Drug abuse in Poland
Author: Andrzej E. MAREK,, Slawomir REDO,
Pages: 43 to 52
Creation Date: 1978/01/01
Ph.D. Slawomir REDO, Assistant Professor at the Institute of Criminal Law of the Nicolaus Copernicus University, Torun, Poland 1
The abuse of drugs in Poland, a lesser problem than that of alcoholism, has only recently become a subject of interest. Although at present it is not of crucial importance in the pathology of social life, it may still have serious effects on the individual and society.
This paper discusses the results of several surveys carried out by different researchers in Poland to assess different aspects of the drug abuse phenomenon. Drug abuse patterns in Poland, as in other countries, change rapidly. Therefore, yesterday's situation may not be considered as valid today. The first part of this article presents some of the characteristics that were observed since 1968, when the phenomenon appeared, up to 1976. The second part describes the provisions of the Polish criminal law to fight drug abuse, and envisages some measures to better control this phenomenon in the future.
It is difficult to give precise statistical data regarding the magnitude of drug abuse in Poland for the following reasons: Firstly, drug abuse patterns change rapidly; secondly, the information available may not truly reflect a given situation; thirdly, there exist great discrepancies between different estimates. Despite all these shortcomings, one should seek quantitative evaluation.
Warsaw, the capital of Poland with over 1.2 million inhabitants, had, on 1 September 1972, 213 adolescent drug abusers (born between 1953-1959) undergoing treatment (4 per cent of the population born between 1953 and 1959) [ 1] , From the XXXIst Congress of Polish Psychiatrists held at Poznan in 1973, we learn that this rate may also be extrapolated to the population of other large Polish cities, where also 1/25th of the young population were registered in hospitals or out-patient psychiatric departments [ 2] .
1Addresses of the authors: Andrzej E. Marek, ul. Matejki 61/54, 87-100 Torun, Poland; Sławomir Redo, ul. Mickiewicza, 55/31, 87-100 Torun, Poland.
As the population of Warsaw is one-fifth of the population of all the other large cities in Poland, it could be assumed that there were some 1,250 adolescents born between 1953-1959 abusing drugs who would need treatment.
However, the real size of drug abuse is perhaps not limited to the known drug abuser population. Some authors estimate that about 10,000 people, including treated patients, abused drugs in Poland in 1973 [ 3] . B. Holyst [ 4] considers that the number of occasional drug abusers might have reached 30,000 at the beginning of the seventies, in addition to some 15,000 drug-dependent persons, while Cz. Czapów estimates that 47,000 to 71,000 persons abused drugs in 1972 [ 5] .
These views on the magnitude of drug abuse show considerable differences varying from 5 to 35 times that of the number of registered persons abusing drugs. Over the last two years (1975-76), a quantitative stabilization in the size of the drug abuse phenomenon has been observed. The abuse of drugs is considered to be rather modest and it certainly does not at present represent an issue of social importance.
However, the fact that the drug abuse phenomenon has not at the present moment a great significance does not mean that a prediction of the possibility of its spreading should not be ventured. Since, as in other countries, the drug abuse phenomenon has a tendency to develop foremost amongst the urban population, several local surveys have been carried out since 1972 in Poland in cities with over 200,000 inhabitants.
The first survey was conducted in 1972 by M. Latoszek, A. Lemska and P. Sieliwonczyk from Gdansk Medical Academy [ 6] . The authors sent a questionnaire to 2,500 school children aged 14-18 and received 748 replies. Reference to the issue of using narcotics was made only twice: "Have you ever used narcotics or remedies with narcotic effects?" and "You may elaborate on the subject". Remedies with narcotic effects had been used by 8.3 per cent of pupils (62 cases).
Slightly different data were obtained in a survey conducted at Szczecin in 1973/74 [ 7] . The author, A. Szakowski from the Pomeranian Medical Academy, interviewed 1,215 persons, representing 25 per cent of all school students in the area of Szczecin. That number included 602 students from grammar schools, 426 from technical schools, 71 from fine arts schools and 116 from schools for auxiliary medical personnel. The author, "having regard to an attempt at determining the degree of involvement with dependence-producing drugs in the school environment", made an analysis of the various forms of abuse. The first degree of involvement with drugs included students who were purported to take drugs. The second degree those who were offered drugs and had friends taking them. The third category included those who were taking drugs themselves following their friends' suggestions. The fourth degree of involvement dealt with those who were taking drugs, but not all of them at the suggestion of their friends. The fifth degree included those who were taking drugs regularly. It should be stressed that there was a high rate of involvement with drugs among students of fine arts schools. The frequency of involvement with drugs was always higher among students of grammar schools than that of students of technical schools, except for the first degree of involvement. The smallest number of young people involved in drug taking was found amongst students of schools for auxiliary medical personnel, although there, too, 21 per cent of them admitted that they had been offered drugs and had friends taking drugs.
Similar results were obtained by the same author in a survey carried out in 1972, which included 701 pupils from schools in Szczecin [ 8] . That population consisted of 301 pupils from elementary schools, 205 from grammar schools, 144 from technical schools and 51 from schools of fine arts. The percentage of pupils taking drugs was as follows: elementary schools 3.3 per cent, technical schools 4.2 per cent, grammar schools 9.3 per cent and schools of fine arts 9.8 per cent.
Unfortunately the same breakdown of information on the Gdansk survey is not available. This makes a comparison of these two populations impossible.
The findings of the survey conducted at Szczecin in 1973/74 show that 30.3 per cent of the pupils interviewed (371 cases out of 1,215) were taking drugs. If, however, one counted only the cases of the fourth and fifth degrees of drug involvement (119 persons altogether), the percentage would radically fall to 10.2 per cent. This is not very different from the results obtained in the Gdansk survey, but varies significantly from the findings obtained in the Szczecin survey conducted in 1972, which showed only 40 persons (5.7 per cent) taking drugs. These findings differ even more from the results of the Warsaw study mentioned above. However, the data obtained in Warsaw, comprise only the population of registered abusers, and may not be representative of the whole drug abuser population. It should also be borne in mind that adolescents from elementary schools are included in the earlier Szczecin investigation.
Boys significantly outnumber girls in the population of drug abusers. The rate is almost 2:1 for both the Gdansk survey, and the Szczecin survey of 1973/74; 4:1 for the Szczecin survey of 1972.
As in other countries, it is often young people who are involved in drug taking. The findings of several surveys show that the 14 to 25 age group is the age group at most risk for taking drugs, the peak corresponding to the 17 to 22 age bracket. However, other data indicate that even an 8-year-old child was involved in drug taking, and that 12 to 13-year-old children abuse drugs more frequently than before [ 9] , [ 10] .
Patients suffering from drug addiction in relation to age and sex (per 100,000 inhabitants) treated in psychiatric hospitals (Z. Jaroszewski and Z. Karewicz, 1972)
Nevertheless, it is not only young people who are affected by drug abuse. Z. Jaroszewski and Z. Karewicz show that, apart from 15 to 19 year-old boys and girls, persons over 35 years of age also take drugs (see table 1) [ 11] . The number of persons over 35 abusing drugs may be smaller and they may have different motivations for drug taking than adolescents. Young people were mainly hospitalized because of acute poisoning, while older people were usually treated for drug dependence. The low percentages of people taking drugs in the age groups 25 to 29 and 30 to 34 may indicate that in many cases drug dependence does not arise from drug taking at a very young age.
From the two Szczecin surveys, we see in table 2 that opiates were frequently abused. Morphine seems to be the most common drug of abuse as shown in the larger and certainly more representative survey of 1973/74. This is confirmed by other authors [ 12] , [ 13] . Because the drug abuse phenomenon in Poland is relatively recent, young drug abusers are not too deeply involved in drug taking. This may explain why morphine [ 14] and similar opiates, and not heroin or LSD, are commonly taken. Another reason for the non-abuse of LSD and heroin is that these drugs are not easily available. Stringent and successful customs measures have practically eliminated them from the black market, and the manufacturing of illicit substances does not exist. On the other hand, it is relatively easy to obtain licit medicines, such as Ritalin (formally available on special prescription) or trilene (used regularly for laundry purposes and sniffed by young drug abusers).
In 1972, a survey of 142 patients was conducted at the Poznan Psychiatric Clinic [ 15] . The authors found that among persons between 14 and 19 years of age, multiple drug abuse prevailed, while among the older persons (40 to 70 years old) the abuse of only one drug predominated. Similar results were obtained in Gniezno Psychiatric Hospital (1970-72) where 29 out of the 30 persons treated between 14 and 21 years old were multiple drug abusers [ 16] . Results from another survey conducted in Łódź (1972) by Z. Rydzynski et al. [ 12] among 52 patients aged up to 22 indicate that multiple drug abuse was only "relative" (65 per cent of the cases). After "the period of trials" the patients usually found one favourite "basic" drug.
Drugs commonly abused
aStomach pain reliever containing Tinctura opii simplex.
Drug taking is closely linked with a low level of education. It is very interesting to note that in Poland the drug abuse phenomenon affects mainly pupils from secondary or elementary schools. J. Mazurek, who observed his patients at Lubiaz Psychiatric Hospital found that out of 60 persons examined above the age of 15, one-third had completed primary education, a few secondary and none of them had finished university studies [ 10] . Results from a larger Warsaw survey conducted among 243 patients showed that 18 per cent did not go to school at all, and that as many as 60 per cent of them had school problems, constantly or periodically; 20 per cent had repeated grades twice or more and 35 per cent changed schools [ 13] . However, it is not known whether the difficulties described here are the cause of drug taking or its consequences. No doubt, long-lasting abuse reduces mental efficiency preventing such pupils from continuing their education, but it cannot be excluded that previous psychological problems may have interfered, particularly during adolescence, and motivated them towards drug taking. It is also probable that the lower the student's expectation to obtain a high level of education in the future, the more likely it is that he will take drugs [ 17] .
The findings of the Łódź survey mentioned above [ 12] indicate that 42.3 per cent of persons undergoing treatment came from broken homes. Results of the Lubiaz survey [ 10] show that about 50 per cent of patients came from broken homes; 70 per cent had disturbed relations with both parents (50 per cent with the mother). It is, however, difficult to differentiate between causes and consequences. The results of the Warsaw survey [ 1] show that as many as 40 per cent of the persons came from broken families; 51 per cent admitted that being at variance with parents is a predisposing factor towards drug taking.
Several authors have reached the conclusion that a high percentage of drug takers come from intellectual families. For example, in the Gdansk survey, pupils from manual worker families constituted 7.6 per cent and from intellectual families 9.7 per cent.
Latoszek et al. [ 6] , who conducted a survey in 1972, point out that a comparison between the percentage of drug abusers from these two categories of social backgrounds (workers, intellectuals) taking into account the percentage for the whole population of pupils taking drugs (i.e. 62 persons, or 8.3 per cent, out of 748 school children), indicates that drug takers coming from intellectual families are "over-represented" by 1.4 per cent, whereas the manual worker group is "under-represented" by 0.7 per cent (see table 3).
A similar conclusion appears from the 1973/74 Szczecin survey: "craft" adolescents represent 13.1 per cent of the total; 11.5 per cent of pupils descended from intellectual families, 5.5 per cent were of rural origin and 3.4 per cent came from the manual worker group. In comparison with the Gdansk survey, the Szczecin investigation provides a far richer differentiation of social origin. In Poland, as in most countries, drug abuse is limited to the urban population. However, none of these surveys included pupils from technical (trade) schools, recruited chiefly from the working class. Some Polish authors have also observed that groups of adolescents seriously contribute to the spread of the drug abuse phenomenon [ 18] . The findings of another 1970-71 Łódź survey conducted among 33 adolescent patients at the psychiatric hospital indicate that as many as 72 per cent of them were from manual worker families [ 19] . Taking into consideration that this investigation was not conducted among a large population, it is difficult to draw a conclusion concerning the predominance of that category of young people among the drug abusers. Thus one can venture to give an opinion that the drug abuse phenomenon is composed of a fairly proportional participation of both intellectuals, and adolescents coming from the manual worker groups.
Social origin of drug abusers: survey conducted among school children aged 14-18 at Gdansk in 1972 by Latoszek et. al.
Number of persons
Number of drug abusers
Although the information presented on drug abuse in Poland shows modest dimensions of this phenomenon, it is important to pay attention to the measures aiming at limiting it to its actual size and preventing it from spreading further. Two types can be mentioned: penal and rehabilitation measures. One must agree that "penal measures against drug abuse should be envisaged as part of a broader national response which also includes preventive and rehabilitative elements and takes account of general policies of social development" [ 20] .
Several provisions of the Polish law deal with penal measures. Article 161 of the Criminal Code (Act of 19 April 1969, Dziennik Ustaw, No. 13, item 94) states that "Any person who, not being authorized to do so, supplies an intoxicant to another person or induces him to take an intoxicant shall be liable to imprisonment for not more than five years". This provision, which is common to most legal systems, complements another provision of the Act of 8 January 1951 regarding pharmaceutical substances, hygienic products and drugs (Dziennik Ustaw No. 1, item 4) which reads "Any person using a narcotic drug without a doctor's prescription in the company of another person shall be liable to arrest for a term not exceeding one year or to a fine or to both". The idea behind this provision is not to penalize a person who takes drugs by himself but to punish drug abusers when they take drugs in front of other persons, publicly or privately. This regulation aims at preventing the spread of drug use. Although it is an old provision, it does not seem to be in conflict with the new demand for depenalization of personal use.
These two provisions are closely linked. They aim at preventing proselytism. They also aim at adopting the necessary measures for those drug abusers who have not yet become dependent on drugs. A comparison of the penal sanctions would reflect the differentiation made in the gravity of crimes. It would also allow one to make the necessary differentiation between the seller and the user.
The same Act of January 1951 comprises another regulation which deals with the illegal drug traffic. In Article 29 it is stated that "Any person manufacturing, converting, importing, exporting, transporting, warehousing or marketing a narcotic drug without a licence or in breach of a condition of a licence shall be liable to imprisonment for a term not exceeding five years and to a fine". As mentioned above, eases of illegal traffic in Poland are rare, because of strict customs control measures. However, this regulation does not foresee the cultivation of drugs as a punishable offence or make the differentiation between seller and user. It should therefore be more closely linked with the provision of Article 36 of the Single Convention on Narcotic Drugs 1961.
As is often stressed, "treatment and rehabilitation are far more significant for the user than punishment" [ 21] . A regulation of 19 April 1969 provided in Article 102, paragraph 1, of the Criminal Code foresees that "where a sentence has been imposed for an offence committed in association with the habitual use of alcohol or other intoxicant, the court may commit the offender to an institution for the treatment of his dependence before the sentence is carried out". Paragraph 2 thereof reads: "The period of stay in the institution shall not be fixed in advance; it shall not, however, be shorter than six months or longer than two years; the court shall decide upon discharge from the institution in the light of the results of the treatment".
This provision provides a basis for the compulsory hospitalization of the drug offender. Experience shows that this kind of compulsory treatment gives very positive results. However, some authors rightly demand to reduce the minimum period of treatment in the hospital to three months, since it seems that positive results can be obtained during such period [ 22] .
In connexion with article 102, there exists another regulation of the Criminal Code embodied in Article 82, which foresees that "The Court may decide on the type of the correctional facility, type of the régime of the penalty served and administer the alternations in using the methods and means of penitentiary influence". This means that it is possible to undergo treatment in gaol, while the sentence is being served. Both provisions mentioned above are accepted by legal practice and theory. They are consistent with the view expressed in a resolution adopted at the XIth International Congress on Penal Law which reads: "...governments are urged to provide as an alternative to or in connexion with punishment, rehabilitative conditions for drug abusers committed an offence" [ 21] .
These two provisions of the Criminal Code are basically the only ones which foresee compulsory treatment for drug offenders. They constitute, together with the other provisions described above, a body of actual measures aimed at fighting the whole drug abuse phenomenon in Poland.
If the criteria are applied according to the classification of cases of drug dependence in Western countries, the number of drug-dependent persons in Poland would be very small. This situation results not only from a relatively short history of the drug abuse phenomenon, but also because different drugs are being abused. For instance, Ritalin is not regarded as an intoxicant in many countries, but in Poland many experimental users take it.
This does not mean that the significance of the phenomenon should be disregarded. What we want to say is that we should not attach as great an importance to it as is done in other countries. It also seems that compared to other social pathology problems, for instance alcoholism, the extent of the phenomenon will remain unchanged for a long time, while its structure may be subjected to several alterations. By perspectives of drug abuse, we mean the "qualitative" picture of the phenomenon; the elements comprising this picture may look different depending on the prophylactic measures adopted. But even then "in some ways the drug problem is like a balloon - squeezed in one place it tends to expand in another" [ 23] . That is why in presenting the possibilities of its further development, one must remember its complexity and accept the estimates with caution.
Stringent customs measures prevent the entry of several drugs in Poland. Only small quantities of hashish coming from Afghanistan were seized in 1972. Since then, illicit drugs have very seldom been introduced into the country. For this reason, some drug users have tried to grow the unobtainable Cannabis sativa plant and distribute it illicitly to other users. This fact does not constitute any serious problem as yet, but it may, together with the extracting of opium from naturally grown Papaver somniferum, become more frequent in the future.
Most people taking drugs in Poland are experimental or occasional users. It may be expected that if they continue taking drugs, more people will in the future depend on drugs than at present. We may expect also that the types of drugs used will have stronger effects. Since heroin, as well as other drugs with a similar effect, are not available in Poland, it may be expected that they will be substituted by either "home-made"or new drugs. That assumption is based on today's practice: at present some of the drug users take Guttae Inoziemcovi (stomach pain reliever) in drops, having tinctura opii simplex as one ingredient.
Although we only foresee a slight increase in the size of the phenomenon, other persons will undoubtedly start taking drugs. Simultaneously, experimental or occasional users may stop taking drugs - except those who have become dependent on drugs. Thus it may be expected in the near future that the population of drug abusers will become older as persons dependent on drugs may continue using them [ 24] .
These remarks lead to the conclusion that the perspectives of the development of the drug abuse phenomenon in Poland are very much like the stages through which drug abusers go in other countries. However, there may be some specific features of this phenomenon in Poland, such as the issue of so-called "substituting" drugs.
Measures have been formulated mainly on the basis of a "moralistic" or "prohibitive" approach. Since the drug abuse situation in Poland may worsen, it is anticipated that action will be taken to establish more effective measures to treat and readapt persons abusing drugs.
The old concept of "fighting" still means an extremely hard and somewhat ineffective antagonistic strategy, relying upon the classical idea of retribution. This "negative" approach should be changed into a positive integrated programme of measures in order to cope most efficiently and appropriately with this deviant behaviour. Measures aimed at removing effectively and rationally the causes of the phenomenon, as well as at relieving its harmful elements and resisting its consequences should be structured [ 25] . For this kind of task, the term "fight" seems to be too narrow. Similarly the concept of "social pathology" does not fit too well. As A. Podgorecki says, the drug abuse phenomenon is too complex. The term "negative deviance" may be more suitable and more correct from the semantic viewpoint to elaborate adequate measures to uproot it [ 26] .
This type of approach is often called multi-modality, medico-social or permissive. It may be envisaged that a programme based primarily on treatment and rehabilitation measures which will consider punishment measures as secondary might be introduced in Poland.
Since this issue is of importance, specialists have for a long time been working on the most beneficial model to treat mentally disturbed people. Two approaches can be mentioned. The first one foresees that drug abusers could be cured and readapted through a multi-modality programme, providing treatment for all persons suffering from any kind of mental deviance. The second approach consists of a specific programme for drug-dependent persons. The last 1975 draft Act concerning "the protection of psychic health" foresees that a person can be compulsorily hospitalized when he (she) is mentally disturbed and constitutes at the same time a danger for himself or for the health of other persons. When an individual is mentally ill and his behaviour shows that if he is not treated, he will be a danger to himself or other persons, only the relatives are legally empowered to request compulsory hospitalization [ 27] .
This draft provision is inconsistent with the 1971 draft regulation which foresees specific measures based upon the well-known "British system" to supply legally drugs to patients [ 28] . For the time being, the discussion continues among experts and the public at large. It may be expected that in the near future a law will be enacted which will permit the implementation of these measures. One thing seems to transpire: regardless of the system that will come out from either of the two draft regulations, voluntary treatment is strongly emphasized. The new measures, together with those relating to the auxiliary panel, will help to establish a new approach to uproot this symptom of negative deviance.
References 2 A. Piotrowski and G. Malatynska, Who and why uses drugs for intoxication?, Zdrowie Psychiczne, 3, 1973. Material published in: XXXIst Congress of Polish Psychiatrists, 38-44, Poznan, 1973.003
A. Duracz-Walczak, Intensity and a character of toxicomania in Poland, Patalogia Spoleczna - Zapobieganie, vol. II, 84, 1976.004
B. Holyst, Crime detection, 73, Warszawa, 1973; Cz. Czapów, The structure of adolescents' social maladjustment with special regard to self-destructive behaviour adopting the form of drug addiction , in: Selected problems of health education and social adjustment of children and adolescents, Warszawa, 1974.005
Cz. Czapów, The structure of adolescents' social maladjustment with special regard to self-destructive behaviour adopting the form of drug addiction. In: Selected problems of health education and social maladjustment of children and adolescents, Warzaw (1974).006
M. Latoszek, A. Lemska and P. Sieliwonczyk, Preliminary results of the survey on the drug addiction among adolescents of secondary schools in the area of Three Cities: Gdansk, Gdynia, Sopot, Zdrowie Psychiczne, 3, 1973.007
A. Szakowski, The degree of menace by dependence-producing drugs among adolescents of secondary schools in the area of Szczecin, unpublished doctor's dissertation, 1974.008
A. Szakowski, The risk of toxicomania among adolescents of Szczecin schools, Psychiatria Polska, 4, 1974.009
W. Jedrzejczak, M. Jedrzejczak and A. Szakowski, An attempt of evaluation of the personality and social conditions of suffering from toxicomania, in: XXXIst Congress of Polish Psychiatrists.010
J. Mazurek, Family and school and the problem of toxicomania among the children and adolescents, Zdrowie Psychiczne, 1-2, 94, 1974.011
Z. Jaroszewski and Z. Karewicz, Statistical data regarding patients of the psychiatric hospitals in Poland suffering from drug addiction, Biuletyn Instytutu Psychoneuro-logicznego, 3, 68, 1972.012
Z. Rydzynski et al., Drug abuse among the adolescents of Lodz, Zdrowie Psychiczne, 1-2, 88-93, 1974.013
H. Piotrowski, Pharmacomania and drug addiction of adolescents, quoted after S.Batawia, The problem of toxicomania and drug addiction among adolescents, Panstwo i Prawo, 3, 36, 1975.014
S. Redo, Criminality related to drug abuse in the light of investigation of tried cases, Zeszyty Naukowe Instytutu Badania Prawa Sadowego, 4, 1976.015
A. Czerwinski et al., From the problem of drug dependence in the area of Poznan: primary epidemiological results, 1969-1971. in: XXXIst Congress of Polish Psychiatrists, 42-43.016
B. Borakowa, W. Borak and A. Ziebina, The analysis of 30 cases of toxicomania, in: XXXIst Congress of Polish Psychiatrists, 40.017
D. Wellish and J. R. Hays, A cross-cultural study of the prevalence and correlates of student drug use in the United States and Mexico, Bulletin on Narcotics XXVI: 1, 38, 1974.018
S. Milewski, Drug addicts, 1973: the escape from life, Gazeta Sadowa, December 16, 1973.019
K. Borysiewicz-Charzynska et al., Abuse of parcopan (Ritalin) among the adolescents of Lodz, Zdrowie Psychiczne, 1, 29, 1973.020
Resolution 73 (6) adopted by the Committee of Ministers of the Council of Europe, A.2, Bulletin on Narcotics, XXV:3, 57-58, 1973.021
A. Noll, Drug abuse and its prevention as seen by the international legal profession, Bulletin on Narcotics, XXVII:1, 42-43, 1975.022
S. Batawia, The problem of toxicomania and drug addiction among adolescents, Panstwo i Prawo, 3, 41-42, 1975.023
E. Bryant, Making a complex problem worse, American Journal of Ortopsychiatry, 43:4, 524, 1973.024
Expert Group on Drugs in Modern Society: community reactions to drug use by young people, Bulletin on Narcotics, XXVI:2, 2, 1974.025
M. Los, The role of deviance in the processes of social change, in: The problems of social pathology, ed. by A. Podgórecki, 22-23, Warszawa, 1976.026
A. Podgórecki, Introduction, in: The problems of social pathology, ed. by the same author, 10, Warszawa, 1976.027
Polityka, January 10, 1976.028
S. Redo, British system of the treatment of the drug addicts on the background of Polish draft acts considering the protection of mental health, Materials of VIIth Szczecin Symposium, Szezecin 1977, in printing.
With the exception of references 17, 20, 21, 23 and 24 the material quoted was written in Polish.