Drug abuse: Tendencies and ways to overcome it

The measures, which the health centers, are obliged to take, can

roughly be divided into two groups. Group One includes the properly medical

efforts in the treatment and rehabilitation of addicts. Group Two embraces

other organizational steps to keep narcotics at bay.

The international community also pays considerable attention to the

treatment of drug addicts. Article 38 of the Uniform Convention on Drugs

states that the signatory countries will take every possible step to

prevent the misuse of narcotic substances, ensure an early identification

of abusers, treat them, restore them to full working capability, re-

socialize, and monitor them after the completion of treatment (Paragraph

1). The countries will train appropriate personnel (Paragraph 2), and will

inform the population about the hazards of drug abuse (Paragraph 3). The

medical treatment of drug addicts is also presupposed by Resolution II of

the UN conference on implementing the Uniform Convention on Drugs.

Reminding of the provisions of Article 38, the conference stressed that

hospital treatment in a drug-free atmosphere is the most efficacious

medical approach to the issue. It recommended that economically potent

countries where drug abuse is a serious problem provide the opportunities

for such treatment.

The Treatment and Rehabilitation of Drug Addicts:

The issues of medical treatment/social rehabilitation of addicts and other

relevant measures are to a greater or lesser degree incorporated in the

public health programs of all nations and have found reflection in certain

regional programs. As a rule, these documents emphasize perfection of the

strategies and organization of drug abuse services on the assumption that

drug abuse is a social disease. The other important aspects are financing

and material/technical support, personnel, informing definite sectors of

society on the hazardous impact of addiction, research in the field of more

effective medicine.

Experts, however, warn against an overly simplified belief that

containing drug addiction boils down to the availability of medicines and

available hospital beds. The prophylactics of social illnesses like

alcoholism, misuse of narcotics and toxic chemicals cannot be built upon

the same methods as the treatment of serious infectious diseases. Alongside

pharmaceutics, it requires psychological aid and education which more and

more often involves the addicts' families and friends. It is naive to

believe that medicines and injections alone can bring about the desired

results and that the selection of individually suitable pharmaceutical

preparations gives a clue to the problem of treatment. Good results are

yielded by a combination of psychology and pharmacy. Therefore, the

treatment for drug addiction consumes much painstaking effort of a doctor,

psychologist, educator and other specialists working with a person who is

likely to develop the illness or is ill already.

On the face of it, the issues of treatment and prophylactics

necessitate comprehensive programming and proficient organization. Their

solution lies in the medico-biological, medico-psychological and medico-

social spheres.

From the standpoint of government policy, public health institutions

have the exclusive authority to treat drug addicts by officially approved

methods, including compulsory treatment of the addicts who pose danger to

society.

According to the results expected in this field, health centers must

organize and effectuate a series of measures destined to establish firm

grounds for progress in the drug abuse situation.

In the first place, this means the early identification, diagnosis and

registration of the persons who use drugs for non-medical purposes and

hence stand in need of prophylactic and treatment. However, shortcomings in

the existing methods of express-diagnostics and in the expert check-ups of

drug addicts make establishing the degree and the type of drug dependence

somewhat problematic.

Identification, Diagnosis, and Registration of Drug Users:

The identified addicts may belong to different age and social groups;

their condition may have a different degree of narcotic neglect. This fact

may influence the choice, distribution and intensity of medical measures,

as well as their combination with other types of aid.

Of particular importance is the early identification of addicts among

the young and the adolescents. A timely medical interference, caring

participation and influence of parents, relatives, teachers, police

officers, and the atmosphere of friendliness can stop the youngsters' slump

into illness.

When the consumers of different drugs have been identified, it is

exigent to inform the police to enable it to find the sources of drugs and

trafficking channels and execute other preventive measures.

Information is especially important if the drugs have been manufactured

illegally or their origins are unclear.

The following list of measures can help identify the individuals who

misuse narcotic substances:

medical check-ups of industrial labor staffs, school and college

students;

medical check-ups of inmates in jails and penitentiaries;

medical examination of the perpetrators of drug abuse for further

registration and treatment, including compulsory treatment;

specialized testing of certain professionals (the military, pilots,

drivers of all means of transport, police officers) for the bodily presence

of narcotic substances;

revealing the most dangerous forms of drug abuse that complicated

detoxification, revealing the cases of multiple drug misuse (the combined

use of more than one drug) and the cases of an intertwined abuse of drugs

and alcohol;

identification of addicts who carry the HIV and other infectious

diseases, elimination of the consequences of infectious transmission;

timely registration, treatment and rehabilitation of those who need it.

Another way to improve the health servicing of drug abusers is to

organize:

fundamental research; development of efficacious pharmaceutical

preparations and novel methods of treatment for different types of narcotic

dependence, their speedy translation into public health practices; large-

scale contribution to research from Russian and foreign scientists (the

Academy of Sciences, medical, pedagogical, psychological and other research

institutions, application of practices adopted abroad);

accelerated training of highly qualified personnel (addictive

conditions psychiatrists, psychologists, educators, social workers) at

medical colleges and upper level courses, specialized training of medical

attendants, nurses and technicians. The study program should cover not only

the novel methods of treatment, but also the specifics of contacts with the

drug addicts and methods of readiness for treatment and prophylactic

practice;

organization of new preventive-treatment/ registration clinics, out-

patient departments at industrial facilities and offices, emergency aid

centers and a wide publication of data on their mode of operation,

anonymous and commercial treatment centers for drug addicts;

extensive adoption by drug-abuse monitoring services of the

achievements in the medical science, psychology, pedagogy, pharmacy, and

special-purpose technology;

modernization of drug-abuse monitoring services, improvement of

material supplies and provision of the necessary personnel.

The post-treatment rehabilitation measures should include: a) the

creation of purpose-oriented government-run and charity funds, ex-drug

abusers support funds and diverse forms of work with them; b) development

of rehabilitation methods based on the effective analysis of the existing

rehabilitation procedures and of qualification levels of the personnel; c)

psychological assistance to the former abusers' families, relatives, and

friends who must be taught the techniques of exerting favorable influence

on the patients.

Equally important is the organization of other anti-narcotics efforts

taken by public health institutions.

The health of the nation is an important element of the social and

economic development of a country. From this angle, the popularization of a

rational way of life, the cultivation of respect for human health as the

basic value of society ranks high among the priorities of medical

institutions.

Publicizing Information Against Drugs:

A skillful and persistent dissemination of knowledge about the

destructive impact of drugs and their detriment for the future generations

is a crucial activity of medical institutions in the struggle against

narcotics.

It is advisable to find a particular audience and do masterly

presentations. Lectures and discussions are not the only means of knowledge

dissemination. Meetings with former drug addicts and presentations about

broken human lives have also proved productive.

To increase the prophylactic effects of popularization, it would be

useful to train the instructors on the methods and tactics of campaigning

against narcotics, design a system of mass anti-narcotic education, based

on medical science, provide the necessary teaching aids, control and

stimulate this activity.

Organization of Control Over the Use of Narcotic Substances:

Public health institutions have responsibilities in exercising control

over narcotic substances under international conventions, treaties,

agreements and other forms of international cooperation in combating drug

abuse. As mentioned earlier, their primary responsibility is to control the

proper use of drugs, the correct taking of their stock, their storage,

distribution and removal. The issue of special prominence is the storage of

narcotic substances at medical institutions and warehouses and the

thwarting of attempts to misappropriate them. Inspections often expose

serious flaws in this field.

To rule out a possible abuse, leakage or misappropriation of drugs, the

following list of measures is essential:

guarding narcotic substance storage facilities, fitting them out with

new equipment and fire/break-in alarm systems connected to the central

control panel or to the 24-hour operational medical personnel or guards

mail;

proper protection of the points where drugs are stored in small

quantities for distribution as administered by the physicians;

tightened control over big-batch long-term storage facilities like the

warehouses of regional drug-store administrations, and strategic reserves

warehouses;

regular inspections at narcotic drug warehouses;

strict abidance by the rules of taking stock, storage and use of drugs

for medical purposes;

a timely exchange of information with the police on the above issues

and cooperation in drawing up the lists of drug storage facilities.

Experience suggests that a successful solution of the problem depends

on the depth of our insight into it. This is especially true of such a

complex issue as the treatment and rehabilitation of drug addicts

regardless of what stage they are at. That is why the fullest and the most

objective information is essential for the medical and other institutions

to organize a counter-offensive against drug abuse. With that goal in mind,

public health centers should adhere to the following organizational

guidelines:

gathering and analysis of information on the conditions of drug

addicts, tendencies in and results of their treatment and rehabilitation,

and types and means of using drugs and the impact they have;

interaction with other institutions and departments in concrete forms

of anti-narcotics activities in such large-scale operations as Poppy and

Doping, in check-ups and research;

control surveys prepared by the narcology service.

Organizational support for these guidelines could be achieved through:

the establishment of a strict procedure for and the terms of turning

in, and registration of documents, supply of dependable information on the

actual situation with drugs and their sales and use for both medical and

non-medical purposes, on the individuals perpetrating misuse, supply of

other data essential for making specific decisions;

cooperation with other departments in holding joint selective research

and express-tests to obtain reliable information on the actual levels of

drug abuse, the damage it inflicts, the effects of treatment and other

types of aid to the addicts;

scheduled and unscheduled departmental and/or inter-departmental

inspections of how control over drugs is maintained, and how the rules of

their use and storage are observed;

analysis and broad publicity of the achievements of medical staffs who

have a record of positive results in combating narcotics, as well as

provision of incentives.

The scope of health institutions' duties also embraces revealing and

timely informing the relevant departments and the public at large on

dangerous tendencies in drug abuse, new varieties of stupefying substances,

the techniques of their manufacture and the means of use. The public health

system develops the adequate methods of prevention, treatment, and

counteraction.

Par. 3. Enforcement of Legal Measures of Narcotics Counteraction

The organization of legal enforcement of anti-narcotics measures falls

into three groups:

1) application of legal administrative and criminal legal norms

regulating the prevention and suppression of narcotics; 2) government legal

measures to set and refine law enforcement and other agencies combating

narcotics; 3) international anti-narcotics measures.

Group One includes compulsory treatment of drug addicts and measures

against drug-related crimes. Compulsory treatment of drug addicts is a law-

enforcement measure aimed at cutting down the non-medical use of narcotic

substances. It can be administered by the court to an addict who evades

voluntary treatment or who continues misusing drugs after a course of

treatment. If an addict commits a crime, the court metes out punishment in

combination with compulsory treatment.

Compulsory treatment of Drug Addicts:

Compulsory treatment is prescribed to all categories of abusers at medical

institutions with a specialized treatment procedure in the course of work

therapy. If criminal punishment is imposed, the treatment is executed at

the penitentiary during the term of imprisonment.

Placement of drug addicts to mandatory treatment centers is in the

domain of responsibilities of police departments. This activity goes hand

in hand with the following organizational measures:

identification of individuals perpetrating drugs abuse;

administering a medical examination, and a compulsory visit to a

medical institution in case of a refusal to undergo the procedure

voluntarily;

compulsory hospitalization for complete check-up upon conclusion of a

narcologist (psychiatrist specializing in addictive conditions -

translator's note). Notification is given to the prosecutor's office and,

if an underage addict is hospitalized, to his or her parents.

timely and renewable registration of drug addicts at the drug-patient

monitoring clinics, and prophylactic registration of the individuals whose

misuse of drugs has not yet acquired the form of an illness;

supervision over the daily way of life of the registered patients and

checking their attempts to skip compulsory treatment, imposition of other

measures of educational, medical and legal influence;

issuance of documents for placing the addicts who avoid mandatory

treatment to rehabilitation and work-therapy clinics and specialized drug-

abuse Medicare centers; filing documents on treatment of evaders with the

courts;

escorting of addicts to the places of mandatory treatment, registration

of individuals who were formerly sentenced for drug-related crimes or fell

under administrative liability for misuse of drugs;

individual prophylactic measures against addicts to whom corrective

labor has been meted out without a term of imprisonment, or whose sentences

have been suspended or deferred;

treatment of drug addicts at corrective labor institutions

simultaneously with serving a term, supervision over inmates' treatment and

behavior.

Organizational Law Enforcement Measures against Drug-related Crimes:

Other organizational law enforcement measures against narcotics-related

crimes are: locating the illegal plantations of narcotic-bearing crops and

identifying their growers, eradicating such plantations, securing

prohibitions to grow narcotic substance containing crops, making special

maps upon the inspections of gardens, private plots of land and wastelands,

cooperating with agriculture experts, army units and other departments

concerned, carrying out special task operations and disseminating

information on drugs.

It is of paramount importance to reorganize the system of guarding

government-controlled plantations of hemp and the like crops or create such

a system in the places where it is absent. This measure is closely linked

to the development of advanced methods of crop guarding, especially, in

harvesting seasons. Work by shifts and material incentives may prove

effective. Good results can also be obtained through the improvement of

technical and chemical means of protection.

To limit the access of the public at large to the areas of government-

sponsored drug- bearing crop plantations, it would stand to reason to

establish special passport and traffic control in such areas.

Organization of Measures to Suppress Drug-dealing:

The measures to suppress drug dealing are the most important issue at

present. Manufacture and trade in narcotics has become a branch of the

shadow economy. It is gaining momentum, creating production facilities and

channels of distribution. In a large number of cases the understaffed law

enforcement departments are unable to rebuff the onslaught of drug

manufacturers and offer sound alternatives to all aspects of drug abuse.

The illegal production of drugs that spill over the state borders and

continents is at the top of the world community's agenda. Particular

significance is attached to the clandestine drug laboratories.

In the wake of it, it is exigent to set up specialized police

departments, which will concentrate the officers of high professional

expertise, and to provide them with the necessary material and technical

support.

Foreign experts believe tangible results in eradicating clandestine

laboratories can be achieved if police operations to uncover the channels

by which the raw materials arrive and the end product is dispatched are

synchronized with the efforts to block access to chemical substances and

equipment the manufacture of drugs requires. This, however, is not easy as

some drug synthesis components such as acetic anhydride, ether, benzene,

acetone are extensively used in the industrial sector. Their industrial

consumption is not controlled in practical terms since, in most countries,

legislation does not regulate the production, storage and use of these

chemicals.

Experts in Germany propose in this connection that the laws against

drugs should extend to cover these chemicals too. But the output and

industrial use of the above substances is so massive that the attempts to

take them under control within the boundaries of a single country have

yielded no results while entailing substantial expenditure on organizing

the control service.

Another measure suggested is marking the packing of chemical substances

with special marks that would help the police identify the country of

origin and the manufacturer. Such a step, however, is unproductive as in

most cases the police does not get a hold of packing of the chemicals which

had already been used.

Experts consider as more promising the special laboratory tests of the

confiscated narcotic substances and chemicals used in the manufacture of

drugs. The tests can be more helpful in identifying the country of origin,

elucidating specific features of the technological process and other

fundamental properties of the chemicals.

For instance, specialists of the German institute of criminology have

designed on the basis of the American and Swedish experience methods of

identifying the places of origin of heroin through chromatographic testing.

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