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Helplessly Hooked

The number of drug users in Georgia is steadily rising, as funds for treatment steadily decline. From EurasiaNet. by Paul Rimple 24 May 2006 With the number of Georgia’s recently registered drug users exceeding those in Armenia and Azerbaijan combined, the demand for treatment programs is rapidly rising in the Caucasus nation.

The latest data provided by the South Caucasus Anti-Drug program (SCAD), reveals that in 2004, 2,016 new cases of drug abuse were reported in Georgia, while 1,275 cases were noted in Azerbaijan and 538 in Armenia. The Georgian Research Institute on Addiction (GRIA) says there are 24,000 registered drug users currently in Georgia, 14,400 of whom are intravenous users. Some estimates, however, claim that up to 240,000 individuals, or roughly 5 percent of the country’s population, are addicted to narcotics. An explosion in the use of the designer drug subutex has driven the rapid rise in Georgia’s addiction rate.

Some local experts are critical of the Georgian government’s response to the brewing addiction crisis. “I’m ashamed to describe the current state policy toward treatment in Georgia. The Minister of Health has reduced funding from the budget five times in the last three years; from 250,000 [Georgian lari, or about $140,000] to 150,000 lari last year to 50,000 [$28,000] this year,” says Jana Javakhishvili, a project manager for SCAD, which is funded by the European Union. “No treatment is funded by the state, although every patient has the right to be treated,” Javakhishvili added.

Georgia’s 2003 law on Drugs, Psychotropic Substances, Precursors and Narcological Aid classifies drug addiction as a disease, granting addicts the same rights as people with mental disorders. It defines the need for compulsory treatment, but Javakhishvili says that no entity exists to provide the services mandated by the law. “The state has neither money nor means, and depends on the handful of NGOs to fill in the gap.”

The deputy minister of labor, health and social affairs, Levan Jugeli, told EurasiaNet that outside funding is needed to address addiction issues, saying Georgia’s treasury does not have the funds to cover the cost of treatment programs. “The Health Ministry is limited when you consider all the public health programs that are underdeveloped – like TB, diabetics, psychological care, and so on,” he said.

There are currently four drug detox centers in Tbilisi and one in Batumi, yet none of them possesses the resources to function properly. Nongovernmental organizations are trying to cover the gaps in governmental programs. GRIA began a pilot methadone treatment program at the Asatiani Psychological clinic with support of the Global Fund. Operational since December, the clinic has the capacity to treat 60 outpatients at a cost of 10 lari (roughly $4.50) per day, per patient. Two more clinics of similar size, one of them in Batumi, are expected to open by September. “We have more people seeking methadone treatment than our capacity,” said Khatuna Todadze of GRIA.

THE PATIENTS’ BURDEN

Many Georgians remain reluctant to seek treatment, in part out of concern that their identities will not be kept confidential. Before President Mikheil Saakashvili’s administration launched an expansive anti-corruption campaign, crooked police officers were occasionally known to obtain medical records of addicts in order to extort money from them. Another deterrent to participation in detox programs is the fact that no health insurance plans cover such treatments. Thus, patients must bear the program’s full costs.

A patient, who gave his name as Guram, said he paid $400 to check himself into the detox center at the Asatiani Psychological clinic in Tbilisi. “I’ve tried to quit on my own many times, but I’m so sick of this, I really need help.”

Even the NGO anti-addiction programs have serious shortcomings. Todadze explained that Georgian detox centers treat only the first stage of addiction by administering drugs to ease withdrawal symptoms. “They do not provide necessary medical and psychological support for outpatient treatment, as they do in the West,” Todadze said.

Methadone maintenance involves diagnosis by a psychologist before a daily dose is prescribed. Doses are gradually decreased until the heroin effect is blocked. In a good case, the first stage can take three months, but Todadze, a physician, says most patients aren’t psychologically prepared to quit and need further therapy. GRIA has only one social worker who provides it. “But patients’ needs vary from individual to group therapies, which include family and spouse. Our single social worker has a limited capacity,” Todadze says. “No psychological counseling exists here yet.”

Eliso Amirejebi, regional coordinator of the NGO Anti-Violence Network of Georgia, believes treating withdrawal symptoms without providing the psychological care is like cutting weeds without pulling roots. “It’s easy to get rid of physical symptoms but you cannot ignore the mental ones. Without the proper psychological care and support, a patient can start using again at any time, as they often do,” she says.

Several years ago Amirejebi attended a human rights workshop in Poland, where she learned about the 12-step method to treat chemical addiction, which is implemented in Polish prisons. Upon her return to Tbilisi, she eagerly began to share her knowledge with colleagues and approached treatment centers. The 12-step concept, however, was rejected by the clinics.

The Anti-Violence Network has been sending personnel to Warsaw to learn the 12-step method and currently has about 15 trained therapists. Georgian Patriarch, Illia II, donated a room at Taburi monastery in Tbilisi and later included additional rooms from three monasteries around the capital, enabling ex-convicts to continue treatment. Today a total of 26 patients are receiving treatment at the monasteries. “My dream is to have a clinic of our own, outside of prison and easily accessible,” Amirejebi said.
Paul Rimple is a freelance writer based in Tbilisi. This is a partner post from EurasiaNet.
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