ref. 2)

Various programs have integrated HIV prevention into their activities. In addition to HIV prevention, the OSI needle exchange programs offer IDUs consultation on TB and hepatitis B and C. (Ref. 4) With WHO support, an anonymous testing center was opened for sex workers in Bishkek to test for HIV and STDs. Many more have used the facility than expected. (Ref. 9)

The health of children of drug users, alcoholics, and incarcerated parents is below average. They are registered and indirectly become criminals. If they get into trouble they are treated more severely than other children and put in detention centers. (Ref. 15)

In 1995, along with all other CIS countries, Kyrgyzstan’s president launched a national campaign to address TB. The rate of TB in Kyrgyzstan is high and the year 2000 data indicate that TB affects a wide segment of the population. Bishkek’s TB hospital treats 1,200-1,300 patients every year. Out of a sampling of 230 patients, 73 have been poly-drug users and 161 chronic alcoholics. Most TB drug using patients come from prison and have hepatitis, which was also contracted in prison. The prisons do have TB hospitals and in some cases the prisoners are released early to their home or village because of their deteriorating health. Many patients leave the hospital before their treatment is completed without the permission of the doctors. The doctors and nurses are unable to stop the flow of alcohol and drugs into the hospital and, in any case, it is preferable to violent withdrawal. (Ref. 7) PAGE 2

Email this article
Posted March 1, 2001 © Eurasianet
http://www.eurasianet.org

	The Central Eurasia Project aims, through its website, meetings, papers, and grants, to foster a more informed debate about the social, political and economic developments of the Caucasus and Central Asia. It is a program of the Open Society Institute-New York. The Open Society Institute-New York is a private operating and grantmaking foundation that promotes the development of open societies around the world by supporting educational, social, and legal reform, and by encouraging alternative approaches to complex and controversial issues. The views expressed in this publication do not necessarily represent the position of the Open Society Institute and are the sole responsibility of the author or authors.