June 30, 2008
Produced by national South Caucasus Anti-Drug (SCAD) Programme team led by Zaruhi Beglaryan, SCAD Local Epidemiology Expert,
Edited by Tomas Zabransky, SCAD International Epidemiology Expert,
Proofread by Gregory Connor, SCAD Regional Advisor
Content
• Country Information
• Drug use in the general population (and young people)
• Problem drug use
• Drug-related infectious diseases
• Drug-related deaths and mortality of drug users
• (Drug) treatment demand
• Prevention
• Treatment responses
• Drug markets and drug-related offenses
• National drug laws
• National drug strategies
• Coordination mechanisms in the drugs field
• References
Country Information
The Republic of Armenia is a land–locked mountainous country in the Southwest of the Trans Caucasus, with a surface area of 29.8 sq.km. Armenia is administratively divided into eleven provinces (marzes) one of which is a capital- Yerevan. The State language is Armenian. The population is about 3 222 900 of which 97% are Armenian (National Statistical Service, 2007). The Armenian Apostolic Church is the national church of the Armenian people. In 301 AD, Armenians were the first nation to adopt Christianity as state religion.
The history of the Armenian statehood dates back to the late 12th century B.C. After losing its independence in the 14th century, the first independent Republic of Armenia was established on 28 May 1918. From 1920 to 1991, Armenia formed part of the Union of the Soviet Socialist Republics (USSR).
After the referendum held on 21 September 1991, the Supreme Council proclaimed the Republic of Armenia an independent State on 23 September.
The Constitution of the Republic of Armenia (CRA) was adopted on 5 July 1995. The first article of the constitution declared the Republic of Armenia as a sovereign, democratic State, based on social justice and the rule of law (Art. 1 of the CRA). State power is exercised in accordance with the Constitution and the laws based on the principle of the separation of the legislative, executive and judicial powers (Art. 5 of the CRA).The CRA provide guarantees for fundamental civil and human rights and freedoms, such as freedom of association, freedom to choose a profession, maternity protection, and the right to rest (Charter 2 of the CRA).
Drug use in the general population (and young people)
The epidemiological and statistical data on drug use in Armenia is lacking. Estimating the actual number of injecting drug users in Armenia was problematic; since the stigmatization and criminalization of drug use gave an environment for remaining the drug use mostly hidden phenomena (Markosyan, 2005).
Several studies have been conducted in Armenia assessing the prevalence of drug use with inconsistent results. General population survey (GPS) on the use of the psychotropic substances was conducted in Armenia in 2005, which was the first study of this type within CIS. The European Model Questionnaire (EMCDDA, 2002) was used and further adjusted for the GPS in Armenia. Two types of questions were included in questionnaire for assessing drug use prevalence among the general population. The first type of questions assessed the personal history of drug use (“Have you ever used drugs?”) , while the second type of questions relates knowing other people using drugs ( “Do you know somebody close to you using drugs?”)
The number of positive answers for the first type of questions was insignificant for any type of drug, while survey revealed relatively high percentage of people who knew others using cannabis type drugs (5.4%), about 0.9% for those using cocaine and 0.6% heroin (Gyurjyan and Bazarchyan, 2005). However several study limitation seriously affect the reliability of study results. First of all this study did not include “opiates” or derivatives in its questionnaire as separate substances of abuse. Additionally, severe discrepancies in obtained estimates of indicators related to the problem drug use indicate limited adaptability of European Model Questionnaire in the cultural context of Southern Caucasus (Asiryan and Zábranský, 2006).
In 2005, a pilot European School Survey Project on Alcohol and Drugs (ESPAD) was conducted in Syunik marz of Armenia by NGO “AIDS Prevention, Education and Care (APEC)”. The survey sample was targeted 1202 schoolchildren aged 15-16 years.According to the results of the survey, 2.7% of surveyed schoolchildren reported lifetime marijuana use, 0.9% - ever used drugs other than marijuana, 17.1%- ever used inhalants/sedatives and 0.4% - used alcohol with pills (AIDS Prevention Education and Care, 2005).
Nationwide representative ESPAD survey was conducted in Armenia in 2007, but the results of the survey are not available yet.
Problem drug use
According to the operative data of the Ministry of the Interior of Armenia* the number of drug users (last month use of any illegal drugs) was estimated to be 20,000 individuals in the country in 20,000 (50% of them residing in the capital city Yerevan), of whom 2,000 were estimated to be injecting drug users.
The “Rapid Assessment of the Situation on Spread of HIV Infection Including Intravenous Drug Users” found higher rates of heroin use in the general population of Armenia. According to the survey, in Yerevan alone, there were between 19,000 and 20,000 drug users who report drug use during the last year, and of whom approximately 10% were injecting drug users (Grigoryan et al., 2002).
According to the World Health Organization (WHO) EURO databases**, the estimated number of injecting drug users was between 7,000 and 11,000 in Armenia as of 2003.
An anonymous survey on infectious diseases and related risk behavior among Armenian prison population and the prison staff was carried out in Armenia in 2004 (Weilandt et al., 2005). The study was conducted in a representative sample of seven prisons (including the Hospital for Detainees) using structured quantitative questionnaires for prisoners and members of the staff and conducting anonymous salivary HIV and hepatitis (WASH) surveillance for prisoners. Altogether, 542 of 556 eligible prisoners (97.4%) completed the questionnaires and gave a saliva sample. 348 members of the actual staff of 483 (72.0%) was interviewed.
The survey revealed that 27.2% of the study population used cannabis before imprisonment, 4.2% continued to use cannabis inside prison and 3.2% started to use cannabis in prison. The distribution for heroine use and use of self prepared poppy-based mixtures (called “chimia” – a Russian word for “chemistry”) is quite similar: 12.3% of the study population stated they used heroine/opiates before imprisonment and exactly the same percentage mentioned use of self prepared mixtures (chimia) before imprisonment. There is a substantial overlap of heroine and chimia use: 86% of the prisoners that ever used (inside or outside prison) heroine also stated chimia use and 79% of the chimia users also stated heroine use.
The proportion of prisoners who reported lifetime prevalence of injecting drug use (ever injected drugs) was 13.3%.
* Since 1 January 2003, the Ministry of the Interior of the Republic of Armenia was restructured into the Police of the Republic of Armenia.
**WHO EURO and UNAIDS, WHO EURO Data Collection, Joint workshop of WHO EURO and UNAIDS (Geneva 2003): “Data in the WHO EURO databases are drawn mainly from national sources, and are generated by national surveillance, service providers, and NGOs, or by such international organizations as the UN Reference Group on Injecting Drug Users. Where no published or official data are available, preliminary estimates made by national experts during a workshop on estimating and modeling the HIV/AIDS epidemic in Europe are used.”
Drug-related infectious diseases
While the number of peoples living with HIV (PLHIV) in Armenia is comparatively low, the rate is growing rapidly. Current prevalence among officially registered cases is about 0.02%. The actual rate of prevalence is estimated to be approximately ten times higher, with a greater prevalence among distinct key population groups (Papoyan et al., 2005).
According to National Center for AIDS Prevention of Armenia as of 31 December 2007, 538 cases of HIV were registered in the Republic of Armenia cumulatively (with first notification in 1988). Males constitute a major part in the total number of HIV cases at 401 cases (74.5%). So far, 13 cases of HIV among the children (2.4 % of recorded cases) were identified in Armenia. The overwhelming majority of the HIV-infected individuals (72.3%) have belonged to the 20-39 age groups. The highest number of HIV cases was reported in Yerevan, constituting 48.1% of all the registered cases; the HIV prevalence in Yerevan is then 24.3/100,000 inhabitants, whereas for whole Armenia it is 16.7/100,000. The main mode of HIV transmission is through injecting drug use (47.4% of new/all cases in 2007, vs. about 56% in 2006) (National Center for AIDS Prevention, 2007)
The morbidity rates of viral hepatitis B (VHB) among the general population has remained stable, between 3.2 (in 2000) and 2.8 (in 2006) per 100,000 inhabitants. In 2006, 91 cases of VHB were registered in Armenia. No official data on viral hepatitis C is available in the country; however, according to the data of the Eurasian Harm Reduction Network the number of reported cases of Hepatitis C in Armenia in 2006 was 71 (Merkinaite, 2007).
The results of the Anonymous Survey on Infectious Diseases and Related Risk Behavior among Armenian Prisoners indicated that compared with the HIV prevalence rate in the general population, the rate in prison (2.4%) was 27 times higher (Weilandt et al., 2005)
As regards Hepatitis C (HCV), the study indicated that the prevalence rate in prison was 23.8%. The most important risk factor for contracting an HCV infection in the study population was drug use and the second, time spent in prison within the last 10 years, which was an independent risk factor in the anonymous study.
The study on Hepatitis C conducted by the Research Institute of Epidemiology, Virology and Medical Parasitology has estimated the prevalence of Hepatitis C in Armenia at about 7% (Melik-Andreasyan, 2004).
Drug-related deaths and mortality of drug users
The National Statistical Service collates information in respect of mortality rates from both the Ministry of Health and the Ministry of Internal Affairs, but no specific data on number of fatal overdoses is available in statistical reports.
The Forensic Scientific Center is the only source of statistical information on drug-related death in Armenia. These data is based on the results of forensic tests and toxicological analyses. According to forensic center in 2007 two cases of drug-related deaths was identified. Starting from the 2004 16 total drug-related deaths was reported with the mean age at death 34.4. Morphine was detected in 87.5% of all drug-related deaths cases.
Figure 1: Drug-related deaths, 2004-2007
(Drug) treatment demand
Full-scale Pompidou questionnaire was introduced in Yerevan Narcological Clinic, which is the main provider of medical treatment of drug addiction in Armenia, in 2005. By 1 of June of 2008, there are 300 registered drug addicts at the narcological register (“Pompidou protocol based electronic register”) of Yerevan Narcological Clinic. The narcological register includes drug addicts getting inpatient treatment at Narcological Clinic. The available data of narcological register indicate that 83 drug addicts (1 woman and 82 men) were admitted for treatment in 2007 (according to the report of Narcologic Clinic 122 patients were treated in 2007, of whom 79 were treated for the first time in their lives).The mean age of patient admitted for treatment was 35 years old. Among all treated drug users, 53.0% reported the use of “chernyashka” (dark colored solution made of fresh poppy bulbs or poppy straw), 26.5% the use of opium and 18.1% the use of heroin.
Table 1: Number and percentage of drug treatment presentations to Narcologic Clinic by primary drug of use, 2007
| Main drug of use | Frequency | Percent |
| Cannabis | 1 | 1.2% |
| Chernyashka | 44 | 53.0% |
| Ephedrine | 1 | 1.2% |
| Heroin | 15 | 18.1% |
| Opium | 22 | 26.5% |
First treatment demand in 2007 was 68.7%, 27.7% of patients have treated before in Narcological clinic and 3.6% in other medical centers. Most of the demands for treatment were related to the use of “chernyashka” representing 56.1% of all first demands for treatment.
Table 2: Number and percentage of drug treatment presentations to Narcologic Clinic of Yerevan by history of treatment, 2007
| History of treatment | Frequency | Percent |
| First treatment in Narcologic Clinic | 57 | 68.7% |
| Have treated before in Narcologic Clinic | 23 | 27.7% |
| Have treated in other medical Centers | 3 | 3.6% |
Table 3: Drug use patterns of patients getting inpatient treatment at Narcologic Clinic of Yerevan, 2007
| Drug use patterns | Frequency | Percent |
| Injecting drug use | 78 | 94.0% |
| Smoking of drugs | 1 | 1.2% |
| Inhaling | 4 | 4.8% |
Figure 2: First treatment demand and number of patients registered at narcological register of Narcologic Clinic of Yerevan by years, 2005-2007
Prevention
The history of systemic drug prevention in Armenia is quite young.
From 2002-2003, South Caucasus Anti-Drug Programme (SCAD) implemented the “Drug Prevention in Schools” project. A Manual of Guidance was developed for teachers, police officers and community members and 200 copies were distributed. In July 2003, NGO “APEC” was contracted by UNDP to implement a pilot project in Syunik marz (region) to establish relations between teachers, police officers and community groups under the banner of primary drug prevention, and to enhance knowledge on drug-related subjects. In 2005, APEC also implemented the Swedish International Development Cooperation Agency (SIDA)-funded Primary Drug Prevention Project, whose objective was to develop drug prevention materials, known as a “Drug Box” for school children of grades 8-10.
Based on the Government Decision dated 10th January 2008, on Amendments and Alterations to the Government decision #900-N dated 14th June 2004 to approve the national standards for secondary education, the school curriculum on Healthy Lifestyles consisting of 28 hours for students in 8-9 grades will be developed and adopted to be included in school curricula for 2008-2009 year. The course curriculum will also include topics on HIV/AIDS, drugs education.
Treatment responses
Only short-term detoxification (“drug-free”) treatment is available for patients addicted to injecting drugs in Armenia. There is no established system to deal with treatment-related issues nor is there any institution available that would provide long-term rehabilitation services to drug-addicted people.
The Law on Narcotic Drugs and Psychotropic Substances of the Republic of Armenia,” includes articles that regulate the treatment and medico-social rehabilitation measures provided by the state to drug-addicted people. It explicitly states that “the treatment of drug addiction in the Republic of Armenia is provided by the Narcological Clinic of “Psychiatric Medical Centre” CJSC of the Ministry of Health, the Gyumri Mental Health Centre, the Vanadzor Neuro-psychiatric Dispensary, the Kapan Neuro-Psychiatric Dispensary, the Sevan Republican Psychiatric Centre and the narcological cabinets of district polyclinics and primary health care institution.”
Thus, the main inpatient medical institution is the Narcological Clinic, which covers both Yerevan and regional districts. The treatment available is limited to short-term (“drug-free”) detoxification with no provisions for rehabilitation or support. The hospital section of the Narcological Clinic has 3 departments of hospital care with a total of 60 beds. Dispensary of the same clinic provides outpatient care, which is mainly narrowed to short-term medical monitoring rather than rehabilitation. The minimal observation period for addicted clients (“episodic” users) is one year, but this term could be prolonged if the patients had one or more relapses or did not regularly contacted narcological institutions during the year. Narcological cabinets of district polyclinics merely provide limited outpatient care usually administered by a non-drug treatment specialist (often neurologists) who provides limited consultation and possible referrals to the Narcological Clinic.
OSI-Armenia foundation and SCAD programme along with the in-country partners has implemented advocacy project on introduction of Methadone Substitution Treatment in Armenia together with the national partners. The project is also aimed at further social integration of IDUs and ensuring access to healthcare services. Currently process of assessment and certification of methadone (5mg, 10mg and 40 mg methadone-HCL tablets) produced by the “Mallinckrodt Pharmaceuticals Inc” by the Scientific Centre of Drug and Medical Technology Expertise of RA is underway.
Harm-reduction responses
The first harm reduction project was launched in Armenia by the Open Society Institute Assistance Foundation-Armenia (OSI AF) in August 2003. Since November 2003, the Global Fund has supported the implementation of the Drug Harm Reduction project in Armenia; the principal national partner responsible for field implementation of this project is the NGO “APEC.” In the framework of the program, the Global Fund will support a National Programme on HIV prevention and finance Voluntary Counseling and Testing (VCT) sites in Yerevan, Gyumri, and Kapan up to mid-2008; additionally, OSI AF operates a needle exchange project in Vanadzor. So far, syringe/needle exchange projects in Armenia have been funded by international organizations exclusively.
The services provided by the VCT centers include distribution of disposable syringes/needles, dissemination of condoms and educational/informational materials. The centers also offer voluntary counseling and symptomatic treatment for sexually transmitted infections and legal advice.
Drug markets and drug-related offenses
Armenia is not considered a major transit country for drugs and there is no significant reported drug production in the country identified so far (European Neighbourhood Policy, 2005).The two most important trafficking routes pass through Iran in the South (opiates), and through Georgia in the North (opium, heroin and cannabis) and occasionally via the international airport in Yerevan (2004)
The total amount of drugs confiscated by law enforcement authorities from illegal trafficking in the territory of the republic during the 2007 was 0.339 kg of heroin, 0.173 kg of cocaine, 3.231 kg of opium, 0.31 kg hashish, and 39.305 kg of marihuana (Police of RA, 2007).
According to the official data of the Police in 2007, 1084 cases of drug related crimes were identified (Articles 266-274 of the Criminal Code of RA), whereas in 2004 the number was 411. Out of 1084 cases 643 were related to the illegal turnover of narcotic drugs(Article 266, 268) and out which 235 cases referred to illegal turnover of narcotic drugs for the purpose of sale(Article 266 of the Criminal Coder of RA) (Police of RA, 2007).
Figure 3: Drug related crime, 2004-2007
In 2007 537 persons were convicted for drug related crimes out of which 20 were women (3.7%).
Table 5: Accused persons for drug-related crimes by age groups
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Figure 4
National drug laws
The provisions of the “Law on Narcotic Drugs and Psychotropic Substances” of the Republic of Armenia can be characterized – using the EU context – as rather repressive since it prohibits not only the sale but, also the possession of any amount of drugs for any unauthorized purpose, and simple consumption of narcotics. As a consequence, drug users are reluctant to seek assistance from public health facilities out of fear that they will be turned over to law enforcement authorities and be denied health care. Those drug users who are diagnosed as drug addicts may also be forced into compulsory drug-non-assisted detoxification treatment under Article 49.4 of The Law on “Narcotic Drugs and Psychotropic Substances”.
The legislative framework related to medical aspects of illicit drug use in Armenia is mainly pre-determined by the above-mentioned law and the Criminal Code of the Republic of Armenia. The former was adopted on 26 December 2002 and entered into force on 10 May 2003. The latter entered into force in 1 August 2003 and in the same month the “List of Narcotic Drugs, Psychotropic Substances and their Precursors under the Control on the Territory of Armenia” was adopted. In the same month, the Minister of Health issued an Order on “Establishing Small, Large and Especially Large Quantities of Narcotic Drugs and Psychotropic Substances”. Next, a new Order of the Minister was issued in February 2007 to amend the previous one. Since 2005, drug use has been criminalized in Armenia according to the provisions of Article 271 of the Penal Code of Armenia.
In the period from 2001-2006, SCAD provided ongoing support to drafting and implementing drug-related legislation in Armenia. In December 2001, SCAD helped establish the Task Force on Legislation, which adopted an Action Plan and began its implementation. The Office of the Prosecutor General of the Republic of Armenia, which has been represented on the Task Force, has initiated a drug use de-criminalization process and developed and circulated the draft “Law on Amending the Penal Code of the Republic of Armenia” proposing the abolition of Art 271 of the Criminal Code and its replacement with administrative sanctions for drug use (instead of imprisonment). In March of 2008, National Assembly of Armenia in its first reading has adopted three draft laws of Armenia on making:
(i) Amendments and Alterations to the Criminal Code, mainly aimed at decriminalization of drug use;
(ii)Amendments and Alteration of the Law on Narcotic Drugs and Psychotropic Substances** mainly aimed at permission of substitution therapy and legalizing methadone treatment throughout Armenia.
(iii)Amendments and Alterations to the Administrative Code proposing a fine of 200-400 times of the minimum wages for drug misuse.
Standards of Narcological Care** and Clinical Guideline on Methadone Treatment*** was developed and ratified by the Ministry of Health of RA.
*A package of amendments in the Law on “Narcotic Drugs and Psychotropic Substances” considers the complete change of Article 28.5 of that Law. This article stated that “The treatment of drug addiction with the narcotic drugs and psychotropic substances included in the list of the narcotic drugs shall be prohibited in the Republic of Armenia”. Currently it is phrased as “The treatment of drug addiction shall be organized by provisions made by the state authorized body in health”.
** “Standards of Narcological Care in Armenia” are ratified by the Minister of Health RoA (Order # 532-A as of June 02, 2005)
***The “Clinical Guideline on Methadone Treatment in Armenia” (in Armenian, (ISBN 99941-2-030-1) is developed and ratified by the MoH RoA (Order #1440-A as of December 12, 2005)
National drug strategies
There is no national drug strategy in Republic of Armenia; however, one of the objectives of the SCAD-V is to support the national authorities to adopt the National Drug Strategy or National Action Plan on Drugs. The Ministry of Justice of Armenia requested the SCAD-V to support in developing the National Drug Strategy 2009-2104.
Coordination mechanisms in the drugs field
According to the Law on Narcotic Drugs and Psychotropic Substances the coordination of national drug strategy is the responsibility of the Interagency Commission on Preventing the Trafficking of Narcotic Drugs and Psychotropic Substances and Regulating the Circulation of Narcotic Drugs and Combating Drug Trafficking and Drug Abuse chaired by the Head of Police of Armenia. The deputy ministers and heads of relevant agencies are represented in the Commission.
References
(2004) Eurasian Narcotics , Country Factsheet: Armenia. Central Asia-Caucasus Institute & Silk Road Studies Program.
AIDS PREVENTION EDUCATION AND CARE (2005) Report on the prevalence of Alcohol, Tobacco and Drug Use among 16 Years Old Schoolchildren of the Secondary Schools of Syunik Marz. Yerevan.
ASIRYAN, N. & ZÁBRANSKÝ, T. (2006) First General Population Survey on Psychotropic Substances in Armenia. DrugNet Europe 54, 6-8.
EMCDDA (2002) Handbook for surveys on drug use among the general population. EMCDDA project CT.99.EP.08 Lisbon.
EUROPEAN NEIGHBOURHOOD POLICY (2005) Country Report, Armenia. Brussels.
GRIGORYAN, S., BUSSEL, A. & PAPOYAN, A. (2002) Rapid Assessment of the Situation on Spread of HIV Infection Including Intravenous Drug Users. International Journal of Drug Policy, 13, 433-436.
GYURJYAN, G. & BAZARCHYAN, A. (2005) Report on the Results of the National Survey on Drug, Alcohol and Smoking Prevalence among the General Population of Armenia.
MARKOSYAN, K. (2005) Meeting the Challennge of Injection Drug Use and HIV in Armenia. Yerevan.
MELIK-ANDREASYAN, G. (2004) Epidemiology of blood-borne viral hepatitis in Armenia. Yerevan, The Research Institute of Epidemiology, Virology and Medical Parasitology.
MERKINAITE, S. (2007) HCV Infection in Europe. Eurasian Harm Reduction Network.
NATIONAL CENTER FOR AIDS PREVENTION (2007) HIV situation in Republic of Armenia. Yerevan.
NATIONAL STATISTICAL SERVICE (2007) Statistical Yearbook of Armenia. Yerevan.
PAPOYAN, A., ARAKELYAN, A. & BAKSHINYAN, E. (2005) HIV/AIDS in Armenia: a socio-cultural approach. Paris, UNESCO.
POLICE OF RA (2007) Annual Statistical Newsletter of Police. Yerevan.
WEILANDT, G., ECKER, J. & STÖVER, H. (2005) Anonymous Survey on Infectious Diseases and Related Risk Behavior among Armenian Prisoners and on Knowledge, Attitudes and Behaviour of Armenian Prison Staff towards Infectious Diseases and Drugs. Bonn, European Network on Drugs and Infections Prevention in Prison (ENDIPP).
