on Drug НАРКО- Situation ЖАҒДАЙ

Transcription

1 ҚАЗ en РУС 2012 National Report Нашақорлықтың медициналық әлеуметтік проблемаларының республикалық ғылыми практикалық орталығы ҚАЗАҚСТАН РЕСПУБЛИКАСЫНДАҒЫ on Drug НАРКО- Situation ЖАҒДАЙ in the Republic of National Scientific and Practical Center on Medical and Social Problems of Drug Addiction ТУРАЛЫ Kazakhstan ҰЛТТЫҚ ЕСЕП 2012 This project is funded by The European Union

2 Drug Situation in 2011 REPUBLIC OF KAZAKHSTAN Republican Scientific-Practical Centre of Medical and Social Problems of Drug Addiction & CADAP-5 Project, 2012 This programme is funded by the European Union.

3 2012 National report on the Drug Situation in the Republic of Kazakhstan (Drug situation in 2011) Қазақстан Республикасында есірткі ахуалы туралы ұлттық есеп 2012 (2011жылы есірткі ахуалы) Национальный отчёт о наркоситуации в Республике Казахстан 2012 (Наркоситуация в 2011 году) Published by National Scientific and Practical Center on Medical and Social Problems of Drug Addiction, Republic of Kazakhstan, 2012 мен жарияланған Нашақорлықтың медициналық-әлеуметтік проблемалары республикалықғылыми-практикалық орталығы, 2012 Опубликовал Республиканский научно-практический Центр медико-социальных проблем наркомании, Республика Казахстан, 2012 Editor: Tomas Zabransky Редактор Томас Забрански Редактор Томас Забрански 1st edition 1шi басылым 1-е издание For bibliographical citations Библиографиялық ақпарат Библиографическая информация: Yusopov Oleg, Akhmetova Roza, Gafarova Nuria, Elizaryeva Alla, Ergaliev Zhasulan, & Zhumataeva Gulnar (2012). National Report on the Drug Situation in the Republic of Kazakhstan for 2012 (Drug situation in 2011) (Ed. T. Zabransky). Astana/Prague: National Scientific and Practical Centre on Medical and Social Problems of Drug Addiction/CADAP. Юсопов Олег, Ахметова Розa, Гафарова Нурия, Елизарьева Алла, Ерғалиев Жасұлан, Жұматаева Гулнәр. (2012). Қазақстан Республикасында есірткі ахуалы туралы ұлттық есеп 2012 (2011жылы есірткі ахуалы) (Ред. Т. Забрански). Астана / Прага: Нашақорлықтың медициналық-әлеуметтік проблемалары республикалық ғылыми-практикалық орталығы/ CADAP. Юсопов Олег, Ахметова Розa, Гафарова Нурия, Елизарьева Алла, Ергалиев Жасулан и Жуматаева Гульнар. (2012). Национальный отчёт о наркоситуации в Республике Казахстан 2012 (Наркоситуация в 2011 году)(ред.забрански, Т.). Астана / Прага: Республиканский научнопрактический Центр медико-социальных проблем наркомании / КАДАП. ISBN УДК 323/324 (574) ББК 66.3 (5каз)3 2

4 Table of Contents SUMMARY DRUG POLICY: LEGISLATION, STRATEGIES AND ECONOMIC ANALYSIS INTRODUCTION LEGAL FRAMEWORK NATIONAL STRATEGY AND COORDINATION IN THE FIELD OF THE FIGHT AGAINST DRUGS BUDGET AND FUNDING ISSUES DRUG USE AMONG THE GENERAL POPULATION AND AMONG SPECIFIC TARGET GROUPS INTRODUCTION DRUG USE AMONG THE POPULATION DRUG REGISTRATION SYSTEM DRUG USE AMONG YOUNG PEOPLE DRUG USE AMONG OTHER TARGET GROUPS PREVENTION INTRODUCTION GENERAL PREVENTION SELECTIVE PREVENTION BY RISK GROUPS MEDIA CAMPAIGNS PROBLEM DRUG USE INTRODUCTION PROBLEM DRUG USE PREVALENCE ESTIMATE INFORMATION ON PROBLEM DRUG USE FROM NON-TREATMENT SOURCES NEW FORMS OF PROBLEM DRUG USE DRUG TREATMENT INTRODUCTION TREATMENT SYSTEM DRUG ADDICTS APPLYING FOR TREATMENT INTERRELATION BETWEEN HEALTH AND CONSEQUENCES OF DRUG ADDICTION INTRODUCTION DRUG-RELATED INFECTIOUS DISEASES OTHER DRUG-RELATED DISEASES DRUG-RELATED DEATHS AND MORTALITY OF DRUG ADDICTS RESPONSES TO HEALTH CONSEQUENCES OF DRUG ADDICTION INTRODUCTION PREVENTION OF OVERDOSES AND DRUG-RELATED MORTALITY PREVENTION AND TREATMENT OF DRUG-RELATED INFECTIONS SOCIAL INTERRELATIONS AND SOCIAL REINTEGRATION DRUG-RELATED CRIMES INTRODUCTION CRIMES PREVENTION OF DRUG-RELATED CRIMES ALTERNATIVES TO IMPRISONMENT FOR OFFENDERS WITH A DRUG ADDICTION ASSISTANCE TO DRUG USERS IN PRISONS DRUG MARKETS INTRODUCTION AVAILABILITY AND SUPPLY OF DRUGS SEIZURES PRICES AND PURITY SELECTED ISSUES

5 11. RESIDENTIAL TREATMENT OF DRUG USERS IN KAZAKHSTAN INTERNATIONAL COOPERATION IN THE FIELD OF FIGHT AGAINST DRUG ABUSE AND THE DRUG TRADE INTRODUCTION HARM REDUCTION PROGRAMMES PREVENTION AND TREATMENT OF DRUG ADDICTION THE FIGHT AGAINST THE DRUG TRADE AND ILLICIT DRUG TRAFFICKING COMPREHENSIVE PROGRAMME CADAP REFERENCES ANNEXES LIST OF FULL REFERENCES TO THE LAWS LIST OF FIGURES LIST OF TABLES LIST OF MAPS LIST OF RELEVANT INTERNET RESOURCES LIST OF ABBREVIATIONS

6 SUMMARY In the Republic of Kazakhstan solving problems related to drug use is one of the priorities which is reflected in the Messages of the President of the Republic of Kazakhstan and in the Governmental Programmes. The main directions of work on the prevention and treatment of drug addiction, as well as combating the drug trade, are reflected in Governmental Decree of the Republic of Kazakhstan No. 784, dated May 27, 2009, On the Programme of Countermeasures against Drug Abuse and the Drug Trade for the Period In addition, regional programmes of countermeasures against drug abuse and the drug trade are established in every region of the country; these programmes are reviewed on an annual basis. The implementation of the State Programme of Countermeasures against Drug Abuse and the Drug Trade for the Period was completed in On the basis of Presidential Decree No. 922, dated February 1, 2010, On the Strategic Plan for the Development of the Republic of Kazakhstan until 2020, in 2012 the Government of the Republic of Kazakhstan approved a Sectoral Programme of Countermeasures against Drug Abuse and the Drug Trade in the Republic of Kazakhstan for the Period The Salamatty Kazakhstan State Programme for the Development of Healthcare in the Republic of Kazakhstan for the period , which plans the activities to improve drug prevention and the treatment system, was developed and introduced on the basis of the above-mentioned Presidential Decree. An interdepartmental headquarters, which included representatives of 12 ministries and agencies, was formed at the governmental level in September The main function of this headquarters is to coordinate the activity of various state agencies in the field of combating drug abuse and the drug trade. Regardless of the fact that in international organisations reduced their provision of financial support to the Republic of Kazakhstan, large-scale technical support is provided for the improvement of the system of countermeasures against drug abuse and the drug trade and for bringing this system into a state of compliance with international standards. In the field of countermeasures against drug abuse and the drug trade there is a phased transition from the prosecution of drug users for committing minor offences towards the suppression of organised crime and drug smuggling in the country. The issue of the introduction of criminal liability for the illicit handling of precursors is also under consideration in the country. The funding of activities aimed at countermeasures against drug abuse and the drug trade increases every year; however, the correlation between the funds allocated to supply reduction, demand reduction, and harm reduction programmes will remain unequal as the highest level of financial support is provided to those activities aimed at the fight against the drug trade. The correlation of expenditures for the prevention and treatment of drug abuse, as well as for the prevention of the consequences of drug use in the country, remains approximately equal and equates to 10% of total expenditure for each sphere of activity. At present it is extremely difficult to obtain an objective picture of drug consumption both among the general population and among specific groups (young people, prison inmates, etc.) because of the lack of a good-quality epidemiological study in the country. The recent studies in 5

7 the country do not reflect the current situation related to drug use among the population. At present, the country needs high-quality and objective data on the drug situation, as well as an improvement of the data collection and monitoring system in accordance with international standards. One of the sources of information on drug consumption among the general population and for analysis of the situation is the data from the narcological register, which are used by various agencies for the evaluation and planning of preventive and treatment programmes. However, the register only covers the tip of the iceberg, and two thirds of drug consumers are invisible. The other source of information on problem drug users is Sentinel Epidemiological Surveillance (SES). It should be noted that the level of representativeness is decreasing in all the groups that are surveyed because of the use of an incorrect methodology for the formation and calculation of the sample sizes. Because of the limitation of the approaches to the formation of the sample and data analysis, the possibility of extrapolating the results obtained to the national level is disputable. Nevertheless, if the available data are analysed as a whole, several important conclusions can be drawn about the change in the drug situation in the Republic of Kazakhstan. Regardless of the fact that the Sentinel Epidemiological Surveillance data show some divergence from the indicators of demand reduction and supply reduction, it can be supposed that the population of drug users in the country shows a decreasing trend. This is proved by the annual increase in the average age of problem drug users, by the reduction in the number of drug addicts in the narcological register, and by the increase in the average length of their history of consumption. On one hand, because of the progressive limitations on the availability of heroin (reduction of supply, increase in price), injecting drug users have had to pass on to other types of drugs (synthetic smoking mixtures, cannabis) or to use alcoholic beverages, as well as to apply for assistance to the specialised narcological facilities. On the other hand, some drug users have had to pass on to the consumption of drugs produced from medicines that are available legally, such as medicines containing codeine and tropicamide. In 2011 the number of registered drug users shows a decreasing trend among all registered drug users, both men and women. In terms of dynamics by years (Table 4. Number registered and removed from narcological registration) a decreasing trend can be observed among persons registered for the first time in their lives. The number of persons removed from narcological registration shows unbalanced dynamics, with increasing trends, whereas the number of persons removed from narcological registration because of their death shows a small decrease, and the number of persons removed from registration because of remission shows an increasing trend. Starting with 2007, the number of cases of registration in the narcological service of persons consuming volatile organic substances, opioids, and stimulants has decreased. However, the number of persons with disorders caused by the consumption of cannabinoids and polydrug consumption has increased. In the previous 5 years the number of persons aged under 18 years old consuming volatile organic substances and opioids shows a decreasing trend. The number of persons registered with the narcological service because of the use of cannabinoids and sedatives shows a tendency to increase in terms of its dynamics by years. 6

8 It is necessary to mention the high level of activity of various ministries and agencies in the implementation of preventive activities. However, most of the activities receiving funding in the country include information campaigns and activities. An urgent need for the stable funding of preventive programmes implemented in educational institutions and aimed at prevention among risk groups and prevention through the family and the community exists in the country. Such programmes are barely represented on the territory of the country and very often are represented by separate projects and are not stable. In addition, at present there are no regulatory documents regulating preventive activities in educational institutions. Thanks to harm reduction programmes, which are deployed all over the country, the prevalence of infections among drug users can be stopped at a stable level. However, these programmes require further improvements in the quality of the services provided and an increase in the coverage of drug users by these services. The mortality among drug users remains relatively high in comparison with that in the general population (the mortality rate is 2.4 times higher on average than among the general population; it is 2.3 times higher among male drug users and 6.8 times higher among female ones). Nevertheless, the programmes to prevent overdoses are insufficiently developed and cover only an insignificant percentage of injecting drug users. The following conclusions can be drawn if the data on treatment are analysed. In the previous three years the number of patients applying for the treatment of drug addiction shows a decreasing trend. At the same time, the proportion of patients treated for the first time in their lives among the patients receiving treatment is increasing year by year. An increasing trend to use other opiates (mostly desomorphine) and other substances (produced from available medicines) is observed among patients being treated for the first time in their lives. The social characteristics of clients applying for treatment are also changing. For several years a significant decrease can be observed in the number of persons with higher education being treated and an increase in that of persons who are unemployed and unoccupied. The question of the introduction of substitution therapy in the country in the field of the treatment of problem drug users is still a delicate one. The main results of the evaluation of Opioid Substitution Treatment projects in the Republic of Kazakhstan indicate the feasibility and effectiveness of the use of methadone for the treatment of drug abuse in the country, and the legislation of the Republic of Kazakhstan allows this type of service to be introduced as a standard treatment for opiate dependence. Nevertheless, the monitoring system and the scope and the quality of the provision of organisational and methodological assistance to institutions providing substitution treatment are insufficient for expansion and require further improvement. The percentage of registered drug-related crimes in the total number of crimes registered in the republic was 2%. In 2011 the law enforcement bodies of the Republic of Kyrgyzstan registered 4360 crimes related to illicit trafficking in drugs, psychotropic substances, and precursors (hereinafter drugs ), in comparison with 8795 crimes in a similar period in 2010, which makes 50.4% less than in the previous year. The reduction in the number of registered drug-related crimes is caused by the decriminalisation of Article 259 Part 1 of the Criminal Code of the Republic of Kazakhstan, Illicit purchase, transportation, or storing without intent to sell of narcotic substances or psychotropic substances in a large amount in January 2011, and the transition of this article to the section covering administrative violations. The percentage of 7

9 crimes falling under Article 259 of the Criminal Code of the Republic of Kazakhstan in the total number of registered drug-related crimes is 92.5 %. In crimes were committed after the consumption of drugs. Work is being conducted on the prevention of reasons and factors promoting the appearance of new types of substances consumed by drug addicts, such as desomorphine and tropicamide. For this purpose, in October 2011 the Ministry of Internal Affairs and Ministry of Health of the Republic of Kazakhstan issued a joint decree on cooperation between the Committee for Countermeasures against the Drug Trade of the Ministry of Internal Affairs of Kazakhstan and the Committee for Control of Medical and Pharmaceutical Activities of the Ministry of Health of Kazakhstan for the provision of preventive measures ensuring the non-proliferation of drug addiction and drug-related crimes, and of the cases, which are becoming more frequent, of the misuse of drugs containing codeine and tropicamide. Within the past four years the amount of drugs seized from illicit trafficking has remained stable; in 2011 the total weight of drugs that was seized was 33 tones 998 kilograms. The majority of the drugs seized are cannabinoids. In general, the volume of heroin seizures in Kazakhstan is low, considering that Kazakhstan is the last country which is crossed by drugs on their way to the markets of the Russian Federation. Almost 90 per cent of seizures in Central Asia are made before the heroin reaches Kazakhstan. According to information provided on the basis of operational data of the Committee for Countermeasures against the Drug Trade of the Ministry of Internal Affairs of Kazakhstan, both wholesale and retail prices for all types of drugs increased significantly in the period In 2011 the prices remained approximately at the level for In 2011 the retail price of heroin varied from 2000 KZT to 15,000 KZT per gram, and the cost of marijuana was from 2000 to 10,000 KZT per 250 grams. According to the results of examinations conducted by the National Laboratory dealing with problems related to the legal and scientific provision of state control of trafficking in narcotic substances, psychotropic substances, and precursors, it was detected that the content of tetrahydrocannabinol in the marijuana seized varies from 0.02 to 4.23% (on average 1.59%), and in hashish from 0.51% to 6.73% (on average 3.31%). The purity of heroin varies from 1.04% to 39.9% (on average 14.3%). In conclusion it is necessary to note that the volume of data and quality of data in the Republic of Kazakhstan can be estimated as satisfactory. The data collection system in the country and further reporting requires significant improvement in terms of all five key indicators proposed by the European Union: drug use among the population; problem drug use; drug-related diseases; drug-related mortality and deaths of drug users, and drug treatment demand. At present the collection of qualitative data on the activities of private narcological facilities and compulsory treatment institutions is not performed. Reports on the activities of nongovernmental organisations in the field of primary, secondary, and tertiary prevention of drug addiction are not available either, though from the volume of funds allocated for projects it can be assumed that these organisations should make a significant contribution to national efforts on counteracting the spread of drug abuse. 8

10 Table 1-1a: Summary table of main indicators of the drug situation in the Republic of Kazakhstan, Indicator As of December 31, 2010 As of December 31, 2011 Estimated number of injecting drug users (IDU) 119,100 (1.05% of the population aged 15-64) 123,640 (1.08% of the population aged 15-64) Number of persons on preventive 15,210 14,566 narcological registration Number of persons on dispensary 32,637 (1,517) 30,259 (538) narcological registration (and those registered for the first time this year) Number of deceased persons registered by 1,050 1,079 the narcological service this year Number of persons who underwent 3,482 2,972 inpatient treatment for drug addiction HIV prevalence among IDUs 2.8% 3.8% Hepatitis C prevalence among IDUs 58.7% 61.3% Syphilis prevalence among IDUs 8.2% 10.9% Number of needles/syringes distributed among IDUs (per IDU involved in preventive programmes) Weight of marijuana seized (kg) 27,348 27,380 Weight of hashish seized (kg) Weight of heroin seized (kg) Weight of opium seized (kg) Number of persons arrested for storing 6,217 5,644 drugs (without intent to sell) Number of persons arrested for drug 3,434 3,099 dealing (including production) Average street price of heroin (per gram) 4,969 KZT 4,900 KZT Average street price of opium (per gram) 2,214 KZT 2,214 KZT Average street price of marijuana (per 250 grams) 4,469 KZT 4,625 KZT 9

11 MAIN DEVELOPMENTS AND TRENDS 1. DRUG POLICY: LEGISLATION, STRATEGIES AND ECONOMIC ANALYSIS 1.1. Introduction Countermeasures against illicit trafficking in drugs represent one of the most important components of the state policy of Kazakhstan. In the field of countermeasures against drug abuse and the drug trade a phased transition from the prosecution of drug users for committing minor offences towards the prosecution of organised criminal groups controlling drug traffic and extensive drug dealing networks is planned Legal framework The fundamental document regulating the legal basis for state policy in the field of the trafficking of narcotic substances, psychotropic substances, and precursors and establishing countermeasures against the illicit trafficking of such substances is the Law of the Republic of Kazakhstan: On narcotic substances, psychotropic substances, and precursors, and countermeasures against illicit trafficking and drug abuse (No. 279, dated July 10, 1998). Involvement in any activities (storing, trade, etc.) related to an extra-large amount of a narcotic substance serves as a basis for applying criminal liability to a person. For trading in narcotic substances or psychotropic substances criminal liability is applied regardless of the amount of such substances. The administrative legislation stipulates administrative responsibility for the commission of such offences as: failure to destroy cannabis that is growing wild (Art. 318); failure to ensure the guarding of drug-containing plants (Art. 319); failure to prevent the sale and/or non-medical consumption of narcotic substances, psychotropic substances, and precursors (Art ); illegal production, handling, or storing of narcotic substances with no intent to sell (Art. 320), and propaganda and illegal advertising of narcotic substances, psychotropic substances, and precursors (Art. 321). The list of narcotic substances, psychotropic substances, and precursors in Kazakhstan is approved by the law; this significantly increases the period required for making amendments to the list. For this reason, the opportunity of providing this function to the Government, with the unification of this list with the partners in the Customs Union (Russia, Belarus, and Kazakhstan) and taking international experience into account, is being considered in the country. The country is also considering the introduction of criminal liability for the illicit handling of precursors. The practice shows that administrative punishments (fines) do not ensure the necessary effect if imposed on large enterprises for violations concerning the storage of precursors. Drug consumption is not criminally punishable in Kazakhstan. According to Article of the Administrative Code, non-medical consumption of narcotic substances in public places is an administrative offence and is punishable with a fine. The same activity, if repeated within one 10

12 year, results in a higher fine. A person who commits this offence twice within one year is subject to administrative arrest. The measures for the compulsory treatment of drug addicts are laid down in the legislation. In Article 130 of the Code of the Republic of Kazakhstan On people s health and the healthcare system, dated September 16, 2009, Organisation of medical assistance to persons suffering from alcoholism, drug addiction, and toxicomania, item 2 reads Measures of compulsory medical intervention are applied by a court decision to persons who have committed a crime and were recognised as requiring treatment for alcoholism or drug addiction, as well as to persons who have committed an administrative offence and are recognised as suffering from chronic alcoholism, drug addiction, or toxicomania, and avoiding voluntary treatment. Regulation No of the Government of the Republic of Kazakhstan, dated December 2009, On the adoption of a list of medical psychiatric contraindications for the performance of specific types of professional activity, as well as work associated with an increased danger level prohibits persons who are active consumers of psychoactive substances from being allowed to perform all types of labour activity related to sources of increased danger, including driving vehicles. Drug users who are in a state of remission are not allowed to perform some specific types of labour activity, including driving vehicles Implementation of legislation in 2010 The Law of the Republic of Kazakhstan On the introduction of amendments to some legislative acts of the Republic of Kazakhstan on issues relating to the humanisation of the criminal law and the strengthening of guarantees of legality in the criminal procedure (dated January 18, 2011) was adopted in January 2011 for the implementation of the concept of the legal policy of the Republic of Kazakhstan until 2020 with regard to humanisation of the criminal law. Within the framework of this Law, part 1 of Article 259 of the Criminal Code of the Republic of Kazakhstan, which stipulated criminal responsibility for the illicit purchase, transportation, or storing without intent to sell of narcotic substances or psychotropic substances in a large amount 1 was decriminalised. Starting in 2011, administrative responsibility (Part 1-1, Art 320 of the Administrative Code of the Republic of Kazakhstan) is stipulated for the commission of the above-mentioned activity. These measures allowed the criminal punishment of persons who are mostly addicted to drugs to be minimised, as well as the prison population of the country to be reduced National strategy and coordination in the field of the fight against drugs National strategy The implementation of the State Programme of Countermeasures against Drug Abuse and the Drug Trade for was completed in The aim of the programme was the blocking and regression of socially dangerous trends towards an increase in the spread of addiction to 1 LAW OF THE REPUBLIC OF KAZAKHSTAN, DATED JULY 10, 1998, No. 279 "On narcotic substances, psychotropic substances, precursors, and countermeasures against their illicit trafficking and abuse ". 11

13 psychoactive substances among the population of the country. The main tasks of the programme included: - an increase in the coordination and effectiveness of anti-drug activities at the regional level and the development of a system for the primary prevention of drug abuse and healthy leisure of the population; - strengthening anti-drug propaganda; - the large-scale introduction of innovative anti-drug technologies in the healthcare system and social sphere of the Republic of Kazakhstan; - monitoring of the effectiveness of preventive activities in the field of drug addiction; - the improvement and development of a system for the provision of narcological assistance to the population on secondary and tertiary prevention, effective regulatory legal and scientific-informative support, the introduction of innovative technologies for prevention, diagnosis, treatment, rehabilitation, and re-socialisation in the healthcare system and social sphere of the Republic of Kazakhstan, and provision of full coverage of the drug-addicted population with effective programmes of medical and social rehabilitation; - improving the qualifications and large-scale training of specialists in the healthcare system and social sphere on modern anti-drug technologies, training of scientific pedagogic staff, and conducting special educational sessions on anti-drug topics for the staff of the educational system; - improvement of the legislative basis regulating anti-drug activities and further harmonisation of national legislation aimed at countermeasures against drug abuse and the drug trade with the guidelines of international legal acts and recommendations of public organisations; - strengthening the material and technical and personnel capacity of authorised state bodies, as well as medical institutions, dealing with the prevention and treatment of drug addiction; - strengthening of interagency cooperation in the field of countermeasures against the drug trade, increasing the effectiveness of blocking the channels of drug trafficking by means of strengthening the southern boundaries of the country; - expansion of international cooperation in the field of countermeasures against drug abuse and the drug trade; - implementation of international anti-drug projects in the Republic of Kazakhstan and activation of the work of Kazakhstan in the Commission on Narcotic Drugs of the United Nations Organisation and in its auxiliary bodies for participation in the development of decisions of the UNO in the field of the fight against drugs, with account being taken of the interests of Kazakhstan and the regions of Central Asia. 12

14 30% of the activities of the programme were aimed at the development and improvement of the monitoring system, coordination, and international cooperation, 24% at the prevention of drug addiction among the population,14% at the system for the treatment and rehabilitation of drug addicts, and 32% at the system of countermeasures against the drug trade and illicit drug trafficking. Activities aimed at the prevention of health consequences/harm reduction programmes related to drug consumption were not stipulated within the framework of this programme. In 2009 an analysis of the social anti-drug strategies and principles that were used was performed, and an analysis of the representation of these strategies in the basic regulatory documents regulating anti-drug activities in the social sector of the Republic of Kazakhstan was conducted (Katkov A.L., 2009). Most of the conclusions reached in the course of this analysis remain valid up to the present time. The main strategies used in the country drug demand reduction, supply reduction, consumption reduction, and harm reduction comply with the international practice of combating the spread of drug abuse. The main institutional deficit in the sphere of social antidrug strategies under consideration is a lack of compliance and a lack of structural compromise in the activities of the main anti-drug agencies of the social sector. This is expressed, particularly, in the conflicting norms for the regulation of anti-drug activities and approaches in this sector (Katkov A.L., 2009) Developments On the basis of Presidential Decree No. 922, dated February 1, 2010, On the Strategic Plan for the Development of the Republic of Kazakhstan until 2020, in 2012 the Government of the Republic of Kazakhstan approved a Sectoral Programme of Countermeasures against Drug Abuse and the Drug Trade in the Republic of Kazakhstan for the period The main aim of this programme is to further develop the system of effective state and public countermeasures against drug abuse and the illicit drug trade. The activities of the programme, which mostly continue the directions of the previous programme, also provide for the implementation of a range of legislative initiatives and the introduction of alternative forms of punishment, which stipulate alternatives to criminal penalties (deprivation of freedom) in the form of compulsory treatment of drug addiction for drug addicts committing minor criminal offences. The Salamatty Kazakhstan State Programme for the Development of Healthcare of the Republic of Kazakhstan for the period was developed and introduced on the basis of Presidential Decree No. 922, dated February 1, 2010, On the Strategic Plan for the Development of the Republic of Kazakhstan until In 2011 approximately 12% of the activities stipulated by the Salamatty Kazakhstan Programme were directly aimed at the development and improvement of the prevention system for drug abuse and its consequences, as well as the development of the treatment system for drug addicts. Out of these activities, 42% are aimed at the development and improvement of the monitoring system, coordination, and staff capacity building, 33% at the prevention of drug addiction among the population, 4% at the development and improvement of the system for the treatment and rehabilitation of drug addicts (this includes only the expansion of opioid substitution treatment), and 21% at the prevention of health consequences/harm reduction programmes related to drug consumption. 13

15 Coordination In September 2011, an interagency headquarters for the coordination of the activity of state bodies aimed at countermeasures against drug abuse and the drug trade, which included representatives of 12 ministries and agencies (the Ministry of Internal Affairs, the agency for the fight against economic crime and corruption, Committee for Countermeasures against the Drug Trade, Ministry of Foreign Affairs, Ministry of Education and Science, Ministry of Culture, Ministry of Communications and Information, Ministry of Finance, Office of the General Attorney, Ministry of Health, Ministry of Defence, and Ministry of Tourism and Sports) was established at the governmental level. An active policy of integration and cooperation with international partners and other states is continuing in the country, and the international legal basis in the field of countermeasures against the drug trade is being strengthened. The adoption of the Anti-drug strategy of the Shanghai Cooperation Organisation (SCO) for a five-year period and the programme for its implementation (approved by a decision of the Board of Heads of SCO Member States on June 15, 2011 in the city of Astana, at the Anniversary Summit of the Shanghai Cooperation Organisation) took place in This strategy determines general directions for the improvement of the system of countermeasures against illicit drug trafficking, the prevention of drug abuse, and the treatment and rehabilitation of drug addicts. Activities for the implementation of a range of joint projects aimed at the improvement of the activity of state bodies in the field of the fight against drug abuse and the drug trade continued. This cooperation was arranged with various offices of the United Nations, with the European Union within the framework of the Central Asia Drug Action Programme (CADAP), with the Collective Security Treaty Organisation (CSTO), and with the Central Asian Regional Information Coordination Centre for Combating the Illicit Trafficking of Narcotic Drugs, Psychotropic Substances, and their Precursors (CARICC) (see International cooperation in the field of the fight against drug abuse and the drug trade) Budget and funding issues Data on the financing of state agencies from the assets of republican and municipal budgets within the framework of the Programme of Countermeasures against Drug Abuse and the Drug Trade in the Republic of Kazakhstan for 2011 are provided in Table

16 Table 1-1b: Volume of financing of the Action Plan for Implementation of the Programme of Countermeasures against Drug Abuse and the Drug Trade in the Republic of Kazakhstan for the period (MIA RK) in Kazakhstan in 2011 Volume of financing (thousand KZT) 2 Republican budget Municipal budget Total for each agency Percentage of total volume Pos. Ministries and agencies Main direction of activity Ministry of Internal Countermeasures against 1. Affairs illicit drug trading, 1,107,815 21,649 1,129, prevention of crime 2. Ministry of Culture and Preventive information Information campaigns in the media 301,302 17, , Ministry of Health Treatment and prevention of drug addiction 8, , , Ministry of Education Prevention in educational and Science institutions 64,781 47, , Committee of National Countermeasures against Security illicit drug trading 6,593, ,593, Committee of Customs Countermeasures against 6. Control of the Ministry illicit drug trading 6,609, ,609, of Finance 7. Ministry of Tourism Prevention through and Sports alternative types of activity 4,085 36,180 40, Total 14,690, ,979 14,997, In general, for the whole period of implementation of the Programme of Countermeasures against Drug Abuse and the Drug Trade for , 2.1% of the financing was allocated to the development and improvement of the monitoring system, coordination, and international cooperation; 2.2% was spent on the prevention of drug abuse among the population, 1.3% on the system of treatment and rehabilitation for drug addicts, and 94.4% on the system of countermeasures against the drug trade and illicit drug trafficking. 65,262.7 million KZT was issued within the framework of the Salamatty Kazakhstan State Programme for the development of healthcare in the Republic of Kazakhstan for % of the financing of this programme is allocated for direct expenditures for the development and improvement of the prevention system for drug abuse and its consequences and the treatment system for drug addicts. 0.6% of this amount is allocated to activities for the development and improvement of the monitoring system, coordination, and staff capacity building, 28.6% to the prevention of drug addiction among the population, 14.8% to the development and improvement of the system of treatment and rehabilitation for drug addicts (this includes only the expansion of OST), and 56% to the prevention of health consequences related to drug consumption. 2 In 2011 the average exchange rate was KZT to 1 Euro. 15

17 The financing of healthcare in general in the republic has increased from 1.9 % of Gross Domestic Product in 2002 to 2.4 % in It should be noted that the largest part of the population s expenses for healthcare is covered by the state. In 2010 the Single National Healthcare System of the Republic of Kazakhstan was introduced, for the implementation of which the funding of all inpatient medical assistance and substitutes for inpatient assistance in the republic, including narcological, was transferred to the republican budget, while outpatient funding remained the responsibility of local budgets. Payment for each bed-day spent by a patient in an inpatient facility or day patient facility was made by the republican budget to medical organisations, using a basic rate, through the regional departments of the Committee for Payment for Medical Services of the Ministry of Health. Table 1-2 below provides information on state expenditures for the provision of specialised medical narcological assistance, which includes the treatment of alcoholism, drug addiction, and other addictions, as well as approximate expenses for the treatment of drug-addicted persons in 2011 by regions of the country. The data on the number of bed-days of patients treated for drug abuse in every regional narcological dispensary and centre and the average basic rate of payment for one bed-day in every region were used to determine approximate expenditures for the treatment of drug-addicted persons. 16

18 Table 1-2: State expenditure for the provision of specialised medical narcological assistance, 2011 (NSPC MSPDA) Region Expenditure for provision of specialised medical narcological assistance In national currency (thousand KZT) In EU currency (thousand Euro) Approximate expenses for treatment of drug addicts 3 In national currency (thousand KZT) In EU currency (thousand Euro) Akmola Oblast 349, , , Aktyube Oblast 448, , , Almaty Oblast 209, , , Atyrau Oblast 142, , Eastern Kazakhstan Oblast 478, , , Zhambyl Oblast 298, , , Western Kazakhstan Oblast 405, , , Karaganda Oblast 637, , , Kyzylorda Oblast 365, , , Kostanai Oblast 297, , , Mangistau Oblast 149, , Pavlodar Oblast 275, , , Northern Kazakhstan Oblast 339, , , Southern Kazakhstan Oblast 455, , , City of Almaty 545, , , City of Astana 325, , , Republican Scientific-Practical Centre for Medical-Social Problems of Drug Abuse 460, , , Republic of Kazakhstan 6,184, , , ,169.0 In 2011 the financing of the narcological service in the Republic of Kazakhstan increased insignificantly in comparison with previous years, to KZT per resident per year; in 2010 the figure was KZT, and in 2009 the figure was KZT. The lowest level of financing is in the Almaty Oblast (110 KZT per resident per year), while the highest is in the Western Kazakhstan Oblast (664.6 KZT per resident per year) (NSPC MSPDA, 2012). The payment for one bed-day in the narcological facilities in the country varies from 890 KZT (4.6 Euro) to 6951 KZT (35.6 Euro). The average payment rate for one bed-day in the narcological facilities of the Republic of Kazakhstan in 2011 was 3513 KZT (18 Euro). The approximate expenditure for the inpatient treatment of drug addicts in the Republic of Kazakhstan was million KZT; the cost of treatment of one case in average equals 148,318 KZT. Figure 1 further represents the correlation of state expenses in the Republic of Kazakhstan for the main directions in the field of countermeasures against drug abuse and the drug trade. This calculation was made by summing the funding of two programmes in 2011 the Programme of Countermeasures Against Drug Abuse and The Drug Trade and the Salamatty Kazakhstan state 3 This includes expenses for the inpatient treatment of drug addicts. Expenses for outpatient and compulsory treatment are not included. 17

19 programme for the development of healthcare in the Republic of Kazakhstan, as well as approximately calculated expenses for the treatment of drug addicts in Figure 1-1: Correlation (%) of state expenses for the main directions in the field of countermeasures against drug abuse and the drug trade in Kazakhstan, ,1 5,4 9,9 Monitoring, coordination and training Drug abuse prevention 6,2 Treatment of drug addiction Harm reduction 78,4 Countermeasures against drug trade and illicit drug trafficking The major part of state expenses in 2011 for the above-mentioned programmes was allocated for countermeasures against the drug trade and illicit drug trafficking. The correlation of expenses for the fields of prevention, the treatment of drug addiction, and the prevention of consequences related to drug consumption in the country remains approximately equal and does not reach 10% in any direction. 18

20 2. DRUG USE AMONG THE GENERAL POPULATION AND AMONG SPECIFIC TARGET GROUPS 2.1. Introduction No research for evaluation of the prevalence of drug use among the general population was carried out in No representative study was conducted among schoolchildren and other specific target groups Drug use among the population The most recent research study on the national level was conducted in 2001 by the Republican Scientific Practical Centre of Medical and Social Problems of Drug Addiction (NSPC MSPDA). That research was aimed at studying the attitudes of the populations of the cities of Kazakhstan towards the problem of drug addiction and monitoring the main directions of social activity which block the spread of drug addiction among the population of the Republic of Kazakhstan in the most efficient way. Estimation of the number of people in the country with symptoms of drug addiction was also planned within the framework of this research. The population group covered by the research consisted of residents of large cities 4 in Kazakhstan (with a population of 150,000 or more) aged 7-55 years old. The sample used in the research comprised 7029 persons. The surveying was carried out by means of the respondents personally filling in questionnaires, except for those groups of respondents who were unable to fill in the questionnaire by themselves because of their physiological and psychological condition, as well as children aged 7-11 years old, with whom personal interviews were carried out. (NSPC MSPDA, 2004). According to the data received in the course of the above-mentioned research, the drugaddicted population represented 1.7% of the total population of the Republic of Kazakhstan in Of these 31.6% were addicted to opiates (mostly heroin addiction), 81.3% to cannabinoids, and 15.5% to other narcotic substances ( Table 2-1). 10% of the respondents indicated that they had used drugs at least once in their life, but the type of substance was not indicated in the research. Table 2-1: Estimated number of substance-addicted persons categorised by types of drugs consumed, 2001 (NSPC MSPDA) % of addicts out of total number of addicts Absolute number of addicts (% of population aged 7-55 years old) Opiate addicts Cannabinoid addicts Addicted to other drugs ,328 (1.17%) 206,667 (3.02%) 39,402 (0.58%) 4 According to the Agency of Statistics of the Republic of Kazakhstan, in 2001 the urban population aged 7-55 years old was approximately 6.8 million people. 19

21 Among drug consumers, the main group is represented by persons aged years old (69.8%), with a low level of personal income (unemployed, doing casual work) (92.6%), and with secondary education (68.1%) (NSPC MSPDA, 2004). As the above-mentioned research was carried out ten years ago, at present there are no indepth epidemiological studies in the country reflecting the current situation related to drug use among the general population of the country Drug registration system The registration system for drug addicts, which includes several types of registration, functions in the country on the basis of Decree No. 814 of the Minister of Health of the Republic of Kazakhstan, dated December 2, Preventive observation is organised for persons who applied for medical assistance voluntarily or by order of a local government, medical organisation, or law enforcement body, and in whom the consumption of psychoactive substances is not accompanied by clinical symptoms of disease (risk group). Dispensary registration of patients with mental and behavioural disorders resulting from the consumption of psychoactive substances and preventive observation of patients in the risk group is conducted by the narcological organisations. Residential 5 and anonymous dispensary registration and case monitoring in outpatient medical organisations providing narcological assistance are to be applied to persons with mental and behavioural disorders resulting from the consumption of psychoactive substances which have been diagnosed by a narcology doctor, by a medical consultation commission, or by a special medical commission for forensic narcological examinations. If the patient follows all the requirements during the process of treatment, complies with the treatment period in the narcological organisation, and reaches steady and objectively proved remission after the completion of treatment, the following periods of residential dispensary registration will be set: 1) For patients with mental and behavioural disorders resulting from the consumption of alcohol 3 years 2) For patients with mental and behavioural disorders resulting from the consumption of psychoactive substances (except alcohol) 5 years. The period of preventive observation of persons consuming psychoactive substances for non-medical purposes is 1 year. In the course of preventive observation, the persons in the risk groups mostly receive medical assistance in outpatient conditions. The following cases can serve as the basis for removal from dispensary registration (both residential and anonymous): 1) steady remission (recovery); 2) change in permanent place of residence with departure outside the territory served by the narcological organisation, including because of transfer for dispensary registration to another narcological organisation; 5 In this context, residential means dispensary registration by address of permanent residence of the client 20

22 3) when the narcological organisation is unable to provide examination of the patient within 1 year, regardless of all measures taken, the patient is removed from dispensary registration (the decision about the removal from registration in such cases is also made by the medical consultation commission of the organisation which monitors the case of the patient); 4) imprisonment related to deprivation of freedom for a period of more than 1 year; 5) death. Within recent years the only data source for the estimation of drug use among the general population has been the data of the narcological register, which are used by various agencies for the evaluation and planning of preventive and treatment programmes. Figure 2-1 provides data on the number of persons registered with the narcological service of the Republic of Kazakhstan within the period from 2007 to 2011 (NSPC MSPDA, 2012). Figure 2-1: Number of persons registered with the narcological service of the Republic of Kazakhstan in (NSPC MSPDA) Total of them women As can be seen from the data provided, the number of registered injecting drug users in 2011 shows a decreasing trend for all registered drug users, both men and women. In terms of dynamics by years (Figure 2-2), a decreasing trend in the number of persons registered for the first time in their lives is observed. The number of persons removed from registration has unequal dynamics, with an increasing trend, whereas the number of persons removed from registration because of their death shows a slight decrease and the number of persons removed from registration because of remission shows an increasing trend. 21