TBILISI, Georgia -- A plague of used syringes has descended on this Georgian capital. Tossed along the sidewalks or buried in mounds of dirt, they are a jarring sign of a mounting drug epidemic.
There are not enough treatment centers to help even a fraction of Georgia's drug users, who now total 275,000, according to official estimates. This marks an increase of 80 percent since 2003 and a huge number in this Caucasus country of just 4.6 million people.
Most surprising is what accounts for the rise. It is the prescription drug Subutex, a heroin-withdrawal therapy brought in from Western Europe by smugglers in planes and used cars.
``It is visible that Subutex use has dramatically increased," says Khatuna Todadze, scientific director of Georgia's biggest drug treatment center, the Research Institute on Addiction, in Tbilisi. ``In the last two or three years it has become a really big problem."
Subutex is the name under which buprenorphine, a synthetic opiate, is sold. Designed to treat heroin addicts and first introduced in France in 1996, it is now available in 30 countries and has all but replaced methadone, another heroin-detoxification treatment, in many parts of the world.
Since its effects are weaker than those of heroin, codeine, or methadone, it has received a less restrictive classification under the United Nations' Convention on Psychotropic Substances.
Buprenorphine, manufactured by Reckitt Benckiser, based in Kenilworth, N.J., and Schering-Plough of Slough, England, is the first heroin withdrawal treatment that can be prescribed in a physician's office. But as its popularity as a treatment has grown, so has misuse.
World consumption of buprenorphine nearly tripled from 2000 to 2004, according to the UN's International Narcotics Control Board, increasing to 1.7 billion DDD, or defined daily doses, a World Health Organization statistical measure of consumption.
``In some countries, such as Finland," the board's 2005 report said, ``buprenorphine has become the most important illicitly used substance for opiate addicts; in some illicit markets, it has almost totally replaced heroin."
The fact that buprenorphine costs less than heroin and is more accessible has hastened the development of illegal markets in various countries. Buprenorphine manufactured in India, for example, is smuggled into Nepal and Sri Lanka, as well as Bangladesh, where it is used by 90 percent of the country's intravenous drug users, according to a UN Drug and Crime report last year.
A 2004 report from the US National Drug Intelligence Center lists ``lucrative" black markets for Subutex in Britain, Germany, and New Zealand.
Supporters of buprenorphine note that overdose deaths from opiate use in France have fallen 79 percent since Subutex was introduced, and drug-related crime has decreased. Dr. Andrew Byrne, an opiate treatment specialist in Australia, says the results in France have been ``staggeringly good."
Others say that Subutex, even when abused, is better than heroin from a public health standpoint. ``An upshot of so much Subutex abuse going on overseas is that it is going to be safer than heroin, because you know the purity and dose," said Dr. Wendy Kissin, who oversaw a US national study on buprenorphine legislation.
© Copyright 2006 Globe Newspaper Company.
Weltweit wurde am 26. Juni der Tag gegen den Drogenmissbrauch begangen. In vielen Ländern wurden öffentlichkeitswirksame Aktionen gestartet, um das Thema in das Alltagsbewusstsein der Menschen zu bringen. In Polizeirazzien wurden Drogen beschlagnahmt, an anderen Orten gab es öffentliche Verbrennungen von Drogen. Eine UN-Organisation legte umfangreiches statistisches Material zum weltweiten Drogenmissbrauch vor. Erstmals wurde der 26. Juni 1987 von der UNO zum weltweiten Tag gegen den Missbrauch von Drogen erklärt.