Sergei Jargin, an associate professor at the Peoples’ Friendship University of Russia, Moscow, Russian Federation, talks about the article he recently published in the International Journal of High-Risk Behaviors & Addiction about the alcohol consumption in Russia and implications for public health.
Could you describe the aim of the study?
The problem of alcohol misuse in Russia is immense; but, nonetheless, there is a tendency to exaggerate it, which is evident for inside observers. Such exaggeration tends to veil shortcomings of the healthcare with responsibility shifted onto the patients, that is, supposedly self-inflicted diseases caused by excessive alcohol consumption. The aim of this report was to draw attention to the problems related to the alcohol consumption in Russia: toxicity of some legally sold alcoholic beverages, which have sometimes caused poisonings even after consumption in moderate doses; offences and crime against alcoholics and people with alcohol-related dementia, sometimes aimed at appropriation of their apartments, houses and other property, treatment not always in agreement with medical ethics.
What would you say are the key take-home messages from this study?
During the anti-alcohol campaign in the former Soviet Union (1985-88), many distilleries producing alcoholic beverages of standard quality were closed and dismantled. Restrictions of the alcohol production and sales resulted in drinking by many alcohol-dependent people of alcohol-containing industrial liquids and perfumery. Considering the large scale of the window cleaner sales in some places e.g. in Siberia, it was knowingly tolerated by authorities. The alcohol consumption predictably increased after the campaign. At the same time, technical alcohol (synthetic and cellulosic) found no demand from the partly disorganized industry. Official permissions to use alcohol from non-edible raw materials for the production of beverages were issued during the 1990s. On the background of disrespect for some laws and regulations, diluted technical alcohol was sold in vodka bottles through legally operating shops and eateries, added to beer,
On the background of disrespect for some laws and regulations, diluted technical alcohol was sold in vodka bottles through legally operating shops and eateries, added to beer, wine and other drinks. Following the abolition of the state alcohol monopoly in 1992, the country was flooded by low-quality alcoholic beverages. It should be commented that adaptation of certain human populations to alcohol included by-products of natural fermentation. Synthetic and cellulosic alcohol may contain admixtures, adaptation to which has not developed. The intake of alcohol-containing technical liquids is even more hazardous. For example, methanol and carbon tetrachloride can induce pancreatic injury. Non-purified technical and homemade alcohol may contain more methanol than standard beverages. Epidemiologic data indicate a higher frequency of alcohol-induced acute pancreatitis in areas where surrogates or homemade alcohol are consumed. In Russia, the rate of pancreatitis mortality has been among the world highest.
It was reported that about 50% of lethal intoxications by alcohol-containing liquids during the 1990s were caused in some areas by legally sold beverages, while in many lethal cases a relatively low blood alcohol concentration was detected. The real percentage could have been higher as the consumption of technical liquids and lotions has decreased abruptly after the anti-alcohol campaign, while legally sold vodka and beer have become easily available and relatively cheap. For example, in the Republic of Karelia, solely during the year 1992, the incidence of lethal alcohol poisonings increased 3 times along with a 1.4-fold decrease in the average blood alcohol concentration.
For the whole Russian Federation, the mortality rate from alcoholic poisonings increased from 1998 to 2004 by 58 %. The unrecorded alcohol-related mortality must have been higher due to the post-mortem diagnostics of cardiovascular diseases in unclear cases. An outbreak of toxic liver injury in 2006 was reportedly caused by disinfectant Extrasept-1 sold in vodka bottles in many regions of Russian Federation. Apart from ethanol, this liquid contained diethyl phthalate and polyhexamethylene guanidine hydrochloride (PHMG). The number of poisonings with pronounced jaundice during the period August-November 2006 was 12,611 cases including 1189 lethal ones. Unrecorded figures must have been higher. However, the toxicological assessment of PHMG has not shown any strong toxicity for the liver. PHMG is used worldwide for the disinfection of swimming pools. As for diethyl phthalate, its toxicity is low. There is a professional opinion that the 2006 mass poisoning and some others were caused by organochlorines. Sporadic poisonings can be caused by remnants of toxic substances in unwashed bottles. Cases of organochlorine intoxication from contents of vodka bottles are known. Unscrupulous manufacturers would not spend much money on bottle washing and necessary equipment. In particular, carbon tetrachloride, used in dry cleaning of clothes, could have caused the liver injury. The 2006 outbreak of poisonings followed an elevation of excise duties and
Unrecorded figures must have been higher. However, the toxicological assessment of PHMG has not shown any strong toxicity for the liver. PHMG is used worldwide for the disinfection of swimming pools. As for diethyl phthalate, its toxicity is low. There is a professional opinion that the 2006 mass poisoning and some others were caused by organochlorines. Sporadic poisonings can be caused by remnants of toxic substances in unwashed bottles. Cases of organochlorine intoxication from contents of vodka bottles are known. Unscrupulous manufacturers would not spend much money on bottle washing and necessary equipment. In particular, carbon tetrachloride, used in dry cleaning of clothes, could have caused the liver injury. The 2006 outbreak of poisonings followed an elevation of excise duties and a temporary deficit of vodka. The vacuum was filled by surrogates sold in vodka bottles through legally operating shops and kiosks, which has been obfuscated by some writers creating an impression that consumers deliberately purchased disinfectant for drinking.
For the period 1993-2001, the life expectancy of Russian men was estimated to be 58-59 years. Apart from the high level of alcohol consumption and hazardous binge drinking, among the causes of the low life expectancy has been insufficient quality and availability of healthcare as well as the toxicity of some legally sold alcoholic beverages. The quality of beverages has improved since the last decade, although beer and wine do sometimes smell technical alcohol. The decrease in mortality since approximately 2006 may be related to the gradually decreasing level of alcohol consumption and a decline in the heavy binge drinking of vodka, partly replaced by a moderate consumption of beer.
What future studies would you recommend to further establish these results?
Future studies should be aimed at the toxicity and quality control of alcoholic beverages as well as foodstuff reported to contain antibiotics and other admixtures. Modern methods can detect admixtures. Several vodka specimens bought in Komi-Permyak Okrug – the region with one of the lowest life expectancy levels in the Russian Federation – were assessed by Prof. David Ford and Prof. Ronald Korthuis by means of gas chromatography with flame ionization detection (GC-FID) and gas chromatography – mass spectrometry (GC-MS). The modern methods should be applied by supervising authorities in Russia.
Who would benefit most from interventions potentially resulting from your report?
Socially unprotected citizens including those suffering of alcoholism and alcohol-related dementia. Alcohol still remains a part of our life; and it can be eliminated only together with the life. The anti-alcohol campaign (1985-1988) and its consequences have demonstrated it. The campaign destabilized the Soviet society paving the ways for the economical reforms of the early 1990s. The relatively high mortality of ethnic Russian workers coupled with migrations led to their partial replacement by immigrants.
A link to the primary paper: Jargin SV. Alcohol consumption in Russia and some aspects of public health. Int J High Risk Behav Addict. 2016;5(1):e26617. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4859937/
A link to the last paper on the same topic: Jargin SV. Alcohol and alcoholism in Russia since 1985 with special reference to the suicide rate. Int J Psychiatry 2016;1(2):1-7 Retrieved from http://www.opastonline.com/wp-content/uploads/2016/11/alcohol-and-alcoholism-in-russia-since-1985-with-special-reference-to-the-suicide-rate-ijp-011.pdf
Sergei’s ResearchGate page: https://www.researchgate.net/profile/Sergei_Jargin