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Organization of Medical Counteraction to Narcotics

E.G. Gasanov

This and many other very interesting materials have been published in the book "Drug Abuse: Tendencies and Ways to Overcome It (based on materials of the Republic of Azerbaijan)" (Мoscow: "JurInfoR" Educational and Consulting Center, 1998)

The primary aspect of the entire anti-narcotics effort is a series of medical treatment measures. They are carried out by different medical institutions as actions against narcotics is inalienable from the activities of public health services of all levels, including the medical service of the Ministry of Internal Affairs. In 1975 the former Soviet medical authorities detached the addictions treatment service from psychiatry. Thus the treatment of drug and other addicts became a separate branch of medicine known as narcology.

The efforts of the medical institutions make up a significant part of the anti-narcotics strategy. Their goal is to bring about a decrease in the demand for drugs. This is achieved by the treatment and rehabilitation of abusers and, in the final run, is a positive factor of a general improvement in the drug abuse situation.

The measures which the health centers are obliged to take, can roughly be divided into two groups. Group One includes the properly medical efforts in the treatment and rehabilitation of addicts. Group Two embraces other organizational steps to keep narcotics at bay.

The international community also pays considerable attention to the treatment of drug addicts. Article 38 of the Uniform Convention on Drugs states that the signatory countries will take every possible step to prevent the misuse of narcotic substances, ensure an early identification of abusers, treat them, restore them to full working capability, re-socialize, and monitor them after the completion of treatment (Paragraph 1). The countries will train appropriate personnel (Paragraph 2), and will inform the population about the hazards of drug abuse (Paragraph 3). The medical treatment of drug addicts is also presupposed by Resolution II of the UN conference on implementing the Uniform Convention on Drugs. Reminding of the provisions of Article 38, the conference stressed that hospital treatment in a drug-free atmosphere is the most efficacious medical approach to the issue. It recommended that an economically potent countries where drug abuse is a serious problem provide the opportunities for such treatment.

The Treatment and Rehabilitation of Drug Addicts

The issues of medical treatment/social rehabilitation of addicts and other relevant measures are to a greater or lesser degree incorporated in the public health programs of all nations and have found reflection in certain regional programs. As a rule, these documents emphasize perfection of the strategies and organization of drug abuse services on the assumption that drug abuse is a social disease. The other important aspects are financing and material/technical support, personnel, informing definite sectors of society on the hazardous impact of addiction, research in the field of more effective medicine.

Experts, however, warn against an overly simplified belief that containing drug addiction boils down to the availability of medicines and available hospital beds. The prophylactics of social illnesses like alcoholism, misuse of narcotics and toxic chemicals cannot be built upon the same methods as the treatment of serious infectious diseases. Alongside pharmaceutics, it requires psychological aid and education which more and more often involves the addicts' families and friends. It is naive to believe that medicines and injections alone can bring about the desired results and that the selection of individually suitable pharmaceutical preparations gives a clue to the problem of treatment. Good results are yielded by a combination of psychology and pharmacy. Therefore, the treatment for drug addiction consumes much painstaking effort of a doctor, psychologist, educator and other specialists working with a person who is likely to develop the illness or is ill already.

On the face of it, the issues of treatment and prophylactics necessitate comprehensive programming and proficient organization. Their solution lies in the medico-biological, medico-psychological and medico-social spheres.

From the standpoint of government policy, public health institutions have the exclusive authority to treat drug addicts by officially approved methods, including compulsory treatment of the addicts who pose danger to society.

According to the results expected in this field, health centers must organize and effectuate a series of measures destined to establish firm grounds for progress in the drug abuse situation.

In the first place, this means the early identification, diagnosis and registration of the persons who use drugs for non-medical purposes and hence stand in need of prophylactic and treatment. However, shortcomings in the existing methods of express-diagnostics and in the expert check-ups of drug addicts make establishing the degree and the type of drug dependence somewhat problematic.

Identification, Diagnosis and Registration of Drug Users

The identified addicts may belong to different age and social groups, their condition may have a different degree of narcotic neglect. This fact may influence the choice, distribution and intensity of medical measures, as well as their combination with other types of aid.

Of particular importance is the early identification of addicts among the young and the adolescents. A timely medical interference, caring participation and influence of parents, relatives, teachers, police officers, and the atmosphere of friendliness can stop the youngsters' slump into illness.

When the consumers of different drugs have been identified, it is exigent to inform the police to enable it to find the sources of drugs and trafficking channels and execute other preventive measures[147].

Information is especially important if the drugs have been manufactured illegally or their origins are unclear.

The following list of measures can help identify the individuals who misuse narcotic substances:

medical check-ups of industrial labor staffs, school and college students;

medical check-ups of inmates in jails and penitentiaries;

medical examination of the perpetrators of drug abuse for further registration and treatment, including compulsory treatment;

specialized testing of certain professionals (the military, pilots, drivers of all means of transport, police officers) for the bodily presence of narcotic substances;

revealing the most dangerous forms of drug abuse that complicated detoxification, revealing the cases of multiple drug misuse (the combined use of more than one drug) and the cases of an intertwined abuse of drugs and alcohol;

identification of addicts who carry the HIV and other infectious diseases, elimination of the consequences of infectious transmission;

timely registration, treatment and rehabilitation of those who need it.

Another way to improve the health servicing of drug abusers is to organize:

fundamental research; development of efficacious pharmaceutical preparations and novel methods of treatment for different types of narcotic dependence, their speedy translation into public health practices; large-scale contribution to research from Azerbaijanian and foreign scientists (the Academy of Sciences, medical, pedagogical, psychological and other research institutions, application of practices adopted abroad);

accelerated training of highly qualified personnel (addictive conditions psychiatrists, psychologists, educators, social workers) at medical colleges and upper level courses, specialized training of medical attendants, nurses and technicians. The study program should cover not only the novel methods of treatment, but also the specifics of contacts with the drug addicts and methods of readiness for treatment and prophylactic practice;

organization of new preventive-treatment/ registration clinics, out-patient departments at industrial facilities and offices, emergency aid centers and a wide publication of data on their mode of operation, anonymous and commercial treatment centers for drug addicts;

extensive adoption by drug-abuse monitoring services of the achievements in the medical science, psychology, pedagogy, pharmacy, and special-purpose technology;

modernization of drug-abuse monitoring services, improvement of material supplies and provision of the necessary personnel[148].

The post-treatment rehabilitation measures should include: a) the creation of purpose-oriented government-run and charity funds, ex-drug abusers support funds and diverse forms of work with them; b) development of rehabilitation methods based on the effective analysis of the existing rehabilitation procedures and of qualification levels of the personnel; c) psychological assistance to the former abusers' families, relatives, and friends who must be taught the techniques of exerting favorable influence on the patients.

Equally important is the organization of other anti-narcotics efforts taken by public health institutions.

The health of the nation is an important element of the social and economic development of a country. From this angle, the popularization of a rational way of life, the cultivation of respect for human health as the basic value of society ranks high among the priorities of medical institutions[149].

Publicizing Information Against Drugs

A skillful and persistent dissemination of knowledge about the destructive impact of drugs and their detriment for the future generations is a crucial activity of medical institutions in the struggle against narcotics.

It is advisable to find a particular audience and do masterly presentations. Lectures and discussions are not the only means of knowledge dissemination. Meetings with former drug addicts and presentations about broken human lives have also proved productive.

To increase the prophylactic effects of popularization, it would be useful to train the instructors on the methods and tactics of campaigning against narcotics, design a system of mass anti-narcotic education, based on medical science, provide the necessary teaching aids, control and stimulate this activity.

Organization of Control Over the Use of Narcotic Substances

Public health institutions have responsibilities in exercising control over narcotic substances under international conventions, treaties, agreements and other forms of international cooperation in combating drug abuse. As mentioned earlier, their primary responsibility is to control the proper use of drugs, the correct taking of their stock, their storage, distribution and removal. The issue of special prominence is the storage of narcotic substances at medical institutions and warehouses and the thwarting of attempts to misappropriate them. Inspections often expose serious flaws in this field.

To rule out a possible abuse, leakage or misappropriation of drugs, the following list of measures is essential:

guarding narcotic substance storage facilities, fitting them out with new equipment and fire/break-in alarm systems connected to the central control panel or to the 24-hour operational medical personnel or guards mail;

proper protection of the points where drugs are stored in small quantities for distribution as administered by the physicians;

tightened control over big-batch long-term storage facilities like the warehouses of regional drug-store administrations, and strategic reserves warehouses;

regular inspections at narcotic drug warehouses;

strict abidance by the rules of taking stock, storage and use of drugs for medical purposes;

a timely exchange of information with the police on the above issues and cooperation in drawing up the lists of drug storage facilities.

Experience suggests that a successful solution of the problem depends on the depth of our insight into it. This is especially true of such a complex issue as the treatment and rehabilitation of drug addicts regardless of what stage they are at. That is why the fullest and the most objective information is essential for the medical and other institutions to organize a counter-offensive against drug abuse. With that goal in mind, public health centers should adhere to the following organizational guidelines:

gathering and analysis of information on the conditions of drug addicts, tendencies in and results of their treatment and rehabilitation, and types and means of using drugs and the impact they have;

interaction with other institutions and departments in concrete forms of anti-narcotics activities in such large-scale operations as Poppy and Doping, in check-ups and research;

control surveys prepared by the narcology service.

Organizational support for these guidelines could be achieved through: the

establishment of a strict procedure for and the terms of turning in, and registration of documents, supply of dependable information on the actual situation with drugs and their sales and use for both medical and non-medical purposes, on the individuals perpetrating misuse, supply of other data essential for making specific decisions;

cooperation with other departments in holding joint selective research and express-tests to obtain reliable information on the actual levels of drug abuse, the damage it inflicts, the effects of treatment and other types of aid to the addicts;

scheduled and unscheduled departmental and/or inter-departmental inspections of how control over drugs is maintained, and how the rules of their use and storage are observed;

analysis and broad publicity of the achievements of medical staffs who have a record of positive results in combating narcotics, as well as provision of incentives.

The scope of health institutions' duties also embraces revealing and timely informing the relevant departments and the public at large on dangerous tendencies in drug abuse, new varieties of stupefying substances, the techniques of their manufacture and the means of use. The public health system develops the adequate methods of prevention , treatment, and counteraction.

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