economic analysis of drug addiction 2012
TRANSCRIPT
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Economic analysis of drug addiction(examples from Bulgaria)
J asmine Pavlova, Lora Afanasieva, Dimitar Popov, Gabriela Ivanova(abstract)
BackgroundNowadays Bulgarian population is facing a number of challenges: economic crisis, demographic ageing
and bad general health status.The global burden of mental disorders can be assessed in four ways: prevalence, burden, inequities in
the distribution and their impact on other health conditions.Drug use is a significant health and social problems for the world population. The European Union has
more than 2 million problem drug users. The incidence of HIV/AIDS among this contingent represents a majorchallenge to the public health.
Purpose:To examine the social and economic reasons for drug abuse and its impact on the society; to suggest
how problems of drug abuse prevention and control can be addressed in a constructive, coordinated manner.A study of injecting drug users is conducted in 8 large and medium cities during 5 years period.Results and discussionAuthors study the socio-economic conditions and analyze their impact on the mental health and drug
addiction. About 5% of Bulgarians have tried any drug. There are a large number of heroin addicts and someexisting treatment programs. The implementation of a comprehensive new treatment program for heroin addictsis indispensable. Interdependence between life standard, level of education and health status is found out.
ConclusionSerious obstacles to access to health care are the reduced incomes and the increased economic
vulnerability of the population. Bad economic and health status are bound into a vicious circle whereunemployed people remain out of the health aid scope. As a result poor peoples health limits their access to thelabor market, increases their poverty and social isolation. The limited financial resource for the health system hasto be allocated and spent more effectively.
Treatment of Addiction is insufficiently accessible and effective. Many of the existing treatmentprograms are private and are therefore financially inaccessible to users.
Drugs history shows that they are used since ancient times. First
descriptions around 4000 BC mention how Sumerian tribes are extracting the
Opium poppys (Papaver Somniferum) juice and were using it as drink and
nutrition supplement. In Egypt the opium was used around 2000 BC. The word
opium has Greek etymology and means juice. Important civilization stages
are related to rituals and customs involving usage of some kind of drugs. One of
the most important reasons drugs use to become a problem is the interconnection
with money and euphoria. It is registered in the beginning of 19th century with
the mass-production of narcotic (opiates) substances all around the world after
1878. Lately it becomes one of the serious problems for humanity known as
The opiums wars. With their desire to increase benefits, European traders try
to access the traditional spiritually oriented Asian Fortresses especially India
and China. While the English East Indian society trades actively with India,
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the goods exchange with China is exclusively unilateral. England had to pay the
silk and tea from China only with silver. The humble Chinese on their side
didnt need any of the English goods. Thats England became with negative
trade balance. In 1794 Chine forbid the opium import in the country. Beside this
order opium trading continued and in 1837 it reaches more than 43 000 trunks
per year with average price per item around 700 silver dollars. The opium
dependence spread around all the country and reach up to 90% of the
population. The irony of the worlds history is that former users are becoming
todays dealers. It is supposed that China is one of the largest producers of
opium nowadays with presumed amount of 6000 to 8000t/year. Behind this
historical irony is hidden a considerable change opium became a world tradegood. Nowadays Afghanistan is one of the largest producers. Considering the
UN report, after the Talibans regime fall in 2001 there is high production
growth and it reaches about 60% of the GDP of the country.
Nowadays Bulgarian population is facing a number of challenges:
economic crisis, demographic ageing and bad general health status.
The global burden of mental disorders can be assessed in four ways: prevalence,
burden, inequities in the distribution and their impact on other health conditions.
Drug use is a significant health and social problems for the world population.
The European Union has more than 2 million problem drug users. The incidence
of HIV/AIDS among this contingent represents a major challenge to the public
health.
In the beginning of the new millennium Bulgaria faced the growing
problem with drug abuse and addictions which was getting more and more
serious in the first years of transition. Thats why in 2003 the government
elaborated a National strategy against drugs with an executive program with 5
years (2003-2008) duration. We analyzed this programs database and compared
its results with the actual information.
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During last years in Bulgaria there have been many researches of the drug
dependant people group. The purpose is to examine the social and economic
reasons for drug abuse and its impact on the society; to suggest how problems of
drug abuse prevention and control can be addressed in a constructive,
coordinated manner.
A study of injecting drug users is conducted in 8 large and medium cities during
5 years period. This allowed making demographic and socio-economic profile of
the group. At first place drug use compared between genders shows that male
users are 4 times more than females (Chart 1), which again demonstrates the
cultural basis of the phenomenon.
20032005
2007
Female
Male0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Chart 1. Drug users by gender
Female
Male
Female 20% 17% 17%
Male 80% 83% 83%
2003 2005 2007
The research in Sofia, Plovdiv, Varna and Kjustendil shows that around23% of the group belongs to the roma ethnos and 7% of the users declare
Turkish ethnicity (Chart 2.).
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Chart 2. Users by ethnic group
70,30%
23,10%
6,60%
Bulgarians
Romas
Turks
In comparison to the stable state of genders participation there is a clear
change in the age structure of the group with a tendency of increasing the part of
people administrating i.v. drugs with higher age and less younger subjects
(Chart 3). The tendency that the group is getting older is even more obvious if
we compare the average age of the users by years: in 2003 24 years, 2005 25
years, 2007 27 years. The average age of the users is different in differentcities with higher age in the bigger cities (with maximum in the capital Sofia
31 years). The explanation of these differences is that the heroin abuse started
from the capital and the bigger cities and then spread to other smaller cities
within the years.
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Chart 3 Age tendencies among the drug users.
In addition to that the group is getting older is the fact that nearly half of
them didnt graduate high school and 13% dont have any education (Chart 4).
Their situation at the labor market is worsening and more than 60% are
unemployed and every 5th of them doesnt have any ID. In 2003, 49% of them
didnt have a health insurance, in 2005 43% and now 39% dont have one.
These factors are getting more and more evident the marginalization of these
people and demonstrate how the most important social spheres education,
labor, health are inaccessible for them.
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13%
13%
24%
48%
2%
0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%
Without education
Primary school
Secondary school
High school
Higher Education
Chart 4 Education profile of the drug users
This future marginalization will multiply the health and social problems
making rehabilitation and resocialization for users and ex-users harder. From a
point of view what is the access to specialized treatment of addiction, all the
social factors are diminishing the chance of these people for access to treatment
programs and their eventual reintegration as a well-functioning individuals.Nearly 70% of the drug abusers are using not only heroin but in
combination most frequently with marihuana followed by methamphetamine.
This make the challenge of curing opiates dependencies more difficult for
physicians which have to treat addiction not to one but several substances. In
addition to the drug poly-consummation is the risky behavior and the increased
incidence of HIV/AIDS, HCV and HBV infections. Most of the addicted are
used to some dangerous practices 62 % says that at least once in their life they
used a shared needles or syringes, 74 % used common spoon, filters or water,
and 56 % separated doses in a used syringe. Treatment programs and programs
for distribution of sterile needles and syringes are still not enough effective to
diminish the HIV/AIDS incidence. The problem is obviously much more
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complex and needs responsibility and active position to find a working solution
for this not only personal problem, but of the families, health specialists and the
whole society.
Results and discussion
Authors study the socio-economic conditions and analyze their impact on
the mental health and drug addiction. About 5% of Bulgarians have tried any
drug. There are a large number of heroin addicts and some existing treatment
programs. The implementation of a comprehensive new treatment program for
heroin addicts is indispensable. Interdependence between life standard, level of
education and health status is found out.
There are two major ways to treat drug abuse in the world. The first is toact as it is a severe crime or sin and the only option is to eradicate it from the
society. The second is to accept that drug addiction is sickness and to help
people with this problem you have to cure them. In many countries when drug
addicts are ready and want to get cured and continue their life health system
propose them multi-professional aid and support. When they are still not at a
point to realize their need of help, society doesnt reject them, but physicians
from Anti-drug programs prescribe them the needed drug dose to avoid
abstinence syndrome and to give them a chance and support to get safely to a
treatment program. In conclusion sickness is much more unattractive than sin.
Thats way most of the societies are developing such treatment programs for
hard drug addictions in particular those for heroin with controlled methadone
substitution. The methadone is one the well-known synthetic opiate used for
heroin substitution. Its way of administration is per orally thats why it reduces
the incidence of blood-transmissible diseases. It has long acting effect and
allows to be taken once per day. Methadone has no euphoric effects and its
abstinent syndrome is longer but much easier to handle. Treatment usually starts
with 80-100mg doses with the perspective of step-by-step reducing of the daily
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doses. The success of each program is based not only on the drug substitution
but in multi-professional health, psychotherapeutic and social support.
The latest information about the costs of such interventional programs in
Bulgaria is 27 712 euro (54143 levs) for 100 addict patients for one year. These
costs are comparable with the only detailed information on this subject given
from R.J. Caplenorn and coll. /1995/ 35-42$ per patient, per week in Australia.
The main problem in evaluating costs and effectiveness of these Methadone
substitution treatment programs is that some of their parameters are hard to be
defined and estimated. Suffering, grief and death are hard to be evaluated as a
burden in humans life and society loss. Most of these programs and temporarily
functioning depending on project financing or other programs being private.Patients are facing a vice circle being unable to pay such price and are forced to
quit the treatment returning to their previous way of living.
Conclusion
Serious obstacles to access to health care are the reduced incomes and the
increased economic vulnerability of the population. Bad economic and health
status are bound into a vicious circle where unemployed people remain out of
the health aid scope. As a result poor peoples health limits their access to the
labor market, increases their poverty and social isolation. The limited financial
resource for the health system has to be allocated and spent more effectively.
Even the high direct and indirect costs for heroin addiction treatment in health
and social sector we consider the drug abuse as a social important problem.
Treatment of Addiction is insufficiently accessible and effective. Many of
the existing treatment programs are private and are therefore financially
inaccessible to users. Investing in prevention programs and financing such
substitution treatment programs will reduce two to three times the further
treatment costs for these patients.
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