Suchergebnisse

Abstract

Background
In 2006 the country of Georgia implemented Article 45 of the Administrative code and Article 273 of the Criminal Code of Georgia, a public policy that enable police to detain any individual, anywhere, at any time on grounds of suspicion of drug use; and require them to submit to urine screening to test for the presence of illegal drugs and their metabolites. This policy is referred to as the street drug testing policy. Positive drug screening results in fines and potential jail time. The purpose of this paper is to conduct a cost analysis of this policy and assess the execution of the policy and the extent to which the policy meets its stated aims.


Methods
This study employed cost analysis methodology to calculate annual direct material and labor costs associated with carrying out Georgia's street level drug testing policy. These costs encompassed law enforcement, drug testing, associated judicial processes, imprisonment and income offset through fines collected during the two years covered in this study (2008 and 2014). In addition, we measured: fidelity of the execution of the policy measured by the accuracy of the percentage of people detained who were found to actually have used drugs; and the policy's effectiveness in deterring drug use among those who tested positive. Impact on drug use behavior was measured through impact analysis interviews conducted with a national sample of 500 detainees who tested positive for drugs under Article 45 and Article 273.


Results
Using conservative financial estimates the cost of carrying out the policy offset by fine revenues broke even in 2008 (−111,889 GEL); however, by 2014 the costs increased 20 % in conjunction with an 18 % increase in the number of people detained for testing. However, the percentage of people who tested positive for drugs declined 39 % indicating decreased fidelity in the execution of the policy; accompanied by a financial imbalance of −10,277,909 GEL. Moreover, effectiveness analysis revealed that within one month of being detained and having tested positive for drug use, over 90 % of individuals had returned to pre-detention drug use levels, and within 12 months 100 % of detainees had resumed prior drug use behaviors.


Conclusion
The financial costs associated with Georgia's street level drug screening policy has rapidly increased while becoming decreasingly accurate and efficient in its execution. Moreover, data indicates that the policy is not effective in reducing or stopping drug use among those who tested positive. In conclusion, it is fiscally unsustainable to continue the policy as it is being executed and the policy is ineffective in changing drug use behavior among people who use illegal substances.

<i>Aim:</i> The aim of the study was to understand the prevalence and patterns of the non-medical injecting use of buprenorphine among drug injectors in Georgia. <i>Method:</i> A self-administered questionnaire was distributed among injecting drug users enrolled in Georgian needle exchange programmes. The questions covered topics related to drug use career, patterns (frequency, history, dosage) and reasons for the use of buprenorphine. <i>Results:</i> Pharmaceutical buprenorphine in the form of Subutex® was the most commonly injected drug in terms of lifetime (95.5%) and last-month (75%) prevalence of use. 48% of those study participants who had injected Subutex at some point reported having used it to cope with withdrawal or to give up other opioids. 90.5% of Subutex injectors used 1–2 mg as a single dose, and the mean frequency of its injection was 6 times per month. 75% of Subutex injectors had used 3 or more types of illegal drugs during the last 30 days. <i>Conclusion:</i> While widely misused by Georgian drug injectors, Subutex is neither the principal nor the favourite drug, and it is rather used as self-treatment. The authors consider the introduction of buprenorphine maintenance treatment to be a promising effective measure to decrease its non-medical and illegal use.

There is concern that the tremendous economic, social, and political upheavals that the Republic of Georgia has undergone in the years since the fall of the Soviet Union may have created an environment fertile for HIV transmission. Notably absent from official statistics and HIV-related research in Georgia is discussion of men who have sex with men (MSM) and, therefore, little is known about the MSM population or its potential to acquire or transmit HIV. Data were collected from 30 MSM recruited through a testing and counseling center in Tbilisi, the capital of Georgia. Two focus groups with six men each and 18 individual in-depth interviews were conducted between October 2006 and February 2007. The study participants described a Georgian culture that is largely intolerant of sexual contact between men. In describing the various forms of discrimination and violence that they would face should their sexual identities be discovered, the MSM in this sample described a variety of behaviors that they and other Georgian MSM undertake to conceal their sexual behavior. Many of these could put these men and their partners at risk for HIV. Although official HIV rates in Georgia are still low, results from this qualitative study indicate that efforts to educate and to provide unobtrusive and anonymous testing and counseling services to MSM may be critical to the deterrence of an HIV epidemic in the Republic of Georgia.