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Table 1 Timeline of major policy events and changes in drug use patterns

From: Policing, massive street drug testing and poly-substance use chaos in Georgia – a policy case study

Timeline Legal changes Enforcement measures/practice Drug use patterns Factors influencing users behavior
Mid 1990s   • Widespread corruption among police • Drug users - subjects to harassment and extortion of bribes • Opium↓ replaced by heroin↑ • Tramadol + sedatives↑  
Late 1990s • Tramadol scheduled   
Early 2000s   • Heroin↓ replaced by buprenorphine (Subutex®)↑ • 40 % of treatment clients say Subutex® is primary drug • More than half report they use Subutex® to substitute opium or heroin • Home-made ATS (vint, jeff)↑ • Buprenorphine not detected by police urine testing • External signs of intoxication less visible • Increased mobility to Russia and Ukraine • Recipes via internet
2002–2003 • New Frame Law on Narcotics allowed substitution therapy • Poppy seeds scheduled • Poppy seeds↑ • Price/availability
2005–2008    • Tianeptin (Coaxil®)↑ • Home-made ATS↑ • Price/availability • Not detected in police urine tests
2005 • Tianeptin scheduled • First OST programme opened (GFATM) • Subutex® and heroin - leading drugs  
2006 • War on crime - war on drugs • Adm. fine for drug use increased 5 fold • Drug testing facility moved to MIA • Massive street drug testing launched • 12 fold increase in persons tested in 2007 vs 2006  
2007 • New law on Drug Crime (restrictions on civil rights)   
2007–2009   • Subutex-enemy #1 • Public campaigns “Anything but Subutex”, “Killer in the city”  
2008   • First state supported OST opened  
2009–2013   • Victory over Subutex® and heroin announced • Subutex®↓last month use from 75 % in 2007 to 7 % in 2013) • Heroin↓ • Poly-subs use↑ (90 % of injectors use 2 or more drugs, 75 % use 3 or more drugs) • Availability (police claimed they successfully collaborated with French counterparts to restrict smuggling of buprenorphine)
2009    • PDU size estimation - 40,000  
2010 • Pregabalin scheduled • State funded OST scaled up - 17 sites • 4,600 patients treated in 2013 • Testing↓, imprisonment↓ • Pregabalin (Lirica®)↑ • Substitute for injectable opioids • Not in narcotics list • Not detected by police tests
• Desomorphine (krokodil)↑ • Availability • Price • No need to engage with dealer/illicit market
2011 • Presidential Decree- Interagency Coordinating Council established  
2012   • Krokodil - leading inj. drug • PDU size estimation - 45,000  
2013 • National (anti)Drug. Strategy and Action Plan 2013–2015 • New Government came to power • Codeine tablets moved under strict control • 60,000 tested • Testing↑, Imprisonment↑ • Krokodil named as most dangerous drug  
2014 • Law on New Psychoactive Drugs • Victory over krokodil announced • MIA reported 90 % reduction in Krok. use (based on seizures and urine tests) • MIA reported 90 % reduction in NPS use (based on seizures and urine tests) • Krokodil ↓( from 53 % in 2013 to 34 % in 2014, GHRN) • Heroin ↑ (heroin driven commuting to Turkey) • Buprenorphine ↑ • Tropicamide injection ↑ • Attempts to compensate for reduced desomorphine
2015    • PDU size estimation - 49,000