Ukraine: Overview of the Drug Situation in the country (data of 2016) Contents

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1 Ukraine: Overview of the Drug Situation in the country (data of 2016) Contents Introduction Chapter 1: Illicit Drug trade and market Chapter 2: The level and trends of drug use Chapter 3: Harm caused by drug use and ways of responding to the problems of drug use Reference Introduction Overall, the policy of Ukraine in the area of circulation of narcotics, psychotropic substances and precursors can be characterized as restrictive, aimed at control over these substances, counteraction to crime in this area, providing accessibility of vitally important medications, including painkillers, for the population. As the formation and implementation of the state drug policy is an important component of systemic reforms, the Strategy of State Policy on Drugs up to 2020 (approved by the Regulation of the Cabinet of Ministers of Ukraine No 735-r of August 28, 2013) has been developed and implemented over the last three years. The document aims to solve systemic issues, primarily related to medical and social, economic and law enforcement directions. It accumulates the national experience of countering drug trafficking, up-to-date knowledge on the approaches to forming and implementing a drug policy and is complying with the Eurointegration aspirations of Ukraine. In the context of the practical implementation of the policy in this area, Ukraine is adhering to such principles: population s health is a priority and drug addicts should be provided with a necessary complex of prevention and treatment; accessibility of vitally important medications for the population, including painkillers, is mandatory; rejection of the punitive approach to drug users; aiming the law enforcement at countering organized drug crime and laundering money received from illegal drug distribution. The 2016 Action Plan of the implementation of the mentioned Strategy was not approved due to organizational changes in the system of central executive authorities that form and implement drug policy. Alongside with this, measures envisaged by the Strategy of State Policy on Drugs up to 2020 were executed in 2016 by all the entities of forming and

2 implementing the drug policy in line with their competences. This is confirmed by the information provided by these authorities for the 2017 National Report on the Drug Situation in Ukraine (data of 2016) for the European Monitoring Centre for Drugs and Drug Addiction. In 2016, a number of normative and legal acts that influenced the drug policy of the country were adopted. On February 24, 2016, the Government of Ukraine endorsed a list of medications that contain narcotics, psychotropic substances and precursors, other potent substances, with regards to which a special regime in terms of production and sale may be imposed in the course of implementing the measures of the martial law (Resolution of the Cabinet of Ministers of Ukraine No 128 of February 24, 2016). On April 6, 2016, Licensing conditions were approved for the economic activity related to cultivating plants included on the Chart 1 of the list of narcotics, psychotropic substances and precursors approved by the Cabinet of Ministers, development, production, manufacture, storing, transportation, purchase, sale, import to Ukraine, export from Ukraine, use, destruction of narcotics, psychotropic substances and precursors included on the mentioned list (Resolution of the Cabinet of Ministers of Ukraine No 282 of April 6, 2016). On May 16, 2016, the Provision on the Program of differentiated educational influence on the convicts Overcoming drug addiction was approved (Decree of the Ministry of Justice of Ukraine of May 16, 2016, No 1418/15 registered in the Ministry of Justice on May 17, 2017, under No 727/28857). On July 17, 2016, changes were adopted to the Code of Ukraine on Administrative Offences in terms of increasing responsibility for driving in the state of alcohol, narcotic or other intoxication or under the influence of medications that impair attention and reaction time (The Law of Ukraine No1446- VIII of July 7, 2016). On September 29, 2016, the Methodology of calculating the need in substitution therapy medications in the treatment of persons with mental and behavioral disorders as a result of opioid use was endorsed (Decree of the Ministry of Public Health of Ukraine No 1011 of September 29, 2016 registered in the Ministry of Justice on October 12, 2016, under No 1355/29485). On October , the Government adopted the changes to the Conditions of prevention of theft of plants included on the list of narcotics, psychotropic substances and precursors in terms of determining the ways of providing security of drug-containing crops by the MoI (Resolution of the Cabinet of Ministers No 728 of October 19, 2016). The act aims to delimit the powers of central executive authorities related to control of cultivating, using, storing and destruction of drug-containing crops. On October 26, 2016, the Government of Ukraine adopted the changes to the list of narcotics, psychotropic substances and precursors endorsed by the Resolution of the Cabinet of Ministers No 770 of May 6, The list No1 was amended by adding to the Chart IV the position Phenyl-nitropropene (precursor) (Resolution of the Cabinet of Ministers No 747 of October 26, 2016). The objective of the act is to establish measures of control and limit the circulation of the mentioned substance on the territory of Ukraine. 2

3 On June 21, 2017, the Ministry of Public Health of Ukraine established the amounts (large and especially large) for the precursor Phenyl-nitropropene (Decree of the MPH No 685 of June 21, 2017, which came in force on August 18, 2017). The drug situation in the country is influenced by the two factors: first a high level of non-medical drug use; second illegal proposition of these substances, i.e. the illicit market, which is growing in scale. One of the topical issues in the practice of the counter narcotic units is keeping a record of persons related to non-medical drug use. Over the last 10 years, substantial discrepancies were observed between the statistics on drug addiction and the real picture of the population s addiction to drugs and psychotropic substances. One of the reasons for this is a lack of targeted and comprehensive analysis or study of the level of narcotization of the population. According to the data of the MPH of Ukraine in terms of the level of drug abuse per people (clinic group), the regions most affected by non-medical drug use are Zaporizhzhya region (364 drug addicts), Kyiv city (291), Kirovograd (251), Odesa (232), Mykolayiv (206). On average, there are 141 drug addicts in Ukraine per people. Monitoring of the real state of drug use by the healthcare institutions and the National Police would allow to: - identify the rate of this socially dangerous phenomenon in the society and carry out a prognosis of the situation for the foreseeable future; - carry out analysis of regional peculiarities of drug addiction and ensure the functioning of the system of early detection of new types of psychoactive substances on the illicit market; - assess the level of efficiency of counter narcotic units in detecting drug dealers etc; - draft a joint action plan including the measures aimed at reducing the harm from psychoactive substance use. At the same time, to fulfill the functions incumbent on the National Police of Ukraine and its regional departments it is necessary to carry out a systemic quantitative record (without personal data) of drug users with stating the age, gender and social criteria as well as the type of psychoactive substances the person is using, mortality rate from drug overdosing and diseases related to drug addiction. Moreover, drug criminals are searching for ways of legalizing their product all the time. New types of psychoactive substances appear so fast that the existing control mechanisms and the national legal and regulating norms lag far behind. China and India remain the main producers of new kinds of psychoactive substances. The main way of delivery to Ukraine via international mail. The uncontrolled psychoactive substances that have not been verified in terms of their health impact have a substantially higher potential threat than traditional drugs. The major obstacle for efficient counteraction to new psychoactive substances in Ukraine is absence of legal mechanisms of operational detection and establishing national control over new substances. The existing procedure is time- 3

4 consuming, burdensome and unacceptable for the fight against such a dynamic phenomenon. In order to provide a timely monitoring of new psychoactive substances and precursors emerging on the market and prevent their spread and free sale, the Ministry of Public Health of Ukraine and the law enforcement bodies should develop an efficient and operational mechanism of bringing these substances under state control. The solving of this issue is also necessary to avoid the existing bureaucratized ways of interaction between central executive authorities. To solve this problem as well as to improve other legal acts, the Ministry of Public Health of Ukraine has endorsed the action plan to prepare draft acts in 2017, which includes drafting the following normative acts: 1. Draft Law of Ukraine On changes to the Article 6 of the Law of Ukraine On the basics of state oversight (control) in the area of economic activity (regarding the contingent measures of state oversight (control)). The adoption of this act will facilitate: - efficient and productive contingent measures of state oversight in the area of controlling the quality of medications; - operational detection of medications of poor quality as well as counterfeit medications; 2. Draft Law of Ukraine On changes to some of the Laws of Ukraine (regarding the need to specify the type of economic activity, which requires licensing). 3. Draft Resolution of the Cabinet of Ministers of Ukraine On approving the criteria used to assess the risk from economic activity of production of medications, retail and wholesale trade in medications, import of medications (except active pharmaceutical ingredients), cultivation of crops included on the Chart 1 of the List of narcotics, psychotropic substances and precursors endorsed by the Cabinet of Ministers, development, production, manufacture, storing, transportation, purchase, sale, import and export, use and destruction of narcotics, psychotropic substances and precursors included on the mentioned List, and to determine the frequency of planned measures of state oversight (control) by the State Service of Ukraine on Medications and Drug Control. 4. Draft Resolution of the Cabinet of Ministers of Ukraine regarding changes in the List of narcotics, psychotropic substances and precursors endorsed by the Resolution of the Cabinet of Ministers No 770 of May 6, The idea of the draft resolution is to bring the mentioned List in compliance with international treaties and reinforce the state control over the circulation of a number of substances in connection with their hazard for the lives and health of people. Moreover, the following draft normative acts are currently under the consideration of the MPH of Ukraine: Draft Resolution of the Cabinet of Ministers of Ukraine On introducing regarding changes in the List of narcotics, psychotropic substances and precursors, which suggests changes and amendments to the List endorsed by the Resolution of the Cabinet of Ministers No 770 of May 6, 2000; Draft Resolution of the Cabinet of Ministers of Ukraine On approving the size of quotas for 2017 for cultivation of crops that contain narcotics, psychotropic substances, production, manufacture, storing, import and export of narcotics and psychotropic substances ; 4

5 Draft Order of the Cabinet of Ministers On approving the 2017 Action Plan to implement the Strategy of state policy on drugs up to 2020 ; Draft Decree of the MPH of Ukraine On approving the Procedure of acknowledging the substances as analogues of narcotics and psychotropic substances. In order to bring the acts in compliance with the Laws of Ukraine On the licensing system in the area of economic activity, On the List of permitting documents in the area of economic activity, On licensing of certain types of economic activity, the State Service of Ukraine on Medications and Drug Control developed a draft law of Ukraine On the changes to the Law of Ukraine On narcotics, psychotropic substances and precursors registered in the Parliament of Ukraine under No This draft law envisages: solving problematic issues related to the activity of using, storing, transportation, purchase, import and export, destruction of narcotics, psychotropic substances and precursors in the military units and state emergency services; expanding the area of cultivating and processing of poppy and cannabis crops; bringing to order the activity of using, storing, transportation, purchase, destruction of narcotics, psychotropic substances and precursors in the research institutions, comprehensive and professional educational establishments; providing an opportunity to individual entrepreneurs who have a license for wholesale and retail trade in medications to receive a license for circulation of narcotics, psychotropic substances and precursors. The law also suggests to determine the entity that will be empowered to provide conclusions whether substances belong to analogues of narcotics and psychotropic substances. The changes suggested to Article 2 of the Law of Ukraine On narcotics, psychotropic substances and precursors determine the procedure of forming the List of narcotics, psychotropic substances and precursors, namely the list of crops (list 3 of Chart 1) that contain narcotics of psychotropic substances will be moved from Chart 1 (list of narcotics, psychotropic substances and precursors whose circulation is prohibited in Ukraine) to Chart 2 (list of narcotics, psychotropic substances and precursors whose circulation is restricted in Ukraine) as the circulation of the substances in the List 3 is not prohibited, but restricted. These changes in forming the respective charts stipulate the changes to Article 7 of the Law of Ukraine On narcotics, psychotropic substances and precursors. The suggested draft law includes the introduction of a mandatory check by the licensing entity of the material and technical infrastructure/facilities of the economic subject before the license is issued, whereas the MoI permission to use the premises for circulation of controlled substances is abolished. The State Service of Ukraine on Medications and Drug Control is working on the draft resolution of the Cabinet of Ministers of Ukraine On changes into certain resolutions of the Cabinet of Ministers, which suggests changes in the following documents: 5

6 The procedure of carrying out activity related to the circulation of narcotics, psychotropic substances and precursors, control over their circulation approved by the Resolution of the Cabinet of Ministers No 589 of June 3, 2009; The procedure of purchase, transportation, storing, sale, use and destruction of narcotics, psychotropic substances and precursors in the healthcare institutions of Ukraine approved by the Resolution of the Cabinet of Ministers of Ukraine No 333 of May 13, 2013; Licensing conditions (approved by the Resolution of the Cabinet of Ministers of Ukraine No 282 of April 6, 2016) for economic activity related to the cultivation of crops included on the Chart 1 of the List of narcotics, psychotropic substances and precursors endorsed by the Cabinet of Ministers, development, production, manufacture, storing, transportation, purchase, sale, import and export, use and destruction of narcotics, psychotropic substances and precursors included on the List. The aforementioned acts are being brought in compliance with the requirements of the current legislation and the newly adopted changes in pharmacy and medicine. Introducing changes to the Licensing conditions regarding the simplification of conditions of storing will provide an opportunity to the economic subjects engaged in retail trade in medications to receive a license for the circulation of narcotics, psychotropic substances and precursors, which will lead to more licensees and will increase the accessibility to narcotic (psychotropic) medications for the population. With a view to continue the reform of the penitentiary system, the Ministry of Justice of Ukraine jointly with civil society and experts are developing the draft Law of Ukraine On Penitentiary System aimed at regulating the functioning of penitentiary institutions, defining the principles of their activity and status of the workers within this system. Besides, the draft law envisages the regulation of issues related to improving the procedure of parole for convicts, expanding the powers of probation bodies in line with international norms. Additionally, the Parliament of Ukraine is considering the draft Law of Ukraine regarding changes into certain laws related to psychiatric assistance (registered under No 4449). The adoption of this act will improve psychiatric assistance and social protection of persons with mental disorders etc. Analyzing the activity on forming and implementing the drug policy, we can make a conclusion that: - state control over drugs circulation is ensured; - new technologies have been put into practical use in the area of countering illicit circulation of drugs; - conditions have been created for the cooperation between the state and the civil society institutions in forming and implementing the drug policy; - persons addicted to illicit drugs have been engaged into medical, social and prevention programs etc. However, it is necessary to agree the drug policy with the principles of the public health policy with regards to the drug addiction treatment, including socially 6

7 dangerous consequences such as HIV/AIDS, TB, and to coordinate the actions of all the entities of forming and implementing the drug policy. CHAPTER 1: Illicit drug trade and market Coordination mechanisms related to drugs The changes of in the legal framework of Ukraine aimed to improve the system of central executive authorities have reinforced the role of the Ministry of Public Health of Ukraine. In accordance with the Resolution of the Cabinet of Ministers No 442 of September 10, 2014, the State Service of Ukraine on Medications and Drug Control was set up by joining the State Service on Medications and the State Service on Drug Control. The new Service received the functions of implementing state policy, which used to be fulfilled by the former services (except for the functions of forming state policy regarding the circulation of narcotics, psychotropic substances, their analogues and precursors, counteraction to their illicit circulation as well as coordination of the executive authorities in relation to these issues). In line with the Provision on the Ministry of Public Health of Ukraine endorsed by the Resolution of the Cabinet of Ministers of Ukraine No 267 of March 25, 2015, the MPH is defined as the major agency in the system of central executive authorities that ensures the formation and implementation of state policy related to the circulation of narcotics, psychotropic substances, their analogues and precursors, counteraction to their illicit circulation. The main tasks of the MPH include: - ensuring the formation and implementation of state policy related to the circulation of narcotics, psychotropic substances, their analogues and precursors, counteraction to their illicit circulation, - coordination of the executive authorities regarding the circulation of narcotics, psychotropic substances, their analogues and precursors, counteraction to their illicit circulation. Drug situation monitoring The scale of drug addiction is directly dependent on the illicit trade in these substances. In Ukraine, the monitoring of the drug situation is carried out basing on the material of the relevant subjects of drug policy that have the data in the area of circulation of narcotics, psychotropic substances and precursors and counteraction to their illegal circulation: Administration of the State Border Guard Service, Security Service of Ukraine, State Fiscal Service, General Prosecutor s Office, Ministry of Justice, MoIA, Ministry of Public Health, Expert Services of the Security Service of Ukraine and the MoIA, State Court s Administration and some other structures. Taking into account the experience of European countries, the state institution Ukrainian monitoring and medical center on drugs and alcohol of the 7

8 MPH of Ukraine (Centre) in order to improve data collection, reveal reasons and conditions and ways of prevention of the diversion of narcotics, psychotropic substances and precursors into the illegal circulation and their non-medical use, is developing unified approaches to collection of information for further monitoring of the drug situation in the country. The following reasons and trends in illicit drug trafficking are the most worrying: 1. The use of Ukraine, its port infrastructure for the transit of drugs to Western Europe. 2. Smuggling of cocaine by various routes from Latin America to Ukraine for sale at the internal market and for transit to other countries. 3. Diversification of types and trafficking routes of synthetic drugs from the Netherlands, Poland, Lithuania, China, in particular amphetamine type stimulants and analogues of psychotropic substances. 4. Attempts of organized criminal groups to arrange smuggling channels of methadone from Russia and Belarus. 5. Smuggling of extracted opium from Hungary to Ukraine with the aim to sell it. 6. Domestic drug production (cultivation of poppy and cannabis), synthetic drugs and psychotropic substances production in the labs for sale in Ukraine and for trafficking to neighboring countries. 7. Expansion of illicit operations with potent medications and smuggling of falsified medications from China and India to Ukraine. 8. Saturation of the market with foreign made medications containing narcotics, in particular, paratralm, terofyn, subutex, ketamine, coldak, trifed etc. 9. The use of Internet to distribute narcotics, psychotropic substances and smoking mixtures. The analysis of the available information indicates a stable increase in crimes related to illicit trafficking in drugs, psychotropic substances, precursors and falsified medications. The problems of countering illicit drug trade are more than significant for the world as well as for Ukraine. More and more layers of society in Ukraine are being engaged into illicit drugs circulation, which has become a widely developed high profit industry. Smuggling of narcotics and psychotropic substances: origin of psychoactive substances and channels We do not have information about principally new routes for smuggling of drugs. All recorded cases were carried out using traditional schemes. The illicit ways of transporting narcotics and psychotropic substances cross the territories of all countries adjacent to Ukraine. The territory of Ukraine is used as a transit zone for smuggling of cocaine from Latin America and Europe, heroin from Asia, psychoactive compounds from China, methadone from Belarus and Russia etc. Routes for Afghani origin heroin smuggling cross the territory of Ukraine on the way to Central and Western Europe (so called Balkan Northern way): Afghanistan, Pakistan Iran Azerbaijan Georgia Ukraine Western Europe, 8

9 or: Afghanistan, Pakistan Iran Turkey (Georgia) Ukraine Western Europe, and the so called Silk way: Afghanistan, Pakistan Iran Azerbaijan, Russia, Belarus EU countries, or: Afghanistan, Pakistan, Iran Middle Asia (CIS states), Russia, Ukraine, Belarus - Western Europe. According to available information, cocaine supplied to European countries is produced mostly in Bolivia and Peru. Analysis of negative trends indicates that Latin American criminal groups are actively using Black Sea ports to import drugs by sea container shipments. Couriers that use air transportation way are also engaged in cocaine smuggling. We also observe an increase in the volumes of smuggling of psychotropic substances, predominantly of amphetamine type stimulants, from EU states (Poland, the Netherlands and Lithuania etc.). As a rule, drugs are transported by automobiles, using technical cavities or specially equipped concealment places. Additional factor that affects the accessibility and demand for cocaine is the emergence of new markets, including the one in Ukraine. Besides, cocaine traffic via Western Africa caused a collateral effect of a substantial increase in the proposition of this type of drugs. The threat of heroin trafficking from Afghanistan remains significant, which is connected with expansion in poppy cultivation in this country. Although considerable quantities of heroin are still transported by the Balkan way (Afghanistan, Iran, Turkey), international drug groups are changing extremely quickly and are flexible in using new alternative routes. Recently, a shift in the Balkan way due to an increase in Turkish cargo traffic via Ukraine, Moldova, Russia and Romania is observed. Part of the drug flow from Iran and Turkey is carried to the Western Europe using automobiles, including traffic via Ukraine. Construction peculiarities of freight vehicles, specially equipped concealment places in the luggage compartments, trailers and cabins of the vehicles are used for the transportation of drugs. New psychoactive substances (smoking mixtures, bath salts, psychoactive mushrooms etc.) gain special popularity among drug users. These drugs are shipped to the market of Ukraine from China, India and countries of Central Asia via international express mail. Synthetic narcotics, in particular methadone, are supplied from Russia and Belarus. Methadone is mostly distributed by the representatives of Roma diaspora. The traditional smuggling to Ukraine of the following drugs continues to take place: - methamphetamine, MDMA (ecstasy) and LSD from Western Europe; - ephedrine and potent medications from Romania, Moldova and Bulgaria. Another problematic issue for the law enforcement is the spread of a prohibited potent medication Subutex. In Western Europe (the UK, France, Italy) this medication is used to treat drug addicts treated according to programs similar to substitution therapy in Ukraine. The active substance of this drug is buprenorphine. The major producers of this medication is the UK, France and Italy and its price in the EU states is from 5 to 5 Euro. In Ukraine, it costs from 200 to 350 HRN UA per pill (Ivano-Frankinvsk region), HRN UA in other regions 9

10 (Chernivtsy, Lviv). To reach the desired effect, one pill of Subutex is used by 4-5 addicts. The medication is supplied to the territory of Ukraine from abroad by passenger transport or by international mail. The problem of applying of criminal responsibility in this case is explained by the fact that before August 2012 criminal responsibility for possessing Subutex was envisaged in the amount of 1.5 pill, now for more than 10 pills. Due to a simplified mechanism of poppy cultivating in Hungary, which is widely used there in pharmaceutical industry, the representatives of the Roma diaspora who live in Hungary and in Ukraine have arranged the production and supply of extracted opium. The delivery of this drug is carried out by drug couriers, including Ukrainians working abroad. It is mostly distributed through Roma families. Fast development of the Internet impacts all areas of human life. This also pertains to illicit drug trade, where classic forms and methods of distribution are changed for the ones involving the use of the Internet and information technologies. The advertisements for drugs are posted as graffiti on buildings and city infrastructure. Teenagers are the most vulnerable category here, since they understand the meaning of these advertisements and get engaged in their spreading. They are good at computers and can be easily involved in drug distribution via the Internet. The analysis of the information received due to arrests of people engaged in the drug distribution via the Internet shows that usually these criminal groups are headed by young people, including minors, with thorough knowledge of how the information systems and the Internet work. Today, in Ukraine the mechanism of blocking or restricting the access to the Internet resources used for committing crimes or that contain prohibited content is not regulated by laws. In practice, blocking of Internet resources in the Ukrainian domain can be carried out only on the basis of a court s decision. However, such algorithm is not working, as there is no defined body empowered to execute court s decisions to block access to such websites. The situation is different when the Internet resource used to sell drugs is abroad. In this case, the court s decision and a request in the framework of an international agreement on mutual legal assistance are sent to the law enforcement agency of a foreign state. However, this procedure is time-consuming and complicated. Drug seizures According to the State Border Guard Service of Ukraine, the highest quantity of drugs in 2016 were seized on the land part of the border ( kg). The total quantity of drugs seized by the Service over the year is kg. The operational units of the Service suppressed the activity of 10 criminal groups (groups included 21 member). 287 notifications were sent to the Integrated Registry of Pretrial Investigations, in particular under the Article 305 of the 10

11 Criminal Code of Ukraine (Smuggling of drugs, psychotropic substances, their analogues or precursors) 103. Chart 1.1. Detection and seizure of psychoactive substances by the State Border Guard Service in By types Total marijua na cannab is poppy straw cocaine opium tram adol others total, including on the border with: 153, ,229 19,423 5,143 0,181 3,528 0,929 9,462 Poland 11,304 2,487 0,171 0,722 7,924 Slovakia 0,295 0,004 0,291 Hungary 0,044 0,002 0,04 0,002 Romania 0,11 0,001 0,023 0,004 0,082 on the border with the EU 11,753 2,49 0, , ,77 8,299 Moldova 76,326 64,575 7,9 3,543 0,011 0,127 0,17 Russia 58,648 43,01 11,5 1,6 0,01 1,507 0,032 0,989 Belarus 7,168 5,154 2,01 0,004 sea border 0,806 0,645 0,101 0,06 air border 11,498 11,493 0,005 TOTAL ON THE STATE BORDER 166,22 115,874 19,454 5,143 11,664 3,528 1,03 9,527 on the administrative boundary with the Crimean Autonomous 0,17 0,04 0,13 Republic On the contact line in the ATO zone 9,12 8,282 0,59 0,1 0,028 0,12 land border TOTAL 175,51 124,196 20,044 5,143 11,764 3,528 1,058 9,777 Over 2016, the customs bodies of the State Fiscal Service of Ukraine detected facts of illegal transportation of narcotics, psychotropic substances and precursors (in 2015, 970 facts were revealed). The highest number of detentions were in relation to transportation by automobile vehicles 540, by railway 106, by aviation 31, by sea - 23, by mail 383, on foot 39 cases. The number of facts of detection by direction: import 830, export 292. The number of cases of illegal transportation of narcotics, psychotropic substances, their analogues and precursors on border with Russia 221, with Moldova 182, with Belarus 132, with Hungary 85, with Poland 72, with Romania 15, with Slovakia 10. In order to identify sources and routes of drug traffic as well as persons responsible, in line with the Article 456 Control delivery of narcotics, psychotropic substances and precursors of the Customs Code of Ukraine,

12 operational units of the law enforcement jointly with the State Fiscal Service carried out 76 controlled deliveries of such substances. We must also point out the annual increase in the number of facts of illegal movement of drugs by mail and express mail. In 2014, 101 of such facts were identified (9% of such crimes), in facts (19%), in (34%). The drugs transported by mail were coming from the Netherlands, Israel, Germany, China, and Thailand. The most widespread in Ukraine are plant-based drugs produced domestically (poppy straw and cannabis). As stated by the Security Service of Ukraine, according to the assessments of national and foreign experts, Ukraine is ahead of many Eastern European countries in terms of the volumes of opiates production and consuming (mostly surrogates from poppy straw). The use of cannabis is widespread. A peculiarity of the illicit circulation of this drug is a gradual transfer to its illegal cultivation under the guise of other agricultural crops. Whereas a considerable difference in price for it in Ukraine and the neighboring countries makes this narcotic valuable in terms of smuggling it to Russia, Belarus and other countries. To detect and destroy illegal crops of poppy and cannabis, disrupt the routes of supplying the drugs to the users, a complex of operational and prevention measures Poppy was carries out in the country from May 23 to September 29, The result of the conducted work was the revealing of the facts of illegal drug-containing crops (1 800 facts of illegal cultivation of poppy, cannabis). During the operation, 3.7 million drug-containing plants were destroyed (2.1 million poppy plants and 1.6 million cannabis plants). As the market for synthetic drugs is stable, there are facts of organizing domestic production of synthetic drugs and psychotropic substances. Due to the availability of the information on the Internet, there are no obstacles in learning the formula for methamphetamine, for example, any chemistry student can synthetize this drug having the necessary precursors. The units of the National Police of Ukraine registered 95 facts of functioning of illicit drug labs. In the course of pre-trial investigation of 66 cases, the suspects were notified. 70 individuals were brought to criminal responsibility for involvement in operating of a drug lab. Measures were taken to counter the keeping of drug dens. Facts of keeping 449 of such hubs for drugs production and use were documented in Over 2016, the Counternarcotic Department of the National Police of Ukraine seized grams of psychoactive substances. Chart 1.2. Drug seizures by the Counternarcotic Department of the National Police of Ukraine in 2016 Psychoactive substances Total seized (gr) Percentage of the total quantity seized (%) Narcotics ,03 Psychotropic substances ,15 12

13 13 Precursors ,81 Total Over 2016, according to the statistical data on criminal proceedings grams of narcotics and psychotropic substances were seized from illicit circulation including grams of cannabis, grams of poppy straw; grams of cocaine; grams of amphetamine; grams of opium; grams of methadone; grams of MDMA etc. Chart 1.3. Seizures of psychoactive substances by the law enforcement in 2016 (MoI and the Security Service of Ukraine) Psychoactive substances Total seized (gr) Percentage of the total quantity seized (%) Narcotics ,56 Psychotropic substances ,17 Precursors ,27 Total Chart 1.4. Detection of psychoactive substances in the penitentiary institutions and investigatory wards of the State Criminal Executive Service of the Ministry of Justice of Ukraine Psychoactive substances Total detected (gr) Percentage of the total quantity detected (%) Narcotics ,96 99,07 Psychotropic substances 66,244 0,64 Precursors 27,92 0,27 Total 10197, Narcotics detected included (in grams): heroin 0.41; cannabis resin, cannabis tinctures and extracts ; poppy straw, poppy straw concentrate ; opium 49.73; acetylated opium 79.68; buprenorphine 3.008; codeine 0.06; methadone Psychotropic substances included (in grams): MDMA 0.48; amphetamine 52.2; methamphetamine 12.64; phenazepamum The precursors included (in grams): acetic anhydrate 22.25; pseudoephedrine 3.29; ephedrine Other substances seized included 0.01 gr of trihexyphenidyl, gr of diphenhydramine, 0.03 zopiсlone that are components of medications. Over 2016, operational units of the penitentiary institutions of Ukraine jointly with the territorial internal affairs bodies seized gr of psychoactive substances gr of them are narcotics with the biggest in quantity being cannabis ( gr) or 99% of all substances seized, gr of psychotropic substances (amphetamine gr) and gr of precursors.

14 In comparison with 2015, the amount of seized controlled substances as a result of operational, detective and preventive measures decreased in 2016 for gr. Chart 1.5. Detection of psychoactive substances by the State Border Guard Service in Psychoactive substances Total detected (gr) Percentage of the total quantity detected (%) Narcotics ,13 Psychotropic substances ,35 Precursors ,5 Total Narcotics and psychotropic substances included (in grams): poppy straw 5 140; marijuana ; cocaine 4 960; tramadol 1 060; opium 3 530; hashish 53; cannabis The precursors included (in grams): acetone ; potassium permanganate 2 200; hydrochloric acid Other psychoactive substances gr. Having compared the statistics regarding the detection of drugs on the state border, we can state that gr of psychoactive substances were detected in 2016, which is a considerably higher amount in comparison with 2015 ( gr). Chart 1.6. Detection of psychoactive substances by the State Fiscal Service in 2016 Psychoactive substances Total detected (gr) Percentage of the total quantity detected (%) Narcotics ,5 Psychotropic substances ,4 Precursors ,1 Total Among drugs with prohibited circulation, the highest amounts detected was cannabis gr, with restricted circulation cocaine gr. Among psychotropic substances with prohibited circulation, the largest amount detected was MDMA 607 gr and AB-FUBINACA 1023, with restricted circulation 205 gr of amphetamine and 1362 gr of methamphetamine. Besides, pills containing psychoactive substances were seized. The pills contained MDMA, buprenorphine, codeine, tramadol, sibutramine, alprazolam etc.

15 Drug market The reasons for establishing a price and changes in prices for some drugs directly depend on their accessibility as well as on the efficiency of the work of the law enforcement, and the stability of prices for other drugs depends on their stable availability on the market. 1 gram of poppy straw in the beginning of 2016 cost about 15 HRN UA, which is 1.5 times higher comparing with prices of early The prices for opium derivatives remained stable and were about 100 HRN UA per 1 gr of acetylated opium. The price for leaves and flowers of marijuana went up a bit. In 2015, 1 gram of marijuana was 20 HRN UA, in 2016 it was 40 HRN UA. The price for extracted opium increased three times; in 2015 it cost 300 HRN UA for 1 gram, in HRN UA. However, the price for it vacillated and varied in different regions. Due to the instability of the currency exchange rate in the country, there was an increase in the price of drugs smuggled into the country (heroin, cocaine). 1 gram of heroin cost HRN UA, which is 50% more than in early However, methadone became cheaper and its average price was HRN UA for 1 gram. The price for subutex over the last two years remained stable and in the beginning of 2016 it was 300 HRN UA. The popularity of sonat and dimedrol is going down as well as the price: 10 HRN UA for 1 pill of either of them. There was no change in the price of amphetamine (200 for 1 gram). The price for methamphetamine grew twice in comparison with 2015: from 250 HRN UA in 2015 to in Chart 1.7. The prices for some of the drugs and psychotropic substances in 2016 at the illicit market (data of MoI) 15 Poppy straw Extracted opium Acetylated opium Cannabis (leaves and flowers of an unidentified sort) Heroin Methadone Amphetamine Methamphetamine Cocaine Subutex Sonat Dimedrol 1 gram - 15 HRN UA 1 gram 400 HRN UA 1 gram 100 HRN UA 1 gram - 40 HRN UA 1 gram HRN UA 1 gram HRN UA 1 gram HRN UA 1 gram HRN UA 1 gram HRN UA 1 pill HRN UA 1 pill - 10 HRN UA 1 pill - 10 HRN UA Consequences of violating the legislation related to drugs The current legislation regulates a wide range of legal relations regarding the reduction of illicit proposition of drugs and the demand for them and is aimed at achieving a balance of the state drug policy between the punitive measures against the illicit circulation of drugs and ensuring their accessibility for medical purposes.

16 Over 2016, the units of the National Police of Ukraine detected criminal offences related to illicit circulation of narcotics, psychotropic substances, their analogues or precursors (not counting the closed cases), of them are serious and especially serious offences. In the course of pre-trial investigation of crimes, the suspects have been notified including serious and especially serious cases criminals were brought to criminal responsibility on drug-related cases, 668 of them were arrested. The pre-trial investigations of drug-related crimes were completed, of them were sent to court with indictment acts facts of illegal sale of drugs were registered. During pretrial investigation of 655 of these facts, perpetrators were identified. 567 individuals were brought to criminal responsibility for sale of drugs, 207 of them were kept in custody. Pretrial investigation was completed in 905 cases, 827 of them were forwarded to court with an indictment act facts of storing drugs without purpose to sell were detected. In the course of pretrial investigation of cases, perpetrators were identified individuals were brought to criminal responsibility. Efforts were also focused on detecting facts of drug distribution through the Internet, 26 of such criminal offences were documented. Files of criminal proceedings in relation to the activity of 7 organized criminal groups involved in drug-trafficking were forwarded to courts. 7 criminal offences related to the use of money received from drug trafficking were documented. The property of suspects of drug crimes worth 6.8 million HRN UA was arrested, property worth HRN UA was seized. 95 facts of functioning of drug labs were registered. In the course of pretrial investigation of 66 cases, suspects were notified. 70 individuals were brought to criminal responsibility for involvement in keeping drug labs. Measures were conducted to reveal the facts of keeping drug dens. 449 of such dens were documented over the last year. The Security Service of Ukraine jointly with other law enforcement agencies of Ukraine detected the features of committing 485 criminal offences related to illicit operation with narcotics, psychotropic substances or precursors; in 303 cases suspects were notified, in 95 smuggling of drugs was prevented (in 79 of these cases suspected were notified and drugs seized). As a result of pretrial investigations of 18 criminal proceedings, 70 members of organized criminal groups engaged in drug trafficking were notified of suspicion. 14 drug labs producing especially dangerous drugs and psychotropic substances were detected and eliminated kg of drugs and narcotic raw material, 17.5 kg of psychotropic substances and kg of precursors were seized from illicit circulation. Basing on the files of the Security Service of Ukraine, 36 pretrial investigations were launched in relation to the criminal proceedings of crimes in the area of circulation of narcotics and psychotropic substances (against officers of the National Police of Ukraine 21, State Penitentiary Service 9, State Emergency Service 2, State Border Guard Service 2, military servicemen of the Armed Forces of Ukraine 2). 16

17 Operational units of the State Border Guard Service of Ukraine disrupted the activity of 10 criminal groups with 21 members. 287 notifications were forwarded to the Integrated Registry of Pretrial Investigations, in particular related to the Article 305 of the Criminal Code of Ukraine (Smuggling of narcotics, psychotropic substances, their analogues and precursors) 103; related to the Article 307 of the Criminal Code of Ukraine (Illicit production, manufacture, storing, transportation, sending, purchase or sale of narcotics, psychotropic substances, their analogues and precursors) 9; related to the Article 309 of the Criminal Code of Ukraine (Illicit production, manufacture, storing, transportation, sending of narcotics, psychotropic substances, their analogues and precursors without purpose to sell) 136; related to the Article 310 of the Criminal Code of Ukraine (Sowing or cultivating of opium poppy or cannabis) 39. As a result of operational and prevention measures over 2016, grams of narcotics were seized. Among the detected and seized drugs, according to the experts conclusions, cannabis made up over gr or 94% of the total weight. According to the statistics provided by the General Prosecutor s Office of Ukraine, criminal offences related to illicit circulation of narcotics, psychotropic substances, their analogues and precursors were registered in the Integrated Registry of Pretrial Investigations over The statistics of the General Prosecutor s Office indicates a stable downward trend in the number of such crimes ( in 2013, in 2014, in 2015). There is also a decrease in the percentage of these crimes in the total quantity of crimes registered by the General Prosecutor s Office (from 6.03% in 2013 to 3.89 in 2016). The number of drug-related crimes includes 383 especially serious crimes (509 in 2014), serious crimes (7 440 in 2014), misdemeanors ( in 2014), minor offences (1 503 in 2014). In the cases of criminal offences, suspects were notified, cases were forwarded to court ( with an indictment, 57 with a request to apply forced medical measures), in 179 cases pretrial investigation was stopped (in in connection with no information on the whereabouts of the suspect), proceedings were completed in cases, in cases no decision was taken on either closing the case or stopping the investigation as of the end of the reporting period individuals who committed criminal offences in the area of circulation of controlled substances were detected, of them were kept in custody. Among the detected offenders were women, foreigners, 697 of them from the CIS countries. Distribution by age at the moment of committing the offence: 218 under 14 years old, at the age of years old, 873 at the age y.o., at the age of y.o., at the age of y.o., at the age of y.o., at the age of y.o., over 60 y.o. Among individuals who committed criminal offences related to the circulation of controlled substances, 152 (0.15%) committed the crimes as part of the group, including 30 individuals who committed the crimes as part of an 17

18 organized group or a criminal organization (12 of them as members of an organized group or a criminal group with interregional connections), as part of mixed group (with minors participating) 9 individuals, as a part of a group of minors 2 individuals. 189 (0.19%) of offenders were detected in the state of alcohol intoxication, 377 (0.38%) in the state of toxic or psychotropic intoxication individuals had committed crimes before (3.62%), for of them criminal record was not cleared or cancelled. Over 2016, same as in the years before, in the structure of crimes related to drugs circulation the predominant are the ones classified under the Article 309 of the Criminal Code of Ukraine (Illicit production, manufacture, storing, transportation, sending of narcotics, psychotropic substances, their analogues and precursors without purpose to sell) and under the Article 307 of the Criminal Code of Ukraine (Illicit production, manufacture, storing, transportation, sending, purchase or sale of narcotics, psychotropic substances or their analogues). Chart 1.8. Percentage of crimes under Article 307 and 309 of the Criminal Code of Ukraine in the structure of crimes related to illicit circulation of drugs Article 309 of the Criminal Code of Ukraine Article 307 of the Criminal Code of Ukraine Total Percentage Total Percentage Total Percentage Total Percentage ,75% ,10% ,47% ,55% ,75% ,59% ,53% ,96% Total of drugrelated crimes ,00% ,00% ,00% ,00% In the structure of crimes in this area, we observe an increase in the percentage of crimes classified under Article 309 of the Criminal Code of Ukraine (from 57.47% to 75.55%) and a decrease in the percentage of crimes under Article 307 of the Criminal Code of Ukraine (from 25.53% to 9.96%). There is a decrease of the overall number of criminal proceedings where suspects have been notified (for 29.82%) as well as a small decrease in the number of offences under Article 309 of the Criminal Code of Ukraine (for 5.53%) and a drop in the number of crimes under Article 307 (for 82.84%). According to the statistics of the State Court Administration of Ukraine, in 2016 the decisions regarding individuals came in legal force for drugrelated crimes (Articles of the Criminal Code of Ukraine) individuals were convicted, which is for 19.6% less than in 2015 (11 280), cases were closed in relation to individuals. The total number of individuals convicted in the country in 2016 is Crimes in the area of illicit circulation of drugs are rated second after the crimes against property. Among the convicts for drug-related crimes, (almost 99%) are Ukrainian citizens, 45 citizens of other states. Women made up a small 18

19 proportion or 12% of all convicts, minors - 74 or 0.8%, 2 minors committed a crime in a group of minors, 3 minors committed a crime within an adult group. 19 Chapter 2: The level and trends of drug use Drug use monitoring The epidemic situation in Ukraine is largely concentrated in the group of injection drug users (IDU s). Although over the last years considerable progress was made to overcome HIV in this group, primarily, due to large-scale prevention interventions, this group and their contact groups remained in the focus of the epidemiological oversight over HIV. This chapter includes the results of the biobehavioral survey among IDU s Monitoring of behavior and spread of HIV-infection among IDU s as a component of epidemiological surveillance for second generation HIV. The survey was carried out in the framework of the project Engaging of local organizations in the development of monitoring and assessment of response to HIV/AIDS epidemics (the METIDA project), implemented by the International Charity Public Health Alliance with the financial support of US Centres for Disease Control and Prevention (CDC) in the framework of the Extraordinary Plan of the US President to provide assistance in connection with AIDS (PEPFAR). The survey was carried out from 2011 to 2015 among IDU s in 29 cities of Ukraine (25 administrative centers, the Crimean Autonomous Republic, Sevastopol city, and three towns in Kyiv region - Bila Tserkva, Fastiv and Vasylkiv) as well as among 769 sexual partners of IDU s in 10 cities of Ukraine. The analysis of the results of the mentioned survey was completed in The results are presented here and include data on initiation of drug use, the drug scene, frequency of injection drug use by IDU s, ways of obtaining drugs, accessibility of the main drug, dangerous practices during injection drug use, overdosing and treatment of drug addiction. The majority of IDU s start using drugs from non-injection drugs (66%). Only 2% of IDU s tried injection drugs before non-injection ones. 14% of IDU s have never used non-injection drugs. They mostly try drugs for the first time before the age of 19 years old: 73% had the experience of using non-injection drugs and 59% - tried injection narcotics. The average age of initiating drug use varies depending on the sex, age, status of the client of syringe exchange program. The analysis by the type of drugs indicates that the group of IDU s that practiced the mixed use (both opiates and stimulants) started using narcotics some time earlier than other groups. Chart 2.1. Average age of initiating the drug use Average age of drug use initiation Disaggregation variables non-injection way, quantity (age*) injection way, quantity (age*) Among all respondents 7614 (16,4) 9227 (19,8)

20 Years 20 Respondents sex Males 6175 (16,2) 7388 (19,6) Females 1439 (17,1) 1839 (20,4) Respondents age y.o. 165 (14,8) 189 (16,3) y.o. 682 (15,6) 756 (17,9) y.o (16,0) 4065 (19,5) 35 y.o. and older 3286 (17,1) 4217 (20,6) Types of drugs Opiates 4980 (16,4) 6177 (19,9) Stimulants 958 (16,7) 1151 (20,3) Mixed use 1619 (16,0) 1834 (18,9) Status of the syringe exchange program client** Clients 2026 (16,1) 2456 (18,9) Non-clients 5570 (16,5) 6749 (20,1) * The data are weighted according to the research design. ** У < 0,001 The analysis of this indicator shows that this age remained unchanged in 2015 in comparison with the results of such surveys in 2011 and There was a decrease in the average age of the first use of non-injection drugs in 2015 in comparison with 2013 (Graph 2.1) Graph 2.1. Dynamics of the indicator of the average age of drug use initiation, ,6 20,4 19, ,6 18,6 16,4 injectionally non-injectionally % of IDU s are a group with a long-time experience of using injection drugs (11 years and more). Among women, in comparison with men, the predominant group is the ones who recently started using injection drugs. The same trend is observed among those who use stimulating drugs in comparison with those taking opiates or those who practice mixed use. Teenaged IDU s mostly have the drug use experience of less than three years (79%), while the IDU s older than 34 y.o. have experience of more than 10 years of drug use (91%) (Chart 2.2).

21 Average age of IDUs, years Hence, there is a strong correlation between the experience of using injection drugs and the age of IDU s (р<0,001). Chart 2.2. Experience of drug use, % Disaggregation variables less than 3 years, N (% * ) Drug use experience 3-5 years, N (%*) 6-10 years, N (%*) 11> years, N (%*) Among all respondents 732 (7,3) 1038 (10,8) 1762 (19,2) 5695 (62,7) Respondents sex** Males 516 (6,6) 787 (10,3) 1393 (18,9) 4692 (64,3) Females 216 (10,2) 251 (12,7) 369 (20,7) 1003 (56,5) Respondents age** y.o. 153 (78,9) 35 (20,8) 1 (0,2) 0 (0,0) y.o. 187 (22,4) 314 (40,2) 250 (36,8) 5 (0,6) y.o. 299 (6,3) 550 (12,6) 1292 (31,1) 1924 (50,0) 35 y.o. and older 93 (1,9) 139 (2,9) 219 (4,7) 3766 (90,5) Types of drugs** Opiates 401 (5,6) 586 (9,1) 1051 (17,7) 4139 (67,5) Stimulants 193 (18,0) 221 (18,8) 282 (23,6) 455 (39,5) Mixed use 136 (7,1) 214 (11,2) 419 (22,2) 1065 (59,5) Status of the syringe exchange program client** Clients 71 (2,5) 163 (6,3) 373 (14,5) 1849 (76,7) Non-clients 659 (9,0) 871 (12,4) 1386,9) 3833 (57,6) * The data are weighted according to the research design. ** p < 0,001 Graph 2.2. Average age of IDU s depending on the experience of drug use Experience of injecting drug use, years National drug scene Opium extract remains the most popular drug among IDU s in Ukraine. Among stimulants, the most often taken is liquid methamphetamine (Chart 2.3). Among the drugs used by IDU s in non-injection way only, the most popular was cannabis 27%. 4% reported taking amphetamine non-injection only, 1% of respondents used tramadol, 2% - other medications.

22 22 Chart 2.3. Types of narcotics used over the latest 30 days and 12 months, (p=9405), % Types of narcotic substances Injection use over the latest 30 days*, % Injection and noninjection use over the latest 12 months*, % Methamphetamine in the form of 15,5 19,7 8,6 solution Amphetamine 12,7 22,4 5,4 Street methadone 11,9 16,5 6,0 Street buprenorphine 6,7 8,8 3,0 Desomorphine 4 5,4 2,0 Medications (tropicamide, 2,2 5,7 0,2 rynazolin, calipsol, ketamine) Heroin 1,6 3,9 0,6 Methamphetamine in the powder 1,6 3,4 0,2 form Salt 1 2 0,3 Тramadol 0,5 2,5 0,1 Methcathinone 0,3 0,8 0,1 Cathinone 0,3 0,6 0,0 Defined by respondents as the main drug**, % * The sum of responses is not equal to 100% as respondents could chose several options. ** 4.4% of IDU s chose other drugs as their main drugs. The disaggregation analysis by major social and demographic features was conducted for those types of drugs, the use of which over the latest 30 days was reported by 4% or the larger part of IDU s. Chart 2.4. Types of drugs used over the latest 30 days in correlation to social and demographic features, % Disaggregation variables Opium extract, N (%) Methamphetamine, N (%) Amphetamine, N (%) Methadone/ Buprenorphine, N (%) Desomorphine, N (%) Respondents р < 0,001 р < 0,001 р=0,042 р < 0,001 р < 0,01 sex Males (14,8) 1042 (12,9) 1399 (18,6) 339 (3,9) (78,2) Females (18,5) 236 (12,1) 243 (14,6) 99 (4,4) (75,1) Respondents р < 0,001 р < 0,001 р < 0,001 р < 0,001 р < 0,001 age y.o. 83 (46,8) 57 (37,4) 67 (34,2) 27 (11,5) 8 (3,4) y.o (23,2) 214 (26,6) 142 (17,7) ^47 (5,3) (58,4) y.o (16,5) 652 (14,4) 873 (21,0) 259 (5,3) (76,0) 35 y.o. and (12,1) 345 (7,3) 600 (14,8) 124 (2,4) older (84,3) Status of the syringe р < 0,001 р<0.001 р < 0,001 р=0,991 р < 0,001

23 23 exchange program client Clients 1963 (80,8) Non-clients 4985 (76,4) 392 (17,5) 284 (9,9) 432 (17,8) 153 (5,4) 1038 (14,9) 990 (13,7) 1202 (17,8) 284 (3,4) The analysis of drug use in indicates that the biggest change is the decrease of the percentage of IDU s who use liquid methamphetamine, medications, heroin, methcathinone, cathinone and tramadol. The use of opium extract remains on the same level as well as the use of the less popular drug salt. The percentage of those who use amphetamine, street methadone, buprenorphine, methamphetamine in powder form grew. With regards to desomorphine, there was an increase in the number of users in 2013, while after that the number of those who used it gradually declined. Diagram 2.3. Dynamics of using various drugs in an injection way, , % 80 79,9 79,6 79, Opium extract Liquid methamphetamine ( vint ) Amphetamine ( phen ) Desomorphine ,5 3,5 5,2 11,9 6,8 2,2 0,8 0, Street methadone Street buprenorphine Pharmacy drugs (tropicamid, rinasolin, calipsol, ketamine) Salt

24 24 10 Heroin 8 Methamphetamine Tramadol 6 Methcathinone ( jeff ) 4 2 3,9 4,5 4,2 4,1 3 1,7 1 1,3 1 1,5 1,8 1,8 0,7 0,4 0,4 Cathinone Frequency of injection drug use The frequency of injection drug use is measured in the times of using the drugs over the latest day, over the latest week and month. IDU s reported that on average they used drugs once over the latest day, over the latest week on five days and over the latest month on 20 days. The biggest changes in frequency of drug use happen in relation to the age of IDU s and the types of drugs. Chart 2.5. Frequency of injection drug use, times/days Disaggregation variables over the latest day, N (times) Average frequency of drug use over the latest week, N (days) over the latest month, N (days) The main drug over the latest month, N (days) Among all 8856 (1,2) 9211 (4,7) 9254 (19,8) 9097 (18,9) Respondents sex р <0,001 р <0,001 р <0,001 р <0,001 Males 7108 (1,2) 7374 (4,8) 7408 (20,3) 7278 (19,4) Females 1748 (1,0) 1837 (4,2) 1846 (17,7) 1819 (17,0) Respondents age y.o. 183 (0,9) 189 (3,6) 189 (15,3) 189 (14,1) y.o. 735 (1,2) 758 (4,4) 760 (18,3) 752 (17,4) y.o (1,2) 4069 (4,8) 4078 (20,6) 4002 (19,6) 35 y.o. and older 3995 (1,1) 4195 (4,6) 4227 (19,4) 4154 (18,7) Types of drugs Opiates 5940 (1,2) 6175 (4,8) 6190 (20,2) 6082 (19,6) Stimulants 1085 (0,7) 1139 (3,5) 1159 (14,5) 1143 (13,7) Mixed use 1771 (1,4) 1835 (5,0) 1843 (21,3) 1814 (19,4) Status of the syringe exchange р <0,001 р <0,001 р <0,001 р <0,001 program client Clients 2392 (1,3) 2461 (4,8) 2470 (20,3) 2425 (19,4) Non-clients 6443 (1,1) 6728 (4,6) 6763 (19,6) 6653 (18,7)

25 The highest frequency of using the main drug is among IDU s who stated that their major drug is buprenorphine, the lowest frequency among tramadol users. 25 days Diagram 2.4. Average frequency of using the main drug by the type of drug, ,7 19,6 18,3 17, ,1 14,2 12,5 12,2 9,9 5 0 Average frequency of drug use Ways of obtaining, expenditures and accessibility of the main drug The majority of IDU s reported that they bought their main drug over the last month. A considerable part of respondents reported that they prepare the narcotic themselves or are treated by their friends. Diagram 2.5. Ways of obtaining the main drug over the last 30 days, %

26 26 Buying only ready-to-use narcotic drug Buying ready-to-use narcotic drug and friends are preparing Prepared only by friends Prepared only by themselves Buying ingredients Buying ready-to-use narcotic drug and preparing by themselves Buying ready-to-use narcotic drug, ingredients, preparing by themselves and friends are preparing Buying ingredients and preparing by themselves Buying ingredients and ready-to-use narcotic drug Buying ingredients, preparing by themselves and friends are preparing Buying ingredients, preparing by themselves and buying ready-to-use narcotic drug Preparing by themselves and friends are preparing Buying ready-to-use narcotic drug, preparing by themselves and friends are preparing Buying ingredients and friends are preparing Buying ready-to-use narcotic drug, ingredients and friends are preparing Given by sexual partner and friends Given by sexual partner Others 0,0 20,0 40,0 60,0 80,0 The chart 2.6 presents data on the ways of obtaining the main drug reported by the 4% of the IDU s: opium extract, methamphetamine, amphetamine, methadone, buprenorphine, desomorphine. For all the substances except for desomorphine, purchase is the most widespread form of obtaining a drug. With regards to desomorphine, equal proportions of IDU s reported that they prepare the drug themselves or buy the prepared narcotic. Liquid methamphetamine is often obtained from friends. 4.7% of IDU s stated that they did not spend money on drugs over the last month as they already had all the necessary ingredients to prepare it or received the drug for free from friends or their sexual partner. Average expenditures for drugs over the last month were HRN UA, among men HRN UA, among women HRN UA. Teenagers (14-19 years old) spent the least money to buy or prepare narcotics over the last month in comparison with other groups HRN UA, year-olds HRN UA, year-olds HRN UA, 35 y.o. and older HRN UA. A strong correlation between the expenditures for drugs and the frequency of its use is observed: when the frequency of drug use over the month increased, the expenditures per day increased for average 61.9 HRN UA (р<0.001).

27 Chart 2.6. Ways of obtaining the main drug over the latest 30 days, % Way Opium extract Methampheta mine Amphet amine Street methadone Street buprenorphine Desomorphine (п=6138) (п=819) (п=556) (п=518) (п=357) (п=238 ) By purchasing prepared narcotic 60,1 41,6 75,1 77,4 85,8 22,7 substances By purchasing prepared narcotic 7,3 18,9 3,5 0,6 0,2 2,8 substances and prepared by friends Prepare themselves 6,8 6,3 3,4 3,9 3,1 25,4 Prepared by friends 6,4 11,9 8,4 2,4 2,4 19,2 Purchase prepared narcotic substances and prepare themselves 4,3 1,3 1,4 2,6 0,2 2 Buy ingredients 3,7 4,2 4, ,4 Purchase prepared narcotic substances and prepare themselves/or by friends 3,6 2, ,4 Buy ingredients and prepare themselves Buy ingredients and prepared narcotic substances Buy ingredients, prepare themselves and purchase prepared narcotic substances Prepare themselves and by friends Purchase prepared narcotic substances, ingredients, prepare themselves and by friends Buy ingredients, prepare themselves and by friends Purchase prepared narcotic substances, ingredients, prepared by friends 1,9 1,8 0,3 1 0,4 7,7 1,5 0,8 0,8 0,7 0,7 1,8 1,2 0,4 0,2 0,2 0 0,4 0,7 1 0,5 0,2 0 6,1 0,7 0,6 0, ,5 5,9 0 0,2 0 0,4 0,2 0, Purchase ingredients, prepared 0,1 0,2 0,1 0,1 0 3,9 by friends Treated by sexual partner 0,1 0, ,7 Treated by sexual partner and friends 0 0, Other 0,7 1,7 1,5 6,6 2,3 0 Positive changes with regards to price, quality and access to the main drug was reported by 1.9%, 2.6% and 6.1% of IDU s respectively. The majority stated that over the last year the changes were for the worse: 68% reported this about the prices, 52% - worsening of quality and 44% - worsening of the access to the drug. The analysis of the basic indicators of injection risk shows that over the last 5 years ( ) a substantial progress was made with regards to the safety of such injection practices as buying the drug in a syringe, filling the syringe from a used syringe/needle and sharing dishware. The use of a sterile syringe during the latest injection and not sharing a syringe over the latest 30 days remains on a stable high level over the reported period. 27

28 28 Overdosing and treatment of drug addiction Overdosing over the latest 12 months was reported by 6% of IDU s. Such experience is almost equally spread among female and male IDU s (6.1 and 5.7% respectively, р<0.237). Statistically relevant differences with regards to overdosing are observed by: - respondents age: 7.5% among year-olds, 5.9% among yearolds, 6.9% among year-olds and 5.2% among IDU s of the older age group, р<0.001; - type of narcotic: 5.2% among users of opiates, 5.1% among users of stimulants and 9.7% among those who practice mixed use, р<0.001; - experience of taking part in the prevention programs: 6.5% among clients and 5.9% among non-clients, р< A third of IDU s reported that they are registered with a state narcological clinic in connection with injection drug use. There are statistically relevant differences related to the age, type of drug and status of a client of an NGO (Chart 2.7). 7.9% of IDU s who took part in the survey underwent treatment in a state narcological clinic in connection with the drug addiction over This percentage was considerably higher among IDU s of 35 y.o. and older (8.5%), IDU s who practice mixed use (9.3%) and among clients of NGO s (13.4%). Chart 2.7. Registration with and experience of undergoing treatment in a state narcological clinic Disaggregation variables Registered with a state narcological clinic, N (%) Underwent treatment over the last two years in a state narcological clinic, N (%) Among all 4516 (32,6) 731 (7,9) Respondents sex р<0,001 р<0,572 Males 3578 (32,9) 594 (7,9) Females 938 (31,5) 137 (8,0) Respondents age р<0,001 р<0, y.o. 77 (4,6) 12 (2,9) y.o. 393 (13,7) 60 (6,8) y.o (28,0) 352 (7,8) 35 y.o. and older 2008 (42,3) 307 (8,5) Types of drugs р<0,001 р<0,001 Opiates 3014 (34,9) 488 (8,3) Stimulants 499 (18,6) 56 (3,3) Mixed use 979 (32,8) 178 (9,3) Status of a client of syringe exchange program client р<0,001 Clients 1174 (53,0) 201 (13,4) Non-clients 3334 (25,2) 527 (5,9) р<0,001 Conclusions Average age of initiation of injection drug use is 20 years old. Opium extract remains the most popular drug in Ukraine. The percentage of those who use

29 methadone, amphetamine and subutex increased. The most popular drugs among teenager IDU s are stimulants. Over 70% of IDU s were under a risk of getting HIV as well as other diseases connected with the injection practices. The most widespread risk injection practices are buying a filled syringe with the drug and sharing dishware to prepare and share the drug. Drug use among risk group teenagers The data of this chapter are based on the biobehavioural surveys in the framework of the program Building up a sustainable system of providing comprehensive services on HIV prevention, treatment, care and support of risk groups and people living with HIV in Ukraine within the METIDA project ( Engaging of local organizations in the development of monitoring and assessment of response to HIV/AIDS epidemics ) implemented by the International Charity Public Health Alliance with the financial support of US Centres for Disease Control and Prevention (CDC) in the framework of the Extraordinary Plan of the US President to provide assistance in connection with AIDS (PEPFAR). As of January 1, 2016, citizens of Ukraine with HIV were registered (297.2 per population). In 2015, the percentage of people of y.o. among newly registered HIV cases was 5.7% in comparison with 6.7% in 2014 and 7.1% in The revised results of assessing the number of children and young people of risk groups show an increase in the number of teenaged IDU s, in particular, boys who use drugs in an injection way. The data also indicates a small increase in the number of girls and young women who provide sex services on a commercial basis. A decrease in the number of teenagers who have sex with men may be considered a positive result. The data on the number of teenagers who live or work in the street was not revised as there were no new surveys conducted. Therefore, the overall number of risk group teenagers, taking into account the 2015 data, is assessed as of individuals from 10 to 19 years old. The cumulative number of teenagers from the groups of IDU s, commercial sex workers (CSW s) and men who have sex with men (MSM) is 991 individuals per teenaged population (in 2008/ individuals, chart 2.8). Such state of affairs gives grounds to stress the importance of reinforcing joint efforts to integrate teenagers into the existing interventions, implement targeted projects and expand primary prevention programs to prevent the growth of risk groups. The results of assessments were used for effective planning, evaluating the level of coverage of the teenagers and young people with prevention interventions, determining the needs of NGO s providing services in connection with HIV in order to provide a larger coverage of such groups of people, monitor and assess the response to HIV/AIDS epidemic, plan the budget expenditures and the development of a network of NGO s in this area. 29

30 30 Chart 2.8. Assessment of the numbers in the risk groups of teenagers Numbers assessment, individuals 2008/ / /2015 RGT, total Teenaged IDU s ( boys and girls) ( boys and girls) ( boys and 4200 girls) Teenaged CSW s Teenaged MSM Street teenagers Indicators and factors of risk behavior of risk group teenagers (RGT) Injection drug use Every year, the percentage of teenaged IDU s who have experience of injection drug use before the age of 15 is decreasing. However, the number of teenagers who start injection drug use before 18 y.o. has gone up (diagram 2.6). Overall, girls are to a larger extent than boys prone to use unsterile injection devices. Diagram 2.6. Age of starting injection drug use among teenager IDU s, % Under 15 years of age Under 18 years of age , Injection drug use among teenaged CSW s and teenaged MSM is not a widespread phenomenon. At the same time, the percentage of IDU s among teenaged CSW s is higher than among teenaged MSM.

31 31 Chart 2.9. Percentage of IDU s among teenaged CSW s and MSM, % 2007/ / Teenaged CSW s Teenaged MSM 19 2,1 2,6 1,4 0,1 0,2 Sharing injection tools The dynamics of the last three years with relation to the use of unsterile injection tools among teenaged IDU s remains practically unchanged; 8% of teenaged IDU s reported that they used unsterile injection tools over the latest 30 days. Diagram 2.7. Percentage of teenaged IDU s who reported the use of unsterile injection tools (syringe/needle) over the latest 30 days, % 40 Among all teenagers Among boys Among girls Non-injection drug use Non-injection drug use is an additional risk for teenagers as they are more likely to start using injection drugs and there is increased likelihood of risk sexual behavior under the influence of narcotics. Teenaged MSM to a larger extent than teenaged CSW s practice non-injection drug use. Chart Percentage of teenaged CSW s and MSM who used drugs noninjectionally over the last 30 days

32 Teenaged CSW s 9,5 Teenaged MSM 18 Conclusions The work with teenagers, especially with RGT, is an effective way of early prevention of the HIV epidemic. Due to age peculiarities and less opportunities, in comparison with the adults, teenagers have more complex needs, they are less protected and have a worse access to services, primarily due to their legal status of minors. In the opinion of specialists engaged in the collection of data on drug use in Ukraine, the phenomenon of injection drug use among teenagers did not change much in Chapter 3: Harm caused by drug use and ways of responding to the problems of drug use As of January 1, 2017, there were individuals with mental and behavioural disorders as a result of psychoactive substance use or per population (for 0.72.% less than in 2015). Over 2016, newly diagnosed cases of mental and behavioural disorders related to psychoactive substance use were registered, which is for 1.3% more than in 2015 ( individuals). Among the newly registered, are children (0-17 y.o.); are young people of y.o.; (clinic and prevention group) are rural residents or per rural population. Disease incidence of mental and behavioural disorders as a result of psychoactive substance use (clinic group) in 2016 was individuals or 78.0 per population (for 2.35% more than in 2015). Disease incidence of mental and behavioural disorders as a result of psychoactive substance use (prevention group) in 2016 was individuals or per population (for 1.5% more than in 2015). Within the structure of disease incidence of mental and behavioural disorders as a result of psychoactive substance use in 2016 (clinic group), are males or 16.7 per male population (including opioids users or 9.8% per male population). The group includes 430 females or 1.9 per female population (including opioid users 305 or 1.3 per female population). The comparison of these indicators with those of 2015 shows that they are almost identical.

33 33 Graph 3.1. Distribution by types of drugs in , absolute figures opioids cannabinoids cocaine hallucinogens few other substunses The spread of mental and behavioural disorders as a result of psychoactive substance use (clinic group) in Ukraine in 2016 was individuals or per population (for 0.54% less than in 2015). The spread of mental and behavioural disorders as a result of psychoactive substance use (prevention group) in Ukraine in 2016 was or per population. In 2015, it was individuals and per population (in 2016 this indicator is higher for 0.37% than in 2015). In 2016, the number of individuals with of mental disorders as a result of injection drug use was in Ukraine (7.3% of the overall number), which is for 0.14% more than in 2015 ( individuals). Among the overall number of newly registered cases, individuals were using drug intravenously. Incidence of mental and behavioural disorders as a result of using psychoactive substances (clinic and prevention group) in 2016 was per population or individuals. In 2015, it was individuals or per population (for 1.81% less than in 2016). In 2016 within the structure of disease incidence of mental and behavioural disorders as a result of psychoactive substance use, the clinic group amounted to 28.8% (in %). The percentage of mental and behavioural disorders as a result of narcotic psychoactive substance use (drug addiction) was 11.2% or individuals or 8.73 per population. Disorders caused by use of other narcotic substances (besides alcohol) (toxicomania) amounted to 0.31% or 103 individuals or 0.24 per population. The indicator of the prevention group was 71.2%, severe intoxication and mental disorders with harmful consequences due to drug use amounted to 6.64% or individuals or per population, severe intoxication and mental disorders with harmful consequences due to the use of other substances (narcotic

34 but not alcohol) amounted to 9.9% or individuals or per population. The disease rate of class F under the ICD-10 Classification of Mental and Behavioural Disorders (Narcology: clinic and prevention groups; Psychiatry: clinic and consultation group) in 2016 in Ukraine was individuals or per population (for 1.01% less than in 2015). The spread of mental and behavioural disorders (psychiatry and narcology) by the same groups in 2016 was individuals or per population (for 0.42% less than in 2015). Disease rate of mental and behavioural disorders (clinic and consultation group) in 2016 in Ukraine was individuals or per population (for 4.9% less than in 2015). The spread of mental and behavioural disorders (clinic and consultation group) in 2016 was individuals or per population (for 0.49% less than in 2015). PREVENTION In Ukraine, same as in the most of European countries, prevention of drug addiction is carried out in such forms: universal aimed at drug addiction prevention through raising the awareness of the public about the harm and consequences of non-medical drug use and through propaganda of healthy lifestyle; selective aimed at preventing the involvement of children and young people, who as a result of biological, psychological or social factors are in the conditions that facilitate the use of alcohol and drugs, into taking psychoactive substances; indicative aimed at preventing the recurrence of the disease. These forms of prevention are carried out in the following ways: - implementation of prevention strategies that have been approbated by the leading international and national practitioners related to the formation of life skills, development of new and improvement of existing programs and methods of solving drug- and alcohol-related problems in compliance with the requirements of the Ministry of Education and Science; - ensuring state support of the development of extracurricular school education; - development and implementation of mechanisms coordinating the activity of state and civil entities in the area of preventing the non-medical use of psychoactive substances; - implementing the strategies to reduce the level of illicit demand for drugs among young people, form skills of the young people enabling them to face the risks and hazards related to drugs; - preparation and implementing a complex of prevention activities aimed at increasing the psychological and pedagogical competence of parents, forming conscious responsible attitude of parents to their duties related to upbringing and educating their children; 34

35 - providing the educational establishments at the expense of budget funds with the sufficient quantity of information and methodological literature to conduct preventive work; - ensuring the development of infrastructure of providing comprehensive social and pedagogical, medical and psychological assistance to children and their parents; - implementing the up-to-date methods of prevention work to overcome negative phenomena among children, schoolchildren and students in the curricular for training and advanced training of teachers and family doctors; - creating and implementing a method for early identification of children who belong to risk groups due to lack of protection and other factors that may lead to drug use (children whose parents are abroad as labour emigrants, families with addiction problems, children who are victims of violence or sexual abuse, homeless children etc.), protection of their rights and preventing social exclusion; - carrying out a deep and systematic monitoring, assessment of efficiency of drug addiction prevention and correcting this work upon the results of such analysis. Therefore, the essence of drug addiction prevention is: - comprehensive measures aimed at reducing the level of primary drug use and the illicit demand for drugs, reducing harm from non-medical drug-use; - forming of a healthy lifestyle of children and young people, prevention of drug addiction, informing and developing skills of healthy and save lifestyle; - planned work to raise the awareness and form a healthy way of life of the population, including the IDU s, as well as skills of safe behavior, awareness regarding the risks of HIV infection and being responsible for one s health; - providing various social services related to reduction of risks and prevention of the spread of HIV and other diseases among drug addicts. Substitution therapy (ST) As of January 1, 2017, individuals have been accepted for outpatient treatment as a result of opioids use, which is for individuals more than in Overall, in 2016 in Ukraine individuals were newly registered for medical treatment as a result of psychoactive substances use, which is for 50.2% more than in However, the number of newly registered as a result of opioids use went down from to and is 39.1% of the total number (62% in 2015). These data may indicate a rapid increase in the use of new, non-opioid psychoactive substances and a relative stability of the opioid drug scene in Ukraine. The access to the ST program varies greatly in the regions and, on the whole, is unsatisfactory. The percentage of individuals with opioid addiction covered by the ST services in relation to the individuals under medical supervision is 21.8% (average for Ukraine), and this indicator is different in the regions: from 45% in Sumy region to 8.3% in Odesa region (without the data on Donetsk and Luhansk regions). Over the 9 years, the ST program has been implemented in Ukraine with the financial support of the Global Foundation Against AIDS, TB and Malaria. 35

36 However, in 2016 the program was supposed to transfer from donor to state support in terms of purchasing the medications for patients for the funds of state and local budgets. At the moment, 106 patients are receiving medications purchased with the local budget funds. As of December 31, 2016, there were 174 ST sites in the 25 regions of Ukraine (except for the temporarily occupied Crimea and the parts of Luhansk region not controlled by Ukraine), which are based on treatment and prevention facilities. These sites provided services for patients. The number of sites in 2015 was 173. Over 2016, the number of ST program patients grew to include 702 patients more (8%), from to Diagram 3.2. Distribution of patients who receive ST in the healthcare facilities of Ukraine as of January 1, Narcological dispensaries AIDS centers 2578; 27,98% Antituberculosis dispensaries/ hospitals 500; 5,43% 4658; 50,55% Primary care health centers, clinics Psychoneurologic dispensaries/hospitals 315; 3,42% 431; 4,68% 732; 7,94% Others (city hospitals, central district hospitals, infectious hospitals, mental health centers) Of the ST program patients, received methadone in pills (86.6%), 967 sublingual buprenorphine (10.4%), 260 liquid oral methadone (2.8%). In 2016, liquid methadone was used in the ST program only in Kyiv city. Gender distribution of ST patients remains almost unchanged with the prevailing number of male patients. The analysis of social and demographic features of ST patients showed that 81.3% of participants of the program are male and 18.7% are female. This gender distribution is corresponding to the general trend of how opioid addiction is spread among drug users. The average age of participants of ST program is 38 y.o. Average experience of drug use is 16 years. In this way, the majority of patients are people of middle age, who had a long experience of drug use as well as, according to anamnesis, several unsuccessful attempts of treatment. The problem of gender inequality in access to treatment was observed in 2016, too. 41.8% of ST patients have an established HIV positive diagnosis (3 856 individuals). Only 70.4% of them receive ART (2 713 people). Besides, as of the end of reporting period 195 patients are preparing for ART. The average indicator

37 of coverage with ART of HIV-positive patients who receive ST on the basis of AIDS centres is higher than the total indicator for the country and is 84.3% (428 of 508). This confirms the effectiveness of providing integrated services to patients with opioid addiction and the necessity to open ST sites on the basis of AIDSrelated facilities. Hepatitis C remains the most widespread disease among ST patients, 57.3% of program participants (5 283) have the disease, (16.59%) have Hepatitis B, or 15.7% are the patients with TB. The overall number of patients who receive ST services on the basis of 9 AIDS Centres is 732, which is 7.9% of the overall number of ST participants and this is a comparatively low indicator (8.7% in 2015). The percentage of retaining patients in the ST program as of December 31, 2016 (patients who started treatment in the first half of the 2016 and were receiving medical and psychosocial support financed by the Global Foundation) is 77.16%, which is higher than the indicator required by the Global Foundation (76%). Over 2016, patients joined the ST program and patients left the program. The main reasons for leaving the program are: - completing the ST program course 108 individuals (6%); - voluntarily left the program 514 (29%); - were forwarded to a different treatment and prevention facility 258 individuals (15%); - died 337 individuals (17%); - administrative check-out 131 (7%); - were called to criminal responsibility (deprivation of liberty) 146 (8%). The 48 penitentiary institutions of Ukraine are equipped with narcological rooms that provide prevention, treatment and diagnosis and rehabilitation medical assistance. Convicts who require narcological assistance receive general supportive care. Infectious diseases related to drug use Due to wider coverage of the groups with high risk of HIV with the express testing services and including the testing results into the seroepidemiological monitoring (SEM), the level of HIV in this group of individuals decreased substantially in The dynamics of HIV testing of IDU s over the last three years: in individuals, in , in , and the number of IDU s screened with express tests increased almost three times and made up (in , in ). The level of the spread of HIV among IDU s (SEM code 102) in %; in %; in %; among individuals who had homosexual contacts with individuals with unidentified HIV-status (SEM code 103) in %; in %; in %; among individuals who provide sexual services for reward (SEM code 105.2)- in %; in %; in %. In the same way as in the previous years, in 2016 the highest level of HIV was identified in the screening of individuals with code 101 (those who had sexual contacts with HIV-positive 13.53%), code 119 (those who died 11.67%) and 37

38 absolute number code 112 (those who are kept in the penitentiary institutions including detention units 4.24%). HIV among drug users A trend of almost double reduction in the absolute and relative number of new cases of HIV among IDU s has been observed in Ukraine since 2006: in 2006 the number of IDU s was 44% (over 7000), in % (3 728). In 2016, individuals infected with HIV as a result of injection drug use were registered in comparison with the year before. Graph 3.3. Dynamics of the numbers of officially registered new HIV cases among IDU s (without the data on Crimea since 2014 and parts of the ATO zone since 2015) % The absolute number of new cases of HIV infection among IDUs The share of IDUs among new cases of HIV infection According to the data of a biobeharioural survey in 2015, spreading of HIV among IDU s increased and made up 21.9% in comparison with 19.7% in 2013, 21.5% in 2011 and 22.9% in 2008/2009. The group of IDU s of 25 years and older remains more affected by the HIV. The spread of HIV in this group in 2015 was 24%, which is higher than this indicator was in 2013 (21.7%). In the younger group, this number is 4.1%, which is lower than in 2013 (6.4%). According to the official data of 2016, women are more vulnerable in terms of HIV than men (level of HIV spread among females is 27.6%, among males 20.5%). To study the trends of HIV transmission among IDU s, it is recommended to calculate the indicator of the spread of HIV among IDU s with the experience of

39 injection drug use of 3 years and more. In 2015, this indicator was 3.7% and was almost equal to the indicator of %, %. Although there are signs that the epidemiological process is slower, the data of surveys show that this group still remains the most vulnerable to HIV. Co-infections: TB, HIV/AIDS, Hepatitis B/C According to the data of monitoring of behaviour and HIV spread among IDU s and their sexual partners conducted by the Public Health Alliance: - the level of Hepatitis C spread is 55.9%; - the level of HIV spread is 21.9%; - the level of Hepatitis B spread is 5.4%; - according to the respondents, 11.8% had had lung TB. The level of the spread of co-infections of HIV/Hepatitis C 16.9%, HIV/Hepatitis B 1.8%. Drug use death rate The number of deaths connected with the drug use in 2016 is 237 cases. Chart 3.1. ICD codes related to drug use death rate, data for ICD-10 code Causes of death Number of individuals F10-F19 Mental and behavioral disorders due to psychoactive substance use 69 F11 Opioid related disorders 42 F12 Cannabis related disorders 1 F14 Cocaine related disorders 0 F15 Other stimulant related disorders (including caffeine) 0 F16 Hallucinogen related disorders 0 F19 Mental and behavioural disorders due to multiple drug use and use of other psychoactive substances 26 X40-X49 Accidental poisoning by and exposure to noxious substances 101 X41 Accidental poisoning by and exposure to antiepileptic, sedativehypnotic, antiparkinsonism and psychotropic drugs, not elsewhere classified 8

40 40 X42 Accidental poisoning by and exposure to narcotics and psychodysleptics [hallucinogens], not elsewhere classified 93 X60-X84 Intentional self-harm 12 X61 Intentional self-poisoning by and exposure to antiepileptic, sedativehypnotic, antiparkinsonism and psychotropic drugs, not elsewhere classified 10 X62 Intentional self-poisoning by and exposure to narcotics and psychodysleptics [hallucinogens], not elsewhere classified 2 Y10-Y34 Event of undetermined intent 55 Y11 Poisoning by and exposure to antiepileptic, sedative-hypnotic, antiparkinsonism and psychotropic drugs, not elsewhere classified, undetermined intent 21 Y12 Poisoning by and exposure to narcotics and psychodysleptics [hallucinogens], not elsewhere classified, undetermined intent 34 TOTAL: 237 In the group of codes Mental and behavioral disorders due to psychoactive substance use (F11-F12, F14-16, F19), the majority of deaths (24 cases) happened in the age group of 35 to 39 years old. The second highest number of deaths is in the group of year-olds 12 cases, the third highest number of deaths in the age group of y.o. 10 cases. Gender correlation of the distribution of death causes related to psychoactive substance use is represented in the graph 3.2. Graph 3.4. Gender correlation of the distribution of death causes related to psychoactive substance use Mental and behavioral disorders due to psychoactive substance use (F11-12, F14-F16,F19), 69 cases Accidental poisoning by and exposure to noxious substances(x41,x42), 101 cases Intentional self-harm (X61,X62), 12 cases Male Female Event of undetermined intent (Y11,Y12), 55 cases