• Drug use among the general population and young people
• Prevention
• Problem drug use
• Treatment demand
• Drug-related infectious diseases
• Drug-related deaths
• Treatment responses
• Harm reduction responses
• Drug markets and drug-related offences
• National drug laws
• National drug strategy
• Coordination mechanism in the field of drugs
• References

Drug use among the general population and young people

No general population survey (GPS) had been performed to measure drug use in the general population, prior to 2007. In 2008, a repeated comparable household survey targeting the young population aged between 15 and 24 years was conducted on the right bank of the Dniester River . The ‘European model questionnaire’ (European Monitoring Centre for Drugs and Drug Addiction, 2002) was included as part of the survey questionnaire. The final sample size counted 1 182 (537 male, 645 female) respondents; the size of the sampled population was estimated as being as high as 683.2 thousand.

Out of the total sample size, 17.1 % of young people aged 15–24 years old reported that they know someone who uses marijuana or hashish. The lifetime prevalence of marijuana or hashish among the survey target population reached 7.0 %, and the last year prevalence reached 2.9 %. When asked at what age they had tried marijuana or hashish for the first time, the mean age was 16.65 and the median 17 years old (Scutelniciuc Otilia 2008b). In comparison with the previous survey data from 2006, the lifetime prevalence (7.1 %), the last year prevalence (2.9 %), and the mean (16.9 years) and median ages (17 years) did not change (Scutelniciuc Otilia 2007).

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Prevention

Preventive measures targeting drug use among schoolchildren are stipulated in the Law of the Republic of Moldova, No 713-XV, dated 6 December 2001, On the control and prevention of the abuse of alcohol and use of illegal drugs and other psychotropic substances (Parlamentul Republicii Moldova 2002). The development of a course about the harmfulness of drug use in the curricula of pre-university institutions was envisaged in the ‘Measures for fighting drug addiction and drug trafficking in the years 2005–06’, approved by the Resolution of the Government, No 166, dated 15 February 2005 (Guvernul Republicii Moldova 2005). As of 1 September 2005, pre-university education in institutions on the right bank of the Dniester River included in their curricula the obligatory compulsory training course ‘Life Skills Education’, which included a chapter on the prevention of drug use. After negative reactions from some parents, schoolchildren, and religious organisations targeting sex education, and following several months of discussions, the course became optional, and the sex education chapter was excluded. This optional course starts in the sixth grade, once the pupils are 13 years of age, and continues until the pupils turn 18 years of age and graduate from high school.

The Ministry of Internal Affairs of the Republic of Moldova, within the ‘Measures of fighting drug addiction and drug trafficking in the years 2007–09 (Guvernul Republicii Moldova 2005), should also perform activities designed to prevent drug use in pre-university educational institutions. Such activities have been implemented by way of organising classes, attended by the representatives of the Ministry of Internal Affairs.

Extracurricular education for the prevention of drug use is stipulated in the Law of the Republic of Moldova, No 713-XV, dated 6 December 2001, On the control and prevention of the abuse use of alcohol and use of illegal drugs and other psychotropic substances, adopted by the Parliament of the Republic of Moldova (Parlamentul Republicii Moldova 2002). The development of extracurricular programmes was stipulated in the plan ‘Measures for fighting drug addiction and drug trafficking in the years 2005–06’, approved by the Resolution of the Government, No 166, dated 15 February 2005 (Guvernul Republicii Moldova 2005). The prevention of drug use within out-of-school activities, envisaged in this legal enactment, bears the character rather of a programme for the overall support of healthy lifestyles than of one for the (specific) primary prevention of drug use.

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Problem drug use

An attempt to estimate the number of IDUs, was performed by World Bank (WB) consultants in 2003 (Godinho Joanna 2003) for the Project Appraisal Document of the World Bank grant to fight HIV/AIDS in Moldova. According to the report, it was estimated that there were 35 000 IDUs in the Republic of Moldova in 2001, with an estimated monthly increase of 0.05 %; the model, however, does not estimate the decrease and other important factors, or the dynamics of the prevalence of drug use, and thus its forecast that in 2011 the number of IDUs would reach 37 000 is rather doubtful. Moreover, the model makes several assumptions. The situation of the Republic of Moldova does not correspond to any of these assumptions.

Another attempt to estimate the number of IDUs was performed in 2007, applying the multiplier module within the Behavioural and sentinel surveillance survey (Scutelniciuc Otilia 2008a), conducted among IDUs who use harm reduction services; first of all, this means syringe exchange programmes. Taking into account the sampling method (random sampling from the list of current beneficiaries ), the results are considered representative for the population being studied. According to the results of this survey, almost 45 % of respondents stated that they are officially registered as IDUs. According to routine statistical data, the number of officially registered IDUs by the end of 2006 is almost half (3 385) that of the number of IDUs who use harm reduction programme services (7 847). The conclusion drawn is that the officially registered IDUs are a subpopulation of the IDUs who use harm reduction programme services.

Thus, in the Republic of Moldova, there are still no reliable estimations of the size of the IDU population.

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Treatment demand

Police testees (persons tested for the presence of drug metabolites in their saliva or urine at the request of the police) and the healthcare system (voluntary admission to treatment or accidental detection during prophylactic checkups ) serve as the main sources for the registration of drug users in the ‘Narcological Register’.

Once a person is considered to be a drug user by the narcological experts (which means a urine or saliva test for the presence of drugs and/or metabolites, performed by orientation strip tests), s/he is compulsorily registered (entered into the ‘Narcological Register’ database), regardless of his/her wishes. Furthermore, the patients are referred to the district-level narcologist for final diagnosis and treatment according to the diagnosis and the willingness of the patient. In terms of the clinical findings, all registered cases are divided into two broad categories: drug use without addiction syndromes and drug use with addiction syndromes. The Regulation on the detection, registration, and record-keeping of the people who use drugs and other psychotropic substances envisages different scenarios for each case type (Order of the Ministry of Health No 260, from 3 September 2003).

By 1 January, 2007, on the right bank of the Dniester River, 7 413 people had been officially registered as drug users in the RND database. During 2006, 1 030 newly registered cases of drug use on the right bank of the Dniester River were entered into the RND database, representing an almost identical number to that in 2005 (1 017 newly registered cases of drug use). The police, as a source of detection, accounted for an increased rate for the registration of newly registered cases for drug use both with and without addiction syndromes throughout 2006 (52.5 % for drug use cases without addiction syndromes and 76.3 % for drug use cases with addiction syndromes). The great majority of the total number of newly registered cases of drug use on the right bank of the Dniester River in 2006 was newly registered cases of drug use without addiction syndromes — 86.9 % (cannabis users in 77.0 % of cases without addiction syndromes).

The number of beneficiaries of substitution treatment was quite low until 2006 (73 covered at any point in time) because of the restrictive criteria regarding their involvement. In 2007, the criteria were changed and by the end of 2007, 221 drug users had been involved in substitution therapy with methadone in a free setting at some point (in the capital city and in the municipality of Balti only) and out of them 134 were receiving methadone treatment at the end of 2007. At the end of 2007, in the penitentiary system (four institutions involved) 74 drug users had been involved in substitution treatment with methadone at some point; 28 out them were receiving treatment at the end of the year (Fundatia Soros Moldova & Programul de Reducere a Noxelor 2008).

At the end of 2006, on the right bank of the Dniester River, the total number of IDU beneficiaries (7 847) of Harm Reduction Programmes (HRPs) exceeded the total number of IDUs officially registered by the healthcare system for drug use (3 385) in the database of the Republican Narcological Dispensary (RND) on the right bank of the Dniester River.

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Drug-related infectious diseases

The diagnosis of newly registered HIV cases associated with injecting drug use may occur, both following voluntary and direct recourse and as a result of compliance with the legal framework of HIV testing twice per year, of registered injecting drug users. The diagnosis is established when the person undergoes two ELISA tests that are finally confirmed by the Western blot test. There is a trend towards an increase in the number of newly HIV reported cases among injecting drug users (IDUs), mostly because of the increasing number of new HIV cases in IDUs reported on the left bank of the Dniester River ((Centrul National Stiintifico Practic de Medicina Preventiva 2008).

Even if in 2007 the number of IDUs that were reported as new HIV cases (223) was lower than in 2006 (232), it is still too early to state that there is a reduction in the number of new HIV cases reported among IDUs. The inconsistency in this type of data — specifically those regarding the left bank of the Dniester River — is explained by the fact that the political context has affected the number of samples referred for confirmation (Western blot test) from the left bank of the Dniester River and this has delayed the confirmation, since the only reference laboratory which confirms HIV cases is located on the right bank of the Dniester River (municipality of Chisinau).

According to the results of the HIV prevalence survey conducted in 2007 (Scutelniciuc Otilia 2008a), the HIV prevalence among injecting drug users (IDUs) who use harm reduction services reached 21 %. The distribution of HIV prevalence by geographical location registers a disparity between sentinel sites. The Municipality of Balti is one of the regions with a higher number of registered injecting drug users in comparison with other regions from the right bank of the Dniester River. The registered HIV prevalence in IDUs from the municipality of Balti who use harm reduction services is the highest among sentinel sites in the 2007 prevalence study, confirming the results of the 2004 HIV prevalence study (36.5 %) (Bivol 2004).

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Drug-related deaths

The forensic examination of dead bodies is performed according to the ‘Regulations for the forensic examination of a corpse’, approved on February 24, 1999 by the Ministry of Health. In compliance with these regulations, in the event of a drug-related death (henceforth ‘DRD’) or any suspicion of one, the expert performing the autopsy must sample the biological material required for toxicological investigations (blood, urine, portions of the viscera). The toxicological investigations of the presence of illegal drugs in the samples taken from the bodies of people who died an unnatural death are not compulsory, which could result in cases of DRDs being overlooked. The technical capacities of the toxicological laboratory of the Forensic Medicine Centre (henceforth ‘FMC’) and of the sub-national infrastructure of the FMC make possible only a qualitative analysis of the main groups of illegal drugs. As such, it does not provide the best possible supporting data for the diagnosis of the forensic doctor. The long period between the sampling of biopsies and the receipt of the final toxicology results (3–4 months after the death) may result in the registration of the death under a different cause than that ultimately ascertained by the forensic doctor. The social stigma and the complexity of the legal procedures encourage the relatives of the deceased to actively hide the real cause of death in cases of drug-related deaths.

In 2007, out of 209 toxicological investigations of the biopsies sampled from corpses suspected of the presence of illegal drugs, in 13 cases the results were positive, reaching 6.2 % of the total number of cases investigated and 0.34 % of the total number of cases suspected of an unnatural death.

In 2007, only 6 DRDs were added to the General Registry of Mortality with their causes attributed to one of the codes F 11.0 – F 19.9, X 62.0, X 42.0, T 40.0 – T 40.9 according to the 10th revision of International Classification of Diseases (ICD 10). Out of them, 1 case had F11.5 (Mental and behavioural disorders resulting from the use of opioids, psychotic disorder) and 5 cases – X 42.0 (Accidental poisoning by and exposure to narcotics and psychodysleptics [hallucinogens], not elsewhere classified).

The data provided by the Republican Narcological Dispensary are gathered by district narcologists on the basis of lists of officially registered cases of drug use, once they get such knowledge. In EU/EMCDDA terms, these data are illustrative of the ‘overall mortality of registered drug users’ in Moldova. Statistics based on this reporting system show higher figures than the previous two sources.

Apart from the partial monitoring mechanisms reported above, no research studies on DRD were performed in the country prior to 2007.

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Treatment responses

The main service offered by the national public healthcare system is detoxification. This can be provided anonymously or with the disclosure of the person's name. All anonymous patients pay for their healthcare services. The private sector of the healthcare system provides only detoxification. Until 2007, private healthcare providers had not been contracted by the National Health Insurance Fund for treatment provision to drug users. Thus, if the detoxification was provided by a private healthcare institution, this service was paid for.

Figure 3 shows the reported number of patients who underwent detoxification for the first time during the reporting year and does not include private healthcare facilities. The private healthcare facilities are not included, because they do not report, because of confidentiality issues. In 2007, there was an increase in the number of such ‘first detoxification demand during the year’ cases in the Republic of Moldova (right bank of the Dniester River). In the early 2000s, as a result of the deterioration of the healthcare system and unstable financing, healthcare services, especially detoxification, were not free and access to the healthcare system was being reduced. Since 2004, the health insurance system has been implemented and covers detoxification for insured persons and since 2006, the Ministry of Health has covered detoxification for uninsured persons.

There are no other details available on the characteristics of people seeking detoxification. Data on people who have undergone detoxification are not entered consistently into the ‘Narcological Register’ database.

Since November 2007, a rehabilitation centre with 60 places (30 for outpatient care and 30 for inpatient care) has been open in Chisinau, the capital city of the Republic of Moldova. Comprehensive treatment for addiction following detoxification in residential institutions is not routinely available in the Republic of Moldova. An insufficient amount of it is provided by NGOs focusing on the reintegration and re-socialisation of people freed from drug addiction.

In 2004, substitution treatment using the opiate agonist methadone was introduced in the Republic of Moldova. Using external and internal funds , this type of healthcare service is offered in free settings in the capital city, Chisinau, by the RND and in the municipality of Balti; both are public healthcare institutions. In the penitentiary system methadone treatment is available in four institutions (out of 19).

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Harm reduction responses

The basic components of the harm reduction strategy for IDUs in free settings in the Republic of Moldova are as follows:

• information/education/outreach about HIV and ways of preventing it in the context of high risk practices (distribution of informational materials, condoms, workshops);
• referral to medical and social services (offering medical counselling, usually for sexually transmitted infections, psychological counselling, pre- and post HIV-test counselling); and
• needle exchanges.

Altogether, at the end of 2007, 14 projects provided harm reduction services to prevent the spread of HIV among IDUs in free settings, providing, in particular, information/education/outreach, needle exchange, and referral to medical and social services in 21 administrative territories; 95 % of the projects are implemented by the NGO sector, funded by a Global Fund grant.

The basic components of the harm reduction strategy within the framework of penitentiary institutions are as follows:

• information/education/outreach about HIV/AIDS and their prevention in the context of high risk practices (distribution of informational materials, condoms, workshops); and
• needle exchange for IDUs.

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Drug markets and drug-related offences

The reporting of the statistical data on crimes from the left bank of the Dniester River ceased in the early 1990s, following the Trans-Dniestrian conflict, currently frozen, that divided the country into territories on the right and left banks of the Dniester River. There is no exchange of data in terms of drug-related crimes either. The data below refer only to the drug-related crimes registered on the right bank of the Dniester River.

At the end of 2005, new modifications to the Penal Code were approved. The main modifications were made to the criminal qualifications for the cultivation of plants containing drugs, which is now considered to be subjected to penal punishment. In the list of substances approved at the end of January 2006, no new substances were added to the list for which penal punishment is applied. However, these two important modifications to the legal and regulatory framework have not changed the overall trend in the number of drug-related crimes (2 147 drug-related crimes in 2007 and 2 087 drug-related crimes in 2006). Analysis in terms of the age groups of the people arrested for drug-related crimes shows an increase in the rate of people aged 30 years old and more (48.2 % in 2007 and 43.9 % in 2006) and a decrease in the rate of those aged 18–24 years old (28.8 % in 2007 and 32.5 % in 2006) in the last three years. In 2007 the proportion of females arrested for drug-related crimes reached 15.4 % and decreased in comparison to 2006 (20.3 %).

An important decrease in the amounts of poppy straw and acetylene opium seized, and an important increase in amphetamines, ecstasy, and heroin, were registered during 2007 in comparison to 2006. On the other hand, seizures of cannabis (another drug produced mostly domestically) decreased to less than half of the amount seized in 2004.

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National drug laws

Simple drug use is not a crime in the Republic of Moldova, but it is an administrative offence according to Article 44 of the Administrative Code. According to this Article, a person can be sanctioned for:

• the illegal purchase or possession of drugs or psychotropic substances in small amounts or;
• the use of drugs or psychotropic substances without a medical prescription; or
• the illegal purchase or possession of drugs or psychotropic substances in small amounts without the purpose of distributing them.

The above-mentioned are sanctioned with a fine of up to three conventional units. In exceptional cases, when the application of this measure is considered insufficient, taking into consideration the circumstances of the case and the offender’s background and behaviour, administrative arrest for a term of up to 15 days can be imposed.

According to the modifications to the Penal Code approved in 2003, drug-related crimes were divided into serious and minor crimes with a considerable reduction of the minimum amounts of drugs that make the forces of justice consider the given activity to be a crime subject to penal punishment. The approval by the Parliament of the Republic of Moldova of the Law No 277 – XVI, dated 4 November 2005, On the amendment of the Administrative Contraventions Code, of the Penal Code of the Republic of Moldova and of the Penal Procedure Code of the Republic of Moldova (Parlamentul Republicii Moldova 2005) has been the most important legislative event with reference to the drugs issue in recent years.

The amendments to the Administrative Code, stipulated in the Law of the Republic of Moldova, no. 277-XVI, dated 4 November 2005, change the fines for:

• Illegal (unauthorised) cultivation of plants that contain drugs or psychotropic substances, in small amounts and without the purpose of distribution.
• Unauthorised production, preparation, processing, experimenting, purchasing, storing, delivery, transportation, distribution or carrying out of any other operations with precursors.

The amendments to the Penal Code, as approved in the Law of the Republic of Moldova, No 277-XVI, dated 4 November 2005, define the penal punishment for the large-scale illegal (unauthorised) cultivation of plants that contain drugs or psychotropic substances, illegal circulation of precursors with the purpose of producing or processing drugs, psychotropic substances, or their analogues, and illegal circulation of materials and equipment designed for the production or processing of drugs, psychotropic substances, or their analogues. The above-mentioned actions are liable to penal prosecution under the amendment to the Penal Code in 2005; previously, they were considered administrative contraventions.

Following that law, the amount of every drug type that serves as a basis for its possession being considered drug-related crime has been defined by the Resolution of the Government of the Republic of Moldova, No 79, dated 23 January 2006, On the approval of the List of drugs, psychotropic substances and plants that contain these substances, identified in trafficking, and their amounts (Guvernul Republicii Moldova 2006). The new amendments to the list are characterised by an increase in the minimum quantities of drugs rendering the possessor liable to penal punishment.

Comparing the list of substances from the synthetic table, updated in 2003, and the list of drugs, psychotropic substances, and plants that contain these substances, identified in trafficking, approved at the beginning of 2006, no new substances have been added.

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National drug strategy

In the Republic of Moldova, no national drug strategy has been developed so far.

National actions aimed at fighting and preventing illegal drug use and trafficking are stipulated in the Resolution of the Government of the Republic of Moldova, No 166, dated 15 February 2007, On the approval of the Measures of fighting drug addiction and drug trafficking for the years 2007–09 (Guvernul Republicii Moldova 2007). This enactment assigns the duties of the central and local public authorities for the fulfilment of this governmental resolution. The plan of measures envisages actions both for fighting drug trafficking and for preventing illegal drug use.

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Coordination mechanism in the field of drugs

The Government of the Republic of Moldova is in charge of the development and consolidation of the national policy of fighting illegal drug use and trafficking. The Resolution of the Government of the Republic of Moldova, No 585, dated 19 June 2000, On the establishment of the Interdepartmental Commission for Drug Abuse and Drug Trafficking Control (Guvernul Republicii Moldova 2000), lays down the operation and the nominal membership of the Commission. The nominal membership of the Commission was laid down by the Resolution of the Government of the Republic of Moldova, No 1318, dated 8 October 2002 (Guvernul Republicii Moldova 2002), On the nominal membership of the Interdepartmental Commission for Drug Abuse and Drug Trafficking Control. The Commission members are representatives of all ministries and central authorities whose activity is related to the prevention and tackling of illegal drug use and trafficking. The approach to fighting drug trafficking in the Republic of Moldova is an inter-institutional one. The network of institutions working in the domain is composed of:

• Ministry of Internal Affairs
• Ministry of Health
• Ministry of Education and Youth
• Customs Service
• Border Service
• Information and Security Service
• Ministry of Justice, Department of Penitentiary Institutions

The decisions of the Commission de iure bear a recommendatory character and are not mandatory.

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References

Centrul National Stiintifico Practic de Medicina Preventiva 2008, Buletin informativ privind situatia epidemica in infectia HIV/SIDA, realizarea Programului National pe semestru II, 2007 si sarcinile pentru 2008 Chisinau.

European Monitoring Centre for Drugs and Drug Addiction 2002, Handbook for surveys on drug use among the general population, EMCDDA, Lisbon.

Fundatia Soros Moldova & Programul de Reducere a Noxelor. Raport de Monitorizare, trimestrul IV 2007. 2008. Chisinau. Ref Type: Unpublished Work Godinho Joanna 2003, Moldova AIDS Control Project Washington DC.

Guvernul Republicii Moldova 2000, "Hotarirea Guvernului Republicii Moldova nr. 585 din 19 iunie 2000 Cu privire instituirea Comisiei Interdepartamnetale de Combatere a Narcomaniei si Narcobusinessului", Monitorul Oficial al Republicii Moldova, vol. 75-76/672.

Guvernul Republicii Moldova 2002, "Hotгrirea Guvernului Republicii Moldova nr. 1318 din 8 octombrie 2002 Cu privire la componenta nominala a Comisiei Interdepartamentale de Combatere a Narcomaniei si Narcobusinessului", Monitorul Oficial al Republicii Moldova, vol. 142-143/1452.

Guvernul Republicii Moldova 2005, "Hotarirea Guvernului Republicii Moldova nr. 166 din 15.02. 2005 Cu privire la aprobarea Masurilor de Combatere a Narcomaniei si Narcobusinessului in anii 2005 - 2006", Monitorul Oficial al Republicii Moldova, vol. 42-45/294.

Guvernul Republicii Moldova 2006, "Hotarirea Guvernului Republicii Moldova nr. 79 din 23 ianuarie 2006 Cu privire la aprobarea Listei substantelor narcotice, psihotrope si plantelor care contin aceste substante identificate in traficul ilicit si cantitatilor acestora se defineste cantitatea pentru fiecare tip de drog care sta la baza calificarii infractiunii prin trafic de droguri ", Monitorul Oficial al Republicii Moldova, vol. 16-19/109.

Guvernul Republicii Moldova 2007, "Hotarirea Guvernului Republicii Moldova nr. 166 din din 15 februarie 2007 Cu privire la aprobarea Masurilor de Combatere a Narcomaniei si Narcobusinessului pentru anii 2007 - 2009", Monitorul Oficial al Republicii Moldova, vol. 42-45/294.

Ministerul Afacerilor Interne 2008, Nota informativa privind traficul ilicit de droguri in anul 2007 Chisinau.

National Bureau of Statistics. Statistical Yearbook of the Republic of Moldova. 1-738. 20-6-2008. Chisinau, Statistica. Ref Type: Serial (Book,Monograph)

Parlamentul Republicii Moldova 2002, "Legea nr. 713 - XV din 6 decembrie 2001privind controlul si prevenirea consumului abuziv de alcool, consumului ilicit de droguri si de alte substante psihotrope - pentru a raporta la Concluziile Consiliului si ale reprezentantilor guevrnelor statelor membre, reuniti in cadrul Consiliului din 4 decembrei 2000, privind combaterea dopajului (2000/C 356/01) ", Monitorul Oficial al Republicii Moldova, vol. 35-38/208.

Parlamentul Republicii Moldova 2005, "Legea nr. 277 - XVI din 4 noiembrie 2005 Pentru modificarea si compeltarea Codului cu privire la Contraventiile adminsitrative, Codului Penal al Republicii Moldova si Codului de Procedura Penala al Republciii Moldova", Monitorul Oficial al Republicii Moldova, vol. 161-163/795.

Scutelniciuc Otilia. Cunostintele, Atitudinile si Practicile tinerilor referitor la HIV/SIDA. Studiul de evaluare. Raport final. 1-71. 2007. Chisinau, Rolsi-Media SRL. Ref Type: Serial (Book,Monograph)

Scutelniciuc Otilia. Behavioral and Sentinel Surveillance in MARPs, Moldova 2007. Bivol Stela. 2008a.
Ref Type: Unpublished Work

Scutelniciuc Otilia. Cunostintele, atitudinile єi practicile tinerilor cu referire la HIV/SIDA. Condrat Igor. Studiu de Evaluare. Raport Final. 1-78. 2008b. Ref Type: Unpublished Work

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