In Serbia, the consequences arising from personal possession of drugs vary widely, ranging from the person (if fortunate) being released, or paying a simple fine (only in cases when the drug is for personal use) or in the worst case, imprisonment. There are no clear limits defined in the law for quantities beyond which the possession is penalized (EMCDDA, 2012; Pompidou Group, 2010).
When a case reaches the judicial system, judges can order mandatory treatment, either as an inpatient in prison, or outpatient at one of the special hospitals for addictive disorders. The decision regarding the type of treatment depends on the psychiatrist. When treatment is ordered in the prison setting, the prisoner first undergoes treatment, but then has to serve his or her sentence without any follow-up during detention or when released, and this sadly often leads to overdoses - even though statistics show an increase in mandatory treatment instead of incarceration (Pompidou Group, 2010).
The principles of Serbia's National Strategy to Fight Drug Abuse (2009–2013) by definition respect law, human rights, and the right to appropriate information on the risks and consequences of drug use. Furthermore the Strategy specifies the need to protect individuals and communities from the consequences of drug use and abuse, availability of treatment for all drug users, ethical attitudes towards drug users without discrimination and stigmatization, strengthening of institutional capacity, and a multidisciplinary approach. It also includes an action plan focusing on coordination between agencies, based on demand and supply reduction, information, research and evaluation, international cooperation, and harm reduction. Relevant laws have been drafted (EMCDDA, 2012; Government of Serbia, 2009; Pompidou Group, 2010).
Signs of an attempt to provide services for inmates with addictions
Among the activities regarding treatment issues, the action plan mentions the establishment of treatment programs in penitentiaries, but without providing further details on the type of treatments proposed. Harm reduction is not mentioned as such, but “decrease of drug-induced damage” includes needle-and-syringe programs (NSP). Again, however, there are no available details of an implementation plan for prisons (Government of Serbia, 2009).
At the same time, the new National Strategy against HIV/AIDS (2011-2015) highlights the importance of HIV prevention among especially vulnerable groups within Serbian society. Injecting drug users are the main target group of the HIV/AIDS strategy, based on special harm-reduction methods. In respect of prison inmates, the Serbian goal is: ”to lower the risk of HIV and sexually-transmitted infections among sentenced persons, so that by 2015 at least 60 percent of them have been reached by preventive activities and programs”.
Reality versus plans and strategies
While the legal environment and the agreed strategies seem to be ready for the introduction of needle exchange programs, actual harm reduction in prisons is still completely absent. In the year 2009, the Ministry of Justice prison administration reported 4495 drug addicts. 60 percent of them had used heroin before detention, and 80 percent had smoked marijuana (EMCDDA, 2012).
Despite the agreed aims of the above-mentioned strategies, prison staff in Serbia tend to concentrate on attempting to minimise the entry of drugs, and discouraging use. On the other hand, inmates have poor or no access to psychological support. Prisoners claim to have heard that during their sentence, some nice people may come once for one hour and talk about risks, dangers, and their rights. The National Strategy against HIV/AIDS mentions that by the end of September 2010 over 4828 prisoners from 12 prisons had been covered by preventive activities i.e. almost 43 percent of the entire Serbian prison population. However, no details on the specific activities are reported (Ministry of Health, 2011). They probably consist of educational activities and voluntary confidential counseling and testing for HIV/AIDS, as distribution of condoms isn’t allowed in prisons. But the Ministry knows that in general, prisoners’ awareness of about sexually transmittable infections is alarmingly low, and they often do not see a doctor even when symptoms become apparent.
It tells a lot about how “seriously” health checks are taken that when a person enters prison, examinations do not include compulsory HIV and Hepatitis tests. Inmates are advised to undergo testing on a voluntary basis - though at least HIV and Hepatitis tests are available, and results are handled confidentially. If the results are positive, the person is referred to a special clinic for infectious diseases. An additional advantage is that all prisoners recognized as drug users are educated on prevention of HIV, Hepatitis and overdose. At the same time, users are well aware of the stigma they will face when it becomes known that they are infected with HIV or Hepatitis.
One progressive sign, within the Serbian system is that methadone maintenance therapy (MMT) can be continued, if it was started before the person entered prison.
Independent medical sources warn, however, that there is a chain of bureaucratic procedures between Ministry of Health and Ministry of Justice that can be time-consuming. In practice, this means that inmates usually have to spend couple of days on low methadone doses. Symptomatic treatment and benzodiazepines are used to relieve detoxification symptoms. Another obstacle is the fact that the prison service is not officially recognised as an addiction centre, so that until recently, it was impossible provide methadone therapy in prisons. (103 inmates, however, were receiving substitution therapy, based on statistics from EMCDDA.)
At the same time, there is a reversed discrimination when it comes to women. Women tend to receive shorter sentences than men, in drug-related cases. (UN Team Group on HIV/AIDS, 2010). Females make up only 5 percent of prison populations. Among them, 10 percent are being treated for a psychiatric or drug-related illness.
What could bring hope
Serbian drug users are aware of the extent of “EU influence” on the Belgrade government, so they might place some hope in the report to the Government of Serbia on the visit to Serbia carried out by the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT):
“CPT recommends that the Serbian authorities develop a strategy for combating communicable diseases in prison (in particular, hepatitis, HIV, and dermatological infections) including the provision of information to both prisoners and prison staff concerning methods of transmission, as well as the supply of appropriate means of protection, analogous to those used in the community at large.” In 2007, “The Committee recommended that the Serbian authorities should develop a comprehensive strategy for the provision of assistance to prisoners with drug-related problems, in the light of these remarks.”
According to the Serbian government's response to CPT, “Popular brochures were published on the prevention of transmission of communicable diseases, and distributed in all Serbian prisons”.
The government repeatedly asserts that Serbia is moving to align itself with EU practice:
The idea of starting needle exchange programs in Serbian prisons was announced by the government, but at same time prisons in Germany stopped exchange programs. And as needle exchange isn’t generally present in EU counties, Serbian politicians won’t be over-motivated to introduce such programs in prisons.
On a wider perspective, the Ministry of Justice is aware that drugs exist in prison, but seems unable to accept the fact that the spread of disease is drug-related. There is a lack of awareness on medical problems in Serbian prisons, so this topic isn’t publicly recognised. Issues like needle exchange or condom distribution are still politically incorrect, and in general lack public support.
Finally - driven by prejudice, lack of information and lack of public awareness, these issues aren't being aired in the wider society.
Furthermore, with the current government being far from liberal, there is little if any hope that conditions for drug users in prisons will change substantially, to allow their problems to be seen as a health issue.
Dragan Stamenovic, Re Generation