EMERGING DRUG PROBLEMS IN HUNGARY
Since the iron curtain has fallen, a Picture of illicit drug use which is not incomparable with the decadent capitalist nations has finally started to emerge. Gabrielle Lipiay examines the way that Hungary is beginning to deal with its emerging drug problem
For most people the word drug does not call to mind Eastern Europe, but rather the USA, the nervous and zealous police organisations, the drug mafia, pushers on the street and astronomical sums of money. Slowly, however, these phenomena are also becoming familiar in Hungary, even though, at present, access to drugs is through pharmacies. Instead of spectacular chases, it is the tens of thousands of forged prescriptions produced every year that is characteristic.
However, the final outcome can be just as tragic. Hungary is at the threshold of the age of hard drugs, although as yet it is not one of the target countries of the drug trade, and there is no organised manufacturing activity; however, the borders of the country have been opened, and the proposed convertibility of the forint could play a part. At present Hungary is 'only' the transit country of the Balkan route for international drug trade. Shipments from the Middle East arrive in Hungary from Turkey, and are passed on to Eastern Europe, mainly by Arab mediation.
What drug problem exists in Hungary today? Should it be seen as one of the problems of adapting to society or is it a consequence of either the increasing availability of various drugs, or the growth in numbers of drug users? In my opinion, the drug problem includes all these aspects, as well as others, ranging from the uncertainties in legislation to the extreme attitudes often resulting from ignorance.
HISTORY OF HUNGARY'S DRUG PROBLEM
Illegal use of drugs was first encountered by the police and health agencies at the end of the 1960s - in 1968. At the time the figures involved, riot surprisingly, were blanketed in silence, because public opinion, panicularly the opinion of the leaders, was that drug use is antagonistic to the socialist system. The first group, involving larger numbers, to use hallucinogens (Parkan) was discovered in 1972. A law, which was effective until 1978, forbade the publication of any articles, programmes or books about drugs in the media. In 1977 the Ministry of Health and Education and the National Board of Youth jointly issued a statement prohibiting any scientific surveysand recommended that the drug issue he given confidential treatment. From 1978 the Penal Code has included penalties for drug use under the heading 'Pathological arousal of passion'. The law, still effective, imposes a punishment of 2-8 years on those who consurne, make, acquire, keep or distribute within, export to or import from the country any drugs or harmful surrogate suitable for pathological .abuse. However, only a few cases had appeared in the mass media. A more thorough introduction had to wait until the mid-1980s. The main reason for all these prtohibitions and cover-ups, apart from being antagonistic to socialism, was the wish to protect the youth, due to the belief that drug abuse would increase arnong the young by calling attention to it.
HUNGARY'S PRESENT DRUG PROBLEM
On two occasions the Ministry of Health took measures regarding the care of drug-dependent patients. In 1976, it issued a circular, in which the care of drug-addicted youngsters was referred to the child and youth mental institutions for the young, with orders to report any cases. In 1987 provision was made for delivering acute toxic cases to detoxification stations.
From 1975 the health institutions have attempted to treat drug abusers at three locations in llungary. The evangelical churches also started treating illegal drug abusers in an organised way from 1988. In 1986 the National Board Against Alcoholism was established as a subcommittee to deal with drugs. Two drug outpatient facilities were opened in Budapest in 1987, and a further two in the countryside in 1988. In both these facilities specially trained professionals work as teams.
Since the start of the 1980s, therefore, a form of liberalisation has been seen in treatment methods for drug problems, but not in legal judgments (the legal profession and psychiatrists argue against legislation penalising consumption of drugs). This liberalisation resulted partly from elimination of the media embargo in 1985 and partly from development of treatment methods. A campaign of sorts was started in the media. This not only advocated the solution of the drug issue, but also attempted to illustrate the phenomenon from different angles. A multitude of films, articles, radio reports and documentaries were published, following the silence of several decades, resulting in an illusion for many of a larger drug problem than is actually the case. This opportunity for funding has been grasped by some institutions of the health administration (e.g. care units for alcoholics, children, inental patients, psychiatric departments etc.) in the belief that the financial support would increase proportionate to the size of the problem. There was also an increase in the resources allocated for research over this period.
In order to be familiar with the domestic drug problem it is necessary to learn about the epidemiology of drug addiction, otherwise the nature of Hungary's drug problem and which groups are at the greatest risk can only be guessed at. So far including the lack of coordination and the uncertainty of the sampling and the caregories only provides the opportunity for stating that a drug problem exists. As already mentioned, at present an increase in drug prob[ems is evident, but there is no reliable information regarding the credibility of this trend. Is the increase due only to increased interest and: documentation or to ,in actual increase in drug abusers in Hungary? Why is it so difficult to acquire inforniation?
As a result of the legal consequences of drug abuse, it is considered, by the public, to be a crime rather than an illness. Consequently epidemiological studies based on confession - useful for learning the real nature of domestic drug use - will be more unreliable than those obtained in a more tolerant country. Stigmatisation will affect the family - often the stigmatised person does not care - so reliable data cannot be expected from the family either. However, reliance on data collected from the health, social and police organs, and determination of the number of drug users frorn these data, would result in complications frorn several factors: lack of desire to help; non-provision of confidential information; repetition and overlap between records from different institutions etc.
Despite this, what information is available and of what value? The scientific approach is still pre-paradigmatic. There has been no national survey, and the figures for numbers of drug abusers, circulated among public and scientific groups, vary from 20 000 to 100 000; in addition the number of reliable studies is still relatively small.
International experience has shown that the data obtained on the number of drug abusers should he treated cautiously because these numbers are often ,a reflection of a government's drug policy and the efficiency of its police operations, rather than the actual extent of narcomania. Moreover, Hungarian statistics do not differentiate between acute intoxiGition, occasional users and drug addicts; in addition the estimated number of drug abusers, from a survey in 1982-83, was 30000-40000-obtained by multiplying the numberof discovered cases (3000) by a latency factor of 10!
THE PREVALENCE OF VARIOUS TYPES OF DRUGS
The aim of the following grouping of drugs is to describe the various narcotic substances use,,] by drug abusers 'in Hungary, taking into account the pharmacological and efficacy characteristics. It is not necessarily the ideal breakdown for other countries!
Opiates (mainly hydrocodeine, codeine ao mor, phine, methadone and heroin)
Hungary lies on the heroin transit route between Austria and Yugoslavia. In spite of this the use of this stibstance is not widespread among Hungarian drug abusers. During the last 2 years an estimated 380 kg heroin has crossed the borders. Hydrocodeine isa strong pain killer containing codeine, and does not strictly belong to this group; however, it contains sufficient active ingredient to cause addiction.
Currently, in Hungary there 20 types of medicine that belong to the group which is undera strict account obligation. This means, in the first instance, that the physician must feel that the patient is in permanent need of the particular medicine; permission for regular prescription of the drug must be obtained; also pharmacies have to keep strict account of these drugs - down to every pill. Every year about 70 kg of the active ingredients of such drugs are used. There are about 30-40 varieties of drugs sold on a narcotic basis and a further 20-30 are suitable for drug abuse in combination. About a tonne of medicines containing codeine is used annually; there is also organised forging of prescriptions.
The prescription price of one box of hydrocodeine is 20 forint, whereas the black market value is about 1500 forint. It is belie ved that people are involved in the network for prescription forging, with 3000-5000 forged prescriptions presented annually, and an annual prosecution rate of about 1600 people involved in such activities. It is common for pharmacists to risk assault if they refuse to handle a forged prescription.
Hydrocodeine itself is used intravenously and, in conjunction with prescription forging, Hungar an youth are satisfied with opiates, without the expensive heroin.
Stimulants (mainly gracidin, amphetamine and cocaine)
So far cocaine abuse in Hungary is practically unknown. By 1954 the Hungarian control system of pharmaceuticals had already included amphetamines among controlled drugs, thus preventing an amphetamine epidenitc. However, gracidin was only withdrawn from trade when a large number of abuse cases already existed. Crack is also incidental, with the a uthori ties having no information on abuse.
Soporifics, sedatives, tranquillisers
Soporifics and sedatives account for "about 15-20 per cent of drugs prescribed in Hungary, ,and there is concern about how to prevent excess consumption and abuse. The cases of alcohol and barbiturate addiction are more frequent than those of methaqualone or henzodiazepine derivatives. In most cases, the addiction remains undiscovered because most of the patients are unaware of their dependent situation; the symptoms of withdrawal only occur when the drug is stopped. Such medicines are relatively easy to obtain - for instance one individual can request a prescription from several physicians, and Hungarian physicians prescribe such drugs frequently. Soporifics containing barbiturates are traditionally used in suicide attempts. The abuse of non -barb iturates containing soporifics, e.g. glutethimide (Noxiron in Hungary), is also frequent.
The introduction of benzodiazepine derivatives has completely restructured the consumption of medicines in Hungary. Their recognised advantages, namely lower toxicity, have been taken advantage of, with many people using them on a permanent basis in large dose., obviously can also lead to addiction. One of the main ways of becoming addicted through legal channels is by taking Elenium and Seduxen.
Hallucinogens (LSD, Parkan and cannabis, hashish, marijuana)
These hallucinogens are discussed together because the active ingredient of Indian hemp (THQ is a hallucinogenic compound comparable to LSD. Hernp, whether grown wild or cultivated anywhere in Europe, contains trace amounts of THC, thus its danger is less. Some individuals experiment with cannabis in Hungary. On the whole it arrives through the hashish trade between the Middle East and western Europe. Parkan is a medication used in Parkinson's disease; the medicine contains hallucinogens and is therefore subject to abuse.
Organic solvents and other substances
Glue sniffing (or solvent sniffing) is particularly popular among children and teenagers. In fact according to certain surveys this is the most prevalent form of drug abuse in Hungary among the young generation (Elekes,1986). To ascertain the alcohol and drug abuse habits of the 14-18 year age group pertinent questions were posed to pupils of three secondary schools and a reformatory school. From the answers, it became clear that 9.6 per cent of the 489 youngsters questioned had already tried some form of narcotic, and 6 per cent said that they had sniffed glue. Glue sniffing tends to occur earlier, compared to the abuse of medical drugs or other narcotics.
HUNGARY'S DRUG SITUATION FROM EPIDEMIOLOGICAL STUDIES
Information in Hungary is very sparse. Surveys in 1970, and then in 1980, on non-representative groups of youngsters, showed that 4.8 per cent and 3.5 per cent of this group admitted to the use of drugs at the level of trial, occasional or regular abuse. From the survey conducted among the secondary school-age group 33 per cent of those living at the reformatory school had already tried some narcotic substances and 21 per cent sniffed glue regularly. A survey was conducted in 1986 on a national representative sample of 6000 people in the over- 18 age group. It was found that 16 per cent of men and 26 per cent of women take some kind of medication regularly, and 5.4 per cent of men and 7.7 per cent of women use some sort of narcotic substance on prescription (Elekes and Liptay, 1987). However, these figures are obtained by self-confession and are therefore subject to drug policy and the attitudes towards drug consumption. The author is working on a survey, covering 3000 people nationwide, about drug consumption and attitudes, but as yet there are no data available.
Those individuals who are trying out drugs or are occasional abusers are usually in the younger age group and will use anything that they can lay their hands on most frequently this is organic solvents, Parkan and opiate derivatives. Regular users and addicts show significant differences in social status and the substances used. Those of lower social status use organic solvents and alcohol, whereas those of higher social status use medical drugs, hard drugs, and sometimes intravenous abuse.
The proportion of the younger generation using drugs is decreasing, e.g. in 1976, 56 per cent of all drug users belonged to this age group, whereas currently their share has fallen to below 20 per cent. Women are'represented to an increasing extent, with the proportion increasing from 10 per cent in 1976 to 31 per cent. At the start, glue was most prevalent with 64 per cent of abusers using it; this then changed to polydrug LISC, with opiate-containing preparations and from 1986 'hoinemade' heroin has appeared. Intravenous use has increased, although hopefully as a result of the recent anti-AIDS propaganda this has started to fall. From the grouping designed by Ildiko Erdelyi, young drug users can be listed on the basis of their motives under three major headings. For children in state care - and this group contains a large number of drug abusers - the substance acts as a substitute for attachment, as a surrogate. Drug-using children who are not in state care can be grouped into two categories: in one group the youngsters choose drugs to maintain family homoeostasis; in the other the drug use is a source of excitement and adventure.
HANDLING THE DRUG ISSUE
As mentioned earlier the National Board Against Alcoholism established a drug subcommittee in 1986, the main task of which is to implement the drug programme. The drug programme itself combines the Caplan preventive model and the ecological approach; prevention is not for the individual, but for the social system.
There are four areas of the drug programme:
1. Scientific basis consisting Of a databank and scientific studies.
2. Preventive model experiment consisting of the drug prevention programme and the coordination of human organisations and services.
3. Therapeutic and rehabilitative model experiments.
4. Training and development.
The drug programme lays emphasis on primary prevention, providing development training for teachers, and issuing the social programme for health protection. Secondary prevention has as its basis the drug outpatient facility, which provides both psychotherapy and social care services. Various institutions are involved with this: daycare and nightcare sanatoria, clubs and treatment provided at the alcoholic and psychological departments. Tertiary prevention (rehabilitation) has an even broader scope, involving the churches actively and officially.
However, there are a large number of difficulties with the drug programme.
In March 1990, the health, cultural and social policy departments of the metropolitan council (dissolved very recently) issued a statement ordering the health and training institutions to report drug users to the council. Anonymity is a vital concept of drug programmes. The whole patient attendance system, based on the trust between the psychiatrist and the drug abuser, would be threatened. This instruction was justified by referral to socialist ethics, and recommends that such patients be cared for in mental units and other, nonexistent, so-called special institutions, which Ire not suitable for this purpose. What can the drug programme do about this?
Another question is whether it is worth separating the drug users sent for compulsory treatment from the others. Could not this become a source of a kind of social discrimination? Both material and human resources are limited, and are not the best from the point of quality. As a matter of fact, there are no nationwide special institutions and drug experts as yet.
Care for 14 to 18 year olds is not developed. Cooperation with the educational institutions is difficult; the schools see it as harmful for their image, if there are too many children involved. Also, they wish to protect their students from the legal consequences, and anyway it is difficult to know where to direct children struggling with such problems.
The worldwide drug epidemic of the last 20-25 years and its impact on Hungary, which reaches adolescents first of all, has found the health care system unprepared. Without the social and self-supporting groups and organisations, care and rehabilitation of drug users would be impossible.
Neighbouring countries have made much better progress in the professional and social approach to the issues of dependent drug use. There have been considerable steps forward since 1985, but Hungary still lags behind.
This social problem cannot be solved by legal methods alone. However, it would be useful to revise the drug laws of the country, as the law is frequently uncertain. The courts do not treat drug users fairlyand, so far, the matter of liberalisation is discussed only in close professional circles and among drug users.
Budapest University of Economics, Budapest, Hungary
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Elekes, Zs. (1989). Drug epidemiology in Hungary. Unpublished manuscript.
Elekes, Zs. and Lipiay, G. (1987). The spread of alcohol consumption and other deviant behavioural patterns in Hungary. T13Z Bulletin IX, Budapest, pp. 1-152. Racz, J. (1988). Drug using behaviour of the drug user, Medicina, 1- 160.