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.