Disrespecting the Law on Execution of Sanctions – reason for adverse consequences on the life of people who use drugs

Pursuant Article 193 from the Law on Execution of Sanctions during a prison sentence, with an increased intensity in the last three months before the expiration of the sentence, “it is necessary to undertake activities in order to prepare the convicts for release from prison and their adjustment to life at freedom.” However, quite often people are released from prison without any personal identification documents and proper health care.   

On October 9th, 2016, M.H. was released from prison, serving a sentence at the correctional facility Idrizovo in duration of 14 years. During imprisonment he had no personal documentation. And here is where the first question arises. How could M.H. have been convicted without proper personal identification? How did the prosecutor and the judge establish the defendant’s correct identity without proper personal identification documents? According to our sources, the judiciary system doesn’t allow for such situations, however convicts without valid personal identification documents are still found in prisons. The failing system goes so far that during elections convicts vote with their facility badges instead of IDs. However, convicts who lack valid personal identification documents are faced with real problems once they are released.

Providing sustainability of harm reduction programs with funds from beer, ethyl alcohol and cigarettes excise duty

The funds allocated to the Ministry of Health for promotion of citizens’ health on annual basis, from beer, ethyl alcohol and cigarettes excise duty, , are potential source for funding of harm reduction programs. Half of the funds collected from this source, are spent for the Ministry’s current expenditures, instead of providing health care.
 
The Ministry of Health and the Macedonian Government have at their disposal many opportunities for providing sustainability of the 16 active harm reduction programs, implemented by 10 civil society organizations in the country. These should be seriously considered in the development and budgeting/operationalization of the 2017-2021 National HIV Strategy, especially since the financial support received from the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria designated for these purposes is ending on June 30, 2017. Consequently, if the Global Funds’ participation is not compensated with funds provided from the National Budget, Macedonia is going to face a severe increase in the HIV incidence, other blood-borne diseases, and other consequences to the health of people who use drugs.

We have located funding for the HIV programs, it’s the politicians’ move now

The budget of the Macedonian Ministry of Health provides possibilities for financing the harm reduction programs, yet it remains inexplicable why funds allocated for these programs in the 2017 Budget were significantly cut. Was the Ministry attempting to avoid support and consequently the obligations under the contract between the Global Fund to Fight AIDS, Tuberculosis and Malaria and the Macedonian Government?   

Harm reduction programs in Macedonia have been financially supported by the Global Fund to Fight AIDS, Tuberculosis and Malaria since November 2004. The programs help provide health, social, legal, psychological and other services to people who use drugs. Finances are granted to the Ministry of Health, i.e. a separate unit working within the Ministry as the primary recipient, which further allocates specific amounts to secondary recipients (civil society organizations) that have previously signed detailed contracts with the Minister of Health, all towards smoother sustenance of the 16 harm reduction programs in 13 towns in Macedonia. The contract between the Global Fund and the Republic of Macedonia on financing harm reduction programs ends in June 30, 2017. The contract stipulates that after the Global Fund finishes its financial support, the Macedonian Government will resume the obligation. According to the estimations, harm reduction programs require a budget ranging from 27,392 MKD in thousands to 34,875 MKD in thousands, depending on the financing model, a minimum or an optimal one. However, the latest indications from the Government, confirmed with the latest 2017 Budget, revealed insufficient funds for financial support of the harm reduction programs.

A Message against Neglect

Harm reduction programs are facing a serious threat of being closed unless finances for future sustenance and development are allocated from the Budget of the Republic of Macedonia. If this happens, many people will lose the only health, social and legal support they receive in this state, with consequences resonating throughout the society. This is far from just our personal opinion. The staff at the City of Skopje, Department for Social, Child and Health Protection agrees. We asked Eleonora Panchevska Nikolovska about her personal views on the advantages of harm reduction programs for the protection of public health and the potential disadvantages in case of closure.

Eleonora Panchevska Nikolovska is the head of the Department for Social, Child and Health Protection at the Sector for Public Activities in the City of Skopje. She is also the coordinator of the Coordinative Body on Drugs of the City of Skopje, founded in 2007, with representatives from the Skopje municipalities, institutions, civil society organizations and religious organizations concerned with drug issues. The Coordinative Body developed the two consequent strategies on drugs of the City of Skopje.  

We HAVE the support but NOT the finances!!!

We were approaching Macedonia Square with heavy hearts, silently wondering whether it was possible to fall down in obscurity and be forgotten after 12 years at the forefront of the epidemic struggle. Was it possible to lose the defence lines against an epidemic dropping in European countries, whereas here, after decades of successful low HIV prevalence we couldn’t afford to provide the basic services? Was it really possible that the country would simply dismiss its citizens after 12 years?  

Ninth issue of Drugs - Policies and Practices

We have published the ninht edition of the magazine Drugs - Policies and Practices. This edition is dedicated to Harm Reduction Programs.

The hour has come. The Harm Reduction Programs are being closed. It took an incredible amount of effort to draw the attention of those elected and paid to provide for the protection of the citizens’ health. Now the excuse is the current political crisis, despite the fact that the competent institutions had more than 10 years to come up with and introduce measures for sustaining and developing harm reduction programs. We keep waiting for someone else to solve our problems, only to complain afterwards how foreigners interfere in our internal politics. And yet, there is a way; finances as well. All it takes is strong will.

We take this opportunity to appeal to decision-makers that the country’s policies cannot revolve around their personal beliefs or individual mood. Decision-makers are elected and paid to address citizens’ needs and requests, citizens’ health and wellbeing, which is more important than prolonging the mandate or indulging other people’s caprices.

Psychoactive Substance Use in Pregnancy and Effects on the Fetus

With opioid addiction, methadone substitution treatment is recommended for better control of the addiction as opposed to risking the life of the woman and the fetus with abstinence crises which cause additional stress to both. 

Numerous studies confirm the harmful influence of alcohol and nicotine on fetal development and the potential occurrences of fetal abnormalities, mental or physical disorders, deformities, as well as miscarriages. However, there are very few studies on the effects of illegal psychoactive substances, such as cannabis, opioids and psychostimulants on the fetus during pregnancy, and no studies at all on the harmful effects of new psychoactive substances. Data and potential harms are based on isolated cases and cannot be used to make a generalization on the negative impact. 

Harmful effects are largely dependent on the drug use frequency during pregnancy, particularly if persistent in the first trimester when the pregnancy might remain undetected if unplanned. 

Harmful effects can be heightened with addiction, abstinence or drug injection, all additional risk factors for the pregnant woman and the fetus, simultaneous use of different drugs like alcohol, nicotine, caffeine, cannabis, opioids, psychostimulants etc. Life style, nutrition, stress and socio-economic circumstances should not be disregarded neither, with drug use or in general.  

Call for Articles for 10th issue of the Drugs – Policies and Practices magazine

HOPS – Healthy Options Project Skopje’s Center for Education, Documentation and Research and Coalition “Sexual and Health Rights of Marginalized Communities” announce call for articles for 10th issue of the Drugs – Policies and Practices magazine.

The main topic for the 10th issue of the magazine is Drugs across culture. Despite the main topic, we welcome all other articles related to the mentioned topics.

Dead line for this call is October 20, 2017. Editorial Board will do the selection of received articles and other materials. Selection criteria are:
  • Expertise (knowledge and experience for described topics)
  • Creativity
  • Cutting-edge
  • Due performance

Drugs – Policies and Practices promotes topics about drugs, drug use, drug treatment, and other related topics, such as: sex work and drugs, HIV/AIDS and drugs, Hepatitis B and C and drugs, Tuberculosis and drugs, rights of the marginalized groups/communities, gender perspectives, free access to public information, researches, policies, advocacy, civil society, activism, social work, social policy, health, through the drugs perspectives.

Another Sad Story

During my long experience working with people who use drugs in HOPS – Healthy Options Project Skopje, I have often been faced with instances where I simply couldn’t remain indifferent to the institutions’ disregard. The constant transfer of responsibility to one another whenever we ask the required services on behalf of a client is annoying. It is beyond comprehension that after years of cooperation and trainings, they still fail to establish joint coordination and alleviate the process of giving services to the socially marginalized communities. Somehow, it seems to me, civil society organizations doing their job suits them just fine. And yet, these organizations are no better off than their clients. After having wandered pointlessly through the institutional labyrinths all we can do is announce bitterly to our clients how we are unable to help further and just watch their lives crumble to pieces. I could talk for days about various examples, but I will attempt to capture the harm people who use drugs experience due to the institutional barriers through one specific example.

R. was 16 years old when she asked help from HOPS. At the time she was injecting drugs and came to seek help for opioid addiction treatment. That’s where the laborious journey through the institutional labyrinths began.

A woman who has used drugs can also make something of herself in life – she can become a mother, have a job

Е. is a woman with first-hand experience in using different drugs for many years, although she is only addicted to opioids. She hasn’t been using drugs for a long time now and is treated from addiction with a methadone substation therapy. In the meantime, she has a job and takes care of her child as a single parent. The difficulty of expressing her feelings was quite obvious, particularly when being interviewed by a man, and yet she agreed to the conversation, happy for the opportunity to share her experiences as a woman who has used drugs. Е. sincerely hopes her testimony will help appeal to the competent institutions to increase the help offered to girls and women who use drugs, including those treated from drug dependence. Her experience, and from what she knows from other girls and women, confirms the need for introducing specific gender-oriented services for girls and women who use drugs and are treated from drug dependence. 

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