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Youth and Drugs (Sociology of Narcotism) »

EPIDEMIOLOGICAL SITUATION IN DRUG DISEASES SPREAD IN UKRAINE AND KHARKIV REGION

V. N. Kuzminov

* Originally in Russian:
Kuzminov, V. N. (2000). Epidemiological situation in drug spread in Ukraine and Kharkov region. In: Youth and Drugs (sociology of narcotism) (eds. V. A. Sobolev and I. P. Rushchenko), pp. 159–193. Kharkiv: Torsing.

The aim of this research — description of the epidemiological situation of spreading drug diseases in Ukraine and in Kharkov region.

Empirical basis of research: 1) official statistic data about the spread of the disease and offering medical assistance to drug addicts and toxicomania patients in Ukraine (statistical data of the Ministry of Health of Ukraine), statistical data presented by Kharkiv regional narcological dispensary; 2) medical documentation of narcological department of the 32nd narcological hospital of Kharkiv (psychiatric hospital of Kharkiv) from 1st of June, 1997 — the 1st Department of the 9th Narcological Clinic) offering assistance to the patients suffering from narcomania and toxicomania in Kharkiv region; 3) statistic data of the regional center of the forensic psychiatry expertise, questionnaire data of those under expertise in the regional center of forensic psychiatry expertise.

Peculiarities of the researched objects are described. The limited nature of the information in gathering of statistic data of the Ministry of Health of Ukraine is shown the necessity to have more complete information about the epidemiology of drug diseases and research of additional sources of information.

Factors that influence the spread of drug diseases in Ukraine and in Kharkiv region are outlined: 1) geographical position of Ukraine; 2) climatic conditions of Ukraine; 3) demographic peculiarities of the region; 4) socio-economic situation in the country.

The comparative analysis of the epidemiological situation of spreading drug diseases in Kharkiv region and of the situation in Ukraine in general is made.

By the 31st of December, 1998 about 61,063 patients suffering from drug disease have been registered by the Health Administration of Ukraine (12.15 for 10 thousand people and 21.432 drug consumers without drug dependence (2.18 for 10,000 population).

Undoubted leaders both in absolute quantity of drug patients and in relative indices for 10 thousands of the population are the developed industrial regions of the East, South-East and South of Ukraine, Dnepropetrovsk, Nikolaev, Odessa, Zaporozhye, Donetsk regions (33.84; 29.9; 25.61; 18.7; 16.19 for 10 thousands of the population correspondingly). The spread of drug diseases in this region is 3–7 times higher than in Kharkiv region. Kharkiv region looks all right at this background — 5.07 for 10 thousand of the population by 31/12/98.This index is one of the lowest in Ukraine and is the nineteenth among 27 administrative territories of Ukraine.

Indices, directly showing the activity of the narcological services of the regions are as follows: the developed narcological capacity and the effectiveness of their work. As to the provision of beds of narcological profile the region takes the ninth place (2.2 bed for 10,000 of the population), that it refers to the group of regions with the most developed stationary narcological service. Practically all regions with developed industry are relevant to this group, Kiev region included. The city of Kiev is the exception to this rule, the provision of narcological treating places is 3 times less there (0.8 for 10,000 of the population).

The effectiveness of drug treatment in the whole world is low. It is not high in Ukraine as well. However the task of the narcological service is in achieving maximum possible effectiveness in this objectively complicated situation. Kharkiv region is in the group of regions with maximum effectiveness of treatment (it has been evaluated by the number of people, being in remission, taken off the registration list because of recovery).

The last fact is directly connected with the availability of the leading scientific institutions in Ukraine in the field of narcology. This is, first of all, Ukrainian Research Institute of Clinic and Experimental Neurology and Psychiatry and Academy of Postgraduate Education of Physicians.

In traditional agrarian regions from 1989 to 1998 the level of narcomania and toxicomania has not changed essentially and was at a rather low level. Registered level of morbidity of all kinds of drug diseases constituted 0.87 for 10,000 of the population of the region. By this index Kharkiv region takes the 20th place among other regions of Ukraine. The tempo of the epidemic spread was high in the developed industrial regions of the east and south of the country.

Low figures of morbidity of toxicomania diseases in Ukraine in general and in Kharkiv region in particular are explained by slow forming the dependence on toxicomania remedies and the difficulty of diagnostics of toxicomania diseases — absence of credible objective characteristics out of the state of alcoholic intoxication and out of the withdrawal syndrome. The fact that the quantity of patients suffering from narcomania and toxicomania diseases outnumbers the preventive measures, testifying to bad exposure of people with episodic taking of addictive preparations with no syndrome of dependence formed draws attention. The most intensive spread of drug diseases is noted in Lozovskoy, Krasnogradsky, Kupyansky, Balakleevsky, Pervomaisky, Dergachevsky, Kharkov regions. These regions are distinguished by the closeness to the regional center and have developed industrial and transport net.

The morbidity was higher in the agricultural regions mentioned above.

Drug addiction is still the disease mainly of the urban population of Ukraine (more than 95% of the registered drug consumers — residents of either region or regional center). The tendency to increasing the share of rural residents has been marked for the last 8 years. Their number in Ukraine increased from 1% in 1990 to 4 % in 1997 and to 5% in 1999, i.e. in 5 times. One can presuppose the fast tempo of the development of epidemics of narcotism in the countryside.

There is a tendency from prevalence of residents of the regional center to the increase of the share of drug addicts in the structure of the general number of sick residents of regional centers and then to the rural population.

The spread of the registered patients with HIV in Kharkiv region, the main part of whom are injection drug addicts in the districts of the region is shown. The number of HIV patients is significantly higher in the rural districts of the region than in the center of the region.

When analyzing the main kinds of dependence on psychoactive substances the change of the structure of preferences of various drugs among drug addicts is noted in the population of drug patients. The general data about the structure of consumers depending of drug sort and psychoactive substances is shown.

The prevalence of drug patients of opium group is noted. The spectrum of the taken psychoactive substances both included in the list of drugs and not included, the patients with chemical dependence, is widening.

The spread of the abuse with preparations made of hemp should be taken on a larger scale than the number of patients admitted to the narcological hospital as the drug taking has often an episodic character and even drug addicts don’t have motives to consult Health institutions because of the anosognosia and absence of marked withdrawal syndrome.

The share of opium addicts is increasing, among persons who during hospital treatment mention the use of heroin powder. The share of drug addicts abusing drug stimulators of amphetaminolike action is increasing among the patients diagnosed with the syndrome of dependence on the psychoactive substance F1x.2. Cases of nonmedical use of tramadol became more frequent. Two patients have been diagnosed with the syndrome of dependence as a result of taking tramadol.

The analysis of some social and demographic characteristics of the segment of drug addicts has been done.

Together with the described above changes, which took place during the analyzed period in the structure of the segment of the revealed patients, a number of important parameters of the epidemic process stayed unchanged. The average age of the patients suffering from drug disease, registered in narcological institutions of Kharkiv is 26.3. The distribution of patients who consume psychoactive substances according to age is shown. This data reflects the social disadaptation of drug addicts. As with the low level of curability of these patients, for 10 years a complete change of people registered in medical institutions takes place. Besides recovery, patients can be taken off registration because of the change of residence, being in prison or death of patient. An early taking of the legal psychoactive substances — tobacco and alcohol has been noted.

For the last nine years the gender structure of patients, suffering from drug diseases, has been kept as it formed in 1990. The share of women stabilized at the level of 20% of the general number of patients. During the period of 10 years there had been observed the prevalence of men in Kharkov segment of patients.

Drug affection of people of pre-conscription and conscription age brings to the reduction of the number of people fit for military service. A high level of crime rate is noted among drug addicts, mostly they are made answerable for taking part in illegal drug turnover. The overwhelming majorities of drug addicts don’t study or work anywhere. Among people on preventive registration, as drug consumers there is dominance of young people, students of professional technical colleges and schools. The majority of schoolchildren are put on preventive registration in narcological consulting rooms in connection with taking inhalants, abusing sedative preparations, ephedrine, and hemp preparations. The consumption of psychoactive substances by the pupils needs special attention because of the epidemic character of the drug spread.

Further deterioration of the situation in the labor market will make more difficult social disadaptation of drug addicts.

So, we came to the following conclusions.

  1. Under relatively favorable conditions in comparison with other regions of Ukraine, first of all, the East and South-East, there is still growth of the number of drug addicts.
  2. At present there is an outstripping tempo of drug spread in rural areas.
  3. The drug spread in the rural areas will have harder consequences than in the regional center. It will be motivated by social and economic, cultural peculiarities of the countryside, difficulties of taking treating and preventive measures.
  4. The majority of drug consumers use self-made drugs. The main problem group is opium addicts. Alongside with it the number of people taking psychostimulators has increased.
  5. The number of consumers of “hard” drugs (heroin, cocaine) smuggled from abroad is increasing.
  6. New forms of drug dependence (analgetics of non-drug line, self-made psychostimulators from preparations “Effect”, “Coldact”, “Trifed”) appear and spread.
  7. The spread of drug addiction has hard social consequences which become apparent: with the spread of infectious diseases (first of all HIV infection), growth of crime rate, non-participation in public activities of the big part of the young population (work, service in armed forces).

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