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?
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.
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.
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)
- 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.
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.
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.
In Europe, almost a quarter of the people with severe problems caused by drug use are women. On average, there is one woman for every three men being treated, and one in five death cases caused by drug use are women.
The gender perspective is crucial for the interpretation of every issue and every problem, drug use not being any different. Men and women differ not only biologically, rather femininity and masculinity are determined culturally, historically and socially. The topic of this issue of Drugs – policies and practices strives to accentuate the importance of gender specific approaches in the drug use, addiction and treatment problematic in order to solve the challenges of women who use drugs.
In October 2013, the Association HOPS - Healthy Options Skopje and the Coalition „Sexual and Health Rights of Marginalized Communities" published the first issue of the journal Drugs - Policies and Practices. Today we are promoting the 8 issue of the magazine, dedicated to "Women's Voice For effective programs for women who use drugs. "
Yes, that’s right, as strange as it might sound, women also use drugs. They have used drugs in the past too. At least as far in the past as current research allows us to investigate. The only difference was that they were forced to hide better due to the predominant values, more tolerant towards men. While drug use has been a bitter topic for decades, discussion of women using drugs was apprehensively introduced to the public some twenty years ago. However, it was not until the past few years that more and more people gathered the courage to loudly and openly speak about what women who use drugs need. Why is that? Because gender aspects are biologically, but also culturally determined. Because women who use drugs face different challenges than men who use drugs, hence the different needs.
So, you would say it must be entirely their fault for being too weak and slipping into addiction, while you belong to the tribe of "strong, rational, 9-4, no-bullshit" people?
But, are you sure that you want to point a judgmental finger at entire generations of confused, apathic, self-sabbotaging, ruined young people, many of whom just couldn't stand being part of the rat race, many of whom simply never had anyone to teach them how to adapt to it; young people who pretty much inherited only one big, rusty fan and a huge pile of shit from the previous self-righteous generation?
Before you rush in to dismiss them as "scumbags who oughta be killed" because such a thing is strictly a private problem that only happens to lazy, stupid, unambitious people and could never happen to you or your close ones, just take one closer look at the illusion of control and comfort that you're helping maintain, day in, day out, until your name gets engraved onto a tombstone, above the epitaph "A well-behaved citizen who never rocked the boat as he/she sailed the ocean of self-interest".
/Shot at "La Luna", a popular night club during the time when this industrial city was enjoying economic prosperity; today the place is in ruins and serves as a local hotspot for junkies and vagabonds.
The first Harm reduction programme in Macedonia was initiated in 1996, and since then a total of 17 programmes have been developed in 13 cities across the country. These programmes provide complementary services integrated at one spot, including needle exchange, condoms, basic medical services, social support, HIV and Hepatitis C testing, as well as free-of-charge legal support. Because of these characteristics, the programmes are recognised as good practices in the region and much wider. Many study visits have been hosted in Macedonia, whereby participants from different countries have visited the services operated by HOPS in Skopje to learn how to develop a successful harm reduction programme.