Narcomania and Injecting Drug Use

By the end of 2002, Russia’s narcological service registered 449,000 drug users, including 323,000 diagnosed narcomania and 126,000 drug abusers. A widely accepted estimate of drug users’ population in Russia is about 3 million, i.e., 2-2.5% of the entire population.

Narcomania was spreading in the country in the 1990s at very fast rates (Table 7), but over the past two years there was a marked decline in the growth rate. 

Table 7. Narcomania incidence, Russia, 1995-2002

	1995	1996	1997	1998	1999	2000	2001	2002
Patients diagnosed with narcomania for the first time in their life, who were placed under servaillance
ths people	22.9	30.4	41.6	51.6	60.9	73.3	62.8	27.3
per 100,000	15.5	20.7	28.5	35.4	41.9	50.7	43.4	18.9
Registered for preventive purposes because of drug abuse
ths people	21.6	27	39.2	47	52.4	51.1	45.3	32.6
per 100,000	14.6	18.5	26.8	32.2	36.1	35.4	31.3	22.6
Registered as narcomaniacs (year end)
ths people	64.9	88.1	120.6	160	209.1	269.1	317.2	322.9
per 100,000	44	60.2	82.6	109.9	144.4	186.6	219.2	223.4
Registered because of drug abuse (year end)
ths people	41.7	52.8	72.4	93.1	122.2	125.9	130.9	125.8
per 100,000	28.3	36.1	49.6	64	84.4	87.3	90.5	87.0

Sources: Zdoroviye naseleniya i deyatelnost uchrezhdeny zdravookhraneniya in 2001 godu. Stat. Materialy/ Minzdrav RF. M., 2002. Zdravookhraneniye v Rossii: Stat. sb./ Goskomstat Rossii. M., 2001. Dannye Nationalnogo nauchnogo centra narkologii MZ RF (The Population’s Health and the Activities of Health-Care Institutions in 2001. Statistical Materials/ Russia’s Health Ministry. Moscow, 2002. Health-Care in Russia: Collection of Statistics/ Russia’s State Statistics Committee. Moscow, 2001. Data by the National Research Center on Addictions, Russian Federation Ministry of Health).

The vast majority of those registered as narcomaniacs use opioids, including heroin. 

Table 8. Registered narcomaniacs by the type of the drug, 2001, %

Source: Kirzhanova V.V. Communication to the conference «AIDS in Russia: Trends, Factors and Consequences». FRMC AIDS, CDHE NEFI RAS, CFDP, UNFPA. Moscow, March 19-20, 2003.
 

Fig. 1. Registered narcomaniacs per 100,000 of population, by age, 2001

Source: Kirzhanova V.V. Communication to the conference «AIDS in Russia: Trends, Factors and Consequences». FRMC AIDS, CDHE NEFI RAS, CFDP, UNFPA. Moscow, March 19-20, 2003.

As can be seen from Figure 1, narcomania is predominantly young people’s disease, with 18 - to 19-year-olds making up a greatest number of those registered as narcomaniacs. 

The experts, participated in the conference «AIDS in Russia: Trends, Factors and Consequences» (Moscow, March 19-20, 2003) held as part of the present project, suppose that causes of a recent decrease in the number of registered drug abusers may be attributed to different forces: drugs have begun to go out of fashion among adolescents (giving preference to alcohol), stronger efforts against drug traffic resulted in shortages of drugs (heroin, in particular), and faults in the operation of national narcological service, being a reason for drug users to avoid of state narcological service’s help in favor of private doctors’ anonymous treatment.
 

Injecting Drug Users

Since 1996 in Russia IDU is both the major engine and the fuel of epidemic, virus penetration into this community was the very launch of HIV epidemic.

The IDU group does not coincide with either the group of registered drug abusers or narcomaniacs, being much larger. A part of the group fully drops out of observation, but due to a definite effect of injecting drugs, among which heroin is most widely used, on the human organismremaining unobserved is rather temporal.

Attempts were made in several regions of Russia to estimate the ratio of the registered and hidden (non-registered) drug users. For example, the estimate made by means of a nomination method in Moscow in 1998 showed that there were seven hidden users per one registered by a narcological service. According to the estimate made by means of a capture-recapture technique (city of Chapayevsk, Samara Region), the ratio of the registered and hidden drug users was 1 to 3, thus the total number of drug users in Chapayevsk was estimated at 3% of the entire population. It should be kept in mind, however, that both the Samara Region and Moscow are among the areas where the spread of narcomania is at a highest level. In addition, the regions of Russia differ by a degree of attractiveness of narcological services (the frequency of applying for help depends upon it), the level of law-enforcement agencies’ operation efficiency, etc. Moreover, the methods that were used have significant shortcomings, and it would be incorrect to apply the obtained estimates to the entire population of Russia.

The main features of IDUs’ behavior that result in their contamination with HIV are the use of unsterile instruments for drug injection, and in Russia these are often not only a common syringe or needle, like is the case in foreign countries, but a common drug container or a common water container for washing a syringe, after drug is used, or common filters. Besides, in Russia there is a risk of being infected through drug solution containing HIV. A very rapid spread of HIV infection among IDUs can be attributed to these features.

Nearly 120,000 HIV-infected IDUs had been officially registered in Russia by the start of 2003, and it is assumed that another 90,000 HIV-infected contracted the virus through the use of drugs.

The screening testing of the IDUs group revealed 6% HIV+ in 2001, and 3% - in 2002. As described above, a decrease in the percentage of HIV+ cases in 2002 was probably not true but more likely represented an annual increase in the percentage of infected in this group. The true HIV prevalence among the group in 2002 may stand at about 17%.

This figure corresponds better with the findings of sample surveys among IDUs in the territories of Russia. According to sentinel epidemiological surveillance data of 2000-2002, 6% of IDUs is HIV+ in Novosivirsk, 56% - in Tolyatti, and as much as 64.5% - in Irkutsk. However, the sentinel surveillance data are available only for large cities of the regions where HIV prevalence is above average. HIV prevalence of the entire population is undoubtedly at a lower level. After summing up the official annual indicators of HIV-detected cases among IDUs in the regions where the above-mention cities are located, the results were as follows: 1.2% of drug abusers are HIV-infected in the Novosibirsk Region, 29.7% - in the Samara Region, and 39.1% in the Irkutsk Region. According to the FRMC AIDS experts, these indicators are most representative. There are no HIV+ IDUs up to now in many territories of the country. The saturation of the epidemic in IDU community should not be ignored. Even among drug users the percentage of HIV-infected has never reached 100 and generally comes to the level of 60-80%. The percentage of HIV-infected drug abusers in some of the cities in Russia has already approached this number. Thus, a further increase in the percentage of HIV-infected among IDU will be unlikely.