Pubdate: Mon, 16 Apr 2001
Source: Times of Central Asia (Kyrgyzstan)
Copyright: 2001 The Times of Central Asia
Contact:  http://www.times.kg/
Details: http://www.mapinc.org/media/1202

EXPLORING CENTRAL ASIA'S DRUG DANGER

Central Asia's emergence as a drug trafficking hub has helped cause a 
dramatic rise in narcotics use among residents of the region. The 
increase of drug use has, in turn, helped fuel potentially 
destabilizing social trends, including crime and health issues. Dr. 
Nina Kerimi, an expert affiliated with the World Health 
Organization's office for Europe, based in Copenhagen, Denmark, has 
been tracking drug-use patterns and the possible consequences in 
Central Asia. On April 6 she presented a paper at the 6th annual 
convention of the Association for the Study of Nationalities, held at 
Columbia University in New York. Kerimi, who has served in a variety 
of advisory roles at Turkmenistan's Ministry of Health, took time out 
during the ASN gathering to talk to EurasiaNet about drug use in 
Central Asia.

EurasiaNet: You maintain there are some differences in the 
characteristics of narcotics use today compared with that during the 
pre-Soviet times. Can you explain these differences as they pertain 
to Central Asia?

Kerimi: In the old days, opium - I will be talking about opium, 
because this is the main problematic drug - was used mostly as a folk 
remedy, as a panacea for illnesses, mental disorders, and physical 
diseases. It was ingested, and later - approximately in the 18th 
century - it started to be smoked. And at that time, the recreational 
meaning of its use became clearly visible. Since the late 18th 
century, opium use became a social phenomenon, in the sense that it 
created a lot of problems; the social response from the government at 
that time was just to destroy [opium] dens - the places where people 
used to smoke it - trying to prohibit consumption of the drug. It 
didn't work, and the smoking continued. Under Russian administration, 
officials also tried to prohibit the spread of opium. Then, in the 
late 19th century, they tried to prohibit the importation of opium. 
At that time, official imports, as well as smuggled opium from 
Persia, was flourishing and the flow of opium was very heavy, and it 
spread into all of Central Asia.

EurasiaNet: So what's the main difference between narcotics use today 
and narcotics use then?

Kerimi: I would focus on three features: First of all, there is the 
mode of use. Now, more and more, people inject opiates. Secondly, the 
characteristics of the opiate itself. Now it's heroin, which is 
processed opium. And thirdly, it is no longer used as a remedy, it is 
just used for recreational purposes. These are the main 
characteristics of the patterns.

Of course, the consequences are also different. In the past, the most 
serious consequence was overdose, or drug dependence itself. This 
encouraged the impoverishment of addicts because people many could 
not afford opium. Nowadays, there are some other very serious 
consequences which should be added to these two, like HIV infection, 
hepatitis, and sexually transmitted diseases, which are flourishing 
among drug users. There are some other diseases which accompany this. 
They are not the direct consequence of drug use, but they are there. 
I am talking mainly about tuberculosis. Patients with tuberculosis 
are over-represented among drug users, and vice versa. If you go to a 
tuberculosis clinic, you can see - up to 90 percent of them are drug 
users, in Kyrgyzstan for example. In Turkmenistan it was 
approximately 30 percent.

So the cluster of disorders linked to the use itself - and I have to 
add some social characteristics to that: a very high rate of 
unemployment; a tendency towards criminal activity; and a history of 
family problems. It is interesting to note that the family problems 
are specific to Central Asia, because in our culture people get 
married at a young age. When we investigated the social and marital 
status of drug users, we found that some of them have never been 
married at all, just because they started to use drugs. So there are 
two kinds of family problems - they can't be married and they can't 
have normal family lives because they have started to use drugs; and 
vice versa - when they begin using drugs, they caused a divorce. 
There are big problems with their children, especially now, because 
these children are not receiving care, and in a sort of social 
inheritance, they are acquiring deviant behavior.

EurasiaNet: From your research, what are the trends - at what rate is 
drug use growing, as best you can estimate?

Kerimi: According to statistics, the incidence of drug use is going 
up very quickly. It's a very high rate. Between 1991 and 1999, the 
rate absolutely skyrocketed. Somehow we forget that the main reason 
for the number of drug users is the availability of the drug. And it 
is available, and it is relatively cheap, and it is promoted by the 
dealers, because it's in their interest to have more and more people 
involved. So now we' re having the situation where it's a real 
commodity - it's an economic commodity.

Also important to note is the social context in which this phenomenon 
is going on. And this is unemployment, it is poverty, it is this 
search for a new identity - because we lost the Soviet identity, and 
now the nations are trying to build up something new. If people don't 
have jobs, and they have to earn money and they can do it through 
trafficking or dealing drugs, they'll do that. If they want to get 
out from poverty, they will try to do anything - including an 
activity that's criminal or on the edge of criminal.

EurasiaNet: Do you believe that the statistics that you read are 
accurate, or do you think that governments are not accurately 
reporting the situation, and if they' re not accurately reporting the 
situation, what are the factors behind the inaccuracy?

Kerimi: My absolutely sincere belief is that the governments don't do 
any cheating. They just get the numbers which are supplied by 
registration - taken from narcological surveys, police surveys, and 
so forth. And in terms of the healthcare system, there are numbers 
and referrals. So they have registered cases. And police also have 
seizure numbers and arrests. Of course all this does not provide a 
whole picture, but I am not so inclined to only stick to the exact 
figures, because first of all you can always make some estimate - 
some rapid assessment - and secondly, what is more important is the 
dynamics within the group of drug users. I'm talking about age of 
onset, I'm talking about demographic indicators, I'm talking about 
many other things which are much more important than just the number 
itself; and there are techniques which allow us to estimate these 
things.

EurasiaNet: Does the new pattern of drug use, specifically the 
injecting of drugs, have social consequences? Does it create problems 
between generations?

Kerimi: This is a very interesting question, and it is a complicated 
one. I can talk about my country [Turkmenistan]. Here we have two 
distinct sub-populations of drug users. One, which I call 
"classical," people with traditional use - they smoke raw opium or 
they ingest it - and they have rather mild consequences. I can't say 
that it is absolutely harmless, there are a range of consequences, 
but in comparison with what is going on now with injection drugs, it 
is not as serious. On the other hand there is a group of people who 
are injecting drugs. These two groups clearly understand that they 
are different. Those traditional users look with some contempt and 
disgust at the intravenous users, and the intravenous users have a 
very deep feeling of guilt and shame because they know that they 
violate social norms. Smoking and eating opium is a quasi-tolerated 
behavior: it's not encouraged, it's not praised, but somehow it has a 
tradition. But injecting is very new, and if you are injecting drugs 
it's almost equivalent to being a criminal - I might be exaggerating, 
but it's very dangerous, it's very bad, if people learn that you are 
an injection drug user, it's very difficult for you to be treated 
well.

EurasiaNet: Does this new development in narcotics use threaten to 
have a very significant destabilizing impact on Central Asian society?

Kerimi: It is difficult for me to judge this in terms of political 
stability, because I am not a specialist in assessing the whole 
situation from an economic and political point of view, but I think 
yes. From the reports which are available from the republics, it 
seems like it has a serious impact on the economic situation, so it 
is worsening the situation. Again, because crime is going up, because 
of economic loss.

EurasiaNet: Where do you see the drug use trend heading? Do you see 
it leveling off or even decreasing, or will it increase, and at what 
rate?

Kerimi: Well, I think it will depend on the efforts made by the 
countries. And it is in our hands, whatever pessimistic picture we 
can see now. It is in our hands. Because if we know that there are 
some levers for influencing the situation, like availability, the 
social context, we can do something. If nothing is done, it will get 
worse.
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