Side event: Evidence-based public policy improvement on drug policies: Wastewater analysis in Turkey

Organized by the Government of Turkey and the Turkish Green Crescent Society

Ambassador Ahmet Muhtar Gün, Turkey: This year is particularly important for the CND. We have a solid basis for cooperation at the international level fighting against trafficking and in prevention. You’re all aware of discussions underway concerning possible changes to the Conventions, which are the basis of this very solid international cooperation. As Turkey, we’re very clear, the system of the conventions, the INCB, the WHO, Is extremely important and we want to preserve its integrity. If we open the Pandora’s box, we’d lose this solid basis. This is my first priority.

Ömer Ulu, Head of the Smuggling and Intelligence Bureau: Turkey is the bridge between East and West. This location brings advantages but also disadvantages. Turkey is in the middle of drug producing countries (Afghanistan, for instance, for opioids). Synthetic drugs produced in European countries like Netherlands, Poland and Czechia end up in our country. We seized over 80 million pills, the highest seizure in the world. In Europe, heroin is killing thousands. Which is why Turkey fights heroin without tolerance. In Turkey, there are also thousands of deaths related to synthetic drugs; which is why we expect the same level of fight in Europe against drug as we do in our countries. Our security units are very successful on the street. We’re looking for other systems, though. Drug wastewater analysis is very new to us, but we have completed this project with great success.

Department of data collection, Ministry of Interior: The issue of ensuring the determination of the amount of drugs in wastewater is included in the National Strategy on Fighting Against Drugs and Action Plan (2018-2023). The aims are: spatial inquiry on the basis of the city to reach crime and suspects; creating a region and crime profile related to use; determining active production and consumption regions; creating a drug map to intervene properly; carrying out prevention and awareness more easily. The Turkish Green Crescent Society is implementing this project. Following the determination of responsible institutions, project started. The annual cost was about 1.5 million TL. The project selected 18 provinces, with a population of about 50 million people. The criteria for selection follows: crime of using drugs or stimulants, or buying, accepting or possessing drugs or stimulants to use (incidents, suspect), crime of manufacturing and trafficking drugs (incidents, suspects). But also probation numbers, inpatient/outpatient numbers on drug use, patients applying to emergency clinics for drug use, denunciation numbers, drug-related deaths. 77% of drug incidents took place in this country and 75% of the suspects caught in drug incidents occurred in these provinces. 76% of drug related deaths took place in these provinces. The project will report in 2020. The samples analysed came from 49 wastewater facilities (Istanbul University and Çukurova Üniversitesi). The project was carried out in contact with the governorships and municipalities. There have been no problems reported with the project. The project also took place in 73 cities of 20 EU countries in 2019.

Ömer Ulu, Head of the Smuggling and Intelligence Bureau: The drug problem is a big threat to society. Which is why we established a new cooperation under the new presidency. NGOs are very important for our policy. I introduce you to Mehmet Dinc, representative of the Turkish Green Crescent, one of the most important NGOs in Turkey.

Dr. Mehmet Dinç, Turkish Green Crescent: In line with the role of the Green Crescent as member of the High Council for Addiction, the collaboration with government is fundamental. We aim to produce appropriate policy with appropriate data. We also seek to share this data with other institutions, like the EMCDDA, to improve coordination. Analysing data accurately is fundamental. Turkish Green Crescent organises 10 events and we thank you for being here today.

Ömer Ulu, Head of the Smuggling and Intelligence Bureau: Thank you. We don’t feel alone in fighting drugs because we count on organisations like yours. First projects entail big risks.

Selda Mercan, Istanbul University: This is the first study model for Turkey. There are key indicators for illicit drug consumption monitoring: general population survey, drug related deaths and morality, treatment demand and seizures. Complementary methods are EWS and Wastewater analysis. Why monitor illicit drugs from wastewater? Because it’s urine analysis of a city. The technique relies on the principle that almost everything we consume is excreted unchanged or metabolised and goes into the sewer system. So it can provide real time information about amounts and trends of drugs. And it’s anonymous data. We don’t stigmatise for using or abusing drugs. It complements the existing survey-based methods. Why do we need this analysis? Illicit drug use is a global problem with severe consequences for health but also security, economics and social development. Policymakers need accurate and reliable information to effectively allocate resources. The method was initially used to measure environmental impact of household wastewater. In early 2000s, it started being used to estimate illicit drug use. In 2007, the very first article in the field was published by an Italian researcher. In 2010, the SCORE group was established and joined by experts in most European countries. This has become a rapidly developing discipline thanks to the EMCDDA. In 2019, 73 European cities in 20 European countries used the method. In Turkey, it was supported first by the Development Agency of Istanbul covering conventional illicit drug monitoring in two districts of Istanbul. Turkish Green Crescent joined as contributor. This produced research paper on two districts. Wastewater analysis has been officially included in the Illicit Drug Action Plan of Turkey as a complimentary indicator. Results so far from the first period: I will present two cities. The most consumed illicit drug in Istanbul is cannabis, by far; the second is heroin. A 1000 inhabitants consumed around 27 doses per day. For Adana City, per 1000 inhabitants, 70 doses per day. For alcohol, 4000 millilitres per day. When we compare cannabis use, it’s clear that Adana has a higher rate of consumption of cannabis than Istanbul.

 

Ozge Atalan Loomis, Turkish Medicine and Medical Devices Agency: The Single Convention of 1961 mandates the control by the State of the dispensation of drugs for medical use. Which is why Turkey established a prescription system in the 1980s. They were printed in either green (psychotropic) or red (narcotics). Each had 3 identical copies with specific serial numbers. They were distributed in our agency to health directorates. Pharmacists recorded all the information of the prescribed person (including ID and phone number). Initially it worked. But problems: abuse of medicines (patients visiting different doctors in different cities) and counterfeit/lost prescriptions. To prevent problems, an electronic coloured prescription system was launched on 17 March 2017. Expanded the system. Web-based prescription system to prescribe. The system prevents counterfeit, lost/stolen or duplicate prescriptions. It obliges users to fill the compulsory fields in the form or medicines are not dispensed. Warns users about recommended daily doses to encourage the right use and impede prescription of more than the maximum dose. The system provides instant monitoring of transactions in the supply chain so that authorities have reliable and comparable data. The e-prescriptions are 93,07% of prescriptions. The number is still increasing. THe number of physicians prescribing electronically exceed 120,000.

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