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Table 1 Timeline of major policy events and changes in drug use patterns

From: Policing, massive street drug testing and poly-substance use chaos in Georgia – a policy case study

Timeline

Legal changes

Enforcement measures/practice

Drug use patterns

Factors influencing users behavior

Mid 1990s

 

• Widespread corruption among police

• Drug users - subjects to harassment and extortion of bribes

• Opium↓ replaced by heroin↑

• Tramadol + sedatives↑

 

Late 1990s

• Tramadol scheduled

  

Early 2000s

 

• Heroin↓ replaced by buprenorphine (Subutex®)↑

• 40 % of treatment clients say Subutex® is primary drug

• More than half report they use Subutex® to substitute opium or heroin

• Home-made ATS (vint, jeff)↑

• Buprenorphine not detected by police urine testing

• External signs of intoxication less visible

• Increased mobility to Russia and Ukraine

• Recipes via internet

2002–2003

• New Frame Law on Narcotics allowed substitution therapy

• Poppy seeds scheduled

• Poppy seeds↑

• Price/availability

2005–2008

  

• Tianeptin (Coaxil®)↑

• Home-made ATS↑

• Price/availability

• Not detected in police urine tests

2005

• Tianeptin scheduled

• First OST programme opened (GFATM)

• Subutex® and heroin - leading drugs

 

2006

• War on crime - war on drugs

• Adm. fine for drug use increased 5 fold

• Drug testing facility moved to MIA

• Massive street drug testing launched

• 12 fold increase in persons tested in 2007 vs 2006

 

2007

• New law on Drug Crime (restrictions on civil rights)

  

2007–2009

 

• Subutex-enemy #1

• Public campaigns “Anything but Subutex”, “Killer in the city”

 

2008

 

• First state supported OST opened

 

2009–2013

 

• Victory over Subutex® and heroin announced

• Subutex®↓last month use from 75 % in 2007 to 7 % in 2013)

• Heroin↓

• Poly-subs use↑ (90 % of injectors use 2 or more drugs, 75 % use 3 or more drugs)

• Availability (police claimed they successfully collaborated with French counterparts to restrict smuggling of buprenorphine)

2009

  

• PDU size estimation - 40,000

 

2010

• Pregabalin scheduled

• State funded OST scaled up - 17 sites

• 4,600 patients treated in 2013

• Testing↓, imprisonment↓

• Pregabalin (Lirica®)↑

• Substitute for injectable opioids

• Not in narcotics list

• Not detected by police tests

• Desomorphine (krokodil)↑

• Availability

• Price

• No need to engage with dealer/illicit market

2011

• Presidential Decree- Interagency Coordinating Council established

 

2012

 

• Krokodil - leading inj. drug

• PDU size estimation - 45,000

 

2013

• National (anti)Drug. Strategy and Action Plan 2013–2015

• New Government came to power

• Codeine tablets moved under strict control

• 60,000 tested

• Testing↑, Imprisonment↑

• Krokodil named as most dangerous drug

 

2014

• Law on New Psychoactive Drugs

• Victory over krokodil announced

• MIA reported 90 % reduction in Krok. use (based on seizures and urine tests)

• MIA reported 90 % reduction in NPS use (based on seizures and urine tests)

• Krokodil ↓( from 53 % in 2013 to 34 % in 2014, GHRN)

• Heroin ↑ (heroin driven commuting to Turkey)

• Buprenorphine ↑

• Tropicamide injection ↑

• Attempts to compensate for reduced desomorphine

2015

  

• PDU size estimation - 49,000