The FINANCIAL -- Drug policy reform is now at the center of a heated debate in Georgia. Despite the importance of the subject, however, most of the discussions I have heard so far are based on phobias and myths, rather than on evidence. This is a pity, as society will ultimately have to decide on the subject by voting YES or NO on this reform, thereby choosing between very different potential outcomes. Having an informed opinion on the issue is, therefore, extremely important.
Let’s start from the beginning - what are Georgia’s major drug-related problems?
1. Georgia ranks third (out of 101 countries) in the world with respect to the prevalence (share of people) who inject drugs, after Seychelles and Russian Federation.1 The estimated figure for injection drug use is 2.02% among individuals aged 18-64 2 (see figure below).
2. The number of people who regularly inject drugs has been increasing over time: 40,000 in 2009, 45,000 in 2012, and 49,700 in 2014.3
3. The country has a high incidence of drug-related infectious diseases (hepatitis B and C, HIV/AIDS, etc.). Bio-Behavioral Surveillance Survey among People Who Inject Drugs in Georgia (2015) revealed alarmingly high Hepatitis C Virus prevalence among injection drug users - 66.2%, as for HIV prevalence, it was 2.2%, with no change since 2012 when HIV prevalence was 3.0%.
4. The age of first drug use in Georgia is very low (in 2015, first drug use was estimated to be at age 13). The country has high consumption rates of psychoactive substances among youth (defined as under 18 years). The share of Georgian 16-year-olds who have consumed new psychoactive substances (commonly referred in Georgia as “bio”) is almost twice the EU average4.
What is Georgia’s policy response to this challenge?
The country’s response is a very strict drug policy. Drug use is criminalized. The state strictly prohibits and penalizes drug usage. Murder, intentional severe health injury, rape, and other criminal offences are punished less harshly than drug use, if the drug user is caught possessing drugs above a certain amount (see figure below).
This comparison raises a question: what is the rationale of punishing people who are mainly harming themselves more than people who do harm to others?
The answer is that Georgian policy makers count on very harsh laws and fear of jail as the main motivation to decrease the demand on drugs. Yes, harsh laws (once properly enforced) have the potential to decrease the supply of drugs, but they do not seem to work when it comes to demand, as addicted drug users are not able to make rational decisions. According to the National Institute on Drug Abuse, “Although the initial decision to take drugs is voluntary for most people, the brain changes that occur over time challenge an addicted person’s self-control and hamper his or her ability to resist intense impulses to take drugs.” It is worth mentioning that the appearance of new psychoactive substances in the drug market is hardly predictable in nature, which will make it more and more difficult for Georgian police to deal only with supply. Measures have to be taken to decrease demand, too. The increased number of problematic drug users in Georgia, despite a very repressive drug policy, seems to support the National Institute’s position.
International evidence shows that there is no correlation between the harshness of national drug policies and the number of drug users. For example, looking at Figure 1, we can see that countries with liberal and harsh drug policies can be found in all segments of the distribution (from top to bottom). If we look at countries with the most liberal drug policies, we find: Czech Republic -#18, Australia - #19, Argentina -#35, Portugal - #50, Mexico - #51, Croatia - #80, Uruguay - #85, and Netherlands - #92. On the other hand, countries with the harshest drug policy do not show a significantly different pattern. Among them: Malaysia -#11, Iran - #37, Thailand - #61, Costa-Rica - #68, Columbia - #70.
Thus, criminalization does not ensure a lower number of drug users. Even worse, it creates additional barriers to the treatment process. The fear of being caught increases cases of comorbidity of substance use and other related diseases (as drug users in such environment share needles), and it even increases fatal cases, as drug users are reluctant to apply for treatment and prefer to stay in the shadows.
In addition, the system can be quite costly. For example, the so called „street test“ procedures (designed to identify drug users) cost approximately 18 mln GEL per year to the public budget.5 In 2013, the number of individuals subjected to this test reached its peak, almost 60,000 individuals. Only one-third of them showed positive results, i.e. prohibited substances where found.
What about alternative treatment and prevention?
In contrast to strict drug-use laws, in Georgia the availability of treatment centers is very limited. Clinical drug addiction services are currently provided by only seven institutions (6 in Tbilisi, 1 in Batumi). In 2015, these institutions treated only 5,392 patients,6 a negligible share of the country’s drug users.
Georgia has no institutionalized primary prevention mechanism for psychoactive drug use. Almost nothing is done to decrease the demand for psychoactive drug use among youth, who represent the most vulnerable group. There is vast international experience that shows that teenage boys and girls start to take drugs for many different reasons (experimentation, peer pressure, to escape or to relax, relieve stress, etc.) and timely intervention can prevent them from future drug abuse.7
Would a greater focus on the determinants of demand, studying the reasons for drug abuse (especially at a young age), and treatment of the addicted help improve the picture? Definitely.
The proposed drug reform. On the right path?
The drug policy reform concept currently being discussed is based on an analysis of the above-mentioned weaknesses of the country, and aims at changing the systemic approach toward drug users. Instead of strict and punishment-oriented measures, the emphasis is put on treatment/rehabilitation and on the introduction of primary prevention. The reform package has the following components: drug use decriminalization; softening of sanctions for drug-related offence; fair fixing of the amounts of narcotic substances; conduct of compulsory drug testing procedures; improvement of the legal status of convicted drug offenders; creation of new treatment centers, where persons with drug-related problems will receive aid; improvement of the prevention/rehabilitation system; and, setting up persuasion commissions, responsible for adjudicating administrative drug offenses, imposing administrative sanctions, providing psychological help or directing drug users to treatment centers.
While almost everyone agrees on the need for more treatment centers and establishment of a prevention system, there is a lot of disagreement about decriminalization. As we have seen, criminalization does not necessarily help to decrease the demand for drugs (neither in Georgia, nor around the world). Jails are not substitutes for treatment centers or places where patients with drug-related problems can get aid. Drug abuse is a severe problem which needs to be addressed properly, with the contribution of psychologists, medical personnel, educational specialists and other professional figures, and the solution to this problem cannot (and should not) be entrusted solely to the police.
If this reform is approved, specialists could finally take on the responsibility of dealing with the treatment and prevention of drug use, while the police could direct their resources to fighting drug suppliers, instead of chasing potential drug users in the streets. This would very likely be a much better use of public money and lead to much better outcomes for the society as a whole.
1. World Drug Report (2017). United Nations Office on Drugs and Crime. 2017.
2. Population Size Estimation of People who Inject Drugs in Georgia 2014. Study Report, Bemoni Public Union, Curatio International Foundation, July 2015.
3. Source: NCDC 2016
4. საქართველოს ნარკოპოლიტიკის რეფორმის შეფასება. საქართველოს პარლამენტი. 2017 წელი.
5. source: NCDC
6. International Narcotics Control Board. Annual Report. 2016