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National Report on Drug Policy of Kyrgyz Republic

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  52 SESSION OF UN COMMISSION ON NARCOTIC DRUGS
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  NATIONAL REPORT
  ON DRUG POLICY OF KYRGYZ REPUBLIC
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  BISHKEK 2009
  
  
  
  
  
  
  
  
  National Report on drug policy of Kyrgyz Republic
  Under edition of Mr. NOGOIBAEV B.B, Director of Drug Control Agency of Kyrgyz Republic General-Lieutenant, Ph.D.
  
  
  Group of authors:
  Isakov Т.А. Chief of Legal Narcotic Substances Control and Drug Abuse Prevention Service of DCA of KR, Expert of UN International Committee on Drug Control;
  Tokubaev R.B. Director of Republican Drug Treatment Center of MOH of Kyrgyz Republic;
  Esenamanova A.T. Coordinator of MSMT Programs of Republican Drug Treatment Center of Kyrgyz Repiblic;
  Zelichenko A. L. Director of Public Fund "Central Asian Center of Drug Policy", Ph.D.;
  Estebesova B.A. Director of "Socium" NGO, President of "Partnership network" Kyrgyzstan Association;
  Ishemkulov B. Specialist on Cooperation with NGO, Secretary of Country Multi-sector Coordination Committee on Socially-significant and Highly Dangerous Infections under Government of Kyrgyz Republic;
  Iriskulbekov E. Projects Coordinator: "Bureau for protection of rights of people living with HIV/AIDS and vulnerable groups of population", Social Fund "Adilet" legal clinics";
  Tezina N. Project Coordinator "Advocacy of drug policy from the part of civil society", Association of Centers for Civil Society Support;
  Tokombaeva M. Executive Director, Association "Harm Reduction Network"
  Ocheret D.A. Coordinator on Drug Policy, Eurasian Network of Harm Reduction.
  
  
  
  
  
  
  National report is prepared for 52 Session of UN Commission on Narcotic Drugs by working group of leading specialists of interested ministries and authorities of Kyrgyz Republic, non-governmental organizations, acting in sphere of prevention of drugs and psychotropic substances abuse.
  
  
  
  
  
  
  
   ADC of Kyrgyz Republic
   Ministry of Health of Kyrgyz Republic
   Ministry of Justice of Kyrgyz Republic
   Group of authors
  
  Introduction
  
  In the frames of present report Kyrgyz Republic is honored to introduce comprehensive picture of ongoing situation with:
  
  • Illegal drug and psychotropic substances turnover,
  • Drug abuse,
  • Consequences and measures, taken by the government in order to reduce supply, demand and harm.
  
  Also this report contains the results of national drug prevention policy in compliance with the Resolution, accepted on 9th Plenary Meeting of UN General Assembly XX Special Session from June 10th, 1998.
  
  The problem of illicit drugs has three main components: (1) growth and production; (2) transportation and dope-peddling; (3) drug consumption and abuse. Kyrgyz Republic has organized resistance on all mentioned above directions: reducing deliveries of drugs in the country, activating the struggle with their distribution, preventing of drug consumption and lowering the drugs demand level. And from the end of 90th of the last century the country started to implement necessary measures on reducing harm from the use of IV drugs.
  
  Taking into account that the main target of this UN Commission on Drugs Session is to evaluate the results of decisions, accepted in 1998, this National report also includes the review of the republican governmental and non-governmental organizations activity outcomes in context of the abovementioned Resolution.
  
  I. Kyrgyz Republic drug problem history
  
  It is assumed that on the territory of modern Kyrgyzstan narco situation aggravated three times:
  • in the last third of XIX century,
  • during the period since 1916 till 1974
  • and starting from 1993 until present time.
  
  These three periods fit the moments of Kyrgyz history when it was part of Russian Empire, then the USSR and sovereignty.
  
  It is necessary to notice that narcotic substances in the Central Asia grew and were consumed long since. At the time of USSR Kyrgyzstan took one of the leading positions in the world on industrial production of high quality standard opium for medical purposes. In the period from 1916 to 1974 on the territory of modern Kyrgyzstan 98 cooperative and state-owned farms legally cultivated opium poppy and produced opium for medical needs. Total area of opium poppy fields made 64 thousand hectares, and volume by some calculations reached to 80 % made in the USSR and equaled 16 % of world legal production of opium.
  
  Great part of produced opium leaked to the illegal market.
  
  Because the authorities of the USSR couldn"t control the increasing wave of a drug addiction and trafficking, in 1974 there was made a decision on the termination of legal cultivation of an opium poppy. However, even after that the volumes of illegal drug turnover (mainly of cannabis group and in forms of pharmaceuticals) steadily increased. Vast fields of wild cannabis and ephedra are situated in the republic. Since the USSR period this circumstance has favored the hashish and marijuana production from plants of cannabis and also development of primitive "know-how" for methcathinone (ephedrone) proceeding from wild-growing ephedra for IV use.
  
  Moreover, after gaining independence in 1991, the situation with illegal drug turnover is influenced by different aggravating factors: transparency of borders with Tajikistan and Uzbekistan, that are bordering Afghanistan directly, active migratory processes and inability of border guard and customs services to prevent the Afghani drugs traffic problem.
  
  The situation, caused by the traffic of the Afghani drugs through the territory of republic, is aggravated with the negative social and economic circumstances connected with disintegration of USSR and general decrease of population living standards. These factors lead to involvement of wide parts of population (especially the marginalized part) to drug dealing and to steady growth of illicit drug users number.
  
  In structure of consumed drugs from 1993 to 1996 prevailed the category "cannabis and other cannabis derivates", and with 1996 till 2000 "opium" occupies leading position. Number of heroin users steadily grows and since 1999 heroin strongly takes the third position in structure of consumed drugs.
  It is necessary to note such phenomenon, as a polydrug addiction (polynarcomania). For the analyzed period on the basis of the Substance Abuse Service statistical data it is possible to draw a conclusion that the polydrug addiction has received wide circulation in republic and has the expressed tendency to growth (growth ratio = +6,9 %). So, in 2007 the given type of substances abuse has grown more than in 2 times in comparison with 1993 when registration of the given type of consumption started (12,7 and 5,5 on 100 thousand population accordingly).
  In spite of the fact that the heroin addiction is rather "young" and has been officially registered for the first time in territory of Kyrgyz Republic in 1998, its prompt growth is observed from the moment of registration. From all revealed cases of a heroin addiction the 60.1 % had been registered in 2006-2007 (35,6 and 47,0 on 100 thousand population accordingly).
  
  Quantitative analysis of the injection drug users, registered by Drug Service, showed clear increase tendency. In 1999 in comparison with 1993 drug usage has increased more than in 10 times, after 1999 number of IDUs decreased by one third, but growth rate still remains high (growth rate is +12%). However, these numbers more reflect the improved screening activities of the Substance Abuse Service of MOH of Kyrgyz Republic, and can not be used as an indicator of IDU number growth. In total the main peak of IV use of opiates growth fits to the 1999. According to UNODC estimated data (2006) there are 26 thousand drug users in the country and 25 thousand out of those are IDUs (96%).
  
  
  According to medical statistics for 2007 the use of opium and opium derivates, especially heroin, prevails in consumption structure. Cannabis and its derivates are on the second place; on the third place is polydrug addiction. The tendency of inhaled substances consumption growths (household chemicals, volatile dissolvers, gasoline, etc.) also remains pressing. The most widespread method of drug use is injection, then, by prevalence, smoking and combined drug usage (Republican Substance Abuse Center, 2008).
  
  II. Consequences of illicit drug use
  
  The increase of opiates/opioids consumption is accompanied by increase of injection drug use level (IDU) and its consequences.
  
  a) HIV/AIDS incidence
  Problems, connected with injection drug consumption, are aggravated with other serious threats accompanying drug addiction - HIV/AIDS pandemic and other dangerous infections. For the February 1st, 2009 there are 2057 HIV-infected registered in the republic, 1381 (67.1%) out of those are IV drug users, 534 (26%) - people living with HIV infection registered in penitentiary institutions of Kyrgyz Republic.
  
  Centralized state management in combination with low income level and poor resources of state healthcare system make the country a potential epidemiologic "burning point". That fact that in 2000 expenses on public health services per capita in the Kyrgyz Republic have made 145 US dollars, underlines weakness of an infrastructure of public health services in the country.1
  
  b) Viral Hepatitis
  According to sentinel surveillance study for the 2007, serum-prevalence of Hepatitis "C" in tested group of 898 IDUs was 50.9%. By gender 51.2% from them were males and 48.9% females. Out of 457 IDUs, positive to Hepatitis "C", HIV-infection was found in 63 cases, which means presence of co-infection in 13.8% of cases (Toktalieva R.Sh, 2008).
  
  There is also data from AIDS laboratory service, according to which hepatitis "C" infection rate in tested IDU group in 2007 was 45.5% (Republican AIDS association, 2008)
  
  c) Sexually transmitted diseases (STD)
  Serum-prevalence of syphilis in tested group of 898 IDUs, according to sentinel surveillance study, in 2007 made 12.8%; sex distribution demonstrated that syphilis is more spread between females (30.8%) than between males (9.8%). Presence of sexually transmitted infections raises the risk of HIV-infection. Thus, between 115 IDUs, positive to syphilis, 9.6% appeared to be HIV-positive.
  
  d) Mortality rate
  According to data of Republican Bureau of forensic medical expertise, in 2007 number of deceased with alkaloids of drug substances found in biological material made 87 persons. The cause of death was intoxication (overdose) of drug substances/alkaloids of opiates group (Republican Bureau of forensic medical expertise, 2008). This indicator in comparison with previous ones is shown in Table 1 below.
  
  Table 1
  Cause of death 2005 2006 2007
  Opium alkaloids intoxication 13 77 43
  Narcotic substances intoxication 20 21 41
  Acute intoxication with opium alkaloids 6 7 2
  Acute narcotic substances intoxication - 5 1
  Total 39 110 87
  
  According to Republican Substance Abuse Centre, 139 registered people with drug substances addiction were taken off the registry due to lethal outcome in 2007, which is 24.5% more than in 2006 (105 people).
  
  e) Other consequences
  In 2007 678 drivers were tested for narcotic or toxic substances intoxication, 63 (9.3%) out of them were in narcotic intoxication (Republican Substance Abuse Center, 2008).
  
  III. Reduction of supply and turnover of illegal drug substances
  
  a) Engaged agencies
  
  Up to new challenges and threats, forms, methods and organizational structure of law enforcement bodies in response to narco-expansion were changed.
  
  In 1993 by President"s of Kyrgyz Republic decree the State Commission for Drug Control (SCDC) under the Government of Kyrgyz Republic was established. It was national coordination body and had authority to control legal turnover of narcotic, psychotropic substances and precursors. In 2003 SCDC was reformed into the Drug Control Agency (DCA) of Kyrgyz Republic, operating in three main directions: (1) coordination of anti-drug activities of all governmental authorities in this sphere; (2) operational search activities and investigation of crimes, related to illegal turnover of drugs, psychotropic substances and precursors; (3) control of legal turnover of narcotic substances, psychotropic substances and precursors.
  
  Besides the Drug Control Agency of Kyrgyz Republic, State Committee of National Security of Kyrgyz Republic, State Customs Committee of Kyrgyz Republic, Border Control Service of Kyrgyz Republic, and Prosecutor"s Office of Kyrgyz Republic also closely involved into fight against illegal drug turnover.
  In frames of CIS, internal affairs offices coordinate their anti-drug activities under the authority of Bureau on coordination the struggle against organized crime and other dangerous types of felony on the territory of the CIS countries, founded by decision of Government Executive Board of CIS countries from September 24, 1993.
  In the frames of Collective Security Treaty Organization (SCTO) there is Coordination council of heads of competent authorities for fight against illegal drug turnover. Members of SCTO are: Republic of Armenia, Republic of Belorus, Republic of Kazahstan, Kyrgyz Republic, Russian Federation, Republic of Tajikistan and Republic of Uzbekistan. Coordination council of heads of competent authorities for fight against illegal drug turnover of countries - members of SCTO was created in May 13, 2004.
  
  In international frames law enforcement services work closely with organizations as "Interpol" and IDEC ("International Drug Enforcement Conference").
  
  In March 2007 Government of KR approved project document of UN Office on Drugs and Crime N KGZI75 "Creation of inter-authority law enforcement - mobile operative groups in Kyrgyzstan (MOG)" in the frames of implemented program "Frames of Strategic Program for Central Asia". Work planned under this project is approximated for 3 years and is conducted by UN Office on Drugs and Crime Sector on illicit drugs and precursor"s turnover, human trafficking and migrants smuggling, weapon smuggling, contraband, and terrorism prevention. Responsible national authorities of Kyrgyz Republic are: Drug Control Agency, Ministry of Internal Affairs, Border Control Service, State Committee of National Security, and State Customs Committee. The goal of the project is to develop 10 mobile groups, deployed inside the country that would be able to fight drug trafficking, organized crime, and also collect and analyze information of criminal nature. The project develops mechanisms of struggling against illegal drug turnover and international criminality, and also provides with full spectrum of technical help in terms of vehicles, equipment, trainings on operative filed work, analysis of gathered criminal information on regional and national level.
  
  
  b) Dynamics of statistics data on illegal drugs withdrawal
  
  For the, passed from adoption of UN General Assembly Resolution S-20/3 "Declaration on the Guiding Principles of Drug Demand Reduction", law enforcement authorities of Kyrgyz Republic have done much to objectively reduce level of illegal drug supply.
  Law enforcement authorities each year raise efforts on withdrawal of drug and psychotropic substances from illegal turnover. As it is shown on diagram 1, withdrawal of all kinds of drug substances for the period of years 1998-2008, raised by 4.6 times.
  
  Diagram 1
  
  
  For the period from 1974 to 1993 in Kyrgyzstan mainly drug substances of cannabis group were ceased. However, starting from 1993, the period of Afghan opium and heroin narco-expansion began. And if in 1992 through the whole territory of Kyrgyzstan it was ceased only 5 kilograms of raw opium, in 1993 it raised to 154 kilograms, mainly of afghan origin. From that moment, volumes of withdrawn from illegal turnover opium were steadily increasing. In 2000 more than one ton of opium was ceased. But stepwise heroin supplanted opium in supply scheme. So, in 2007, 270 kilograms of opium were ceased, and in 2008 only 140 kilograms of opium were withdrawn from illegal turnover.
  
  In parallel with opium, heroin started to appear on illegal market: in 1994 5 grams of heroin were ceased, in 1995 - 299 grams, in 1996 - 1 kilogram 100 grams, in 1997 - 4 kilograms 200 grams, in 1998- 24 kilograms 732 grams, in 1999 - 24 kilograms 759 grams, in 2000 - 206 kilograms. For the period until 2009 volumes of heroin withdrawal reached 200-250 kilograms yearly. In 2007 431 kilograms of heroin and in 2008 - 299 kilograms were ceased.
  
  Diagram 2
  
  
  
  Drug substances of cannabis group have rich raw-material base in Kyrgyzstan. For example, around 100 hectares in Issyk-Kul, Jalal-Abad, Talas, Chui and Naryn regions are soiled with wild-growing cannabis. Out of it local population produces marijuana and hashish, which are sold both on local and on regional illegal markets.
  
  In 2007 4 tons 468 kilograms and in 2008 5 tons 198 kilograms of drug substances of cannabis group were ceased in Kyrgyzstan. Moreover, in 2007 4 tons 28 kilograms and in 2008 3 tons 422 kilograms of marijuana were ceased. In 2007 440 kilograms and in 2008 457 kilograms of hashish were ceased.
  
  c) International anti-drug cooperation
  
  Kyrgyz Republic in full scale shares principles of complex and balanced approach to drugs related problems. Policy, conducted by our country proceeds from generally accepted principles and goals, confirmed in United Nations Charter and United Convention on drug substances (1961) and Protocol (1972), Convention on psychotropic substances (1971) and Convention of UN on fight against illegal turnover of drug and psychotropic substances (1988). The Republic has joined all these international legal documents and carries out a series of measures on implementation of their provisions into national legislation and law-enforcement practice. Being a fully legitimate member of UN, the Republic fully implements Political principles and Global Action Plan to Combat Drugs, accepted by UN General Assembly, and follows normative acts and requirements of ICDC.
  
  In 1996 law-enforcement authorities of Central-Asian region (Kazahstan, Kyrgyzstan, Tajikistan and Uzbekistan) have signed the memorandum of cooperation in struggle against drug trafficking. Other coordinating agreements of CIS and Central Asia countries promote simplification of operations against organized crime conduction. Kyrgyzstan is one of the parties of Memorandum of Understanding (MOU) (May 4, 1996) between 5 Central Asian countries and UNODC, which was later adopted by Russia, Aga-Khan development network and Azerbaijan. Memorandum is urged to strengthen anti-drug cooperation in Central Asia and highlights following priority spheres:
  1. mechanisms of coordination and cooperation;
  2. harmonization of legislation in sphere of combating against drugs;
  3. information sharing and strengthening of national capacities of analysis and intelligence in sphere of drug control;
  4. combined operations;
  5. gathering information on narcotic substance abuse, prevention and treatment of drug addiction
  
  Kyrgyzstan signed all three anti-drug UN Conventions and Convention against transnational organized crime. In 2005 Kyrgyzstan joined UN Convention against corruption. The President of Kyrgyzstan also signed the Law "On combating terrorism and money laundry".
  
  Thus, summing up this part of the report, it is possible to say that the state undertakes active efforts at all accessible levels - local, regional, international to put a barrier on ways of delivery of drugs from manufacturers to final consumers.
  
  IV. Change of drug control policy focus
  
  The experience, gained by Kyrgyz Republic in counteraction to spread of drug addiction, determined that only consecutive long-term strategy can really reduce drug trafficking, and also demand and harm from their use.
  
  In consideration to abovementioned, Kyrgyz Republic developed and approved the Concept of counteraction to drug addiction and drug trafficking, and the third (starting from 1997) National program of Kyrgyz Republic on counteraction to drug addiction and illicit drug turnover for the period until 2010. This document contains detailed plan of actions that obliges all governmental institutes to participate in realization of National program, contains three main stages in struggle against drugs:
  Stage I: 2005-2006 - reduce tempo of drugs spread.
  Stage II: 2007-2008 - stabilize narco situation.
  Stage III: starting from 2008 - to reduce level of drug addiction and to lower a turn of illegal drugs.
  
  The Concept of counteraction to spreading of drug abuse and illicit drug trafficking to the Kyrgyz Republic reflects problems of strategic and tactical character, key directions of a state policy of drug addiction prevention, demand reduction, struggle against illegal production, supply and turnover of illicit drugs. There were developed special indicators needed for monitoring and the control over illegal consumption and a drug trafficking in the country. All responsible governmental authorities and wide range of interested public organizations took place in development of this Concept.
  
  During the period between 2006 and 2007 in conformity with directions of the President of Kyrgyz Republic Bakiev K.S., sounded in June 2005 on the republican conference "Kyrgyzstan: to the future without drugs", government took course for humanization of drug policy towards modification of criminal and administrative legislative norms and elimination of excessive punitive tendencies.
  
  This course is fulfilled through changes and amendments to Criminal Code, Criminal Procedural Code, Administrative Violations Code, Correctional Code, to laws "On Supreme court of KR and local courts", "On prosecutor"s office of KR", "On order and conditions of detention in custody of people, detained on suspicion and criminally accused", "On general principles of amnesty and clemency granting", etc.
  
  The most important changes in drug policy took place in connection with increased spread of HIV/AIDS by injection drug use, especially heroin.
  
  The threat of swift spread of HIV and other infections, inaccessibility of drug users for prophylactic interventions, have placed in front the necessity to find new effective strategies and approaches counteracting to drug dependency forming and prevention of drug abusing consequences.
  
  Starting with 1998 Kyrgyzstan started to introduce strategy of reduction of harm, associated with illicit drug use, and to implement harm reduction programs.
  Harm reduction strategy became topical in presence of persistent aggravating of sociopolitical and economic situation in the republic and limited capabilities to counteract drug spreading with traditional strategies of lowering demand and consumption.
  
  The harm reduction strategy is mainly focused on reduction of negative consequences of drugs abuse, and stepwise implementation of demand and consumption reducing measures. Priority in drug prevention strategy is given to easy access to medical and social aid, maximal consideration of the drug consumers" needs and providing efficient support to them.
  
  Stages of harm reduction program implementation
  
  • May 14, 1999 - Approval of Security Council of KR for inclusion of harm reduction programs into the plan of strengthening the combating measures against drug abuse and illegal drug turnover in KR
  • June 22, 1999 - Approval of Commission on healthcare reform and mandatory medical insurance under Administration of the President of KR for introduction of drug prevention programs for IDU
  • October 15, 1999 - A concept document on drug treatment for IDUs in frames of reforming of healthcare system, with consideration of new conception of harm reduction, presented to the Ministry of Health of KR
  • November 12 - Agreement between UNDP Mission and Soros-Kyrgyzstan Foundation for joint financing of project on preventive interventions for IDU
  • February 14 - political support from Ministry of Health and Bishkek city Mayor"s office (Decree #60)
  • 2004 - Conception of combating against drug addiction and illicit drug turnover by President"s of KR Decree #455 from December 22, 2004 and National program of KR against drug addiction and illegal drug turnover for the period up to 2010
  • 2005 - Session of KR Cross-sector Board for alcoholism and drug abuse prevention "On political support of harm reduction programs".
  
  Thus harm reduction programs received political support, and issues of drug prevention and therapy were included into programs of combating drug addiction and illicit drug turnover.
  Most implemented 6 components of harm reduction programs:
  • Exchange of syringes/needles and risk-reducing devices, outreach-work;
  • Methadone substitution maintenance therapy;
  • Awareness - rising and educational activities;
  • Consulting by specialists;
  • Basic medical aid;
  • Advocacy.
  
  In 1999-2000 two non-governmental organizations ("Socium" NGO and "Parents against drugs" Social Fund) initiated programs on syringes exchange for IDUs in Bishkek city and city of Osh. They covered 818 IDUs or 1% from estimated total number of IDUs.
  
  For January 1, 2009 15231 IDUs (60.9%) are covered by syringes exchange and harm reduction programs (not including IDUs in penitentiary system).
  
  26 NGOs work in the field of drug prevention, reduction of harm from drug use and HIV/AIDS problem, 10 of them cover specific problems, related to injection drug users; in addition 3 initiative groups from drug users" community work in the same spheres. Number of NGO associations and networks were specially formed to work with drug users: network of harm reduction programs in Kyrgyzstan "Partnership network", "Harm reduction network of the drug users" community".
  
  In 2006 the inter-agency group of involved ministries and authorities of Kyrgyz Republic with wide participation of civil society and NGO associations "Partnership network" and "Harm reduction" had been developed a draft law "On prevention of drugs and psychotropic substances abuse". The proposed document tends to regard harm reduction programs as key directions for drug prevention.
  
  Through the low-threshold HR programs (syringes exchange, outreach-work, "peer to peer" programs, and rehabilitation centers for IDUs) access to drug users" community was gained. This allowed reaching and providing with effective support the target auditory - drug users and people in need for social re-integration.
  
  In present time, with the goal to broaden the involvement of IDUs into preventive interventions, the non-governmental organizations are working to extend range of supported by donors harm reduction services (GF, CARHAP, East-West Foundation, PSI, UNAIDS, USAID, WHO). Harm reduction programs were strengthened by social-legal, medico-psychological, rehabilitation services and legal assistance, e.g. "Social bureau" Project; "drop-in centers"; "half way home"; community centers; outpatient rehabilitation of drug users; motivational and psycho-social consulting of IDUs; pre-test consulting; re-integration and client - oriented case management programs.
  
  "Friendly pharmaceutical service" program started in 2007. Private pharmaceutical drugstores joined the harm reduction programs - pharmaceutical networks "Neman" and "Zaman".
  
  Syringes exchange programs, methadone substitution maintenance therapy and other components of harm reduction from non-medical drug use received support from Government of Kyrgyz Republic and Drug Control Agency of Kyrgyz Republic. These programs do not contradict and fit legislation of Kyrgyzstan and became an inherent part of state policy in sphere of HIV/AIDS prevention for injection drug users.
  
  The institutionalization of harm reduction programs is in progress. Standards of harm reduction programs were developed and now are pending for approval by Ministry of health and other interested authorities. Monitoring standards and quality management tools for harm reduction programs are being tested.
  
  Innovative alternative approaches for lending aid for injection drug users are being introduced.
  
  Activities for mobilization of wide spectrum of civil society, and attraction of drug users" community representatives into preventive programs are being conducted.
  
  Factors, created favorable conditions for harm reduction programs:
  • Advocacy activities conducted both by state authorities and NGOs;
  • Multi-sector approach to drug addiction and AIDS problem, proposed by Ministry of health of KR, supported by Government of KR. This approach formed a model for successful interaction and cooperation of state authorities, public associations and all interested structures.
  • Evidence-based approach: focus on priority of harm reduction strategy in programs on drug addiction and AIDS prevention
  • Involvement of drug users community representatives into development and implementing of harm reduction programs, and creation of favorable conditions for community-based non-governmental organizations development;
  • NGOs participation in all components of harm reduction program;
  • Involvement of clients in harm reduction programs developing and implementing;
  • Creation of favorable conditions for peer-to-peer supporting groups
  • Cooperation and coordination of governmental institutions and NGOs on mutually beneficial basis;
  • Financial support from international donors.
  
  Prospective directions for harm reduction
  
  In view of necessity to adjust the legislative base and law enforcement practices, following programs become necessary:
  • Strengthening of regulatory legislative coverage of harm reduction programs.
  • Institutionalization of HR programs and integration into other prevention programs
  • Effective partnership and cooperation of governmental and non-governmental institutions, private structures and international society.
  • Strengthening of organizational capacities of NGOs and initiative groups of drug users" community.
  • Improve role of community and codependent people in harm reduction programs
  • Development of system of motivational trainings in frames of "peer-to-peer" program
  • Development of programs for treatment and rehabilitation of drug users, including ones receiving substitution maintenance therapy
  • Creation of favorable conditions for groups of self- and peer-to-peer support;
  
  
  V. Human rights
  
  Kyrgyz Republican drug policy, aimed to decrease demand and supply of illicit drugs, truly accepted principles and regulations of basic and generally recognized international legal acts on human rights. Being a full member of international society and UN, Kyrgyz Republic ratified fundamental international conventions on human rights and actively conducts work for their implementation into national legislation.
  
  It should be noted, that rights and freedoms of human and citizen of Kyrgyz Republic are exactly and fully formulated in Chapter 2 of acting Constitution of Kyrgyz Republic.
  
  Constitution of Kyrgyz Republic defines system of state guarantees in sphere of human and citizen rights, gives right for self-defense, judicial and international defense of violated rights, harm compensation. It secures such important institutions as:
  - Right of a citizen for juridical aid;
  - Presumption of innocence;
  - Prohibition of double acquisition;
  - Invalidity of illegally received proofs and self-incrimination;
  - Right for court verdict reconsideration;
  - Restriction for law retroactive effect and others.
  
  It should be noted, that a row of new dispositions were included into Constitution. Thus, death-penalty is not anymore used as measure of punishment for criminal offences in Kyrgyz Republic. Frames of conception of "self-defense" were extended. The power to sanction law-enforcement actions, that might affect constitutional rights and freedoms of citizens, was devolved from the prosecutor"s office to the court and now fall within its competence. The institution of jury was introduced. Right of citizens of Kyrgyz Republic for applying to international courts was allocated.
  
  Accordingly, all this novels formed basics for future reformation in sphere of both substantive and procedural rights of a person.
  
  Among other private rights of a person and citizen, a special role goes to right for healthcare, which based on the Kyrgyz Republican Public Health Law. It should be noted, that its regulations exclude all kinds of stigmatization or discrimination, also for people belong to category of drug users or HIV-infected.
  
  VI. Medical aid for drug users
  
  a) Types of medical services available in drug treatment institutions of the country
  
  Treatment of opium addiction is an important strategic element of activity, aimed at minimization and annihilation of medical and social negative consequences on individual and community levels.
  All citizens of the republic have equal opportunities in realization their rights of receiving medico-sanitary and medico-social aid, stated by Constitution of Kyrgyz Republic. Unfortunately free of charge access to medical services cannot be provided for all population of the country. Free of charge medical service, pharmaceuticals and medical items are provided only for medical emergency aid . According to Law "On mandatory medical insurance of citizens in Kyrgyz Republic", persons, not covered by system of mandatory medical insurance, pay for medical aid, prevention, rehabilitation and health-improving services on their own account. People with no fixed abode may count only on free of charge ambulance service and medical emergency aid. Unemployed, if they are officially insured by mandatory medical insurance, have rights to claim receiving part of medical services free of charge .
  
  Legislation of KR stipulates voluntary treatment (drug-abuse treatment, conducted by obtaining consent of treated person or his legitimate representative) and mandatory treatment (conducted by court decision regarding person, avoiding voluntary treatment or continues to use drug substances without medical prescription and violates rights of others).
  
  Voluntary treatment of drug or psychotropic substances addiction is conducted in governmental, private and in some non-governmental institutions. Medical institutions belong to penitentiary system provide mandatory treatment by court decision and voluntary treatment in rehabilitation centers as well. After release from places of detention people with psychotropic substances addiction may continue treatment in civil sector of health care system and non-governmental institutions.
  State Drug Service offers patients following types of treatment:
   Detoxification in hospital and outpatient settings of healthcare system;
   In-hospital medico-psychological rehabilitation and outpatient programs of rehabilitation;
   Motivating to receive and continue treatment, relapse prevention - on outpatient level;
   Methadone substitution maintenance therapy
  
   In 2007 total number of patients, that received treatment, was 2277 persons (43.7 per 100 thousand people), that is 54.5% more than in 2006. 575 patients received treatment in hospital settings and 192 patients - in outpatient settings, 669 clients participated in programs of methadone substitution maintenance therapy (MSMT), and 841 patients took part in rehabilitations programs. Total number of people, that started treatment for the first time in their life, was 2020 persons (88.7% out of all people, received treatment in 2007).
  
   b) "Non-pharmaceutical" treatment
  
  Programs of medico-psychological rehabilitation consist of following components:
  • Psychotherapy section,
  • Psychological section,
  • Environmental therapy,
  • Occupational therapy,
  • Family member"s involvement.
  
  So, in 2007 91 patients (12 of them women), received treatment in rehabilitation department of Republican Drug Centre. 53 patients (58.2% of all passed rehabilitation course) had psychotropic substances addiction.
  636 drug users and 889 relatives of IDUs applied in 2007 to rehabilitation programs, launched by non-governmental organizations ("Socium" NGO, 2008).
  
  c) Substitution maintenance therapy
  Final and complete cessation of opium and its derivates use is an ultimate and ideal goal, existing only in long term prospective, but for many people with opium addiction it is unfortunately unreachable, especially in short terms. Unwavering concentration on one ultimate goal (to get free from drugs) and to consider it as immediate task for all patients (without intermediate steps) might harm other important tasks solving, e.g. prevention of HIV-infection.
  As it was noted in joint statement of World Health Organization, UNODC, UNAIDS (2004) there is no single treatment method, effective for all individuals with opium and opium derivates addiction, and for such people wide arsenal of different methods must be accessible.
  In accordance with international obligations and recommendations of World Health Organization, in goals of reduction of consequences, related to illicit drug use, Ministry of Health of Kyrgyz Republic conducted a row of measures to improve drug treatment system, to raise its accessibility and to widen spectrum of medical services. One of those measures was accepted in decision made in 2001 on implementing of pilot projects on methadone substitution therapy in specialized medical institutions, rendering drug treatment. Reasons that stimulated introduction of such therapy in 2001 in Kyrgyz Republic are listed below:
  1. Growth of injection drug users" number. According to official statistics there are more than 5 thousand drug users in Kyrgyz Republic, 68% of them or about 3.5 thousand people are IDUs. These numbers are considerable below the real figures. For 1.01.08 Republican Drug Center accounted 8354 drug addicts, 64.5 of them were IDUs.
  2. Increased number of HIV-infection cases among injection drug users. "Unit weight" of IDUs between HIV-infected in 2002 was more than 80%.
  3. Absence of highly effective methods of chemical abuse treatment.
  4. High level of crimes, related to illicit drug abuse.
  
  United Convention on drug substances (1961, with changes, included by protocol from 25 March, 1972) restricts use of narcotic drugs only in medical and scientific purposes. This regulation is confirmed in article 4, point b), that highlights that a country, joined the Convention is obliged to limit to only medical and scientific purposes production, manufacture, export, import, spread of drug substances, their trade, use and storage. Law of Kyrgyz Republic "On narcotic drugs, psychotropic substances and precursors" (1998) does not prohibit use of drug substances in medical and scientific purposes, including treatment of drug abuse.
  
  Methadone in Kyrgyz Republic is included into List 1 of drug substances (substances under the state control) and, correspondently is not included into List 4 of drug substances (substances prohibited for use in medical purposes).
  
  According to European Bureau of WHO report on pilot program of MSMT in Kyrgyz Republic for 2002-2004, positive effect of MSMT program (voluntary in-program staying or full cessation of opium and its derivates use) reported more than 60% of patients. The reduction of heroin use rate among participated patients (up to 22%) and growth of employment level (from 34% to 84%) is also highlighted in the report. (WHO. 2005).
  
  General statistic data
  
  Table 2
  Number of patients admitted to the program per year
   2002 2003 2004 2005 2006 2007 2008
  Kyrgyz Republic 121 114 69 13 133 430 753
  Bishkek 61 37 35 9 52 152 207
  Osh 60 77 34 4 81 147 202
  Chuy region - - - - - 131 344
  
  As it is seen out of the table, the lowest number of patients was admitted to MSMT program in 2005 that was conditioned by insufficient reserves of methadone and long-lasting procedures of its purchase, delivery and customs and registration clearance. In 2006, problems, related to methadone supply were solved, and by initiative of Ministry of health of Kyrgyz Republic, International Drug Control Committee raised the importing country quote of methadone hydrochloride from 5 to 9.5 kilograms per year. The fact of direct connection between MSMT programs expanding (2007) and 3.2 times growth of admitted patients number in 2007 versus 2006 (430 vs. 133) can be clearly seen. In 2002 -2006 there were only two points of methadone distribution (cities of Bishkek and Osh), and in 2007-2008 it was already 12 additional programs through-out republic.
  
  Number of clients admitted to program of methadone substitution maintenance therapy in Kyrgyz Republic (including penitentiary system) starting from 2002 is 1763 cases or 32.7% from total number of officially registered injection drug users (5386 people RNC, 2007), or 7% from estimated number of IDUs in the country (25 000, UNODC). For 1.01.2009 841 program participants continued therapy.
  
  Influence of MSMT programs on HIV-infection spread among IDUs in KR
  
  
  As it is seen on diagram, number of new cases of HIV, registered during a year, has a tendency to grow, especially during 2007-2008 (upper line), when indicator of infection burden among IDUs stays on the same level for identical period (lower line). This picture of relative stability can be explained in two ways: either work on volunteer consulting and testing (VCT) among IDUs took a turn for the worse (which is unlikely, taking into consideration efforts of governmental institutions and NGOs in this sphere), or all actions, conducted in the country with the goal of prevention of HIV/AIDS in injection drug users, really started to suppress HIV spread in this population.
  
  VII. Measures for drug abuse counteracting in penitentiary system institutions of Kyrgyz Republic
  
  Penitentiary system of Kyrgyz Republic starting from 2002 is under the jurisdiction of Ministry of Justice. Its exclusion from the Ministry of Internal Affairs structure fits common practice and helps reduce number of corrupt practices, conditioned to criminal-procedural and operation-investigative activities.
  
  Informational Center of Health Protection in Correctional Facilities is functioning on the base of Correctional System Reforming Department of MJ of KR. It is mainly focused on statistical data gathering, creation of database in sphere of prevention and treatment of socially-significant diseases. All this allows acting as a base of united informational network.
  
  On July 1st, 2006 Correctional System facilities accounted 15249 prisoners. Among them 8402, or 55%, were kept in correctional facilities and 4194, or 27.5% were in colony settlements. During last year it was registered a certain reduction of total number of prisoners (for example, for July 1, 2005 the total number was 16364). The Index of prison population in Kyrgyzstan is 300-350 persons per 100000 population, and that is although average, but still high indicator, particularly for Central Asian region .
  
  On the background of negative factors criminal subcultures developed and received prevailing influence within penitentiary system. This negative phenomenon, representing strictly hierarchical informal community is based on permanent threat, physical abuse and murders . Although thus criminal substructure was inherited with the system from soviet past, in our days it is still hardly controlled . Supply and turnover of illicit drugs in the correctional facilities, contributing in growth of drug users number, are also controlled by criminal groups.
  
  On 1.07.2007, according to official statistics of the Ministry of Justice of Kyrgyz Republic, 648 drug users were officially registered in correctional facilities. However, as a result of express-test conducted by "Inter-Demilge" CF, with support of "East-West" AIDS Fund in 2005-2006 in Bishkek and Chuy region, 35% of total population of correctional facilities uses drugs, and 50% out of those are injection drug users.
  
  Growth of injection drug users number together with presence of dangerous practices of dirty needles and syringes sharing lead to HIV-infection spread among imprisoned.
  
  Diagram 3
  
  
  The experience gained by healthcare services in Kyrgyz Republic, and also medical practices in prisons all around the world proved that harm reduction creates basis for effective work on prevention of HIV and Hep.C in prisons. Today, with the support of international and non-governmental organizations, number of different projects and programs are introduce and being implemented in correctional facilities.
  
  These programs are based on UNAIDS conclusion, stating that: "Whether authorities recognize it or not - and no matter how many efforts they put to suppress it - drugs reach the prisoners, and they use drugs in many countries ... Denial or neglect of those factors will not solve problem of continuing HIV spreading" .
  
  These programs on Demand Reduction are:
  
  1. Awareness-rising educational programs.
  2. "Atlantis" rehabilitation programs. In year 2008 127 prisoners completed the full course of treatment on this program, 79 patients pass rehabilitation course for the end of 2008. Starting from 2007 these Centers are financed from the country budget and work in close cooperation with non-governmental and community-based organizations.
  In sphere of reduction of harm from drugs:
  
  1. Awareness-rising educational programs.
  2. 14 spots of syringes exchange (SSE) in 10 correctional colonies and 1 colony-settlement.
  3. In August 2008 HR programs admitted first patients for methadone maintenance treatment in correctional facilities of Kyrgyz Republic. 65 patients participate in the program for 1.01.2009.
  4. Assistance in social rehabilitation and client management for prisoners, with focus on people living with HIV and drug addiction. On the present day 10 Social Bureaus are functioning in correctional colonies and 1 in pre-trial detention center, providing clients with legal, psychological and social assistance and preparing prisoners for release and transition to civil sector.
  
  Since drug users in prison often do not have access to qualified medical service, such initiatives of harm reduction programs as syringes exchange or methadone maintenance therapy, create an essential connections between healthcare workers, non-governmental organizations and marginal communities, helping drug users to save and improve their health.
  
  
  Conclusion
  
  Growth of illicit drugs market in the republic, situated on one of the main world drug traffic routes, is a harsh reality for Kyrgyz Republic. Implementation of strong countermeasures and preventive efforts is needed from the side of law-enforcement authorities. An adequate addressing the needs of people, affected by drug abuse and concurrent threats is also required. It affects many aspects of life, including healthcare system and social sphere. Government of the republic clearly acknowledges this and allots financing for the account of state and local budgets, along with efforts to raise funds, facilities and experience of international organizations and donors.
  
  Great support is rendered by international organizations, including, Global Fund Program on AIDS‚ TB and Malaria, United Nations Office on Drugs and Crime, World Health Organization, Soros-Kyrgyzstan Fund, etc.
  
  Summarizing National report of Kyrgyz Republic for 52 Session of UN Commission on Narcotic Drugs, it should be added, that Government of our country is opened for cooperation with international society on all spectrum of problems associated with basic context of present Session and with conception of human rights and democracy. Kyrgyz Republic expresses vital gratitude to all international organizations that render their support in establishing and strengthening the new approaches in securing healthy and decent life of our citizens, with special appreciation for United Nations and UN Commission on Narcotic Drugs. We have strong belief, that our joint efforts will allow us to give an adequate response to the present-day challenges and threats.
  
  _________
  
  
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