Interim Report of the
Inaugural Iraq Community
Epidemiology Work Group
(CEWG)
May 8-9, 2012
Baghdad Iraq
Nesif Al Hemiary, MD
Jawad Al-Diwan, MD, Ph.D.
Albert Hasson, MSW
Richard A. Rawson, Ph.D.
1
Abstract
The initial meeting of the Iraq Community Epidemiological Work Group
(CEWG), May 8-9, 2012, was held at the Ishtar Baghdad, in Baghdad, Iraq. The
meeting brought together leaders from the substance use disorders sector, public
health sector, mental health sector, law enforcement representatives, university
teachers and researchers, governorate representatives, NGOs, representatives from
the Ministries of Health, Interior, Labor & Social Affairs, Youth & Sports, and
Justice and international technical assistance experts. The 2 day meeting reviewed
the importance and methods for developing a capacity in Iraq for better
understanding the nature and extent of the drug and alcohol problem in the country
and reviewed some of the existing data on this topic. During the morning of the
first day, Iraqi and international speakers provided background and a rationale for
using the CEWG methodology as an optimal epidemiological data approach.
During the afternoon of day 1, and the morning of day 2, a series of 14 reports
were given to present data and information on the current use of drugs and alcohol
in Iraq. On the afternoon of day 2, a workshop was conducted to discuss ways of
improving future CEWG meetings by expanding the types and sources of data that
would benefit the CEWG goals in subsequent meetings. In addition, a group
discussion was conducted to address who the best individuals would be who
should be invited for subsequent meetings in order to have an optimal data set in
the future. Finally a meeting evaluation was conducted using the SAMHSA GPRA
forms.
The findings from the reports suggest that since the time of the reports by
Aqrawi and Humphreys (2009) and Al Diwan (2011) on drug use in Iraq,
2
summarized in Rawson (2011), some things have remained relatively stable and
there have been other significant changes. The psychoactive substances most
widely used in Iraq continue to be alcohol and the prescription drugs:
benzodiazepines, benzhexol, codeine and a variety of psychiatric medications.
This set of “primary drugs” is consistent with the earlier reports. However, there
was near universal agreement that the use of hashish, Tramadol (opioid-type
analgesic) and amphetamine-type substances (ATS) is increasing rapidly in some
areas and that drug and alcohol use overall is increasing. Reports from Basrah
from health and police were noteworthy.
Two types of amphetamine type
stimulants (ATS) have made an appearance in Iraq:
“01 Pills” (Tablets of
Captagon, an amphetamine-type drug) and “crystal” (methamphetamine) have
been seized in considerable quantities in Basrah. The “01 Pills” appear to be of the
same type of ATS that are being used in epidemic amounts in Saudi Arabia and
they appear to be coming into the country via ships traveling to the Gulf and Saudi
Arabia. The “crystal” is likely coming from Iran, since crystal use in Iran is
extensive and is the most rapidly growing drug in that country. At the present
time, there is little evidence of increased use of heroin in Iraq and rates of injection
drug use appear to continue to be relatively low.
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Introductory Presentations
The meeting was opened by
Dr. Sabah Sadik
manager of the
training and professional development center, MOH, who welcomed attendees
and provided a overview for the 2 day meeting. His comments reviewed the
importance of understanding the nature and extent of the drug use problem to the
public health and security of Iraq and emphasized the need to have good data to be
able to establish effective policies and services to address the drug use problems.
Dr. Emad Abdulghani:
The advisor of mental health, of the Iraq
Ministry of Health, described the Ministry of Health’s efforts to assess the
psychoactive substance use problem in Iraq and develop services to address the
problems. In his presentation, he covered the following points:
Background and Current Situation
 The Mental health Council in the structure of the ministry of health was
initiated in 2003.
 Currently there are 170-250 staff persons working in mental health and
substance abuse field
 ~2000 individual visits to Primary HealthCare (PHC) Centers report drug
and alcohol problems and another 738 are addicted.
 Benzodiazepines and Tramadol are the most frequently cited drugs of abuse
in PHC centers
Efforts included in the Drug Control Strategies are:
Safe storage (pharmacies, etc)
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Use of media to promote prevention with an emphasis on youth
Develop brochures to distribute on prevention efforts
Contributing factors to substance abuse include:
Low employment
Poor living conditions
Trauma and violence
The Ministry is currently developing training programs for:
Paramedical professionals
Psychologists
Physicians and Psychiatrists
Efforts are underway to establish treatment units in hospitals and outpatient
facilities throughout Iraq.
Dr. Mushtaq Al-Hachami,
manager of substance abuse control
program , Ministry of Health, described a report from 2008 that articulated the
substance abuse control program in Iraq.
The program includes prevention
strategies, treatment strategies and supply reduction strategies. Components of the
program include:
 Efforts to determine the extent of alcohol and drug use
 Cooperation with the media to let the community know of the dangers of
drug and alcohol use.
 Reduce diversion of prescription drugs
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o Prescriptions should be limited in duration and are to be filled within
2-3 days
 Strategies to address the problem through the Ministry of Health
o Professional staff attended TOT workshops with UCLA ISAP outside
of IRAQ, Cairo, Egypt and Beirut, Lebanon
o Two-day training courses developed by the Ministry of Health on
treating substance abuse disorders to be presented by local experts to
professional medical and paramedical staff.
o Treatment interventions being developed through the MOH.
 Law issued in 2008 to allow for treatment seeking drug users to receive one
formal course of treatment without being considered a “criminal”.
o Control the use of specific drugs to reduce the impact on the health of
the community
o Effectively enforce laws to capture and punish drug traffickers
o Distributers should be licensed and medications should be for medical
purposes only
Dr. Nesif Al Hemiary, Associate Professor, Baghdad University and
Project Director of the Iraq Drug Demand Reduction Initiative welcomed the
attendees to the first Iraqi CEWG meeting. Dr. Nesif described a set of reasons
about why the CEWG method would be a useful way for Iraq to develop
actionable knowledge on the drug situation in the country.
He described:
 That the purpose of this meeting is to develop a network to monitor drug
use trends within population centers in IRAQ
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 The format for the CEWG meeting will consist of a series of 15 minute
presentations by each invited guest from specific geographic areas and
disciplines from around Iraq, followed by workshops to address:
o Who should be selected to participate within the CEWG to collect and
report on the data?
o What information will be collected and what is the most efficient way
to obtain it?
o How can future CEWG meetings be improved?
 The CEWG information will be used to:
o Develop a plan for services to meet the needs of drug users in Iraq.
o Inform the public as to the dangers of specific substances available
within their communities.
o Example-- recently in Egypt it was recognized that the use of
Tramadol, a narcotic analgesic has reached epidemic proportions. For
many individuals the use of Tramadol often starts out as a treatment
for a pain problem, but with persistent use can produce dependence
and serious problems.
 The CEWG will allow for a timely response to the needs of our communities
 While the specific locations have yet to be determined, we anticipate data to
be collected from:
o Hospitals admissions
o Emergency Department admissions
o Substance Abuse treatment center admissions
o Police and Customs Seizures
o Arrest Records
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o Prison populations
o Schools and Universities
o HIV/AIDS Service providers
o Ministry of Health
o Healthcare facilities
o Specialized clinics
o Poison control centers
 Drug and alcohol use are international problems which can better be
managed with accurate and timely information as will be collected in
regularly scheduled I-CEWG meetings.
 Information should be collected and analyzed quickly to allow for decisions
to be made regarding potential interventions. If done properly we should be
able to determine:
o Specific contributing factors to drug and alcohol abuse
o Emerging trends and patterns of drug use in our communities
 In data collection effort for the CEWG, the privacy of all individuals is a
priority. Data will not include personal identifiers and data will be collected
in a non-judgmental way.
Dr. Richard Rawson,
Professor at UCLA School of Medicine and
Principal Investigator of the Iraq Drug Demand Reduction Initiative. Dr.
Rawson reviewed that the goals of the Iraq Drug Demand Reduction Initiative are
to identify the nature and extent of the drug problem in Iraq and assist in building
the skills and knowledge of the Iraqi substance use disorder treatment workforce.
 This is a one year project is to:
o Establish a Center of Excellence on substance use disorder treatment
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o Train a core group of medical professionals
o Develop a drug use monitoring program using the Community
Epidemiology Work Group methodology
o Identify professionals interested in conducting substance abuse
research and assisting in introducing them to the field of addiction
research.
 To date training efforts have been held in Cairo with Dr. Tarek Gawad and
in Beirut with Dr. Ramzi Haddad
 Drs. Salih Al-Hasnawi, Dr. Sabah, Dr.Nesif, Dr. Emad, Dr. Mustaq and Dr.
Jawad have all played key roles in the establishment of this project.
Dr. Jawad Al Diwan,
Assistant Professor, Baghdad University,
Medical Epidemiologist, described that there is a growing body of anecdotal
evidence and clinical report of an increase of substance abuse in Iraq. Recent
unrest has have made data collection difficult if not impossible. However, without
proper epidemiological methods, it is impossible to understand the nature and
extent of diseases in the community.
 Epidemiology is defined as the study of the occurrence and distribution
of health-related states or events in specified populations, including the
study of the determinants influencing such states, and the application of
this knowledge to control the health problems.
 The unique skill of epidemiologists is to look at the disease and it’s
attributes. It is important to know the frequency of the disease in a
population.
o Classify and categorize the disease
o Define what constitutes a case
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o Find a source to ascertain the case
o Define the population of the disease
o Define the period of time risk
o Obtain permission to study people
o Relate cases to a population
 It’s important to recognize
o Person: Age, socio-economic status, gender, education, behaviors
o Place: Geographic location, what is the distribution, wide spread or
localized
o Time: Changing or stable, short or long, seasonal variations, is it
clustered
These principals of epidemiology will be central to the value of the data of the
CEWG program.
Dr. Richard Rawson:
Professor at UCLA School of Medicine and
Principal Investigator of the Iraq Drug Demand Reduction Initiative. Dr. Rawson
described The American CEWG Experience.
 There are many challenges to measuring a disease in a community.
 Certain diseases may be quantified such as HIV, HIV, H1N1. Measuring
drug and alcohol trends in a society are more difficult to quantify.
 It is difficult if not impossible and impractical to test every person in a
community so the next best tool is to ask them about their use through
survey methodology.
 Challenges to survey research in the field of substance abuse, include access
to the population and the stigma and legality of using drugs, tends to make
those participating in the surveys less than truthful about their behavior.
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The Community Epidemiology Work Group was established in the US in 1976.
Comprised of a network of researchers from major metropolitan areas, has been
able to provide on-going community level surveillance of the nature emerging
trends in substance abuse. The information obtained through the course of the
local data collection efforts has been able to direct policy in the US. Numerous
countries worldwide have developed a CEWG primarily utilizing existing available
data collected in local agencies such as hospital and emergency department
admissions, arrest records, drug treatment program admissions, drug seizures, etc.
Data gathered during the CEWG meetings can show how a problem is changing,
whether it is increasing or decreasing but generally cannot provide an absolute
number of drug users. Data can be collected from the following sources:
o Treatment admissions
o Death records-coroners office
o Emergency Department admissions
o Health Centers
o Forensic labs
o Local surveys
What does CEWG do?
o Monitors drug abuse trends
o Provides local perspectives
o Reveals local variations
o Serves as a network of local contacts
o Allows for dissemination of findings
Strengths of the CEWG
o Efficient and rapid
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o Current information
o Utilizes unpublished data
o Multiple sources
o Local perspectives
o Global dynamics
o Emerging Issues
o Incorporates new data
o Extended historical perspective
Limitations of the CEWG
o Coverage gaps exist (rural areas)
o Uneven access to data at specific sites
o Less coverage in non-metropolitan areas
Data Presentations
Each of the following speakers gave a 10-25 minute presentation, with most
speakers providing data using power-point presentations.
Speakers
1. Dr Waddah Hamid; Manager of the National Center for AIDS (Baghdad).
2. Dr Akeel Al-Sabbagh: Consultant psychiatrist from Basrah governorate (South
of Iraq)
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3. Dr Saman Anwer Faraj: Specialist psychiatrist from Sulaimani governorate(
Kurdistan region) and Dr Rawisht Rasheed: specialist psychiatrist from Erbil
governorate( Kurdistan Region).
4. Dr Rathwan Al-Tuhafy: consultant psychiatrist from Mosul governorate( North
of Iraq)
5. Dr Ahmed Jaafer Karaguly: specialist psychiatrist - Kerbala governorate (
Middle south)
6. Dr Jawad Al-Diwan : Epidemiologist from Baghdad
7. Forensic Department (No presentation, but data were provided)
8. Baqer Salim : police officer/central office of Narcotics -Ministry of interior
9. Dr Raad Taher and Dr Siham Mohammed: Juvenile prisons -MO labour and
social affairs.
10.Mr Fuad Kadhim Mermas: Prisons directorate - Ministry of justice.
11. Mokhaled Karim Kadim : Police of Narcotics control- Najaf governorate(
Middle south)
12.Dr Issam Salim Ismail: Primary health care- Wasit governorate( East of Iraq)
13.Mr Amer Abdulla Ibrahim : Directorate of customs - Anbar governorate ( west
of Iraq)
14.Dr Khalid Ahmed Farhan : Child future organization (NGO from Baghdad)
PRESENTATIONS
Dr. Waddah Hamid, Director, National Center for AIDS:
Dr. Waddah reported on the work in Iraq to address the problem of
HIV/AIDS. He reviewed the current population of Iraq (33.8M), major population
centers and the current scope of the program in Iraq to address the problem of
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HIV/AIDS. As of 2012, the National Center for HIV/AIDS has 18 focal centers
and 98 testing centers utilizing both rapid testing and ELISA testing methods,
located throughout Iraq. The centers provide information and testing and
counseling for the public and treatment for persons living with AIDS.
Within Iraq there is a National Action Framework with the goal of
maintaining low prevalence rates by educating the general public, training of
health workers, early detection of conversions, and the provision of residential care
for persons living with AIDS. There are 15 Residential and Social Care facilities
throughout Iraq which provide financial support, medical care, and coordinated
care for orphans of AIDS victims. Currently the Center for HIV/AIDS employs
400 people.
The current data on HIV/AIDS in Iraq is as follows according to Dr.
Waddah’s report: There have been 1.3 million individuals tested for HIV and as of
the end of 2011 the cumulative total number of HIV cases detected is 615, or .05%.
According to the report, 85% of the cases are male, 65% were reported to be
hemophiliacs, infected via blood transfusions, 17% from heterosexual contact and
5% from mother to child transmission. According to the report, through 2011,
there has not been a single case of transmission among men who have sex with
men, nor as a result of injection drug use. Figure 1 presents the number of Iraqis
detected per year from 2003 to 2011.
14
%
2003
2004
2005
2006
2007
2008
2009
2010
2011
Years
Fig. 1 Distribution of positive HIV in Iraq
In considering the data on HIV/AIDS in Iraq and particularly the data on method
of infection, it is important to remember that injection drug use and homosexuality
are highly stigmatized behaviors in Iraq (and during the time of Saddam, these
behaviors could result in very severe penalties). Therefore, it is highly likely that
there is under-reporting of these routes of infection. However, the low prevalence
rate in the overall picture of HIV/AIDS in Iraq, does suggest that injection drug use
plays a very minor role in spreading HIV in Iraq. At present it is not clear how
extensively individuals are screened for alcohol and drug use in these centers, nor
how knowledgeable the staff are regarding discussing drug and alcohol use with
individuals who are tested.
Dr. Akeel Al-Sabbagh: Consultant Psychiatrist from Basrah
Governorate (South of Iraq):
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Basrah is the 3rd largest city in Iraq, with a population of approximately 2
million. It is located in the far south of Iraq, not far from the borders with Kuwait
and Iran, and it is located approximately 55 km from the Gulf. It is the only port
city in Iraq (Al-Fao, Umqasser and via the Shatt Al-Arab Waterway). Before the
2003 the regime enhance a religious campaign and immediately after 2003 war,
alcohol was available and widely used in Basra, but with increasing religious
influence in the area, alcohol use has dropped sharply and drug use has increased.
It is the perception of law enforcement officials in Basrah that the city has become
a central entry point for many drugs and is a major distribution point for drugs in
Iraq. Drugs can be obtained in many of the shops throughout the city. Data for
this report come from two hospitals, the Basrah police, the Ministry of Justice, and
the Ministry of Interior.
Data from the Basrah anti-addiction police suggest that there has been a substantial
amount of drugs seized in the Basrah area by local police over the past 8 years.
Tables 1 and 2 below reflect the seizures of illegal drugs (including amphetamine
tablets referred to as “01 Pills” [Table 1], and pharmaceutical medications diverted
into the drug market [Table 2]). Of particular significance in these data are that, as
seen in Table 1, the kilograms of drugs include all classes of drugs. Through 2009,
the drug category that made up these drug seizures was almost exclusively hashish,
with very small amounts of cocaine and opium. However in 2010 and 2011,
hashish represented 80% of the total weight of confiscated drugs, crystal
methamphetamine represented 15%, and heroin/opium represented 5%.
In
addition to these amounts, as noted in the 2011 line of Table 1, 15,849 tablets of
Captagon (01 pills) were seized by Basra police. Captagon (Fenethyline) is an
amphetamine-type stimulant (ATS) that is widely used in the Gulf region
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(particularly Saudi Arabia), with sources of the tablets identified as India and
China. According to United Nations, it is consumed in Gulf region. Saudi Arabia,
Qatar ,and Kuwait reported that the use is prevalent among their younger affluent
citizens. The emergence of large amounts of Captagon and crystal
methamphetamine, another powerful ATS, being used in Iraq is of substantial
concern.
It should be noted that kilograms of hashish and crystal
methamphetamine do not represent equivalent amounts of active psychoactive
drugs. Hashish is very bulky and heavy, whereas crystal methamphetamine is
much more concentrated and psychoactively potent. Therefore, if in 2009 and
2010, 15% of the drug total weight was methamphetamine, that 15–20 kilos of
crystal methamphetamine represents a much greater concern than an equivalent
amount of hashish. In addition, in a report from the Iraq Ministry of Health
pharmacy inspectors, there was a report of a single seizure of 500,000 tablets of
“01 pills” in the Basra region. In combination, these reports of the emergence of
two forms of ATS (crystal methamphetamine and Captagon “01 pills”), represents
a potentially important new drug threat in Iraq.
TABLE 1. WEIGHT OF PSYCHOACTIVE SUBSTANCES CONFISCATED IN
DRUG SEIZURES IN BASRA, IRAQ, BY YEAR FROM 2004–2012
NO
Year
Total Weight of Drugs
Seized
1
2004
127kg
2
2005
30kg
3
2006
57kg
#
of
PILLS”
Seized
17
Tablets
of
“01
(Captagon)
4
2007
1kg
5
2008
49kg
6
2009
443kg
7
2010-
8
2011
Hashish
185 Kg
amphetamine 35 Kg
Heroin
9
2012
10
TOTAL 938kg+18g
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15849
18g
15849
The data in Table 2 reflect the ongoing problem of diversion of the medications
benzehexol (Artane), diazepam (Valuim), and codeine (cough syrup) for sales
through illegal drug markets. Of interest is the fact that before 2011, there were no
reports of Tramadol seizures in the Basra police data. However in 2012, there
have been 5 seizures of Tramadol tablets within the first 2 months of the year.
TABLE 2. PSYCHOACTIVE PILLS SEIZED IN BASRA, IRAQ, BY YEAR
FROM 2008–2012
Year
# of Pills
2008
24083
18
2009
36850
2010
194979
2011
4500
2012
4720
TOTAL
265132
The data from Basrah include some cause for concern. The emergence of ATS in
two forms and in substantial quantities is a significant new problem. Because
Basrah is in such a critical geographical position, with close access to the borders
with Iran and Kuwait and direct access to the Gulf, it might be considered a major
entry point for drugs never before seen in Iraq and as such, it could be an early
warning site for potential new drug problems. It will be very important to continue
to monitor drug seizure data in the Basra area, as well as monitoring health system
data, to watch for patients in the health and mental health sectors with evidence of
ATS use. No data were available from health sector in Basra (inpatient or
outpatient dept. in the hospitals).
Drs.Saman
Anwar
Faraj and
Rawisht Rashid
reporting on data from Sulaymaniyah and Erbil
(Kurdistan).
Sulaymaniyah is a governorate in the Kurdistan section of Northern Iraq and it
has a long border with Iran and a shorter border with Turkey. It has a population
of approximately 1.8 million, with 70% of the population living in urban settings.
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Erbil is the fourth largest city in Iraq and is located between the cities of Mosul on
the West and Sulaymania on the East. Data from this presentation come from
psychiatric units, 2 surveys, jails and forensic medical units and data are compiled
at the Department of Psychiatry at Sulaymania General Hospital.
Both speakers discussed the fact that at present, the health system data do not
accurately reflect the extent of substance use in Sulaymania or Erbil. The stigma
about drug use is very substantial and there has not been much attention given to
the issue of drug and alcohol use within the health sector. Because alcohol and
prescription drugs are both legal, it is very likely that people are willing to discuss
these forms of substance use, rather than the use of illegal drugs. Further, even
when physicians identify individuals with substance abuse disorders, they may not
note this finding in the medical record for fear of stigmatizing the patient. At
present, any data from the health system represent a very misleading picture as
they very seriously underestimate the nature of the problem.
Data from law enforcement has consistently shown that drugs are being sold
in Kurdistan and that there is evidence that drug availability is increasing. In 2008
and 2009 there were 59 and 56 drug convictions in Sulaymania, with an increase to
69 convictions in 2010. Further, between 2005 and 2010, there was an average of
50 arrests for drug dealing per year.
In 2011, this number spiked to 204,
suggesting either a substantial increase in drug dealing activity or a much greater
attention to drug dealing by police. In addition in 2011, in Erbil, 250 kilos of drugs
were seized
During recent years, the amounts of drugs seized by police have also
increased. In 2008 the total drugs seized (all categories) was 278 kilos. In 2011
the amount seized increased to 726 kilos, including 428 grams of teriac, an opium
derivative. The large majority of the arrests and seizures occurred in locations near
the Iranian border. The major categories of drug seized included hashish, heroin,
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teriac, opium, crystal (methamphetamine) and opium seeds. Data from the prisons,
indicate that while approximately 12 % of the inmates are regular drug users, the
drugs in the prison are generally restricted to the prescription drugs diazepam and
benzehexol (Artane).
Both doctors from Kurdistan, emphasize the need for better data and better
coordination between the Federal Ministry of Health and the Kurdistan health
officials. This lack of coordination between the federal and governorate health
officials makes it difficult to obtain data and to fully assess its validity and
reliability. Further, the doctors from Kurdistan, strongly recommend a survey of
street drug users in order to better ascertain the types of drugs on the street, how
these drugs are being used and by whom. With better access to more and better
data, the expertise of the professionals in Kurdistan would allow for a much better
analysis and understanding of drug use problems.
Dr. Rathwan Al-Tuhafy: Consultant Psychiatrist from
Mosul Governorate (Northern Iraq).
With a population of approximately 2 million, Mosul is the second largest
city in Iraq. It is in the north of Iraq and is approximately 100 km from the Turkish
border. Dr. Rathwan reviewed background information that he felt was important
in understanding the drug and alcohol problems in Mosul and more generally in
Iraq. The low prevalence of drug use that has been the case in Iraq for most of the
past 3 decades was, in great part, due to extremely tight border security and very
severe criminal penalties for drug use. However, since 2003, the civil war and the
changing conditions have resulted in a much greater potential for drug use. In
2012, the borders are much more open, allowing easier transportation of drugs in
the country. The changing cultural values, increase in violence and social disorder,
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increase in internal displacement and immigration, higher rates of unemployment,
and a weakening of the criminal justice system has created an environment in
which drug use is more accepted and less likely to be penalized. In short, the
societal changes have produced an environment in which drug/alcohol use is more
likely to be seen as acceptable, and the decreasing controls over the border and the
pharmacy system make it possible for greater access to drugs. All of these factors
produce conditions that are conducive to the development of a more serious drug
and alcohol problem in Iraqi society.
From 2004–2011, 22,438 patients were treated in Mosul hospitals and
outpatient clinics, and of this number, 5.4%, or 1,206, were identified as having a
substance use problem. During the first year that drug type data were available
(2006), the most common substance abuse problem was benzodiazepines (n=126),
followed by benzhexol (94) and alcohol (17), with small numbers of users of
codeine and volatile substances. Through 2011, the general pattern of drug types
remained consistent, with the following exceptions: alcohol mentions dropped
significantly to 2 in 2010 and 7 in 2011, while Tramadol use increased
significantly: 6 cases in 2009, 8 cases in 2010, and 13 cases in 2011.
In recent years, there have been a number of research projects conducted by Dr.
Rathwan at Mosul city on the topic of substance use. He discussed data assessing
the rate of substance use among adolescents at the youth prison in Mosul and
found that approximately 22.7% of the sample assessed met criteria for substance
use histories. In another study conducted in 2006-07, Dr. Rathwan and colleagues
assessed 883 prisoners at the Badoosh prison and found that 10.3% had histories of
substance abuse and 7.1% reported current use of substances. Most commonly
used substances were benzehexol, benzodiazepines, codeine, and carisoprodol.
Dr. Rathwan mentioned a seizure of 250 kilo of Tramadol, made in 2011.
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However, no details were provided. Dr. Rathwan said that there was 7 women
addicted on hashish, all of them were young widows.
Finally, in a recent study of Tramadol use in Mosul, researchers reported
that large numbers of individuals were purchasing Tramadol from pharmacies with
and without prescriptions.
In this study of Tramadol users in Mosul, Dr. Rathwan
described the patterns of use and the consequences of use for a group of 122
individuals who purchased Tramadol at one of ten pharmacies in Mosul. These
study participants filled out a questionnaire and were interviewed about a variety
of aspects of their Tramadol use. 81 of the interviewees were male (67%) and 41
(33%) were female. 31 interviewees (25.4%) were 18 years old and under and
under half of the entire sample were employed (45%).
Only 40.2% of the
interviewees had a prescription for Tramadol and they reported purchasing
Tramadol for themselves (42%), someone else (27%) or both (31%). All had
experience using Tramadol daily for periods of one week or more, some (8%),
more than 4 episodes of one week or more in the past year.
15.6% of the interviewees used Tramadol by injection. Regarding reasons
for using Tramadol, 45.8% reported using for chronic pain, 23.8% for acute pain
and 30.2% for psychological well-being. 30.2% reported having a prior addiction
to drugs or alcohol and 18% reported that they had tried to stop Tramadol, but had
been unsuccessful. 14.7%, reported that they sometimes take Tramadol to get high
and 46.7% have purchased Tramadol from a drug dealer. Although the sample
selected in this study appears to have been a mixture of individuals taking
Tramadol for pain, along with some people who are addicted, it does document
that very easy availability that people have for obtaining Tramadol in Mosul.
Dr. Rathwan concluded his talk by strongly recommending that services for
substance use disorders in Mosul needed to be strengthened as well as efforts to
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reduce drug availability. He listed a variety of trainings that have been conducted
for professionals in the Mosul area and described future plans for research efforts.
Dr Ahmed Jaafer Karaguly: Specialist Psychiatrist Karbala governorate (Middle South)
Karbala is a city with a population of 1.1M, in South Central Iraq. It is the
location for a very important Islamic Shrine, especially to Shia Muslims. As a
result of this shrine, Karbala is a major religious tourism site and over 30 million
individuals visit Karbala annually, with a majority coming from Iran and Pakistan.
This large influx of people into Karbala is thought to provide drug trafficking
opportunities for people to bring drugs to Karbala. In addition, after 2003, as
individuals who left Iraq during the period of Sadaam Husein, began to return to
Karbala, they brought with them experience in drug use and these individuals
added to the initial customer base for the drugs brought into Karbala. Alcohol is
forbidden in Karbala Governorate.
Dr. Ahmed presented information from Karbala police concerning drug
seizures and from the Karbala Heath Centers on numbers of individuals seen who
have drug involvement. According to police, the primary types of drugs seized in
Karbala during the past 5 years are prescription drugs. The source of these drugs
come from pharmacies via MD prescription (prescriptions to the drug user and
his/her family members) and from sales of these drugs via drug dealers. The major
categories of drugs that have been seized in recent years, include: benzodiazepines,
Parkizol (Artane), Percodan, alcohol and codeine, including cough syrup. During
2011, ten oil drums filled with pills were seized by police. In addition, a seizure of
500 methadone pills was made and a seizure of 5000 grams of opium. In 2011,
there were 121 arrests for drugs and 81 individuals prosecuted in the courts for
24
drug related offenses. In general over the 6 year period from 2006-2012, the data
from the polices appears to be relatively stable, although the 4 month data from
2012, suggest that 2012 will have many of the categories of police data at the
highest levels to date, including a first time seizure of 500 methadone tablets.
Table 3 illustrates the data from police on drug seizures and arrests and convictions
from 2006-2012.
Table 3. Drug seizure and Arrest/Conviction Data in Karbala
NO
2006
2007
2008
2009
2010
2011
2012
203
111
216
328
217
228
81
265
154
293
407
263
261
125
Substance
10g
27209
13302+
2Kg
21567 pills 1170
Amount
opium
pills
pills
Hashish
Mg
pills
40g
Opium
Methad
Teriac
35178
one
35262
pills
4990g
Number
of
Cases
Number
arrested
of
people
4039 pills
pills
500
Opium
17223
pills
Number
of 60 Crime
28
27
16
35 crime
41
Crimes Crimes
Convicted
150
Crime
Crime
Crime
112
People
Misdeme
83
37
44
Misdemean 159
anor
Misdeme Misdem Misdem or
25
Misde
8
62
anor
eanor
eanor
meanor Misde
meanor
Data from the Department of Forensic Medicine,
Ministry of Health (No presentation)
Although a representative of the Department of Forensic Medicine, Ministry
of Health (MOH), was invited to participate in the CEWG meeting and accepted
the invitation, on the dates of the meeting, she was unable to attend due to an
emergency in the department. However, she did send data reflecting the drugs
seized throughout Iraq in 2011 by all agencies including law enforcement.
As can be seen in Table 4, the total amount of drugs seized in Iraq during 2011
included substantial quantities of hashish and opium and a significant amount of
heroin. Table 5 confirms that the major prescription medications seized during
2011 in major quantities are the ones that have been consistently reported over the
past decade, with benzehexol and diazepam as the two medications seized in the
largest amounts. However, the very substantial amount of amphetamine tablets (01
pills) seized in 2011, represents a potentially important new development.
26
TABLE 4. SUBSTANCES SEIZED IN IRAQ
NO
SUBSTANCE
AMOUNT RECEIVED
1
HASHISH
116,345,030 kg
2
OPIUM
2,660,908kg
3
HEROIN
515,220g
4
BUTADIN
200 ampoule
COUGH
5
SYRUP(Pulmocodine-
465 bottle+2 letters,600ml
Tuseram-Semo)
6
7
Diphenoxylate
320 tablets
Hydrochloride
Methadone
46 tablets
27
TABLE 5. PSYCHOACTIVE SUBSTANCES: PILLS RECEIVED AND
DESTROYED IN IRAQ
NO
ITEMS
QUANTITY
1
Benzhexol tab
396296tab+22.03g
2
Diazepam
20483 tab+1 amp
3
Amphetamine tab
492615 tab+74.9g
4
Clonazepam tab
940 tab
5
Somadril tab
13022 tab
6
Tramadol
969 tab+10 amp
7
Asseel glue tubes
7
8
Chlordiazepoxide
tab
35 tab
9
Amitriptylline tab
649 tab
10
Alprazolam tab
6 tab
11
Lorazepam tab
74 tab
12
Sertraline tab
14 tab
13
Ephedrine tab
198 tab
14
Phenobarbital tab
6 tab
28
Baqer Salim: Police Officer, Central Office of
Narcotics - Ministry of Interior
The Central Office of Narcotics, Ministry of the Interior, is the governmental
organization with responsibility for the control of illegal drugs in Iraq. This office
has the most comprehensive data on the drugs seized, including the illicit drugs
and prescription drugs that have been diverted into the illegal drug market. Mr.
Baqer presented data from a variety of databases maintained by the Ministry that
reflect information on all seizures by the Ministry of Interior throughout Iraq.
Table 5 documents the amount of pills seized by the Ministry of Interior by year
from 2004-2011.
Table 6. Number of Drug Cases and Pills Seized by the Iraq Ministry of
Interior, 2004-2011
YEAR
NUMBER
OF NUMBER OF PILLS
CASES
PILLS
2004
UNKNOWN
1601
2005
218
100,813
2006
249
129,445
2007
504
44947
2008
735
887,275
2009
902
478,923
2010
999
479,770
2011
872
600,037
TOTAL 4542
1,974,484
29
Data from Table 6 demonstrate that over the 7-year period, the amount of pills
seized by the Ministry of Interior has substantially increased. During 2005–2007,
the average number of pills seized was 91,735 per year, whereas during the most
recent 3-year period, 2009–2011, the average number seized was more than 5
times higher, at 519,576 per year.
Table 7 documents the number of cases of drug seizures per year and the types of
drugs seized.
Table 7. Number of Cases and Types of Seized Drugs by the Ministry of
Interior (2004–2011)
YEAR
NUMBER
CASES
2004
UNKNOWN
2005
51
OF
AMOUNT
Hashish (909)Kg(446)g(992)Mg
Opium(128)g (150)Mg
Hashish (121)Kg(217)g(459)Mg
Opium(35)Kg(585)g(2)Mg
Hashish(136)Kg(520)g(700)Mg
2006
42
Opium(196)g(600)Mg
farm (1)
2007
54
Hashish(377)Kg(450)g(633)Mg
Opium(2)Kg(556)g(890)Mg
Hashish(152)Kg(597)g(809)Mg
2008
96
Opium(370Kg(257)g(87)Mg
Farm(1)
Hashish(225)Kg(380)g(990)Mg
2009
100
Opium(8)Kg(407)g(805)Mg
Capsule(70)
Heroin(49)Kg(675)Mg
30
YEAR
NUMBER
CASES
OF
AMOUNT
Devil's Apple(5)Kg
Datura(26)plant
Hashish(107)Kg(225)g(653)Mg+(4)plants
+(4)cigarette
Opium(2)Kg(678)g(532)Mg
Datura(5)Kg+(2)plant
2010
81
Morphine(5)Mg
Devil's Apple(230)𝑐𝑚 3 juice with seeds
Butdan(200)ampoule
Captagon(55,446)pills+(1,650,595)Kg powder
Hashish(156)Kg(858)g(300)Mg+(25)plant
Opium(1)Kg(667)g(489)Mg
2011
37
Heroin(3)g(5)Mg
Captagon(331,855)pill
Datura(1310)plant
Hashis(21860Kg(688)g(536)Mg+cigarette(2)+(29)plant
Opium(89)Kg(477)g(945)Mg+(70)capsule+(2)farm
Heroin(490Kg(678)g(5)Mg
TOTAL
462
Devil's Apple(5)Kg+(230)𝑐𝑚 3 juice with seeds
Datura(1340)plant(5)Mg
Morphine(5.01)Mg
Butdan(200)ampoule
Captagon(433,301)pill+(1,650,595)Mg powder
As documented in Table 7, hashish and opium were the two most commonly
seized drugs over the 7-year period.
However the first seizure of Captagon
31
tablets(and powder) was made in 2009, and in 2010 and 2011, the amount of such
pills seized has increased substantially each year.
Tables 8 and 9 document the location of the pill and illicit drug seizures over
the 18 Governorates of Iraq. Table 7 indicates that there are seizures of pills
(prescription medications) throughout virtually the entire country of Iraq,
suggesting that this is a widespread practice nationwide. In contrast, seizures of
illegal drugs are made predominantly in Thiqar, Basra and to a far lesser extent in
other Governorates of Iraq.
As presented in the report from the Basrah
representative, it appears that Basrah is one of the main entry point for much of the
illicit drug supply. Thiqar is a main entry point from Saudi Arabia as it has a long
border with it.
Table 8. Pills Seized in Iraq by Province (2011)
PSYCHOACTIVE
LSD
OTHER
SUBSTANCE
PILL
PILLS
-
156308
-
-
156308
KARBALA
-
57923
-
40
57963
NAJAF
3
11483
-
293
11779
BABIL
-
27657
-
147
27804
WASIT
-
6287
-
105
6392
THIQAR
284400
74116
-
117
358633
MISAN
-
30147
-
40
30187
ALDIWANIA
-
57431
-
-
57431
ALMUYHANA
-
59650
-
-
59650
BASRA
45000
34100
-
210
79310
DIALA
-
281
-
3
284
KIRKUK
-
15307
-
1099
16406
SALAHALDIN
-
64
-
174
238
ALANBAR
2371
154
-
-
2525
PROVINCE
CAPTAGON
BAGHDAD
32
TOTAL
NINEVEH
-
12400
-
1211
13611
TOTAL
331774
543308
-
3439
878,521
Table 9. Kinds and Amount of Drugs Seized in Iraq According to Provinces
(2011)
PROVINCE
HASHISH
OPIUM
HEROIN
TOTAL
BASRA
86,972,300Kg
206,99g
-
86,992,999kg
-
-
20,005kg
ALMUTHANA 20,005kg
THIQAR
-
1,214,,300kg -
1,214,300kg
BAGHDAD
1,265kg
1,960g
3,5g
1,269965kg
MISAN
-
15,750g
-
15,750g
KARBALA
-
21,430g
-
21,430g
KIRKUK
-
16,500g
-
16,500g
NAJAF
21g
-
-
21g
WASIT
48,595kg
-
-
48,595kg
TOTAL
156,858,300kg 1,290,639
3,5g
158,151,944kg
The report from Mr. Baqer emphasized that drugs of abuse are seized
throughout Iraq in substantial amounts. Increasing amounts of illicit drugs are
being seized primarily in the Basrah Governorate; in addition, new drugs are
appearing, including ATS (Captagon and crystal methamphetamine). During the
first part of the last decade, Iraq was primarily considered a transit country, or one
in which drugs passed through on their way to other consumer countries.
However, increasingly, Iraq is becoming a consumer country, and new drugs are
finding their way to new markets in Iraq.
33
Dr. Jawad K. Al-Diwan
Dr. Al-Diwan referred to the growing anecdotal and clinical reports of
increasing abuse of drugs in Iraq and to Iraqi Mental Health Survey (IMHS) which
showed a prevalence of 1.5% for substance use disorder (SUD). A survey in
Baghdad was carried out in 2010. A questionnaire of lay administrative interview
and criteria of DSM-IV diagnostic system were used. A total of 2678 persons aged
11 to < 35 years with male to female ratio of 3.8:1, was included in the survey. The
findings were demonstrated in tables
Table 10. Lifetime prevalence of alcohol and substance abuse
Variable
No.
%
Alcohol abuse
447
17.8
Substance abuse
188
7.02
Table 11. Age and sex distribution of alcohol and substance abuse
Variable
Alcohol abuse
Substance abuse
No.
%
No.
%
< 18
15
2.1
8
1.1
18 – 23
86
10.7
39
4.9
24 – 29
154
28.2
63
11.4
30 – 35
99
29.5
55
16.3
>35
93
34.4
23
8.6
Total
447
Age
188
34
χ 2 =36.7, d.f.=4, p= 0.0001
χ 2 =13.7, d.f.=4, p= 0.0001
Male
447
21.1
188
8.8
Female
0
0.0
0
0.0
Sex
Total
Table 12. Distribution of crowding index in alcohol and substance
abuse
Crowding
Alcohol abuse
Substance abuse
index
No.
%
No.
%
>2
282
23.7
119
8.0
<2
165
11.1
69
4.6
χ 2 =4.9, d.f.=1, p=0.026
35
χ 2 =1.8, d.f.=1, p=0.17
40
35
30
25
% 20
Alcohol
substance abuse
15
10
5
0
< 18
18 - 23 24 - 29 30 - 35
Age
> 35
Fig. 1 Age distribution of alcohol and SUD in Baghdad
Dr. Al-Diwan showed the effect of control of militants on alcohol and SUD
during years of civil war. The effect demonstrated in the fig.2
36
S
U
D
/
a
l
c
o
h
o
l
90.8
80.8
70.8
60.8
r
a
t
i
o
50.8
40.8
30.8
20.8
10.8
0.8
Governorates
Fig. 2 Distribution of alcohol / SUD in Iraq
Drs. Raad Tahir and Siham Mohammed, Ministry of
Labour and Social Affairs.
Drs. Raad and Dr.Siham reviewed the responsibilities of the MOLSA and
among these responsibilities are the tasks of identifying needs of Iraqis who are
affected by poverty and unemployment. Among these groups are youth in prisons
(delinquents) and shelters who have been severely impacted by significant family
problems. In a survey of youth under the age of 15, currently in custody in the Iraq
youth prison, it was reported that 4% of the youth in this facility admitted to selling
drugs in the prison, while 6.6% reported selling alcohol. These data suggest that
youth in this facility do have access to drugs and alcohol, but at present there is not
adequate data to understand how severe this problem is. Drs. Raad and Siham
reported that they believe that tobacco, drugs and alcohol are substantial problems
among youth in shelters, and while at present there have been no surveys that have
been conducted, the development of a survey is underway to quantitatively assess
this problem.
They also strongly believe that in border cities there are very
37
significant drug and alcohol problems among people served the Ministry of Labor
and Social Affairs.
They closed their talk with an acknowledgment that the
Ministry has limited data upon which to understand the substance use disorder
problems of the people they serve and that this data could greatly improve the
effectiveness of the Ministry.
Mr Fuad Kadhim Mermas: Prisons Directorate Ministry of Justice.
The presentation described a study in which 100 prisoners, all of whom
were self reported drugs users, were studied regarding the medical consequences of
their drug use.
The study revealed that there was a high rate of medical
comorbidity among this population and that their drug use appeared to be
associated with serious medical conditions and high rates of use of the prison
medical services. In this project, the focus was on the 100 identified drugs users,
not the entire prison population.
However, the presenter did note that
approximately 60% of the individuals in prison had previous histories of drug
and/or alcohol use, including a small number with prior histories of injection drug
use.
It is estimated that out of a group of 30,000 prisoners, 1500 or 5% are regular
users of drugs in the prisons. In an annual report on drug use in the prisons, drug
use of 1000 individuals was reviewed. All drug use was taken as pills and the vast
majority of the pills being used within the prison system were psychiatric
medications, including anticholinergics, anti depressants and codeine.
38
Dr. Issam Salim Ismail, Ministry of Health Wasit
(Kut City)
Kut is a border city in central Iraq with a population of 1.2 million. Dr. Issam
has attempted to quantify the nature and extent of drug use and drug trends over
the past several years. However it has been quite difficult to access data on drug
use in a reliable manner. In an annual report from the hospital in Kut, 100 cases of
substance abuse were reported. Valium and Tramadol are the drugs most often
reported by users.
Mr. Amer Abdullah Ibrahim, General Authority for
Customs, From Anbar Governorate
Mr. Amer reported that the responsibility of the Customs Authority was to
monitor the very vast borders of Iraq to prevent smuggling and to monitor all
materials coming into and going out of Iraq. He reported this to be a very large
task for a relatively small staff of Customs agents with limited resources of
supplies and equipment needed to carry out their objectives.
At present the
General Authority of the Customs believes there is a significant problem of drug
smuggling in Iraq, though he has no data on drug/alcohol seizures to quantify the
problem.
Mr. Haider Faisal Rauf, Director of Children’s Future
NGO
39
Mr. Haider described the current activities provided by the Children’s Future
NGO to address the needs of children and adolescents in Iraq. The organization
provides a broad range of social services to address the social needs of youth in
Iraq. He reviewed the challenges of providing these services and the importance to
society of ensuring that the young people of Iraq have the necessary services to
allow them in a healthy way. He views drug and alcohol use as a major concern of
the youth the Children’s Future serves. At present, he has no quantitative data on
the nature and extent of substance use among the youth served by Children’s
Future NGO, however anecdotal reports indicate that children and adolescents are
smoking cigarettes, inhaling solvents, using alcohol and are using prescription
medications obtained from their own households.
Informal Survey of Meeting Participants
Near the end of day 2 of the Iraq CEWG meeting, the meeting chairs, Dr.
Nesif and Dr. Jawad polled the meeting attendees to assess their perceptions on the
current drug use situation in their domains. In the first exercise, members were
asks to give yes or no answers to “Do you think the following psychoactive
substances are significant problems in the domain you represent (either
geographical or Ministry/NGO). Table A below shows the results of this exercise.
Each box with an X indicates that the representative responded in the affirmative
that the drug category is a significant problem in their domain.
40
Table 10: Drug Use Types Across Regions
Psychi
Amph
Cryst
eta-
al
atric
Trama mine
Amp
Her
Opi
Coca
Code
Hash
Alcohol
Pills
dol
Pills
het
oin
um
ine
ine
ish
Basra
X
X
X
X
X
0
X
0
X
X
Karbala
X
X
X
0
0
0
0
0
X
X
Mosul
X
X
X
0
0
0
X
0
X
X
niyah
X
X
X
0
0
0
0
0
X
X
Erbil
X
X
X
X
X
X
0
0
X
X
Survey
X
X
X
0
0
0
X
X
X
X
Najaf
0
X
0
0
0
0
X
0
X
X
Police
X
X
X
X
X
X
X
0
X
X
Prisons
0
X
X
0
0
0
0
0
X
X
0
X
X
0
0
0
0
0
X
X
Sulayma
Baghdad
Baghdad
Ministry
of
Social
Affiars
41
Center
for AIDS
0
0
0
0
0
0
0
0
X
X
NGO
0
0
X
0
0
0
0
0
0
X
Customs
X
X
X
0
0
0
0
0
0
X
Wasit
X
X
X
X
X
0
X
0
X
X
Childre's
Future
Drug
X
present
Drug
0
not
present
The second exercise was to ask all attendees to indicate the specific
psychoactive substance that represented the most serious public health problems in
the domain they represent.
Despite all the discussion in the meeting about
increasing evidence of drugs like amphetamine and cannabis, all members of the
group reported that the most serious psychoactive substance use problem in the
domains they represent is the category of prescription drugs, primarily
benzodiazepines, codeine and benzhexol, the same drugs that were reported by
Aqrawi and Humphreys in their 2009 report.
42
Synthesis of Data Reports
Some tentative findings from the reports suggest that since the time of the
reports by Aqrawi and Humphries (2009) and Al Diwan, (2011), summarized in
Rawson (2011), some things have remained relatively stable and there have been
other significant changes. The psychoactive substances most widely used in Iraq
continue to be alcohol and the prescription drugs: benzodiazepines, benzhexol and
a variety of psychiatric medications. This set of “primary drugs” is consistent with
the earlier reports. However, there was near universal agreement that the use of
hashish, Tramadol (opioid-type analgesic) and amphetamine-type substances
(ATS) is increasing rapidly in some areas and that drug and alcohol use overall is
increasing. Reports from Basra from health and police were noteworthy. Two
types of amphetamine type stimulants (ATS) have made an appearance in Iraq:
“01 Pills” (Tablets of Captagon, an amphetamine-type drug) and “crystal”
(methamphetamine) have been seized in considerable quantities in Basra. The “01
Pills” appear to be of the same type of ATS that are being used in epidemic
amounts in Saudi Arabia and they appear to be coming into the country via ships
traveling to the Gulf and Saudi Arabia. The “crystal” is likely coming from Iran,
since crystal use in Iran is extensive and is the most rapidly growing drug in that
country. At the present time, there is little evidence of increased use of heroin in
Iraq and rates of injection drug use appear to continue to be relatively low.
43
Day 2 I-CEWG Workshop Discussions on Future
Plans for Next I-CEWG Meetings.
The purpose of these meetings in the afternoon of Day 2 was to determine
how to improve the information presented at the future I-CEWG meetings and
expand the coverage of the types of data and the geographical coverage of future
data.
The first question posed by the meeting chairs was:
GEOGRAPHIC
REGIONS
ARE
THE
MOST
IMPORTANT
“WHICH
TO
BE
REPRESENTED AT FUTURE I-CEWG MEETINGS?”
Priority CEWG Regions.
The discussion about the most important/productive geographic regions to be
represented in future I-CEWG meetings centered on cities/regions with high rates
of tourism/visitors, including border cities and religious centers. The following
cities were identified as the 10 cities with the highest priority.
Basra
Anbar
Najaf
Wasit (Kut)
Karbala
Sulaymania
Baghdad
Erbil
Mosul
Muthanna(Samawah)
44
Types of Data and Locations for Data Collection.
In addition to locations, the group clearly recognized the need to access
different data sources to provide a better and more accurate picture of drug use in
Iraq. To address this question, the chairs posed the question: “WHAT DATA DO
WE WANT TO COLLECT AND WHERE CAN WE GET IT?”
The group came up with the following list of suggestions for types of data and sites
for data collection.
1. Classify kinds and types of drugs
2. # of drug users including gender, age socio-economic status, location,
3. Quantity of drugs
4. Distribution routes
5. Route(s) of administration
6. Price/cost of drugs used
7. How is it is used (groups or individually)
8. Frequency of use
9. Drug related deaths
10.Drug related accidents
11.Arrests
12.Emergency department admissions
13.Police records (arrests and accidents, automobile, falls, etc)
14.Court records
15.Health Center Admissions
16.Source (where were the drugs obtained)
17.Social Police or detectives
18.Family history of use
19.Pharmacy records
20.Sexual harassment related to drug and alcohol use (police records)
45
21.Emerging trends in drug use and distribution routes and center
In Response to the question about where to get the data, the following suggestions
were made.
1. Health Centers
2. Police
3. Courts
4. Customs
5. Border crossings
6. Prisons
7. Schools and Universities
8. Internet and media outlets
9. Other country reports
10. Reports that are already routinely collected (identify these)
11. Interpol arrests
12. Poison control centers
13. Military courts
14. Military/soldiers
15. Ministry of Youth
16. Need to obtain existing CEWG data collection forms to assist in the
development of I-CEWG collection instruments)
17. Community centers, (beauty salons, cosmetic shops, coffee shops, places
where people gather-clubs etc)
46
Ways to Improve Subsequent I-CEWG Meetings
There was a great deal of discussion about the need to have more lead time to
prepare data and that it would be very important to have each governmental
representative receive an official designation as the CEWG representative, in order
to facilitate their access to governmental data. This would include communication
between the federal health officials and Governorate officials when needed
(especially with Kurdistan representatives).
The third question posed by the
meeting chairs was: “HOW CAN WE IMPROVE UPON THIS MEETING FOR
NEXT TIME?”
The group came up with the following list of suggestions for ways to improve
future meetings.
1. Everyone invited should be prepared to provide a report
2. A formal letter of invitation should be provided to CEWG
representatives.
3. As time is needed to prepare the report and to schedule time to attend the
meeting, ample notice should be given as to the date and location of the
next meeting
4. A formal agenda should be distributed ahead of time
5. Will there be financial support for report writing? Meeting attendance?
6. Email will be used to communicate to the nature of the data to be
collected and to provide notice regarding the next meeting
7. The National Committee should have a representative on the I-CEWG.
Other Suggestions
The following suggestions were given to improve the I-CEWG effort.
47
1. Establish a website for the I-CEWG and when the reports are finalized
and approved they should be posted on the website.
2. Conduct a e-survey with psychiatrists in Iraq to collect data on the nature
and extent of substance use among individuals in private psychiatric care.
3. Conduct a street survey (with biological data, eg urine tests, saliva tests
to confirm self report). Individuals surveyed should be groups who are at
high risk for drug use, including; street vendors, adolescents in high drug
use areas, sex workers, members of the military. The following points
were discussed about this survey idea:
I-CEWG SURVEY
Collect 2000-3000 surveys in 10 geographic areas to be completed
in 2 months including 2 week training time and 6 weeks of data
collection
Hire local staff and pay them 300 to 500 per month to collect 100
surveys per month
Cost is to be provided by the Ministry (20k).
Target “High Risk” populations
Sex workers
Street Users
Adolescents
Street vendors
Collect data in 3-5 separate areas in each governorate?
Use oral swabs or urine drug screens
Test
for
Hashish
(THC),
Methamphetamine, Tramadol
48
benzos,
Opiates,
Amphet,
Recommendations
A set of recommendations will be developed after the data reports have been
synthesized. A preliminary list of recommendations is below.
1. CEWG is to be linked with the Higher Committee of Substance Abuse .
2. The Council of Ministers will be asked to approve the committee and to order all
agencies concerned with substance abuse to cooperate in giving the needed data
and information.
3. Dr Jawad Al-Diwan is nominated as the chair of the committee and Dr Nesif AlHemiary as deputy until the next meeting to help in the preparation and
communication between members.
4.
An administrative person should be hired to conduct administrative and
secretarial work for the I- CEWG.
5. The next meeting is will be held during the first week of March,2013.
6. A website will be developed for the I- CEWG and the final, approved reports
will be posted.
7. A training course for the members of the I-CEWG, to improve their skills in
gathering and analyzing data will be held, with support requested from the UCLASAMHSA grant and NIDA.
8. Administrative preparations of the next meeting will be started with adequate
preparation time.
9. The agenda of the meeting will be prepared and sent to members with adequate
time for review.
10. Some standard forma for data collection and preparation will be prepared.
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11. The governorates that were selected for information gathering were: Baghdad,
Mosul, Erbil, Sulaimani, Wasit, Kerbala, Anbar,Najaf, Muthanna , and Basrah.
Information is also needed from central office of narcotics control police, prisons
directorate, ministry of higher education, sports health department , forensic
department, juvenile prisons department, center for AIDS, and substance abuse
control program in the ministry of health.
13. MOH should partially support a survey project to collect data about substance
abuse from high risk populations in certain places like streets and high population
places in five governorates including Baghdad, Basrah, Najaf, Mosul and
Sulaimani.
(End of report)
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