2011 Drug Situation in the Republic of Moldova Annual Report

Transcription

1 Ministry of Health of the Republic of Moldova National Center for Health Management National Drug Observatory 2011 Drug Situation in the Republic of Moldova Annual Report Chișinău, 2012

2 Abbreviations and definitions RM Republic of Moldova WHO World Health Organization UNODC United Nations Office on Drugs and Crime MH Ministry of Health, NCHM National Center for Health Management, NDO National Drug Observatory, MOI Ministry of Internal Affairs, ADD Anti- drug Division DPI Department of Penitentiary Institution, RDN IMSP Republican Narcological Dispensary, NCPH National Center for Public Health, PI CIMU HSRP Public Institution Unit for Coordination, Implementation and Monitoring of the Project on Health System Restructuring, FMC Forensic Medicine Center, NBS National Bureau of Statistics of the Republic of Moldova, PIN People who inject drugs GD Government Decision HRP Harm reduction programme ESPAD European School Survey Project on Alcohol and Other Drugs, Republic of Moldova 2008 and IBBS Integrated Bio-Behavioral Survey among people who inject drugs; men who have sex with men; Sex Workers; prison inmates. KAP Survey on Knowledge, Attitudes and Practices of the general population (15-64 years old), and of youth (15-24 years old) EMCDDA European Monitoring Center for Drugs and Drug Addiction, Authors Olga Vacarciuc, Otilia Scutelniciuc, Valeriu Pleșca Consultants Oleg Barbă, Mihai Oprea, Vitalie Slobozean, Veronica Zorilă, Igor Patrașcu, Petru Oprea, Tatiana Costin, Igor Condrat, Diana Simașco. Acknowledgments Our goal is to develop strategies to achieve maximum impact in the prevention of and fighting against drug abuse and illicit drug trafficking using scientific evidence. Data quality is the priority of the National Drug Observatory. The 2011 Annual Report 1 gives a detailed evaluation of the situation concerning drug abuse and illicit drug trafficking in the Republic of Moldova by observing the policies of the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). We would like to express our gratitude to the people concerned for their insistence, patience and competence in drafting this report, especially to our national partners from RDN, ADMIA, and DPI. We would like to convey special thanks to the United Nations Office on Drugs and Crime (UNODC) for its assistance in translating the report into English language. 1 Original version of this document is in Romanian language. 2 The disapproval answer category included the answers I disapprove and I rather disapprove. NCHM, NDO 2011 Drug Situation in the Republic of Moldova, annual report I

3 Table of contents National Drug Observatory... 1 Executive Summary... 1 Country Information... 6 I Developments in drug policy and responses... 7 I.1 Introduction... 7 I.2 Political framework in the drug field... 7 I.3 Legal framework I.4 Implementation of the law I.5 Developments in public attitudes and debates I.6 Budget and funding arrangements II Prevalence, Patterns and Developments in drug use II.1 Main developments and emerging trends II.1.1 Surveys on drug use in the population II.2 Illegal Drug use in the general population II.3 Tobacco smoking in the general population II.4 Alcohol use in the general population II.5 The use of tranquilizers and sedatives in the general population II.6 Drug use among youth II.7 Tobacco smoking among youth II.8 Alcohol use among youth II.9 Illegal drug use in the school population II.10 Perceived accessibility of drugs II.11 Tobacco use among school children II.12 Alcohol use among school children II.13 Use of tranquilisers and sedatives among school children II.14 Abstinence III Injecting drug use III.1 Injecting drug use in the penitentiary sector IV Health consequences IV.1 Drug treatment demand IV.2 The system of data collection on officially registered drug users IV.3 Drug users receiving detoxification treatment IV.4 Drug users in methadone substitution treatment IV.5 Drug users in the penitentiary system IV.6 Injecting drug users beneficiaries of the harm reduction programmes IV.7 Drug users using the services of the Centre of Rehabilitation for drug-addicted persons V Drug-related mortality VI Drug related infectious diseases VI.1.1 HIV/AIDS VI.1.2 Viral hepatitis VI.2 Other drug-related co-morbidity VI.3 Social and legal correlations and consequences VI.3.1 Social problems VII Drug offences and drug-related crime VII.1 Social/economic costs of drug use VII.1.1 Drug markets VII.1.2 Availability and supply VII.1.3 Drug seizures VII.1.4 Prices and purities NCHM, NDO 2011 Drug Situation in the Republic of Moldova, annual report II

4 VIII Trends per drug VIII.1 Cannabis VIII.2 Opioid/heroin VIII.3 Synthetic drugs VIII.4 LSD VIII.5 Cocaine/crack VIII.6 Limitations IX Strategies in demand reduction at national level IX.1 School programmes IX.2 Reduction of drug related harm IX.3 Introduction IX.3.1 Description of interventions IX.3.2 Standards X Treatment X.1 Drug-free treatment and health care at national level X.2 After-care and reintegration X.3 Substitution and maintenance programmes XI Interventions in the Criminal Justice System XI.1 Assistance to drug users in prisons XI.2 Alternatives to prison for drug-dependent offenders XII Annex XII.1 Lists of tables XII.2 Lists of figures XII.3 Amendments and completions of names and quantities of narcotic and psychotropic substances and the precursors subject to control, according to GD No. 825 of XII.4 List no.1 Narcotic substances XII.5 References NCHM, NDO 2011 Drug Situation in the Republic of Moldova, annual report III

5 National Drug Observatory National Drug Observatory Background Following the recommendations of the Program for the Prevention of Drug Abuse and Fight Against Drug Trafficking in Belarus, Ukraine and Moldova (BUMAD Program), funded by the European Union and co-funded and implemented by the UNDP Moldova, the Interdepartmental Commission of the Government for Drug Abuse and Drug Trafficking Control created a unit responsible for centralized analysis of non-confidential data on drug abuse and drug trafficking within the Ministry of Health of the Republic of Moldova by Decision no.2 of February 27, According to the Order of the Ministry of Health of the Republic of Moldova no.164 of May 18, 2004, this unit, also known as the National Drug Observatory (National Focal Point in the European Union terminology), was established under the National Centre for Health Management. The Objectives of NDO Creation and maintenance of a national integrated, inter-ministerial, functional, comprehensive drugrelated informational system for data collection from the source, data processing and data analysis in order to generate reliable and detailed information on drug situation in the Republic of Moldova. Participation in setting political and scientific basis for prevention measures and combating drug phenomenon interventions in the Republic of Moldova. Strengthening European and international cooperation in the field of drug abuse and illicit drug trafficking monitoring and evaluation. The Importance of NDO The NDO is the authority responsible for the centralized analysis of non-confidential data on drug abuse and illicit drug trafficking in the Republic of Moldova. Its role is to collect, analyze and release genuine, objective, reliable, and comparable information regarding drugs and drug addiction with a view to the provision of a clear and fundamental picture of these phenomena at national and European levels. Since its foundation, the NDO has focused its activities on enhancing data availability and quality in the field of drug abuse and drug trafficking. NDO monitors the situation in the given field and is responsible for annual reporting on drug abuse and illicit drug trafficking in the Republic of Moldova. Executive Summary The political situation of 2011 is described by the important step made by the Republic of Moldova in adopting Government Decision No of on the approval of the National Anti-Drug Strategy for and the National Anti-Drug Action Plan for , which is integral part of the Strategy. The Strategy is based on the Single Convention on Narcotic Drugs adopted on 30 March 1961 in New York and amended through the Protocol Amending the Single Convention on Narcotic Drugs adopted on 25 March 1972 in Geneva, The Convention on Psychotropic Substances adopted on 21 February 1971 in Vienna, The Convention Against Illicit Traffic in Narcotic Drugs and Psychotropic Substances adopted on 20 December 1988 in Vienna, The Political Declaration Guiding Principles of Drug Demand Reduction adopted in Special Session of the UN General Assembly Devoted to Countering the World Drug Problem Together in 1988, as well as the European Drugs Strategy for , which are considered legal and major instruments in adopting drug problem. NCHM, NDO 2011 Drug Situation in the Republic of Moldova, annual report 1

6 Executive Summary The 2011 Annual Report is based on the information provided by central public authorities, national governmental organizations, non-governmental organizations and specialized institutions that collect data to generate indicators recommended by EMCDDA. The report displays the data within the limits of their availability. The epidemiological indicators used in the Report are: Prevalence of drug use, Demand for treatment, Problem drug use, Drug-related infectious diseases, Drug-related mortality, Drug-related crimes, Other indicators. Prevalence of drug use among general population According to the 2010 survey, cannabis is the most used drug among general population. Thus, 3.8% of the population of the Republic of Moldova on the right bank of the River Dniester with the age between years used marihuana/cannabis at least once (lifetime prevalence); 0.7% declared the consumption during the last year (last year prevalence) and 0.3% of respondents used marihuana/cannabis in the last month (last month prevalence). The lifetime prevalence of cannabis use is 9 times higher among male respondents (7.3%) as compared to female respondents (0.8%). The lifetime prevalence of ecstasy use is 0.5%, and of opium 0.4%. Other drugs registered a smaller prevalence. 153 persons of the total number of respondents reported the use of sedative drugs and/or tranquilizers during the last 12 months, which constitutes 3.8% of the total sample. Out of the total number of persons who used drugs in the last 12 months, 41.8% used them once a month or less. Only 29 persons reported the use of drugs 4 times a week or more often, 27 persons consumed 2-3 times a week, and 30 persons consumed 2-4 times a month. 86 people of the sample, or 2.1%, consumed sedative drugs and/or tranquilizers in the last 30 days. Prevalence of drug use among young people The survey carried out in 2010 among young people of years from the right bank of the River Dniester showed that the most used drugs are marihuana and cannabis, and thus, the lifetime prevalence of the abovementioned drug is 4.9%, prevalence in the last 12 months 2.3% and prevalence in the last 30 days is 1.3%. The prevalence for other drugs showed a decrease [1]. The use of tranquilizers or sedative drugs during the last 12 months is reported by 2.8% of respondents. Prevalence of drug use among students According to ESPAD 2011, the lifetime use of any illicit drug among students from the Republic of Moldova on the right bank of the River Dniester is 7%, which is by 11% less than European average level; as compared to 2007, the 2011 data did not register significant changes. The lifetime use of marihuana or cannabis among the students of the Republic of Moldova is 5%, with no changes compared to 2007, but by 12% less than European average level (17%) [2]. Prevalence of drug use among detainees According to the results of integrated bio-behavioural surveillance survey carried out in 2010 among detainees on the right bank of the River Dniester, out of a representative sample of 530 respondents, 43.3% NCHM, NDO 2011 Drug Situation in the Republic of Moldova, annual report 2

7 Executive Summary know people who use drugs, 25.5% used drugs at least once and 8.9% (47 respondents) injected drugs at least once. In the last 12 months, the injection of drugs was reported in 3.0% of cases (16 respondents). The average age of the respondents who used drugs at least once is 32.7 years (44 males and 3 females). Problematic use of injecting drugs The number of drug users, according to 2011 data, on the right bank of the River Dniester is ~ 21 thousand, and on the left bank of the River ~ 10.5 thousand. The estimation was undertaken through network scale up method, multiplier method and nominal technique among IDU in Chisinau, Balti Municipalities and Tiraspol City. Data analysis was made through RDSAT statistics analysis software. The integrated bio-behavioural surveillance survey among the injecting drug users (IDU) in 2009/2010 [3] showed that the most often injected drug was opium. According to the data, 92.2% of cases followed by 4.3% of heroin cases were reported in Balti Municipality. Chisinau 69.2%, followed by 8.9% of heroin cases. In Tiraspol there are 87.6% users of opium, 3.1% of heroin users. As for the non-injecting drugs, the highest rate of use during the last month in Balti was the marihuana (30.4%). In Chisinau and Tiraspol, the cannabis is the most widespread non-injecting drug (Chisinau: marijuana 67.4% and cannabis 16.5%; Tiraspol: marijuana 58.9% and cannabis 13.2%). According to the results of the mentioned survey, the direct share of syringe during the last month was seldom reported (in Balti 92.4%, Chisinau 97.8%, Tiraspol 77.6% of respondents used sterile syringes for the last injection, and 98.0%, 97.3, and 85.2% of respondents who inject drugs from Tiraspol, Chisinau, and Balti, respectively, affirmed that they did not offer/sell/borrow the needles and syringes during the last month). Less than a half of respondents from Balti (42.9%), Chisinau (45.2), and Tiraspol (41.1%) declared that they inhaled the drug from a common container. The respondents who injected the drug from a pre-packed syringe were reported in Balti (51.2%), Chisinau (44.7%), and Tiraspol (60.1%). The respondents who declared that they divided the dose through top and bottom side of the syringe in Balti (17.8%), Chisinau (1.6%), and Tiraspol (6.5%). The drug stores were declared the main source of buying sterile syringes by respondents (63.1 % in Balti, 96.2% in Chisinau, 71.1% in Tiraspol, followed by the respondents who mentioned the services of syringe exchange points (25.8% in Balti, 2.7% in Chisinau, 12.7% in Tiraspol). Use of condom during the last sexual intercourse is 61.2% in Balti, 34.9% Chisinau, and 38.0% in Tiraspol. Demand for treatment This indicator comprises the information on the treatment system, describes the data collection procedure about the officially registered drug users, the assistance programmes and accessible service provision systems for drug users, both in civil and penitentiary sector. Moldova s data collection about the officially registered drug users under medical supervision is vested with the RND that adds all the new officially registered cases into the database and ensures its maintenance. In 2011 as in previous years, the detoxification was the main service available for the drug users in the national health services system. The number of patients that benefited from detoxification in in-patient units for the first time in 2011 within RND was 381 persons. According to DPI data, there were undertaken 49 detoxifications within the penitentiary system in Another service rendered within public health system is the detoxification of drug addicts; in 2011 this service was offered within RDN (Drug Addiction Rehabilitation Centre) to 319 persons. NCHM, NDO 2011 Drug Situation in the Republic of Moldova, annual report 3

8 Executive Summary At the end of 2011, 23 territorial-administrative units offered syringe exchange services within harm reduction programmes. The aggregate number of beneficiaries of the syringe exchange service within the harm reduction programme was in 2011 and in In 2011, the harm reduction programme was available in 13 penitentiary institutions on both banks of the River Dniester; the syringe exchange programme was implemented in 9 penitentiaries (right bank). The harm reduction programme on the left bank is implemented in 3 penitentiaries. Methadone substitution treatment is available in 7 penitentiaries on the right bank of the River Dniester. As of 31 December 2012, the number of beneficiaries under methadone substitution treatment was 334 patients, out of which 270 patients from the civil system and 56 patients from the penitentiary system. Drug-related mortality Data sources available in the Republic of Moldova: 1. CLM. In 2011, 20 cases out of 73 toxic tests of samples collected from the bodies suspected of illegal drug use were positive. 2. General Register of Mortality held by the NCHM. A decrease of the drug-related deaths number is registered in 2011 as compared to 2010 (4 and 6 cases, respectively). 3. RDN. During a decrease of the number of deaths of registered drug users from 123 cases in 2000 to 0 cases in 2012 was recorded. Drug-related infectious diseases Most information in this chapter is based on the results of integrated bio-behavioural surveillance survey (IBSS) 2009/2010. According to the results of this survey, in 2009 the prevalence of Hepatitis C Virus (hereinafter referred to as HCV) among IDU is 72.8% in Chisinau, 70.2% in Balti and 20.5% in Tiraspol. The highest prevalence of the Hepatitis B Virus (hereinafter referred to as HBV) was registered in Balti 14.2%, followed by Chisinau with 10.9% and Tiraspol with 7.5%. According to the same source, the prevalence of HIV in Balti Municipality registers 39.8%, in Chisinau is 16.4% and Tiraspol -12.1%. Average weighted prevalence (according to the estimated number) of HIV among injecting drug users is 17.0% on the right bank of the River Dniester. In accordance with the NPHC data, 3208 HIV tests were made in 2011 (690 in the medical institutions from the left bank of River Dniester) having the purpose to test the injecting drug users (Code 102). The real number of injecting drug users tested for HIV in the reporting period could be higher, because not all cases are tested based on Code 102. Sixty four new HIV cases among IDU were discovered in The cumulative number of HIV-infected IDU is 2685 cases between 1987 and Tuberculosis data on both banks of the River Dniester are stored in an electronic database (SIME TB) at the NCHM. In 2011, on both banks of River Dniester, 60 out of 4675 patients with tuberculosis, new cases and relapses, declared that they use drugs. Drug-related crimes Error! Reference source not found. According to the data provided by the ADMIA, 1606 drug-related crimes were registered in 2011, and narcotic substances were removed from illicit trafficking in the amount of about MDL million (1.5 kg of NCHM, NDO 2011 Drug Situation in the Republic of Moldova, annual report 4

9 Executive Summary heroin, 6 litres of opium, 2.4 kg of amphetamine, 26 t of narcotic plants, 15.3 kg of cannabis, 213 kg of marihuana). As a result of actions of fighting illicit drug trafficking, 32 mobs that were involved in drug trafficking and 2 criminal branches, specialized in marihuana and heroin trafficking, were discovered and annihilated; thus, 12 cases of drug smuggling were discovered. As for gender distribution of persons criminally charged with drug trafficking in the last 3 years, the share of women is decreasing, while the ratio of men is growing. Thus, in 2008 the rate of women criminally investigated was 27.6%, and 15.9% in 2011 (men 80.3% in 2009 and 84.1% in 2011, respectively). In the case of men involved in drug-related crimes, the highest rate is registered in the age group of 30 years and older, which accounted for 49.7% in 2009, and decreased by 6.5% in %. Most of the people involved in growing of plants with narcotic substances are 30-year old or older people (85.0%). Out of this number, the share of women between 30 years and older (96.0%) is higher than the share of men in the same age group (76.0%). Accessibility of drugs According to the results of ESPAD 2011 survey, on average, boys more often than girls consider cannabis as being easily obtained, 7% compared to 4% [2]. According to HIV/AIDS-related Knowledge, Attitude and Practice Surveys among the y.o. general population undertaken in 2010, there were no differences in the answers regarding the availability of different types of drugs, except for marihuana, in general population. On average, 18.0% of respondents affirmed that it is easy to find/buy drugs [4]. NCHM, NDO 2011 Drug Situation in the Republic of Moldova, annual report 5

10 Country Information Country Information The Republic of Moldova is located in the southeast of Europe. The country borders Ukraine in the north, south, and east and Romania in the west. The Republic of Moldova has become independent on August 27, It is a parliamentary republic and the President is elected for Figure 1 Geographical location of the Republic of Moldova a 4-year mandate by the Parliament. The total length of the border is 1,389 km, 450 km with Romania and 939 km with Ukraine. The country s surface area is 33,843 sq km; 472 sq km are waters especially the Danube and Dniester Rivers, and Prut and Raut Rivers, and Beleu, Bic and Dracele lakes. Although the Republic of Moldova is a landlocked country, the Giurgiulesti port on the Danube River ensures the maritime transport. Following the political conflict of the 1990s, currently frozen, the territory on the left bank of the River Dniester is not fully controlled by the Government of the Republic of Moldova. According to the data of the National Bureau of Statistics (2011 data), thousand people or 41.6% of the population is urban and thousand people or 58.4% rural. The gender distribution is as follows: females 51.9% and males 48.1%. The majority of the population (93.3%) identifies themselves as Orthodox Christians. The biggest cities on the right bank of the River Dniester are the capital city, Chisinau (with a population of thousand), and the city of Balti (148.9 thousand). Administratively, the Republic of Moldova is divided into 35 districts (rayons), 3 municipalities (Chisinau, Balti, and Comrat), and the Transnistrian region (with 2 municipalities: Tiraspol and Bender). Table 1.The socio-economic situation, the Republic of Moldova (right bank of the Dniester River), 2011 Year Indicator value Source Population, thousands ,4 National Bureau of Statistics GDP per capita in PPS (Purchasing Power Standards) National Bureau of Statistics Unemployment rate, % of labor force National Bureau of Statistics Population below poverty line National Bureau of Statistics Prison population rate (per 100,000 of national population) Ministry of Justice NCHM, NDO 2011 Drug Situation in the Republic of Moldova, annual report 6

11 Developments in drug policy and responses I Developments in drug policy and responses I.1 Introduction Taking into account the globalization of drug use and illicit trafficking problem, the Republic of Moldova develops and enhances its anti-drug normative basis. The appearance of new narcotic and drug substances, as well as new generation synthetic substances with severe health consequences represent a huge danger lately. The Republic of Moldova took an important step in 2010 by approving the National Anti-Drug Strategy and the National Action Plan As it was the case over the last years, the Moldovan Government has limited control over its territory on the left bank of the River Dniester, thus the enforcement of the national policy and legal framework as described below apply only to the territory on the right bank of the River Dniester. I.2 Political framework in the drug field The National Anti-Drug Strategy for the years The National Anti-Drug Strategy for and the National Action Plan for , which is a part of the Strategy, were approved by Decision no of with a view to the enforcement of Law no. 382-XIV of May 6, 1999 on the Circulation of Narcotic and Psychotropic Substances and Precursors and fulfillment of the commitments assumed by the Republic of Moldova on combating drug addiction and narco-business. This Strategy is a key government document that describes the current situation in the field, and defines the objectives, actions and measures necessary to establish clear responsibilities for all actors involved in the prevention and suppression of drug use and/or illicit drug trafficking. This document defines the starting points and ways to follow in tackling the issue of drug use, as well as the basic framework for creating and implementing the drug policy. The Strategy is developed in accordance with the European Union Drugs Strategy for , is based on the Single Convention on Narcotic Drugs, adopted in New York on March 30, 1961 and amended by the Protocol modifying the Convention, adopted in Geneva on March 25, 1972, the Convention on Narcotic Psychotropic Substances, adopted in Vienna on February 21, 1971, the Convention against Illicit Drug and Psychotropic Substances Trafficking adopted in Vienna on December 20, 1988, the Political Declaration on the Guidelines of Drug Demand Reduction, adopted at the Special Session on Drugs of the UN General Assembly in 1988, considered to be the major legal instruments in tackling drugs issues. [5] In addressing the drug use problem, the Republic of Moldova takes into account the concept of the World Health Organization "Health for All in the 21st Century", according to which drug use is a problem that endangers public health and may hinder the healthy development of citizens and society in a broader context. This Strategy aims at a complex, multidisciplinary and balanced approach to the drug use- related problems, based on a complex, interdepartmental, interdisciplinary and cross-sector cooperation at all levels, based on three component parts as the foundation of modern drug policy, which do not substitute each other, but complement each other: 1. drug supply reduction (exercise control over the legal circulation of drugs and responding to illicit trafficking and illicit drug distribution); 2. drug demand reduction (primary prevention of drug use, treatment, social reintegration of drug users) 3. harm reduction. In this regard, the drug policy will be based on four basic pillars: (1) primary prevention, (2) treatment and rehabilitation, (3) harm reduction, (4) drug supply reduction. NCHM, NDO 2011 Drug Situation in the Republic of Moldova, annual report 7

12 Developments in drug policy and responses In the context of balanced application of the basic components listed above, the National Anti-Drug Strategy will have the following general objectives: 1. Reduce traffic to and through the Republic of Moldova. 2. Reduce the supply and accessibility of all types of drugs. 3. Maintain the trend of reducing the number of crimes. 4. Increase activism in order to detect primary drug traffickers, not users. 5. Reduce and stabilize the use of all types of drugs and the associated consequences, by stabilizing and maintaining the number of persons under observation. Specific objectives: 1. Improve the quality of the current system. 2. Establish an appropriate organizational and functional framework for achieving a set of measures in the field of drugs. The Action Plan serves as the basic mechanism for implementation of the Strategy, establishes in the identified areas specific purposes and activities to achieve them, expected results/benefits, deadlines, responsible institutions and indicators to monitor the implementation. The tasks pursued in the National Anti- Drug Strategy for are: 1. Stabilization and reduction of drug use in the society, especially among minors. 2. Reduction of risks related to the use of all types of drugs and of the economic, health, social, criminal and security effects on the citizens and society. 3. Increase the quality of life of all types of drug users, of their families and other persons in their circle by offering a wide range of qualitative services of harm reduction, treatment, rehabilitation and reintegration. 4. Reducing the accessibility of drugs, especially among teenagers through the appropriate use of legal and institutional instruments. 5. Stopping and reducing the growing of domestic plants with narcotic content for drug production in the Republic of Moldova. Institutional framework In order to implement the National Anti-Drug Strategy for and the National Anti-Drug Action Plan for , approved by Government Decision no of December 27, 2010 and in order to fulfill the commitments assumed by the Republic of Moldova regarding the response to illicit drug trafficking and drug use, amendments were made to Law no. 382-XIV of May 6, 1999 on the Circulation of Narcotic and Psychotropic Substances and their Precursors. Thus, in the Law, the phrase Interdepartmental Commission for Fighting Drug Addiction and Narco-business is replaced with the National Anti-Drug Commission, which is an interdepartmental body established by the Government to promote the State s policy on the movement of narcotic and psychotropic substances and precursors. The duties of the National Anti-Drug Commission are as follows: 1. to implement the requirements stipulated in the international conventions of the United Nations, such as Single Convention on Narcotic Drugs (1961), Convention on Psychotropic Substances (1971) and the Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances (1988), to which the Republic of Moldova is a party; NCHM, NDO 2011 Drug Situation in the Republic of Moldova, annual report 8

13 Developments in drug policy and responses 2. to create a platform for on-going communication with the central government and local public authorities that contribute to the implementation of the drug policy in order to implement the actions set out in the National Anti-Drug Action Plan approved by the Government; 3. to develop proposals to improve the legislation in the field; 4. to ensure coordination of activities undertaken by specialized institutions and nongovernmental organizations to reduce drug demand and supply; 5. to implement the measures provided for in the National Anti-Drug Action Plan; 6. to cooperate with non-governmental organizations, with external partners, with other bodies for providing technical and financial support necessary to achieve the objectives stipulated in the National Anti-Drug Strategy and the National Anti-Drug Action Plan, together with the Ministry of Health and Ministry of Labour, Social Protection and Family of the Republic of Moldova; 7. to develop national programs for the organization of integrated medical and social assistance (medical, social assistance, rehabilitation, harm reduction etc.) for drug users, together with the institutions concerned; 8. to conduct research on the drug phenomenon, together with representatives of central government and local public authorities, of nongovernmental organizations to develop programmes for preparing and training the staff regarding the anti-drug behaviour; 9. to ensure on-going collaboration with media representatives to promote a healthy lifestyle and inform the society on the output of actions undertaken by the central government and local public authorities, as well as the nongovernmental organizations, in order to reduce the drug demand and supply; 10. to establish mechanisms for carrying out projects and programs to combat illicit drug trafficking, develop new methods in this field, based on international experience. The nominal composition of the National Anti-Drug Commission was approved by Government Decision no.481 of Annex no.1 presented in Table 2. Table 2. Nominal Composition of the Interdepartmental Commission to Fight Drug Addiction and Narco-business ( ) March 2008 November 2009 June 2011 Deputy Prime Minister, Chairman of the Commission Deputy Minister of Internal Affairs, Deputy Chairman of the Commission Head of Permanent Committee on Drug Control, Deputy Chairman of the Commission Senior Consultant in the State Chancellery, Secretary of the Commission Prime Deputy Minister of Health Prime Deputy Minister of Education, Youth and Sports, Chairman of the Commission Deputy Minister of Internal Affairs, Deputy Chairman of the Commission Senior Consultant in Special Issues, Office of the Government, Secretary of Commission Deputy Minister of Deputy Prime Minister, Chairman of the Commission Deputy Minister of Internal Affairs, Deputy Chairman of the Commission Senior Consultant in Special Issues, Office of the Government, Secretary of Commission Deputy Minister of Health Deputy Prime Minister, Chairman of the Commission Deputy Minister of Internal Affairs, Deputy Chairman of the Commission Head of Anti- Drug Department under the Ministry of Internal Affairs, Secretary of Commission Deputy Minister of Health Deputy Minister of Justice Deputy Minister of Local Public Deputy Prime Minister, Chairman of the Commission Minister of Internal Affairs, Deputy Chairman of the National Commission Minister of Health, Deputy Chairman of the National Commission General Director of the Outpatient Department, Public medical-sanitary institution, Republican Dispensary of Narcology under the Ministry of Health, Secretary of National Commission NCHM, NDO 2011 Drug Situation in the Republic of Moldova, annual report 9

14 Developments in drug policy and responses Minister of Foreign Affairs Deputy Minister of Labour, Social Protection and Family Prime Deputy Minister of Justice Psychiatrist- Narcologist, Doctor of Medical Sciences Deputy Minister of Education and Science Deputy Director of Customs Control Department under the Ministry of Finance Head of Anti-Drug Department under the Ministry of Internal Affairs Head of Fighting against Smuggling Division of the Customs Control Department under the Ministry of Finance Senior Consultant in the Office of the President of the Republic of Moldova Health and Social Protection Deputy Minister of Justice Deputy Minister of Local Public Administration Prime Deputy Director of Customs Service Director of Medicines Agency Chief Narcologist of the Ministry of Health and Social Protection Head of the Anti-drug Division, Ministry of Internal Affairs, Deputy Head of General Division, Intelligence and Security Service Head of Division, General Prosecutor s Office Head of Outpatient Department, Public medicalsanitary institution, Republican Dispensary of Narcology under the Ministry of Health and Social Protection Deputy Minister of Justice Deputy Minister of Local Public Administration Prime Deputy Director of Customs Service Director of Medicines Agency Chief Narcologist of the Ministry of Health Head of the Anti-drug Division, Ministry of Internal Affairs Deputy Head of General Division, Intelligence and Security Service Head of Division, General Prosecutor s Office Head of Outpatient Department, Public medicalsanitary institution, Republican Dispensary of Narcology of the Ministry of Health Administration Deputy Minister of Education and Youth Deputy Minister of Social Protection, Family and Child Director of General Division of the Border Guard Service Interim Head of the Customs Fraud Division, Customs Service Head of the Pharmaceutical Inspection, Medicines Agency Chief Narcologist of Outpatient Department, Public medicalsanitary institution, Senior Specialist in Narcology, Ministry of Health Head of the Anti-drug Division, Ministry of Internal Affairs, Head of Division, Intelligence and Security Service Head of Division, General Prosecutor s Office Head of Outpatient Department, Public medicalsanitary institution, Republican Dispensary of Narcology Minister of Justice Minister of Defence Minister of Education Minister of Youth and Sports Minister of Labour, Social Protection and Family Deputy Minister of Foreign Affairs and European Integration General Director of the Border Guard Service General Director of the Customs Service of the Ministry of Finance Director of Intelligence and Security Service Prime Deputy Director of Medicines Agency under the Ministry of Health Chairman of the Steering Committee for Drug Supervision under the Ministry of Health Head of Anti-drug Division of the General Division of Operational Services of the Police Department of the Ministry of Internal Affairs Head of National Drug Observatory within the National Centre for Health Management Representative of Soros-Moldova Foundation Representative of the UN Office on Drugs and Crime in the Republic of Moldova NCHM, NDO 2011 Drug Situation in the Republic of Moldova, annual report 10

15 Developments in drug policy and responses The Secretary of the National Anti-Drug Commission has the role to organize and monitor the implementation of the operating regulations of the Commission, to organize the liaison between central public administration authorities and non-governmental organizations involved in reduction of drug demand and supplyrelated activities, and other responsibilities that lead directly to enhanced collaboration between the key institutions involved. During 2011, the Commission held 4 sessions, which addressed the activities undertaken by all stakeholders involved in the implementation of the National Anti-drug Action Plan for I.3 Legal framework Administrative Offences Code Modifications and amendments to the Code of Administrative Offences approved in 2008 foreseen the introduction of legal person s liability and the application of unpaid community service as a sanction for some drug-related administrative offenses. According to the Code s provisions: Art. (85), simple drug use is considered administrative offence, and not a crime. Thus, the illegal purchase or possession of narcotic drugs or psychotropic substances in small quantities without the intention to distribute them, as well as their use without medical prescription, is sanctioned with a fine from 3 to 10 conventional units or community service up to 40 hours. At the same time, an individual who gives away willingly narcotic drugs or a psychotropic substance possessed illegally, or addresses or intends to address willingly to a medical institution for health care assistance due to drug or psychotropic substances use, is exempted of liability for the actions provided for in this article; The Penal Code Art. (86), the failure to take measures, foreseen by the legislation, for ensuring the prescribed protection regime of cultures of opium poppy, cannabis, coca, and other plants, of places used to store and process the harvest of these cultures, the failure to take measures for the destruction of what remains after harvesting and of processing residuals which contain narcotic drugs and other psychotropic substances. This administrative offence is punished with a fine from 70 to 150 conventional units for officials and from 200 to 300 conventional units for legal entities; Art.(87), the illegal cultivation of plants that contain narcotic drugs or other psychotropic substances, even in small quantities and with no intention to sell. This administrative offence is punished with a fine from 30 to 50 conventional units for a natural person, from 100 to 300 conventional units for an official, and from 300 to 400 conventional units for legal entities, with or without freedom deprivation, in all cases, of the right to practice a certain activity for a period between 6 months and one year. Essential modifications and amendments of the norms that regulate the punishments for drug-related crimes were made in 2008 and The imprisonment punishment was abolished and (or) promoted, or increased, depending on the case, by applying the administrative contravention as a punishment. Being an essential progress, the new provisions are in line with the international norms, according to the expertise carried out by the Council of Europe and other independent expertises, by humanising the criminal punishments, promoting alternative punishments to imprisonments, and adjusting the national criminal law. The main features of the amending process are the reduction of the minimum and maximum levels of punishments (especially imprisonment) and generally, reviewing all punishments prescribed by the law for specific crimes, the exclusion of the concept of repeated crime, and the logical arrangement of the Criminal Code content. NCHM, NDO 2011 Drug Situation in the Republic of Moldova, annual report 11

16 Developments in drug policy and responses Amendments to Law no. 382-XIV of May on the Circulation of Narcotic and Psychotropic Substances and Precursors Law no. 382-XIV of May 6, 1999 on the Circulation of Narcotic and Psychotropic Substances and Precursors is the main legal act that promotes the state policy on drugs and aims at promoting the state policy as regards the circulation of narcotic and psychotropic substances and precursors, human health protection, ensure social and state security. According to the amendments proposed in 2011, this law establishes the institutional framework by setting up the National Anti-Drug Commission and its duties (see above). Amendments to Law no. 713 of December on Control and Prevention of Drug Abuse, Illicit Use of Drugs and Other Psychotropic Substances The Law sets forth the state policy on the control and prevention of the abusive use of alcohol and of the illegal use of drugs and other psychotropic substances, the reduction and eradication of such use, the education of the population in a spirit of abstinence and of a healthy lifestyle, as well as the elimination of the consequences of physical and/or psychological addiction to them. In order to improve the preventive legal framework, the Law was subject to amendments and completions, which were adopted in December 2008 (Law No. 260 of ). The amendments improve the terminology used by the law in order to avoid gaps and eliminate erroneous interpretations. The law foresees that driving schools will be obliged to provide in their curricula an 8-hour course on anti-alcohol and anti-drug education in groups of a maximum of 15 persons. The consumption of narcotic drugs without a medical prescription will be determined on the basis of the results of a medical examination and an examination of biological liquids. Other amendments refer to the procedure of providing ordinary medical assistance (specialists in charge, rules to be followed, appeal procedure, settlement of disputes etc.) and narcological medical assistance (the types of narcological medical assistance, specialists in charge, situation in which it occurs, termination of assistance etc.). List establishing the quantities of narcotic drugs, psychotropic substances, and plants that contain these substances, identified in illegal trafficking The List of narcotic drugs, psychotropic substances, and plants that contain these substances, identified in illegal trafficking, as well as their quantities was adopted by Government Decision No. 79 of 23 January 2006 to tackle issues pertaining to fighting against illicit trafficking in drugs, psychotropic substances, and plants that contain these substances, identified under Article para (4) and (5) of the Criminal Code of the Republic of Moldova. This list is used by the law enforcement bodies in the qualification of a drug-related action/inaction as a drug crime or administrative offense, depending on the quantity of substances identified and under control. This list defines small, large and very large quantities for each drug, psychotropic substances or plants containing such substances. The illicit actions/inactions with small quantities of illegal drugs, psychotropic substances or plants containing such substances are punishable under the Administrative Offences Code of the Republic of Moldova. Similar actions/inactions with large and very large quantities are punishable under the Criminal Code of the RM. The quantity includes the mixture of narcotic and/or psychotropic substances with precursory, supplements (medical substances, acids, glucose, starch, flour, etc.), in any state of aggregation. Small, large and extremely large quantities of analogue narcotic and psychotropic substances correspond to the calculated amounts of narcotic and psychotropic substances in the list. Small amount of drugs, psychotropic substances or plants containing such substances is the amount smaller than the large amount defined in the List. Large quantities of drugs, psychotropic substances or precursors that were discovered in illegal trafficking are considered the quantities that exceed small quantities up to maximum quantities indicated in the Table of Large Quantities. Extremely large quantity of drugs, NCHM, NDO 2011 Drug Situation in the Republic of Moldova, annual report 12

17 Developments in drug policy and responses psychotropic substances or precursors that were discovered in illegal trafficking is considered the amount that exceeds large quantity. The list derives from the Tables and lists of narcotic and psychotropic substances and precursors under control according to the UN conventions in the drug field, approved by the Government (GD no.1088 of ). The amendments and completions, including the revision of amounts, to List 1 and List 2, were approved by GD no. 825 of 9 November 2011 (see Annex XII.3). Table 3.Comparative table of large amounts of drugs, Tables and lists of narcotic drugs, psychotropic substances and their precursors subject to control, 2004 and 2011 versions, Republic of Moldova Item 2004 version large quantities 2011 version large quantities Heroin g g Raw Opium g g Cocaine ,5 g g LSD blooters (doses) Poppy plants plants plants Cannabis plants 3-30 plants 6-50 plants Probation Service Alongside with the revision of the Criminal Code of the Republic of Moldova, the probation reform is one of the most important measures taken to humanize the punitive policy of the Republic of Moldova with a view to updating the legal norms and adjust them in accordance with the European standards. The law on probation was passed by the Parliament on 14 February 2008 (Law No. 8 of ) and entered into force on 13 September Law enforcement facilitates the individual punishments, contributing to the prevention of relapses and ensuring the criminals re-socialization. The probation is an important step in the context of alignment of national legislation to the international standards, having the purpose to create an intermediate zone in the punishment system, a re-evaluation of the repressive concept and its re-direction to a curative concept Probation is a set of activities of evaluation, assistance, psychological counseling, and supervision in the community of the person in conflict with criminal law (suspect, defendant, and convict) with a view to his/her reintegration into the society and community protection from the risk of relapse. The subjects of probation are the people in conflict with criminal law; people released from detention, people who require social adaptation. The following persons are considered in conflict with the law: suspect, accused, defendant; exonerated of criminal punishment; exonerated of criminal liability; convicted to unpaid community service, as well as deprived of the right to hold a certain position or carry out a certain activity (Article 3-4 of Law no.8 on Probation of ). The probation has intervention strategies at all levels of the criminal justice process. Thus, there is probation: pre-trial psycho-social evaluation of the personality of the suspect, accused, defendant; community sentence activity oriented towards the social re-integration of people exonerated of criminal punishment through assistance, counselling, behaviour control and supervision of observance of obligations imposed by the court; penitentiary socio-educative activities carried out in the penitentiary and activities aiming at preparing the detainees for release from detention places; post-penitentiary assistance to people released from detention to re-integrate them in the society. The probation service has an important role in the social re-integration of exinmates who face complex drug use-related issues. The law stipulates the development of individual and group NCHM, NDO 2011 Drug Situation in the Republic of Moldova, annual report 13

18 Developments in drug policy and responses programmes, depending on the group of beneficiaries, although it is not specified expressly, specialized programmes dealing with drug users in conflict with criminal law. International cooperation According to the National Action Plan of the National Anti-drug Strategy , Chapter X International Cooperation outlines a specific action: To initiate official cooperation with the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) and use its recourses to continuously develop and enhance the national data and information collection in the field of drugs. This clause is also reflected in the provisions of the National Programme for the Implementation of the EU-RM Action Plan on Visa Liberalization, and namely, endorsement of the Memorandum of Understanding between the Ministry of Health of the Republic of Moldova and EMCDDA. Thus, the endorsement procedure of the Memorandum of Understanding with EMCDDA was initiated in 2011, and as a result, the national efforts of fighting the phenomenon will be included and coordinated with the activities undertaken in Europe. I.4 Implementation of the law In 2011, according to the criminal prosecution cases started by the MIA in the field of drug trafficking, 60.6% were submitted to the court. The data available on the implementation of legislation is limited only to the share of criminal prosecution cases for drug trafficking submitted to courts on the right bank of the River Dniester. Figure 2.The share of cases in which there was a charge of drug trafficking referred to the courts of law for sentencing, %, Republic of Moldova (the right bank of the Dniester River), % 95.6% 96.2% 97.1% 95.5% 92.1% 93.5% 95.6% 92.4% 88.3% 82.8% 80.6% 80.9% 73.40% 71.40% 60.60% 61.50% Source: MIA The fluctuations of the indicator values cannot be thoroughly explained due to the lack of additional relevant information. These fluctuations are caused by legislative changes that occurred during The Ministry of Internal Affairs has prioritized its work over the last three years, focusing rather on combating drug distribution, discovery of drug trafficking networks and drug manufacturers than on arresting/persecuting the drug users. These priorities have probably led to the increased criminal prosecution period as a result of the complexity of registered cases. For details about the legal changes, see Chapter Treatment. The feedback information mechanism regarding the verdict of the court on each criminal prosecution case is deficient in what regards NCHM, NDO 2011 Drug Situation in the Republic of Moldova, annual report 14

19 Developments in drug policy and responses efficiency and computer processing, which does not allow for a thorough analysis of the law. The lack of a modern information system has an impact on the data presented for analysis to the National Drug Observatory. I.5 Developments in public attitudes and debates The second survey among the general population has been carried out in 2010; its main objective was to measure the knowledge, attitudes and practices regarding HIV/AIDS and psychotropic drug use among the general population [4] (hereinafter referred to as KAP years). The details about sampling are presented in the Paragraph Drug Use among the General Population The respondents answered the following questions in the study: what is the attitude toward drug users, drug use and legalization of certain types of drugs. One third of respondents think of a drug user as mostly a patient, and 23.4% think of a drug user as mostly a criminal (Figure 3). As compared to the 2008 survey, the share of persons who think that the drug user is a patient has decreased (from 43.4% to 38.7%), and the share of those who think of them as criminals has increased (from 21.7% to 23.4%). Figure 3 KAP years: The attitude of respondents toward the drug users 20% 10% 23,4% 7,9% 38,7% Eventual legalization of cannabis use was disapproved 2 by 92.7% of the sample and locally produced heroine and opium use by 94.6%. The share of those who disapprove the drug use increases with the age of respondents. Thus, the percentage of those who answered I definitely disapprove" increases with age and of those who answered "I rather disapprove" decreases with age. Most respondents disapproved of the frequent use of legal drugs (alcohol and tobacco) and the illicit drug use (Figure 3). 2 The disapproval answer category included the answers I disapprove and I rather disapprove. NCHM, NDO 2011 Drug Situation in the Republic of Moldova, annual report 15

20 Prevalence, Patterns and Developments in drug use Figure 4.KAP years: The percentage of respondents who disapprove legal and illegal drug use Injecting drugs 96.7% Trying heroin/other opiates once or twice 96.2% Trying ecstasy once or twice 94.5% Smoking marijuana or hashish occasionally 95.1% Smoking 10 or more cigarettes a day 80.9% Having one or two drinks several times a week 50.9% As compared to 2008 data, there is a decrease in the disapproval of drink 1-2 standard glasses several times a week (from 55.3% to 50.9%) and Smoking of 10 or more cigarettes a day (from 84.2% in 2008 to 80.9% in 2010). I.6 Budget and funding arrangements It is not possible to measure/estimate the expenditures of the national budget spent on fighting against drug use and on other measures of fighting against illicit drug trafficking in The executed budget is presented in a consolidated budget line. Currently, it is not possible to disaggregate the amount of funds disbursed by the National Health Insurance Fund for contracting rehabilitation services; only the disbursements per each medical institution are available. Data on public funding will became available once the National Anti-drug Strategy and National Action Plan for are implemented. Currently, there is no data available for this chapter. The harm reduction activities are funded exclusively from external sources, specifically from the Global Fund grant. A substantial deficit is expected in the following 2-3 years because of the cut in the foreign funds planned for such type of activities and due to decreased purchasing power of the American dollar. In 2010, the UNODC has launched a project for , to assist the country to provide drug users, prisoners and people vulnerable to human trafficking with comprehensive HIV prevention, treatment, care and supporting services. The UNODC provides technical assistance to review and adapt national HIV, illicit drugs and criminal justice policies and legislation and build the capacity of national stakeholders, including civil society and community organizations, to ensure optimal coverage of these groups with HIV services. The total project budget is USD 690,500. II Prevalence, Patterns and Developments in drug use II.1 Main developments and emerging trends II.1.1 Surveys on drug use in the population The prevalence and patterns of drug use in the general population are estimated through surveys based on representative samples of the population of interest. Surveys allow a direct estimation of the prevalence of drug use, via the share of the population that reports having used specific drugs. Interview surveys are based on NCHM, NDO 2011 Drug Situation in the Republic of Moldova, annual report 16

21 Prevalence, Patterns and Developments in drug use the self-reporting of participants regarding their present and past behaviours, personal characteristics, and knowledge and attitudes regarding drug topics (according to EMCDDA recommendations). The Republic of Moldova uses 3 standard indicators to assess the drug use: Lifetime prevalence (use of a drug in any period of life), Last year prevalence, Last month prevalence. The lifetime prevalence is less sensible to reflect current situation among three standard indicators. This indicator does not reflect current situation of drug use, but can be useful to understand drug use patterns and the incidence of first use. The focus is on the drug use events from the last year and last month. II.2 Illegal Drug use in the general population The data used were collected during the KAP years Survey based on a representative age sampling of years on the right bank of the River Dniester [4]. The final study sampling was 4060 respondents, with a maximum error of ±1.6%. The data were weighted to bring the structure of the survey sample to the official structure of the population by gender, age groups and type of households in accordance with the NBS data. The data of the analogical 2008 survey were used for comparison/trends [6]. The drug prevalence values for the general population (15-64 years old) are low, except for cannabis. From the epidemiological and policy point of view, the analysis of the youth group (15-24 years old or years old) is relevant, especially among male respondents, where the drug use is mainly concentrated. The results of the survey show that the prevalence of cannabis over the last year among men is 15 times higher than among women, the largest difference between the genders being registered in the year age group. The greatest gender difference in the prevalence of lifetime cannabis use was registered in the year age group (Table 4). Table KAP compared to 2008 KAP among age group: prevalence of the cannabis use among general population, desegregation by age groups and gender Age groups KAP 2008 KAP 2010 Male Female Total Male Female Total years years years years years years Lifetime prevalence, % Last year prevalence,% Last month prevalence,% Lifetime prevalence, % Last year prevalence, % Last month prevalence, % Lifetime prevalence,% Last year prevalence, % Last month prevalence, % Lifetime prevalence, % Last year prevalence, % Last month prevalence, % Lifetime prevalence,% Last year prevalence, % Last month prevalence, % Lifetime prevalence, % Last year prevalence, % Last month prevalence, % Total Lifetime prevalence, % NCHM, NDO 2011 Drug Situation in the Republic of Moldova, annual report 17

22 Prevalence, Patterns and Developments in drug use Last year prevalence, % Last month prevalence, % The highest value of the prevalence of cannabis use was registered in the year and year age groups. The average age of the first cannabis use is 19 years for men and 18 years for women. As compared to the previous analogical survey in 2008, the Chapter cannabis use registers an insignificant decrease from the statistical point of view. Some high decreases/increases at Lifetime prevalence (for instance: age group years ) can be explained by respondents change of age group. The highest value of cannabis use prevalence was registered among the respondents from urban area (Table 5). As in the case of age group/gender disaggregation, there are no significant differences compared to Table 5.KAP 2010 compared with KAP years, cannabis use prevalence among general population, breakdown by gender and residency area KAP 2008 KAP 2010 Male Female Total Male Female Total Urban areas Lifetime prevalence, % Last year prevalence,% Last month prevalence,% Rural areas Lifetime prevalence, % Last year prevalence,% Last month prevalence,% Total Lifetime prevalence, % Last year prevalence,% Last month prevalence,% The results of the survey show that the lifetime prevalence of ecstasy use among men is approximately 4 times higher than among women. There are no gender differences in the prevalence of ecstasy use over the last year. The prevalence of the ecstasy use disaggregated by age groups is presented in Table 6. Table 6.KAP 2010 compared with KAP years, prevalence of ecstasy use among general population by gender and age group KAP 2008 KAP 2010 Male Female Total Male Female Total years years years years Lifetime prevalence, % Last year prevalence,% Last month prevalence,% Lifetime prevalence, % Last year prevalence,% Last month prevalence,% Lifetime prevalence, % Last year prevalence,% Last month prevalence,% Lifetime prevalence, % Last year prevalence,% Last month prevalence,% Lifetime prevalence, % NCHM, NDO 2011 Drug Situation in the Republic of Moldova, annual report 18

23 Prevalence, Patterns and Developments in drug use years Last year prevalence,% Last month prevalence,% Lifetime prevalence, % years Last year prevalence,% Last month prevalence,% Total Lifetime prevalence, % Last year prevalence,% Last month prevalence,% The highest lifetime prevalence of ecstasy use was registered in the year age group (1.7%), followed by the year age group (1.5%). The average age of the first ecstasy use for men is 20 years and 24.5 years for women. The respondents from the rural areas reported less frequent experience of ecstasy use compared to respondents in the urban areas. The lifetime prevalence of ecstasy use for the males in the urban areas is 6 times higher than for women. The prevalence of the ecstasy use disaggregated by gender and place of residence is shown in Table 7. Similar to the cannabis use, the ecstasy use shows no trends compared to the 2008 survey. Table 7.KAP 2010 compared with KAP years, prevalence of ecstasy use among general population, breakdown by gender and residency area KAP 2008 KAP 2010 Male Female Total Male Female Total Urban areas Lifetime prevalence, % Last year prevalence,% Last month prevalence,% Rural areas Lifetime prevalence, % Last year prevalence,% Last month prevalence,% Total Lifetime prevalence, % Last year prevalence,% Last month prevalence,% II.3 Tobacco smoking in the general population According to the study conducted among general population in 2010 (KAP years), the current prevalence of tobacco use among general population (15-64 years old) is 28.3%, 5 times higher among men (49.4%) compared to women (9.7%). The same is true for the prevalence of lifetime tobacco use (43.3%): men have ever smoked tobacco more often (71.6%) than women (18.2%). It should be noted that the prevalence of lifetime tobacco use in case of women is reduced with age. Thus, the highest value in the prevalence of lifetime tobacco use among women is recorded in the year age group, which is reduced in the older age groups. For men, lifetime prevalence of tobacco use has also the highest value for the year age group, but it retains its stability in older age groups (Figure 5). NCHM, NDO 2011 Drug Situation in the Republic of Moldova, annual report 19

24 Prevalence, Patterns and Developments in drug use Figure 5.KAP years, lifetime prevalence of tobacco use, distributed by gender and age groups 90.0% 80.0% 70.0% 68.8% 77.3% 78.3% 77.2% 74.1% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 46.9% 32.5% 17.3% 48.7% 49.8% 30.7% 26.0% 48.0% 45.5% 22.9% 15.7% 37.6% 8.9% Males Females Total 0.0% The prevalence of the current tobacco use has the maximum value in the year age group and is reduced with age. Differences between male and female respondents are shown in Figure 6. Compared to 2008, the share of women who used to smoke, especially in the age group years, has increased (from 21.8% to 26.0%). The percentage of smoking women, especially the age group years, shows an increase in current tobacco use by 7.5% in 2008 and 12.4% in Figure 6.KAP years, Prevalence of current tobacco use, distributed by gender and age group 70.0% 60.0% 57.9% 56.2% 56.8% 54.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% 42.7% 29.2% 35.9% 34.1% 32.5% 30.7% 19.1% 20.9% 16.2% 14.9% 12.4% 8.4% 8.9% 3.8% Males Females Total In case of disaggregation by type of residency and gender, the current prevalence of tobacco use (31.2% in the urban population and 26.0% in rural population) is higher among women in urban localities % (in rural localities - 4.0%). The prevalence of lifetime tobacco use is higher among men in rural localities % (68.8% in urban localities) and women in urban localities % (in rural localities %). The respondents who reported smoking (current tobacco use), 35.6% smoked cigarettes a day. Among smoking men, most of them, smoke cigarettes a day (40.0%), and women, most often, NCHM, NDO 2011 Drug Situation in the Republic of Moldova, annual report 20

25 Prevalence, Patterns and Developments in drug use smoked 5-10 cigarettes a day (37.5%), without any significant differences between urban and rural localities neither for men nor women. II.4 Alcohol use in the general population According to results of KAP years, the prevalence of alcohol use over the last year is 76.7%, (83.1% for men and 71.0% for women)[4]. The disaggregation by age and gender shows that the highest value is recorded among year old men (88.6%) and year old women (77.1%) and lowest recorded among year old men (78.2%) and year old women (63.8%), see Table 8. The prevalence of alcohol use over the last months is 80.0%. Similarly, the prevalence value over the last month is higher for men % than women %. The disaggregation by age group and gender shows that the highest value was recorded in case of year old men (89.2%) and year old women (76.5%) and lowest for men - in the age group of years (76.9%) and women in the age group of years (68.7%) Table 8.KAP 2008 compared with years, prevalence of alcohol use, disaggregated by age groups and gender Age groups Males Females Total Last year prevalence,% years Last month prevalence,% Last year prevalence,% years Last month prevalence,% Last year prevalence,% years Last month prevalence,% Last year prevalence,% years Last month prevalence,% Last year prevalence,% years Last month prevalence,% Last year prevalence,% years Last month prevalence,% Total Last year prevalence,% Last month prevalence,% No significant differences were registered per residency type. The last year prevalence of alcohol use shows an insignificant decrease for both genders and all age groups. In turn, the last month prevalence shows a growth trend, both by gender as well as by age group. In case of sampling, the prevalence of "the excessive episodic use" of alcohol over the last month is 20.5% and it is higher for men %, compared to women %. The prevalence of excessive episodic use of alcohol during the last month is higher in rural localities (25.5%) compared to urban localities (14.9 %) for both genders (men in rural areas 36.1%, men in urban areas 21.8%, and for women in rural localities 13.8%, women in urban localities 7.7%) Compared to the situation of 2008, there is no "excessive episodic use" of alcohol trends over the last month by gender, but these appear when disaggregated by gender and residency: the prevalence has decreased for men from 26.4% to 21.8% in urban areas and for women it increased from 9.4% to 13.8% in rural area. NCHM, NDO 2011 Drug Situation in the Republic of Moldova, annual report 21

26 Prevalence, Patterns and Developments in drug use Figure 7.KAP 2008 compared with years, last month prevalence of alcohol use, disaggregated by age groups 90.0 % % % % 50.0 % 40.0 % 30.0 % 20.0 % 10.0 % 0.0 % For men the prevalence of "the excessive episodic use" of alcohol over the last month increased with age and reaches the highest value in the age group of years (33.8%) and the lowest in the age group of years (15.0%), see Figure 8. As for women, the prevalence of "the excessive episodic use" of alcohol over the last month reached a maximum value in the age group of years (14.5%), and the lowest in the age group of years (2.8%). In the general population the prevalence of "excessive episodic use" of alcohol over the last month increased from 9.7% (in the years old group) to 20.5% (in the year old group) and remained stable in groups of older age. Figure 8.KAP years, prevalence of excessive episodic use of alcohol during the last month, disaggregated by age groups and gender 40.0% 35.0% 30.0% 30.0% 32.5% 31.2% 33.8% 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 15.0% 9.7% 2.8% 20.5% 20.7% 10.9% 8.7% 22.1% 22.8% 22.1% 13.6% 14.5% 11.3% Males Females Total 0.0% Compared to the 2008 situation, a decreasing trend is observed of the excessive episodic use of alcohol per year-old age group (from 14.3% to 9.7%). The same trend is noticed with men (from 22.8% to 15.0%). An essential increase is registered for women from 30 years and older (Figure 9). NCHM, NDO 2011 Drug Situation in the Republic of Moldova, annual report 22

27 Prevalence, Patterns and Developments in drug use Figure 9.KAP 2008 compared to years, prevalence of excessive episodic use of alcohol during the last month among women 16.0% 14.0% 12.0% 10.0% 8.0% 6.0% 4.0% 2.0% 0.0% % 10.9% 8.7% 13.6% 11.3% 14.5% % 14.1% 8.3% 5.7% 8.5% 7.9% II.5 The use of tranquilizers and sedatives in the general population According to the results of KAP years, the prevalence of use of sedatives and tranquilizers in the last year is 3.6%, higher among women, 5.0%, compared to men - 2.1%. Most respondents used sedatives or tranquilizers once a month or less (41.8%), 63.1% used tranquilizers over the last year which they bought at a drugstore based on a doctor s prescription, 33.4% purchased them without a prescription, 1.5% refused to answer and 0.5% mentioned other sources. As compared to 2008, a decrease is noted of the number of respondents who used sedative drugs and tranquilizers once a month or more seldom (from 47.7% to 41.8%) and an increased number of persons who bought them in the drug store, both on doctor s prescription (from 24.3% to 33.4%) and without a prescription (from 28.2% to 33.4%). II.6 Drug use among youth In 2010, the Knowledge, Attitudes and Practices of Youth (15-24 years) regarding HIV/AIDS Study (hereinafter referred to as KAP years) was repeatedly conducted on the right bank of the River Dniester; these studies were previously conducted in 2006 and 2008 ([1], [7], [8]). The questions recommended by the EMCDA about the drug use were part of the questionnaires of the above-mentioned studies. The comparison of results of studies is presented in Table 9. Table 9.KAP 2006 & 2008 & years, prevalence of illegal drug use Do you know Lifetime anyone who uses prevalence use? Prevalence of use the over the last year Cannabis Ecstasy Amphetamine Prevalence of the use over the last month NCHM, NDO 2011 Drug Situation in the Republic of Moldova, annual report 23

28 Prevalence, Patterns and Developments in drug use Heroin Opium Cocaine LSD If we compare the results of the 2010 survey with the results of the 2006, 2008 surveys, it is clear that no significant differences have been registered. In 2010, the prevalence of the cannabis use over the last year among year old youth was 2.3%, while the prevalence of the ecstasy use over the last year was 0.6%. II.7 Tobacco smoking among youth According to the results of KAP years, 22.3% of young people were active smokers at the moment of interview, out of which 21.5% were smoking cigarettes, 0.8% - pipes. Other 18.0% of the respondents smoked in the past. The prevalence of the lifetime smoking is 40.3%, by approximately 3 times more in case of men (65.5%) compared to women (20.0%) and is considerably greater in case of the age group of years (53.1%) compared to the age group of years (32.5%). The prevalence of the current tobacco use is 22.3% and is 4 times higher in case of men (37.3%) then among women (8.4%) and is 20.4% in the rural area and 25.0% in the urban one. The prevalence of the current tobacco use is higher among men in the urban area (41.8%), 34.0% in the rural area, while the percentage of women in the urban area is 10.8% compared to 6.3% in rural areas. From the respondents who reported tobacco smoking habit (current use of tobacco), one third (31.9%) smokes up to 5 cigarettes a day, every forth (24.5%) smokes from 5 to 10 cigarettes a day, and another third (32.3%) smokes from 10 to 20 cigarettes. Those who smoke more than a standard pack (20 cigarettes) a day account for 8.5% of the smokers. The male smokers (9.5%) and those from the year age group (14.0%) smoke more cigarettes per day. There are no significant differences when comparing the analogical 2006 and 2008 surveys. II.8 Alcohol use among youth According to the KAP years, the prevalence of alcohol use among youth over the last year is 73.6%, (81.9% for men, and 65.9% for women). This share is larger for the age group of years (81.5%), while in the case of the age group of years it is 68.4%. Compared to 2008, the same positions show an decrease (from 81.8% to 73.6%), but it grew in 2008 as compared to 2006 (72.4%). At the same time, the 2010 report mentions that there are reasons to believe that the 73.6% prevalence is underestimated. The prevalence of alcohol use over the last month is 76.3%. Similarly, the last month prevalence is higher for men 81.5%, compared to women 70.4%. After the disaggregation by age group and gender, the highest value was registered among year old men (86.0%), for the years age group 78.2% and women in the age group of years (75.0%) and the years age group 66.6%. NCHM, NDO 2011 Drug Situation in the Republic of Moldova, annual report 24

29 Prevalence, Patterns and Developments in drug use The last month prevalence of alcohol use has a tendency of continuous growth in time: 53.9% in 2006, 61.3% in 2008 and 76.3% in Figure 10.KAP years, prevalence of alcohol use, disaggregated by age groups and gender Republic of Moldova, Total Republic of Moldova, Boys Republic of Moldova, Girls years old,last year prevalence years old, last month prevalence yers old, last15-19 yers old, last year prevalence month prevalence II.9 Illegal drug use in the school population The Alcohol, Drug and Tobacco Use among Students Survey (ESPAD) was conducted for the second time in the Republic of Moldova in 2011 [2]. This survey was conducted in 36 countries in Europe, including in the Republic of Moldova (right bank of the River Dniester). The goal of the ESPAD is to obtain comparable data about the knowledge, attitudes, practices of students of 16 years regarding drug, alcohol, tobacco use at European level, thus, having the possibility to draw a picture regarding the characteristics of use at this age segment, at national and European level. The Republic of Moldova has become a party of the ESPAD Project in 2007, but the data collection for ESPAD 2007 took place in the Republic of Moldova in The use of any type of illicit lifetime drug use among students in the Republic of Moldova is 7%, by 11% less than registered European average. As compared to 2007, the 2011 data did not register any significant changes (Figure 11). Figure 11.ESPAD , lifetime prevalence of illicit drug use Republic of Moldova, Total Other ESPAD countries, Total Republic of Moldova, Boys Other ESPAD countries, Boys Republic of Moldova, Girls Other ESPAD countries, Girls NCHM, NDO 2011 Drug Situation in the Republic of Moldova, annual report 25

30 Prevalence, Patterns and Developments in drug use The cannabis or marihuana use among students of the Republic of Moldova during lifetime is 5%, without changes compared to 2007, which is 12% below the European average for all participating countries in the ESPAD Survey, Figure 12. Figure 12.ESPAD , lifetime prevalence of cannabis or marihuana use Republic of Moldova, Total Other ESPAD countries, Total Republic of Moldova, Boys Other ESPAD countries, Boys Republic of Moldova, Girls Other ESPAD countries, Girls According to ESPAD results, the lifetime prevalence of illicit drug use, other than marihuana or cannabis, compared to 2007, did not register essential changes in the Republic of Moldova or in other countries participating in the survey. Figure 13.ESPAD , lifetime prevalence of illicit drug use other than marihuana or cannabis Republic of Moldova, Total Other ESPAD countries, Total Republic of Moldova, Boys Other ESPAD countries, Boys Republic of Moldova, Girls Other ESPAD countries, Girls II.10 Perceived accessibility of drugs As for the students of the Republic of Moldova, there were no significant changes in the percentage value of the perceived accessibility of cannabis. Compared to ESPAD countries, the perceived accessibility of cannabis in the Republic of Moldova is essentially small (by ~17%), Figure 14. There are no significant changes at this position during the period from 2007 to NCHM, NDO 2011 Drug Situation in the Republic of Moldova, annual report 26

31 Canabis Amphetamine Exstasy Tranquillisante or sedative % Prevalence, Patterns and Developments in drug use Figure 14.ESPAD ; perceived accessibility of drugs, the percentage of people who answered fairly easy or very easy to obtain cannabis Republic of Moldova, Total Other ESPAD countries, Total Republic of Moldova, Boys Other ESPAD countries, Boys Republic of Moldova, Girls Other ESPAD countries, Girls According to the results of ESPAD 2011, in the Republic of Moldova, boys (7%) consider that cannabis is easy to access more often than girls (4%). This can be explained by higher level of cannabis use among boys. The Amphetamine and ecstasy were declared fairly easy or very easy to obtain by 3% and 4% of respondents, respectively. 4% of students reported the accessibility of tranquilizers or sedative drugs. The cannabis is considered the most accessible drug by students - 6%. Figure 15. ESPAD 2011; perceived accessibility of drugs, the percentage of those who answered fairly easy and very easy to obtain; disaggregated by type of drug 8 % 7 % 6 % 5 % 4 % 3 % 2 % 1 % 0 % Total Băieți Fete II.11 Tobacco use among school children According to 2011 ESPAD Study results, the lifetime tobacco smoking among students of the Republic of Moldova was reported by 42% of respondents. The share is higher among males (59%) compared to female respondents (27%). NCHM, NDO 2011 Drug Situation in the Republic of Moldova, annual report 27

32 Prevalence, Patterns and Developments in drug use The last month prevalence of smoking is 15%; the share is higher among male respondents (23%) then among female respondents (8%). There are no differences between the results of 2007 and 2011 regarding tobacco use in the last month by students of the Republic of Moldova. Figure 16.ESPAD , cigarettes smoked in the last month Republic of Moldova, Total Other ESPAD countries, Total Republic of Moldova, Boys Other ESPAD countries, Boys Republic of Moldova, Girls Other ESPAD countries, Girls II.12 Alcohol use among school children On average, the students who participated in ESPAD Survey declared that they consumed alcoholic beverages equalling 5.1 centilitre of pure alcohol per day in the last day of alcoholic beverage consumption. If we measure this in standard drinks, this quantity equals to about 13 centilitre of alcoholic beverages (2-3 drinks), 40 centilitre of wine and one litre of beer. From the point of view of quantity, 5.1 centilitre of pure alcohol equals to 40 grams of pure alcohol. According to ESPAD 2011 results, the average quantity of alcohol consumed in the last day of drinking is lowest in the Republic of Moldova compared to other European counties (2.7 cl) followed by Albania (3.0 cl), Romania (3.1 cl), Montenegro (3.3 cl), Figure 17. NCHM, NDO 2011 Drug Situation in the Republic of Moldova, annual report 28

33 Prevalence, Patterns and Developments in drug use Figure 17.ESPAD , average quantity of alcohol drunk in the last day of drinking (equivalent in centilitre of pure alcohol) Republic of Moldova, Total Other ESPAD countries, Total Republic of Moldova, Boys Other ESPAD countries, Boys Republic of Moldova, Girls Other ESPAD countries, Girls According to ESPAD results, the beer consumption compared to wine and spirits among the boys registered the highest value in the Republic of Moldova in %, and the results for girls were higher for wine consumption - 54%, Figure 18. The biggest difference between boys and girls is registered with consumption of spirits. Figure 18.ESPAD , Consumption of alcoholic beverages in the last month (beer, wine, spirits) Republic of Moldova Republic of Moldova, Boys Republic of Moldova, Girls 0 Beer 2007 Beer 2011 Wine 2007 Wine 2011 Spirts 2007 Spirts 2011 The percentage of those who declared that during the last 30 days they had at least once minimum 5 standard drinks in the Republic of Moldova was 37%, which is very insignificant compared to the results of 2007 (38%). In the Republic of Moldova, compared to other countries, individual and relationship issues appear more often due to alcohol consumption, Figure 19. NCHM, NDO 2011 Drug Situation in the Republic of Moldova, annual report 29

34 Prevalence, Patterns and Developments in drug use Figure 19.ESPAD , problems due to alcohol consumption during the last 12 months Republic of Moldova Other ESPAD countries Individual problems Relational problems Sexual problems Delinquency problems The individual issues include the following elements: weak school or labour performance ; accidents, injuries, traumas ; and hospitalization or care in an emergency room. The relationship issues include serious problems with friends or parents. II.13 Use of tranquilisers and sedatives among school children The lifetime use of tranquilizers or sedative drugs without doctor s prescription was reported by 6% of students in the ESPAD countries in 2011; in the Republic of Moldova it is 5%. The girls reported a higher prevalence as compared to the boys in all ESPAD countries, including in the Republic of Moldova, Figure 20. Figure 20.ESPAD , lifetime prevalence of tranquilizer or sedative drugs use without doctor s prescription Republic of Moldova, Total Other ESPAD countries, Total Republic of Moldova, Boys Other ESPAD countries, Boys Republic of Moldova, Girls Other ESPAD countries, Girls In the Republic of Moldova, compared to ESPAD countries, the use of inhaled drugs is much lower and is 2%, Figure 21. NCHM, NDO 2011 Drug Situation in the Republic of Moldova, annual report 30

35 Injecting drug use Figure 21.ESPAD , lifetime prevalence of inhaled drug use Republic of Moldova, Total Other ESPAD countries, Total Republic of Moldova, Boys Other ESPAD countries, Boys Republic of Moldova, Girls Other ESPAD countries, Girls II.14 Abstinence The lifetime abstinence includes the students that declared no use of cigarettes, alcohol, illicit drugs or inhaled drugs and did not use tranquilizer or sedative drugs without doctor s prescription. A final measurement of abstinence is no use of the above mentioned drugs. On average for 2011, one of ten students of ESPAD countries reported that they did not use any of the mentioned above drugs. For the Republic of Moldova, the abstinence in 2011 was reported by 20% of students with a 6% increase compared to Compared to ESPAD countries, the abstinence is 9% higher in the Republic of Moldova, Error! Not a valid bookmark self-reference.. Figure 22.ESPAD, the lifetime abstinence from using cigarettes, alcohol, inhaled drugs, tranquilizers or sedative drugs without doctor s prescription or illicit drugs Republic of Moldova, Total Other ESPAD countries, Total Republic of Moldova, Boys Other ESPAD countries, Boys Republic of Moldova, Girls Other ESPAD countries, Girls NCHM, NDO 2011 Drug Situation in the Republic of Moldova, annual report 31

36 Injecting drug use III Injecting drug use In accordance with the definition of EMCDDA, the problem drug use is defined as intravenous drug use or long-term/systematic use of opium, cocaine and/or Amphetamine. The biggest issues related to drug use in the European Union countries refer to heroine and opium use. Using data from different sources, an operational survey was carried out in the Republic of Moldova to estimate the size of drug users groups. The size of the injecting drug users group accounts for people on the right bank of the River Dniester and people on the left bank of the River Dniester. The number of opium users (injecting and non-injecting) is estimated to be people on the right bank of the River Dniester and 7109 people on the left bank of the River Dniester ( [9], [10]). III.1 Injecting drug use in the penitentiary sector According to the results of the Integrated Bio-Behavioural Surveillance Study (IBBS) conducted in 2010 among inmates on the right bank of the River Dniester, 8.9% (47 out of 530 respondents) reported that they injected drugs. Drug injection was reported in 3.0% of cases over the last 12 months. The average age of respondents who have injected drugs over the last 12 months is 30.4 years. Respondents reported an average drug experience of 8.5 years. They injected drugs for the first time at the average age of 21.5 years ([9], [11]). IV Health consequences IV.1 Drug treatment demand Treatment demand indicator (TDI) is one of the main sources of information in the field of drug epidemiology in the European Union. Currently, the Republic of Moldova has no data collection system to measure the treatment demand indicator. The potential component parts of a future system of data collection for the treatment demand indicator in the Republic of Moldova are as follows: data collection system for the officially registered drug users; units responsible for the methadone substitution treatment; private and public medical institutions; Department of Penitentiary Institutions; harm reduction programs; Rehabilitation and socialization service providers IV.2 The system of data collection on officially registered drug users The IMSP Republican Dispensary of Narcology (RDN) under the Ministry of Health is responsible for the data collection system of officially registered drug users. It introduces all new officially registered cases in the database and ensures its maintenance. The case is considered officially registered when the notification sheet (hard copy) is completed and submitted to the RDN, where the information is entered into the database. The main source for detecting new cases of drug use is the police (which addresses the narcological service for expert analysis of the persons arrested for different reasons) and medical institutions (voluntary treatment demand or accidental detection during preventive controls 3 ). The regulation for detection, recording and reporting of drug users provides different scenarios for each case and is presented in the Chapter Treatment. 3 Ex.: examining the health status while enlisting for the military service. NCHM, NDO 2011 Drug Situation in the Republic of Moldova, annual report 32

37 Health consequences Due to the fact that persons receiving treatment in conditions of anonymity are not registered in the database of the RDN, the information presented below does not include these patients. As of 1 January 2012, there were 9449 drug users on the right bank of the River Dniester registered in the RND database. During 2011, 968 new cases of drug use were registered compared to 2010 when 1304 cases were registered, which represents a decrease by 336 cases. In terms of clinical findings, all newly registered cases are divided into two broad categories: drug use without addiction and drug use with addiction diagnosed, Figure 23. Figure 23. Structure of newly registered cases of drug use, Republic of Moldova (the right bank of the River Dniester), % 90% 80% 70% 60% % 40% 30% 20% 10% % Newly registered cases without adiction Newly registered cases with adiction The two groups of new drug use cases registered in 2011 can be described as follows: 1. The group of newly registered drug users without addiction: average age at the moment of registration is 25.4 years; the drug used at the moment of registration in most cases is cannabis (86.2%); the route of drug administration at the moment of registration was mostly smoking (86.2%); the males represent the majority (95.4%). 2. The group of newly registered cases of drug use with addiction: average age at the moment of registration is 27.7 years; the most used drugs belong to the opium group (90.5%); the route of drug administration at the moment of registration is injection (92.2%); the males represent the majority (96.6%). The analysis of the newly registered cases of drug use could only reflect the trends of drug use in the country to a certain extent (unknown). IV.3 Drug users receiving detoxification treatment The main service available for drug users within the national health care system is rehabilitation. The rehabilitation treatment is free of charge in the case of insured people (employees, students, pupils and NCHM, NDO 2011 Drug Situation in the Republic of Moldova, annual report 33

38 Health consequences pensioners with purchased insurance policy), who address public medical and sanitary institutions, on the condition of revealing the patient s name and the names of other people, followed by the registration in the RND database. In the case of patient who requests anonymous treatment, the rehabilitation is provided on a fee-basis. The rehabilitation is also provided by an accredited private medical institution Salvarea Natiunii. This institution provides services on fee-basis and the patients are not registered in any database. The distribution of patients who benefited from rehabilitation for the first time during the reporting year per accredited institution is presented in Figure 24. Figure 24.Number of patients who benefited from rehabilitation in an in-patient unit for the first time during the year, Republic of Moldova (right bank of the River Dniester), Republican Narcological Dispensary, mun. Chisinau Source: Republican Narcological Dispensary According to IBSS Study conducted in 2009/2010, the breakdown of injecting drug user s part of the sample that benefited of rehabilitation in the last year: in Balti is 5.5%, Chisinau 5.0%, and Tiraspol 2.7%. IV.4 Drug users in methadone substitution treatment Psihiatric hospital, mun. Balti Department of Penitentiary Institutions Hospital "Salvarea Natiunii", mun. Chisinau Others In 2004, substitution treatment using methadone started to be implemented in the Republic of Moldova using national and international funds. Since 2005, the methadone substitution therapy is available also in the penitentiary institutions of the Ministry of Justice of the Republic of Moldova. In 2007, the criteria for admitting patients under methadone substitution treatment became less restrictive and this led to an increase in the cumulative number of new patients enrolled in substitution treatment. Until 2007, all methadone substitution treatment patients were hospitalized for the determination of the appropriate methadone dose for 1-2 weeks, but since 2008, patients of RND have started to receive their treatment in outpatient units. At the end of 2011, there were 3 methadone treatment units in the premises of the RND (3 sectors of the city), 1 methadone treatment unit in the Municipal Hospital in Balti, and 7 methadone treatment units in penitentiary institutions. NCHM, NDO 2011 Drug Situation in the Republic of Moldova, annual report 34

39 Health consequences Figure 25.The cumulative number of beneficiaries of methadone substitution treatment, Republic of Moldova (right bank of the River Dniester), Penitentiary sector Free settings Source: Soros-Moldova Foundation By the end of 2011, altogether 983 drug users have been cumulatively enrolled in methadone substitution treatment (706 in the civil sector and 277 in the penitentiary sector). For more details on treatment with methadone see Chapter Treatment. IV.5 Drug users in the penitentiary system The penitentiary system has data on officially registered drug users (who were identified as drug users during the judicial process) and separate data on potential drug users (who were not registered officially as drug users, but were suspected of drug use by the internal penitentiary security, regime and surveillance officials). According to RND data, there were 52 detainees registered as drug users in the penitentiary system of the Republic of Moldova (right bank of the River Dniester). At the end of 2011, 277 drug users were enrolled at some point in time in methadone substitution treatment based in the penitentiary system. For treatment options in the penitentiary system see Chapter Assistance to drug users in penitentiary institutions. IV.6 Injecting drug users beneficiaries of the harm reduction programmes The Information System IDU/Ident was implemented under the aegis of NDO and with the support of Soros Foundation-Moldova in The system is intended for the organizations that provide services to injecting drug users. The system aims at: keeping record of beneficiaries of harm reduction programme on the basis of the single anonymous identifier; keeping record of the services provided by the harm reduction programme; generating reports. Since the harm reduction programmes render services under anonymous conditions, it creates a difference in accessibility as compared to other services, where the identity is required. Out of IDUs who benefit of harm reduction programmes, 45.0% report being officially registered with the National Narcological Register (no matter what the source of referral) [12]. The characteristics of those recorded in the official statistics NCHM, NDO 2011 Drug Situation in the Republic of Moldova, annual report 35

40 Health consequences cannot be extrapolated to the whole population of IDUs in the Republic of Moldova. This fact is confirmed by data inconsistencies in gender structure of IDU from harm reduction programmes and those officially registered by the RND. For instance, the rate of females (19.0%) among IDU beneficiaries of harm reduction programmes was about 1.7 times higher than the rate of females (11.3%) among officially registered by the RND. (Table 10). Table 10.IDU registered with the IMSP Republican Narcological Dispensary and harm reduction programmes, Republic of Moldova (right bank of the River Dniester), IDUs registered in the database of the Republican Narcological Dispensary IDUs registered as beneficiaries of harm reduction programmes Total number M, % F, % Total number M, % F, % ,4 12, ,8 21, ,5 12, ,1 21, ,6 12, ,0 17, ,7 11, ,0 17, ,3 10, ,0 18, ,1 6, ,0 18, ,9 10, ,0 18, ,7 11, ,0 19,0 Source: RDN, Soros-Moldova Foundation There has been an insignificant increase of new beneficiaries of harm reduction programmes determined by reduced funding for harm reduction services (see Chapter Budget and funding arrangements ) in the last 2 years. A decrease in the total number of syringes distributed within projects that implement needle exchange activities from grants operated by the Soros Foundation-Moldova 4 was noticed in In 2011, a slight increase of the number of syringes distributed in civil and penitentiary sectors was attested (see Table 11). Table 11.Number of syringes distributed by HRP, right bank of the River, Free settings Penitentiary sector Total Source: Soros-Moldova Foundation For further details about the implementation of the harm reduction programs in the Republic of Moldova see the Chapter Harm Reduction. 4 Only data on the implementation results of projects operated by Soros Foundation Moldova are available for this report. NCHM, NDO 2011 Drug Situation in the Republic of Moldova, annual report 36

41 Drug-related mortality IV.7 Drug users using the services of the Centre of Rehabilitation for drug-addicted persons In 2011, 319 people were registered for rehabilitation in 2011 (294 men and 25 women; average age of people at the moment of registration was 25 years); 31 people out of the total were covered from external financial sources (Global Fund). 301 persons of the total number of persons who have enrolled in the rehabilitation process in 201 finalized it successfully. For further details regarding the activities of the Centre see the Chapter on Table 12. Table 12.Drug users who benefit from the services of the Rehabilitation Centre for Drug Addicted People, right bank of the River Dniester, The number of people who started the rehabilitation The number of people who finished successfully the rehabilitation The number of people who abandoned the rehabilitation Total Women Men Age <= 25 years- 38% > 25 years - 62% Source: RND V Drug-related mortality <= 25 32% >25 years - 68% <= 25-62% > 25-38% The Republic of Moldova has no data to report in accordance with the standard definition 5 of drug-related deaths (DRD). No progress has been registered in the Republic of Moldova on the right bank of the River Dniester in 2011 for the standardization of the definition of a case of Drug-Related Death. The data for the key indicator of drug epidemiology were collected from three sources: 1. Centre of Forensic Medicine under the Ministry of Health; 2. General Registry of Mortality, held by the National Centre for Health Management within the Ministry of Health; 3. Republican Narcological Dispensary under the Ministry of Health. There are no other available sources regarding DRD in the Republic of Moldova. Forensic Medicine Centre The Forensic Medicine Centre (FMC) is the only institution specialized in forensic and toxicological expertise in the Republic of Moldova on the right bank of the River Dniester. The organizational structure of the Forensic Medicine Centre (FMC) involves 34 regional offices (municipal and district/rayon) and a specialized 5 Drug-related death refers to the deaths that are caused directly by drug use, i.e. fatal overdoses that generally occur shortly after the use of the substance(s), and deaths in the presence of drugs, where there is no clear causal relationship between the death and the biochemical effects of the drug (HIV, viral hepatitis, endocarditic, emboli, etc.), suicide and other violent deaths and fatal accidents committed under drug influence (EMCDDA). The standard of the drug-related death in version 3.0 gives a shorter definition: deaths associated to drugs and mortality among drug users refer to those deaths that are caused directly by drug use. As a rule, these are fatal overdoses that occur shortly after the use of substance(s)[24]. NCHM, NDO 2011 Drug Situation in the Republic of Moldova, annual report 37

42 Drug-related mortality laboratory with four departments located nationwide. All biological samples (cadaverous material - blood, urine, tissues of the body) from the entire territory of the right bank of the River Dniester are concentrated in the laboratory. In case of deaths outside medical-sanitary institutions, the bodies are examined at the place of death by an operative investigation group with the compulsory participation of the forensic pathologist, who performs the external review of the body and surrounding objects. After the examination at the scene, the bodies are shipped by the prosecuting officer of the Ministry of Internal Affairs (or by the Prosecutor 6 ) for examination/forensic expertise in order to establish the cause of death, post-mortem interval, presence of injuries, their mechanism and severity, the presence of alcohol, drugs (if applicable) or other toxic substances etc. The decision on making a forensic expertise is taken by the representative of the prosecuting bodies, who come on site and establish whether or not there is suspicion of violent death, after which the forensic pathologist is invited. The toxicological examination for drugs in the blood is made at the request of the prosecuting bodies or at the initiative of forensic pathologist. Current legislation does not entitle the forensic pathologist to conduct toxicological tests on all bodies subject to forensic examination (such as in determining the blood alcohol content, which is performed on all bodies subject to forensic examination). In 2011, 73 bodies were examined to determine the presence of illegal drugs. This represents 2.2% of death cases suspected to be violent (3083) or 0.8% of the total number of bodies (7820) examined by the Forensic Medicine Centre (FMC) (Table 13Error! Reference source not found.). The very small share of toxicological investigations to identify illegal drugs in the samples examined by the FMC can be explained by the following: lack of well-established legal framework in this area, the decision is taken based on the intentions of the forensic pathologist or the request of the prosecuting authorities; insufficient and obsolete equipment in the FMC toxicological laboratory; reduced capacity of the toxicological laboratory of FMC, due to shortage of human resources; insufficient cooperation between the Ministry of Internal Affairs, General Prosecutor s Office and forensic medical experts in this sector, including the field of cadaver material transported to the toxicological laboratory. Table 13.The number of possible DRD according to the FMC, Republic of Moldova (right bank of the River Dniester), Deaths investigated by the FMC Deaths suspected of being unnatural Number of toxicological investigations targeting illegal drugs Positive results of toxicological investigations In 2011, out of 73 toxicological examinations of samples taken from corpses suspected of the presence of illegal drugs, the results were positive in 20 cases, which is 27.4% of positive results (Table 13). The 20 DRD registered by the FMC in 2011 are disaggregated by age groups and gender in Table The General Prosecutor s Office is subordinated directly to the Parliament. NCHM, NDO 2011 Drug Situation in the Republic of Moldova, annual report 38

43 Drug-related mortality Table 14.Distribution in terms of age and gender of possible DRD cases according to the Forensic Medicine Centre, Republic of Moldova (right bank of the Dniester River), years and less years years years years 46 years and more Males Females General Registry of Mortality Drug-related deaths are not registered in a separate database, but these can be extracted from the General Register of Mortality (GRM). Medical certificates certifying death are verified, coded and processed by the General Register of Mortality (GRM) of the National Centre for Health Management (NCHM). In 2011, only 4 DRD cases were recorded in the General Register of Mortality. According to the International Classification of Diseases, X Revision (ICD X), all 4 cases of DRD have been assigned the code X 42.0 (Accidental intoxication and exposure to narcotic and psychodysleptics [hallucinogenic] substances, not being classified in another category), Figure 26. Figure 26.Distribution of the number of registered DRDs in terms of the codified causes of death in the certificate ascertaining cause of death, GRM, Republic of Moldova (the right bank of the Dniester River), Source: NCHM X F F F F F F F F F F total Figure 26 shows all codes for which at least one case was registered in the GRM in There is a decrease in numbers of DRD according to the GRM over the time. The small number of DRD cases, most likely, is caused by the fact that the death certificates had to be issued as provided by law - before burying the corpse (i.e. a few days after finding the corpse) and the results of the toxicological examination become available much later (in 3-4 months), and the doctors do not change NCHM, NDO 2011 Drug Situation in the Republic of Moldova, annual report 39

44 Drug-related mortality afterwards the cause of death in the death certificates, because they are neither motivated nor have the means to do so. IMSP Republican Narcological Dispensary The district narcologists report all the deaths of drug users and former drug users that are registered once they get such information. In EU terms, these data are, to some extent, illustrative of the overall mortality of registered drug users in the Republic of Moldova. Data from this source are under-reported as in the previous two sources. During , there was registered a decreasing trend in the number of deaths among registered drug users. In 2011, there was no overdose death registered among the officially registered drug users. It is difficult to interpret this trend because of the unknown consistency of data collected from this source (completeness of reports at the district level), Figure 27. Figure 27.Number of deaths due to overdose among officially registered drug users, Republic of Moldova (right bank of the River Dniester), Source: RDN Data inconsistencies Only 4 cases of fatal overdoses were registered in the GRM in The small number of cases reported can be explained by social stigma, complexity of the procedures related to DRD confirmation, according to the legislation in force, and the fact that the results of the toxicological investigations become available later (3-4 months after the death). In the last case doctors do not always change the cause of death in the death certificate. The cross-checking of the data gathered from the Republican Narcological Dispensary and other sources has not been performed. The data inconsistency from different data sources clearly show that the real extent of both, drug-related mortality and fatal overdoses with illegal drugs and other psychotropic substances, is not known in the Republic of Moldova. In the context of the above-mentioned, serious deficiencies are obvious in the system of investigation and registration of deaths related to drug use. The toxicological investigations of the presence of illegal drugs in the NCHM, NDO 2011 Drug Situation in the Republic of Moldova, annual report 40

45 Drug related infectious diseases biological samples taken from the bodies of those who died unnaturally are not compulsory, which could result in cases of DRDs being overlooked. The performance of toxicological tests only in suspicious circumstances such as corporal injuries (signs of injection), syringes found at the scene, powders, etc., effectively excludes other cases of death related to drug use, where the bodies bear no external signs of drug administration. The technical capacity of the toxicological laboratory of the FMC and of the sub-national infrastructure of the FMC can provide only a qualitative analysis of the main groups of illegal drugs. Thus, it does not provide the best possible supporting data for the diagnosis of the forensic doctor. The long period between the collection of biological samples and the availability of the final results (3-4 months after the death) causes the death to be registered under an ICD-10 code other than that ultimately ascertained by the forensic doctor. The social stigma and the complexity of the legal procedures encourage the relatives of the deceased to actively hide the real cause of death in DRD cases. VI Drug related infectious diseases In the Republic of Moldova, the minimum set of infectious diseases monitored within this indicator includes HIV/AIDS and viral hepatitis B and C. Tuberculosis and sexually transmitted diseases, syphilis are also part of the monitoring. VI.1.1 HIV/AIDS Studies and researches HIV in the Republic of Moldova is concentrated among the IDU population; four HIV seroprevalence studies among IDU ([13], [14], [12], [3]) were concluded. The differences between the applied methods can affect the data comparability but offer a picture of general situation (Table 16). Table 15.HIV Prevalence among IDU, Republic of Moldova, 2001, 2003/2004, 2007 and 2009 Locality of data collection Sample HIV Prevalence Sample HIV Prevalence Sampl e HIV Prevalence Sample Chisinau % % % Balti % % % Causeni n/d n/d % % n/d n/d Donduseni n/d n/d n/d n/d % n/d n/d Edinet n/d n/d % % n/d n/d Falesti % % % n/d n/d Orhei % % 21 0% n/d n/d Rezina n/d n/d % % n/d n/d Soroca % % 41 0% n/d n/d Tiraspol n/d n/d n/d n/d % Ungheni n/d n/d % % n/d n/d Total % % % n/d n/d HIV Prevalence HIV prevalence studies undertaken in 2001 and 2003/2004 used time-location sampling method by testing the lavage of syringes used by the beneficiaries of harm reduction programmes. The HIV seroprevalence study carried out in 2007 used the probability sampling method of beneficiaries of harm reduction programmes by testing the blood samples. The 2009 study applied the respondent driven sampling with qualitative testing of blood samples. All studies show the highest HIV prevalence in Balti Municipality. NCHM, NDO 2011 Drug Situation in the Republic of Moldova, annual report 41

46 Drug related infectious diseases The breakdown of the data by age groups and gender, show the highest HIV prevalence in 2009 among 25 year old and older IDU (Table 16). Table 16.HIV prevalence in IDU, disaggregation by gender and age group, Republic of Moldova, 2009 < 25 years 25 years > Men Women Chisinau 12.4% 17.8% 14.2% 29.8% Balti 15.5% 43.2% 39.5% 40.5% Tiraspol 8.1% 14.3% 10.1% 17.7% Statistics According to the data of the National Public Health Centre (NPHC), in 1997, the number of newly registered HIV cases associated to injecting drug use has reached the highest values (Table 16) and the highest share among the newly registered HIV cases (87.9%). The diagnosis of a new HIV cases related to injecting drug use may be established either as a result of a voluntary request, or according to the regulatory framework, which recommends testing twice a year for the registered injecting drug users. The diagnosis is established when the person undertakes two ELISA type tests with positive results which are afterwards confirmed by the Western Blot test. A decrease of new HIV cases on both banks of the River Dniester has been registered starting from However, we cannot speak affirmatively about a reduced spread of HIV among IDU. Figure 28.Number of new HIV cases registered among IDU, Republic of Moldova, Left bank Right bank Source: CNSP Since the beginning of HIV epidemic, males accounted for the majority of the newly registered cases among IDUs on both banks of the River Dniester. In 2011, the share of males was 86.0% of the newly registered HIV cases related to injecting drug use, (Figure 29). NCHM, NDO 2011 Drug Situation in the Republic of Moldova, annual report 42

47 Drug related infectious diseases Figure 29.Distribution in terms of gender of newly registered HIV cases associated with injecting drug use, %, Republic of Moldova, % 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Females 0.0% 17.1% 21.1% 22.3% 18.9% 15.3% 16.8% 20.1% 21.0% 21.2% 11.1% 15.0% 9.5% 11.3% 12.8% 19.0% 14.0% Males % 78.9% 77.7% 81.1% 84.7% 83.2% 79.9% 79.0% 78.8% 88.9% 85.0% 90.5% 88.7% 87.2% 81% 86% Source: NPHC A slow increase of the average age at the moment of registration of new HIV case related to injecting drugs has been noticed since 2000 (31). This trend is valid for both banks of the River Dniester. Figure 30.Average age at time of registration of newly registered HIV cases associated with injecting drug use, Republic of Moldova, Source: NCHM Left Bank Right Bank Both Banks The analysis of the HIV epidemic trends, based on the number of newly registered HIV cases, is limited by the reliance on the regulatory testing framework of the high-risk populations, which has changed over time, and on the political context (frozen Transnistrian conflict reduces the consistency of reporting). Data inconsistency in particular for the left bank of the River Dniester - is explained by the fact that due to the existing political context, the blood samples from the left bank of the River Dniester have been sent with delay for confirmation (Western Blot test) to the only reference laboratory that confirms HIV cases, located on the right bank of the NCHM, NDO 2011 Drug Situation in the Republic of Moldova, annual report 43

48 Drug related infectious diseases River Dniester (Chisinau City). Data on the average duration between the first positive ELISA test and the confirmation of a new HIV case are not available. VI.1.2 Viral hepatitis The study of the seroprevalence of hepatitis C virus (HCV) and hepatitis B virus (HBV) among IDUs was conducted for the first time in 2007, among IDU beneficiaries of the harm reduction programs and applied the probabilistic sampling with testing samples of blood [12]. The second study was carried out in 2009 and used the respondent driven sampling by testing the blood samples [3]. According to this study, in 2009, the prevalence of hepatitis C was 72.8% in Chisinau, 70.2%- Balti, 20.5% - Tiraspol (Table 17). The highest prevalence value of hepatitis B virus (hereinafter HBV) was registered in Balti -14.2%, followed by Chisinau 10.9% and Tiraspol -7.5%. Table 17.Prevalence of HCV and HBV among IDU, 2007 compared to 2009, Republic of Moldova Data collection site Prevalence of VHC Prevalence of VHB Prevalence of VHC Prevalence of VHB # % # % 12/18 225/3 34/30 67/183 36,6 6,6 72,8 Chisinau ,9 249/3 41/36 97/145 66,9 5/145 3,4 70,2 Balti ,2 84/28 25/28 13/68 19,1 7/68 10,3 20,5 Tiraspol 1 1 7,5 The Republic of Moldova is considered an epidemic region for viral hepatitis B and C [15]. General immunization of the newborns against viral hepatitis B has started in 1995 in the RM. The most serious registered cases of hepatitis are based on clinical diagnosis, without applying a standard etiologic diagnosis algorithm (ELISA, immunoblot, PCR). The laboratories of the Republic of Moldova that investigate the viral hepatitis are not subject to any external quality control. This influences the notification process and represents an explanation why the data do not reflect the real situation in the country. However, these can be used with certain reserves to underline the trends. The data from below were presented by the public health centres and show a number of new cases of acute viral hepatitis B and C, which were in contact with medical institutions and were diagnosed. The decrease of the number of new cases of viral hepatitis B and C associated to injecting drug use has been noticed starting from This figure was the lowest in 2006 and 2008 (7 cases each). 5 out of 7 cases in 2008 were registered in Chisinau municipality and 2 in Balti municipality. NCHM, NDO 2011 Drug Situation in the Republic of Moldova, annual report 44

49 Drug related infectious diseases Figure 31.The number of newly registered cases of acute viral hepatitis types B and C associated with injecting drug use, Republic of Moldova (right bank of the Dniester River), Source: CNSP The National Public Health Centre has no data available on new cases of hepatitis B and C associated with injecting drug in VI.2 Other drug-related co-morbidity Data about tuberculosis on both banks of River Dniester are stored in an electronic database (SIME TB) at the National Health Management Centre. Since 2006, the tuberculosis data collection form has been completed with the question about drug use. Drug use is an extremely stigmatized and hidden practice in the Republic of Moldova. Thus, the patients with tuberculosis prefer not to give info about this topic. This could explain why the number of patients with tuberculosis who declared drug use is so small (Table 18). Table 18.Reported TB co-morbidity, Republic of Moldova, TB patients new cases and relapses TB patients (new cases and relapses) who reported drug use Source: NCHM, SIME TB Number % Thus, in 2011, on both banks of the River Dniester, 60 patients of 4675 patients with tuberculosis, new cases and relapses, reported drug use, which equals to 1.28%. The first study on seroprevalence of antibodies to Treponemma pallidum among IDUs was conducted among 2007 beneficiaries of harm reduction programmes by testing the blood samples. The second study was done in 2009, and used respondent-driven sampling by testing blood samples [3]. NCHM, NDO 2011 Drug Situation in the Republic of Moldova, annual report 45

50 Drug offences and drug-related crime Table 19.Prevalence of antibodies to Treponemma pallidum among IDU, Republic of Moldova, 2009 Locality of data collection Prevalence of antibodies # SPSS% Chisinau 7/ Chisinau Balti 7/ Balti Tiraspol 4/ Tiraspol Data breakdown by age groups and gender, the highest value of the prevalence of antibodies to Treponemma pallidum was registered in the age group of 25 years and older (Table 19). Table 20.The prevalence of antibodies to Treponemma pallidum among IDU (%), disaggregated by gender and age group, Republic of Moldova, 2009 < 25 years 25 years and > Male Female Chisinau 0,5 2,6 2,0 3,1 Balti 0 2,5 2,1 3,2 Tiraspol 4,9 0,4 1,9 0 Data on non-fatal accidents related to drug use, psychiatric co-morbidity and other acute and chronic effects related to drug use are not available in this report. VI.3 Social and legal correlations and consequences VI.3.1 Social problems According to the EMCDDA, the concept of social exclusion related to drug use and developed for the European Union countries is multidimensional. It includes a range of exclusion experiences such as economic deprivation or poverty and their consequences, social and political discrimination, dismissal, and reduced access to health care services, education, and qualifications. Social exclusion has appeared as a subject in recent years in the research on the characteristics of drug use and its social and legal consequences for health. The available information covers socio-economic factors related to drug use and, in particular, to problem drug use, focused on the population groups that accumulate multiple processes of exclusion such as affiliation with a minority, drug use, and suffering from the consequences of social and economic exclusion [16]. So far, the Republic of Moldova has not done any research on the aspect of social exclusion associated to drug use. Generally speaking, it is understood that drug use is mainly associated with unemployment and reduced access to general health care services in the Republic of Moldova. According to the Integrated Biobehavioural Surveillance Study in 2009, 48.4% of IDU declared themselves unemployed in Chisinau, 50.6% in Balti and 38.7% in Tiraspol. VII Drug offences and drug-related crime In 2011,1606 drug-related crimes were registered on the right bank of the River Dniester in 2011, which is 8.9% less then compared to 2010 (1764 crimes). The slow decrease of drug-related crimes has been noticed since The number of serious and extremely serious drug-related crimes registered in 2011 account for 33 and 37, respectively, in NCHM, NDO 2011 Drug Situation in the Republic of Moldova, annual report 46

51 Drug offences and drug-related crime Figure 32.The number of registered drug-related crimes, Republic of Moldova (right bank of the Dniester River), Source: MIA Geographical distribution of the drug-related crimes, based on MIA data, is represented in Figure 33Error! Reference source not found. The statistics show that the rayons from the north region of the country are the most affected by the drug-related crimes, especially those related to growing of plants with narcotic substances in prohibited quantities. The highest number of offences related to drug trafficking was registered in Balti, per inhabitants. Chisinau and Balti Municipalities are the main drug markets in the country. NCHM, NDO 2011 Drug Situation in the Republic of Moldova, annual report 47

52 Drug offences and drug-related crime Figure 33 Geographical distribution of the number of drug-related crimes per inhabitants, Republic of Moldova (right bank of the River Dniester), 2011 Source: MIA As for the breakdown by gender of the persons prosecuted for drug trafficking in the last 3 years, a decrease of the share of women and an increase of the share of men has been registered. Thus, the descending NCHM, NDO 2011 Drug Situation in the Republic of Moldova, annual report 48

53 Drug offences and drug-related crime trend for women presented in 2009 accounts for 19.7% and 15.9% in 2011, and the ascending trend for men accounts for 80.3% in 2009 and 84.1% in 2011 (Figure 34). Figure 34.Distribution in terms of gender of arrests for drug-related crimes, Republic of Moldova (right bank of the Dniester River), % 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Source: MIA As for the age group distribution of people involved in drug trafficking, the group of 30 year and older people accounts for the highest share in time in drug-related crimes, but since 2008, the share of this group has decreased significantly, so it accounted for 60.3% in 2008 and 49.0% in In 2011, an increase of the share of the group of years and years age group, who committed drug-related crimes, is noticed (Figure 35). Figure 35.Distribution in terms of age groups of the arrests for drug-related crimes, Republic of Moldova (right bank of the Dniester River), % 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% % 46.7% 41.6% 44.2% 47.7% 55.8% 58.3% 62.4% 44.9% 33.7% 36.0% 43.9% 48.2% 60.3% 55.6% 51.3% 49.0% % 13.3% 20.2% 15.6% 13.1% 12.8% 16.0% 15.6% 16.4% 22.6% 22.3% 19.2% 20.6% 16.8% 19.8% 16.9% 19.8% % 37.8% 32.6% 32.5% 37.7% 25.9% 22.4% 20.1% 34.0% 37.5% 37.7% 32.5% 28.8% 21.1% 22.1% 29.8% 28.0% % 2.2% 5.6% 7.8% 1.5% 5.5% 3.2% 1.9% 4.6% 6.3% 3.7% 4.2% 2.1% 1.6% 2.2% 1.9% 3.1% % 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.1% 0.0% 0.3% 0.2% 0.3% 0.2% 0.1% 0.0% 0.0% Source: MIA NCHM, NDO 2011 Drug Situation in the Republic of Moldova, annual report 49

54 Drug offences and drug-related crime The same trend is observed for men involved in drug trafficking crimes. The highest share is registered in the age group of 30 years and older, which accounted for 49.7% in 2009 which is by 6.5% less as compared to Accordingly, there is an increase in the age group of years and years (Figure 36Error! Reference source not found.). Figure 36.Distribution in terms of age groups of the males arrested for drug-related crimes, Republic of Moldova (right bank of the Dniester River), % 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% % % 0.0% % 6.6% 4.2% 2.9% 2.4% 5.8% 4.1% 5.0% 2.3% 2.2% 2.7% 2.2% 3.3% % 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.1% 0.3% 0.2% 0.1% 0.0% 0.1% Source: MIA In the case of women prosecuted for drug trafficking in 2011, as in the other years, the age group of 30 years or older accounts for the highest share %. Similar to the situation among men, it goes up in the age groups of years and years (Figure 37). Figure 37.Distribution in terms of age groups of the females arrested for drug-related crimes, Republic of Moldova (right bank of the Dniester River), % 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% % % 7.1% % % % 4.3% 8.5% % % 5.3% 2.0% 2.5% 1.5% 4.6% 2.4% 0.7% 2.4% 1.6% 1.2% 0.8% 0.3% 0.0% 0.3% 0.9% 2.1% % 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.6% 0.0% 0.0% 0.0% 0.4% 0.0% Source: MAI NCHM, NDO 2011 Drug Situation in the Republic of Moldova, annual report 50

55 Drug offences and drug-related crime The predominance of men among those growing plants with narcotic content has been registered also in the cases of growing plants with narcotic content for sale. There were registered 3 cases compared to 1 case among women, and 173 cases with no sale intent compared to 79 cases of women (Table 21). Table 21.Distribution of offenders charged with the cultivation of plants containing drugs by gender, Republic of Moldova (right bank of the Dniester River), 2011 Males, nr Females, nr Total, nr With the aim to sell Without aim to sell Total Source: MIA Most people involved in growing weeds are 30 years or older (85.0%). The share of women of 30 years old and more involved in growing plants containing narcotic substances (96.0%) is higher than the share of men of the same age group (76.0%), Table 22. Table 22.Distribution of offenders in the area of cultivation of drugs by age groups and gender, Republic of Moldova (right bank of the Dniester River), 2011 Males Females Total With the aim to sell Without aim to sell With the aim to sell Without aim to sell With the aim to sell years, # years, # years, # years, # years and older, # Total, # Source: MIA VII.1 Social/economic costs of drug use Without aim to sell No studies assessing the social (economic) costs of the drug use have been carried out in the Republic of Moldova before the publication of this report. VII.1.1 Drug markets VII.1.2 Availability and supply The 2008 and 2010 KAP years Studies measured the prevalence of drug use ([6], [4]). According to KAP years, there were no differences in answers about the availability of different types of drugs perceived by the general population, except for marihuana. On average, 18.0% of respondents said it would be easy to find/buy drugs, this share being higher only in the case of marijuana. (Table 23). Table 23.KAP years, Perception of general population about the availability of different types of drugs Very easy Fairly easy Difficult Very Impossible I don t know difficult Marijuana/cannabis Ecstasy Heroine NCHM, NDO 2011 Drug Situation in the Republic of Moldova, annual report 51

56 Drug offences and drug-related crime Locally produced opium Cocaine Amphetamine Meta-amphetamine Compared to 2008, the share of those who refused to answer ( I don t know ) increased by ~11%. If we exclude these respondents, we have a significant increase of the number of people who answered very easy or fairly easy (~ 5% for each type of drug), Table 24. Table 24.KAP years, 2008 compared to 2010: perceptions of the population about the availability of different types of drugs Marijuana /Cannabis Very easy Fairly easy Difficult Very difficult Impossi ble Very Fairly Difficult Very difficult Impossi ble easy easy Ecstasy Heroine Locally produced opium Cocaine Amphetamine Metaamphetamine The most frequently mentioned places where drugs were proposed to them in 2010 were the nightclubs (35.8%), on the street (26.6%) and in friends houses (7.3%). In the case of men, in 9.5% of cases the military unit was mentioned. According to the ESPAD 2011, on average, the boys more often than the girls consider that cannabis is easy to get, 7% compared to 4%. The gender difference can be due to a higher level of use among boys. NCHM, NDO 2011 Drug Situation in the Republic of Moldova, annual report 52

57 Drug offences and drug-related crime Figure 38.ESPAD 2011, perceived accessibility of different types of drugs. Percentage of those who answered very easy or fairly easy to get Total Boys Girls 1 0 Cannabis Amphetamine Ecstasy Tranquilliser or sedatives ESPAD, 2011 Amphetamine and ecstasy: on average, these illicit substances were declared to be fairly or very easy accessible with about 3% for amphetamine, 4% - ecstasy. As for tranquilizers and sedative drugs, students reported 3% for their accessibility (Figure 38). According to the Ministry of Internal Affairs, the local demand for drugs is covered by local production, which is mostly concentrated in the north and northeast of the country. Growing plants containing narcotic substances represents a source of income for local people, in particular in the rural area. Due to the small area of the country, the transportation of drugs is not expensive and does not represent an impediment to the internal distribution and meeting the demand of illegal drugs. According to available data, these drugs are used primarily for local needs, but these are also illegally exported to countries in the region - mainly Ukraine and the Russian Federation. Synthetic drugs, such as ecstasy, are imported from the European Union countries. The Republic of Moldova is one of the poorest countries in the region; this is one of the reasons often cited why importing expensive drugs (primarily heroin and cocaine) is detected rarely and usually only in small quantities (other than the transit seizure). The frozen political conflict on the River Dniester and the absence of any control over the eastern border creates favourable conditions for drug trafficking. VII.1.3 Drug seizures The data provided by the Ministry of Internal Affairs on the quantities of illegal drugs seized on the territory of the right bank of the River Dniester during are presented in Table 25. On average, the capture of illegal drugs manufactured on local market declined in The representatives of Anti-Drug Department of the MIA reported on the activities implemented in 2011 during the session of the National Anti-drug Commission in July Thus, 1606 drug-related crimes were registered, and narcotic substances were seized from illicit trafficking in the amount of about MDL 284,5 million (1.5 kg heroine, 6 litres of opium, 2.4 kg amphetamine, 26 t of plants containing narcotic substances, kg of cannabis, 213 kg of marijuana). As a result of the actions aiming at the fight against illicit drug trafficking, 32 groups involved in drug trafficking and 2 criminal groups specialized in marihuana and cannabis trafficking were discovered and annihilated, and 12 cases of drug smuggling were discovered. In accordance with the MIA report, once the opium use decreases, the heroin use increases, and the number of people, who use synthetic drugs, is increasing. NCHM, NDO 2011 Drug Situation in the Republic of Moldova, annual report 53

58 Drug offences and drug-related crime The increase of the number of people who use synthetic drugs has determined the priority objectives for the following years in the MIA: revealing smuggling routes; activity intensification in discovering the channels of drug penetration on the territory of the country. Table 25.Amount of drugs seized, Republic of Moldova (right bank of the Dniester River), Seized quantities Poppy straw, gr Marijuana, gr Poppy straw, Marijua gr na, gr Acetylated opium Acetyla 000 g ted Ecstasy, pills 155 opium Ecstasy, Codeine, pills 3241 pills Codein Ephedrine 430 e, Ephedri pills pills ne Tramadol, pills Amphetamine, gr 0 0 Tramad ol, Amphet pills Meta-amphetamine 0 amine, Metaamphet gr amine Barbiturate, pills 0 Barbitu Poppy plants rate, Poppy 000 g pills plants Hemp plants, gr Hemp plants, gr Heroine, gr Cocaine, gr 69,5 0 Heroine, Cocaine gr Cannabis, gr 0, Cannabi gr LSD, stripes 0 s, LSD, gr Space, pills 0 stripes Space, Peparazine, pills 0 pills Peparaz Torent, pills 0 ine, Torent, Mister crot, gr 0 pills Mister Source: MIA crot, gr Poppy straw, Marijua gr na, gr Acetylat 000 g ed 155 opium Ecstasy, 3241 pills Codeine 430 pills, Ephedri pills ne 0 Tramad 0 ol, Amphet pills 0 amine, Metaamphet gr amine 0 Barbitur ate, Poppy pills 000 g plants Hemp plants, gr 69,5 Heroine, 0 gr Cocaine, 0 gr Cannabi 0 s, LSD, gr 0 stripes Space, 0 pills Peparazi 0 ne, Torent, pills 0 pills Mister crot, gr Poppy straw, Marijua gr na, gr Acetylat 000 g ed 155 opium Ecstasy, 3241 pills Codeine 430 pills, Ephedri pills ne 0 Tramad 0 ol, Amphet pills 0 amine, Metaamphet gr amine 0 Barbitur ate, Poppy pills 000 g plants Hemp plants, gr 69,5 Heroine, 0 gr Cocaine, 0 gr Cannabi 0 s, LSD, gr 0 stripes Space, 0 pills Peparazi 0 ne, Torent, pills 0 pills Mister crot, gr Poppy straw, Marijua gr na, gr Acetylat 000 g ed 155 opium Ecstasy, 3241 pills Codeine 430 pills, Ephedri pills ne 0 Tramad 0 ol, Amphet pills 0 amine, Metaamphet gr amine 0 Barbitur ate, Poppy pills 000 g plants Hemp plants, gr 69,5 Heroine, 0 gr Cocaine, 0 gr Cannabi 0 s, LSD, gr 0 stripes Space, 0 pills Peparazi 0 ne, Torent, pills 0 pills Mister crot, gr Poppy straw, Marijua gr na, gr Acetylat 000 g ed 155 opium Ecstasy, 3241 pills Codeine 430 pills, Ephedri pills ne 0 Tramad 0 ol, Amphet pills 0 amine, Metaamphet gr amine 0 Barbitur ate, Poppy pills 000 g plants Hemp plants, gr 69,5 Heroine, 0 gr Cocaine, 0 gr Cannabi 0 s, LSD, gr 0 stripes Space, 0 pills Peparazi 0 ne, Torent, pills 0 pills Mister crot, gr VII.1.4 Prices and purities The information on the price of illegal drugs is obtained by the Ministry of Internal Affairs from the confidential reports of informants, from the intelligence acquired during operational actions, as well as from the personal observations during the activities under cover. The prices for illegal drugs on the market of the Republic of Moldova have not registered essential changes in 2011 (Table 26). Table 26.Variations in retail prices on the illegal drug market, Republic of Moldova (right bank of the River Dniester), Drug Average price 1ml opium extract 1 g of marijuana MDL MDL MDL MDL MDL MDL MDL MDL MDL MDL MDL MDL MDL MDL MDL MDL MDL 80 5 MDL MDL 80 5 MDL NCHM, NDO 2011 Drug Situation in the Republic of Moldova, annual report 54

59 Trends per drug Ecstasy pill $ $ $ $ MDL MDL MDL MDL MDL MDL MDL MDL MDL MDL MDL MDL MDL MDL MDL MDL g heroin $ $ $ $ $ $ g cocaine $ Source: MIA $ MDL MDL Currently, the Republic of Moldova does not have the necessary technical capacity to determine the degree of drug purity on a routine basis. VIII Trends per drug Since the data on drug use patterns have not been consistent over the years, it is not possible to track the trends in drug use. The information from various data sources currently existing in the Republic of Moldova differs and in many cases it is difficult to compare these. Due to lack of consistency over time, the available data reduce the possibility of analyzing the trends of the drug use phenomenon. The main sources of information for this subchapter are: study results among the general population (KAP grownups, years) study results among youth (KAP youth, years) study results among students (ESPAD) results of bio-behavioural studies among IDU (IBSS) statistics of the IMSP Republican Narcology Dispensary of the Ministry of Health concerning the profile of the newly registered drug use cases; statistics of the Ministry of Internal Affairs concerning the registered offences related to drug trafficking, as well as the confiscated quantities; interviews with officials of relevant public institutions (Ministry of Internal Affairs, Ministry of Health, Department for Penitentiary Institutions) and NGOs. VIII.1 Cannabis Cannabis is the most commonly used illegal drug in the Republic of Moldova. In 2010, the lifetime prevalence for the use of cannabis on the right bank of the River Dniester was 3.9% among the population between 15 and 64 years old, while in 2008 it was 3.4%. The prevalence of cannabis use is the highest among others illegal drugs (see Chapter Prevalence, Patterns and Developments in Drug Use ). The use of cannabis is more widespread in urban areas and more among males than females. The highest prevalence rates for cannabis use were registered in the year-old age group 6.4%. The survey among young people (15-24 years old) conducted in 2010 on the right bank of the River Dniester, suggests a lifetime prevalence of the cannabis use reaching 4.9% in the target population, which is the highest among illegal drugs in this population; a decrease compared to the results of 2008 study in the same target group is noticed (from 7.0%). Prevalence of cannabis use in the last year, did not record differences (2.3% in 2008 and 2.3% in 2010) over the years. The ESPAD Study conducted for the first time in 2008 among students born in 1992 who attend schools on the right bank of the River Dniester recorded an LTP of 4.8%, which is the highest among illegal drugs [2]. NCHM, NDO 2011 Drug Situation in the Republic of Moldova, annual report 55

60 Trends per drug According to the ESPAD 2011 survey for the Republic of Moldova, the data on the prevalence of cannabis use were not considered qualitative, which makes it difficult to follow the trends among students [17]. According to the study in the general population on the right bank of the River Dniester, the prevalence of cannabis use during the last month is 0.7%, during the last month prevalence is 0.3%, life time prevalence is 3.8%. According to RND, most newly registered cases of drug use without addiction in 2011, on the right bank of the River Dniester, were cannabis users (86.2%) and were smoking drugs (86.2%). Most newly registered cases of drug use without addiction was registered among men 95.4%. There has been a slow increase in the last 10 years in the average age of newly registered cases without addiction at the time of registration. In accordance with the MIA data, all drug trafficking-related crimes (46.0%) were related to illegal cannabis trafficking. VIII.2 Opioid/heroin The lifetime prevalence of opium use among general population (15-64 years) was 0.4% in The lifetime heroine use was reported by 0.1% of respondents. In 2011, 0.1% of young people of years reported the lifetime heroine use. According to IBSS among IDU in 2009, the injection of opium extract during the last month among the interviewed IDUs was the most common of all the drugs injected in all three locations where data were collected: in Chisinau (69.2%), in Balti (92.2%) and Tiraspol (86.7%). According to ESPAD 2008, 0.4% of 16 year old students reported lifetime heroine use. According to the RDN data, the use of locally produced opium is registered in most new drug addiction cases (90.5%). Heroine is rarely registered as the main drug at the moment of registration of new drug addiction cases. Injecting is the most used administration way of drugs in the new drug addiction cases (96.6%). In 2011, the seized quantity was 1,486 kg, in kg. There are no data available regarding a decrease or increase in the number of all opium users in the country over time (MIA). VIII.3 Synthetic drugs Based on the data provided by the MIA, the first seizures of amphetamines were registered at the end of the 90s. Local production of methamphetamine (pervithine) has started in the same period. The lifetime prevalence of ecstasy in the general population (15-64 years old) was 0.6% in 2010, with a higher rate among males (0.9%) compared to females (0.2%). In urban areas, the prevalence of ecstasy use was higher than in rural ones both for men and women. According to KAP results among youth, the lifetime prevalence of amphetamine use among young people (15-24 years) was 0.1% in The lifetime prevalence of ecstasy use among young people was 1.2% in 2010, and last year prevalence was 0.6%; in 2008, the lifetime prevalence of ecstasy use was 2.3%, last year prevalence 1.3%. According to ESPAD, the lifetime prevalence of ecstasy use among students was 1.6% in 2008 and 2% in According to IBSS among IDU in 2009, the highest last month prevalence of methamphetamine use was registered in Chisinau mun. 15.3%. The amphetamine/methamphetamine use at the moment of recording the new drug cases by the health system (RND) is too small to follow the trends. NCHM, NDO 2011 Drug Situation in the Republic of Moldova, annual report 56

61 Strategies in demand reduction at national level VIII.4 LSD LSD is very rarely met, both in case of drug seizures (MIA) and among new cases of drug use recorded by the health system (RND). The MIA captured the largest quantity of LSD in stripes. According to 2010 KAP among youth, the lifetime prevalence of LSD is 0.1%. VIII.5 Cocaine/crack Cocaine is an imported and expensive drug. Cocaine use was rarely recorded among new cases of drug use registered by the health system. In the Republic of Moldova, cocaine is considered to be used by the rich layers of the population, which do not apply for help to the public system of medical care and are very rarely detected by representatives of the law enforcement bodies. The largest capture of cocaine (5.5 kg) ever registered in the Republic of Moldova took place in In 2010, the lifetime prevalence of cocaine use among general population of years was 0.1%. VIII.6 Limitations There is a multitude of sources that talk about the use itself; majorities are studies under the National Programme for Prevention and Control of HIV/AIDS and STI (except for ESPAD). Respectively, these sources are not focused on drug use, but offer tangential data about the use. As for the illicit drug trafficking, there is only simple statistics of the MIA, which allows making conclusions only on the basis of cases registered by the law-enforcement bodies and does not measure the real scale of the phenomenon. The data provided by the MIA about the number of drug trafficking-related offences and drug seizures does not allow for disaggregation by captured quantities per each case. Thus, the information about the trends and crime patterns committed through drug trafficking, disaggregated by gender and age groups, is missing. Currently, the available data collection systems about the drug use and illicit drug trafficking, description of drug use patterns and trends do not meet fully the informational needs to make evidence-based decisions. At the moment, the country is also lacking the possibility to collect data for treatment demand indicator, in accordance with the requirements of the EMCDDA; also, it is not possible to estimate public and private, national and international expenses for the activities to prevent drug use and illicit drug trafficking. Another issue that deserves attention is the drawback in the investigation and registration of DRD. IX Strategies in demand reduction at national level IX.1 School programmes The Law of the Republic of Moldova No.713 of 6 December 2001 On Control and Prevention of Abusive Use of Alcohol, Illicit Drug and Psychotropic Substances Use stipulates measures to prevent the drug use among students and extracurricular activities. The practical actions are described in the National Action Plan for , a component part of the National Anti-drug Strategy for Their main priority is the stabilization or reduction of illegal drug use in the society, especially among minors and contribute to the completion or reduction of illicit drug injection. The Ministry of Education following the implementation of the National Action Plan has defined the following actions: To organize and host the republican competition of drawings/ posters, children s literary creations Drugs between myth and reality ; To extend the youth friendly services: o Diversification of services provided; NCHM, NDO 2011 Drug Situation in the Republic of Moldova, annual report 57

62 Strategies in demand reduction at national level o o Increasing the number of informed youth in the field of fight against drugs; Enhancing the delivered services. To extend and consolidate continuously the capacity of the peer educators in the field of minimizing the risks of HIV/AIDS infection and drug use among youth; Awareness campaigns to prevent drug use through local youth councils, etc. Prevention of drug use in extracurricular activities set forth in this normative acts is a specific early prevention programme with clear responsibilities of the players: to implement drug use prevention programmes in the educational institutions; to create an interdepartmental and inter-sectoral consultative working group for primary prevention outside schools; under the conditions of the special education system, to implement early prevention educational programmes for children and youth who experiment or abuse drugs; to create youth participation conditions in the political, economic, social and cultural life of the country by promoting physical culture and sports, participation in different sports activities to change the perception of drug use by children and youth, etc. IX.2 Reduction of drug related harm IX.3 Introduction The International Harm Reduction Development Program /Open Society Foundation describe harm reduction as a pragmatic and humanistic approach to diminishing the individual and social harms associated with drug use, especially the risk of HIV infection. It seeks to lessen the problems associated with drug use through methodologies that safeguard the dignity, humanity and human rights of people who use drugs. Harm reduction uses a range of services to achieve its goals. Needle exchanges and replacement therapy treatment are two of the most effective interventions to reduce drug-related harm. These are often complemented by other supportive services for drug users such as health and drug education, HIV and STD screening, psychological counselling, and medical referrals. By providing accessible services that meet drug users needs, harm reduction programmes often serve as a meaningful point of contact that can connect drug users with other community, medical, and social service resources. Since 2001, the Open Society Institute has prioritized advocacy to expand the availability and quality of needle exchanges, drug addiction treatment, and HIV treatment, to reform discriminatory policies and practices, and to increase the participation of people who use drugs and those living with HIV in developing policies that affect their lives. The high level of drug use in the Republic of Moldova has imposed the implementation of harm reduction programmes, which become an important link in the prevention of HIV infection, other blood or sexually transmittable diseases and other harm due to injecting drug use, referral to other specialized services, etc. These programmes provide the drug users with sterile equipment, individual protection means and safe liquidation of used injection equipment. The implementation of the Harm Reduction Strategy in the Republic of Moldova began in 1997 and has remained active until now. An agreement between the Ministry of Health of the Republic of Moldova, represented by the PCIMU, and the Soros Foundation-Moldova was signed on May 8, 2003, according to which, the Soros Foundation - Moldova developed a network of NGOs and public institutions implementing activities to prevent the spread of HIV among the most at-risk groups in both civil sector and penitentiary institutions. The Soros Foundation Moldova operates with funding for harm reduction activities from other international sources as well. The government of the Republic of Moldova has not funded harm reduction activities so far. NCHM, NDO 2011 Drug Situation in the Republic of Moldova, annual report 58

63 Strategies in demand reduction at national level IX.3.1 Description of interventions The harm reduction program services package for IDUs provided in the civil sector of the Republic of Moldova in 2011 included the following: syringes exchange, methadone substitution therapy as basic pharmaceutical remedy, information/education/outreach on HIV/AIDS and ways to prevent STIs in the context of high risk practices (distribution of information materials, condoms, counselling and testing, education and information seminars), referral to medical and social services, diagnosis/treatment of hepatitis, diagnosis/treatment of TB. In 2011, 6 projects which provided such services were active in 23 administrative units at the end of 2011 (Figure 39). At the end of 2011, the substitution treatment became available in two localities (Chisinau Municipality and Balti Municipality). For implementation results, see Chapter Treatment.. The basic components of harm reduction programs for IDUs in the penitentiary sector were the following in 2011: Information/education/outreach on HIV/AIDS and ways of prevention in the context of high-risk practices (distribution of information materials and condoms, education and information seminars),; Syringe exchange; Methadone substitution and maintenance treatment, as a basic pharmaceutical remedy. Activities for inmates are held through the health services in the penitentiary institutions, involving 63 outreach workers from among the inmates. In 2011, the informational component was implemented in 18 penitentiary institutions by distributing informational materials and conducting informational seminars on HIV/AIDS prevention. The needle exchange points were active in a round-the-clock regime in 12 penitentiary institutions on the right bank, and 3 penitentiary institutions on the left bank of the River Dniester. At the end of 2011, the methadone substitution treatment was available in seven penitentiary institutions. The changes applied over time in the method of reporting of the number of beneficiaries have influenced the consistency of data and trends. Currently, it is not possible to present and compare in a detailed way the data held. The implementation of the computer program for the system of anonymous unique identifier, which started in 2009, allows increasing the quality and complexity of data. As a result, it offers a solid database for a monitoring and evaluation framework; it provides periodical information for decision makers through monitoring of activities and recording clients. The Information System UDI/Ident simplifies the registration, reporting data, as well as the activities that allow relevant data generation. The system allows the NGOs to maintain the anonymity of the clients of target group, so they can have access to different social services. But during the implementation, the system has required adjustments and enhancement, which will be operated in NCHM, NDO 2011 Drug Situation in the Republic of Moldova, annual report 59

64 Strategies in demand reduction at national level Figure 39.Geographical distribution of services, harm reduction programmes, Republic of Moldova, 2011 Source: Soros-Moldova Foundation NCHM, NDO 2011 Drug Situation in the Republic of Moldova, annual report 60