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Country overview: Ukraine

  • Situation summary

Contents

This summary was prepared by the Ukrainian Medical and Monitoring Center on Alcohol and Drugs of the Ministry of Health. The content does not necessarily reflect the official opinion of the EU and has not been subject to the usual EMCDDA data verification procedures.
(Last update on the EMCDDA website: March 2013)

Key figures

 

Year

Ukraine

Source

Population

2011

45 633 600

State Statistic Committee

Gross domestic product (1) (per inhabitant)

2010

EUR 2 260 

State Statistic Committee (in actual prices)

Household income (or consumption) levels

2010

62.2 %

State Statistic Committee

Unemployment rate

2011

8.6 %

State Statistic Committee

Number below poverty level (in Ukraine — below the minimal subsistence level) (2)

2010

21.8

State Statistic Committee

Number in prison (per 100 000 of population) (3

2010

332.4 %

Council of Europe, SPACE I-2010

1 Gross domestic product (GDP) is a measure of economic activity. It is defined as the value of all goods and services produced less the value of any goods or services used in their creation.

2 In 2007, the minimal subsistence level was EUR 63 (data by the State Committee for Statistics of Ukraine).

3 Situation of penal institutions on 1 September 2010.

Drug use among the general population and young people

Up to 2011 targeted research on the prevalence of drug use among the general population had not been conducted.

In 2010 a socio-demographic survey, Youth of Ukraine, was conducted. The random sample of the study included 1 800 respondents aged 15 to 34 years from all regions of Ukraine. The survey results show that 9 % of respondents aged 15 to 34 years had consumed illicit drugs at least once in their lives. The most common substance was marijuana or hashish, used by about 8 % of respondents. Ecstasy was consumed by about 2 % of respondents. About 30 % of respondents reported that they personally knew people who used drugs. Some 32 % of respondents first used drugs between the ages of 12 to 16 years, 32 % aged 17 to 18 and 30 % aged 19 to 28 years.

Among men, the highest percentage (34.4 %) of respondents first tried drugs aged 12 to 16, while 44.4 % of women first tried drugs aged 19 to 28. The trend shows that men try drugs earlier than women, and the highest risk for experimentation with drugs is between the ages of 12 and 18. Some 31.5 % of respondents who had experience of drug use reported consuming marijuana or hashish during the last 12 months prior to the survey, 8.4 % reported using ecstasy, while 10 % reported using any drug within that timeframe. The use of marijuana or hashish in the last 30 days was reported by 16 %; 1 % reported consuming cocaine and 0.5 % reported consuming ecstasy.

To investigate public attitudes to the problems of drugs, respondents were asked whether they believe drug users are ‘criminals’ or ‘sick’ people. Around 56 % of respondents believe that drug addicted people are ‘sick’, while 27.5 % felt that they are both ‘criminals’ and ‘sick’ (Libanova E., 2010).

By 2011 three waves of the Health Behaviour in School-Aged Children (HBSC) surveys (2002, 2006, 2010) had been conducted in Ukraine. In 2010, there were 10 343 respondents aged 11 to 17 years involved in the survey. They studied in secondary schools, vocational technical schools (VTS) and higher educational institutions of I–II, and III–IV accreditation levels. A total of 594 representatives of the administration of educational institutions were also included in the survey. The survey was performed using standardised self-administered questionnaires that were filled in by students in classrooms.

The questions on the pupils’ experience of drug use such as marijuana or hashish was asked to those aged 15 to 17 years (from the 10th grade of the secondary school).

Results in 2010 showed that 16 % of 15- to 17-year-old respondents had used marijuana or hashish in their lifetime. Over the past 12 months about 8 % of students had used these drugs. Some 4 % of students reported using marijuana or hashish over the past 30 days. The highest rate of recent drug use reported by students at vocational schools and higher educational institutions of I–III level of accreditation was around 3 %. The lowest level was detected among the pupils of 10th and 11th forms of secondary schools, at 1.5 %. In all age categories, young males used marijuana or hashish on average twice as often as young women. A significant difference in the level of consumption of marijuana appeared in young women from vocational schools, when compared with female pupils of the same age in secondary schools. The lifetime use of marijuana 1–2 times was reported by 4 % of female students in secondary schools, and 8 % of female students in vocational schools, universities of I–II level of accreditation and 10 % of female students in high schools and of I–III level of accreditation (Balakireva O. M. et all, 2011a).

Ukraine continues to participate in the European survey project on alcohol and other drugs (ESPAD). The latest research was conducted in 2011 when the sample size consisted of 7 512 students aged 15 to 17 years, made up of 4 157 girls and 3 355 boys. The survey was performed through standardised self-administered questionnaires filled in by students in classroom.

Around 12.4 % of respondents reported ever using marijuana or hashish use at least once. Boys reported ever using marijuana or hashish more frequently than girls (18.9 % and 7.2 % respectively). The major proportion of those who used marijuana or hashish were ‘experimental users’, i.e. those who tried the substance 1 or 2 times during their life. This was particularly observed among students at vocational schools and universities.

Around 7.3 % of respondents had used marijuana or hashish in the past 12 months. The prevalence among boys was triple of that of girls (11.5 % and 4.0 % respectively). Some 3.0 % of respondents reported marijuana or hashish use in the last 30 days, and for the recent drug use the gender difference was even more noticeable as 5.2 % of boys and 1.2 % of girls reported using marijuana or hashish during the past 30 days. Around 1.5 % of recent users reported using drug 1–2 times in the past 30 days, and around 1.0 % more than six times for the same time period. Lifetime prevalence of ecstasy use was 3.1 % (4.7 % among boys and 1.8 % among girls) (Balakireva O. M. et all, 2011b).

The project ‘Challenges to prevention programmes aimed at reducing the vulnerability of youth under the conditions of HIV/AIDS epidemic’, conducted at the Ukrainian Institute for Social Research for the German Society of Technical Cooperation (GTZ) in 2009–10 [www. uisr.org.ua] studied the situation regarding the prevalence of preventive programmes for a healthy lifestyle within the system of vocational education institutions (VET), behavioural practices of the students and possibility of developing interventions for HIV prevention.

The study asked questions about the prevalence of alcohol consumption and drug use among students of vocational schools aged 15 to 21 years in five regions of Ukraine (Kyiv, Vinnytsia, Ternopil, Khmelnytsky, Chernivtsi oblasts). The sample size was 1 008 respondents. Among all respondents, 17 % of students reported having attempted drug use in their life at least once. Some 2 % of students reported having used drugs recently. Some 3 % reported injecting drug use during their lifetime and 1 % reported injecting drugs recently. First drug use among vocational students takes place most often aged 15 to 16 years. Some 4 % of students who had a practice of non-injecting drug use had first used drugs at the age of 11 years, and 20 % had tried the drugs for the first time before the age of 15. Regarding the start of injecting drug use, four respondents first tried it under the age of 11, 12 respondents at the age of 15 and 14 respondents at the age of 18 (Balakireva O. M. et all, 2010).

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Prevention

In all Ukrainian secondary schools, alongside the compulsory school subjects, psychoactive substance use prevention is carried out in the form of voluntary activities within the programmes for the formation of healthy lifestyle skills in children and teenagers. The most spread-out is the ‘Peer-to-peer education’ project. Today, the project involves approximately 7 000 schools. During its operation more than 5 000 peer trainers and over 20 000 teachers have been trained, and more than 100 000 students have been covered by the activity.

In 2009–10 a study was conducted on the prevalence of preventive programmes for a healthy lifestyle within the system of the vocational technical schools (VTS) in 13 VTS in five regions (Vinnytsia, Ternopil, Khmelnytsky, Chernivtsi and Kyiv oblasts). Findings suggest that preventive measures are conducted in all 13 schools involved in the study at the elective courses for a healthy lifestyle. In seven out of the 13 VTS the following programmes were conducted: ‘Peer-to-peer education’, ‘Safe behaviour’, ‘Attention! Drugs’, ‘School against AIDS’, ‘Youth and the law’, ‘The influence of smoking, alcohol, drugs on the human body’ and others. Among all respondents, 22 % have participated in prevention activities (girls 23 %, boys 21 %). The problems of preventing drug use and related issues are considered in VTS only in the context of HIV/AIDS, and they receive only a small portion of coverage. So, films devoted to the problems of alcohol and drugs were watched by only 1 % of the respondents and the exhibition on healthy lifestyles was also visited by only 1 % of the students. Available indicators of coverage may indicate that such programmes are not conducted over a wide scale or in a systematic manner or that school youth are not interested in participating in such events.

The survey on the level of students' knowledge about drugs was also conducted among the staff of educational institutions. Some 38 % of the teachers believed that students’ knowledge about drugs is sufficient, and 28 % of respondents believed that knowledge is not sufficient. It is not known which factors are associated with such a distribution of responses.

With regard to selective prevention, in 2009–10 the project ‘Child protection service’ was implemented in four pilot areas of Kirovograd oblasts. Target group included children whose parents work abroad, parents and tutors of these children, and teachers. The purpose of the project was to test positive behaviour strategies among social orphans, raising children’s awareness and responsibility, substituting aggressive behaviour with the ability to conduct a constructive dialogue and to create a new model of social assistance. The project covered more than 1 000 people, including 100 teachers and education specialists and about 400 students. Within the project 10 coordinators, psychologists and social workers responsible for the social support of children were trained to work with children whose parents are migrant workers. Twenty-five trainees also learned mediation and teamwork skills during the training ‘Let's change the world together!’ The positive experience of the project has, however, not spread to other parts of the country.

In Ukraine, there are 1 884 social services centres for families, children and youth and 468 social work mobile advisory points (MAPs). This is a specialised form of socio-preventive work with families, children and youth living in remote places, including rural and mountainous areas and remote areas of cities, as well as those living in difficult circumstances. MAP specialists work according to the Standard, which defines the main directions, content, scope, process of providing social services to families, principles of service specified categories and requirements for service delivery. The basic form of the MAP includes individual and group counselling, lectures, talks, workshops, videos, outdoor games and preventive measures in summer camps, as well as distribution of promotional and informational materials. In 2010 MAP specialists had conducted individual work on prevention of drug/alcohol problems and formation of healthy life skills with 13 685 children and young people.

Within the framework of psychological services in educational institutions, the social educators and practical psychologists reveal the emotional and behavioural disorders among pupils and carry out appropriate targeted advice for teachers, students, pupils and their parents. They also apply preventive intervention to reduce risk factors that facilitate the emergence of drug/alcohol problems amongst children. In the system of psychological care in general educational institutions (GEI) in Ukraine the corrective and developmental-educational programmes being implemented include: ‘Preventing aggressive behaviour and formation of legal culture’; ‘Programme of correction of anxiety level in teenagers’; ‘Saving the mental health and prevention of emotional disorders’; ‘Dealing with anxiety in teenagers’; ‘Anxiety reduction and prevention of affective manifestations of behaviour of elementary school pupils’; ‘Psychological correction of teenagers with psychopathic and accentuation of character’; ‘Correctional and developing work with deviative children’. However, these programmes remain isolated and their impact is not analysed.

At the Centre of Psycho-Pedagogical Correction in the Fontanskaya rehabilitation school in Odesa oblast, the research project ‘Psychological, educational, medical and social rehabilitation of children with deviant and delinquent behaviour’ was introduced. It was later extended to some other oblasts of Ukraine (Lviv, Donetsk, Mykolaiv, Luhansk, Kharkiv) in social rehabilitation secondary schools. Within these social rehabilitation institutions, the centres of psycho-pedagogical correction were organised and the children of the target group were registered there based on applications of their parents or persons substituting them. Experimental results showed that these institutions were able to provide educational, medical, psychological and social assistance to children who could not adapt to normal schools.

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Problem drug use

A recent study evaluated social groups with a high risk of HIV infection, using the network scale-up method with a multiplier based on hospital admissions, annual coverage rates of IDUs with prevention services and data from bio-behavioural studies among IDUs. The study estimated the number of injecting drug users in Ukraine at 230 000 to 360 000. Taking the central estimate of 290 000 IDUs would give an IDU rate of about 0.9 % of the adult population aged 15 to 64 (Berleva G.O. et all, 2010).

Another study evaluated the number of young people aged 10 to 19 at risk of HIV infection (IDUs, female sex workers and men who have sex with men) at the national level. The estimates were made using two basic methodological approaches, which allowed, based on identified specific weight, the corresponding coefficients to be calculated: (1) the proportion of the population aged 10 to 19 years who are at risk (medical and crime statistics were used); and (2) the proportion aged 10 to 19 years involved in risky behaviours (secondary analysis of sociological studies among certain group). The most objective assessment of the number of adolescent drug users in the country is about 50 000. Among them, the share of girls aged 14 to 19 is about 30 %. Thus the estimated number of boys who are IDUs is 35 000, with girl drug users numbering around 15 000 (Balakireva O.M. et all, 2010).

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Treatment demand

All non-anonymous clients (those who applied themselves, or under the direction of law enforcement) diagnosed in a certain way in the drug treatment facilities (according to ICD-10) with mental and behavioural disorders due to use of drugs or psychoactive substances are introduced to the special registration and surveillance system, so-called ‘narcological supervision’, with the creation of the records in the treatment facilities. In the registration system two groups of patients are identified: (1) those diagnosed with addiction, including withdrawal and psychoses, who are subject to ‘narcological dispensary supervision’; and (2) those who use drugs occasionally and have no dependencies, who are subject to ‘preventive narcological supervision’. Regulations governing the terms of temporary surveillance under the supervision of addiction in Ukraine do not exist. How long patients remain under narcological supervision in the drug treatment facilities depends on the successful outcomes of preventive and therapeutic interventions.

In 2010, according to the Center of Medical Statistics of the Ministry of Health, some 17 391 people were registered for drug problems identified for the first time in their life (acute intoxication, harmful use, addiction, psychotic states, etc.), including over 5 926 people (12.94 per 100 000 population) who underwent medical observation because of drug use dependence. Among them were 5 241 men (86.9 %) and 685 women (13.1 %), including 47 people under 18 years of age.

Data analysis for the years 1999–2010 shows that incidence of drug addiction in Ukraine peaked in 2001, when 11 456 people (23.36 per 100 000 population) were registered. By 2007 there was a significant decrease in the number of newly diagnosed patients and morbidity has reached 5 177 people (from 22.01 per 100 000 in 1999 to 11.14 per 100 000 in 2007). From 2008 there was a gradual increase, and this continued in 2010 (from 11.45 per 100 000 in 2008 to 12.08 per 100 000 in 2010). However, from 1999 to 2010 the number of women diagnosed with drug dependency for the first time in their life fell by 3.4 times, and for people under 18 years of age this number fell by almost 8 times.

As of 1 January 2011, around 114 645 people with drug problems were registered in the drug register (preventive and outpatient group). Among this population, 77 840 people (170.02 per 100 000) were dependent and under medical observation in connection with mental and behavioural disorders due to drug use, including 65 755 men (84.5 %) and 12 085 women (15.5 %). In terms of the substances being abused, most of those under observation in 2010 reported opioid use (56 973 people, or 124.44 per 100 000), followed by cannabinoids (4 992 people, or 10.90 per 100 000), cocaine (85 people, or 0.19 per 100 000) and hallucinogens (78 people, or 0.17 per 100 000). Around 14 566 people were recorded as polydrug users or users of other psychoactive substances (31.82 per 100 000). In total, 36 805 people were registered under preventive supervision in connection with episodic drug use. Out of the total number registered, 70 464 injected drugs.

In 2010, some 60 448 people received treatment in inpatient and outpatient hospitals due to drug use. In total 15 220 inpatient treatment cases were reported. Among all inpatient treatment cases, 6 852 were the first treatment cases, representing 45.02 % of all inpatient treatment cases. In 2010, some 40 489 people received outpatient treatment for drug problems, including 36 284 men (89.6 %) and 4 205 women (10.4 %). When disaggregated by the age, 97 were 0 to 14 years old, 626 were 15 to 17 years old and 27 131 were 18 to 35 years old. In day hospitals 4 739 patients were treated, of whom 2 208 were men (46.6 %) and 2 531 were women (53.4 %), with 19 individuals under age 18 (0.4 %) and 1 747 in the age group 18 to 35 (36.9 %). The reporting system does not allow for an analysis of the structure of this category of patients by the type of drug used.

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Drug-related infectious diseases

People who are HIV-positive in Ukraine are subject to official registration after a double (or, if needed, triple) confirmation of their diagnosis on the basis of special tests (ELISA test) and a proper clinical examination. Thus, analysis of immune blotting (Western blot test) is not necessary to confirm the results of the ELISA test. Estimated indicators of HIV infection among adults in Ukraine are among the highest in the European region, constituting 1.33 % of the total population, or 360 000 people. As of 1 January 2011 some 110 401 individuals were under medical observation (242.0 per 100 000), among which 14 030 were diagnosed with AIDS (30.8 per 100 000) (Cherenko S.O et all, 2011). This means that more than 250 000 people who are HIV-positive are not covered by existing treatment programmes.

The highest prevalence of HIV infection, which significantly exceeded the national average (242.0 per 100 000) was recorded in south-eastern regions of the country: in Dnipropetrovsk oblast, 553.8 per 100 000 (18 470 people); in Donetsk oblast 536.7 per 100 000 (23 738 people); in Odesa oblast 521.3 per 100 000 (12 395 people); in Nicholaev oblast 519.2 per 100 000 (6 143 people); in Sevastopol 402.3 per 100 000 (1 524 people); in Crimea 331.6 per 100 000 (6 482 people); and in Kyiv 268.0 per 100 000 (7 388 people).

In 2010, a total of 20 521 new cases of HIV infection (44.7 per 100 000) were recorded, including 32 cases among foreign nationals. From 2006 to 2010 a decreasing trend in the rate of newly recorded HIV cases was observed. In 2010 almost 26 % of confirmed cases of HIV infection were detected as a result of testing against clinical indications. In 2008 and 2009 the AIDS incidence rate held steady at 9.5 and 9.7 per 100 000 respectively. But in 2010 this level rose to 12.8 per 100 000 (5 861 case).

Injection of drugs was the main HIV transmission route in Ukraine before 2007. However, sexual transmission has dominated since 2008. In 2010, the proportion of people infected through sexual contact increased to 45 %.

In 2010 the lowest number of HIV-infected cases among IDUs was recorded (6 934). This may be due to a general decrease in the absolute number of drug users, and also due to a reduction in drug users being screened for HIV infection.

Registration of chronic forms of hepatitis, including viral hepatitis B and C, started in Ukraine in June 2009. The registration system that covers the population seeking medical help (that is, mass screening), especially among high-risk groups, is not implemented. However, the system does not allow differentiating the virus hepatitis cases caused or related to injecting drug use.

In 2010 a total of 352 388 cases of chronic hepatitis were registered, including 2 297 cases among children. Most cases were registered in the Donetsk (48 336), Odesa (37 174), Transcarpathia (21 388), Kharkiv (20 868), Dnipropetrovsk (18 732) and Vinnytsia (18 204) oblasts.

The acute form of hepatitis C has been recorded since 2003 and its frequency has remained stable at about 1 000 cases per year. Average incidence of acute viral hepatitis in 2004–09 years was 7.03 cases per 100 000 population. But in the absence of mass screening, the actual incidence of acute viral hepatitis B in Ukraine can exceed this number by five to six times, and the number of infected people may be more than one million.

Tuberculosis also remains a significant issue among drug users, and the treatment situation is aggravated by high primary and secondary resistance rates. However, a reduction in tuberculosis incidence rates among the general population (and also mortality due to tuberculosis) were noted between 2006–10. In 2010, about 45 % of clients who received opioid substitution therapy had HIV or AIDS, 52 % had hepatitis B or C and 17 % had tuberculosis.

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Drug-related deaths

To date, the information on trends in mortality associated with drug use is limited. Centralised collection of data on all deaths among the population, including those related to drug use, by the State Statistics Committee of Ukraine (Ukraine Derzhstat) is based on the processing of primary records approved by the Ministry of Health of Ukraine (Medical certificate of death). The number of deaths related to dependence on certain types of drugs within the past six years was on an average 215 people per annum. Over the past three years the number of deaths associated with polydrug use (the use of more than one drug simultaneously) increased by more than two times (from 37 cases in 2007 to 76 cases in 2010), while deaths due to opioid use decreased (from 191 cases in 2007 to 90 in 2010). There are indications that the overall drug consumption trend has shifted towards polydrug use, leading to severe health consequences and death.

The International Classification of Disease Version 10 (ICD-10) limits the possibility of determining the type of psychoactive substance use due to which a death occurred. Thus, the selections ‘accidental poisoning by and exposure to noxious substances’ (X41–X49), ‘intentional self-harm’ (X60–X84) and ‘event of undetermined intent’  (Y10–Y34) provide an overall picture of psychoactive substance related deaths for the last six years. These data indicate a stable trend of deaths due to poisoning by psychoactive substances (Table 1).

Table 1: Number of deaths due to poisoning, 2005-10

 

2005

2006

2007

2008

2009

2010

Accidental poisoning by and exposure to noxious substances

Antiepileptic, sedative-hypnotic, antiparkinsonism and psychotropic drugs, not elsewhere classified (X41)

 15

 11

 12

 11

 14

 17

Narcotics and psychodysleptics ([hallucinogens), not elsewhere classified (X42)

130

138

140

 90

100

114

Other and unspecified drugs, medicaments and biological substances (X44)

 30

 32

 27

 26

 14

 21

Intentional self-harm (intentional self-poisoning)

By and exposure to antiepileptic, sedative-hypnotic, antiparkinsonism and psychotropic drugs, not elsewhere classified (X61)

 15

 14

 21

 23

 20

 14

By and exposure to narcotics and psychodysleptics (hallucinogens), not elsewhere classified (X62)

   3

   1

   5

   4

   3

   1

By and exposure to other and unspecified drugs, medicaments and biological substances (X64)

 38

 31

 39

 34

 51

 48

Event of undetermined intent

Poisoning by and exposure to antiepileptic, sedative-hypnotic, antiparkinsonism and psychotropic drugs, not elsewhere classified, undetermined intent (Y11)   14   11   18   15   30   29
Poisoning by and exposure to narcotics and psychodysleptics (hallucinogens), not elsewhere classified, undetermined intent (Y12)   28   21   29   23   17   14
Poisoning by and exposure to other and unspecified drugs, medicaments and biological substances, undetermined intent (Y14)   15   35   15   26   25   26

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Treatment responses

In Ukraine, drug-related treatment is provided in accordance with the normative-methodical documents approved by the Ministry of Health of Ukraine, such as standards, norms, protocols and guidelines establishing differentiated requirements of preventive, curative and rehabilitative measures in outpatient and inpatient treatment.

According to the Center of Medical Statistics of the Ministry of Health of Ukraine as of 1 January 2011, some 47 separate drug treatment facilities funded by the state were established, including 44 drug treatment clinics (25 of them at the oblast level. These oblast-level clinics also perform organisational, methodological and supervisory functions of other drug treatment facilities in a given region) and three substance abuse hospitals. In total, the drug treatment agencies and other healthcare institutions (hospitals) had 5 943 inpatient beds (13.0 per 100 000 population), including 4 397 in substance abuse facilities (398 in substance abuse hospitals, 3 734 in regional drug dispensaries, 20 in the inter-drug dispensaries and 225 inpatient beds in urban clinics), 165 in the central district and district hospitals and 1 401 in psychiatric hospitals and clinics. Within the structure of drug treatment facilities there were 49 day inpatient drug clinics for 1 493 patients. These clinics provided therapeutic activities during the day.

In 2010, the development of the network of integrated healthcare centres, which would provide all medical, psychosocial and preventive measures in a single institution without the need to refer patients to other institutions, continued within the programme ‘Overcoming the HIV/AIDS epidemic in Ukraine’, supported by Global Fund to Fight AIDS, Tuberculosis and Malaria grants in nine regions of Ukraine. A total of 18 centres were established — three in AIDS centres, three multipurpose centres, four tuberculosis clinics, and eight drug and psychiatric hospitals and clinics.

In 2010 the hospital network with opioid substitution therapy (OST) was expanded to 125 (there were 102 hospitals and medical centres in 2009). OST has been deployed in 127 sites (105 in 2009) in all 27 regions of Ukraine. As of 1 January 2011, a total of 6 025 patients were included in the OST programme, of which 825 (13.7 %) received buprenorphine hydrochloride. The other 5 200 patients (86.3 %) received methadone hydrochloride. Among all patients, there were 4 839 men and 1 186 women. The average age of patients was 34 years; the average length of drug use was 16 years. The programme was used by 2 720 clients with HIV/AIDS, 3 126 with hepatitis B or C and 1 021 with tuberculosis. Some 814 clients were also on antiretroviral therapy (ART), and 302 were in preparation for the ART.

In June 2010, a final report was published based on a seven-year (2004–10) research project monitoring and evaluating the substitution therapy programs in Ukraine. The research was conducted by the Ukrainian Institute of Public Health, the Institute for Studies in Public Health and Dependence on Psychoactive Substances at the University of Zurich and the WHO Center of Cooperation. The three-phase study aimed to explore the possibilities for the implementation and effectiveness of substitution treatment with buprenorphine and methadone for people who are dependent on opiates. The results indicate that successful and proper implementation of OST in Ukraine is possible, including ensuring proper control over the medical use of substitution drugs within the hospital. Moreover, the OST proved to be highly effective in reducing the use of illegal drugs and manifestations of risk behaviours associated with HIV infection; it significantly improved the somatic health of patients. Participation in the OST programmes reduced signs of criminal behaviour in clients and facilitated their social reintegration.

Depending on the social needs of a region and the availability of a local budget and other financial sources, local authorities are also able to create centres for addicted youth. By 1 January 2011, some 79 centres for addicted youth were created by NGOs. In 2010, a total of 2 448 people were included in rehabilitation programmes and 1 228 had completed the full rehabilitation cycle. The drop-out rate was 58 %.

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Harm reduction responses

Social and preventive work with psychoactive substance users, including IDUs, is conducted by the government and NGOs. As of 1 January 2011, the national network of the social and preventive services consisted of 217 units. These services apply the standards of work listed in the industry standard of social services. In 2010 the assistance of the Services was requested by 39 357 psychoactive substances users, including 29 414 drug users.

The clients of harm reduction programmes have access to the following basic services:

  • sterile needles and syringes, alcohol wipes and/or condoms, voluntary counselling and HIV testing using rapid tests. The services are provided in stationary or mobile needle exchange units, and through outreach work;
  • diagnosis and treatment of STDs, counselling on HIV and drug use, as well as information about other prevention and treatment programmes that operate in the region (opioid substitution treatment programme, medical treatment);
  • a system of accessing specialised experts when there is a need for specialised medical, legal or other advice. If necessary and/or available, the social support is provided for clients within relevant services;
  • regular self-help groups and therapeutic groups, training and support with necessary literature and information materials;
  • prevention of overdose by opiates and stimulants (some projects carry out this work using naloxone);
  • distribution of medicines of general use and intimate hygiene items;
  • organised leisure activities, training and employment for project clients.

Basic components of the package of these services are implemented by all public organisations and are required for all projects. These services are mainly project-based, financed by the Global Fund to Fight AIDS, Tuberculosis and Malaria, the programme of the US Agency for International Development (USAID), Levi Strauss and the Open Society Institute.

In 2007 a total of 51 NGOs were active in the field of harm reduction; in 2008 there were 37 community centres; in 2009 there were 71; and in 2010 some 81 centres delivered harm reduction services. According to the data from the International HIV/AIDS Alliance in Ukraine, the number of IDUs who received these prevention services were as follows: in 2007, 140 555 people (or 34.9 % of the estimated total number of IDUs); in 2008, 195 379 (48.5 %); in 2009, 150 815 (37.4 %); and in 2010, 170 081 (42.2 %).

Since 2008 voluntarily counselling and testing for HIV and STDs has been mandatory for all NGOs providing low-threshold services among vulnerable groups (Table 2). The activity is provided according to the requirements of the Model Project on prevention among drug users, in strict compliance with the order of service for voluntary testing for the HIV antibody, with rapid/simple tests among vulnerable groups and standards for STD care for vulnerable populations.

Table 2: Number of tests and positive results for infectious diseases, 2007–10 (International HIV/AIDS Alliance in Ukraine)

Year VCT with rapid HIV tests Share detection Rapid tests for STDs Share detection
Tests Positive result Tests Positive result
2007  21 688* 4 017 18.5% - - -
2008  55 545 8 047 14.5%  45 656 1 142 2.5%
2009  68 737 7 667 11.2%  68 840 1 420 2.1%
2010  70 580 4 903 6.9%  86 717 3 864 4.5%

In 2007, harm reduction services through pharmacies were initiated. At the end of October 2010, some 123 pharmacies, in collaboration with 25 NGOs in 13 (of 27) oblasts of Ukraine provided harm reduction services. The package of services provided to clients (IDUs and sex workers) included: provision of clean syringes, alcohol wipes, condoms, informational materials, referrals to NGOs and health facilities for additional services.

From 2009 these clients were also registered and received a harm reduction programme membership card, unlike in previous years when the card was provided only to the clients of NGOs. So, access to the pharmacy programmes for new customers was simplified, and their number increased. In 2010 the total number of pharmacy programme clients was 25 205 (consisting of 24 829 IDUs and 363 sex workers) who made over 346 600 visits a year. The number of syringes exchanged within harm reduction programmes between 2007 and 2010 is about 50 million (Table 3).

Table 3: Number of syringes exchanged within harm reduction programmes, 2007-10

Year Syringes distributed The average number of syringes per client (1)
2007  6 864 699 23.7
2008 9 398 456 32.4
2009 14 354 428 49.5
2010 17 621 542 60.7

1 Based on the estimated number of 290 000 IDUs (see the section on problem drug use).

The new order of the Ministry of Health (see section on national drug laws), which defines the minimum amounts of certain psychoactive substances and precursors and thus can lead to criminal liability if the amounts of respective substances stored are increased, had an adverse effect on the expansion of needle exchange programmes. Such storage can include the residual psychoactive substance/precursors in used syringes. During nine months of this order in Ukraine, the volume of syringes brought in for exchange within the needle exchange programmes has decreased almost twice in absolute terms to 700 000, since the injecting drug users were concerned they would be detained by the police and fall within the criminal liability for possession of even residual drugs in used syringes. At the moment, in the due process of law and order, there is an appeal to change the set amounts for some drugs and precursors. That is why, at present, some pharmacies have suspended needle exchange.

In 2000 Ukraine introduced the vaccination of newborns against hepatitis B; however, citizens born in 2000 were not covered by the vaccination.

Antiretroviral therapy (ART) for treatment of HIV infection/AIDS is available in 115 health facilities. As of 1 January 2011, some 22 016 people received ART. In penitentiary institutions, out of a total of 6 453 HIV-infected persons 813 (12.6 %) received ART.

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Drug markets and drug-law offences

The international drug cartels use Ukraine as a transit country for trafficking of heroin and cocaine to Western and Central Europe, as indicated by seizures of these drugs at border checkpoints for the last five years. Cocaine comes from Latin America (Venezuela, Bolivia) in containers destined for Europe. Heroin is hidden in trucks that are in transit from Turkey. The small amount of heroin for domestic consumption comes mostly from the Russian Federation. There were also cases of the reverse flow of a small amount of cocaine and heroin from Europe. Synthetic drugs that come from Western European countries (Netherlands, Belgium) enter Ukraine through Poland, Hungary, Belarus, Russia and Lithuania.

In 2010, units of the Department of Combating Illegal Drug Trafficking of the Ministry of Internal Affairs (MIA) seized 10 198.71 kg of narcotic drugs and psychotropic substances. Marijuana was the main drug seized in Ukraine, with 42 370 seizures and 6 785 kg of substance seized. Opiates were the second most-seized drug, with 13 087 seizures. Poppy straw was third at 5 146 cases. Around 3 162 cases involved stimulants such as amphetamines, methamphetamine and ecstasy group substances. Statistics do not provide individual data on each of these substances. Despite some quantitative changes in the seizure of certain types of drugs, illegal domestic market trends remain the same for the three leading drugs of marijuana, opium and poppy straw.

According to the MIA, 2 363 entities are licensed to conduct activities related to import, export, production and transport of precursors in Ukraine. In 2010, MIA units carried out 5 972 inspections, during which 1 148 violations of licensing conditions were found and 863 entities involved in illegal turnover of precursors without a license were detected.

Some 1 715 criminal cases were initiated for the illegal use of precursors under Article 311 of the Criminal Code (Illegal production, manufacture, purchase, storage, transportation or transfer of precursors), and 245 criminal cases were initiated under Article 320 of the Criminal Code of Ukraine (Violation of the rules of narcotic drugs, psychotropic substances or precursors). A total of 1 074 administrative reports were drawn up under Article 164 of the Administrative Law of Ukraine (Violation of economic activity).

Clandestine production of drugs and psychotropic substances remains a concern for Ukraine. According to the MIA, 232 clandestine laboratories were uncovered in 2010, most of them producing acetylated or extracted opium and amphetamines (Article 313 of the Criminal Code of Ukraine). In addition, 560 sites of drug production and use were found (Article 317 of the Criminal Code of Ukraine). Compared to the previous year there was a 4 % increase in the number of laboratories and a 3.3 % decrease in the number of illegal drug production sites. The number of such sites had been continuously reducing for the previous five years.

In 2010, the Ministry of Internal Affairs recorded 30 747 cases of illicit psychoactive substances possession without a purpose of sale, which is 3.6 % less than in 2009 when 31 885 such offences were registered. This constitutes 54 % of drug-related crimes.

In 2010 a total of 56 878 crimes related to drug trafficking were registered, 1.3 % less than in 2009. This was the second consecutive year in which there was a decrease in this category of crimes. In 2010 there were 16 955 (29.8 %) crimes registered for illegal production, manufacture, purchase, storage, transportation or transfer of drugs (Article 307, the Criminal Code of Ukraine).

In 2010 a total of 17 224 people were sanctioned for the illegal manufacture, acquisition, possession, transportation, transfer of narcotic drugs or psychotropic substances without intent to sell in small amounts (Article 44, Administrative Code of Ukraine); in 2009 the number was 18 075. For the failure to take measures to ensure the protection of crops of somniferous poppy or cannabis, their places of storage and processing (Article 106-1 of the Administrative Code of Ukraine), 952 people (557 in 2009) were administratively sanctioned and 946 people faced administration sanctions for the illegal planting or cultivation of opium poppy or cannabis (Article 106-2 of the Administrative Code of Ukraine) (888 in 2009).

In 2010, a total of 37 496 people who had committed crimes related to narcotic drugs, psychotropic substances or their precursor analogues were detected. Of these, 32 157 were men and 5 339 were women. The age distribution for criminal responsibility for drug-related crimes was: 662 individuals under the age of 18; 14 899 between the age of 18 and 28; and 21 935 over 28 years of age.

A total of 27 042 people were sentenced for crimes related to illegal trafficking in narcotic drugs and psychotropic substances in 2010. Compared with 2009 this is a decrease of 12.8 %. There was a significant decline of 15.9 % among people convicted for possessing drugs (17 766 convicted in 2010 and 21 146 in 2009).

A total of 11 288 crimes committed by drug addicts and persons in a state of narcotic intoxication were registered in 2010, which is 6.8 % more than in 2009 when 10 569 crimes were registered. The increase was due to an increase in thefts, bullying and in the category of ‘other crimes’, which included drug-related crimes. In 2010, the trend of steady decrease in the number of reported crimes committed by the above category of people, which had been observed over the previous five years, changed.

In 2010 there was a slight increase (2.7 %) in the total number of violations of traffic rules – from 6 791 635 cases in 2009 to 6 973 118 in 2010. The number of registered cases involving driving in a state of alcohol, drug or other intoxication, or under the influence of medical drugs, increased by 2.6 %. The number of accidents committed by such drivers dropped by 12 % and the number of such accidents that resulted in death decreased by 35.5 %. In September 2009 the new regulations on identifying drivers for signs of alcohol, drug or other intoxication were approved.

The Ukrainian State penitentiary system comprises 184 institutions: 33 detention centres, 115 penal colonies, 22 correctional centres, eight juvenile correctional colonies and six hospitals.

According to the State Penitentiary Service of Ukraine (DPS), as of 1 January 2011 there were 114 688 people in the correctional facilities, of which 6 924 (6 %) were women. A total of 20 707 people were convicted for offences related to narcotic drugs, psychotropic substances, their analogues or precursors. Compared to the previous year their number increased by 6.2 % (in 2009 there were 19 494 convictions). Together with the quantitative increase in this category of people, this significantly increased their proportion in the total number of persons serving sentences. It should be noted that this trend of gradual increase in the share of persons serving sentences for drug-related offences had been observed for the previous five years.

According to data from the primary medical examination conducted at the time of imprisonment in 2009, a total of 15 398 prisoners have used drugs at some point in their life. There are no statistics on the total number of people serving time in prison who have used drugs at some point in their life.

Within the ‘Programme for implementation of state policy against illicit traffic in drugs, psychotropic substances, and precursors for 2003–10’ in prisons and detention centres, 100 officers to counteract illegal drug trafficking were appointed. In 2010, a total of 1 157 attempts to smuggle drugs into prisons were prevented, 5 % more than in 2009, and 17.2 kg of drugs were seized, 1.2 % more than in 2009.

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National drug laws

In 2010 regulations aimed at strengthening control over drug trafficking were adopted. The Order of the Ministry of Health of Ukraine on 29 July 2010 No 634 amended the table, defining new legal thresholds for small, large and especially large amounts of drugs that would result in criminal responsibility. If the amount of drugs does not exceed the ‘small’ amount, this is classed as an administrative responsibility. In the case of heroin the small amount was 0.005 g; for methcathinone (ephedrone) it was 0.01 g. As with heroin, the amount for acetylated opium was reduced: small amount — from 0.1 g to 0.005 g; large — from 10 g to 1 g; especially large — from 250 g to 10 g. The small amount for opium (clotted opium poppy juice) was reduced from 0.5 g to 0.1 g and the amounts of poppy straw were also reduced: large — from 5 000 g to 500 g; and especially large — from 25 kg to 5 kg. Thus, the probability of punishment for acetylated opium increased 20 times, while for poppy straw it increased five times. Given that these drugs dominate among injecting drug users in Ukraine, the effects of regulation of this legal act may have a major impact on the criminal and epidemic situation. According to the non-governmental organisations, excessive criminalisation of small amounts of opioid drugs jeopardises the performance of harm reduction programmes, including the needle exchange programme, and can lead to a surge in morbidity from HIV because of an inability to use these services.

In response the expansion of trade in so-called ‘smoking blends’ and ‘spices’, in 2010 some 43 substances were entered into the various registers of controlled substances, including varieties of JWH, Chaliponga bark, San Pedro cactus and others. Entering ketamine into the register resulted in a heated debate as ketamine is used in veterinary surgery and this reclassification led to the collapse of veterinary care. However, under pressure from the professional community and public actions, the ketamine reclassification was suspended until 1 October 2011, and veterinary clinics were given this deadline for complying with the law and ensuring appropriate storage of these substances.

On the other hand, a number of regulations adopted in 2010 increased the availability of narcotic substances for treatment. Thus, the maximum quantity of prescribed tablet forms of buprenorphine was increased (for the dosages of 0.2 mg and 0.4 mg — up to 17 mg; for the dosages 2 mg, 4 mg and 8 mg — up to 112 mg). The maximum quantity of one prescription for the oral liquid form of methadone, which had not been used in Ukraine before, was set out at 0.3 g. Prior to this, buprenorphine was prescribed in the form of 12 tablets per prescription, regardless of dosage, and methadone was not available. In 2010, two Ukrainian producers began production of sublingual buprenorphine for substitution and pain relief, and the medication was also available to pharmacies. As of October 2011 the liquid form of methadone had not yet entered the pharmacy network.

From 2010, the licences for certain types of economic activity, including the use of narcotic substances in medical practice, have been issued for an indefinite term, while previously such licenses were issued for a term up to five years.

In September 2009 a joint Order of the Ministry of Internal Affairs and Ministry of Health of Ukraine (No 400/666) approved the instructions for identifying the signs of alcohol, drug or other intoxication or the state of being under the influence of drugs that reduce attention and the speed of response in vehicle drivers. The regulations identified the signs of alcohol and drug intoxication, the procedure of examination for intoxication by law enforcement officers on the road, the minimum level of alcohol concentration (0.2 ppm) and the procedure for examination for intoxication in healthcare institutions. It should be noted that the minimum level of alcohol concentration prior to these regulations was set at 0 ppm. Where signs indicated that the driver of a vehicle was under the influence of narcotics or other intoxicants, or under the influence of drugs reducing attention and the speed of response, the police officer sends the person to the nearest health institution for appropriate examination.

The use of drugs in Ukraine is not a criminal act. However, drug use in public places is punishable by imprisonment of up to three years, according to the Criminal Code of Ukraine. The term of imprisonment for illegal possession of drugs is specified in the range from three to 12 years, depending on aggravating circumstances.

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National drug strategy

In 2010 the ‘Programme for implementation of state policy against illicit traffic in drugs, psychotropic substances, and precursors’ for 2003–10 ended. Control over the implementation of the programme was assigned to the profile section of the Cabinet of Ministers of Ukraine (CMU) while the MIA of Ukraine carried out information gathering and the annual compilation of materials about the programme. Complete synthesis and analysis of programmes for the entire period of its validity was not carried out. The programme included 63 items (82 paragraphs) of practical measures, deadlines, budget items, and responsible officers. The total cost of the programme for eight years was UAH 301 579 800 (approximately EUR 28 886 954); however, it had not been fully financed. According to the 2010 MIA report, 11 of the programme’s tasks were not completed, including six short-term target items and five permanent tasks.

The most significant tasks that have remained incomplete and unfinanced include:

  • creation of an interdepartmental laboratory with technical equipment meeting European standards for the research and logging of electronic catalogue information on synthetic and semi-synthetic narcotic drugs and psychotropic substances (item 3 of the programme);
  • creation of a single interagency automated system of collection, analysis and synthesis of information about people involved in the illicit trafficking of narcotic drugs, psychotropic substances and precursors (item 5);
  • provision of a laboratory in penitentiary facilities with medical equipment and medical facilities necessary for diagnosis, by rapid analysis, of drugs, and diagnostics of their residues in biological matrix of the body long after use (item 30).

Moreover, some monitoring studies were not performed, due to insufficient funding. This included the annual monitoring of illicit use of narcotic drugs and psychotropic substances with a separate annual budget of USD 400 000 (paragraph 2, item 4 of the programme). Among the positive achievements of the programme were the emergence of a number of laws and regulations improving the procedure used when dealing with narcotic and psychotropic substances and precursors, and an increased set of legal tools to combat drug trafficking. The programme improved mechanisms of interagency cooperation and joint planning.

By the end of 2010, on behalf of the CMU, a Concept of state policy was developed on combating the spread of drug addiction, combating the illicit trafficking of drugs, psychotropic substances and precursors for 2011–15 (hereinafter ‘the Concept’). The Concept is a logical extension of the Concept of 2002–10, but unlike the previous one it provides neither the programme implementation nor a limited action plan. Financing arrangements for the implementation are carried out within budget allocations provided for the relevant ministries and other central executive authorities, whose competence includes issues in the field of narcotic drugs, psychotropic substances and precursors, rehabilitation and reintegration into society of persons with drug dependence, shaping the information policy in this field and synthesis of materials to implement the action plan assigned to the State Committee on Drug Control (from 6 April 2011 by the State Service of Ukraine for Drug Control).

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Coordination mechanism in the field of drugs

As a result of administrative reform initiated by the Decree of the President of Ukraine, ‘On optimisation of the central authorities’, some departments involved in the implementation of drug policy were reorganised in 2010. Thus, the Ministry of Education and Ministry of Ukraine for Family, Youth and Sports have been merged into the Ministry of Education, Youth and Sports, and the State Department of Ukraine for Execution of Punishments was reorganised into the State penitentiary service. Changes affected structural and organisational planning, while the functions and powers of these departments as a whole have not been changed.

Coordination of national policy related to narcotic drugs, psychotropic substances and precursors is performed by the National Coordination Council (NCC) on combating drug abuse at the Cabinet of Ministers of Ukraine. In November 2010 guidance on this was again returned to the Deputy Prime Minister of Ukraine. But due to the alignment of the Cabinet of Ministers with the Constitution of Ukraine, the position of the Vice Prime Minister responsible for security issues has been cancelled by the President of Ukraine. Thus none of the existing three Deputy Prime Ministers, according to the functions, could head the NCC. The functions currently assigned to the designated Vice Chairmen of NCC are: Minister of Interior and the head of the State Service for Drug Control (SSDC). The Cabinet considered three possible options for the presidency of the NCC: the Prime Minister, the Deputy Prime Minister and the Chairman of SSDC.

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References

Balakireva O.M., Bondar, T.V., Sazonova Y.O., Sarkisian K.A. (2010), ‘Challenges in the implementation of the prevention programs which aimed to reduce the vulnerability of youth in the HIV / AIDS epidemic conditions: Analytical report’, Kyiv, 80 p. (Балакірєва О.М., Бондар Т.В., Сазонова Я.О., Саркісян К.А. (2010). Виклики до профілактичних програм, спрямованих на зменшення уразливості молоді в умовах епідемії ВІЛ/Сніду. Аналітичний звіт. К. 80 c. ).

Balakіrєva O.M., Bondar T.V., Galіch Y.P. and others (2011), ‘Prevalence and trends in smoking, alcohol consumption and drug use among young children in Ukraine’, Ukrainian institute of social studies named after O.Yaremenko, Kyiv: OBNOVA, 176 p. (Балакірєва О.М., Бондар Т.В., Галіч., Ю.П. та ін. (2011). Рівень поширення і тенденції вживання тютюну, алкогольних напоїв, наркотичних речовин серед учнівської молоді України: 2011 /. Укр. ін-т соц. дослідж. ім. О. Яременка. – К.: «ОБНОВА». 176 с.).

Balakireva O. M., Bondar, T.V., Artyukh O.R. (2011a), ‘The Health Conditions and Health Factors of the Ukrainian Teenagers’, Kyiv, UNICEF, Ukrainian institute of social studies named after O.Yaremenko, 172 p. (Балакірєва О.М., Бондар Т.В., Артюх О.Р. (2011a). Стан та чинники здоров’я українських підлітків: К.: ЮНІСЕФ, Укр.ін-т соц. дослідж. Ім.. О. Яременка. 172 с.

Berleva G.O., Dumchev K.V. Kobyshcha Y. V. (2010), ‘Estimation of the number of high risk groups to HIV infection in Ukraine: Analytical report of sociological survey on Year 2009’, Kyiv, 104 p.(Берлева Г.О., Думчев К.В., Кобища Ю.В. (2010). Оцінка чисельності груп високого ризику інфікування ВІЛ в Україні: Аналітичний звіт за результатами соціологічного дослідження станом на 2009 рік. К. 104 c.).

Cherenko S.O and others, (2011), ‘HIV infection in Ukraine: Periodical bulletin No 35’, Kyiv, 62 p.(Черенько С.О. та інші. (2011). ВІЛ-інфекція в Україні: Інформаційний бюлетень, № 35. К. 62 c.).

Libanova E. (2010), ‘Youth and Youth Policy in Ukraine: the socio-demographic aspects’, Kyiv: Institute for Demography and Social Studies named after M.V. Ptukha of the National Academy of Sciences of Ukraine, 248 p. (Лібановa Е. (2010), Молодь та молодіжна політика в Україні: соціально-демографічні аспекти. Київ: Інститут демографії та соціальних досліджень ім. М.В. Птухи НАН України. 248 c.).

 

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Page last updated: Monday, 27 May 2013