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Drug abuse: Tendencies and ways to overcome it


p> 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.

Experts believe the most effective way to control the proliferation of the substances used in drug manufacturing could be the marking of such substances with dyes or radiation. The weak point of the method is a possible impact the marking may have on the qualities of the chemicals and the end products. Besides, it would contradict the legislation of many countries and some international agreements. That is why the researchers of anti-narcotic methods tend to pin hopes on the method of a different nature
- self-control. It encompasses a set of police-proposed measures that are effectuated by the services directly involved in actions against illegal manufacturing, trafficking and trade in drugs, as well as by all companies and individuals who have a connection with the manufacturing, sales and use of narcotics and auxiliary chemicals. According to this concept, the producers, suppliers and consumers of chemicals report to the police all suspicious purchases. The police, in its turn, work out detailed recommendation and criteria for such cases. Examples of these criteria are above-the- statistic-average size of a purchased batch of chemicals, a request from a new client, etc. Such kind of reporting gives the police more opportunities to locate illegal laboratories, channels of raw materials supplies and dispatch of the end product.

An imperative condition for putting in effect practical anti-narcotics measures is stringent control over the narcotic raw materials and their storage and limitations on trade in them.

It is important to note those drug-dealing affects the legitimate turnover of narcotic substances. Violations of the rules of their storage, manufacturing, and accounting continue increasing. There are misappropriations and other offenses, including attacks on warehouses of narcotic preparations in health centers, drug stores, etc. Executives do not take adequate measures to safeguard narcotic substances and sometime become accomplices in crimes. A possible explanation for this state of affairs is the breach of the rules outlined above.

It is important to reveal violations of the effective rules of manufacturing, storage, accounting, and sales of narcotic preparations, invoking criminal liability when necessary. This necessitates joint steps by the anti-drug units, licensing system of the internal affairs ministry, fire detachments and units of extra-departmental guards.

The perpetrators of drug-related crimes' utmost secrecy calls for the improvement in the procedures of investigation in strict compliance with the criminal law procedures.

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