Harm reduction in Republic of Macedonia
Harm reduction (definition)
Drug use in contemporary society can be viewed as a cultural, as well as medical, social and economic phenomenon that requires interventions on several levels: creating services, programs and policies that will cover all aspects related to the use of drugs, prevention, treatment, harm reduction, re-socialization and rehabilitation.
There are several definitions for harm reduction. The International Harm Reduction Association (IHRA) provides the most encompassing definition:
„Harm Reduction“ refers to policies, programmes and practices that aim primarily to reduce the adverse health, social and economic consequences of the use of legal and illegal psychoactive drugs without necessarily reducing drug consumption. Harm reduction benefits people who use drugs, their families and the community.
A specific program or intervention is treated as „Harm reduction“ if: „It’s primary objective is the reduction of harm arising from the use of drugs, rather than drug use itself“ (Dekov, V., Ignjatova, L., Jankuloski, H., Kostovski, D., Tosheva, M., Harm reduction and HIV manual, HOPS, 2006) or a link to the manual once it’s up on the web.
Harm reduction programs and interventions include: 1. Availability and exchange of injecting equipment; 2. Substitution treatment; 3. Outreach and education; 4. De-penalization of the use of drugs; 5. Medical and social help; 6. „Early detection system“ and drug and psychoactive substance testing; 7. Alcohol programs; 8. Nicotine programs; 9. Motivation interview (Dekov, V., Ignjatova, L., Jankuloski, H., Kostovski, D., Tosheva, M., Harm reduction and HIV manual, HOPS, 2006).
Towards accepting the concept of harm reduction and decreasing stigma and decriminalization of persons using drugs, proper use of terminology is important. The use of insulting terminology stigmatizes both people using drugs, and their families and close ones, and makes them even more vulnerable and unavailable for support. HOPS uses the terms drug users and persons using drugs.
National legal regulation of drug use
The Macedonian legislation regulates the use of drugs as a misdemeanor – „The person who resorts to the enjoyment of narcotic drugs, psychotropic substances and precoursors will be proscribed a pecuniary penalty in the amount of 200 to 500 euro in denar counter value“ (article 20 of the Law on misdemeanors against the public order, „Official Gazette“, no. 66/2007).
The possession and use of drugs from a criminal-legal aspect is regulated by two criminal acts accommodated in the chapter „Criminal acts against the health of people“ in the Criminal Code of the Republic of Macedonia (CC). According to article 215 paragraph 1 of the CC, „the unauthorized production and release into traffic of narcotic drugs, psychotropic substances and precursors“, is sanctioned as possession of psychotropic drugs because of their sale, purchase or transport.
This provision states: „ A person who without authorization produces, processes, sells or offers for sale, or who for the purpose of selling, buys, keeps or transports, or mediates in the selling or buying, or in some other way releases for trade, without authorization, narcotics, psychotropic substances and precursors, shall be punished with imprisonment of one to ten years“. Since 2009, article 215 of the КЗ has been amended with a new paragraph (2), according to which, the sanction for possession of a minimal amount for sales, purchase or transport is lesser and is now from six months to three years in prison.
„The provision of use of narcotic drugs“ has been regulated with article 216 paragraph 1, which states: „ A person who induces another to taking narcotics, psychotropic substances and precursors, or who gives narcotics, psychotropic substances and precursors to another for this person or someone else, or who makes available premises for the taking of narcotics, psychotropic substances and precursors, or in some other way enables another to take narcotics, psychotropic substances and precursors, shall be punished with imprisonment of three months to five years“ in the CC.
Although article 215 does not foresee any sanction for the possession of drugs for personal use, in practice this provision has been regulated so that every user who has been detained possessing even the smallest amount of narcotic drug has been indicted and is most often sentenced for the criminal act from art. 215 of the CC without even proving the intent to sell, i.e. trade with narcotic drugs (this is an act performed solely with intent). Art. 216 of the CC sanctions cases in which a person makes available, i.e. provides to another person a drug for use (passes over a cigarette he/she has been smoking, a ready for injection syringe.) Also, the provision sanctions cases if more persons gather at one person’s home and use drugs together, the person who owns the premises shall be criminally charged, while others will have bear no responsibility.
Based on a behaviorist study and assessment of the number of drug injecting population in Macedonia carried out in 2010, the estimated number of people injecting drugs in Macedonia aged 18 to 45 is 10.900, while the estimated number of people injecting drugs in Skopje, aged 18 to 45 is 3.150, i.e. around 2.650 up to at 4.050 IDUs at most. The study was carried out by the Public Health Institute, in cooperation with HOPS, supported by the Global fund for fight against HIV/AIDS, tuberculosis and malaria, and UNAIDS.(Mikikj, V., Kuzmanovska, G., Memeti, Sh., Report from the behavioral research and assessment of the drug injecting population number in Macedonia, 2010, Skopje, 2011).
In Macedonia, information on people who use drugs is collected by:
- MOI – registers every person who they’ve come in contact with on account of using drugs or any drug related misdemeanor. The Registry does not differentiate between people who’ve tried marihuana for the first time and heroin dependent persons;
- HOPS – through its needle exchange services;
- Public and private institutions providing substitution therapy;
- Penal institutions for drug users who have been assigned to imprisonment there;
- The Ministry for labor and social policies via its social centers;
- The National focal point for the European monitoring center for drugs and drug abuse (EMCDDA) collects data from all sources and sums them up in an annual report: http://www.emcdda.europa.eu/publications/country-overviews/mk
Also, occasionally targeted research activities are carried out for various aspects of the use of drugs among different groups:
- A research made by UNICEF about most at risk adolescents (Most at Risk Adolescents MARA) in 2006: http://www.iea.pmf.ukim.edu.mk/ENG/UNICEF_MARA_Research.pdf
- Research of the European School Survey Project on Alcohol and Other Drugs (ESPAD), in 1999 and 2008: http://www.skopje.gov.mk/images/Image/Brza%20procenka%20i%20odgovor.pdf
- Behavioral studies at the Institute for public health among drug injecting persons in 2005, 2007 and 2010,
- Research by HOPS and the Coalition „Sexual and health rights of marginalized communities“ for the „Improvement of the quality of drug dependence treatment programs in Skopje": http://www.hops.org.mk/ ; http://coalition.org.mk/2008/10/makedonija/
- Research by HOPS „Improvement of the right to access to social and health services of drug using Roma people“: http://www.hops.org.mk/
Needs and problems
The community of people who use drugs is one of the most marginalized ones in Macedonia. The penal code, stigma and discrimination against them and their families, makes them a vulnerable and clandestine population. According to the research „Macedonian social values“, carried out from the Macedonian center for international cooperation (MCIS), in 2010 ( HYPERLINK "http://www.mcms.org.mk/mk/za-nasata-rabota/istrazuvana-i-publikacii/istr... http://www.mcms.org.mk/mk/za-nasata-rabota/istrazuvana-i-publikacii/istr...), biggest intolerance is demonstrated against drug users, as much as 96,8% of all interviewees do not like drug users for neighbors.
Existing treatment programs, above all, are intended for opioid addiction and are with limited capacities, especially in Skopje. Methadone treatment programs exist in eight towns, but the buprenorphine treatment is centralized in Skopje (University clinic for toxicology at the Clinical centre „Majka Tereza“ – Skopje), there are lack of programs for other types of drugs, and especially programs for re-socialization and rehabilitation. Also, there are no programs for the treatment of people younger than 16.
There is a methadone program in prisons, but programs for the support after going out of prison lack, programs for re-socialization and rehabilitation, or a needle exchange program in prisons.
Despite the lack of programs for treatment, re-socialization and rehabilitation, as well as lacks of existing treatment programs, Macedonia has good coverage with needle exchange programs (PRPI), i.e. there are 16 PRPI in 13 towns across Macedonia.
Ppt. presentation – Problems and needs of drug users in Macedonia
National response to drug use
Needle exchange programs in Macedonia have been existing since 1996. They are recognized by competent authorities and are part of the „National strategy on drugs 2006-2012“, „National strategy on HIV/AIDS 2006-2011“, „National strategy on HIV/AIDS 2012-2016“. Harm reduction programs in Macedonia have become an integral part of the Law on control of opioids and psychotropic substances, article 3 point 6.
A list of strategic documents and links to them:
- National strategy on HIV/AIDS 2007-2011: http://www.unicef.org/tfyrmacedonia/Nacionalna_Strategija_za_HIV-SIDA_2007-2011.pdf
- National strategy on HIV/AIDS 2012-2016: http://mz.gov.mk/wp-content/uploads/2012/12/NOVA-STRATEGIJA-HIVSIDA.pdf
- Law on the control of opioid drugs and psychotropic substancesL http://www.reglek.com.mk/publikacii/Kontrola_na_opojni_drogi_i_psihotropni_supstancii_24_7_2008.pdf
- National strategy on drugs 2006-2012: http://www.reglek.com.mk/publikacii/Nac_strat_dorgi_MK.pdf
- Local strategy on drugs of the City of Skopje 2008-2013: http://www.skopje.gov.mk/images/Image/lokalna%20strategija%20makedonski.pdf