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.
HOPS’s team received a confirmation from the Centre for Social Work that R. was indeed living in a care facility for children and that she was 16 years old, however she needed to acquire permission from her parent/guardian in order to start addiction treatment. The Centre for Social Work took the responsibility to find the father since they had had no contact with the mother. In the meantime, we found out that the mother had left abroad, which was also confirmed by R. and we passed this information on to the Centre for Social Work.
We also found out that R. was pregnant, at which point HOPS provided a gynaecological examination to confirm the pregnancy, in the presence of an employee from the children’s care facility.
In a phone conversation with the manager of the methadone centres regarding treatment of the 16 year old pregnant girl, we were informed that day centres for addiction prevention and treatment do not allow individuals under 18, in accordance with the Statute of the PI Psychiatry Hospital Skopje – Skopje. In the meantime, the Centre for Social Work informed us that they were going to provide the father’s consent for the girl’s treatment. From there, we contacted the Toxicology Clinic regarding the possibility for opioid addiction treatment for individuals under the age of 18. The Clinic responded that individuals at the age of 16 or older can be treated with buprenorphine, with the precondition that we provide consent from a parent/guardian and a psychiatrist’s evaluation, along with a recommendation to include a paediatrician and a gynaecologist due to the pregnancy. The next obstruction was the psychiatrist’s evaluation. Psychiatrists from the day centres for addiction treatment are unable to conduct evaluations since they only work with adults. On the other hand, we were informed that the Psychiatry Clinic, Department for Children and Youth are also unable to conduct an evaluation because they do not work with addiction. Despite this information, I contacted a psychiatrist from the Psychiatry Clinic and explained the case upon which he agreed to conduct an evaluation. The meetings, conversations and appointments took more than a week, with the girl being updated daily by HOPS about the case. Then, just when it seemed that we saw the light at the end of the tunnel, i.e. we scheduled an examination with a psychiatrist regarding the evaluation, the girl, exhausted from the wait, changed her mind on the day of the examination. She had been tired, hungry and without any sleep. We bought her breakfast and asked her to reconsider the examination. After an hour she told us she was going to come the next day for the examination. The girl failed to come to HOPS the following days, and we didn’t manage to find her. After around two weeks, she returned to our offices and told us she had had a miscarriage. A responsible person from the children’s care facility had taken her to the Gynaecology and Obstetrician Clinic. The girl lacked motivation to start anew the procedure for opioid addiction treatment.
Afterwards, the girl and the children’s care facility contacted us regarding the health issues that had arisen due to incorrect and long-term injection. The cooperation with the children’s care facility continued. Whenever they couldn’t find solution for the problems the girl was facing, they would seek HOPS’s help and support. Still, to what extent can HOPS and similar organizations help deal with problems which the system has no solutions for or proper legislative regulations, while the competent institutions claim no responsibility? We help with harm reduction and connect people who need help with the institutions, however, addiction treatment is in the state’s responsibility.
This is a very sad story about a girl who lost her baby and is still not being treated from drug addiction because she has nowhere to turn to. We don’t even know how many other girls who use drugs face identical or similar problems? We know only of those who have asked help from HOPS. HOPS raised the entire initiative for the girl’s treatment since no one else would take care of her. The care facility institution that accommodates her is aware of her drug use, yet does nothing about it, while most of the time the girl is absent from there. The Ministry of Labour and Social Policy and the Ministry of Health are aware of the need for treatment centres for minors who use drugs, and yet they fail to establish them. The existing centres for addiction treatment are also aware and urge that special centres for under-aged patients should be opened. Yet, is anyone listening? Will the competent ministries have the ear and solution for these problems?
All institutions “cooperated” with HOPS on the case, and at the same time avoided taking responsibility with the excuse that the problem is not in their competence, out of their jurisdiction and that a solution is necessary. But who should find the solution?
HOPS has been looking for the solution for years, has had the role of mediator between institutions and those looking for help, has cooperated with the competent institutions, issued recommendations, offered information directly through our outreach team. Until the state opens treatment centres, we will continue to write and read sad stories for lost dreams and young lives.
Silvana Naumova is a graduated social worker. At present, she is the program manager of the Services Program in HOPS – Healthy Options Project Skopje and has 14 years of experience in giving and organizing services for drug users and sex workers.