obtain money for drugs is on the rise. The law-enforcement agencies' task

has been set as eradicating drug abuse, opening specialized medical centers

for the addicts who volunteer to undergo treatment, and combating drug

addiction and prostitution as the factors increasing the risk of AIDS

infection.

The main goals of the Spanish program against drug abuse are to halt

the proliferation of the most heinous drugs like heroin and cocaine,

organize prophylactic measures among the young people of 16-to-18,

promulgate popular knowledge about medicine and treatment of drug addicts

by way of educational lectures, and advance public organizations'

activities.

France:

The French national program against narco-business sponsored by the

Ministry of the Interior and Public Safety focuses on curbing the illegal

trade in drugs, and, in particular, the street vending of narcotic

substances. The document provides for the creation of special-task police

units and a national center to coordinate all police operations against

drug abuse. Narco-business-suppression training courses have been

introduced at police schools. Large police commissariats now have

specialized branches to monitor drug abuse. These branches render practical

and financial assistance to various organizations engaged in fighting

against the abuse of narcotic and toxic chemical substances.

The experience of foreign anti-narcotics programs can be adapted to the

requirements of the Russian Federation and help work out a feasible

National Program of Comprehensive Counteraction to Narcotics

Par. 2. Organization of Medical Counteraction to Narcotics

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 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.

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 Russian 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.

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.

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

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