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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 April 21; 334(7598): 821.
PMCID: PMC1853181

Georgian drug misusers switch to Western heroin substitute

A heroin substitute that is made in Britain and mainland Europe and used in harm reduction programmes has resulted in an epidemic of addiction elsewhere, with the former Soviet state of Georgia hardest hit.

Georgians, who have traditionally shunned heroin, are becoming hooked on what is seen as a “clean” alternative. They buy up pills of the synthetic opiate buprenorphine that have been prescribed to registered users in other European countries and smuggled over the Georgian border.

It now poses by far the country's biggest drug problem, says Zaza Berozashvili, a legal expert on the matter in Georgia.

At the end of March he addressed the Tbilisi international conference on countering terrorism and drug trafficking, which largely focused on the movement of drugs from Afghanistan through the region to the West.

With buprenorphine, though, the problem is moving in the opposite direction. Mr Berozashvili said that Georgia had at least 200 000 drug addicts in the country of just over four million, an estimated 70% of whom were using buprenorphine.

“The problem is increasing all the time,” he said. “We know the exact route: from which countries it is being smuggled, to where. We know that it goes through Ancona in Italy and Igomeniza in Greece.

“It is made in Germany, France, Belgium, England; it is coming from central Europe, where it is legal, used for treatment of injecting drug users. It is creating the kind of problems here which it is being used to solve in those countries.”

The pills, which are sold on the streets of Tbilisi for around $120 (£60; €90) each, come from a variety of sources, including people on substitution programmes who sell their drugs to smugglers, some corrupt doctors who sell prescriptions, and a small number of thefts.

The drug, which looks like paracetamol, is often hidden in cars coming from Italian and Greek staging posts and then driven through Turkey and over the border into Georgia. Sniffer dogs cannot detect it, and Georgian border controls rarely have the equipment to find or identify it.

The United Nations' International Narcotics Control Board said in its annual report of 2006 that in some countries, such as France, up to 25% of buprenorphine is diverted from legal use into the black market, bringing huge profits for the smugglers. Other countries identified as having a problem with the drug include Finland, the Czech Republic, and Pakistan, but none of them are as badly affected as Georgia.

Once in Tbilisi each pill is divided into four or even six parts, making a dose—which addicts say lasts all day—cheaper than heroin.

In a culture where strong familial control similar to that in southern Italy has loaded shame on those dealing in heroin, there is a certain cachet in taking a Western drug that is seen as safer, cleaner, and more modern.

But it is at least as addictive as heroin, and strong psychological dependence initially masks the physical risks and the accompanying social and eventually wider economic consequences.

Unlike in the West, where the pills are taken orally, the Georgians dissolve them in water and inject them intravenously, and it is feared that the already mounting but poorly documented death toll from buprenorphine overdose will at some point be overtaken by an HIV problem.

Some of those observing the problem in Georgia want the government to legalise buprenorphine there, while others call for stricter prescribing practices throughout Europe, so that harm reduction policies do not cause chaos elsewhere.

Articles from The BMJ are provided here courtesy of BMJ Publishing Group