Abstract
<jats:p>For the period 2014–2024. The drug situation in the Kabardino-Balkarian Republic has undergone a qualitative transformation: from an opiate-heroin model of consumption to a synthetic-polytoxicological phase. An analysis of statistical and epidemiological data from the region’s drug treatment service revealed a 5.9-fold (486%) increase in deaths from acute poisoning by narcotic drugs and psychoactive substances (NS and PS) compared to 2014. The purpose of this study is to comprehensively analyze the transformation of the drug situation in the Kabardino-Balkarian Republic from 2014 to 2024 and to scientifically substantiate the need to transition to a proactive management model that takes into account the phenomenon of asymmetric adaptation of the illegal drug market and the increasing toxicological aggressiveness of synthetic substances. The study identified the dominant causes of deaths from synthetic opioid use (methadone and its combinations), reflecting the changing chemical profile of the drug market and its increasing toxicogenicity. A parallel increase was found in the proportion of patients diagnosed with «harmful (with harmful consequences) use of NS and PS» to 77% of the total number of individuals with addiction syndrome, indicating a shift in the drug situation to a preclinical phase. Conclusions. A critical need for the implementation of proactive management mechanisms in the region’s anti-drug policy has been identified. These mechanisms, focused on early detection and relapse prevention, ensure the asymmetric adaptation of the institutional response to the dynamically changing drug market. Thus, proactive management of the healthcare system and asymmetric adaptation represent interconnected aspects of a single process – a dynamic reaction and counter-reaction in the «drug market – institutional response» system. Keywords: drug situation, Kabardino-Balkarian Republic, synthetic drugs, methadone, proactive management, asymmetric adaptation, addiction prevention.</jats:p>