Central Asia's emergence as a drug trafficking hub has helped cause a dramatic rise in narcotics use among residents of the region. The increase of drug use has, in turn, helped fuel potentially destabilizing social trends, including crime and health issues. Dr. Nina Kerimi, an expert affiliated with the World Health Organization's office for Europe, based in Copenhagen, Denmark, has been tracking drug-use patterns and the possible consequences in Central Asia. On April 6 she presented a paper at the 6th annual convention of the Association for the Study of Nationalities, held at Columbia University in New York. [Click here to see Dr. Kerimi's convention paper]. Kerimi, who has served in a variety of advisory roles at Turkmenistan's Ministry of Health, took time out during the ASN gathering to talk to EurasiaNet about drug use in Central Asia.

EurasiaNet: You maintain there are some differences in the characteristics of narcotics use today compared with that during the pre-Soviet times. Can you explain these differences as they pertain to Central Asia?

Kerimi: In the old days, opium – I will be talking about opium, because this is the main problematic drug – was used mostly as a folk remedy, as a panacea for illnesses, mental disorders, and physical diseases. It was ingested, and later – approximately in the 18th century – it started to be smoked. And at that time, the recreational meaning of its use became clearly visible. Since the late 18th century, opium use became a social phenomenon, in the sense that it created a lot of problems; the social response from the government at that time was just to destroy [opium] dens – the places where people used to smoke it – trying to prohibit consumption of the drug. It didn't work, and the smoking continued. Under Russian administration, officials also tried to prohibit the spread of opium. Then, in the late 19th century, they tried to prohibit the importation of opium. At that time, official imports, as well as smuggled opium from Persia, was flourishing and the flow of opium was very heavy, and it spread into all of Central Asia.

EurasiaNet: So what's the main difference between narcotics use today and narcotics use then?

Kerimi: I would focus on three features: First of all, there is the mode of use. Now, more and more, people inject opiates. Secondly, the characteristics of the opiate itself. Now it's heroin, which is processed opium. And thirdly, it is no longer used as a remedy, it is just used for recreational purposes. These are the main characteristics of the patterns.

Of course, the consequences are also different. In the past, the most serious consequence was overdose, or drug dependence itself. This encouraged the impoverishment of addicts because people many could not afford opium. Nowadays, there are some other very serious consequences which should be added to these two, like HIV infection, hepatitis, and sexually transmitted diseases, which are flourishing among drug users. There are some other diseases which accompany this. They are not the direct consequence of drug use, but they are there. I am talking mainly about tuberculosis. Patients with tuberculosis are over-represented among drug users, and vice versa. If you go to a tuberculosis clinic, you can see – up to 90 percent of them are drug users, in Kyrgyzstan for example. In Turkmenistan it was approximately 30 percent.

So the cluster of disorders linked to the use itself – and I have to add some social characteristics to that: a very high rate of unemployment; a tendency towards criminal activity; and a history of family problems. It is interesting to note that the family problems are specific to Central Asia, because in our culture people get married at a young age. When we investigated the social and marital status of drug users, we found that some of them have never been married at all, just because they started to use drugs. So there are two kinds of family problems – they can't be married and they can't have normal family lives because they have started to use drugs; and vice versa – when they begin using drugs, they caused a divorce. There are big problems with their children, especially now, because these children are not receiving care, and in a sort of social inheritance, they are acquiring deviant behavior.

EurasiaNet: From your research, what are the trends – at what rate is drug use growing, as best you can estimate?

Kerimi: According to statistics