An image from Skopje’s centre
Children, barely five years old walk around the Park of the Woman – Freedom Fighter holding a bag, pressing it to their faces from time to time to inhale. Crowds of people pass them hastily, never turning back to look at the children; one would think such a scene is quite common and normal.
We have been witnessing this picture for more than 10 years, and yet these children are still on the streets, still inhaling glue, some even injecting heroin. In the course of our work we have encountered 76 of these children. The youngest we have met, who injects heroin, is 8 years old, while the youngest inhaling is only 3 years old.
Research conducted for the needs of the paper entitled “Overview of the system for treatment of children under 18 years of age who use drugs” in 2012 showed that the Tetovo Educational Correctional Institution in 2011 housed 7 children who used drugs, the Institute for Care, Upbringing and Education of Children and Youth “Ranka Milanovic”has housed 15 until 2012, and according to data issued by the Ministry of Labour and Social Politics, in 2011, in Skopje, there were 20 children who used drugs.
According to ESPAD’s research in 2012, 8.7% of the children surveyed have used marihuana in their life, 3.75% have used ecstasy, 2.18% have used inhalants, 0.6% heroin, while the other 0.6% have injected drugs. ESPAD is doing another research this year to show the current condition.
In addition, according to data from the Clinic for Toxicology 42.2% of the opioid overdose interventions in 2001‒2005 refer to minors.
The country lacks a system for monitoring the condition of children who use drugs, hence there is no accurate information on their number. The data is partial, some of it very old and is derived either from outreach work or research. However, this data sufficiently alarms to the severity of the problem.
Furthermore, Macedonia still lacks treatment programs for children who use drugs, i.e. the competent institutions fail to respond suitably by way of opening integral programs not only for treatment but also re-socialization and rehabilitation with qualified staff, trained according to these children’s needs.
The Ministry of Health has been working on issuing a protocol for treatment of children who use drugs ever since 2012; however it has still not adopted one.
The existing prevention and treatment centres for people who use drugs according to the current Protocol for Substitution Therapy Treatment (methadone and buprenorphine) offer treatment for children under the age of 16, however in practice, according to the data received from the centres in the period 2012‒2014, children under the age of 18 have not been admitted for a methadone or buprenorphine treatment.
Due to the lack of treatment programs, four of the children that HOPS’s team had encountered during outreach work passed away as a result of drug use. In addition, HOPS documented 3 cases of children who use drugs, while in some of these cases we undertook specific actions to provide access to treatment, which at the end was not received. In the first case, in 2009, (an 11-year-old child who has been injecting heroin for 2 years) the clinics first refused to admit the child claiming it was out of their competence, only to request that the child be returned home once they admitted him to the Clinics for Children’s Diseases due to the child’s “behaviour”. Because of the parents’ insufficient motivation and fear, the child was returned to his home. In the other case (2011 and 2012, an 11-
-year-old child, contacted for the first time at 8, the age when the child began injecting heroin) inadequate care placed a child in a wheelchair.
Some of the clinics admit ad hoc cases and undertake measures to treat addiction, however these are individual procedures, nor pursuant protocol and evidence-based medicine.
People often ask how these children find heroin in the first place (they forget that some of them inhale glue, which is easily available), where they find the money or how they buy it all along overlooking the main question ‒ how can we help these children now, without postponements, because in 10 years the picture might be graver.
In order to surpass the problems children who use drugs face, the competent institutions should do the following:
– form a multisectoral working group and compile a protocol and a comprehensive treatment program for children who use drugs as well as a transition period plan (to encompass the current state and the period before the programs are launched);
– establish a system for monitoring the state of children who use drugs;
– provide evidence-based drug addiction treatment for all children, regardless of their age;
– open rehabilitation and re-socialization centres for children who use drugs;
– launch programs for working with families with children who use drugs.
There are numerous examples of good practices for treatment of children who use drugs throughout the world that can serve as an example for Macedonia, among those Vienna and Austria. The organization Dialogue from Vienna provides comprehensive services in one place for treatment and psychosocial services for children who use different types of psychoactive substances. The organization provides methadone substitution therapy for children up to the age of 14. The age level is set at 14 because the youngest child they have encountered in their work to use drugs happened to be at this age. Dialogue has developed a great referral and collaboration system with social work centres, as well as with other organizations that carry programs for children who use drugs.
The state of children who use drugs is disturbing and we need to act here and now. How many more children should die before treatment programs are launched?
Voskre Naumoska – Ilieva
Advocacy Program Assistant at HOPS with an 8-year experience in offering and organizing services for marginalized communities (sex workers, drug users, LGBT) and 2-year experience in advocacy for the rights of children who use drugs.