Background

Considering the serious effect of the increase of transnational drug trafficking, in particular of opium and heroin from the world's largest producer Afghanistan, on the health situation of the peoples of Central Asia, it is a special concern of the EU to support the fight against the drug trade and work towards a reduction of drug demand. The consumption of illicit drugs, especially heroin, has risen since 1990 in Central Asia resulting in increases in HIV, viral hepatitis infection rates due to drug injection use and the related risk of infection by using contaminated injection equipment, with qualitative information suggesting that drug-related mortality among young adults has increased particularly dramatically. More emphasis is therefore to be placed on strengthening efforts to prevent and reduce the demand for and harm from drug abuse. Proven and new methods of treatment, measures of effective community-based prevention, an effective data base collection and a strong network between governmental and non-governmental actors are some of the required actions.
Drug control is increasingly taking a more balanced approach, “placing health at the core of drug policy”, as was stated by the former Executive Director of UNODC, Antonio Maria Costa in the World Drug Report 2010; “By recognising that drug addiction is a treatable health condition, we have developed scientific, yet compassionatenew ways to help those affected. Slowly, people are starting to realize that drug addicts should be sent to treatment, not to jail. (…) Above all, we must move human rights into the mainstream of drug control.”

Given the poverty and unemployment generated by the breakdown of the Soviet Union, reforms of social infrastructure within Central Asia proceed against a backdrop of increasing labour migration, social deprivation and economic disparity.
The use of opium has a long tradition in the region. Long accepted and tolerated by society, it was mostly used in the absence of health care services as a home remedy for certain illnesses.  During Soviet times the use of drugs was defined as a social evil subject to compulsory treatment by narcologists.

After the breakdown of the Soviet Union the dynamics of a market oriented economic policy led to an opening of the cultural barriers against drug use. This dynamic also implied the development of hitherto rarely practised methods of consumption, such as injecting which ensured faster psychoactive effects, at the same time increasing the risk of dependency and infection.

Some 25% of all Afghan heroin is trafficked into Central Asia. An increased availability and overall market dynamics led to an increase in trafficking and use of heroin and opium in the region. Globally speaking, Central Asia has witnessed the highest increase in the prevalence of drug use and HIV in the last 10 years. The number of drug users – mostly relating to heroin, opium and cannabis – is estimated at between 285,000 and 360,000.

“Drug use is a result of a complex multifactorial interaction between repeated exposure to drugs, and biological and environmental factors. In recent years, the biopsychosocial model has recognized drug dependence as a multifaceted problem requiring the expertise of many disciplines. A health sciences multidisciplinary approach can be applied to research, prevention and treatment of drug use. (…) Use of opiates (…), and those injecting, account for a substantial proportion of dependent or problem drug users (however defined). These drug users also tend to be more chronic users, with associated psychiatric and medical co-morbidities, and are either stigmatized or come from marginalized segments of society. Many studies have shown a strong association between poverty, social exclusion and problem drug use.” (World Drug Report – Drug use: nature and typology)

Most of the treatment programmes are abstinence based, with the main component consisting of medical detoxification and a short period of inpatient rehabilitation. Evidence based methods, including Medication Assisted Treatment with methadone are still very limited in their application. Treatment modalities and approaches offered are still to be evaluated to determine their effectiveness, whilst the risk of growing numbers of HIV infections and TB lead to an increasing need for capacity development and a comprehensive approach towards HIV and drug dependence treatment.

Therefore, the Central Asian states and the European Union agreed on strengthening their cooperation in the treatment and prevention of drug addiction within the EU Central Asia Drug Action Plan 2009-2013.

Documents:

Regional Strategy Paper for Assistance to Central Asia for the Period 2007-2013
EU Central Asia Strategy 07

Action Plan on drugs between the EU and Central Asian states for 2009-2013
EU Central Asia Drugs Action Plan 2009

Communication from the Commission to the European Parliament and the Council on an EU Drugs Action Plan for 2009-2012
EU Central Asia Drug Action Plan 2009 - Russian Version

Proposal for an European Parliament recommendation to the Council on the European strategy on fighting drugs (2005-2012)
EU Drug Strategy

Communication from the Commission to the European Parliament and the Council on an EU Drugs Action Plan for 2009-2012
EU Drugs Action Plan 2009

Reports:

CADAP Central Asia Drug Action Programme
Inception Report

CADAP Press Conference
Background Information
Background Information Russian Version

CADAP Workplan
Russian Version

UNODC World Drug Report 2010
Report 

Drug Dependence Treatment: Interventions for Drug Users in Prison 
UNODC

Joint UNODC-WHO Programme On Drug Dependence Treatment and Care
UNODC WHO

Technical Guide for countries to set target for universal access to HIV prevention, treatment and care for injecting drug users
WHO UNODC UNAIDS IDU

Guidelines for the Psychosocially Assisted Pharmacological Treatment of Opioid Dependence
WHO Opioid

Guidelines for the Psychosocially Assisted Pharmacological Treatment of Opioid Dependence
WHO Opioid - Russian Version

Illicit Drug Trends in Central Asia 
Illicit Drug Trends

Opioid Substitution Therapy in Central Asia
Towards Diverse and Effective Treatment Options for Drug Dependence
Opioid Substitution

Principles of Drug Dependence Treatment
Principles

Treatment of injecting Drug users with HIV/AIDS: promoting access and optimizing service delivery
Treatment

The State of the Drug Problem in Europe
EMCDDA

Harm reduction: evidence, impacts and challenges
EMCDDA Monograph

Harm Reduction of Injecting Drug Use and HIV
Best practices in the field of harm reduction

Regions of Expertise
How Knowledge Hubs are boosting HIV prevention, treatment and care across whole regions