2013 has come to an end. It's time to sum up the past year, and make plans and wishes for the coming one. With the end of the year, the implementation period of the first Serbian national strategy related to reduction of supply and demand of psychoactive substances – representing the backbone of Serbian drug policy – has ended. EDPI’s Serbian partner takes stock of the period.
If we go back in time, four years ago when the Strategy for the Fight against Drugs in the Republic of Serbia 2009–2013 was adopted by the Serbian government, it seemed a sensible, but ambitious plan, the implementation of which would lay down a solid foundation for a sensitive drug policy. An Action Plan complemented the strategy for the implementation period.
First of all the principles of the strategy – including the protection of human rights, in the sense that all people who use psychoactive substances should be guaranteed services or assistance free of discrimination – changed the landscape significantly. It was recognised that there are people who cannot or do not want to stop using psychoactive substances, and who are entitled to be provided with harm reduction services. The leading principles of the strategy were to be multidisciplinary, comprehensive and to provide continuous availability for its services. It was also supposed to be ethical, professional and anti-stigma. Programs for people who use psychoactive substances must be free of ideological and moralistic interpretations. These principles sound great in theory, but their implementation in practice was missed, due in part to a chronic lack of funding, but also inertia from the stakeholders.
There are five main areas of activities identified: coordination, supply reduction, demand reduction, information, research and evaluation, as well as international cooperation.
The need for high-quality harm reduction programs and opioid substitution therapy programs was listed as an important goal of the strategy. For effective HIV prevention and early intervention, particularly among hard-to-reach vulnerable populations, the importance of outreach services was also highlighted. For the first time, the significant role of civil society organisations was recognised in the implementation; however, that recognition was unfortunately only theoretical.
According to the analysis of the current situation, there are a growing number of new psychoactive substances available on the Serbian market; there has been an increase in the use of psychoactive substances, and an increasing trend towards the concurrent use of multiple substances – so called poly drug use. Identified deficiencies were: undeveloped national policy and coordination, undeveloped information systems and databases, and insufficiently developed doctrinal attitudes and treatment methodologies, while under-developed rehabilitation programs and therapeutic centres were typical.
One of the first proposed activities of the Action Plan highlighted the need for research based on existing resources and capacities for better implementation. Given that this activity was not initially implemented, the feasibility of the strategy wasn't in fact evaluated, and the action plan was not completed within the planned period. All activities were supposed to be funded from the budget of the Republic of Serbia. Due to a lack of national financial resources, most activities could not be implemented to the planned extent, while others remained merely wishful thinking.
Coordination and information exchange among the relevant ministries and other key stakeholders, as well as collaboration and reporting to international organisations and institutions, have improved. A National Registry of persons treated for substance abuse has been set up, as well as a national questionnaire for data collection. Decentralisation of addiction treatment was executed by devolution to four regional centers – Novi Sad, Belgrade, Kragujevac and Niš. More than twenty methadone centers were opened in primary health care – though low threshold programs that were poorly developed. It is now possible to treat juvenile opiate users who were previously excluded by an age limit from all treatment programs. The only treatment program for minors had very strict inclusion criteria and consisted of daily family therapy – which meant that children from the most vulnerable groups, whose parents could not or would not participate, were automatically excluded from the program.
Activities in the area of supply reduction were effectively implemented even before the adoption of the strategy, and Serbia is a leader in the region, when measured by the amount of seized substances. Supply reduction has therefore effectively continued during the term of the strategy. As a result Serbian prisons are overcrowded with drug users and petty dealers. On the other hand, the health aspect of drug use, embracing prevention and treatment of substance abuse, and social aspects of reintegration and social support for people who are using psychoactive substances during the implementation, was put on the back burner.
Serbia’s traditionally blunt, slow and ineffective social protection system, which was supposed to be responsible for the reintegration of people who use psychoactive substances, has remained purely administrative. It was planned to implement a prequalification and employment program for drug users, establish housing units for drug users, and professional conventions for interested entities for employment of drug users. You already may have guessed that none of these activities were implemented.
The planned standardisation of services provided in therapeutic communities, and adoption of necessary regulations for their governance, as well as the development of guidelines for working in these communities, haven’t been executed. A direct consequence of this failing, is abuse in the name of treatment, which resulted in the death of one of the residents of a therapeutic community run by the Serbian Orthodox Church in Jadranska Lešnica.
Needle exchange programs are also listed as an important element of the strategy. The first needle exchange program opened in 2002 in Belgrade, while three others opened through Global Fund HIV project in Serbia. Needle exchange programs are not legally regulated and there is no coordinating governmental body or institution that could provide supervision, funding and sustainability for these programs, after the Global Fund project funding ends in June 2014. Given that currently there are only four needle exchange programs, their sustainability should be an imperative. The situation is unfortunately far from that. The absence of a coordination body within the Ministry of Health is used as an excuse for not allocating funds for programs of this kind. Do we have to wait for HIV prevalence to skyrocket among injecting drug users and then react, or should we just look at the situation in the other European counties such as Romania and Greece, and prevent a similar epidemic in this country?
The Overall Strategy for the Fight against Drugs, and the Action Plan for its implementation, are two rhetorically perfect but completely unrealistic documents. As such they represent a list of beautiful and unfulfilled wishes.
In 2014, Serbian government is preparing a new drug strategy. When starting to work on that, the Serbian government has to carry out a better assessment of its existing capacities and resources. Based on that, objectives and activities need to be prioritised, so that they can then be comprehensively implemented. And only when these things are done should officials sit down, take time and write a strategy for the next four years.
Jovana Arsenijević, NGO Re Generation/Serbia