Research on the use of new psychoactive substances and challenges in responding to it in Moldova (Eastern Europe)

Background: Eurasian Harm Reduction Association (EHRA) together with College of Law And Criminology, Swansea University conducted a research on the new psychoactive substance (NPS) use in Eastern Europe, particularly in two countries – Moldova and Belarus. The objective of the project – generation of a more accurate picture of the use of NPS and challenges emerging from it, which will then be used to inform both policy advocacy by domestic civil society organisations as well as to contribute to the international peer review literature on NPS use.

Methodology: Research was conducted in two stages: 1) desk-based research and data collection (official data, media, peer review and grey literature, other reports from national government or regional/international organisations) on NPS use and responses to it; 2) Structured interviews/focus group with key respondents (law enforcement, health specialists, harm reduction service providers, people who inject drugs and people who use new psychoactibe substances)

Lessons learned:

• The results of the research indicated, that recently in the Republic of Moldova there has been an increase in the use of NPS.
• Despite the limited data on the use of NPS, undeniable evidence of the presence and significant increase in use of NPS in the Republic of Moldova during the period 2016-2018 is visible: smoking mixtures (himar) are indicated as the main non-injection NPS in 1) Chisinau - 35.8%, 2) Balti - 24.7%, 3) Tiraspol - 6.5%.
• In Moldova the most common NPS could be divided into two main types:

• herbal and chemical mixtures for smoking “Spices” (synthetic cannabinoids – Khimka (himar) / smoking mixtures / ethnobotanical substances);
• mixtures of compressed or injected chemical powders — psychoactive synthesizing substances with a stimulating or hallucinogenic effect, sold mainly under the name of „salts“ (synthetic cathinones).

• One of the biggest problems is a realistic documentation and reflection of the use of NPS in the statistics of medical services and statistics of law enforcement agencies. The problem is connected with the impossibility of applying the WHO classification used by the Republican Narcological Dispensary. Depending on the clinical manifestations of the use of the NPS, the cases are attributed to either the cannabinoid group or the amphetamine group. In the case of a medical examination, these substances are often classified as unspecified substances.
• The data given during the interview of the technical-criminologist center of the court expertises at the moment in Moldova provide information that 70-80% of the examinations of narcotic substances are made for new psychoactive substances - synthetic cannabinoids and synthetic cathinones.
• NPS sales in Moldova are mainly carried out online (darknet, social networks) or by telephone (the buyer does not know the seller).
• Availability and access to harm reduction services adapted to the situation and needs of NPS users (in particular, non-injecting users) is weak and low, which increases the risk of exacerbating the medical and social problems of NPS users in the medium and long term:
  • The existing scheme of financing harm reduction projects targeting key population groups does not create a favorable basis for the provision of comprehensive and adapted services to NPS users. In addition, the existing financing mechanism does not ensure the quality of the services provided. In such conditions, the organizations service providers are not interested in expanding / improving their activities, and the beneficiaries are not motivated to receive such services;
  • The main quantitative indicators of efficiency (for example, services coverage) are determined by the monthly provision of at least two services, one of which must be an exchange of syringes. This situation contributes to limiting the access of noninjecting NPS users to harm reduction services;
  • Existing monitoring schemes for harm reduction programs cannot assess the actual prevalence of NPS use, provide a qualitative assessment of the activities of the programs, and in particular respond to risky consumption patterns in a timely manner.

Reccomendations:

• Ensure periodic collection of data on the use of NPS from different service providers, to develop interventions adapted to the needs of this group of users, followed by application in harm reduction programs and state drug treatment;
• Conduct research on the risks of NPS consumption to document existing knowledge and practices of use, including in selected groups of children, adolescents and young people;
• Adapt harm reduction programs by identifying and implementing interventions that meet the needs and profile of NPS users, including non-injecting ones, providing adequate funding for these interventions;
• Adaptat existing psycho-social and medico-social interventions to ensure effective work with NPS users, including non-injection NPS users;
• Development of a rapid legislative response system to determine the illegal status of NPS by including them in the List of narcotic, psychotropic substances and their precursors, in order to ensure the effectiveness of law enforcement agencies in detecting and eradicating groupings and persons involved in drug trafficking.
• Consideration of the conducted research in the implementation of HIV prevention programs among drug users (harm reduction programs), the National Program for the Prevention and Control of HIV / AIDS and STIs.