The Macedonian War on Drugs

The War on Drugs is a term applied to “the campaign of police and military interventions for the prevention of illegal production, trade and use of illegal drugs.” Drugs are “all psychoactive substances declared as illegal by the UN and specific governments.” The term War on Drugs was “popularized by the media after President Richard Nixon’s speech on 18th June, 1971 in which he declared drugs as public enemy number one and announced harsh measures to eradicate drugs.”  

Absurd Drug Policies

The “War on Drugs” policy has failed. Without a doubt, at the time people had great hopes in it, however, the results are devastating and the costs and human victims huge. For instance, in the United States, the initiator and champion of the policy, more than 50 billion dollars have been spent towards ending drug use, but less than 10% from the total drug quantity has been seized, and drug traders have made more than 300% profit. To contest those that firmly believe in the approach, practice shows that the policy aims against people who use drugs, rather than drug manufacturers and traders, confirmed by statistics as well. Only in 2014, in the United States 1,561,231 people were arrested on drugs charge, while 83% of them were arrested for possession. There were 360,834 HIV infected people in the United States by 2014 due to use of contaminated needles, 30% more than the total number of people with HIV in the country, while 47,055 people died from an overdose only in 2014. Nixon, of course, is considered as the “the villain of the piece” simply because of the phrase “War on Drugs” because the prohibitive drug policies have been present in the USA since the 1850’s.
         
The United States are hardly the only with wrong drug policies though. In fact, although under a different name, a war on drugs was fought throughout the world until the beginning of the 21st century, while similar measures are still formally supported by most countries and the United Nations. Actually, the adoption of several conventions by the League of Nations between the two World Wars initiated the efforts for international drug control. The Single Convention on Narcotic Drugs from 1961 is the first international document at a high level adopted after War World Two. Later on were adopted the 1971 Convention on Psychotropic Substances and the 1988 Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances. These documents still have strong influence on national policies of UN member-countries, including Macedonia.  
         
The efforts for changing the predominant UN drug policies have risen in the last couple of years, however with no significant results. The UN General Assembly Special Session on Drugs, held from 19th to 21st April, 2016 was great disappointment to activists worldwide who had been campaigning several months for humanization of drug policies, due to the adoption of a watered-down document on international drug policies without any debate. Considering UN’s international influence, the activists were right to expect that humanization of UN drug policies would contribute towards humanization of national drug policies.


Macedonia between reality and illusion

Even though formally drug possession and use in Macedonia are not criminal offences, practice reveals that police actions are mostly directed against people who use drugs. According to data from the analysis “Human Rights Violations of People Who Use Drugs During Police Contact”, published by the Coalition “Sexual and Health Rights of Marginalized Communities,” 460 people were detained by the police due to “possession of opioid drugs” from total of 3,434 detained on different grounds in 2012. The next year, this number grew to 608 detainees out of 3,582 in total. The detentions were due to cannabis possession and use. Furthermore, according to the analysis, the police tend to provide evidence with forceful urine testing, i.e. they fail to catch the offenders while committing the act they are accused of. There are absurd cases of imprisonment sentences for possession of exceptionally small quantities of cannabis, for instance a case where a person caught with 0.2 grams of cannabis was sentenced to 1 year in prison. In the period from 2009 to 2013, more than 500 persons were sentenced for drug offences just in Skopje.    
          
On the other hand, prisons in Macedonia are far from fulfilling their mission as punitive-correctional institutions. According to the reports of the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT) within the Council of Europe, the conditions in punitive-correctional institutions in Macedonia are utterly dehumanizing. Prisoners are forced to share a bed, sleep on the floor or corridors outside the rooms due to overpopulation, while dormitories are dirty with dampness on the walls. There isn’t a lack of drugs as well. On the contrary, there are plenty of drugs, particularly opioids, perhaps of poorer quality but certainly cheaper. What is lacking are harm reduction programs. Needle exchange is not permitted in prisons, hence the greater risk of blood-borne infections. True, there are addiction treatment programs in the form of methadone substitution therapies, and in some prisons even buprenorphine substitution, however most prisoners who use drugs avoid these programs. There are hardly any possibilities for re-socialisation. According to HOPS’s analysis “A Verdict for Public Health…” from 2015, the current prison conditions pose a threat to the health of the prisoners as well as the broader community.     
         
Organized treatment in Macedonia is available only for alcohol and opioid addicts. Treatment for people addicted to other psychoactive substances funded with state finances is lacking. Opioid addictions are treated only with methadone or buprenorphine substitution therapy. Methadone treatment programs are available in 10 cities throughout Macedonia: Skopje, Kumanovo, Stip, Strumica, Gevgelija, Veles, Kavadarci, Bitola, Ohrid and Tetovo, while patients from neighbouring municipalities also visit the programs. Buprenorphine substitution therapy is available only in Skopje, and patients from other parts of Macedonia are forced to travel to Skopje. Such ignorant attitude on the part of the Ministry of Health towards addiction programs significantly influences how the public perceives the quality of these programs, which repels people addicted on opioids from joining them. Addiction treatment is not popular among psychiatrists, and the few motivated lack the support necessary to find proper staff and opportunities for professional advancement. As comparison, it is estimated that in Skopje, a city with more than 500,000 citizens, there are 2,000 and 4,000 people who inject drugs, while approximately 900 seek addiction treatment in public and private health institutions.

There are 17 harm reduction programs in Macedonia in 13 different towns which contribute towards protection of people who inject drugs from HIV and other blood-borne and sexually transmitted diseases, confirmed by statistics as well. According to the 2014 bio-behavioural study of the Ministry of Health, there are no new HIV cases among people who inject drugs, while the number of Hepatitis C has dropped for almost 5% since 2009. According to the Institute of Public Health of Macedonia, out of 39 newly diagnosed HIV cases in 2014, only one person injects/injected drugs.

And while competent institutions dream of “Drug Free Macedonia,” reality threatens to devastate us like a tsunami wave. Experiences throughout the world show that repression does not prevent people from using drugs. On the contrary, drugs become more available, while manufacturers and sellers more inventive. Drug criminalization threatens the social and health state of people who use drugs and demands additional investments in the social and health system, which is lacking funding as it is. Due to ideologically-based policies, instead of experience and evidence-based ones, the social and health system will continue to collapse, while individuals will financially profit from illicit drug production and trade.    

Vanja Dimitrievski

The author is a program assistant at CEDR – Centre for Education, Documentation and Research at HOPS – Healthy Options Project Skopje. He has a Master’s degree in Ethnology and Anthropology and long research experience with different socially marginalized groups/communities, particularly people who use drugs.