Fighting the tide

Illegal imports of a UK-made drug have been credited with a steep rise in the number of drug abusers in Georgia.

Crushed on pavements, tossed by the road or in the entrance halls of apartment blocks, the used syringes tell a story of rising addiction. The needles seen across Tbilisi, the capital of former Soviet Georgia, are discarded by addicts to Subutex, a treatment for opiate abuse that has ironically become the country’s most popular new drug.

Manufactured in the UK, Subutex pills are available on doctor’s prescription in more than 30 countries worldwide – including most of western Europe – as a supervised treatment for heroin withdrawal.

Subutex contains buprenorphine, a synthetic opiate like methadone that prompts a mild euphoria and has been credited with a 79% decrease in overdose deaths from opioids in France in the last decade.

But instead of being used to curb withdrawal, thousands of pills are being snapped up by “doctor shoppers” in countries where it is legal who then sell them on to the black market.

The pills are illegal in Georgia but first started appearing on the streets about four years ago. They are smuggled into the country by used-car dealers who sell them on at home at a huge mark-up. Drug addicts then dissolve and inject the Subutex, often in dangerous cocktails with tranquillisers and antihistamines.

And, despite claims that President Mikhail Saakashvili brought a fresh wind of democracy to Georgia when he took power in the “rose revolution” three years ago, funding to battle drug abuse has since been slashed to an all-time low.

Georgia’s annual budget for fighting drug abuse has been cut from 500,000 lari (about £150,000) in 1998 to 50,000 lari in 2006.

The International Narcotics Control Board estimates there has been an 80% increase in the number of drug abusers in Georgia since 2003, a spurt it attributes to the growing availability of illegally imported Subutex.

“It’s a wave of addiction comparable to a tsunami,” says Jana Javakhishvili, a project manager at the UN-backed South Caucasus Anti-Drug programme in Tbilisi.

Last year, 39% of patients treated in Georgian detox centres were treated for Subutex abuse, up from 29% the previous year. The influx of the drug is thought to have caused an overall rise in addiction, pushing the total number of drug users beyond 250,000 in a population of just 5 million.

“Subutex is an injected drug so any abuse is closely linked to blood-borne diseases,” says Javakhishvili. “People are sharing needles. If this increase in abuse goes on, it could cause a big increase in the HIV infection rate – which thus far has been mercifully low in Georgia.”

Officials in Tbilisi admit they are woefully ill equipped to deal with the problem.

“We’re fighting a big business,” says Tamaz Zakalashvili, of the interior ministry’s Unit for Combat of Drug Addiction and Narcobusiness. “Subutex is the most profitable drug. You can buy seven tablets for $20 [about £11] in France and then sell each one here for $120. That’s a hell of a mark-up.”

For now, the flow appears nigh impossible to stem. Georgian police and customs officials have seized 10,000 Subutex tablets since the beginning of last year, even catching a diplomat who was bringing in supplies in a diplomatic bag. However, a much larger quantity gets into the country because the small packets of drugs are odourless and Georgia lacks the necessary detectors to scan vehicles.

For addicts, the drug is cheaper and more accessible than heroin. Dealers are numerous and each tablet can be shared into five or six doses. Irakli, 35, a recovering addict at Tbilisi’s only methadone clinic, says he spent about $900 per month on his Subutex habit. “The effect is not as strong as heroin but psychologically it’s a real addiction. A lot of people say it’s much harder to give up Subutex.”

Reckitt Benckiser, the manufacturer of Subutex, told Guardian Unlimited it was “deeply concerned about any reports of misuse or diversion” but insisted the drug was safe and effective under medical supervision.

Khatuna Todadze, who runs the methadone clinic and is scientific director of the Georgian Research Institute on Addiction, blames the government for a lack of action over the drug crisis. “Nobody is working seriously to solve this problem,” she says.

There are just five state detox clinics in the country: four in Tbilisi and one in the city of Batumi. Under new legislation introduced in 2003, every addict has the right to be treated at least once for free in a state clinic.

However, in practice, funds are insufficient to cover the cost and all patients pay the $400-$700 for treatment themselves.

“Basically, there is no state response to drug addiction,” says Javakhishvili of SCAD. “NGOs are filling the gap but their efforts are piecemeal. We can’t go on like this.”

Source: by Tom Parfitt Guardian Unlimited Friday August 4, 2006

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