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					      REPORT TO THE EMCDDA
  by the Reitox National Focal Point




    “ROMANIA”
DRUG SITUATION 2002




               REITOX
LOCAL CONTACT PERSONS:

             Angela PANTEA, Pharmacist, PhD
             Director of the Romanian Monitoring Centre for Drugs and Drug Addiction
             (RMCDDA)/Observatoire Roumain de Drogues et Toxicomanie (ORDT)
             /Romanian National Focal Point on Drugs (RNFP) within the National
             Anti-drug Agency, Ministry of Administration and Interior
:
             Monica AGAPIE, chemical engineer

             Ruxanda ILIESCU, biomedical engineer

             Lucian SUDITU, MD, epidemiologist




Addresses:

Ministry of Administration and Interior
National Anti-Drug Agency
Romanian Monitoring Centre for Drugs and Drug Addiction
No. 37, “Unirii” boulevard, bloc A4, sector 3
BUCHAREST, ROMANIA

Tel/fax: 00 40 21 326 44 00
         0040 21 326 47 87
         0040 21 323 30 30/ext. 21731 or 21706



E-Mail addresses: angelapantea@yahoo.com
                  monica_mihalcea@yahoo.com
                  ruxanda_iliescu@yahoo.com
                  lutu_suditu@hotmail.com




                                                                                   2
NOTE

Romania has a National Anti-drug Agency and a Romanian National Focal Point on
Drugs
This report will highlight the new organization and framework of this Agency and also will
describe the latest changes in the drugs field in Romania.
 We want to express our hope that in the future this report will be followed by many other
reports, more accurate and complete, elaborated in accordance with the European
Union standards, based on the data obtained through the implementation of the
indicators used by the EMCDDA from Lisbon.
We would like to address our thanks to the Romanian specialists who helped us in the
elaboration of this report, especially to:




Mr. Cristian BELLU BENGESCU, MD - Mental Health Laboratory, Bucharest, district 4
Mr. Gheorghe BUDILEANU, MD – Mental Health Laboratory, Bucharest, district no. IV
Mrs. Teodora CIOLOMPEA, MD – Ministry of Health
Mrs. Geta CUCU, MD, Ministry of Justice, Penitentiary General Directorate
Mr. Cristian CURCĂ, MD – National Institute of Legal Medicine “Mina Minovici”
Ms. Cristina PĂDEANU, sociologist – Ministry of Health
The staff of the Romanian Harm Reduction Network (RHRN)
Chief Commissioner Ilie PERCA – General Directorate for Countering the Organized
Crime and Anti-Drug
Mr. Lucian VASILESCU, MD – Psychiatry Hospital “Al. Obregia”




                                                                                        3
SUMMARY
MAIN TRENDS AND DEVELOPMENTS

PART 1

NATIONAL STRATEGIES: INSTITUTIONAL & LEGAL FRAMEWORK1


1.   Developments in Drug Policy and Responses

     1.1   Political framework in the drug field
     1.2   Legal framework
     1.3   Laws implementation
     1.4   Developments in public attitudes and debates
     1.5   Budget and funding arrangements

________________________________________________________________

PART 2

EPIDEMIOLOGICAL SITUATION

2.         Prevalence, Patterns and Developments in Drug Use

     2.1   Main developments and emerging trends
     2.2   Drug use in the population
     2.3   Problem drug use

3.   Health Consequences

     3.1   Drug treatment demand
     3.2   Drug-related mortality
     3.3   Drug-related infectious diseases
     3.4   Other drug-related morbidity

4.   Social and Legal Correlates and Consequences

     4.1   Social problems
     4.2   Drug offences and drug-related crime
     4.3   Social and economic costs of drug consumption




                                                                   4
5.     Drug Markets

       5.1      Availability and supply
       5.2      Seizures
       5.3      Price, purity

6.     Trends per Drug

7.     Discussion

      7.1   Consistency between indicators
      7.2   Methodological limitations and data quality
________________________________________________________________

PART 3

DEMAND REDUCTION INTERVENTIONS

8. Strategies in Demand Reduction at National Level

                8.1 Major strategies and activities
                8.2 Approaches and new developments

9. Prevention

                9.1 School programmes
                9.2 Youth programmes outside school
                9.3 Family and childhood
                9.4 Other programmes

10. Reduction of drug related harm

       10.1     Description of interventions
       10.2     Standards and evaluation

11. Treatment
       11.1 “Drug-free” treatment and health care at national level
       11.2 Substitution and maintenance programmes
       11.3 After-care and re-integration

12 Interventions in the Criminal Justice System

       12.1     Assistance to drug users in prisons
       12.2     Alternatives to prison for drug dependent offenders
       12.3     Evaluation and training

13.Quality Assurance
________________________________________________________________




                                                                      5
PART 4

SELECTED ISSUES

   14. Evaluation of Drugs National Strategies2
       14.1 Existence of evaluation
       14.2 Methodology of evaluation

   15. Cannabis problems in context: understanding increased treatment demand
       3

15.1         Demand for treatment for cannabis use
15.2         Prevalence of problematic cannabis use and patterns of problems
15.3         Specific interventions for problematic cannabis use

   16. Co-morbidity 4
16.1        Main diagnoses, prevalence
16.2        Impact of co-morbidity on services and staff
16.3        Service-provision
16.4        Examples of best practices and recommendations for future policy
________________________________________________________________
REFERENCES

   Bibliography
   Data Bases/Software/Internet addresses

ANNEX

   Drug monitoring systems and sources of information
   List of Tables used in the text
   List of Graphs used in the text
   List of Maps used in the text
   List of Abbreviations used in the text




                                                                               6
MAIN TRENDS AND DEVELOPMENTS

INTRODUCTION

Romania is supposed to join the EU in 2007. Until then, we have to look like a modern
European country. There are a lot to do, but from one point of view we are like others
European countries: we do have drug addicts, drug market and drug trade routes
coming and getting out of Romania. Although this situation did not developed after night,
as years passed by, it becomes more and more serious. A mixture of curiosity, lack of
information, transition related problems (including misunderstanding of democracy) lead
to a point something had to be done.
The National Anti-drug Agency comes both as an answer for the drug related problems
in Romania and a correspondent for similar institutions from EU member states. The
Romanian National Focal Point, called Romanian Monitoring Center for Drugs and Drug
Addiction is located inside the Agency, as a directorate. We want to thank again to all
the people who helped us in order to have an agency and we are sure we will receive
their support in the future.

ABOUT THE 2002 SITUATION

None of the 5 key indicators or other core indicator was implemented. Still, this does not
automatically mean a complete lack of data. Although most of the data are extracted
form local studies and estimates, sometimes controversial, patching them we can obtain
quite a real image of the drug related field in Romania.

The Romanian Focal Point began its activity in April 2002, in the former Institute for
Health Services Management Bucharest (today National Institute for Research and
Development in Health), benefiting from help from the twinning PHARE Project “Fight
against Drugs” (Romania/Spain/UK). The immediate results were:
    • An action plan for the Focal Point
    • A strategy for the Focal Point
    • Participating in the REITOX training seminars in 2002
    • Participating at the draft for the National Strategy on Drugs
    • Writing the 2002 country report (for the previous year there was no report)

The National Strategy on Drugs draft was presented in October 2002, during a press
conference, joining representatives from all the ministries and institutions involved in the
fight against drugs. The National Anti-drug Agency was officially set up in December
2002, through governmental decision; following these, in February 2003 the National
Strategy on Drugs was adopted, also through governmental decision. This was the final
result of the twinning project “Fight against drugs”, that began in September 2001 and
ended in March 2003, involving Romanian ministries like Ministry of Health and Family,
of Interior, of Finance/Customs, of National Education, of Labor, of Justice, of Foreign
Affairs, of Defense and Youth and Sport and their Spanish equivalents.

The trends for Romania are somehow difficult to estimate with accuracy, due to lack of
national studies, as we mentioned in the first part of this chapter. Based on available
data, we can state that generally, the trends for 2002 remained the same as they were in
2001:



                                                                                          7
   •   Spreading of the phenomenon all over the country, in parallel with the extension
       of the drug smuggling networks at national and international level;
   •   Increase of the number of drug users and drug addicts, (heroine, cannabis,
       opium, cocaine, etc.) and the number of cases of injecting drug users, even from
       the very first use;
   •   The increasing number of alcohol and tobacco users, in the 15-24 years age
       group, especially among women;
   •   The creation of drug users and distribution groups based on age or micro-
       geographical criteria;
   •   The increase of indigenous alcohol and tobacco producers, as well as the
       growing number of advertising campaigns for imported tobacco and alcohol;
   •   The spreading of drug use in bars, discotheques, and entertainment areas,
       abandoned houses, university campuses, etc.
   •   Bucharest remains the city with most drug users and the methadone maintaining
       programs are located only in Bucharest treatment units.
   •   According to treatment units’ data, heroin remains the most common drug,
       especially in the injecting form. Cannabis is second, especially as marijuana-
       smoked.
   •   A 2003 study, done in Bucharest through Romanian Harm Reduction Network
       project (RHRN)- an association of nine NGOs’, revealed that a large proportion
       (3 out of 4) of IDUs declared that they used a needle previously used by
       somebody else. Other studies suggested similar numbers, underlining the fact
       that sharing the injecting equipment is a common practice among IDUs in
       Romania.
   •   Some data identified a new pattern for usage of drugs already prepared (ready
       for injection in a non-sterile syringe) by dealer, which will dramatically increase
       the risk of HIV/AIDS among IDUs. It is somehow surprising to have a very small
       number of HIV injected contaminated drug users- 6 cases reported by National
       Commission to Fight Against AIDS, Ministry of Health between 1996-2001,
       therefore, the need for a determined and co-coordinated action targeting the
       IDUs communities, before an HIV epidemic occurs (like it happened in some
       former Soviet Republics).
   •   Finally, the 2003 Bucharest RHRN study revealed that most of the drug users do
       not rate positive the mass-media prevention campaigns- their feeling was that
       campaigns were directed against the drug users- especially those which
       demonize injecting and drugs.
   •   Other studies suggested different impacts about mass-media campaigns: a 2002
       high-schools study in Iasi county (NE Romania) revealed that 84,7% students
       consider as absolutely real the information about drugs the way are presented in
       Mass-media. Alcohol and tobacco –although seen as drugs, do not trigger
       negative reactions, being considered as inoffensive substances, which do not
       have addictive potential.

It is generally accepted in the governmental and non- governmental structures that
Romania became a drug market and not only a transit route. In 2002 the civil society
proved to be very interested about the topics concerning drugs, like public debates,
promotional musical campaigns, press conferences etc. Unfortunately, due to some
social and cultural traditions, drugs like alcohol and tobacco, widely spread in the
population and furthermore, widely produced domestically, are not yet seen as “real


                                                                                        8
drugs”. Prevention campaigns were launched in order to prevent the society about the
negative effects of alcohol and tobacco; also, advertising for these products was
restricted and so was the selling for people under 18 years old.
Some actions were also taken in the legislative field- the most important being the law
300/2002 regarding the chemical precursors and their circuit. The main law in the drug
field remained the law 143/2000 with its regulations stipulated by Governmental Decision
1359/2000 about the rules for applying it. The main institution in the law enforcement
field was the Anti-drug Squad from the Romanian Police, Ministry of Interior. There are
also 15 “territorial centers” responsible with countering the organized crime in each of
the 41 Romania’s counties - together with the Anti-drug squad they developed a
database, dedicated mainly to supply reduction data. Other important institutions with
responsibilities in the drug related field were Border Police, Customs Office and for the
treatment- Ministry of Health and Family. The Anti-drug Squad has also a specialized
drug analyze laboratory, which can perform emergency analyses on samples. The
Forensic Institutes in Bucharest and other counties are empowered by law to perform
testing for drugs both in dead or alive persons, but until now (June 2003) only the
National Forensic Institute “Mina Minovici” Bucharest does have the technical kits for
drugs or drug metabolites.
The prevention activities in the drug related field are specified through a common order
for the Ministry of Interior, Ministry of Health, Ministry of Education and Research,
Ministry of Youth and Sports and Ministry of Public Administration- order published in the
Official Monitor in 17 September 2001.
All the addiction cases are treated in health centers under the control of Ministry of
Health and Family; in June 2003 were three methadone maintenance programs
available only in Bucharest and other non-methadone centers in Bucharest and other
counties. Also, some cases are treated either in emergency rooms or psychiatric units,
but most of these cases are not reported as being drug addictions and there is an
underreporting of these indicators.
The data available draw us to some conclusions about the factors involved in drug use
and drug addiction:

   •   The lack of information and education in the domain, especially for some hidden
       populations- street children, teenagers who abandoned the school etc.
   •   The society’s acceptance of tobacco and alcohol, considered as we mentioned
       above as non-drugs
   •   The accessibility of the first doses and the curiosity of testing drugs, which lead
       to further use that represents addiction and not experimenting- the Iasi county
       2002 study showed that curiosity was the first reason for trying a drug
   •   The poor economic situation of some addicts, that results in their affiliation to
       organized drug distribution networks, in order to make money for their own drugs;
   •   The improvement of the economic status of certain social groups
   •   The little experience of the authorities and civil society in dealing with this new
       phenomenon, which led to incoherent reactions (demonizing the addicts) and
       partial results.




                                                                                        9
PART1
NATIONAL STRATEGIES: INSTITUTIONAL AND LEGAL FRAMEWORKS


The current Strategy on Drugs 2002-2004 was adopted through Governmental Decision
in February 2003. A first draft of this strategy was presented in October 2002 in front of
all governmental and non- governmental institutions, who contributed in writing the
Strategy. It was the first time Romania developed a National Strategy on drugs and we
want to mention again the support received from Spain and Great Britain through “Fight
Against Drugs” PHARE Project. Also, a very important thing was the involvement of the
civil society – NGOs’ in the National Strategy.

The National Strategy has eight chapters, describing the governing principles, strategic
view, goal and objectives of the strategy, the main areas of intervention (demand and
supply reduction), the institutional framework, the informational systems, the financing
and the evaluation of the strategy. The institution responsible for implementing the
National Strategy 2002-2004 is the Anti-drug National Agency, placed under the
coordination of Ministry of Interior (since June 2003 Ministry of Public Administration and
Interior), established in December 2002 through Governmental Decision. The Agency
became operational in June 2003 and the opening of the Agency was linked with the
International Anti-drug Day- 26 June 2003.

1. Developments in Drug Policy and Responses

1.1 Political framework in the drug field

a)     Objectives and priorities at national level

The National Strategy on Drugs states eleven objectives in order to “provide a realistic
approach to the problematic of illegal drug use”, as it follows:


1. To initiate and support a political and non-political debate at the national level, having
as main goal the decrease of drug abuse and improving the addicts’ situation.

2. To encourage the society’s sensitiveness and to promote the participation of private
institutions, collective groups associations and individuals to public awareness
campaigns in this domain, keeping in mind that everybody’s implication can lead to
solving this problem.

3. Intensifying and diversifying the activities regarding the drug use prevention especially
for the first time users, as well the developing the criminologist studies and trends on
drug users and dealers data.

4. Strengthening the fight against illegal drugs use and trafficking as well against
organized crime associated to the drugs use and trafficking, intensifying the police,




                                                                                          10
Customs and judiciary authorities co-operation and also the co-operation with similar
authorities from other countries, especially with the EU countries.

5. Emphasizing the awareness of the need to approach the drug use problem from a
global point of view, considering all the substances that can be used as drugs and lead
to addiction, including alcohol and tobacco.

6. Organizing a public healthcare and medical services into an integrated network in
order to assure the efficiency of using all the existing resources and to offer a large scale
of therapeutically meanings, as well to facilitate the social recover of drug users.

7. Intensifying and diversifying the measures to combat illegal drug trafficking, money
laundering and other linked activities through the improving co-ordination between the
responsible agencies.

8. Improving the legal framework in order to assure multiple ways of response,
permanent adapted to the dynamics of the phenomenon.

9. Paying attention to the collection, analysis and disseminating of objective, reliable on
and comparative data regarding the drug use in Romania, benefiting from the support of
the Romanian Monitoring Center for Drugs and Drug Addiction from the Anti-Drug
National Agency and of the other institutions in the drug field.

10. Intensifying the international co-operation both in participate to the competent
international organizations and also having bilateral and multilateral relations with certain
countries or geographic areas.

11. Assuring, periodically and efficiently, the evaluation of all activities accomplished in
    the field of drugs.

In the Governing Principles of the National Strategy is stated, from the very beginning
that “The problem of preventing and countering drug trafficking, consume and addiction
is assumed as a priority by the Romanian Government”. An ambitious desire in the
Strategy is to develop, until the end of 2004, an integrated system of prevention and
treatment services in a national network of centers- centers capable to develop
programs both at national and local level.

b) New initiatives and major changes in political approach

We can talk about a new approach in the Romanian drug policy beginning with the set
up of the National Anti-drug Agency, in December 2002. We will present later in extenso
the structure of the Agency and its main responsibilities and also the action plans and
programs.
The Romanian prime minister had a foreword when the National Strategy was officially
approved, in February 2003, expressing the Government wish to pay greater attention
not only to prevention and countering measures in the drug field, but also to reevaluate
the role of school and family. Also, the civil society, represented by the NGOs’, was
asked to support the official initiatives, especially the rehabilitation and reinsertion
measures.




                                                                                          11
c) Coordination policies

The institution responsible for coordinating the policies in the drug field in Romania is the
National Anti-drug Agency. The Agency was set up through Governmental Decision on
18th December 2002, Decision published in the Official Monitor on 27th December 2002.
In this decision, is stated, at second article, that the Agency develops a unitary
coordination and a general overview, based upon a national strategy, in all the problems
related with the fight against drug traffic and drug addiction. The Agency is empowered
to monitor and centralize all the data in the drug field, from public and private institutions
and to organize the cooperation between Romanian and foreign institutions.

The Agency is lead by a president, with rank of secretary of state in the Ministry of Public
Administration and Interior. The decisions issued by the president are compulsory for all
the institutions linked with the drug field. Also, the president does have the final word in
authorizing, according to the existing legislation, the NGOs’ with activities in the drug
field. In his activities, the president is helped by a general director, who also replaces the
president when is the case.

In the Agency, there are the following directorates:
    • Evaluation and coordination
    • Prevention of drug abuse
    • International relations
    • Monitoring Center for Drugs and Drug Addiction (former National Focal Point on
         Drugs)
    • Human resources
    • Audit
The entire staff of the Agency is 40 people, without the president’s staff. Among the staff,
there are physicians, psychologists, social workers, police officers etc. The average age
is 33 years old.
The Agency is financed from the state public budget; it can also benefit from
sponsorships and donations, according to the existing legislation. Because the effective
opening of the Agency took place only at 26th June 2003 (the International Day to Fight
Against Drugs), until the end of 2003 the Agency will receive funds from the Ministry of
Administration and Interior’s budget. Beginning with 2004, the Agency asked for a
separate budget, still inside the Ministry of Administration and Interior global budget.
In order to develop an efficient cooperation with each ministry or institution involved in
the fight against drugs, the Agency intends to sign bilateral protocols regarding the data
collection and data exchange. To give a stronger input to the data collection process
(including network, analyze, sharing etc) the Agency intends to replace the existing
legislation (mainly law 143/2000) and to explicitly include the data exchange process in
the new law. Also, it is intended to give a clearer definition for the harm-reduction
services and for the organizations that develop such activities.

1.2 Legal framework

   a) Major changes in law and regulations

During 2002, the most important changes in the law field were liked with the supply
reduction (precursors/money laundering/organized crime etc), for the demand reduction
field the main law remaining 143/2000.



                                                                                           12
In May 2002 was adopted the law 300, about the legal status of the precursors used to
manufacture drugs, about operations with these precursors and measures to fight
against illegal traffic with precursors. The law states “producing, depositing, or any other
type of activity involving precursors is allowed only for commercial, medical, veterinary,
industrial or research purposes”. The law has an annex with the precursors, divided in
three groups, depending on their risk, annex that can be changed by adding or
extracting substances or by moving the substances from one category into another. For
the precursors in the first and second risk groups is compulsory an authorization from
the Ministry of Health, after an approval from the Police; the precursors in the third group
are authorized by the Ministry of Industry and Resources.
In June 2002 was adopted the law 394, about article 17 in UNODC convention,
regarding illicit drug and psychotropic traffic on sea. Also in June 2002, the parliament
adopted a new law about the drugs and medicines for human use- define the products,
the manufacturing and selling process and the control of these operations.
In the enforcement field, in 2002/2003 were adopted several very important laws: in
December, law 656 about preventing and fight against money laundering; also in
December 2002 law 682 about witnesses protection and in January 2003, law 39 about
preventing and fight against organized crime at national and international level.
Speaking about alcohol and tobacco, there were some changes in 2002, most important
being related about mass media advertising for these products. As is stipulated in the
Romanian legislation, it is forbidden to sell alcohol and tobacco to teenagers under 18
years old, to advertise for these products at radio stations at some hours in the morning
(usually it is allowed the advertise after 10 o clock in the evening), to sell such products
without warning messages (according to directive 89/622 of the EU). In all public
institutions it is forbidden to smoke, beginning generally with 2002.
During 2002, several bilateral agreements were signed between Romania and regional
countries, regarding fight against terrorism and organized crime- including drugs:
accords with Poland, Bulgaria and Albania. An agreement with Israel was also signed in
2002.

   b) Legal framework in the demand reduction field

In 2002 the demand reduction activities were subject to law 143/2000. According to this
law, it is forbidden to posses any type of drug in Romania - no matter for personal use or
for other purposes. Drug addicts in Romania have to follow a detox cure or to be placed
under medical surveillance. The activity of cultivation, production, manufacturing,
experimentation, processing, transformation, offering, setting to sale, sale, distribution,
delivery under any title, shipment, transportation, procurement, purchasing, possession
or any operation related to drugs is punished with imprisonment- from 3 up to 25 years in
some special cases (high risk drugs networks, victim’s death etc). Also the law contains
regulations about confiscated goods, undercover operations, medical and forensic
exams etc.
The most important limitations of the law 143/2000 are those concerning the harm
reduction services, the data collection and analyze network and the full cover of the
medical services. The law does not mention anything about injecting rooms and pill
testing- by contrary, according to the law it is a violation of the legislation to organize
such facilities. The harm reduction services are not explicitly mentioned in the law
143/2000 and these services were organized by NGOs’ only based upon agreements
with local authorities, including police. Data collection, although mentioned in the law
and especially in the law’s annex- together with a very good reporting fiche, was never
organized at EMCCDA standards. There can be several explanations- lack of funds, of


                                                                                         13
trained people, of time but perhaps the most important was the absence of an unique
coding system- in order to compare data from treatment centers with NGOs’ data and
with police data. Finally, the medical services, although mentioned also in the law,
suffered from a severe underdevelopment- in 2001 only a single methadone treatment
center was available (in Bucharest) and only with methadone pills; in 2002 there were
three methadone centers, all in Bucharest; there were no after-care and reintegration
services, working at European standards (two after-care units were available). The
services offered in the treatment centers and other medical units were not evaluated-
compared with the requirements from the key EMCDDA indicators. Most treatment units
performed HIV and VHB/VHC test on demand- usually at first admission in the center.
In Romania, all addiction cases are treated inside treatment centers belonging to the
Ministry of Health (until 2003 Ministry of Health and Family). Drug addicts can also be
treated in psychiatry units- if the county does not have a special treatment center, or- as
it happens more often, are treated as emergencies in emergency rooms or intensive
care units in county hospitals. There is a lack of specialized personal- not only
physicians but nurses, social workers and assistants etc. According to the law, all cases
have to be reported at the County Public Health Department (each of the 41 Romania’s
countries does have such department) and from here to a Central Statistic Office inside
the Ministry of Health. Also, the Ministry of Health has a General Public Health
Directorate that coordinates the public health policy in Romania. Until now (mid 2003)
the data from these centers were unable to fulfill the EMCDDA standards.

   c) Other projects of law

In order to actualize and to complete the existing legislation, in the second half of 2003,
began discussions about the following laws:
            • Law 143/2000 and the regulations of this law- definition about all
               treatment centers, services offered, data collection, harm reduction etc.
            • Law 73/1969- about narcotics (actualize the substances and products)
Romania joined the UN 1971 and 1988 Conventions by the Law no 118/1992.

   d) Legislations which regulate traffic between bordering countries

In 2003 a law (70/2003) ratified an accord between Romania and Bulgaria, about
cooperation in the fight against organized crime, illicit drug traffic, illicit narcotics,
psychotropic and precursors traffic and fight against terrorism, accord signed in July
2002 in Sofia.
In 2001, a similar law (70/2001) was signed between Romania, Moldavia and Ukraine.
There is also a similar accord between Romania and Hungary, signed and approved in
1997; apart from these accords with neighboring countries, Romania has similar accords
with many other EU and non-EU states- USA, Canada, France, United Kingdom,
Belgium, Germany, Italy, Argentina, Brazil, Uruguay, Morocco, Jordan etc.

1.3 Laws implementation

   a) Implementation of law

The institution responsible for implementing the National Anti-drug Strategy is the
National Anti-drug Agency. Because the agency was set up in December 2002, during
2002 the fight against drugs was carried out under the coordination of Interministerial
Committee for Fight Against Drugs (ICFAD), which unite representatives from the


                                                                                        14
ministries and institutions involved in the fight against drugs. The committee was not a
very effective body, because it did not have executive power; besides, it could never met
at high level and few decisions were taken.
Also in 2002 functioned another commission- the Interministerial Commission for the
Prevention of illegal drugs, including representatives from the Ministry of Health and
Family, the Ministry of Interior, the Ministry of Youth and Sports, the Ministry of
Education and Research and the ministry of Public Administration. This commission was
set up through a common order of these ministries, order that describes the structure
and the competencies of the County Centers for Anti-drug Prevention and Counseling.

   b) Prosecution policy

The main law in this field was law 143/2000. We presented the positive and negative
aspects of this law in chapter 1.2/b.

1.4 Developments in public attitudes and debates

   a) Public perception of the drug issues

In 2002 there were no national studies or surveys about the drug related phenomenon-
knowledge, attitude, use of drugs etc. Some studies and surveys were done at local
county level- by NGOs’, County Public Health Departments, Anti-drug County Centers
etc. The results, although sometimes limited, showed common features:
           • Tobacco and alcohol are not considered as drugs- it is significant that
               most people declared they have a negative attitude towards drugs, they
               use alcohol and tobacco
           • There is not enough information about drugs, drug abuse and especially
               about side effects of drug abuse. Due to inexistence of a complete
               monitoring system at national level, there are no scientific explanations
               about phenomenon like increasing the number of drug addicts or changes
               in the patterns of drug abuse
           • Among the potential reasons for drug use, most common answers were
               financial problems, emotional distress and curiosity.
           • For long time the drug addicts were considered as delinquents; even now
               there are persons who do not accept the addiction as a disease
           • There is a positive attitude towards the NGOs’ and the programs
               promoted by these

   b) Orientation of the main public debates in civil society, national Parliament,
      organizations, NGOs’ etc

There was no exact monitoring of these events in 2002 but we can state that the drug
issue raised a great interest among the civil society and a lot of debates were organized
on this topic. Usually, there were hosted by TV or radio stations- at national or local level
and also there were articles in the written media- one of the most important newspapers
(“Ziua”) does have a regular supplement called “Ziua Anti-drug”. Due to a certain lack of
data, most questions were about statistics regarding the drug users- number, seizures,
price on street etc. Also, another topic of interest was about the drug related infectious
diseases- especially HIV and generally about the negative impact on health of drugs;




                                                                                          15
other topics were about the drugs- general presentation, effects, addiction etc. and about
how to cope when there is an addicted person in family.
A special event was the anti-drug musical tour called “It’s up only to you”, where some of
the most popular Romanian bands played and took public position against drugs. The
tour passed through most Romanian counties (34 cities, between March-September
2002) and was supported by mass media advertising

   c) Media presentation

The Ministry of Health, through its sub-program of Promotion of Health and Health
Education (no. 15, objective no. 1): “Developing health favorable attitudes and
behavior by means of health promotion and health education methods” allocated
in 2002 funds to the develop programs for preventing drug abuse, research and
development activities- including information, education and communication campaigns.
        The County Public Health Departments- through the specialized divisions (Health
Promotion) in collaboration with the local authorities, mass-media and non-governmental
organizations rallied in each county and in the Bucharest Municipality, information,
education and communication campaigns on the occasion of the International Day
for Fight against Illegal Drug Trafficking and Consumption.
        In accordance with the recommendations of the International Health
Organization, to celebrate the International Tobacco –Free Day – May 31st, under the
patronage of the Ministry of Health, at central and local level – targeting especially
teenagers, youngsters, parents and teachers – there were organized: drawing
competitions on the topic: “Tobacco –free fashion” (sector 1 Bucharest); meetings of the
Medicine Faculty students (Bucharest, Craiova, Timisoara, Iasi, Cluj); street theater
shows (Bucharest); round tables (Craiova), the theatre play “Chirita and…the smokes”
(Bucharest); distribution of anti-tobacco informative – preventive materials.
        The Ministry for Education, Research and Youth, through its county school
inspectorates organized and developed local campaigns for the prevention of drug
abuse intended for students, teachers, local communities, by means of informational –
preventive materials, notice boards put up in schools, but also in written press articles
and television and local radio shows (Bucharest, Bacau, Mures, Tulcea, Galati, Valcea,
Olt, Cluj).
        The Ministry of Administration and Interior, in collaboration with the mass-media,
offered to be published over 1500 informational –educational materials and it took part in
over 500 shows and campaigns on the local and central radio and television stations,
promoting the activities developed by the police in the purpose of cutting down the drug
demand.


1.5 Budget and funding arrangements

   a) Funding directly related to drug issues at national, regional and local level

In Romania, there are 47 centers for Prevention and Anti-drug counseling at county level
(41 counties and 6 centers in Bucharest). These centers benefited of money from
UNICEF Romania and other NGO’s- for training activities, but also received financial and
logistical support from the public budget. Around 120 000 euro were assigned by the
government to the centers, for furniture and IT equipment. 272 persons were trained
through regional seminars, also with funds from UNICEF. Not al the centers are still



                                                                                       16
operational, main problem being the proper space, but also there were other problems
reported like lack of funds, of equipment, unclear juridical situation etc.

   b) Drugs direct funding at national level

   •   Law enforcement
   •   In 2002, the Ministry of Health financed all treatment centers and other facilities
       through so-called National Programs- like a program for “Health promotion and
       health education” and a program called “ Drug addiction treatment”. These are
       budgetary funds and the Ministry of Health is an intermediary between the
       treatment units and the funds, although the second program is subordinated to
       the National Health Insurance House. There were also two major types of
       indicators in order to evaluate the programs- “physical “ indicators (number of
       addicts treated, number of treatment centers etc) and efficiency indicators (costs
       for treating an addict). The treatment centers were not nominee, furthermore
       there were no clear data about how many such units exists- a possible
       explanation can be the fact that some addiction cases are treated in emergency
       rooms or psychiatry county departments. For first half of 2003, the amount of
       money reported was around 75 euro for each addict and around 3000 euro for
       each treatment center. The funds reported for 2003 were around 450 000 euro
       for the “Health promotion and health education” program and around 150 000
       euro for treatment programs. The National Focal Point on drugs benefit from the
       Ministry of Health of about 10 000 euro in 2002, for specific activities- training,
       equipment, seminars etc.
   •   Research
   •   International actions
   •   National strategy and coordination

   c) Results from specific national surveys on expenditures carried out in the
      recent years

No data available.




                                                                                       17
PART 2
EPIDEMIOLOGICAL SITUATION

2. Prevalence, patterns and developments in drug use

As we have already mentioned, there was no epidemiological study at national level
available in 2002- therefore, there were no data about the 5 key EMCCDA
epidemiological indicators (or at least at EMCCDA standard). Most data came from local
studies, from treatment units, from NGO’s, police departments’ etc. but because there
was no unique coding system implemented, the available data could not be compared in
order to have a clear picture at national level. Furthermore, double counting could not be
avoided; lack of personal papers from people asking for medical or NGO’s services was
another serious problem together with a lack of definition regarding the terms used to
report data.
Main data sources in the demand reduction field were:
    • Ministry of Health and Family- through treatment centers (this number showed
        rather the people asking for medical services than the demand for treatment),
        forensic institutes, emergency rooms and psychiatry departments, public health
        departments etc.
    • Ministry of Education and Research- activities and programs reported by county
        inspectorates for education
    • Ministry of Youth and Sport- also through county inspectorates and departments
        for youth and sport
    • NGOs’ and other organizations (UNAIDS/UNICEF)

For the supply reduction data we found data at:
   • Ministry of Interior: the General Directorate for Countering Organized Crime and
       Anti-drug (unit that hosted the National Focal Point on Drugs between 1996-
       2001); Border Police
   • Ministry of Public Finance: the General Directorate of Customs
   • Ministry of Justice: the General Directorate of Penitentiaries
   • The Public Ministry
   • Ministry of Industry and Research- especially for the some precursors

All the data suggested that in 2002 the drug abuse- including alcohol and tobacco, was
on an ascending trend in Romania. We shall mention just the fact that 3 clandestine
laboratories were dismantled on Romanian territory (compared with 1 in 2001 and none
in the decade 1990-2000) and that there was an increase in the number of people
arrested for drug traffic or drug smuggling.

2.1      Main developments and emerging trends

      a) Overview of the most important characteristics and developments of drug
         situation

13 years after the fall of communist dictatorship, the Romanian society is still confused
about the drug related problems. There are still debates whether an addicted person is a
delinquent or a sick one. As years passed, the number of addicts grew- including also
the number of alcohol and tobacco users, together with the seizures, the number of



                                                                                       18
arrested persons for illegal drug traffic and in the recent years- the number of dismantled
laboratories. Incomplete data, obsolete legislation, decrease of the economic situation of
some groups, new phenomenon like “street children” contributed to the general
confusion.
In the late 90’s the authorities became aware of the fact that Romania passed from a
transit country to the state of drug market, with addicted people and already well
organized drug traffic networks. Youths have been the first persons to be affected by this
phenomenon, and drug users progressively went down to 14 years. Heroine use is the
most frequent and the fastest growing, and lately synthetic drugs, such as ecstasy and
amphetamine, become more “fashionable”. The number of persons using injecting drugs
and the number of persons suffering from B and C hepatitis increased. Most cases are
registered between persons in the 16-25 years range. The vicinity with states such as
Moldavia and Ukraine, where injecting drug use is very high, and the growing prevalence
of HIV/AIDS lately were serious alarm signs, somehow triggering the response from
competent authorities.
Only recent, the so-called “legal drugs”-alcohol and tobacco came into attention of the
public authorities and of civil society and prevention programs and campaigns against
such substances were launched. The existing legislation was accordingly changed-
especially referred to advertising for alcohol and tobacco and selling to underage
persons.
The NGO sector waited some 10 years in order to be able to have an important impact
upon the policy makers and to be recognized as an essential link in the chain of
treatment and prevention programs. Since 1999, the most important NGOs’ in the harm
reduction field joined their action and constituted the Romanian Harm Reduction
Network- RHRN. In fact, most of the preventive programs, treatment facilities and even
of the legislative framework developed in the late 90’s- 1998 first methadone center,
1998 first syringe exchange program, 2000- the main law in the demand reduction field
(143/2000), 2002- new law about the precursors (300/2002) etc.

   b) Emerging trends

The trends for 2002 were estimated based upon data from local studies, treatment
centers, NGOs’, supply reduction field- like seizures, arrests etc, other types of indirect
data- STD sections, opinions of people working in other medical facilities (forensic
institutes/emergency rooms, GPs’ etc), pools in general population etc. Due to the
inexistence of a national epidemiological study and of a national survey, it is difficult to
extrapolate the available data for the entire population, but the picture we realized can
be considered quite a good image of the current situation in Romania. We considered
also the studies and estimations made for the previous years- data that helped us in
drawing some conclusions:
            • The most frequent drug used by people asking for treatment was heroin-
               in the injecting form. Most of the studies suggested that the number of
               drug users increased in 2002 compared with 2001, although the demand
               for treatment remained basically the same.
            • It also appears that there is an increasing tendency to begin the use of
               drugs with heroin, very often in the injecting form.
            • Among the high schools students, the most common drug by far was
               marijuana- according to their declarations.
            • The data from the last 2-3 years suggests also a decrease of the debut
               age for beginning the drug use



                                                                                         19
•   Due to the efforts of several NGOs’ and governmental institutions, the
    civil society begins to realize the need for assisting and helping the
    addicts to reintegrate in society.
•   The prevention programs and actions are more and more seen as an
    effective part of the campaign against drug abuse. The short period since
    such interventions began to be implemented did not allow estimating the
    results- usually, many programs are not evaluated or at least not
    evaluated for all indicators.
•   The drug market in Romania is young and quite “raw”- from the very
    beginning some groups were involved in consuming a particular drug-
    especially injecting heroin or some mixture of medicaments and kept their
    options. Apart from heroin and cannabis, there were encountered cases
    of abuse of hypnotics, barbiturics, benzodiacepines, inhaling substances
    etc. Cocaine addict cases are seldom- a possible explanation can be the
    price of cocaine, prohibiting for most of the Romanian addicts. Also,
    synthetic drugs were not very frequent- but we have to mention that it
    seems this trend is switching (in 2002 three clandestine labs were found
    in Romania, compared with one in 2001 and none in the previous ten
    years 1990-2000). Lack of studies and surveys among the hidden
    populations or among the groups at risk (recreational parties) do not
    afford us to draw other conclusions, like we mentioned before. The data
    from the Border Police, Customs Office and Anti-drug Squad revealed an
    increase of the seizures regarding Ecstasy and precursors- in 2002 was
    adopted the law 300, regarding the precursors and the operations with
    precursors, so this can be a possible explanation of the increase.
•   The economic situation of some groups improved and affords them to
    spend more money on drugs. Other addicts, in order to gain money for
    the daily dose, joined the drug traffic networks and became dealers, or
    were arrested for petty crimes (car thefts/pick pocketing etc).
•   The problems related with drug abuse in Romania have to be analyzed
    from a broader point of view, some of the current (2002) problems being
    just extensions of pre and post 1989 phenomenon- the abandoned
    children, from a era when abortion was forbidden, finally formed the
    groups of “street children” and discovered inhalant substances; another
    part of them were abandoned in the orphanages and were HIV infected-
    some of them, today teenagers could be a serious public health problem
    in the future. The prostitution- very often connected strongly with drug
    trafficking, although illegal in Romania, spread a lot in the last 3-5 years,
    triggering a sharp increase of the STD (excluding HIV). Other infectious
    diseases, in the EU countries found almost exclusive among drug-users
    (like Tuberculosis) spread rapidly in Romania after 1989, but being linked
    with the poor economic condition of some groups and not with the drug
    abuse. Beginning with 1 January 2002 the Romanian citizens do not need
    visas for traveling in the Schengen countries- there are signs that a part
    of commercial sex workers moved into these countries.
•   Finally, the changes in the legislative field- regarding drug treatment
    centers, the regime of some medicaments (benzodiacepines,
    psychotropic, barbiturics etc), the precursors and so on, by improving the
    legal framework, “biased” the statistics- like seizures, arrests etc.




                                                                              20
   c) Analyses of drug trends from a wider social context

The available data regarding the drug demand field suffer from under coverage: the drug
related treatment indicator is in fact the number of people asking for medical services
(and if the medical services are poorly developed, the number is accordingly small); the
studies among teenagers are sometimes made in high-schools, so they do not cover the
whole age groups (teenagers who abandoned the school are not enclosed); the is no
possibility yet to distinguish a small offence from a drug related petty crime and so on.
From these points of view, the analyses and the trends have to be regarded cautiously
and to receive further confirmation.
The Romanian society has not yet found a complete set of values, 13 years after the fall
of communism. The free market competition and the changes- often abruptly, in the
economic condition of some social groups, the spreading of the “Western way of life”,
other new phenomenon (like underground culture, Internet, unemployment etc.)- all of
these puzzled the society and especially the teenagers and were the soil were flourished
the drug traffic networks.
     • The increase in the number of addicts can be seen most probably as a false
         understanding of freedom- but there are for sure other possible explanations
         (poor economic situation, lack of information- many addicts were not aware of
         the negative effects of the drugs or expressed the idea that a non-injecting drug
         is less dangerous).
     • The heroin problem- most people working in field share the opinion that heroin is
         the most used drug in Romania, mainly through injection, can be explain by the
         easy access to drug on the market (including the low price), maybe by the
         already installed social patterns.
     • The alcohol and tobacco are not seen as drugs by most teenagers and generally
         by most Romanians for several reasons: there were for many years the only
         drugs available on the market, the advertising and the selling of such
         substances was not restricted until recently (2002), the Romanian farmers do
         manufacture alcohol in their households (activity illegal until 1989), lack of
         information- it is widely believed for example that a glass of alcohol is
         recommended before lunch etc.
     • Our opinion is that the decrease of the debut age for drug abuse is one of the
         most important (and inauspicious) signs, showing the lack of information, lack of
         prevention programs and widely- lack of reaction from the society.
     • Because the existing legislation- especially in the late 90’s, was obsolete, some
         addicts experimented the use of medicines sold or theft from pharmacies
         (opiates, anti-Parkinson drugs, other narcoleptics) and sometimes those
         medicines were mixed with alcohol.
     • The current legislation do still have some uncovered points or inoperable
         provisions: for example, an addict has to follow a detox cure and- if necessary,
         further therapies (post- cure/rehabilitation etc) but most of these facilities are not
         yet available. The harm reduction activities are also subject to misinterpretation-
         there is space for including syringe exchange in the article regarding “helping
         the addicts” and this can lead to imprisonment. Usually, this type of programs
         (syringe exchange/outreach activities etc) developed by mutual agreements
         between the NGOs’ and the Police Anti-drug Teams.
     • According to the law enforcement institutions’ statistics, in 2002 the number of
         drug related offences/crimes was 120 times higher compared with 1989 and
         more that 5 times compared with 1996. The offences/crimes were distributed all



                                                                                            21
          over Romania’s territory, although some areas had clearly more cases (mainly
          Bucharest area and the Western counties- border with Hungarian and Serbia).
      •   A surprising trend is about HIV/AIDS- according to the Ministry of Health and
          Family, at 31 December 2001 there were only 5 cases among the IDUs. For the
          moment there is no satisfactory explanation about this- supposing the data are
          correct (and most people working in the field believe so). The small number of
          cases of HIV positives is more surprisingly as the percentage of VHB and
          especially VHC among IDUS’ are high (aprox. 40% for VHB and between 75-
          80% for VHC). We have to remark that in 2002 the Ministry of Health and Family
          reported a total number of 2623 HIV/AIDS cases in the adult Romanian
          population (22 millions), out of them 341 died.

2.2       Drug use in the general population

      a) Main results of surveys and studies

In 2002 there were no such studies at national level in Romania. The most important-
and most controversial study, the Rapid Assessment, took place in 2001 in 4 of the most
important cities in Romania: Bucharest, Constanta (400 000 inhabitants, the bigest
harbor at Black Sea), Iasi (400 000 inhabitants, many universities, situated in NE
Romania, very close to the frontier) and Timisoara (also around 400 000 inhabitants, lot
of universities, situated in the western part of Romania, very close to the Hungarian and
Serbian border). The final results of the study estimated between 25000-40000 IDUs in
Bucharest only, but the Ministry of Health and Family did not agreed with this number.
The major limitation of the study was the impossibility to avoid double- counting, when
the data from the NGOs’ were compared with those from treatment centers and the
Police. Because until now (end of 2003) this assessment was the only attempt to
evaluate the drug users at national level, we will present the conclusions from the
original study:
            • Heroin was found to be the most used drug, followed by Fortral (an
                analgesic) and cocaine- on a lesser extent
            • There was not possible to describe a peculiar type of drug addict from the
                social point of view, but the most vulnerable age group seemed to be the
                high schools and university students
            • Also, there were not reported specific areas for selling or using the drugs,
                although some IDUs described “hot spots” areas
            • Between 10 and 50% of the IDUs reported the sharing of injecting
                equipment
            • There were quite few of IDUs admitting they had sexual relation for
                money; most of them declared they have a single sexual partner. There is
                to analyze these statements given that prostitution is illegal in Romania.
            • In general terms, the official policies seemed to have a positive effect on
                the sexual behavior and a negative effect on the injecting behavior. A
                possible explanation can be the fact that in the HIV/AIDS field there is an
                organized policy and a good coordination (the Ministry of Health and
                Family has a National Commission to Fight Against HIV), while there
                were no such initiatives in the drug field
            • Compared with 1998, when the first Rapid Assessment was performed,
                the number of IDUs increased some 30 times in 2001. Even if the




                                                                                        22
               statistics is contested- other estimations showing an increase of “only” 10
               times, the trend is quite clear.

b) General population

 It is for the moment very difficult to estimate the drug use in the general population. We
can only estimate, according to some data like demand for treatment, seizures, police
statistics (arrests etc), other sources- mass media articles and pools that probably more
than 75 % of the drug addicts are located in Bucharest (10% of the country population).
The rest of the users seem to be dissipated mainly in the big urban areas, usually in
cities with universities (some sources indicates that foreign citizens arriving as students
were the first ones who brought drugs in these areas). In some such areas, heroin is no
longer the most used drug, being replaced by marijuana or by different medicines,
sometimes in combination with alcohol.

   c) School and youth population

The first ESPAD study was performed in 1999 and placed Romania on the 20th place out
of 29 European countries regarding the alcohol use among high school students (16/17
years). The position could be in reality higher, because of the wide acceptance in the
society of alcohol and of the habit of producing alcohol domestically. The ESPAD study
will be repeated in 2003, but other researches and investigations suggest that the use of
so-called legal drugs (alcohol and tobacco) is rising. A 2002 study in the Iasi county- NE
Romania, showed that 6,2% high school students admitted they tried at least once a
drug; furthermore, 17,1% of the students declared that they never used a drug because
they did not have the money, the opportunity or the company- so probably they would
join the users if they have the chance. Another study made in Bucharest by the NGO
“Salvati copiii” (Save the Children) and by the Public Health County Department in 2002
discovered that 10,68% of the high schools students used a drug at least once. The
studies among young population (high schools students mainly) revealed that the main
reason for using drugs is curiosity, drug being obtained from the entourage; in order to
make money for drugs, most of the users began their own activity as dealers, forming
networks based on “geographical” criteria (neighborhoods).

All the studies revealed that the fact that the most exposed age group is between 15-24
years (or 15-17 years). Also, the statistics can be biased by the fact that such studies
(among high schools population) did not take into account the teenagers who
abandoned the school. In the last years, these teenagers formed a new culture (for
Romania) and gave birth to a new phenomenon- “the neighborhood gangs” where the
drugs play an important role, together with music (rap/hip-hop), clothes, language etc.
The data from the study made in Bucharest 2002 suggest also that the trends for
cannabis (smoked as cigarettes), amphetamines and different psychotropic medicines
are rising. The circuit of psychotropic medicines in pharmacies is not monitored and
there were reports of cases of addicts using medicines obtained from pharmacies.
Apart from the so-called illegal drugs, the problem of alcohol and tobacco remains very
serious- all the more so they are not yet seen as drugs. For example, the Iasi study
revealed that 90 % of the students tried at least once an alcoholic beverage and 70%
smoked at least once (the sample size was 1430 high school students, between 14-18
years old). When asked about using drugs, only 62 students admitted they did- obviously
the alcohol and tobacco are not seen as drugs.



                                                                                        23
   d) Specific groups

During 2002 there were no specific studies made in groups- like conscripts, workers,
minorities etc. The only available data came form the General Penitentiary Directorate,
data that were collected through self-reporting. According to these data, the prevalence
among the drug users was 22,5% for 2002, compared with 21,2% in 2001. The
prevalence in December 2002 was 32,1%- all these data were calculated for a sample
size of approximate 50 000 prisoners. The General Penitentiary Directorate is member
of the Romanian Harm Reduction Network and during 2002 developed several programs
and activities like:
    • Issuing a common order with the Ministry of Health and Family and Ministry of
        Justice regarding the treatment and the preventive measures for the imprisoned
        addicts;
    • The project “We care…do you?” with funds from the International Harm
        Reduction Development – Open Society Institute, New York
    • The project “Acces” since September 2002, with PHARE funds

For 2003, is intended to open inside the penitentiary sanitary system a detoxification
center and a post cure center, destined special for the prisoners. These centers will offer
both medical and harm-reduction services. For example, with funds from the UNICEF
and technical assistance from the Canadian Legal Network HIV/AIDS was developed a
draft for a project called “Preventing HIV/AIDS and STD in the Craiova Penitentiary for
Youth and in Special Centers for Underage People”.

   e) Description of trends and prevalence and incidence of use

Apart from the data mentioned in the previous subchapters of 2.2 there were no other
studies or surveys available in 2002 in the general population.

               2.3 Problem drug use

   a) National and local estimates

There were no studies at national level in 2002. Local estimates and other partial data
suggested that heroin remains the most popular drug, trend unchanged for last years;
also, heroin is mainly used by injecting- a trend that spread rapidly in the late 90’s due to
lack of information (especially about the effects of using such administration route),
unclear legislation and incoherence of prevention programs. There were two rapid
assessments made in Romania (4 cities including Bucharest) in 1998 and 2002- the first
one estimated about 1000 IDUs, but the second one suggested there are more than 25
000 IDUs only in Bucharest. This second assessment is controversial due to scarce data
(some intersections found a number of only 16 people), impossibility to avoid double
counting and inexistence of a unique coding system. Other serious problem was the lack
of a common definition for some terms like: addict, treatment, drug related death, drug
related infectious disease etc. The only certain conclusion is that the number of IDUs
increased dramatically between 1998 and 2002, especially in Bucharest- data from other
cities revealed that heroin “shares” the first position with other drugs (mainly medicines
like benzodiacepines or barbiturics). This trend can be supported by reports from
treatment centers or psychiatry units outside Bucharest that did not received requests for
heroin addiction detoxification.



                                                                                          24
The prevalence for cocaine is still low- the price may be an explanation, for the moment
being too high for most of the Romanians addicts; another possible explanation can be
the geographical position of Romania, quite far away from cocaine classical transit
routes. The seizures between 1991-2003 (first half) showed that cocaine represented
only 1% of the total amount of drugs seized.
For synthetic drugs users there were few data available in 2002. Based on other data-
like seizures, dismantled laboratories, price etc it seems that the trend for this type of
drugs is increasing. Until specific studies are made in the communities of drug users, we
do not have other information.

   b) Risk behaviors and trends

The study done by the Romanian Harm Reduction Network in Bucharest in 2002
revealed some patterns of use among IDUs:

   •   Most of the participants declared that they inject themselves at home, but other
       places like stairwells, public bathrooms, elevators stairwell, their cars etc. were
       also nominated.
   •   The dose is usually administrated immediately after is brought, mostly because
       of withdrawal symptoms
   •   The injecting place was described as a safe place (from the police), sheltered
       from bad weather (wind, cold etc), with access to some facilities (water, sink etc)
       and private- in fact, this last criterion seems to be the most important.
   •   The data revealed some concern for planning (for the most of participants), but
       high barriers for fining a proper injecting site. Most barriers were associated
       derived from the stigma associated with drug use, and IDUs were more
       concerned to avoid stigma consequences
   •   Another subject was the group- the persons with whom the subject is injecting.
       Data pointed out that the group plays an important role in the injecting activity
       and even more, that each member of the group performs a different role. Most
       often, a group is composed of 3-5 members, with strong links between them,
       especially in the initiation.
   •   The syringes used are very often the insulin ones. There are no legal provisions
       in order to buy syringes, but the addicts declared that usually the pharmacists
       refuse to sell such items to “strange faces”. Other pharmacies, in order to avoid
       troubles, simply do not have such items – like insulin syringes, in their stocks.
       There were no data about the pharmacists’ attitude towards drug users.


The first syringe exchange program………………………

       3.     Health consequences

              3.1 Drug treatment demand

   a) Estimate of people receiving treatment in the country according to TDI
      protocol

There was for sure an important difference between the number of people needing
medical services for drug addition in 2002 and he people receiving medical services.



                                                                                       25
The data from local studies and estimates, although with some limitations, revealed that
the number of addicts is on an increasing trend in the last 4-5 years, while the treatment
centers reported basically the same numbers of patients. This situation can have several
explanations:

   •   The quality of services offered in the treatment centers is not at EU standards-
       beginning with the coding system and ending with the treatment and the after
       care services.
   •   The people working in the centers lack specific training- most of them came from
       psychiatry departments.
   •   The lack of funds and of after care/post cure centers led in fact to a circle, where
       people came in the centers, stayed for a few weeks and get out only to rejoin
       their habits. The rate of relapses is very high and the centers were quickly seen
       just as a temporary shelter and not as a first link in the therapeutically
       community.
   •   There is a contradiction between the estimations- indicating that injecting heroin
       is on top among addicts and the services, only three methadone maintaining
       services being available in 2002 and all three in Bucharest. The methadone
       maintaining programs are not very clearly specified in the existing legislation
       (143/2000) and there is no unique treatment guide for this services. Therefore,
       the rate of relapses is very high among IDUs especially, the lack of after-care
       and post-cure facilities adding more pressure on this relapse rate.
   •   As some researches done by NGO’s pointed out, the Romanian society after
       1990 did not have its own patterns of drug use and drug groups. This can be a
       possible explanation for the “wild” aspect of the Romanian addicts society and for
       the distinct patterns of drug use.

The total number of people asking for medical services for drug addiction in 2002 was
1905. This number includes the treatment facilities mainly from Bucharest- including the
three methadone maintenance centers from Bucharest. The patients were counted
based on their personal data (ID cards), but the centers accepted also patients without
personal papers, based only upon the self-declared identities- except for methadone
maintenance centers, where the admittance into treatment was made only with ID. There
was no unique coding system used by these centers, but because the vast majority of
cases had ID papers, the double counting was quite low.
All the centers are subordinated to the Ministry of Health and Family who is also
financing the centers, but the indicators for evaluating the programs are quite unclear
and most often the reports are limited. The emergency rooms or other hospital
departments (like psychiatry units) who treat emergencies do not always report the
cases as drug addiction so there is a possibility for underreporting right from the data
sources. Also, the underage patients (less than 18 years old) are not always reported
and the final outcome of all these misunderstandings is that different institutions report
different numbers.
The civil society through NGOs’ involved itself only in harm-reduction programs and
other activities like studies and estimates, counseling, testing, peer education, mass-
media campaigns etc. The treatment centers in all their forms- non-
substitution/substitution treatment, post-cure etc. were entirely financed by the state
budget.




                                                                                        26
The annexed table presents the age distribution of the people receiving medical services
in 2002:

                                        All                            First
       Year:                        treatments                      treatments
                              M          F         T          M          F          T
  Treatment
cases/demands
   (Number)                 1489       416       1905        844        215       1059
 Sex distr. (%)
  Male / (%)
    Female                  78,2      21,8        100        79,7       20,3       100
  Mean age
    (Years)                 20-24     20-24      20-24      20-24      20-24      20-24
Age distribution
      (%)           <15      0,29     0,00        0,29       0,38       0,00       0,38
                   15-19    15,26     4,78       20,03      17,19       5,57      22,76
                   20-24    35,69     7,43       43,12      37,20       7,37      44,57
                   25-29    16,47     3,05       19,52      15,20       3,21      18,41
                   30-34     4,89     1,04        5,93       4,72       1,04       5,76
                   35-39     1,21     0,81        2,01       1,04       0,09       1,13
                   40-44     1,38     1,04        2,42       1,04       0,85       1,89
                   45-49     1,32     1,67        2,99       1,32       0,85       2,17
                   50-54     0,98     0,63        1,61       0,76       0,19       0,94
                   55-59     0,29     0,46        0,75       0,38       0,47       0,85
                   60-64     0,23     0,23        0,46       0,19       0,19       0,38
                   >= 65     0,23     0,63        0,86       0,28       0,47       0,76

   b) Description of the main trends over the years in the treatments demand

Apart from the trends mentioned in the first two parts of this chapter (2.1 and 2.2) the
studies showed that:

   •    The average age of the drug users decreased dramatically, from 25/30 years in
        1996 to 13/23 years in 1999 and this trend is maintaining for 2000/2002 (the
        younger addicted found was 7 years old)
   •    Excluding heroin and other opiates, cannabis is also a very popular drug but
        there are also groups “specialized” in using different medicines, especially by
        injection
   •    The trend for drugs like amphetamines is practically unknown, no information
        being available in 2002. Based upon indirect information like seizures, price etc
        we can estimate that the trend for amphetamines is rising.
   •    The youth are the most vulnerable group- for example, most people for treatment
        centers came form the 20/24 years old age group
   •    The number of people asking for medical services remained quite unchanged in
        the last 2/3 years; also the treatment centers statistics showed a high rate of
        relapses. We can presume that a vast majority of addicts gives up treatment and




                                                                                        27
       integrates into so-called “gray” (or hidden) population- the main source for
       epidemics and social problems.
   •   The existing legislation does not support the treatment and the reintegration
       measures: usually, an addict has to follow a medical treatment and a
       complementary therapy. Due to the lack of such treatment facilities, the addicts
       are not very willing to come to medical units. The data coding system used is not
       confidential and the clients can be identified based only on the data from the
       centers fiches.

   c) Characteristics of clients, patterns of use and trends


CHARACTERISTICS                                            2001          2002
Nr. of ALL treatment cases/demands                             2134          1905
Sex distr. Male (%) / Female (%)                       83,4%/16,6% 78,2%/21,8%
Mean age (years)                                       20-24         20-24
Age distribution                               <15              0,66          0,29
                                               15-19          26,10         20,03
(%)                                            20-24          47,28         43,12
                                               25-29          16,78         19,52
                                               30-34            5,34          5,93
                                               35-39            1,27          2,01
                                               40-44            0,70          2,42
                                               45-49            0,52          2,99
                                               50-54            0,52          1,61
                                               55-59            0,28          0,75
                                               60-64            0,28          0,46
                                               >=65             0,28          0,86
Number of cases with missing inform on age
Currently injecting any drug (%)
Ever injected any drug but not currently (%)
Ever injected any drug (%)
IV route of ad. main drug (%)
Main/primary drug (%) -- (% IV use)                    dr. % ( IV%) dr. % ( IV%)
 Opiates (total)                                               95,27        86,87
     Heroin                                                    93,49        83,94
     Methadone (any)                                             0,19        0,17
     other opiates                                               1,59        2,76
 Cocaine (total)                                                 0,23        0,17
    Cocaine ClH                                                  0,23        0,17
    Crack                                                        0,00        0,00
Stimulants (total)                                               0,37        0,40
    Amphetamines                                                 0,09        0,00
    MDMA and derivates                                           0,14        0,35
    other stimulants                                             0,14        0,06
Hypnotics and sedatives (total)                                  2,16        9,67



                                                                                     28
    Barbiturates                                                  0,05           0,52
    Benzodiacepines                                               1,55           6,16
    others                                                        0,56           2,99
Hallucinogens (total)                                             0,23           0,35
    LSD                                                           0,00           0,00
    others                                                        0,23           0,35
Volatile inhalants (total)                                        0,52           0,69
Cannabis (total)                                                  1,17           1,38
Others substance (total)                                          0,05           0,52

               According to these data, the most vulnerable age group is the 20-24
               years old, followed by 25-29 years old age group and 15-19 years old age
               group (both in 2001 and in 2002). These three age groups together
               represent more than 90% of the drug addicts asking for treatment in 2001
               and more than 80% in 2002.
               Like we already mentioned, heroin is by far the most common drug
               There was an increase in the number of people using benzodiacepines
               (generally, hypnotics and sedatives) in 2002, compared with 2001

   d) Comments on different client profiles in different types of treatment

There were no data for 2002.

   e) Comments on treatment demand for different drugs

Like we mentioned several times before, all the data in 2002 indicated that most of the
patients asking for medical services were heroin addicts. Apart from heroin, other drugs
were cannabis, different types of medicines (benzodiacepines, hypnotics) and very few
cases with drugs like MDMA or volatile inhalants.
Data from outside Bucharest suggest that heroin is no longer the most used drug-
cannabis and medicines are also on top positions among drug addicts (treatment center
from Iasi- NE Romania).

               3.2 Drug related mortality

   a) Drug-related death

The data from the National Institute of Statistics showed a number of 3 drug related
death in 2002, all three due to opiates. It is very possible that this number is substantially
underestimated, but for the moment there are limited possibilities to asses the correct
number of drug-related deaths. For example, in 2001 there were reported 15 drug-
related deaths, all in Bucharest. This number differed depending on the information
source- National Forensic Institute or National Institute for Statistics.
There is only one single laboratory capable to perform specific analyses- at the National
Forensic Institute “Mina Minovici” Bucharest- analyses that are not performed routinely.
The network of forensic laboratories contains 5 other big laboratories (in cities where
there are Universities of Medicine: Iasi, Cluj, Timisoara, Craiova and Targu-Mures) but
none of them is able to perform post-mortem drug determination. The rest of the




                                                                                           29
counties do have their own forensic laboratories at the county hospitals, but they are not
able to perform drug determinations.

   b) Death related to opiates and to other drugs

           3   cases of drug-related death were reported in 2002- all for opiates. All 3
               cases were males, with residency in Bucharest, belonging to the 19-24
               years age group.

   c) Description of trends on drug-related deaths

There are no data available.

   d) Overall mortality and causes of death in drug-users

In 2002 overall mortality in Romania was 12,4 ‰ inhabitants- that meant 269 606 death.
The reported number of drug related death seems underestimated- only 3 cases (1125
cases were reported as alcohol related deaths- 912 males and 213 women).



               3.3 Drug- related infectious diseases

   a) Available data on HIV and VHB/VHC and other infectious

There is a common habit to share needles and other injecting equipment among IDUs:
some studies (like the one done by RHRN in 2002) pointed out that 3 out of 4 IDUs
share their equipment. The large proportion of infectious diseases among IDUs (VHC
mainly) is a consequence of this practice; the very small number of HIV cases indicates
that there is still time for intervention in this field.
The treatment centers usually test their clients for HIV and hepatitis- according to clients’
preferences. The vast majority of the patients consent to be tested for these diseases,
but we have to repeat that there is little information about addicts who do not attend a
treatment center.
According to the National Commission for Fighting Against AIDS of the Ministry Of
Health, in 2002 were 4 new HIV cases among IDUs - and the total reported was 10
cases of HIV among IDUs (sample unknown). The available data suggests that
prevalence of HIV among IDUs is still very low- but there is no clear explanation for this.
Again, we have to mention that HIV prevalence in the general adult population in
Romania is quite low- around 2500 HIV/AIDS cases, according to the National
Commission for Fighting Against AIDS.
By contrary, the reported rates for VHB and VHC especially are high: around 40% for
VHB and probably more than 60% for VHC. For example, the Infectious Diseases
Hospital “Prof. Dr. Matei Bals” from Bucharest, in cooperation with “Open Doors” NGO
and the National Commission for Fighting Against AIDS tested 150 drug addicts in 2002:
18 were found positives for VHB and 60 for VHC. Dates from other treatment centers –
like methadone maintenance center “Sf. Stelian” Bucharest (open at the end of 2002)
showed that more than 80% of the addicts tested are positive for VHC.
The studies done by NGOs’ or Public Health Inspectorates indicated a high-risk behavior
among IDUs - it seems that preventive programs and harm reduction activities have to



                                                                                          30
be more implemented and more targeted in order to avoid an HIV epidemic, like it
happened in some former Soviet Republics.
The data for TB are very poor- although there were reported some TB cases among
drug users, it is still unclear if they are truly related to drug abuse- the TB prevalence in
Romania is the highest in Europe, mostly linked with the poor economic situation.
The STD situation among IDUs is also very unclear- the Rapid Needs Assessment in
2001 found addicts with syphilis, gonorrhea and other diseases, but the data were self-
reported and their accuracy was quite low.
Also, some neurological and psychiatric disorders were found among drug users during
the Rapid Needs Assessment, but no further details were offered.
There are no other statistics for associated diseases among drug users.

   b) Estimates for the total numbers of the above infections

The total number of HIV/AIDS cases reported for 2002 by the National Commission for
Fighting Against AIDS of the Ministry of Health and Family was 10- no data were offered
about the sample size. The HIV testing is available on most public hospitals and private
laboratories in Romania and the price for the test is varying between 3-10 euros. The
tests are confidential and if the result is positive, free of charge; the positive patients are
treated from a separated program of the Ministry of Health and Family.
The patients with other infectious diseases- including VHB/VHC are usually discovered
at routine testing when they came into treatment centers or when attend some NGOs’
who offer free tests. The total number for these cases is not known, but as we
mentioned at point “a” the estimates are about 40% for VHB and 60% or even more for
VHC in the drug addicts community.
The STD cases are probably quite frequent- this problem should be regarded together
with the commercial sex market that flourished in Romania especially in the last years.
The specialists working in STD clinics estimate for example that the cases of syphilis
increased 10 times after 1990. Somehow surprisingly, the habit of selling sex for money
was not very much spread among drug users- data from Romanian Harm Reduction
Network Study, but these data were self-declared and prostitution was illegal in 2002 in
Romania, so the answers can be biased. Still, further questions revealed that more than
half of the drug users do have a stable sexual partner, but some of them admitted they
had sexual relations without using a condom.


               3.4 Other drug-related mortality

   a) Non-fatal drug emergencies

There were no such records in 2002. According to the existing data- RHRN enquiry and
other studies, there were cases of non-fatal drug overdoses among drug users, but this
indicator was not developed and the data are rather scratches and patchy data. The
NGOs’ working in the field reported also declarations of their clients about cases of
non/fatal drug emergencies. The RHRN research showed that the risk of overdose is
currently ignored both by injectors as well as service providers. It is noteworthy that a
surprisingly high number of respondents took an O.D or were witnessing one. Data
(although not statistically representative for the Romanian IDUs community) reveal that
about 1/3 of respondents took or saw an overdose.
In the 2001 Rapid Assessment, IDUs were asked also to remember if they previously
had overdoses problems. From the answers, resulted that in Bucharest 31% of IDUs’


                                                                                            31
suffered at least one episode of overdose, in Timisoara 42%, in Iasi 12% and in
Constanta 29%. The most common drug reported that caused overdose was heroin; in
Constanta and Iasi there were also reported cases of overdose from Fortral. There are
no estimates for the non-fatal overdose cases; we can only state that the most common
drug involved in overdose emergencies were Heroin, Codeine and Phenobarbital for
Bucharest, Heroin for Timisoara and Benzodiacepines for Constanta. There is no
statistic available for Iasi.


   b) Psychiatric co-morbidity

 The Rapid Evaluation Assessment in 2001 revealed some cases of neurological
disorders among IDUs - there were no other details (types of disorders/analyses etc).

   c) Other important health consequences

For 2002, there were no estimates about the health consequences (other than HIV/AIDS
and VHC/VHB) apart from the Rapid Assessment Evaluation. According to this study,
STD were reported by 20% of the IDUs in Bucharest, 16% in Timisoara, 12% in Iasi and
7% in Constanta. The most frequent STD was gonorrhoea, reported by 11% in
Bucharest and Timisoara, 4% in Iasi and 7% in Constanta. Other STD reported were
syphilis and trichomonas.
Other frequent complications reported were abscesses and phlegmons at the injecting
place. 38% of the IDUs in Bucharest, 47% in Timisoara, almost 50% in Constanta and
only 8% in Iasi reported these complications. We have to repeat that there was no
possibility to check this data- there were self reported data. Also, some 5% of the IDUs
reported bacterial and fungi infections of the mouth and neck especially, but there were
also some cases of endocarditis.
Mental problems reported were irritability- 43-75% of IDUs, depression- 43-64%, fatigue-
32-58%, aggressively- 28-49% and hallucinations- 26-71%. The staff from treatment
centers reported that in their opinion, the most important consequences of drug abuse
were anti-social behavior, evolution to mental disorders (often irreversible) and lack of
motivation to abandon drug use.
The police did not have test kits for detecting the drugs in driver bodies (like tests for
saliva or urine tests). Also, tests for dead bodies were available only at the forensic
laboratory from National Forensic Institute Bucharest. Therefore, there were no data
available in 2002 about drugs and driving.

       4.     Social and legal correlates and consequences

              4.1 Social problems

   a) Social exclusion

No data available for 2002.

   b) Public nuisance/community problems

According to the Rapid Needs Assessment, in Bucharest, more than 50% of IDUs were
involved in aggressions and 13% in accidents, including traffic accidents. In Constanta



                                                                                       32
the numbers were more than 50% for aggressions and 29% for accidents; in Iasi 12%
and 8% and in Timisoara 42% and 21%.
A major problem for almost all the drug-users was the refuse of the pharmacists to sell
them syringes- the RHRN study confirm this problem, but is unclear if the pharmacists’
attitude is linked with the public nuisance problems (real or imaginary) or with other
problems.

                   4.2 Drug offences and drug-related crimes

   a) Arrests for use/possession/traffic and trends

The data from 2002 suggest an increasing trend for most of the indicators in the supply
reduction filed- including arrests, also with some differences between the reported data
from the institutions working in the field- police, customs office, border police etc.
For 2002, the available data indicate that Romania is ranked under the European
average figures for supply reduction data (arrests, seizures, crimes etc). Comparing the
data from the last 12 years in Romania, there is a steady increase- for example, the
number of drug-related offences in 2002 was 5,2 times higher compared with 1996 and
120 times higher compared with 1989. In 2002 there were reported 1291 official reports
for drug related offences, which meant 5,74 reports for 100 000 inhabitants. The total
number of perpetrators was 1428- 24,40% were women/ 6,30% were underage and
7,70% were aliens.
Compared with the last two years, since the law 143/2000 was applied, in 2000 the data
were 733 investigated people and 706 charged people; in 2001 were 1132 investigated
people and 949 charges.

                                 Drug-related offense dynamics between 1989 and 2002

       1400
                   1291
       1200


        1000


         800                                       803
                             668
                                     604    620           597
         600


         400                                                     386
                                                                        267
          200                                                                  210
                                                                                      103    84
               0                                                                                         4      11
                 02


                            01


                                    00


                                           99


                                                  98


                                                         97


                                                                96


                                                                       95


                                                                              94


                                                                                     93


                                                                                            92


                                                                                                    91
               20




                                                                                                               89
                          20


                                  20


                                         19


                                                19


                                                       19


                                                              19


                                                                     19


                                                                            19


                                                                                   19


                                                                                          19


                                                                                                  19


                                                                                                             19




   b) Prosecution data


                                                                                                                     33
Since 1989 there was a continuous increasing trend for prosecuted persons for drug
trafficking (except for 1998/1999)- from 12 persons in 1989 to 897 in 1997 and 1428 in
2002.

                               Dynamics of accused persons and of the persons caught in the act,
 1600                                      respectively, during the period 1989-2002
                                                                                                                                                               1428
 1400


 1200
                                                                                                                                                                      1035
 1000
                                                                                                              897

 800                                                                                                                                                   723
                                                                                             679                               684
                                                                                                                                                         605
 600                                                                                                                                           519
                                                                            452                                                        438
 400                                                        358                                                         351
                                                                                                       292                       293             296
                                                    226                                                                                  226
 200                                                                                  115
                                76        95          76              74
          12 1        5 0            15        27
   0

           8   9      9   0       91    92     93             9   4           9   5            9   6            9   7            98      99     00      01        0   2
        19         19          19    19     19             19              19               19               19               19      19     20      20        20
                              accused persons                                                                                    persons caught in the act




According to the data from the institutions working in the field, between 1989-1999 the
most frequent age group was over 30 years old, but since 1999 the most frequent age
group was 21-30 years (40,8% in 2000/ 49,1% in 2001 and 43,9% in 2002). Adding the
fact that the number of young people (18-21 years) involved in drug trafficking was on an
ascending trend since 2000 (16,7% in 2000/ 20,7% in 2001 and 31,2% in 2002) we can
assume that there is a decrease of the average age for the prosecuted people for drug
trafficking.




                                                                                                                                                                          34
                The dynamics of the accused persons, the age factor, during the period 1989-2002
 700


 600


 500


 400


 300


 200


 100


  0

         89      90     91             92         93      94      95    96                    97          98     99      00          01       02
       19      19     19             19         19      19      19    19                    19          19     19      20          20       20
               14-18 years                                18-21 years                                      21-30 years                             over


Sex ratio was “dominated” by males (usually 80-90%), but an interesting observation
showed that the percentage of women increased directly with the phenomenon of drug
trafficking- from about 10% in the first years of the 90s’ to about 25% in the beginning of
2002.



  1200
                                                                                                                                                     1079
  1000


   800
                                                                                                           684
   600                                                                                                                                         624
                                                                                                  562
                                                                                                                    496               467
   400                                                                                392                                    386
                                                                          319                                                                         349
                                           73                 205
   200                                            89                                                       213
                 12             4                                                                                   188
                                                                                                  117                                          99
                                                                          39          60                                     52       52
        0            0                     36      6          22
                                1
              1989       1990       1991    1992       1993        1994        1995        1996     1997     1998     1999        2000 2001         2002
                                            men                                                                                     women



Depending on the level of education, the most frequent category was people who
graduated elementary school- except for 1998 and 1999, when the most frequent group
was people with high school education.




                                                                                                                                                          35
              Dynamics of accused persons, study variabile between 1989 and 2002
 800

 700

 600

 500

 400

 300

 200

 100

   0
      89


               90


                      91


                             92


                                       93


                                                94


                                                         95


                                                                96


                                                                            97


                                                                                   98


                                                                                           99


                                                                                                    00


                                                                                                           01


                                                                                                                  02
    19


             19


                    19


                           19


                                     19


                                              19


                                                       19


                                                              19


                                                                          19


                                                                                 19


                                                                                         19


                                                                                                  20


                                                                                                         20


                                                                                                                20
           elementary school                      vocational school                      high-school                   hige




Another observed trend for drug trafficking data was the continuous increase in the
number of arrested persons of unemployed persons- since 1999 the number of
unemployed persons was higher than the number of employed persons.



                               Accused persons, according to professions
                                   900
                                   800
                                   700
                                   600
                                   500
                                   400
                                   300
                                   200
                                   100
                                      0
                                            1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

           Total no. of unemployed           2     2    14    31     66     72   131 210 214 180 196 278 455 825
           accused persons
           unemployed young persons          1     0    10    22     35     37   72     103 122    97    120 177 342 526
           total no. of employed             10    3    62    61   160 286 199 469 683 504 242 239 268 603
           persons




If up until the year 1990 illegal activities were controlled by foreign citizens in proportion
of maximum 90% of the accused persons, during the following decade, their percentage



                                                                                                                              36
dropped to values ranging from 10 to 20%. Thus, in the years 1993 (19.9%) and 1996
(18.8%) the highest percentages of foreign perpetrators were recorded, and after the
year 2000 crime in the field of illegal drug trafficking becomes clearly dominated by the
autochthonous element, as to the lower rate of involvement of foreign citizens (6.5% in
2001, 7.2% in 2002 and 6.8% in the first six months of this year).



                                         Accused persons, foreign citizens
        140
                                                128
        120
                                                        110                                 110
        100

         80
                                                                73     71
         60                              59
                           45                                                 48     47
         40                       40

         20         16
              9
          0
            91


                    92


                           93


                                  94


                                         95


                                                96


                                                        97


                                                                98


                                                                       99


                                                                              00


                                                                                     01


                                                                                            02
          19


                  19


                         19


                                19


                                       19


                                              19


                                                      19


                                                              19


                                                                     19


                                                                            20


                                                                                   20


                                                                                          20
       c) Convictions data and court sentences for drug offences

        Upon passing the Law no. 143/2000 on fighting illegal drug trafficking and
consumption, the competence of criminal proceeding for such offenses fell compulsory
on the prosecutors’ offices. The data for this indicator suggest a continuous increase,
increase that accentuated after 2000- when a number of 347 persons were accused for
drug trafficking, 1038 in 2001 and 1495 in 2002. Also, if in the year 2000 149 persons
were sued, in the following years their number grew approximately four times (575 in
2001 and 665 in 2002).




                                                                                                  37
  1600


  1400


  1200


  1000


   800
                                                                                       1495

   600
                                                 1038
   400
                                                                                                     665
                                                                 575
   200          347
                             149
     0
                      2000                                2001                                2002

                  accused persons (prosecutor's office)     persons sued at law (prosecutor's office)




The data from the General Prosecution Office showed also an increase for most of the
indicators: criminal lawsuits, prosecutors’ reports etc.

                              2000                2001                      2002
  Total                       238                  848                      1239
  criminal
  lawsuits
  Prosecutor’s                 89                  379                       361
  reports
                             37.3%               44.7%                     29.1%
  NUP*                         53                  278                       484
                             22.2%               32.8%                      39%
  SUP**                        36                  56                        78
                             15.1%                6.6%                      6.2%
  S18/1***                     60                  137                       335
                             25.2%               16.1%                      27%


         *NUP = not beginning criminal lawsuit
         **SUP = take out criminal lawsuit
       ***S18/1 = without social danger (the subject can be released and will be
free during the lawsuit)




                                                                                                           38
According with the above-mentioned indicators, the number of sentences increased
between 2000 - 2002: 178 persons convicted in 2000, 268 in 2001 and 432 in 2002. The
number of underage persons convicted was 8 in 2000, 9 in 2001 and 26 in 2002.



                              People convicted by law courts,
  500                           both underage and adults

  450
                                                                       432
  400                                                                  406

  350

  300
                                                   268
                                                   259
  250

  200
                        178
                        170
  150

  100

   50
                                                                        26
    0                   8                          9
                    2000                       2001                 2002
          total of convicted persons            adult persons       underage persons




   d) Imprisonment for drug law offences


The number of imprisonment persons in regard with drug law offences followed the
trends for the rest of supply reduction indicators: a steady increase since 1990,
accentuated in the last 3-4 years.




                                                                                       39
                      The number of convicted persons who are to be found in penitentiaries



                                                                                                         335
               350

               300                                                                        238
               250
                                                                               179
               200                                                                               159
                                                             129        139
               150                       71      101

               100                17
               50

                0
                                  2000                       2001                         2002

                                    detainees     convicted in the first instance    final conviction




                                Sanctions applied to adult convicts by the law court
 300
                                                                                                 254
 250


 200
                     164
                                                           151
 150                                                                                                    126

 100                                                               85


  50                                                                                                           24
               4                                                          11
                            2                          2                                    1                       1
   0
                           2000                                  2001                                   2002

       fines         emprisonment               probation suspension            on parole suspension           service at the w




        Out of the convicted persons, recidivists represent a high percentage, as showed
in the following chart:




                                                                                                                          40
                             The number of convicts in penitentiaries - recidivism


            300                                    275
            250

            200
                                                                                       148
            150                                                                  129
                       113                                      103
            100
                                                          69
                                     50
             50               26
              0
                             2000                        2001                   2002



                               2000           2001          2002
Without criminal record        113            275           455
                               59.7%          61.6%         62.1%
With criminal record           26             69            129


                               13.8%          15.4%         17.7%


Repeated offense               50             103           148
                               26.5%          23%           20.2%


The sentences applied for convicted persons were also on an increasing trend for
serious sentences- between 5 and 10 years and on a decreasing trend for sentences
less than 1 year, proving the continuous extension of the drug trafficking.




                                                                                             41
                  Number of persons placed in penitentiaries - sentence time


                                                                      234                  250



                                                                                           200



                                                                                           150
                                          116

                                                                                           100
                                                                             74
                52
                                                                                           50
                                                  29    24
                      22    21                                                     21
          6                          10                          6
                                                                                           0
                     2000                        2001                       2002
         less than 1 year            1-5 years               5-10 years                 exceeding 10




   c) Other drug-related crimes


There are few data available for this chapter, because in most cases the enlisted offence
is not linked with the drug abuse- this indicator did not exist in Romania in 2002
(accordingly, the reported cases were robberies/car thefts/public nuisance etc without
any mention to the drug). The only available data are self-reported- if the arrested
person declares he/she is drug-addict.
There were 3 dismantled laboratories in 2002, compared with 1 in 2001 and none in
2000. There are data that suggest a tendency to move laboratories from neighboring
countries (Bulgaria/Poland) in Romania.
There appears also to be a strong link between prostitution (illegal in Romania in 2002)
and drug trafficking. Both phenomenons increased in 2002, although the data are
incomplete.
There were no available data for other topics of this chapter.


                4.3 Social and economic costs of drug consumption


        According to the Bucharest Public Health Department, for each treated patient
the average cost was about 80 Euro and the average cost per unit was 3000 Euro- in the
first semester of 2003.
There were no other data available for this chapter.




                                                                                                 42
       5.          Drug market
                   5.1 Availability and supply
            a) Availability and access to different drugs, trends and possible
               reasons
There were no studies on this subject in 2002. The only available data are from the law
enforcement institutions and from the studies at local level, studies based often on self-
declarations.
The drug market in Romania developed very much after 1990, due to two main factors:
the overthrow of the communist dictatorship in 1989 and the geographical position of
Romania, a gateway between Europe and Middle East and Asia. The drug transit routes
extent over the Romanian territory and formed the so-called “northern path” of the
Balkan route. Other events that arise after 1990- like the war in Yugoslavia, war in
Afghanistan etc. only contributed more to the extent of this route.
In 2002, most drugs were generally available on the Romanian market, on top of this
market being cannabis (14 895kg. seized in 2002). Following western countries patterns,
cannabis began to be cultivated in Romania either for personal use or, on a larger scale,
for the drug market. Also, opiates and heroin, amphetamines, different types of
chemical precursors- all were available on the drug market. There were no reports of
poppy crops in 2002- perhaps due to the Romanian climate, not very suitable for this
type of crops. Cocaine was the less frequent drug- regarding the seizures and the
number of addicts who asked for treatment, but still 2,72 kg were seized in 2002. The
high price of cocaine and the relative long transit route- from South America to Romania
can be possible explanations.
The drug trafficking networks spread all over the country in 2002 (35 counties out of 41)-
confirming the extent of the phenomenon. In fact, since the mid 90s’ this developing
trend was observed- proving the existence of a newborn drug market- Romania.
            1989

                     1990

                            1991

                                   1992

                                          1993

                                                 1994

                                                        1995

                                                               1996

                                                                      1997

                                                                             1998

                                                                                    1999

                                                                                           2000

                                                                                                  2001


                                                                                                          2002
Drug-       11       4      85     10     21     26     38     59     80     62     39     45     670    1291
related                             3      0      6      8      7      3      0      2      9
offenses
Total of    9        4      25     29     35     34     40     40     41     41     36     38     31     35
active
counties




                                                                                                          43
                                                                      Counties with a high rate of offenses
                                                                      (drugs)
                                                                      Counties with a mean rate of offenses
                                                                      (drugs)
                                                                      Counties with a low rate of offenses
                                                                      (drugs)




                                                                                          gra
                                                                                       Nea
                                                                                   rea
                                                                                 Ma
5. Drug market
5.1 Availability and supply
      The analysis of the illegal drug trafficking routes in the South-East Europe
suggests that Romania is situated on 3 out of the 5 paths of the Balkan Route.

       a) Turkey-Greece-Italy (the southern route);
       b) Turkey-Bulgaria-former Yugoslavia-Italy (central route);
       c) Turkey-Bulgaria-Romania-Hungary-Austria-Germany-Holland             (the
           northern route);
       d) Turkey-Romania-Hungary-Slovakia-the       Czech       Republic-Germany-
           Holland (the northern route);
       e) Turkey-Bulgaria-Romania-Ukraine-Poland-Germany (the northern route).
       Police data also revealed the development of new transit routes from West
(Holland, Germany) to East and from North (Ukraine) to South used mainly for
smuggling synthetics drugs.

5.2 Seizures

   a) Trends in quantities and numbers of seizures

Before 1990, in 20 years (1970-1990) were discovered about 187 cases of drug
trafficking, 90% being foreign citizens with a total of 475 kg. drugs seized. In the next 12


                                                                                                  44
years 1990/2002 the total seized quantity was about 50 times higher, with a sharp
increase in 2001/2002 (in 2002 were seized 110% drugs compared with the entire
interval 1990-2001).



 45000                                                                                                    43764

 40000

 35000

 30000

                                                                                                  25220
 25000

 20000

 15000
                                   11389
 10000
                                                            5669
  5000
                                           1929                     1542
                36          31                       111                     785     119    407
     0
           91


                       92


                                   93


                                          94


                                                    95


                                                             96


                                                                     97


                                                                             98


                                                                                     99


                                                                                             00


                                                                                                    01


                                                                                                            02
         19


                     19


                                 19


                                        19


                                                  19


                                                           19


                                                                   19


                                                                           19


                                                                                   19


                                                                                           20


                                                                                                  20


                                                                                                          20
The seized quantities of different drugs since 1990 do not follow exactly the demand
reductions indicators- and there can be several explanations: lack of coordination among
the law enforcement institutions (Border Police/Customs/Anti-drug Squad)




         6.            Trends per drug
         a) Information from different indicators and other sources


         The phenomenon of drug abuse and drug trafficking is a relative new one for
Romania - 12 years ago there were just isolated cases (12 persons accused for drug
trafficking in 1989), most of them foreign citizens-sailors, students etc. After 1990, when
drugs appeared more and more on the market, the state institutions were caught
unprepared for the intensity of the phenomenon. The reaction was slow and without
consistency and coordination, another negative factor being the lack of an adequate
legislative framework. The decrease of the economical situation after 1990 added more
pressure on the institutions working in the field- demand and supply reduction. As it
happens very often is such situations, the first reaction of the society was to consider
drug addicts as delinquents and to treat them accordingly.




                                                                                                                  45
Due to all these facts, there was generally a lack of data in the field, also the civil society
proved to be very interested in this topic (drugs and all types of drugs related behavior).
In the late 90s’ it became clear that Romania transformed into a drug market and it was
a need for much more efforts, both in the institutional and legal framework. New
institutions were developed and new laws passed, but the time since is quite short and it
is difficult to draw many conclusions. Furthermore, most data are still collected in an
inappropriate manner and very often are incomplete, self-reported or just non-available.
As a general observation, the demand reduction indicators were not implemented in
2002 and the information from the demand reduction field were poor and incomplete.
The supply reduction data are of better quality, but there are also problems like double
counting (for seizures), lack of data or equipment etc.
With all these limitation, it was clear that in 2002 Romania was a country with drug
addicts and drug market. Drug trafficking networks crossed the territory of the country
and organized crime was a certain presence in the field, dealing not only with drug traffic
but also with linked activities like prostitution or money laundering. We can assume that
drug traffic and drug abuse phenomenon developed very fast during the last 3-4 years,
in opposition with the economical situation of some groups. For the moment it seems
that the economic factor plays an important role in these activities, drugs traffic being a
quick way to make money, especially when there were no adequate legislative
framework- like it was the case with the chemical precursors.


       b) Analyses for the following substances


               •   Cannabis
       According to seizures data, it seems that cannabis is the most used drug in
Romania. Data from the demand reduction field confirm this assumption, also the
treatment centers data showed an overwhelming percentage of heroin users. The
possible explanation is that, due to some reasons (poor information mainly) cannabis is
not seen as a drug therefore is no use to ask for medical services if you use cannabis.
The data from the studies done in high schools or among young population support the
conclusion that cannabis was the most used drug in Romania in 2002. We have to
mention that most data were self-reported and that except Bucharest (where were
located around ¾ of the drug users in Romania), the treatment centers reported cases of
cannabis abuse.
The idea that cannabis is not a real drug- or at least is a “soft” one was encountered in
many debates (TV or radio) or written articles. It seems that most of the youth do not
have access or knowledge about drugs and about cannabis in particular- there were
many occasions when the subjects were convinced that in UE member states cannabis
is “legal” (mass-media debates, lyrics of some bands, interviews etc).
Also, we have to mention that it became more and more popular to grow cannabis at
your own house, trend supported by the large quantity of information available
(especially via Internet) about how to organize such crop. Therefore, the seizures can
reflect only a partial image of the cannabis abuse.
About the form used, the vast majority of cannabis users prefer to smoke it. Few cases
used hashish or other forms.



                                                                                            46
                            Hashish-cannabis confiscations (kg)



      20000

      15000

      10000
                                                                                         16300,69814895,3
                                                        13519
       5000             11181
            0,28 2,13           1579,5   40,36   4852           370,6   43,53   340,81
          0
          1991   1992   1993     1994    1995    1996   1997    1998    1999     2000      2001    2002




              •    Synthetic drugs


Very few data were available on this subject in 2002. The treatment centers reported
very few cases of synthetic drugs addicts and so did the studies in high schools or
among youth.
The reality could be different still and the fact that 3 clandestine laboratories were
discovered in Romania in 2002 is raising a question mark about the available data.
There were no studies among party- seekers or in the discotheques; besides, the price
of synthetic drugs like amphetamines is quite low and it seems that they are easy to buy
if you know the places.
Until the end of 2002 there was no adequate law about the precursors in Romania and
some criminal networks took advantage of this- reports indicated that especially foreign
citizens (Turks or Iraqi) tried to organize clandestine laboratories or manufactories
covered under import-export companies.
Not in the last place, Romania does have a good chemistry school and tradition in the
field and therefore here can be a profitable market for synthetic drugs networks.
The seizures data indicated a number of 133 517 pills confiscated in 2002 (compared
with 67210 in 2001 and 16 057 in 2000) and a total quantity of 2069 kg of precursors
confiscated (151, 86 kg in 2001). Also, were reported as found and dismantled 28
clandestine cultures in 2002 – 17 in 2001.
 Data about LSD and other hallucinogens are very scarce. For the moment it seems that
they are not among the favorite drugs on the Romanian market.




                                                                                                            47
       •   Heroin/opiates


If we consider the data from treatment centers, heroin was the most used drug in
Romania in 2002. The vast majority of these heroin users are from Bucharest, although
the exact figures were not known. The estimates ranged from 10 to 30/40 thousands
injecting heroin users only in Bucharest, but the data from the treatment centers were
much lower – about 1500 people addressed the centers for opiates addiction.
The available data in 2002- some NGOs’ studies and data from Public Health
Departments indicated that a lot of these heroin users had a risk behavior, especially
sharing needles and syringes. The lack of complete and adequate medical services was
a serious factor that affected the services and the programs offered for IDUS’. Also, the
lack of a unique coding system made very difficult the task of implementing the key
EMCDDA indicators.
From the mentioned data, it seems that urgent and coherent programs and preventive
campaigns are of most importance during the close future. It was a lucky situation that
only very few cases (about 10) of these heroin IDUS’s’ were reported as HIV positive- it
means it is still time for action.
Seizures data do not follow a specific trend- this can indicate maybe a lack of efficiency
in the law enforcement field (alternative transit routes/incomplete data etc.).



 500
 400
 300

 200                                                          412,3
                            348,97
                                                                                              202,18   253,391
 100
                    93,53                    103,4   117,92           63,63
  12,4                               54,48                                    52,94   33,45
  0          6,73
  1991       1992   1993    1994     1995    1996    1997     1998    1999    2000    2001    2002       2003
                                                                                                       (sem. I)




       •   Cocaine/crack


In 2002 there were just isolated cases of cocaine or crack users, a trend that followed
the last years’ trend. A possible explanation can be the price of cocaine, expensive for
most of the Romanian addicts, that can find much more cheaper drugs on the market.
It seems that this types of drugs (cocaine/crack) just were not “adopted “ by the
autochthones addicts, because the Romanian drug market is still young and without
stable patterns of use.
The seizures in this case followed the demand reduction data- small quantities (with two
exceptions 1993 and 1996), representing barely 1% of the total quantity of drugs seized
between 1991-2003 (first semester).


                                                                                                       48
                                                                                                   800

                                                                                                   600

                                          712,6                                                    400

                                                                                                   200

              17,7   105,66                       69,56
  13,2                        0   15,79                   1,2   9,67   13,14   2,756   2,726    5,378
                                                                                                   0
  1991               1993         1995            1997          1999           2001             2003
                                                                                               (sem.I)




   •     Multiple use (alcohol/pharmaceutical products/ solvents)

This type of abuse was characteristic especially for special groups- street children, other
people with poor economic situation etc. As we mentioned several times before in this
report, the alcohol situation was a serious one, due to the wide acceptance of alcohol
from the society and to the old habit of producing alcohol in households, in rural areas.
The pharmaceutical products- like benzodiacepines, stimulants, analgesics etc were
also used by some groups and the use of these substances was possible due to the
existing lacks in the control and reporting system from pharmacies (medical receipts,
selling of drugs etc.).
Solvent abuse was typical for street children- a group very present in mass-media in the
first years after 1990. In this field, many initiatives were developed by NGOs’ or
humanitarian foundations- mainly shelters, educational programs etc.
There are no data about the prevalence or use in general population of these
substances.

         7.          Discussion

                     7.1 Consistency between indicators

Although none of the key EMCDDA indicators was implemented in 2002, the available
data afforded us to draw some conclusions:
    • The number of drug users although unknown, is increasing- the two Rapid
        Assessments (1998 and 2001), the NGOs’ studies, the RHRN data etc- all
        indicated a continuous increase, trend accentuated especially in the last 2-3
        years.
    • The seizures support the assumption that Romania became a drug market and
        the number of addicts is increasing- only in 2002 the seizures were almost
        double than in 2001 (and in 2001 the seizures were 110% compared with the
        whole period 1990-2000).
    • The treatment centers data seemed quite unchanged since 2000- a possible
        explanation can be the lack of facilities (medical services/after care etc) and of


                                                                                                        49
    specialized medical services, which lead to an attitude of avoiding the centers
    and all that involved medical services.
•   The drug related deaths was another “blank” indicator- due to lack of proper
    medical equipment in the first place and to non-existence of an unique coding
    system the enlisted drug-related death number was very small (15 in 2001 and 3
    in 2002), figures that seemed to be substantial underestimated. There is difficult
    to make any connection between this numbers and other indicators.
•   The drug-related infectious diseases indicator can be divided in two main
    components- the first one about viral hepatitis (B and C) and the second one
    about HIV/AIDS. The data for VHB and VHC indicated an increasing trend,
    matching the studies about risk behaviors among IDUs done by RHRN and
    others institutions- Public Health Departments etc. The data about HIV are to
    some point difficult to explain- only 10 cases of HIV among IDUs+ were reported
    since 1996. Until now (2002) there was no explanation for this trend- and the
    percentage for VHB and VHB (40% respective 75%) add more questions about
    this indicator. Finally, other infectious diseases like STD, TBC etc were very
    difficult to estimate in Romania, because most of these disease were related to
    other risk behaviors (sexual relations mainly).
•   There were no data about problem drug users and about general population
    surveys- at least any national coverage data.
•   All the supply related data were of better quality, but there was no possibility to
    eliminate double counting. As a whole, the data from the supply reduction field
    support the previous assumptions: there is an increase in the number of drug
    addicts and the Romanian drug market is expanding. There was practically no
    indicator from the supply reduction field (seizures/arrests/convicted persons etc)
    that decreased in 2002- by contrary, in some cases the increase was almost
    100%.

           7.2 Methodological limitations and data quality

•   The most important limitations was the lack of an unique coding system, which
    lead to double counting and impossibility to use the data for further research- like
    it happened during the Rapid Needs Assessment. The databases from NGOs’ for
    example did not match the data from the Police or those from the treatment
    centers.
•   None of the five key EMCDDA indicators was implemented in 2002. Besides the
    lack of data and of funds, the unclear legal status of the National Focal Point
    added more pressure on this action- implementing a key indicator.
•   There was a lack of coordination, even between institutions working in the same
    field- like it was the case with the treatment centers and the Public County Health
    Departments or the National Health Insurance House in the demand reduction
    field or with the Border Police, Customs Office and Anti-drug Squad in the supply
    reduction field.
•   The definitions used for reporting the data were not the same- in fact, in almost
    all indicators there was no clear unique definition. Some indicators just did not
    exist- like it was the case with “drug-related petty crimes”; others were difficult to
    estimate because they relied on non-existing tools- for example the drug related
    deaths was supposed to be count from a General Mortality Register that did not
    exist.




                                                                                       50
        8.      Strategies in Demand Reduction at National Level

                8.1 Main strategies and activities

         In order to agree with the general objectives of the EU Strategy regarding the
progressive integration of the candidate countries in the line set out by the European
strategy and the intensification of the international cooperation with other countries and
international organizations and in order to have a clear program of action against the
drug phenomenon, Romania developed the National Anti-Drug Strategy for 2003 – 2004,
which was approved by Government Decision no. 154 of 02/06/2003.
         This strategy establishes measures specific of the field of activity, both for the
National Anti-Drug Agency and for the ministries and other bodies of the central public
administration and represents a completion of the organizational framework, of the
action coordinates of the institutions authorized to fight against drugs and a benchmark
for future projects and evaluations in this field.
         This Strategy, on short term, targets the development of a multi-sector approach
of drug problems and on long term envisages the reduction of the number of drug
addicted persons, as well as the increase of the national ability regarding the set up and
development of education, prevention and treatment services and their further
development and improvement and programs of illegal drug trafficking fighting, all these
in conformity with the objectives of the European strategy.
         The Strategy is divided on 8 different chapters that present the aim, objectives,
particular intervention areas, international cooperation, institutional and regulating
framework, information system, financing, and also evaluation of activities.
         Having as a main target the reduction of drug demand and supply, the National
Anti-Drug Strategy is ruled by governing principles which set out directions of envisaged
activities, such as: the principles of priority, equality, confidentiality, continuity, global and
unitary vision, complementarily of unitary coordination and cooperation among all
sectors involved.

                8.2 Approaches and new developments

    a) New and innovative approaches

    The National Anti-drug Strategy was the first strategy on drugs Romania developed
after 1989. The strategy tried to bring together both the state institutions and the NGOs’,
benefiting from the PHARE twinning program “Fight Against Drugs” (Romania-Spain-
Great Britain) 2002/2003. The strategy will be implemented by a coordinating body- the
National Anti-drug Agency, with support from all institutions working in the demand and
supply reduction field. As a matter of subordination, the Agency- including the Focal
Point will be placed under the authority of the Minister of Interior and Administration.

    b) Socio-cultural developments relevant to demand reduction

    The National Anti-drug Strategy objectives were split in two main chapters, according
to the main work areas- demand reduction and supply reduction. Each part has two
subparagraphs- general and specific objectives.




                                                                                               51
     I. Demand reduction

A. General Objectives:

1.      Reducing drug use and addiction among the general population.
2.      Diminishing the number of children and youths that start to use drugs.
3.      Diminishing drug use and addiction among persons who are in risky situation.
4.      Reducing the risks resulting from drug use and addiction.
5.      Diagnosing, analyzing and monitoring drug use.
6.      Legislative and institutional harmonization with EU regulations.

B. Specific Objectives:

a.      Reducing risk factors.
b.      Diversifying the means of preventing drug use.
c.      Promoting education for health among the population.
d.      Diminishing the accessibility of drug availability.
e.      Informing the population about the risks and the damages associated to drug
        use.
f.      Involving civil society.
g.      Developing co-ordination structures at the local and national level (National Anti-
        drug Agency)
h.      Improving the quality of prevention programs.
i.      Providing specific training for the specialists.
j.      Creating and promoting alternatives for spending spare time.
k.      Changing the public opinion and creating favorable attitudes for preventing drug
        use and abuse.
l.      Strengthening and developing the network of centers for preventing drug use and
        abuse in all counties.
m.      Developing the specific training courses in the university curricula.
n.      Creating the opportunities for an active involvement of the private sector by
        providing prevention and treatment of drug use and abuse.
o.      Periodically assessment of the preventing programs regarding the drug use and
        addiction.
p.      Developing and diversifying the co-operation between the national and
        international agencies having the same goal like drug use prevention.
q.      Developing the criminological studies on the data regarding the drug users and
        dealers.



II. Supply reduction

A. General objectives

a. Diminishing the drug supply by 30% in the next two years;
b. Diminishing the drug supply through permanent control of the drug supply;
c. Controlling the illegal production and trafficking by means of co-operation between the
state authorities having responsibilities in this field, as well as by means of co-operation
at the international level;


                                                                                         52
d. Legal and institutional compliance with Romania’s commitment to the process of EU
integration;
e. Participating to international programs in the field;
f. Diagnosing and monitoring the drug offer.

B. Specific objectives

a. Reducing risk factors;
b. Counter-balancing international drug trafficking by criminal organizations specialized
in drug production, transport and selling, and with structures in two or more countries;
c. Intensifying the control activities at the border crossing points;
d. Preventing and fighting drug distribution by final consumers – micro traffic;
e. Strengthening institutional co-operation at the national and international levels;
f. Diminishing the number of drug-related crimes;
g. Significantly reducing money-laundering techniques;
h. Diminishing drug accessibility and availability;
i. Involving civil society in the fight against drugs;
j. Developing and improving the co-ordination structures at the national and international
levels;
k. Training of the specialists in the field;
l. Changing of the public opinion and forming an attitude that would lead to the
operational notification of authorities by citizens, regarding persons involved in drug
trafficking;
m. Permanent evaluation of the carried out activities;
n. Providing appropriate financial resources for the application of the drug supply
reduction strategy.
o. Developing and diversifying the co-operation between the Ministry of Justice and
other national and international institutions, which have as an objective the fight against
drugs trafficking.


   c) Developments in public opinion-no available data yet

   d) New research findings- no available data

   e) Specific events during the reporting year- no available data. Observation- the
      National Antidrug Strategy was officially adopted in February 2003, so there was
      no time in order to evaluate or to make any comments about it.

       9.      Prevention

               9.1 School programs

The Ministry for Education, Research and Youth initiated and developed, during the
school year 2002- 2003 through its territorial structures, national and local programs for
prevention of drug abuse and addiction. In order to do this, it was initiated the “Health
Education in the Romanian School” Pilot program which focuses on the presentation
within the class hours of a topic regarding toxic substance consumption and abuse. This
program was implemented in Bucharest and in 15 counties, taking place in 123 school
units, the direct beneficiaries of the program being 120 school teachers and 3,500
students.


                                                                                        53
“Barbacana” Drug consumption prevention program unfolded within the “Drug
Fighting” twinning project between Spain and Romania and it was implemented in
Bucharest (35 school units), Iasi (20 school units), Cluj (16 school units), Sibiu (13
school units), Timis (16 school units), Constanta (21 school units), implying the release
and distribution of 500 guides intended for the use of teachers, 500 video cassettes and
20,000 manuals having educational and preventive contents intended for the use of 7th
grade pupils.
        At the level of educational units in the country there continues to be enforced
“The National Program for Prevention and Fighting Juvenile Delinquency, and Drug
Consumption, for Observance of Traffic Regulations, and of Fire Prevention and
Extinction Regulations, for Information and Action in Case of Natural Disasters” passed
by the Ministry for Education, Research and Youth by the notification no.
40355/22.09.2000. Students are informed about the characteristics and effects of drug
abuse also within the counseling classes, as this topic is present in the methodological
guide “New Benchmarks of the Educational Activity” released by the Ministry for
Education, Research and Youth.




               9.2 Youth programs outside school

         The Ministry for Education, Research and Youth supervised and coordinated
the implementation of local programs for prevention of drug abuse at the level of 30
county school inspectorates. Thus:
By means of local projects of prevention, information, education and
consciousness raising, in partnership with public institutions and non-governmental
organizations, materials have been produced for information and education intended to
prevent the drug abuse in Bucharest, Botosani, Timis, Hunedoara, Harghita, Ialomita,
Tulcea, Galati, Constanta, Olt, Calarasi. This program also included other 7 local
projects of volunteer training, based on the issues specific to the students
environment, as well as 7 local projects of training in the primary prevention of drug
consumption and other categories of professionals (school –doctors, family
practitioner, policemen, pharmacists, teachers of biology, sports, religion). Within the
leisure activities program there have been organized based on anti-drug topics,
quizzes, essays, letters, drawings, Web pages (Bucharest, Cluj, Arges, Botosani, Vaslui,
Tulcea, Ilfov, Constanta), sports competitions (Constanta, Bucharest, Calarasi),
exhibitions (Timis, Vaslui, Bucharest, Mures), shows (Calarasi, Cluj, Vaslui) and other
activities within school camps in the Bistrita Nasaud county.

Training programs (initial and continuous) of professionals working in the drug
consumption and abuse prevention field

        The 3 months’ “Health education” training course that includes also the topic on
the prevention and fighting the illegal drug consumption was founded by the order of the
Ministry of Health no. 497/1999.
        The managing staff within the Health Promotion Services and Health Education
Programs within the county public health departments graduated the courses organized
of which benefited 117 specialists. It is of major relevance the fact that at present
Romania has a network of experts, consistently trained fact that allows them to perform
specific activities, in accordance to the international requirements in the field of public


                                                                                        54
health. This training and specialization mechanism is also operative for other categories
of medical and non-medical staff within the Ministry of Health as well as within other
Ministries, institutions and governmental and non-governmental organizations that need
to or want to perform health promotion and education activities.
        As for the Ministry for Education, Research and Youth, the territorial
structures developed programs for the continuous training of experts in the drug
consumption prevention field, by organizing 9 local sessions of training of teachers
(Bucharest, Harghita, Calarasi, Galati, Constanta, Valcea, Cluj, Maramures, Mures,
Brasov), as well as in other 18 specific activities, consisting of round tables,
symposiums, seminars, debates (Bucharest, Vaslui, Harghita, Cluj).


              9.3 Family and childhood

        Considering the crucial role of the family in the child’s socialization 2
training projects were carried out in the counties of Harghita and Ilfov, intended for
parents so that effective anti-drug education methods could be known and applied in the
relationship with their own children, and in the counties of Ilfov, Mures, Dambovita,
Harghita and the City of Bucharest local prevention projects intended for parents
focused on information and awareness campaigns regarding the effects of uncontrolled
abuse of psychoactive substances.
        In the counties of Botosani, Harghita, Mehedinti, Caras Severin, Mures, Calarasi,
Dolj, Covasna, Vrancea 10 local studies were completed regarding the level of the
students’ knowledge about the main risks of drug abuse and their attitude about the drug
addicts.

              9.4 Prevention in recreational settings

Prevention activities within the law enforcement field aimed mainly at the following
fields:
• Increase of gendarmes and public order patrols, in the areas with high crime risk –, in
   order to prevent and discover persons likely to perpetrate this type of crimes, by
   means of raids, searches, investigations, guards and operational surveillances;
• Actions and checks in and within the educational institutions, bars, night clubs;
• Checks and controls in the pharmaceutical units supporting them to organize their
   registers and keep safe the medicines containing narcotics
• The initiation and setting of partnerships, having financial support and field
   counseling, with different segments of the society in the purpose of developing timely
   activities for preventing the illegal trafficking and drug consumption, in susceptible
   places and environments where such violations are committed;
• Set up within the General Police Department of Bucharest and at the level of sectors
   of a structure specialized in catching in the act of persons perpetrating trafficking,
   procuring and prostitution offences;
• The analysis of the data and information obtained from various sources with a view to
   drawing up crime maps, central elements in the design and implementation of
   community prevention strategies.

         Within the Ministry of Administration and Interior, departments having
informational –operative competence trained their staff, at central level as well as at
territorial level, up to local police chiefs, in order to broaden the work forms and



                                                                                      55
methods, like collecting information regarding the places and environments where drugs
are traded, as well as about people involved in such trafficking and consumption
operations. Moreover, 50 staff members of the Police Headquarters of the County of
Valcea attended a training course with the topic of prevention of and fighting drug abuse
and trafficking.
        In the educational units (The Police Academy “A.I. Cuza”, Police agents School
“Vasile Lascar” in Campina, Post – University Studies Center in Bucharest, Training
School for Border Police Agents “Avram Iancu” in Oradea, the Military High- School
“Constantin Brancoveanu” in Ploiesti, the Center of Training and Specializing the
Instruction of Police Agents “Nicolae Golescu” in Slatina School for Trainers, Breed and
Training of Service Dogs in Sibiu), depending on their specific features and program anti
-drug training and specialization courses are organized and within the field disciplines
specific topics are approached on the issue of reducing the drug demand and supply.
        In partnership with the County School Inspectorates information courses for
teachers were held on the methods of presentation, aid and intervention in case of
potential consumers or of drug addicts and there were organized meetings of policemen
and school units principals in 15 counties, for the purpose of familiarizing with the anti-
drug issue (Dolj, Salaj, Vrancea, Caras Severin, Iasi, Constanta, Giurgiu, Alba, Braila,
Sibiu, Mures, Prahova, Covasna, Hunedoara, Cluj).
        With a view to performing the activities set in the “Program for Preventing
Illegal Drug Consumption among Young People”, developed in partnership with the
Capital’s Prefecture and the Bucharest Municipality School Inspectorate, the prevention
officers within the General Police Department of Bucharest carried out specific activities
with over 3,000 students and 500 teachers.

       10.     Reduction of drug related harm

        The National Antidrug Strategy adopted in February 2003 does mention harm-
reduction activities in two chapters- one is about “Medical and psychological assistance,
rehabilitation and social reintegration” and speaks about implementing harm- reduction
programs (syringe exchange) under the coordination of Ministry of Health and the
second one is in the chapter regarding the Ministry of Justice- the General Directorate
for Penitentiary is suppose to develop harm-reduction programs inside the penitentiaries.
The current Romanian legislation regarding the harm reduction programs is unclear at
some points- so until now all harm-reduction activities were developed by NGOs’
(although these NGOs’ were partially financed from the state budget) except the
Independent Medical Service from the General Directorate for Penitentiary- Ministry of
Justice.

        All institutions involved in harm-reduction activities joined to form Romanian
Harm-Reduction Network - RHRN in the beginning of 2002. The network has a web site
and performed also some research activities among drug users in Bucharest. The main
objective of the RHRN is to reduce the risk behaviours among the IDUs by promoting the
cooperation among the institutions in the field and by improving the overall quality of
services offered to drug addicts. The most important target group is the drug addicts,
followed by people working in the field, other state and private institutions etc. The
RHRN was involved in elaborating the daft of the National Antidrug Strategy- fall 2002
and is suppose to cooperate with the future National Antidrug Agency. During 2002 most
of the organizations from the RHRN exchanged data and information with the Romanian
National Focal Point, including data used to elaborate the 2002 National Country Report.



                                                                                        56
Range of services-most NGOs’ reported services like:

•       Train specialists in outreach work;
•       Edit and distribute informative materials like leaflets, booklets, posters, web
        pages etc;
•       Establish direct contact with drug users, especially on the streets; gathering data
        about them and about their problems;
•       Syringe and other materials exchange;
•       Psychological and psychiatric counselling;
•       Data collection and data analyse;
•       Guiding clients through specific medical services;
•       Peer support;
•       Change public perception and public attitude towards drug users and infected
        drug users;
•       Other kind of harm-reduction programs;

Network between HR professionals- the Romanian Harm Reduction Network began its
activity in 2002, joining organizations from Bucharest, Timisoara (Western Romania) and
Constanta (Black Sea Harbour). The web address (pages both in Romanian and in
English language) is www.rhrn.ro

a)   Role of harm reduction within the national drug policy/strategy
•    Definition and priority
•    Recent policy trends (past 3 years)
•    Current public/professionals discussion5

b) Harm reduction practice
• Key – objective
   To prevent the spread of HIV infections and STD’s through unprotected sex, injection
   drug use
   Promote access to the testing programs for HIV and other STD’s among drug using
   population and their sexual partners
   Promote healthy behaviors by encouraging access to, and use of, condoms and
   clean syringe, as well as education on safer sex and IDU practices
   Lobby and advocacy for developing social and medical services for IDUs
   Working in network with all other services providers for drug addiction and HIV
   prevention programs

•    Targets: groups, drugs, risk behaviors

Groups: iv drug users
Drugs: heroin (mainly), and fortral in some areas from Romania
Risk behaviors:
- Sharing the equipment for drug use (especially syringes, but also the other parts of
the equipment are used in common – like filters, recipients, etc)
- Unsafe sex behaviors (with one or multiple partners)
- Using the drugs in hidden areas, due to the fear of police, fear of being caught by
    family members or friends




                                                                                         57
•    Staffing

c) Range of services

Needle exchange programs

In Romania only nongovernmental organizations implements needle exchange
programs, with international funds. In this moment 4 NGOs (3 in Bucharest and 1 in
Constanta) are developing this kind of projects. The services offered through needle
exchange program from Romania are:
- syringe distribution and exchange
- sterile equipment distribution (swabs, distilled water etc)
- condom distribution
- IEC materials distribution related to the risks associated with intravenous drug use
- Risk reduction counseling
- HIV, hepatitis B and C, STD, pre- and post counseling and voluntary testing
- Vaccination for Hepatitis A and B

Methadone centers6

d) Networking between harm reduction professionals
In Romania harm reduction programs are developed and implemented only by non-
governmental organizations, with international funds, mainly Open Society Foundations.

                RHRN

The Romanian Harm Reduction Network was set up in January 2002, as the first
network of Romanian NGOs and GOs working in the field of harm reduction for
intravenous drug users in three important Romanian cities, Bucharest, Constanta and
Timisoara.
The main and long-term goal of the project was to contribute to the efforts of the
Romanian government in HIV/STD, Hepatitis B & C prevention and control, with
particular attention to a high-risk group – IDUs. This objective was based on the National
HIV/AIDS Strategy for 2000 – 2003, with a stress on the five priority areas identified in
the Situation Analysis and Response Review, namely: youth, vulnerable groups
(commercial sex workers, men who have sex with men, IDUs, prisoners and Roma
communities), nosocomial infection control, health care and social support, testing
policies and surveillance.
Partners:                                      Steering Committee

1.   ARAS                                   1. Maria Georgescu
2.   ALIAT                                  2. Carmen Mihalcea
3.   Salvati copiii (Save the Children)     3. Simona Zamfir
4.   Adolescentul                           4. Michaela Nanu
5.   Timisiensis XXI                        5. Tiberiu Felber
6.   Armonia                                6. Tiberiu Ormos
7.   Open Doors                                     7. Sorin Petrea
8.   General Directorate of Prisons         8. Emanuel Părăuşanu




                                                                                         58
9. Stay Alive                                 11. Augustin Munteanu


e) Co-ordination of national polices and local practices

                10.1   Description of interventions

a) Outreach work in recreational settings (definitions and delivery of services)

Outreach = a community based activity with the overall aim of facilitating improvement in
health and reduction in the risk of HIV transmission for individuals and groups not
effectively reached by existing services
ARAS had developed the only project based on outreach activity and which targets the
commercial sex workers and drug using population from Bucharest. The project is called
“Night by Night” and the services that are delivered through the project activities are:
- Distribution of IEC materials
- Syringe exchange and distribution of the clean equipment for injection (swabs,
    distilled water, etc)
- Condoms distribution
- Hygienic products distribution
- HIV, hepatitis B and C counseling and testing
- Risk reduction counseling

b) Prevention of infectious diseases (delivery of services, at city level/in rural
     environment)
• Dissemination of information/education materials
In Romania RHRN develop a manual for services providers – “Risk reduction associated
with injectable drug use” (ARAS, Bucharest 2003). In the same year, also from RHRN
initiation, it appeared a guide for the iv drug user. These two materials are disseminated
through the NEPs of the organizations members of RHRN (ARAS 2003).
Since 2002 also RHRN realized a periodical newsletter. The articles are making referrals
to the harm reduction services (NEPs, methadone centers etc), to the lesson learned
and best practices, to the participation of different conferences etc.

•   safer use training – YES

All the organizations that are delivering NEPs trained their stuff in the safer use and risk
reduction counseling. Also, members of the teams participated in different international
trainings on these topics, especially with the help of Open Society Institute. In this way,
every organization from RHRN has at least 1 person who has a diploma for trainers of
trainers in harm reduction issues.

• outreach to problem drug users, groups at risk -YES
ARAS project called “Night by Night” is delivering the services (except HIV, hepatitis B
and C counseling and testing) in outreach. The target group is female sex workers and
IDUs from the community.

c) prevention of drug related overdoses
• examples of “policies” in overdose prevention
• examples of specific projects (heroin/other opiates, stimulants)



                                                                                           59
•   projects in high – risk settings (eg release from the prison)
•   documentation, evaluation results, research7

d) users rooms/ safe injection rooms (definitions and delivery of services)
• state of the situation
• list of all services
• key – objective
• user profile
• staffing, budgets
• documentation, evaluation results, research studies
Don’t exist


               10.2    Standards and evaluations

a) Existence of professionals standards on HR interventions
It is not a political instrument. The NEPs are based on the international standards for
this kind of interventions. The indicators used are based on the EU and UNAID
indicators that Romania reports.

b) Evaluation studies of HR measures (if not already not covered under 10.1), give
    references
RHRN realized in 2002 a qualitative survey, which contained also a part for evaluation of
the projects.

c) Training of staff in HR techniques: organization, access, target groups for training
d) Major research projects on HR topics carried out in past five years; amount of public
    research funding available in 2002.
2 rapid assessments of the situation of the iv drug using population were made: one in
1998, and one in 2002.
The Interministerial AIDS Commission of Romania conducted the one from 2002.

       11.     Treatments

               11.1     “Drug free” treatment and health care at national level

a) Objectives and definitions

There were no specific guidelines for drug-free or substitution treatments in 2002-
although this problem was raised several times by people working in the field. The
physicians treated the addicts based on the training received during their post-
graduation courses, on therapeutic guidelines downloaded from Internet and of course,
on their previous professional experience. There was no legal obligation for physicians
working in these treatment centres to have a specific background (apart from being
specialized in psychiatry) or to graduate any other type of course. The auxiliary staff-
psychiatrists, nurses, social workers, psychotherapists etc lacked specific experience in
the field, were generally poor paid and they had few motivations to do their job.




                                                                                      60
The total number of units who did detoxification in 2002 varies depending on the
reporting institution- Ministry of Health and Family/National Health Insurance House/
Public Health Department etc. A possible explanation can be that apart from specialized
units (hospitals “Al. Obregia” and “Sf. Stelian”), treatments can be performed in almost
every psychiatry unit- sometimes reported as specialized treatment centre. Some of
these centres were either specialized as social shelters either dealt exclusively with
alcohol addicts.
The family doctors were also entitled to act not only as health specialists but also as
educators- counselling/health education/risk behaviours etc. for their patients- at least in
theory. There were no records from family doctors and it is not sure whether this type of
activity was really effective.

b) Criteria of admission

The law 143/2000 through its regulations, describes three types of situations when an
addicted person can be admitted in a specialized centre:
   • emergencies (like withdrawal situations)
   • on personal demand (the addicted himself or his/her legal representative)
   • indirect request (by other persons)

In the first situation there is no need for medical or legal expertise and the addicts will
just follow the medical services recommended without other enquiry. Due to the specific
situation- medical emergency, there is no need for any agreements from the patient or
his/her legal representative and the patient can be admitted in the treatment centre
based on any type of personal paper, even without photo.
The personal request (or through legal representative) is also not followed by any further
police investigation, but there here there is a legal provision- only twice a year can such
persons address for medical services.
The third case is somehow unclear- the law did not mention anything about
confidentiality, for patients brought to treatment units by other persons or institutions- like
police for example. According to the medical ethic, these persons are also patients and
therefore their files are confidential and only when there are a juridical decision these
files can be disclosed.

c) Availability, financing, organization and delivery

All drug addicts are treated according to doctor’s professional experience. There was no
special training during the university studies or after graduating for drug addicted
treatment or drug addicted health care until 2000. Only in 2001 a post-university
specialisation was developed for psychiatrists, called “ Toxic-dependence”. Most of the
units reported a lack of specialised personal.
In 2002 there were two such centres in Bucharest and other several centres outside
Bucharest (Jebel- Timis, Socola- Iasi, Tg. Mures etc), but in some cases the centres
focused mainly on treating alcohol-addicted patients. Statistics data from most of the
centres were raw data and in some cases contradictory. Some patients come directly
from emergency rooms where they were treated for overdose intoxication. The proposed
duration is 3 weeks and prolongation is possible. A therapeutic contract is made with
each patient, who is free to leave at any stage of the treatment- except of course the
withdrawal symptoms, but is not allowed to receive visits. Treatment is mostly
symptomatic, using Clonidine, analgesic and anxiolitic medications; it also includes
group therapy. Many patients are admitted repeatedly which indicates a high relapse


                                                                                            61
rate after discharge. No patient was so far ready to continue treatment as offered in the
rehabilitation centre of Balaceanca. Currently there is a waiting list, the waiting period
being around 2 weeks.
All medically supervised treatments are covered by the health insurance scheme and
paid from the budget of the National House and the County Houses for Health
Insurance.


d) Evaluation results, statistics, research and training

Systematic documentation of patients and evaluation of services is not developed. The
current legislation (143/2000) lacks precision in some cases- like what is happening with
addicts who do not want to follow a medical treatment, who is entitled to ask for a
medical expertise in case of a suspect person and what is suppose to happen with this
person, what shall do a medical unit or a treatment centre in case they know about an
addicted person etc.

Basic training and continued education in substance abuse treatment is not included in
the curricula of the relevant professions. There is a shortage of specialised professionals
in this field, especially of people trained in statistics or epidemiologists.

There were no significant studies done in 2002 by the people working in treatment
centres. All data were reported to the Public Health County (or Bucharest) Departments
and from here to the Ministry of Health and Family.




               11.2   Substitution and maintenance programs

   a) Objectives for substitution treatment

There were three methadone maintenance clinics in 2002, all located in Bucharest.
 Patients come after hospitalisation in a detoxification centre and must be referred from
there. There is no waiting list. Frequencies increased from 30 to 120 patients per day.
Recent legislation allows for maintenance treatment without restriction of duration.
Ancillary services (psychotherapy, social work, counselling of parents) are available as
stipulated in a ministerial order (Ministry of Health no 963/1998).
Some of the current rules and practices seem to be problematic when seen from
international research evidence. Patients who continue to inject heroin are excluded
from the program- all the patients are tested for heroin during substitution. In this case,
after spending three months following other types of treatments, the patient can be re-
admitted in a substitution program. The only available form of Methadone is tablet.
Overall, there is no standard protocol how to run methadone maintenance and no
systematic continued education of staff.
If the client wish to follow a substitution treatment with another substance than
methadone- for example, buphenorphine, theoretically it is possible with the express
condition that the client covers the expenses. Also, some arrangements have to be
made with the custom office- for importing the substances, with the hospital and so on.
Practically, this is a very difficult scenario, but we have to repeat that it is possible.


                                                                                        62
Also, the funding of methadone maintenance, the linkage to other services and the legal
basis seem to need improvements. Overall, there is no specific Romanian standard
protocol how to run methadone maintenance and no systematic continued education of
staff. On treating the patients, doctors are based on the Romanian Pharmacopoeia- that
allows a maximum dose of 100 mg of methadone, on foreign guidelines downloaded
from Internet and on their previous education and experience. All medically supervised
treatments are covered by the health insurance scheme and paid from the budget of the
National House and the County Houses for Health Insurance. Also, this type of services
can be founded from National Health Programs, approved and detailed by the Ministry of
Health and Family.


   b) Criteria of admission

The annex of the law 143/2000 states several situations when a person can be included
into a methadone maintenance program:

           •   Diagnosed positive for narcotics (ICD code F10-19) and age over 18
               years old (persons under 18 years old can be included only with the
               agreement of their parents)

           •   At least two years of addiction

           •   3 associated non-substitutive detoxification cures failed

           •   Drug- related diseases (HIV/VHB/VHC/ heart failure/ severe mental
               disorders)

           •   Pregnant addicted women

           •   Multiple addiction

There is a responsible for each program and the law entitled this responsible with great
powers. The final decision for inclusion or no into a substitution program belongs to the
responsible- compulsory a specialist physichiatrist, working in a sanitary unit authorised
by the Ministry of Health.

Each person included in such methadone program has to receive a special identification
card and the program can continue even if the addicted person is implead or is
hospitalised in other department for other affections. Here the law states that the
program responsible has to be informed about these situations, but there is not clear
who has this obligation.

A person can be excluded from the methadone substitution program if he/she has three
positive results, for other medical reasons or on own request. After such a decision is
taken, a further reinsertion in a program can be re-discussed only after at least three
months.

   c) Availability, financing, organization and delivery of substitution treatment
      services




                                                                                       63
The only form of methadone registered in Romania in 2001 was SINTALGON, 2.5.
mg/tablet. The producer is SC SICOMED SA that delivers the product to the
pharmacies, public and hospital, on basis of an authorization for dealing with narcotic
substances shown by the respective unit.
The product is stored in pharmacies inside the special cabinet for narcotic substances,
sealed (labeled “VENENA”) and a quantitative record is kept according to the current
legislation (see 16.10.3).
In order to prescribe such drug, a physician is required to have a legal authorization from
the County Health Department.
This program was also financed form the budget of the National House and the County
Houses for Health Insurance.
As we mentioned, in 2002 three methadone maintenance centres were available in
Romania, all three located in Bucharest.


   d) Substitution drugs and mode of application

Only methadone tablets were available in the substitution centres in 2002. There were
no treatment standard guides- as we explained in the first part of this chapter.

               11.3    After care and reintegration

   a) Links with National Strategy and legislation

Drug-free residential rehabilitation is offered in specialised rehabilitation centres in
“Balaceanca” Psychiatric Hospital and in “Socola”, Iasi, although some NGO’s
developed some centres- in Oradea or Sibiu, destined mainly for alcohol users.
The centre in “Balaceanca” was recently (2001) completely renovated and has 25 beds
on a closed ward. As a rule, patients are high school students and have problems with
heroin, other narcotics or benzodiacepines. Admissions are voluntary. Aggressiveness
and a strong desire to go home are frequent, especially after admission, while the
patient’s families urge staff to keep the patients. Staff has a low opinion of patient’s
motivation to change, while few efforts are made to activate the patients. Their daily
activities are quite monotonous; they have hours of television and can engage in some
physical exercise. Many staff has no training regarding substance dependence and
seems to prefer some other job. The centre lack specialised personnel, especially
psychologists and social workers. Generally, the people working in the centre- like their
colleagues from treatment units do not have financial or professional motivations (poor
wages/work in special conditions- stress, drugs etc) therefore it is difficult to hire and to
keep good professionals.
The communication between the rehabilitation centres and the rest of the units involved
in the treatment circuit has definitely to be improved.
The new National Antidrug Strategy 2002-2004 identified these problems and in the
Demand Reduction Chapter mentions the need for developing the entire therapeutic
circuit according to the EU standards.

b) Objectives, definitions and concepts of reintegration

This centre offers services for post-cure only since 2000. It has a short experience and
no clear treatment guide or program is developed yet. Few drug users know about its




                                                                                          64
existence, so clearly the communication with the rest of the institutions involved in detox
has to be improved.

c) Accessibility for different target groups

There is no limitation for any person or group willing to attend the centre. Still, most of its
patients are high school students, especially males and they clearly lack the motivation
for attending the centre and following the cure.

d) Organization, financing, managing, availability and delivery of services

All medically supervised treatments are covered by the health insurance scheme and
paid from the budget of the National House and the County Houses for Health
Insurance.

e) Statistics, research and evaluation

No systematic studies were developed in 2002. Most of the opinions agree with the fact
that the rate of relapses is high; social and economic factors are often involved and
further efforts and programs had to be focused on this field.

       12.     Interventions in the Criminal Justice System

       Detained drug consumers represent a special current situation. The assistance
structures intended to this special category of addicts operates only at the level of pilot
projects, as they are too low in number and location with regard to the exponential
growth of the imprisoned persons.
      The admission in the penitentiary system does not require the test for identifying
the drug metabolites in blood or urine in case of criminally convicted persons.
Consequently, the statistics data referring to consumption are based exclusively on the
self-reporting of the convicts, in 2002 being registered 1540 such persons.
        The increase trend of the persons confined in penitentiaries, previously assisted
by detoxification treatment, indicates an alarming situation by the association of drugs
with crime, the statistics indicating for 2000 an average of 2.778 to 1000 convicts,
21.285 in 2001 and of 30.48 in 2002.


               12.1    Assistance to drug users in prisons

The Independent Medical Service from the General Penitentiary Directorate, Ministry of
Justice, developed the medical assistance and prevention programs in penitentiaries in
2002. The Independent Medical Service is also member of the Romanian Harm
Reduction Network (RHRN).

Two main programs were implemented in prisons, targeting mainly the drug users:

   •   The program for preventing and fight against drug traffic and drug abuse in
       prisons

   •   The program for preventing HIV/AIDS and other STD in prisons



                                                                                            65
Beginning with 2001, the General Penitentiary Directorate started an activity in order to
increase the overall quality of the medical services in penitentiaries, through
reorganising the 5 penitentiary hospitals existing and setting up a new hospital destined
mainly for surgery. An external loan of about 20 000 000 USD was used to endow the
penitentiary hospitals with high performance medical equipment, including drug testing
devices.

The “Program for preventing and fight against drug traffic and drug abuse in prisons”
was designed in order to inform and train the medical personal (physicians, nurses,
psychologists, social workers) from penitentiaries about drug abuse and health effects.
This program was set up due to the continuous increase- even if the data were self-
reported, of the number of drug addicts in prisons (139 in 2000/1065 in 2001 and 1540 in
2002). For 2003 it is supposed to open a special detoxification section in the Rahova
Penitentiary Hospital.

The “Program for preventing HIV/AIDS and other STD in prisons” due to the special
interest paid to HIV/AIDS problem, was developed earlier- for example in 1996 the
medical staff from penitentiary hospitals attended a training session organized and co-
financed with UNICEF and since 2000 was elaborated another program called
“Prevention and management of HIV/AIDS in penitentiaries”. The Institute for an Open
Society, New York, financed two projects in this program:

   a) “Education for prevention of HIV/AIDS in penitentiaries” in 2000-2001, with a 50
      000 USD grant. This program developed activities in the field of epidemiological
      surveillance, peer education, counselling for HIV positive and testing for HIV.

   b) “We care…do you”, program financed with 24 098 USD, between 2002-2003.
      This program- still running at the end of 2002 was designed mainly for peer
      education services.

Also, beginning with September 2002, together with Romanian Association Against
AIDS (ARAS) – began a program called “Acces”, financed with 51145 Euro- program
that intends to promote peer education among prisoners, inform the medical staff and
promote prevention programs against HIV to policy makers in Romania.

              12.2    Alternative to prison for drug dependent offenders

In 2002 there were no alternative offered for imprisoned drug addicts- social housing,
probation programs etc. The existing legislation stated only that:

   •   That person who, before initiating criminal prosecution, denounces to the
       competent authorities his/her participation in an association or agreement to
       commit any of the offences provided for under Articles 2-10, thus making easier
       the identification and infliction of criminal liability of the other participants, shall
       not be punished.
   •   That person who has committed any of the offences provided for under Articles
       2-10 and, who, during criminal prosecution, denounces and facilitates the
       identification and penal prosecution of other persons who have committed drug-
       related crimes, shall benefit from the reduction to a half of the statutory penalty
       limits.




                                                                                            66
              12.3    Evaluation and training

Since most of the prevention and training programs began in 2001/2002 there were no
data available about this subject. As yet, there is no legal obligation for any convicted
person to declare his/her addiction before imprisonment.

       13.    Quality assurance

In 2002, beginning with April, the National Focal Point on Drugs was located in the
Institute for Health Services Management, Ministry of Health. Its legal status was quite
unclear, therefore the data collection process was hindered- especially the data from the
supply reduction field.

There was practically no possibility to check the available data and to eliminate double
counting. None of the 5 key EMCDDA indicators was implemented and most of the
institutions involved in the demand and supply reduction field did not use the same
definitions.

The National Focal Point was not very well known, both among drug addicts and people
working with addicts and among policy makers. Its resources were scarce and there
were little possibilities to organise seminars or training courses.




       14.    Evaluation of Drug National Strategies

There was no national strategy on drugs in 2002. In October 2002 a first draft of the
National Strategy on Drugs 2002 was presented but the Strategy was officially promoted
in February 2003. The objectives of the Strategy are divided between the involved
ministries and deadlines are established for all these objectives and activities.




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