Drugs - Policies and Practices

DRUGS POLICIES AND PRACTICES
Year II, Issue 2, June 2014, ISSN 1857- 906X, Free issue
Issues topic:
Drugs and Law
Interview: Jaka Bitenc, Slovenia
Cannabis Social Club (SKSK)
The public opinion has changed a lot since 2010. The media have started
to write about the benefts of cannabis. It happened for the frst time in
Slovenia, that a civil campaign managed to gather 28.000 signatures for
three draft laws we made it all together!
www.hops.org.mk
Impressum
DRUGS Policies and Practices
Year II
Number 2
June 2014
ISSN 1857- 906X

Free issue
Published by:
Association HOPS Healthy options
project Skopje
Address: Hristo Smirnenski 48/1-6,
1000 Skopje
Phone: +389 2 324-6205
Fax: +389 2 324-6310
e-mail address: hops@hops.org.mk
www.hops.org.mk
Drugs Policies and Practices is a
publication of the Association HOPS
Healthy options project Skopje.
This magazine is free of charge and
for distribution.

Editorial Offce
Editor in Chief
Vanja Dimitrievski
Editorial Board
Vanja Dimitrievski
Vlatko Dekov
Irena Cvetkovikj
Zharir Simrin

Translated in English by
Suzana Shterjova Tosheva
Photography
Social Marketing - HOPS
Gpaphic design
Social Marketing - HOPS
Printed by:
DataPons
Drugs Policies and Practices is open
for cooperation with all those inter-
ested in sharing attitudes to promote
the humane treatment of people using
drugs. If you want to submit an article
or help the magazine in another way,
please contact us in the following ad-
dress:
hops@hops.org.mk
2
Contents
The death of the actor
3
Legal regulations concerning drugs

4
Slovenia Social Cannabis Club SSCC

10
Drug policy and legislation in South Eastern
Europe

13
Visiting the Portland health society, an organi-
zation carrying out harm reduction policies and
programs in Vancouver Canada
17
Everything under control?????! 22
I love drugs, I only hate its consequences!

24
What makes you happy? 28
Pedagogical support for children with drug us-
ing parents

32
Ganja can kill you, only if Alphas catch you 35
Conference: Availability of Hepatitis C treat-
ment to drug users in RM good practices and
challenges

37
Recently banned substances in the category of
opioid drugs and psychotropic substances
40
We recommend 42
Latest publications about drugs 42
Brief news

43
Attitudes presented in Drugs Policies and Practices does not necessarily refect or
conform to the attitudes of the publisher HOPS Healthy Options Project Skopje.
On February 2nd this year, the actor Philip Seymour Hofmann died from heroin overdose. Another fatality that
could have been prevented.
The media and social networks were brimming with moralizing and judgmental statements criticizing Philip for his drug
use.
However, there were only rarely criticisms of the US government that called it forth for responsibility for its immoral
drug policies and its attitude towards drug using people. The possibility that Philip would still be alive today is com-
mensurate to the countrys human rights-based drugs policy. Namely, in countries where implemented drug policies
emphasize prohibition, the role of the police and penalties instead of prevention, treatment, re-socialization and harm
reduction, mortalities such as this one are by far more numerous than in those countries where drug issues are consid-
ered with health and social issues as priorities. Thats why there is a large probability that Philip would have still been
alive today if he had the chance to use legal injection rooms such as those in Australia, Canada, Norway or Switzerland,
for example, where injection with fatal consequences is impossible, or if he had the possibility for a treatment with
medical heroin such in Germany, Switzerland, Denmark etc. Also, the likelihood of him receiving naloxone would have
been far greater, thus effectively managing any case of overdose. He didnt have any of these options, because his
governments policies didnt make them available. That is why the policy of war against drugs is inhumane, ineffective
and only increases the suffering of people using drugs and their families.
One more thing concerning the media. Fatalities happen every day. Please inform and write about them, too. Please
write not only of the number of death cases but also of the life stories as you did in the case of Philip. Yes, not every-
one is a movie star, not everyone is a celebrity, but in Macedonia alone, there are around 10.000 drug-injecting people
who share their destinies with Philip before his death. They are our co-citizens, neighbors, brothers, sisters, friends,
acquaintances. In Macedonia, none of the programs I mentioned above are available, just as naloxone isnt. Should we
wait for somebody we know to die, before we start talking and writing about the problems?
Vlatko Dekov
Drugs - Policies and Practices
The death of the actor
Pursuing a Masters degree in so-
cial policy, has a thirtheen years
of experience on drug related
issues; currently working as a
manager of CEDR Center for
Education, Documentation and
Research within HOPS. He has
developed most of the harm re-
duction programs in Macedonia.
He is activist for human rights of
marginalized communities and
member of several national and
international committees and
bodies for drugs, HIV/AIDS and
human rights.
4
Evidence shows that penal measures alone, regardless of their strictness, fail to achieve
their aim of reducing drug use. Moreover, in many cases, laws that criminalize drug use
lead to negative consequences, such as stigmatization of people who use drugs, viola-
tion of human rights, diffcult access to treatment and re-socialization etc.
www.hops.org.mk
Legal regulations concerning drugs
Vlatko Dekov
Having in mind that drug use can
cause serious damages both on in-
dividual and on societal level, states
across the world implement diverse
strategies to prevent or decrease
these consequences. In most coun-
tries in the world, the production,
possession, sales or purchase and
use of drugs is banned. The inter-
national legal framework is based on
three conventions for narcotic drugs
and psychoactive substances (dated
1961, 1971, 1988) brought by the
UN, and signed and ratifed by UN
member-states. As stated in the 1988
Convention, with its ratifcation, coun-
tries undertake to carry out sanctions
for the production, sales, transport,
distribution or purchase of forbidden
substances as stipulated in the 1961
and 1971 conventions.
All three conventions enable the
signatories to carry out measures for
treatment, education, post-treatment
care, rehabilitation and social re-inte-
gration for those who have committed
drug-related crimes, and are depend-
ent on drugs themselves. Although
varying interpretations exist, conven-
tions dont contain any specifc arti-
cles or detailed provisions regarding
the criminalization of drugs and they
leave open the possibility for fexible
national policies in terms of sanction-
ing personal drug use.
Still, most signatory countries ban
the production, sales, transport, pro-
curement and use of drugs. Also, a
large number of states criminalize the
use of drugs such as Russia, Georgia,
Singapore, China etc.
In 2008, the Executive Director of
UNDOC the UN Offce on Drugs and
Crime pointed out these negative con-
sequences of the international drug-
related legal framework, which has
proven to be rather restrictive.
Evidence shows that penal meas-
ures alone, regardless of their strict-
ness, fail to achieve their aim of re-
ducing drug use. Moreover, in many
cases, laws that criminalize drug use
lead to negative consequences, such
as user stigmatization, violation of
human rights, diffcult access to treat-
ment and re-socialization etc.
On the other hand, in some other
countries, such as Portugal, Czech
Republic, Holland, Spain etc., focus is
placed on public health, social policy
and human rights, and laws do not
criminalize the use of drugs. In 2013,
Uruguay went a step further and le-
galized production for personal use,
but only for marihuana. Namely, its
citizens, once licensed, can choose be-
tween these three options: to produce
up to 6 plants a year by themselves,
to become members of a marihuana
social club where jointly with other 15
to 45 members, they can raise up to
99 plants a year, or to buy 40 grams a
month from licensed pharmacies.
Some countries, such as several
federal units of the USA, legalize only
the medical use of marihuana, or al-
low the founding of social clubs of
marihuana users (Slovenia, Belgium
etc.), who can jointly grow or possess
marihuana for personal use.
However, movements and initiatives
for law changes towards decrimi-
nalization of the possession and use
of drugs, as well as legalization of
marihuana are ever more increasing,
probably encouraged by the results of
these policies, which were compre-
hensively discussed in the previous is-
sue of Drugs Policies and practices.
Macedonian experiences
In Macedonia, the possession for
personal use is not a crime, and drug
use is considered a misdemeanor
against the public order and peace
and is fnancially penalized. More spe-
cifcally, in Macedonia possession for
personal use is decriminalized. What
is considered a crime is the posses-
sion for sales. However, in practice,
possession is most often treated with-
A huge revenue-generating black
market has been created around
drugs, exploited by powerful criminal
organizations.
Geographic replacement of the
production, i.e. any successful action
against drug production in one part of
the country or a region in the world
creates the so-called balloon effect
and induces increase of drug produc-
tion in another part of the country or
the region. Production doesnt de-
crease, only moves around.
Substance replacement this is
when certain actions and strategies
lead to decrease of production and
demand of a certain type of drug,
dealers and people who use drugs
transfer to a new type of drug, often
multiple times more damaging than
the previous one.
Criminalization of people who use
drugs increases their marginalization
and stigmatization which leads to a
obstructed access to health and social
services and decrease of their produc-
tivity in society.
Ar e l aws wi t hi n t he i nt er est of ci t i zens?
5
In Macedonia, the possession for personal use is not a crime, and drug use is considered
a misdemeanor against the public order and peace and is fnancially penalized. More spe-
cifcally, in Macedonia possession for personal use is decriminalized. What is considered
a crime is the possession for sales. However, in practice, possession is most often treated
within the frames of the Criminal Code.
drugs - policies and practicies
in the frames of the Criminal Code.
The editorial board of the Drugs
policies and practices magazine, car-
ried out a phone and internet survey
for this issue, in order to get an idea
about the attitudes of Macedonian
citizens on these two questions:
1. Do you consider drug possession
exceptionally for personal use should
be punishable by law?
2. Do you think that marihuana use
should be legalized?
The phone survey included 1095 in-
terviewees, on a representative sam-
ple selected according to gender, age,
ethnicity and place of living.
90,5% of the interviewees stated
that drug possession only for person-
al use should be punishable by law,
6,9% considered that this should not
be a punishable act, while 5,3% didnt
know or didnt want to answer the
frst question.
6
At the question about legalization
of marihuana, 83,7% of the inter-
viewed stated that they were against
legalization, 9,3% stated that mari-
huana should be legalized, and 9,7%
didnt know or didnt want to answer.
In age group distribution, the larg-
est percentage of surveyed who were
in favor of marihuana legalization
were people aged 18 to 29 (13,5%).
According to their place of living, mar-
ihuana legalization was mostly sup-
ported by the interviewees from the
Skopje (16,2%) and the South-east-
ern region of the country (12,5%). It
is exactly in the South-eastern region
of the country that the support for
banning the legalization of marihuana
use is the least (70,8%). The remain-
ing 29,2% are people who either sup-
port legalization, or dont know or
dont want to answer.
7
There are other indicators that have not been assessed or measured at all, or have been so, but
only rarely. For example, the suffering and emotional pain of a child whose parent is im-
prisoned under the Law because he possessed marihuana for personal use. How do you
measure the infuence of the Law that criminalized the use of drugs on the suffering of
this child, on its psychosocial development and growth without a parent (because he is in
jail)
www.hops.org.mk
This is a huge difference in com-
parison with the frst research by
Galup carried out in 1969 when only
12% of all interviewees supported
legalization, and in 1987 when only
16% supported it, according to CNN.
In the meantime, in the USA several
campaigns happened promoting the
legalization of marihuana, the most
intensive ones being in the last 10
years, and the results being visible.
public opinion regarding the marihua-
na regulation in the USA. This year
for the frst time, a research showed
that most Americans, 58% accord-
ing to Galup, 54% according to CNN,
were pro marihuana legalization. The
biggest increase, of 10%, appeared
last year, and analysts think that the
reason for this was marihuana legali-
zation in the states of Colorado and
Washington.
The same two questions were
posed at an anonymous survey which
was promoted via social networks on
the internet using a Google-based
survey. The survey was flled in by a
total of 288 interviewees. The results
from this survey differed largely from
those of the phone survey. Namely,
79% of the interviewed in the internet
survey thought that possession solely
for personal use should not be pun-
ishable by law, and only 15% thought
that it should be.
At the question for legalization of
marihuana use, 249, i.e. 86% an-
swered that marihuana use should be
legalized, while only 21 interviewee,
i.e. 7% were against legalization.
Other interviewees didnt want to an-
swer (1%), didnt know (5%) or had
no opinion (1%). It is clear that in-
ternet surveys are not representative
and their weakness is that they are
answered only by those who had the
possibility to learn about the survey
and were motivated to participate.
Also, age-wise, interviewees here
were younger, with an average age
of 30,5 years, which is characteristic
of internet users and it is usual that
younger people favor marihuana le-
galization. This conclusion was con-
frmed by the phone survey results.
On the other hand, one weakness
of the phone survey was that these
sensitive questions were asked via
the phone which decreased the prob-
ability for providing an honest answer.
Still, I will refer to the relevance of the
phone survey, although I am deeply
convinced that it does not express the
actual situation and the attitude of the
Macedonian citizen.
For comparison, I will mention the
example with the dynamics of the
8
Although varying interpretations exist, conventions dont contain any specifc articles or
detailed provisions regarding the criminalization of drugs and they leave open the pos-
sibility for fexible national policies in terms of sanctioning personal drug use.
Marijuana activist and indoor grower Juan Vaz, head of the Uruguayan Cannabis Stud-
ies Association, poses in his indoor garden in Montevideo, in this December 6, 2013.
GALLUP
by politicians, we must ask ourselves
if our politicians take into account all
these negative consequences of the
laws they vote for. I am not convinced
in that, and this is why I believe that
all of us who professionally work on
drug related issues must be much
louder, in order to point to the need
for change of laws and to be actively
included in their drafting.
Now is the real moment to remind
ourselves about Charles De Gaulles
statement Politics is too serious
a business to be left only to the
politicians.
for success in life), how many are ac-
cepted by society, i.e. whether they
are stigmatized, decriminalized etc.
There are other indicators that have
not been assessed or measured at
all, or have been so, but only rarely.
For example, the suffering and emo-
tional pain of a child whose parent is
imprisoned under the Law because
he possessed marihuana for personal
use. How do you measure the infu-
ence of the Law that criminalized the
use of drugs on the suffering of this
child, on its psychosocial development
and growth without a parent (because
he is in jail), on learning and on its
conduct at school, the infuence on
the possible rejection from its school
mates because they dont want to be
friends with a prisoners child etc.?
This is just a segment of the ques-
tions rarely asked when certain laws
are being enacted.
Having in mind all the seriousness
of the laws regulating drugs, enacted
Ethical and social dilemmas of
criminalization
The success of a drugs policy from
the aspect of personal health is often
times measured according to preva-
lence, i.e. the number of people who
use drugs, the number of dependent
people in treatment, mortality, co-
morbidity and other indicators.
From a legal and criminal point of
view, success is measured accord-
ing to the number of prisoners, the
number of drug-related crimes and
offences, the number of newly regis-
tered users etc. However, the assess-
ment of one policy in the specifc case
the criminalization of the use of drugs
will be complete if social and psycho-
logical indicators are also assessed.
Namely, what number of people who
use drugs have found a job, how
many of them have founded a fam-
ily (although I personally dont think
that founding a family is ant criterion
9
10
Jaka Bitenc is activist of the Slovenia Cannabis Social Club (SKSK) and together with
other SKSK members he is fghting for change of law for cannabis in Slovenia, for which
he thinks its senseless, as well as wider in the Balkans. He uses cannabis oil to resolve
diabetes consequences, from which he suffers in the past 23 years. In this interview
Jaka speaks about his personal experiences with medical cannabis and about activities
of SKSK.
SLOVENIA CANNABIS SOCIAL CLUB (SKSK)
INTERVIEW WITH JAKA BITENC,
ACTIVIST IN SLOVENIA CANNABIS
SOCIAL CLUB (SKSK)
I am an activist, a father, a human,
fghting for his health and also for
the health of others in Slovenia. At
the moment I am part of a team
that is touring around Slovenia and
informing as many people as pos-
sible about the benefts and useful-
ness of cannabis. We are tying to
change the laws, which are pretty
much the same all over the Bakans
and do not make any sense.
Who are you? What are you doing?
What is your personal experience with
medical cannabis, and what do you
feel are the differences when compar-
ing regular medications (pharmaceu-
ticals) with medical cannabis for your
condition.
I am an activist, a father, a hu-
man, fghting for his health and also
for the health of others in Slovenia.
At the moment I am part of a team
that is touring around Slovenia and
informing as many people as possible
about the benefts and usefulness of
cannabis. We are tying to change the
laws, which are pretty much the same
all over the Bakans and do not make
any sense. I use cannabis because
Ive had diabetes for the last 23 years
and my body doesnt absorb insulin
suffciently, so I have no other healthy
alternative. At the moment I use only
30% of insulin, because insulin kills
off all the healthy beta cells in our
bodies. I assume that this is being
done on purpose by the pharmaceu-
tical industry to get as many insulin
addicts as possible.
The hash (cannabis) oil, that we
do, is helping me in many ways. First
of all, it calms down my body by low-
ering the adrenaline levels so I can
think more clearly. It also stimulates
my pancreas to produce the insulin on
its own and by doing that it indirectly
lowers my blood sugar levels.
Of course, the most succesful
therapy is wholesome, taking care
with a proper diet, energy frequencies
etc.
Can you notice a difference in the
Governments and public opinions re-
garding medical cannabis, between
the time prior to the start of SKSKs
activities and now?
The main motive to found the
SKSK was most certainly my diabetes,
for as long as I have it, I had to suffer
injecting insulin with those needles,
which was killing me and making an
addict out of me.
I did not have any legal prob-
lems, apart from the fact, that I had
to make many adjustements to the
club statute before the offce was sat-
isfed with the result. The opinon of
the governemnt on the other hand is
clear, self supply is not allowed, we
should be happy to be able to inform
the public. Here in Slovenia, it is like
in most places around the world. We
have secret agents and all sorts of
stuff people see in the movies.
The public opinion has changed
a lot since 2010. The media have
started to write about the benefts
of cannabis. It happened for the frst
time in Slovenia, that a civil campaign
managed to gather 28.000 signatures
for three draft laws we made it all
together!
What is your membership policy and
how many members SKSK have?
Members of our club are only medi-
cal patients. We cannot afford any
other policy untill the law is changed.
The number of memebers is increas-
ing daily, so I cannot give an exact
number, but I can say there are more
than one thousand patients in the
club.
What is the main goal of SKSK?
The aim of the club is to help med-
ical patients, whom the offcial medi-
cine cannot help as well as to change
the law in such a way that it will allow
self-supply of Cannaibs here in Slove-
nia.
Can you say something more about
the activities of SKSK?
We have meetings with patients,
we give lectures on cannabis history
and medical use as well as presenta-
tions of the draft laws around Slove-
nia. Similarly, we help patients from
abroad. We help establish small can-
I nt er vi ew wi t h Jaka Bi t enc ( SKSK)
11
www.hops.org.mk
The aim of the club is to help medical patients, whom the offcial
medicine cannot help as well as to change the law in such a way
that it will allow self-supply of Cannaibs here in Slovenia.
nabis clubs around Slovenia and are
trying to live in a parallel system, be-
cause we are not satisfed with our of-
fcial position.
Can you emphasize some positive ex-
amples of medical cannabis use?
Cannabis is proven to heal 105 dis-
eases, meaning all autoimmune dis-
eases. It is very important to start the
therapy as soon as the diagnosys has
been made. cannabis oil lowers the
blood sugar levels, holesterol levels,
blood presure levels, it dillutes the
blood and improves our sleep, our
digestion which is essential fot the
treatment of HIV and different can-
cers. This is only one part, for can-
nabis consumption has too many ben-
efcial effects to list them all in a short
answer. We would need to explain the
endocannabinoid frst, the most com-
plex metabolic mechanism of our bod-
ies...
What is your opinion regarding can-
nabis and our future?
There is no turning back any more.
We are getting new evidence each
and every day. The future is bright
and we are optimistic.
In the time when interview with Jaka
Bitenc was made, members of SKSK
were in an intensive campaign for
change of Slovenian low for cannabis.
Unfortunately, the initiative was re-
jected by the policy makers in Slove-
nia, but as Jaka says, they dont give
up the fght.
Interview by
arir Simrin
12
Members of our club are only medical
patients. We cannot afford any other
policy untill the law is changed.
Cannabis heals, trust nature!
- Jaka Bitenc
Director of Diogenis Association
Thanasis Apostolou has studied
at the University of Athens and
the university of Amsterdam,
has worked as staff member of
the institute Kerk en Wereld,
in Driebergen, Netherlands
(1972-1976) and the Orthodox
Academy of Crete (1976-1977).
He was director of the Centre
for migrant workers from the
Mediterranean sea in Utrecht,
Netherlands (1977-1989), has
been member of the Dutch
Parliament for the labour party
(1989-2002) and has worked
as consultant on drug issues
(2002-2010). He is director of
Association Diogenis (2010-to-
day).
13
The motive for this project was the idea that in the development of drug policy in the
SEE countries, civil society involvement must play a positive and decisive role. Non-
governmental actors in the feld of drugs have to have a say in shaping drug policy and
to exercise infuence on drug Legislation.
Drug policy and drug legislation in South
Eastern Europe
Thanasis Apostolou
The motive for this project was
the idea that in the development
of drug policy in the SEE countries,
civil society involvement must play
a positive and decisive role. Non-
governmental actors in the feld of
drugs have to have a say in shaping
drug policy and to exercise infuence
on drug Legislation.
Some characteristics of the situ-
ation of drug policy and drug leg-
islation in the countries of South
Eastern Europe are presented in
this study followed by recommenda-
tions. They can be summarized in
the following points.
a. There is a discrepancy be-
tween adopted drug strategies
and their implementation in
every day practice
All SEE countries have adopted
a National Strategy during the last
decade. The majority of them have
also adopted Action Plans for the
implementation of the Strategy. Ac-
cording to the national strategy of
all SEE countries, NGOs and civil
society should play an important
and active role in policy making,
mainly in the feld of treatment and
rehabilitation, but also in harm re-
duction. The actual involvement of
civil society and NGOs is, however,
rather marginal, although efforts
are made to improve it. In practice
there is a gap between strategies
and practice. Harm reduction is ac-
cepted in de drug strategies but is
not enshrined in national legisla-
tion; harm reduction services are
appreciated, but they are fnancially
dependent on grants of external do-
nors; rehabilitation programmes are
recognized as essential part of drug
policy, but they have still to be de-
veloped.
It is pointed out that strategies
and action plans must be evaluated
and practices that are not effective
have to be changed. Most of the
countries do not have yet formal
evaluation mechanisms. Evaluation
will help the relevant authorities to
make changes where necessary and
introduce innovative practices that
meet the needs of those concerned.
b. The application of criminal
law is harsh for drug traffcking
and in cases of drug possession
for personal use is diverse and
often inconsistent.
Criminal Justice systems of South
Eastern European (SEE) countries
are based on different traditions
and the response to the drug issue
proves diversifed. Deviations are
wider in the area of smaller-scale
violations of drug laws, while pen-
alties envisaged for drug traffcking
have more common characteristics
being extremely harsh. In several
countries however, regardless of the
strict scope of legal provisions, the
penalties actually imposed by courts
are less stringent.
In general, SEE countries could
be described as indecisive on is-
sues regarding decriminalization of
possession of drugs for personal
use. This is an extremely crucial is-
sue in the further development of
drug policy, since this issue usually
deeply affects the lenient or harsh
treatment of the user-perpetrators
within the criminal justice system.
Decriminalisation of drug posses-
sion for personal use is heavily dis-
cussed, but several attempts to in-
troduce it in national legislation has
failed. Further research and study of
the current practice concerning pos-
session for personal use, must be a
priority in the future agenda of the
countries of the region, in order to
relieve the criminal justice and the
penitentiary, system.
c. The prison population over
the last years has increased;
the living conditions are poor
and there is increasing drug use
in prisons; medical care inside
prisons is inadequate.
For the majority of the countries,
the living conditions in detention fa-
cilities are very bad because prisons
are overcrowded. This is a common
problem and a general endemic
characteristic of the correctional
systems of the majority of the coun-
14
In 2012 Diogenis Association took the
initiative to set up a project on Drug
Law reform in South East Europe. In
cooperation with the organisations
of the drug policy network in South
East Europe and researchers affliat-
ed with researches institutes and law
faculties of universities in South East
European countries, a research has
been carried out that resulted in the
publication Drug policy and Drug
Legislation in South East Europe.
www.hops.org.mk
http://www.diogenis.info
DRUG POLICY AND DRUG LEGISLATION IN SOUTH EAST EUROPE
The problem of drug-use in prisons emerges clearly through the national reports. There is diversity
in the provision of treatment programmes for drug dependent prisoners. Medical care inside prison
is provided for all prisoners by medical staff while help from other medical institutions and NGO
programs can be provided only outside the prison.
tries.
The problem of drug-use in pris-
ons emerges clearly through the
national reports. There is diversity
in the provision of treatment pro-
grammes for drug dependent pris-
oners. Medical care inside prison is
provided for all prisoners by medical
staff while help from other medical
institutions and NGO programs can
be provided only outside the prison.
It is possible to divert drug users
from prison into community-based
treatment for drug addicted per-
petrators of drug-related offences,
though diversion mechanisms com-
bined with treatment programmes
(suspension of penal prosecution,
execution of the sentence/proba-
tion/ conditional release from pris-
on) are currently implemented on a
very limited scale.
d. There is support for alterna-
tives to incarceration of drug
offenders.
All relevant stakeholders sup-
port alternative measures to incar-
ceration of drug offenders. They are
convinced that alternative measures
will result in a reduction of incar-
ceration and minimization of the
negative consequences of criminal
prosecution and short-term prison
sentences to drug addicted persons.
However, social re-integration pro-
grammes are almost absent. For
the majority of the SEE countries,
the strategy for social reintegration
can be characterized as either in-
coherent or only nominal and there
seems to be a long way to go for
the implementation of such policy.
Consistency requires that a policy in
favour of alternative measures to in-
carceration needs to be followed by
implementation in practice.
e. Relevant authorities and
state recognized agencies and
service providers are reserved
towards drug law reform pro-
posals, while NGOs are in fa-
vour
The relevant national authorities
and the state recognized agencies
and service providers are cautious in
their reactions concerning proposals
for policy change. Reform proposals
are very often considered to be con-
trary to the international conven-
tions. Governments and parliaments
are making use of the room that ex-
ists in the international conventions
to introduce new ways of facing the
problem, but they are hesitant to
speak about reform of the current
drug control system.
NGOs express clearly the wish for
reform in several areas, especially
the decriminalization of possession
for personal use and the wish to
enshrine harm reduction services in
the national legislation. For the intra-
venous drug users, supervised drug
consumption rooms are considered
as necessary prevention measure
to avoid the spread of HIV. NGOs
are, however, concerned about the
general attitude of the public that is
reserved towards decriminalization.
f. The economic crisis is a
real threat for treatment and
harm reduction services
Although in most cases, espe-
cially in recent years, governments
assisted by NGOs have made great
progress in broadening their harm-
reduction policies and the services
offered to drug users, obstacles
mainly related to the lack of fnan-
cial resources and, to a degree,
to a culture of mistrust and phobic
societies have greatly suppressed
programs and initiatives for nee-
dle and syringe exchange and the
establishment of supervised drug
consumption rooms. The shift of in-
terest towards this direction is, how-
ever, a particularly important devel-
opment which will greatly infuence
developments in drug policy in SEE,
especially under the effect of the
wider relevant European policy.
Under the burden of the econom-
ic crisis, treatment and harm reduc-
tion services along with the health
issue in general, medical & pharma-
ceutical care and other social ben-
efts is pushed in the margins of
central policy, while the severe re-
duction of funds seems to already
have a dramatic impact. Most of the
SEE countries now face an unpre-
dictable future on fnancing treat-
ment and harm reduction programs,
as many are (or were) sponsored by
the Global Fund, while most are no
longer eligible to receive new fund-
ing. If National governments are not
going to fnance these services most
of them may cease to function due
to lack of resources.
g. Cannabis production and use
Assesment
15
is dominant in all countries of
the region.
Cannabis cultivation and use
is dominant in all the SEE counties.
Large quantities of cannabis plants
are detected, uprooted and confs-
cated by the law-enforcement au-
thorities. At the same time there is
little debate about cannabis reform.
Initiatives in some countries in the
region have not resulted in serious
political consideration of the issue.
h. Unbalanced Spending of Fi-
nancial resources
Broadly speaking, the available
resources for drug supply reduction
and drug demand reduction is not
balanced. The national strategies
present a comprehensive view in
which the elements to reduce drug
demand and supply of drugs are
balanced.
However, in practice there are
diffculties in implementing this bal-
anced approach. Some say that
this is due to lack of budgetary re-
sources. Others point out that it is a
question of priorities and policy ori-
entation. Lack of human resources
and fnancial support for treatment
programs is a signifcant issue; it
is necessary to allocate increasing
amounts of money from the state
budget for treatment services pro-
vided to drug users.
16
NGOs express clearly the wish for reform in several areas, especially the de-
criminalization of possession for personal use and the wish to enshrine harm
reduction services in the national legislation.
... there is a gap between strategies and practice.
Darko Veleski holds a BA in
social work. He currently works
on his MA thesis within the post-
graduate studies at the Institute
of Sociological, Political and Ju-
ridical research, in the feld of
human resources. He actively
works as a coordinator of the
outreach activities of the HOPS
Healthy Options Project Skop-
je, where he previously worked
as a social worker at the drop-in
centers.
17
... one of the main features of Vancouver which makes it globally prominent are the hu-
mane policies for help and support of homeless people and other socially marginalized
communities.
Visiting the Portland health society, an organization
carrying out harm reduction policies and programs in
Vancouver Canada
Darko Veleski
www.hops.org.mk
In August/September 2013, I
had the exceptional possibility to
travel to a two-month study visit
to Vancouver, Canada within the
programs for help and support
of homeless people and other
socially marginalized communi-
ties there. Vancouver is located
on the west coast of Canada,
on the Pacifc Ocean. In the city
itself there are 603.502 inhab-
itants, and together with the
suburbs it comes to around 2,4
million inhabitants, which makes
it the third most densely inhab-
ited place in Canada. The town
itself leaves the impression of
a cosmopolitan community be-
cause when visiting you get the
impression that people from all
the races and nationalities live
there. Because it is one of the
largest ports in the western part
of North America, trade is a de-
veloped economic branch which
allows its inhabitants to be proud
with the access to the freshest
and most delicious food which is
then distributed inland.
In addition to its beauty, when
visiting Vancouver you cannot
but notice the presence of a large
amount of homeless people.
But, one of the main features of
Vancouver which makes it glob-
ally prominent are the humane
policies for help and support of
homeless people and other so-
cially marginalized communities.
During the study visit, I was a
guest of the Portland Health So-
ciety, known for one of its most
developed harm reduction pro-
grams in the world, but also for
the projects to help and support
homeless people. In addition to
the programs of my hosting or-
ganization, I was able to meet
other organizations and pro-
grams which provide help and
support to different socially mar-
ginalized communities.
In this text, I will focus on
the some of the most remark-
able projects I was able to visit
and practically experience how
it looks like to work in them. All
the harm reduction projects are
located in down town east side.
Insite
Insite is a legal drug injec-
tion place. There, drug users
can bring their own drugs and
inject it in a specially designat-
ed space. The center has a well
trained team comprised of medi-
cal staff, community representa-
tives and activists whose task is
to overview the whole process,
and help during injection if the
patient cannot inject himself or
asks for such kind of help, as
well as to prevent the possibil-
ity of a potential overdose. This
center has around 1000 visits a
day, and around 500 overdoses
are prevented annually. Since its
founding, no mortality has been
registered.
Insite is well known and ac-
cepted by people who inject
drugs because it offers them
the comfort, safety discretion,
i.e. they can use drugs without
being seen by other people. If
somebody tries to inject drugs
in public, the police refer him to
Insite. The center also has a chill
out room, where clients can get
coffee and juice, and sometimes
even food. Within the centre
theres a possibility for working
engagements to those interested
from the community, for a half
working time, which increases
their confdence and responsibil-
ity towards themselves and to-
wards the community.
Onsite
Onsite is a drug detoxifca-
tion center located in the same
building with Insite. It is a treat-
ment facility for people who want
to reach full drug abstinence. It
has a Transitions Ward where cli-
ents who have passed detoxifca-
tion are located, while waiting for
the social workers from Onsite to
fnd accommodation and/or job
to them, which would help in
their re-socialization.
Its an interesting idea to ac-
commodate a detoxifcation cent-
er immediately above the Center
for safe drug injection. At Insites
entrance you can regularly fnd
drug users, as well as drugs.
18
Its an interesting idea to accommodate a detoxifcation center
immediately above the Center for safe drug injection. At Insites
entrance you can regularly fnd drug users, as well as drugs.
Knowing this, people at detoxifcation know that they can get
drugs at the very entrance of the building, and this creates an ad-
ditional pressure in overcoming crises during detoxifcation.
...at VANDUs request, whose Center is located on one of the busiest streets in Vancouver,
speed limit on the street is limited to 30 km/hour. The reason for this is that some of the
drug users tend to cross the street away from the zebra crossing, which used to cause
many car accidents.
Knowing this, people in detoxi-
fcation know that they can get
drugs at the very entrance of the
building, and this creates an ad-
ditional pressure in overcoming
crises during detox. On the other
side, people using drugs at Insite
know that if they want asking for
detoxifcation, they can immedi-
ately get such a treatment in the
same building.
In any case, Onsite marks great
results in the support for detoxi-
fcation.
VANDU
The Vancouver Area Network
of Drug Users is a small organi-
zation comprised of former and
current drug users, whose pur-
pose is improvement of the qual-
ity of life to drug users.
Employees at this organization
have weekly meetings on which
many active and former users
are present, to discuss current
problems of the community.
I would like to point out that at
VANDUs request, whose Center
is located on one of the busiest
streets in Vancouver, speed limit
on the street is limited to 30 km/
hour. The reason for this is that
some of the drug users tend to
cross the street away from the
zebra crossing, which used to
cause many car accidents. This
example is an indicator about the
infuence this organization has
on the citys authorities, but also
about their understanding for the
needs of drug users.
Stanley hotel
The Stanley hotel is a place
most frequently accomodating
drug users. It has 70 rooms and
works 24 hours a day. It accom-
modates homeless drug users.
Accommodation is free of charge
and is available to those who
need it most. People accommo-
dated at the hotel are taken care
of by a team that helps them
with food, regular medical treat-
ment etc.
The Portland health so-
ciety needle exchange out-
reach team
The basic task of the outreach
team is distribution of sterile in-
jecting equipment, as well as
collecting used up equipment.
The team works 18 hours a day.
Morning activities are comprised
of a walk through the city and
collection of used equipment that
has been thrown on public areas.
The team is well known in town
and citizens can call their num-
ber and report the need for clean
up. Afternoon and evening activi-
ties are most usually comprised
of needle exchange at specifc
locations. Locations, depending
on clients needs, are agreed by
phone.
Once weekly, the team vis-
its Abbotsford, a town around
1 hour drive from Vancouver,
but administratively on the terri-
tory of Alberta, where drug use
is regulated under stricter laws
than the ones in Vancouver. Drug
users and homeless people are
forbidden to stay in the streets
in Abbotsford and dont get any
help from the town, so they most
often live in the nearby forest and
the visit of this feld team means
a lot to them. When visiting this
community it was very interest-
ing to see the improvised homes
in the forest and their creativity
to equipping them with beds, TV
sets on solar energy etc.
VSH Stop team
The VSH stop team is com-
prised of outreach workers
whose responsibility is to provide
social help to homeless people,
among which are accompani-
ment, accommodation in institu-
tions, housing etc.
Washington Needle Depot
The Washington Needle De-
pot is a project intended for drug
users who want to remain anon-
ymous.
The premises this program
occupies are on a less frequent
space, a back alley, where drug
users can use the injecting equip-
ment without being noticed.
Also, if they have used equip-
Travel ogue
19
ment, they can leave it there.
New Fountain Shelter
This shelter center serves
homeless drug users above the
age of 25 works from 19:00 to
09:00 the following day. It has
a special part for women if they
request separate accommoda-
tion. It is interesting that within
this shelter center theres a spe-
cial area in which marihuana and
crack smoking is allowed for the
accommodated ones, who dont
need to go out of the centre to
use these drugs, during their
nights stay.
Drug Users Resource Cen-
tre
This center has at disposal
several rooms for different activi-
ties, services and possibilities for
drug users such as: movie pro-
jections, music therapy, kitchen,
a meeting room, creative work-
shop, discussions and lectures
space, showers, washing ma-
chines etc.
I hope that I have managed
to paint a picture to our read-
ers about part of my experiences
from this study visit, although it
is only a segment of what I had
the opportunity to see. My visit
to Vancouver convinced me even
more about the success of harm
reduction programs and the
ways in which they can improve
the quality of life of drug users.
From what I could see, I can
confrm that most of these pro-
jects would help drug users in
Macedonia. For example, Skopje
has no shelter center in the cent-
er of the city where homeless
people and drug users circulate
most often. There is no single
object to house homeless peo-
ple. And of course, if there was
a legal injecting spot, drug users
would be better protected, the
waste used injecting equipment
in public spaces would decrease,
and the wider population would
thus be better protected.
20
www.hops.org.mk
Travel ogue
21
The center also has a chill out room, where clients can get coffee and
juice, and sometimes even food.
1 Youre going to the doctor to tell him you wont to be test-
ed for Hepatitis C. On the way, you see your dealer. What do
you do?
A You score a hit right away. Forget about the doctor.
B You score a hit frst, than make your way to the doctor.
C You go to the doctor frst, than score a hit to reward yourself.
2 Recently, youve been hitting the coke pretty hard and
have forgotten to eat. Your pants are sliding off your be-
hind. What do you do?
A You fnd a new pair of pants you dont want to look like a fool.
B Before using, you get some fuel in you while youre still hungry.
Once youre smoking, you forget everything.
C While scoring a hit, you eat a chocolate bar to maintain your
weight.
3 Youre going to score, but not before you:
A Get all your money together and put it in your pocket.
B Leave some of your money at home so that you cant spend it all.
C Give yourself a good talking to, eat something and buy a bus and
tram card.
4 Youve gotten your hands on a good-sized hit. What do
you do?
A You put the whole thing in the pipe at once and smoke it as fast
as you can.
B You cut the ball in two, smoke your pipe in the users area and
enjoy it to the fullest. You save the other half to smoke at home, so
you can enjoy it later.
C You feel the hit burning a hole in your pocket but look for a safe
and peaceful place so you can enioy it thoroughly.
5 Freebasing is fun as long as you have the cash. You know
all about that. To cushion the crash, what do you do?
A You get some hash ahead of time and smoke it after your last hit.
Then you accept the fact that everythings gone.
B You swallow a handful of pills that your dealer palmed off on
you.
C You go to the convenience store and buy four pints of beer.
6 Youre going to visit your mom on her birthday. Before
leaving, what do you do?
A Take all your drugs at once. At your moms place, theres always
bullshit to deal with, so you can use something to make you numb.
B You smoke a little dope at home. But you dont want to be stoned
out of your mind, that wouldnt be any fun for anyone. So you use
in moderation.
C You dont go out of your way for your mother. Youre not all that
stoned and not all that drunk.
Everything Under Control???
Jasperine Schupp & Jeannot
Schmidt
How much control do you have over your drug use, health and life. Take the
test and pick the answer that you relate to best. Find out how much of a grip
you have on your use with this test. Good luck!
But they say that this pill beats
them all its WICKED!
Heroin, coke, speed, xtc Ive
tried them all way cool, man!
Less than 18 points Beginner
You still have to discover more about getting a hold on your drug use. You have good intention, but practice
makes perfect, so dont be discouraged by your score. Work as it and try taking the test again in a couple of
weeks.
18 to 24 points Advanced
Youre on the right track. Sometimes you really succeed at being the boss on drugs, other times not so much.
Spend some time thinking about when you lose control so you can gain the upper hand on your use. You have
it in you, so keep at it!
24 to 30 points Master
Youre very much in control of your drug use, and you know what youre doing. Keep it up and share what you
know with your friends. Others can learn from you, so be proud of yourself.
Test results:
1 1 point B 2 points C 3 points
5 3 points B 1 point C 2 points
6 1 point B 3 point C 2 points
Taken from:
Mainline, Issue 3, 2008
http://www.mainline.nl
7 Your moneys gone but you stlll have a real craving. What
do you do?
A You steal something. You just cant take it anymore.
B You try to make money by coming up with a sob story at the local
supermarket.
C You know it sucks. But youre no wimp, so you hang in there and
wait until its over.
8 The time between one hit and the next:
A ls as brief as possible.
B ls determined by the quality of the coke.
C ls around half an hour. Then you can really enioy the next hit.
9 You just scored. What do you do?
A You go use in a place where you feel good and its nice and
peaceful.
B You start freebasing, smoking or shooting right away.
C You go freebase where the police cameras cant see you.
10 Youre sick of using. lt costs too much in all senses, so:
A You get clean for the rest of your life.
B You move. Then everything will be all right.
C You decrease the number of days that you use in a row. WOW!
23
Ever yt hi ng Under Cont r ol ???
The author is a long time mem-
ber of Narcotics Anonymous.
24
I came to the Narcotics Anonymous after a typical addicts drama of deceit, larceny and
violence, all related to drugs. In all that despair, not knowing what else to do or where
to go, I remembered that an old acquaintance mentioned NA to me and that it helps
dependent people. I decided to call and until today I consider it the most important
phone call I have made ever. For the frst time I called somewhere where I could get
help instead of calling the dealer. For the frst time I heard a voice that gave me hope,
that understood the language of a dependent person, and told me where to go to an
NA meeting.
I love drugs, I only hate its consequences!
Frankie
drogi - politiki i praktiki
Nar cot i cs Anonymous
25
I am a big fan of drugs. I adored it and was in love with it for a long time.
www.hops.org.mk
I am a big fan of drugs. I adored it
and was in love with it for a long time.
Although I lived with a wonderful girl
and we had a son together, I had a
great job and many friends, they could
never satisfy the needs that drugs did.
It wanted me for itself only and it fnally
managed to separate me from anything
that meant anything in my life.
Looking back now, my relation to
addition started in my early childhood
when I started inhaling exhaust pipe
and glue. Around the age of 14, when I
had my frst real drunkenness episode, I
found out it helped me feel free, as if all
my inhibitions let free and all my anxi-
ety and fear I used to feel since early
child had stopped. At that time (in ex
Yugoslavia) you couldnt get drugs eas-
ily so getting drunk (in school or when
I started going out) became a regular
habit. So regular that my friends already
knew that when I would start drinking, I
didnt know when to stop and they had
to carry me home. But all that was seen
as a normal part of living, that it would
come to pass.
Reality turned out to be different.
Drinking continued and this inability to
establish control over the alcohol was
something that became common for
all other drugs I used. When I went
abroad and started taking other sub-
stances, such as marihuana, my behav-
ior was the same. Just as I started with
the alcohol, so was it with the weed, at
the beginning it was ok, social, relaxed,
and a good fun, until it turned out an
obsession. I used it compulsively, frst
thing in the morning and before going
to bed, and during the day, I had para-
noia if somebody was following me, or
that somebody is talking about me, or
whether I will have enough or do I need
more, and so on.
Taking it together with alcohol in large
quantities, and the paranoid hallucina-
tions that followed, became the norm
for me. I didnt even know what was
real, and what was not anymore. Un-
der the infuence of weed it was normal
for me to smuggle it through the border
when returning from Amsterdam, or to
carry big quantities in my car for selling.
From something I thought was help-
ing me to relax and enjoy, I misused
marihuana just as I misused codeine,
valium, diazepam, ecstasy, cocaine and
anything else that I would come by.
When I started taking heroin, I
thought I had fnally solved my prob-
lem. I felt like I fnally reached the place
I had always searched for. After several
months I thought it was time to stop
and I found out what abstinence crisis
meant. I also found out that methadone
can help me get off heroin, frst as a
medicine, but later to also get the same
effect heroin gave. I spent the following
several years with these two drugs, and
life became harder and harder every
day.
Although I loved my son and my
girlfriend, drugs came always frst. The
business I had stated declining. It be-
came normal for me to lie, or to always
have a justifcation that it was some-
body elses fault. At the end I lost every-
thing. My girlfriend left me, because she
couldnt take it anymore. All my friends
who were worth something and wanted
to help me also lost hope. I promised
to stop so many times, but despite my
best efforts, I simply couldnt. I tried
to decrease the dose, to take drugs on
specifc days only, to change my place
of living, to fnd a new girlfriend (who
knows how to take drugs smartly) and
to go through an abstinence crisis now
and then, leaving everything for a week
or a month or two, but I always returned
to the same situation, the same world,
the same people I used to take drugs
with, the same isolation which became
commonplace to me. I felt helpless.
More specifcally, I was helpless. I was
helpless over the drugs obsession (con-
stantly thinking about it), helpless over
my compulsiveness (my inability to stop
taking), helpless over my selfshness,
because at the end, the truth was that
most important for me was to satisfy my
need for drugs. Today I understand that
these are exactly the characteristics
that make me a dependent person. The
problem is not in the drugs, but in my
relation to it. Theres simply something
in me which, when I use any kind of
drug, makes me lose control over it. I
have the relationship to gambling, food,
pornography, sex, a person or any other
addictive things.
I started losing hope that I would be
able to stop, and I started accepting
that I will die a junkie. I was desperate
and at times even thought of taking my
life but was not brave enough to do it. I
was completely aware that I had lost the
battle to drugs and that I had no choice
whether to use it or not. I simply had to!
It was one too much, and thousands too
little. But it seemed that this surrender
in my struggle against the drugs was
what I really needed. I started opening
towards the possibility that somebody
else, outside of myself and the ones I
used to take drugs with, could help me.
I started going to doctors, to institutions
with psychotherapists, I started reading
about Zen Buddhism again, but I could
not fnd a way to stop. I wanted to go
back to regular life, I yearned for it, but
didnt know how. I knew no other addict
who had managed to stop.
I came to the NA after a typical drug
users drama of deceit, larceny and vio-
lence, all related to drugs. In all that
despair, not knowing what else to do
or where to go, I remembered that an
old acquaintance mentioned NA to me
and that it helps dependent people. I
decided to call and to this day I consider
that to be the most important phone call
I had made in my life. It was the frst
time I called somewhere where I could
get help instead of calling the dealer. It
was the frst time I heard a voice that
gave me hope that understood the lan-
guage of a dependent person, and told
me where to go to an NA meeting.
This is where my road to new life
started. At my frst meeting, I under-
stood nothing and I couldnt believe I
was in a room with around thirty people,
most of them clean, looking healthy and
smiling. The atmosphere was pleasant
and although I was nervous, I felt safe.
I started going to their meetings regu-
larly, I started listening and saw that I
was not alone, that many have already
gone through what I was going though
and managed to get themselves clean
from drugs. I was hopeful that I could
stop, too. Arrogant as I was, I wanted
to prove to them that alcohol was not a
drug, but rather that in Macedonia it is a
part of our culture and that it is normal
to have a glass of wine during dinner, or
rakija on celebrations, that the occa-
sional joint hasnt hurt anybody. Nobody
told me anything, except to keep com-
ing to the meetings. Although from time
to time, I would fall into a crisis, and
would move away from methadone and
heroin, alcohol and weed would bring
me back. The world of addictions still
had a very strong infuence on me, and
sooner or later, in the company of other
people taking drugs, I would start us-
ing again, and would end at the same
desperate place, each time deeper and
deeper.
But when I knew there was a way, I
would go to an NA meeting and would
get new hope. People who were clean
supported me and convinced me that
if they could, I could too. I knew they
didnt lie about how they took drugs,
and what their life was, some of them
with more diffcult stories than mine.
They told me that the NA promises one
thing only, and that was freedom from
the active use of drugs. At that time,
I used anything and everything, and I
strongly wished to stop. Looking back,
that wish was the most important thing
I needed, to be able one day, at one of
those NA meetings, deep inside to ad-
mit to myself that I had lost my battle
with drugs, that I was helpless over it
and that it had destroyed my life and
the lives of all people around me. I was
also aware that NA was offering me
drug free life, I was with people who
knew how I could clean up and stay that
way, who wanted to help me and didnt
ask anything for return.
That night, I resolutely threw away
everything I had and the next day, July
13th, 2001, was my frst day to be clean
of all mind altering substances I had
been using. Now I know that leaving
drugs was not the hard part the hard
part was learning how to live without
them. At the NA, I learned how to do
that, I learned from addicts who had
gone through my experience and who
knew what I was facing. I continued to
go to regular meetings, I found a spon-
sor (mentor) who helped me go through
the 12 steps, the foundation of the NA
program. These steps helped me learn
how addiction affected me. They helped
me face my past, my great sense of guilt
26
NA today is present in 129 countries of the world with
more around 68000 meetings a week. The NA has ex-
isted since 1953 and has 60 years of experience from
thousands of dependent persons who have managed to
turn their failures into success stories.
27
That night, I resolutely threw away everything I had and the next day, on 13 July 2001, was
my frst day clean of all substances that had been changing my state of mind. Now I know that
leaving drugs was not the hard part the hard part was learning to live without it. At the NA I
learned how to do that, I learned it from addicts who had gone through my experience and who
knew what I was facing.
P.S. Narcotics Anonymous is not the only organization that enables better life
to addicts. Although we are independent and not affliated to anybody, our inten-
tion is to cooperate with other organizations in the feld.
and shame because of the life I used to
live. They helped me get my self-con-
fdence back, take responsibility over
my life, and become part of the solution
instead of being part of the problem.
Helped by the NA, I managed to stay
clean in the same environment in which
I used to take drugs for so long. My
life today is completely different com-
pared to back then. Not only am I free
from drugs, but in some kind of mira-
cle, I got everything I wanted from the
drugs, only after I quit. The calmness I
always looked for, I now have inside me
most of the time, I am capable of being
a father to an exceptional son, to be a
brother, or a son as needed. I can have
integrity and pride in myself, and not be
ashamed to look at people in their eyes.
I still go to NA meetings. I am still an
addict (who doesnt use anything) and
I am not ashamed of that, I am free to
live my life the way I want. I got all that
at NA.
I am in Skopje now for an extended
period, and I would like to put forward
the message to those who are sick of
taking drugs, that it is possible to stop
and live without it. I hope that some-
body will fnd similarities between their
lives and my story and will come visit
us on a meeting. You dont have to be
clean, everyone is welcome.
A short description of the associa-
tion:
Narcotics Anonymous is a non-proft as-
sociation, or a group of men and wom-
en with a serious drugs problem. We are
addicts who try to recover from the use
of drug and regularly meet to help each
other in order to stay clean. Many of us
manage to stop using any kind of drugs.
Theres only one condition for member-
ship, and that is the wish to stop taking
drugs.
NA does not come with any strings
attached. Our association is not affliat-
ed to any institution or organization, no
membership is paid nor are there any
notes or minutes kept. Everyone can
join us and all members are completely
equal.
NA today is present in 129 countries
of the world with more around 68000
meetings a week. The NA has existed
since 1953 and has 60 years of experi-
ence from thousands of dependent per-
sons who have managed to turn their
failures into success stories.
Today in Skopje we have regular NA
meetings on which addicts, without any
therapists or experts present, share
their experiences, strengths and hopes.
The anonymity is the most important
principle in order to maintain the safety
of members.
Call 077/810-208 or come to our
meetings:
- every Tuesday and Thursday at 18:30
and Saturday at 16:30 in Pajko Maalo
(Lawyers Street) no. 4, Skopje.
Nar cot i cs Anonymous
Psychologist, psychotherapist.
Works for HOPS Healthy Op-
tions Project Skopje, with a spe-
cialty for treatment of margin-
alized communities and at the
First Family Center in the City of
Skopje, as a psychotherapist of
domestic violence victims. Uses
transactional analysis in her
practice, an integrative psycho-
therapeutic approach.
28
Through my practice as a psychotherapist at the Centre for re-socialization and reha-
bilitation in HOPS - Healthy Options Project Skopje, I managed through separate cases,
to confrm that the destructive life script of people using drugs can change. The only
precondition is awareness of the person that it exists, what its content and processes
are, and the areas it affects.
www.hops.org.mk
WHAT MAKES YOU HAPPY?
Despina Stojanovska
People who have used drugs in the past often have the impression they are not happy and
that they are waging a diffcult fght with life. Through conversation they manage to see
that there truly is a possibility to make a change and that they can make a strong step to-
wards victory and authentic pleasure.
One of the questions I use on my
psychotherapeutic sessions with peo-
ple whove used drugs in the past, is
exactly that: what makes you happy?
It is a seemingly simple question
and the answer should appear spon-
taneously, with an obvious pleasure
in the facial expression and it should
encourage awareness of moments of
happiness. But, people are often con-
fused and dont know what to say.
Happiness is a leading force in a per-
sons success, it gives us the neces-
sary power and motive to set objec-
tives and move on in life.
Encouraged by this insight, that
people are not aware about the lit-
tle things that make them happy, and
seek happiness in unrealistic objec-
tives, I decided to write about the un-
conscious plan that drives us through
everyday life.
Since early childhood, people are
continuously exposed to various in-
fuences, and they develop models
of identifcation and early experi-
ences which are the basics for build-
ing a persons emotional life, cogni-
tive scheme, value system, but also
the image for oneself and the world
in which one lives. The infuence of
these experiences may cause pleas-
ant and unpleasant experiences that
are then the basis for forming this un-
conscious life plan, i.e. life script that
drives people through all aspects of
living.
The life script may be constructive,
destructive and boring, or winning,
losing or banal.
What does it mean to be a
winner?
A winner is a person who achieves
everything s/he wishes for, and is
happy at the same time. Mistakes can
happen, but theres always a second
plan. S/he is aware that the true road
is not the shortest road, but the one
with the least barriers. In a winning
script, a man achieves the objectives
he has set for himself, but not do-
ing any damage to oneself or others.
When s/he reaches his aim he feels
happy and satisfed. Objectives may
vary. Somebody may set up to be rich,
another person will want to be lonely
and isolated, a third one will decide
to become a famous artist etc. People
who have this unconscious plan know
how to keep it.
A loser life script
A loser life script is characteristic of
people who fail to reach their objec-
tive. They unconsciously choose the
hardest road, with the most burdens.
Regardless whether they sometimes
reach their purpose, the road itself is
hard and the enjoyment of the success
at the end is lacking. Many people are
not aware of their loser script. When
life becomes exceptionally hard, they
start complaining and seeking ways
to get out of it. Undertaking new ac-
tivities and involving other people
will help them go through the nega-
tive aspects, but it wont help them
achieve genuine satisfaction because
they simply dont know how thats
done.
A banal life script
As opposed to the previous two,
there are people who live their lives
without wins or lose, uninterestingly
and boringly, i.e. they live their ba-
nal life script. Fearing loses and trag-
edies, these people take no activity
to achieve happiness or pleasure, but
simply wait for the conditions and the
occasions to win. Regardless whether
they will live to see such conditions
come alive, they dont have the cour-
age to make the frst step towards
achieving their aims. They may some-
times win, or sometimes lose, but
they will never feel the full pleasure
of it, because they dont want to take
the risk if things go the wrong way.
Life scripts among people us-
ing drugs
Most people have a mix of loser,
winner and banal elements in their
own life script. Decisions in childhood
may be brought in regards to work,
then you are a winner, in regards to
personal contacts you can be a loser,
and in regards to bodily activities you
can be banal. That is why this analy-
sis through this psychological theory,
will be taken relatively because each
individual will have its own criteria for
happiness.
Through my practice as a psycho-
therapist at the Centre for re-sociali-
zation and rehabilitation at the Associ-
ation HOPS Healthy Options Project
Skopje, I managed through different
cases, to confrm that the destructive
script of people who use drugs can
be changed. The only precondition is
the awareness of the person that s/
he exists, what that beings contents
and processes are, but also the are-
as which it infuences. In addition to
awareness, the individual should frst
want to make a change because no-
body can change lest they wish to do
so. In order to get out, you need new
decisions, specifc skills and activities.
It is exactly the role of the therapist
who works with people who have
used drugs in the past, to change
Li f e scr i pt s i n peopl e usi ng dr ugs
29
their level of awareness and provide
an appropriate manner of building the
persons new script. Although it often
happens that movement will often
happen will be moving from one loser
script to another, banal to loser, or
winner to loser, in the process of reha-
bilitation, experience has shown that
through the analysis of this unaware
activity with the consistent and proper
support by an expert working with the
user, and his/her family, fnally can ex-
pect success, pleasure and happiness
in several of lifes aspects.
Although my experience with the
application of transactional analysis
in working with people who used to
use drugs is relatively brief, I can offer
specifc examples, and among those
who come regularly at scheduled
meetings and actively work on them-
selves, positive changes as to coping
with lifes challenges are already vis-
ible.
As a psychotherapist it was very
important for me to evaluate the as-
pects that reveal a life script well. If
a person becomes aware that it has
a winning script on a certain feld,
it will help him apply this successful
strategy on other felds as well. Peo-
ple who have used drugs in the past
often have the impression they are
not happy and that they are wag-
ing a diffcult fght with life.Through
conversation they manage to see that
there truly is a possibility to make
a change and that they can make a
strong step towards victory and au-
thentic pleasure.
People coming to the Center for
rehabilitation and re-socialization,
who have used to use drugs, think
of the banal life script as a true at-
tack on themselves. Used to living
in extremes, they see this calm type
of life as a survival, rather than liv-
ing, i.e. like an impatient awaiting for
the next phase. Choices in that next
phase can very soon turn to be a loser
script again, but it is exactly the job
of the psychotherapist to provide full
support in choosing positive decisions
that will make any damages neither
to the person nor to the environment.
Treating addiction or abstinence
are the phases in which people most
usually get the impression that they
are losers. Although they had made
the frst step to get out of a destructive
script, and think of the positive result
and the happiness as unachievable.
The rehabilitation and re-socialization
process is in itself a winning step, but
facing all the accompanying tempta-
tions, make it seem diffcult, hard,
unbearable, loser-like. At our psycho-
therapeutic sessions they themselves
say that they do not see the way out,
but they soon realize that this phase
is easier to bear if they actively face
their life scripts and defne their aim
clearly. My role as a psychotherapist
is to lead them through the process
of personal development through
awareness about the moments when
they destructively behave towards
themselves and the environment, but
to also make an adequate change in
regards to their loser life script.
Final words
Life led by an unconscious life
script is a life with unnecessary limi-
tations. A change can come about
in two ways: if a cardinal change in
the form of a tragedy or a big stroke
of luck happens, or if one works on
oneself through a continuous process
of psychotherapy through which one
would become aware about ones life
scripts with the support of an experi-
enced and dedicated psychotherapist.
The second road may be longer,
but it surely leads to a positive devel-
opment, strengthening own needs,
living with authentic experiences of
genuine satisfaction and personal
development and most importantly,
achieving true personal happiness.
30
In order to get out, you need new decisions, specifc
skills and activities. It is exactly the role of the thera-
pist who works with people who have used drugs in the
past, to change their level of awareness and provide an
appropriate manner of building the persons new script.
www.hops.org.mk
Li f e scr i pt s i n peopl e usi ng dr ugs
31
Story about a boy
Led by my need to learn more about the world of people using drugs,
I decided to buy some books on the topic, both non-fction and fction.
For that aim, I went to the woman selling old books on Macedonia
Square who was happy when I told her what I wanted this time. She
said:
- Can you believe that only yesterday a boy came and brought a whole
bunch of books exactly about drugs? He said he owned all of them.
- thats great! I said.
I looked through them, some ten books, and decided to buy them. I
was trying to decide which one I should start reading that night, and
fnally made up my mind to start with the oldest edition. They were
pretty worn out, but that didnt matter. The book had been published
`88 and offered an excellent professional description for the drugs of
the time. I soon noticed that the previous reader underlines parts and
wrote his notes on the side. The parts on different drugs were under-
lined, and the experienced they offered.
I looked through the other books impatiently. In the other several
books he had underlined those paragraphs that referred to the effect
drug use has on the overall family, professional, emotional life, and
so on.
Then, in what I guessed were the books he read last, he had dedicated
most attention on how addiction can be cured and how can you help
with the re-socialization of the user.
I made an image in my mind about this boy. I dont know if its true, it
doesnt matter. Two questions remained open in my mind:
- Did he sell the books because he came to the end of that story,
and he didnt want to have anything to remind him to that period of his
life?! Or, was he losing the war on addiction, he was giving up, and
didnt need those books?!
Making a psychological analysis to a virtual character is not easy, even
impossible. But, in order to explain the function of our unconscious
drives, I tried to do this through this boy which somewhere really
existed.
Wishing to make a change in his life, and get out of his banal script
which wasnt attractive at all to him, the boy, completely accidentally,
enters a whole new world, a new life adventure in which happiness
and pleasure are a daily business. Searching after even more excite-
ment, he loses sight of his aim while enjoying the trip. He socializes,
hangs out, goes out, informs himself through books what to take
and what hell feel next time. After some time he starts failing in other
felds. He understands that a person who is fulflled in only one feld,
while everything else is falling apart, is not a winner. His peers are in
a whole other flm. While they are reading expert literature in various
university areas, he is reading how his life is going in an undefned
direction. That wasnt his purpose when he wanted to run away from
banality. The next step is an active work on himself, change of own
criteria for happiness, return of the lost and search for freedom.
I dont know if this works, but I hope that it does.
Finally, the possibility remains open that he sold his dear books for
goods.
Holds a BA and an MA in Pae-
dagogy.
32
My mission as a pedagogue at the Step Forward centre was to decrease the harmful
effects from the family relations onto this child and to fght for his right to regular school-
ing, in order for him to develop into a complete person, as it is appropriate for a child in
a developed environment.
Paedagogical support of children with drug
using parents
Eleonora Chichevska
My beginnings as a pedagogue were at HOPS Healthy Options Project Skopje, more
specifcally within the Step forward Developing alternative programs for sex workers
and their families project. This was a pilot project with the aim to enable programs for
continuous education and qualifcation of sex workers and their families.
Everybody is responsible for their
lives, but when we have a child our
responsibilities grow. Thus, in ad-
dition to the responsibility for our-
selves, we are also responsible for
the proper psycho-physical develop-
ment of our child in the family and
in the environment where it lives.
My beginnings as a pedagogue
were at HOPS Healthy Options
Project Skopje, more specifcally
within the Step forward Devel-
oping alternative programs for sex
workers and their families project.
This was a pilot project with the
aim to enable programs for continu-
ous education and qualifcation of
sex workers and their families. All
activities foreseen by this project
were realized at the Step Forward
center, which was available to all cli-
ents who needed to use its services.
Although it lasted for only one year,
it still left behind great successes,
as well as possibilities for extending
on what our mission and objective
were.
Through my working experience
as a pedagogue, I was able to learn
about different life stories expressed
through the eyes of the children.
Each child bore its own hardships,
which they unfortunarely had to
bear on their back. One such sto-
ry which touched as a human and
awoke my whole professionality as a
pedagogue was the story of a child
which could not leave a single per-
son indifferent upon their frst meet-
ing. I thought of his life story as an
endless sea, often stormy by what
life brought about. He lived with his
parents, both drug users, of which
one was also a sex worker. This was
the reason why the child could ac-
tively participate in the services we
offered at the Step Forward cen-
tre. The child often faced situations
which could be a tough blow to take
even for an adult. Working with him
I was able to identify two elements
that lacked appropriate care by his
parents and holes in his education,
although I knew he had gone to
regular school. The misteriousness
that came across from this childs
eyes, was a further urge to my en-
thusiasm. The only thing I was sure
about was that through play, as the
most adequate way of expressing
a childs personality, I could touch
deep in his soul, even to the most
hidden parts where his most secre-
tive wishes were kept.
Thanks to the games we played,
I managed to fully uncover the
childs personality. However, the big-
gest question remained open how
come the child didnt go school,
while the school year was ongoing.
Of course, because a minor was
in question, I frst called the parent
who answered some of my ques-
tions. The story the parent told us
was not easy to listen. Days flled
with uncertainty, struggling to make
ends meet, fear of what tomorrow
might bring. The reason the parent
provided for why the child didnt go
to school was the distance between
their home and the school and the
inability to take him there and bring
him back daily.
Although I, as a professional on
one hand, and the parent on the
other, had different position about
the care for the child, still we agreed
that we must take the child back to
school.
All of us working on the Step
forward project the social worker,
the pedagogue and the psycholo-
gist, went to the school in the hope
to infuence the moral and profes-
sional sides of employees there to
bring the child back into school. Ini-
tially, they told us they were familiar
with the whole case, with the life
story of the child. At the frst meet-
ing, the kindness of the school of-
fcials was more than we expected,
or the fact that we didnt announce
our visit created this impression.
Our enthusiasm and the motive to
bring this case to a happy ending in-
creased even more. However, once
we told them why we came, their
smiles disappeared. After a short
conversation of not more than 10
minutes, the school came out with a
position that according to their com-
petences, they cannot bring an in-
dependent and fnal decision about
this case which was why they had
to notify in writing the State Educa-
tional Inspectorate and wait about
their decision whether this child can
return to school or not. The school
failed to provide a clear reason why
the child couldnt go back to school,
which was why I started suspect-
ing that the child might be discrimi-
nated against because his parents
were drug users. Time went merci-
lessly by. The doubt that he will join
his friends in class grew from day
to day. Several months passed since
our meeting with the school off-
cials, but we received no informa-
tion or an answer. Although I often
tried to reach them, it was not easy
to cooperate with them because
they always had execuses not talk
to us. But, despite the many obsta-
cles, we persisted. We realized that
the doors of cooperation between
us as an association, and the school
were slowly closing, which was why
Paedagogy and soci al l y mar gi nal i zed communi t i es
33
Although I, as a professional
on one hand, and the parent on
the other, had different position
about the care for the child, still
we agreed that we must take
the child back to school.
we actively involved the parent, to
take the whole responsibility re-
garding the case, while being fully
supported by us. After several re-
quests to the school by the parent,
we were successful in our requests,
and the child was to start going to
school next year.
It seemed that the schools of-
fcials really had no responsibility
over the re-enrollment of the child,
but if we take a deeper look through
the problems prism, we will see hid-
den stigmatizing and discriminating
attitudes towards the child, because
of his parents behavior. The Law on
primary education clearly states that
every child must be provided regular
schooling, and any discrimination on
the basis of gender, race, skin color,
national, social, political, religion,
economic or social reasons in real-
izing this right is strictly forbidden.
The employees at the school seeked
different excuses only to release
themselves from the responsibility
they had before themselves, and
that was to allow this child a proper
childhood, to give him equal access
and treatment, although his parents
were drug users. Yes, drug users,
they have made such a choice in
their lives, but should their children
be victims of the social system?
Should children of people using
drugs be guilty of bearing the stig-
ma from social institutions to which
their parents are exposed?
My mission as a pedagogue at
the Step Forward centre was to
decrease the harmful effects from
the family relations onto this child
and to fght for his right to regular
schooling, in order for him to de-
velop into a complete person, as it
is appropriate for a child in a devel-
oped environment.
I helped the child daily to catch
up with the material his peers stud-
ied at school. We played all those
games which he would usually play
with them. It wasnt diffcult to be
successful with this child, because
he really wanted to learn and felt
a great need to be with his friends
again. It was a great success for us
that we managed to infuence our
colleagues at the school to take the
child back to the school the following
school year. But, the success would
have been even grater had there re-
mained cooperation between us and
the school. Although the Step For-
ward project allowed not only this
child, but many other children en-
joy their rights and their childhood,
still donor fnancing was planned for
only one year. However, after the
closing of the Step Forward Centre
I had several accidental meetings
with the child and his parent. Dur-
ing every meeting, the parent told
me smiling that he was grateful for
all we did for the child, and that we
managed to jointly help him become
a great pupil, not to lose his wish
to learn, despite the circumstances.
All I could say was: - I didnt do
anything special. I did what I think
every pedagogist should do for his/
her student!
I honestly hope that this story, of
which fnal epilogue I am not cer-
tain, will make you think a bit more
about whether children should be-
come victims of institutional weak-
nesses, and whether we, above all
as humans, and then as profes-
sionals, should bear the guilty con-
science for prematurely terminating
the most beautiful period of a childs
life his childhood.
This is just one of the many cas-
es in which people asked for help at
our centre, but there are many oth-
ers who didnt have and will not get
any help. This is exactly why there is
a need of opening more similar cen-
tres that will support parent from
socially marginalized communities,
especially those at the edges of pov-
erty. Let us open our hands widely
for those on the margins, and touch
the most vulnerable groups in order
to create better and easier life for
all.
34
www.hops.org.mk
The Law on primary education clearly states that every child must be
provided regular schooling, and any discrimination on the basis of gen-
der, race, skin color, national, social, political, religion, economic or social
reasons in realizing this right is strictly forbidden.
Old blogger dudes
35
In the past couple of days, at the beginning of the election campaign for presidential and
parliamentary elections, we witnessed a pompous police action called NETWORK which
was spectacularly announced and shown in the media, and the result from this action
was 5 grams marihuana, two joints and 300 seeds confscated.
GANJA CAN KILL YOU ONLY IF ALPHAS CATCH YOU
Irena Cvetkovikj and Anastas
Vangeli
Some ten years ago, the then pop-
ular blogger Vuna, in an exceptionally
creative way, opened a burning ques-
tion for our society: how are people
using drugs treated by the Police.
Namely, on his blog, Vuna published
a banner with the following content:
Ganja kills you only if Alphas catch
you. This visualized message became
a true hit not only in the virtual world,
but also in the physical by disseminat-
ing a sticker with the same content on
public spaces by young people who
recognized the importance of this
short, but strong message.
After a long time, we asked Vuna
about his motivation, and he told us
that in that period (ca. 2006) there
was a trend of a police crackdown
of people who use marihuana recrea-
tionally, and stories about police bru-
tality during arrest or during extort-
ing confessions at the police stations,
were often times heard. That of
course was not exceptional for 2006,
there have been and will be such peri-
ods. However, that period, at least for
me, it became a very visible and burn-
ing problem. On top of all that, police
raids were accompanied with a public
campaign about the damaging effects
of using marihuana (in the you could
die from smoking weed line). On the
other hand, the consuming marihua-
na culture is endlessly peaceful, and
marihuana in comparison to other
drugs is by itself harmless. From there
the logic of the sticker, that smoking
weed will never do any damage by it-
self, but if the police catches you, and
if they show their full face, then you
are doomed to have consequences
Vuna told us.
The appearance of the banner
corresponds in time to the appear-
ance of the Alphas who, according to
Vuna, compared to their predecessors
(NTSU (abbr.: Unauthorized Trade and
Smuggling Unit)) were far more rigor-
ous, but also more prone to violence.
I dont exactly remember, but it was
at that time that the case of Trajan
Bekjirov happened (I think I made
the sticker just before that); however,
that was the period in which the Al-
phas were sowing fear and panic on
the streets of Skopje says Vuna.
We witnessed a pompous police
action called NETWORK which was
spectacularly announced and shown
in the media, and the result from
this action was 5 grams marihuana,
two joints and 300 seeds confscated.
The news awoke the social networks,
and many young people asked the le-
gitimate question for misuse of peo-
ple who use drugs for defaming and
criminalization during election cam-
paigns. Remembering similar rhetoric
from the past, Vuna told us that even
before making the banner he wrote
a text entitled Alphas collect which
was a critical overview towards the
former government lead by the Prime
Minister Buchkovski and the Minister
of Interior Dzango. The Police then
(and now) was boasting their effcacy
(like they are very tough for arresting
children with 0,1 gram on them), and
Alphas were praised to have particular
merit in this. In the background of all
this was a system of fear, repression
and violence. remembers Vuna.
I think that in this period, my col-
umns opening these issues were posi-
tively received by activists and other
concerned parties, but there were also
a lot of negative comments (for exam-
ple, junkies are asking for it). How-
ever, the sticker went viral, especially
in the blogosphere at the time, and
on several online forums; since then, I
have noticed it appear in social media
from time to time and Ive seen the
sticker on several places across the
city. It gave me real joy when a friend
much younger than me was showing
me the sticker the other day (look,
man), and wouldnt believe me when
I told him I was the author :-) end-
ed Vuna, leaving it on us to open the
theme of police and systemic brutality
on people using drugs again.
36
The appearance of the banner corresponds
in time to the appearance of the Alphas who,
according to Vuna, compared to their prede-
cessors (NTSU (abbr.: Unauthorized Trade and
Smuggling Unit)) were far more rigorous, but
also more prone to violence.
Program assistant for advocacy
in HOPS with seven-year expe-
rience in providing and organ-
izing services for marginalized
communities (sex workers, drug
users, LGBT).
37
Conference: Availability of Hepatitis C treatment to
drug users in RM good practices and challenges
Voskre Naumoska Ilieva
www.hops.org.mk
From March 14th to March 16th,
2014 in Ohrid, with the support from
FOOM, HOPS organized a Conference
on the topic of Availability of Hepa-
titis C treatment to drug users in the
Republic of Macedonia good prac-
tices and challenges. The conference
was attended by representatives of
the PHI University clinic for gastro-
entero-hepathology, PHI University
Clinic for Infective Diseases and Fe-
brile Conditions, units for infective dis-
eases in general hospitals Kumanovo
and Ohrid, the Foundation Open So-
ciety Macedonia, the associations:
Zaedno posilni, Trust and Hops
Healthy Options Project Skopje and
the pharmaceutical companies Ro-
sche Macedonia and MSD Scher-
ing Plough Macedonia. For the de-
velopment of the discussions, special
contribution came from the guest-
participants from Georgia, Archil Ta-
lakvadze, deputy Minister for Justice
and Sanctioning of Georgia and Paata
Sabelashvili, Manager of the Georgian
Harm Reduction Network. They pre-
sented their experiences of the intro-
duction of a Hepatitis C in prisons and
the reduction of price for Hepatitis C
medicines for more than 50%.
In the focus of the Conferences
discussions were issues for the im-
provement of access and conditions
for treatment of Hepatitis C among
people who use or who have used
drugs, and need such treatment. It
was talked about the problems of
monitoring data related to the Hepati-
tis C prevalence, related to the screen-
ing for gaining better insight into the
prevalence, data about the number of
people using a Hepatitis C treatment,
as well as non-reporting Hepatitis C
cases.
According to behavioral research
carried so far among drug users,
around 75% of the tested active drug
users who inject drugs are HCV posi-
tive.
On the other hand, theres a bar-
rier for treating Hepatitis C for active
injecting drug users, a precondition
which requires users to have abstained
from drugs for at least 12 months or
to be in treatment for addiction. As a
main reason for this condition, health
professionals state the risk of possible
re-infection which would mean spend-
ing treatment money in vain.
Despite the general consensus
about the lack of data, existing infor-
mation indicate that active injecting
drug users are an important commu-
nity when it comes to prevention of
Hepatitis C which is why we should
look for the ways in which they should
be included in the treatment. This
question caused heated discussion
and opposed positions among par-
ticipants. Part of the health profes-
sionals were against the inclusion of
active drug injecting users because
of the risk of re-infection. Part of the
participants thought that they should
be included in treatment because that
way you not only treat people with
Hepatitis C, but this is also preven-
tion from spread. In such situation
one can conclude that the treatment
of active drug substances who inject
is not only a question of choice and
a decision from the health institution,
but a public health issue that needs to
be discussed by all concerned parties
and to reach a common solution.
One of the major challenges dis-
cussed was regarding the high treat-
ing expenses, on the one hand, and
the limited budget of clinics, on the
other side. What is important at the
beginning, is the recognition of the
problem with Hepatitis C as a public
health and human rights problem.
This approach would focus on assess-
38
ment of the health of communities
most at risk, in order to identify health
problems and priorities, in order to
create public policies for the improve-
ment of health problems and priorities
and to enable equal treatment of all
by providing a cost effective medical
care. In that direction, it is neces-
sary to improve the cooperation of all
stakeholders (health institutions, the
Ministry of Health, Health Insurance
Fund, patients, drug users and civil
organizations), in order to improve
the coordination from whence the
creation of a national prevention strat-
egy, treatment strategy and strategy
for Hepatitis C care could start. Ad-
ditionally, efforts should be made to
decrease the cost of Hepatitis C treat-
ment, which may be achieved through
negotiations with all stakeholders
(Ministry of health, Health Insurance
Fund, Clinic for infective disease and
febrile conditions, Clinic for gastro-
entero-hepatology, patients, associa-
tions of citizens, as well as pharma-
ceutical companies). The decrease of
the prices of Hepatitis C treatment will
increase the treatment inclusion of
people with Hepatitis C, which is the
fnal aim of each health policy.
At the end, it was pointed out
the need for psycho-social support
of people on treatment for Hepatitis
C, above all, due to the length of the
treatment and motivation for persis-
tence on treatment, but also due to
the increased risk of depression as
a counter-indication from the same
treatment for Hepatitis C. In that di-
rection, we also discussed the need
for support of health professionals
and treatment of Hepatitis C by as-
sociations of citizens that enable
psychosocial support of HCV positive
people.
HOPS Healthy Options Project
Skopje has been working in the feld
of drugs harm reduction for 17 years
now, and includes activities for pre-
vention of Hepatitis C, but also sup-
port to Hepatitis C positive people
in treatment access. Having in mind
the challenges which drug users face
when approaching health institutions
in the treatment of Hepatitis C, two
years ago HOPS started activities for
raising the question of Hepatitis C
treatment especially to drug users.
Part of these activities was the Con-
ference.
Event s
39
International name
of psychotropic sub-
stance
Chemical name
(IUPAC)
Other unprotected name Effects
25I-NBOMe
2-(4-iodo-2,5-
dimethoxyphenyl)-N-[(2-eth-
oxyphenyl)methyl]ethanainine
C18H22INO3
2C-I-NBOMe, Cimbi-5,
Wizard, Medication
Psychedelic drug
AH-7921
3,4-dichloro-N[[1-dimethyl-
amino) cyclohexyi] methylb-
enzamide
C16 H22 CI2 N2O
AH-7921, dohylan. Narcoleptic analgesic with high addiction potential,
around 80% of the power of morphine
MDPV
3, 4-methylenedioxypyrov-
alerone
C16 H21 NO3
Explosion, Blow, Recharge
plant food, bath salts,
research chemicals
Stimulates the central nervous system similarly to
cocaine, amphetamines, MDMA, from the class of
katinomes
Methoxetamine 2-(3-methoxyphenyl)-2-
(ethylamino)cyclohexanone
C15 H21 NO2
MXM Mexxy, M-ket
MEX, Kmax, Special
M, MA, legal ketamine,
Minx, Jipper, Rofcoptr
Alternative to ketamine

analgesic, anesthesiac, halucination,
5-
5-(2-aminopropyl) indole
1-(1H-indol-5-y1) propan-
2-amine
C11H12N
Benzo Fury Stimulates the central nervous system

4-
1-(4-methylpheny1)propan-
2-amine
1-(4-methylpheny1)2-amino-
propane
4-methylamphetamine
PTAP, PAL-313, 4-MeA PmeA
4-MA; Aptrol;
Ephedra stimulating type (described by users,
with physical and psychological effects) paranoia,
hallucinations, anxiety, depression, Anorexic drugs
(appetite suppressant)
Mephedrone 4-methylmethcathinone
C11 H21 NO
4-MMC, MCAT, Meow Meow Stimulates the central nervous system from class of
katinones and amphetamines
BZP 1-benzylpiperazine
C11 H16 N2
herbal high,
Stimulates the central nervous system, imitates

molecular effects of action and some of the effects
of MD (ecstasy)
mCPP 1-)3-chlorophenyl)piperazine
C10H13CIN2
X4, duhovka, rainbow,
Rolls Royce, smarties
Stimulance
40
As the Ministry of Interior reports, the Inter-Departmental Committee on Drugs of the Republic of Macedonia, in
March 2014 brought a decision to ban 15 new substances and to classify them on the list of opioid drugs and psy-
chotropic substances. This bans their production, possession, purchase and use.
Below is the list of banned substances published in Offcial Gazette no. 56, from 27.03.2014.
Recently banned substances in the category
of opioid drugs and psychotropic substances
www.hops.org.mk
International name
of psychotropic sub-
stance
Chemical name
(IUPAC)
Other unprotected name Effects
2C-I 2,5-dimethoxy-4-iodophenethyl-
amine
Hallucinogenic, psychedelic and stimulating
action
2C-T-2 2,5-dimethoxy-4-ethylthiopheneth-
ylamine
Hallucinogenic and stimulating action Derivative
of amphetamine
2C-T-7 2,5-dimethoxy-4-(n)-
propylthiophenethylamine
Hallucinogenic and stimulating action Derivative
of amphetamine
TMA-2 2,4,5-trimethoxyamphetamine Hallucinogenic and stimulating action Derivative
amphetamine
4-MTA P-Methylthioamphetamine
4-Methylthioamphetamine
Stimulating. Derivative of amphetamine
PMMA
Paramethoxymethylamphetamine
N-methyl-l-(4-methoxyphenyl)-
2-aminopropane
Stimulating. Amphetamine analogue, similar in
structure, but differing in elementary composi-
tion
41
More information on:
http://moi.gov.mk
Recent l y banned subst ances i n t he cat egor y of opi oi d dr ugs and psychot r opi c subst ances
High Price is the harrowing and inspiring memoir of neuroscientist Carl
Hart, a man who grew up in one of Miamis toughest neighborhoods and,
determined to make a difference as an adult, tirelessly applies his scientifc
training to help save real lives.

Young Carl didnt see the value of school, studying just enough to keep him
on the basketball team. Today, he is a cutting-edge neuroscientistColumbia
Universitys frst tenured African American professor in the scienceswhose
landmark, controversial research is redefning our understanding of addiction.
In this provocative and eye-opening memoir, Dr. Carl Hart recalls his jour-
ney of self-discovery, how he escaped a life of crime and drugs and avoided
becoming one of the crack addicts he now studies. Interweaving past and
present, Hart goes beyond the hype as he examines the relationship between
drugs and pleasure, choice, and motivation, both in the brain and in society.
His fndings shed new light on common ideas about race, poverty, and drugs,
and explain why current policies are failing.
42
www.hops.org.mk
High Price: A Neuroscientists
Journey of Self-Discovery That
Challenges Everything You
Know About Drugs and Society
WE RECOMMEND:
Latest poblications about drugs:
Friends:
Student organization
43
Year II, Issue 2, June 2014
BRIEF NEWS
On 03.04.2014, the Ministry of Inte-
rior of the Republic of Macedonia in-
formed that the presence of a new
type of drug has been found in Mac-
edonia, known as Methylenedioxypy-
rovalerone, abbreviated with MDPV.
Some of the street names of this drug
are bath salts, blow, research
chemicals, explosion. The depart-
ment for controlled substances within
the MOI classifed MDPV as a synthet-
ic version of cocaine, after which an
immediate procedure for prevention
of this substance was started and on
27.03.2014, with a notice in the Of-
fcial Gazette of RM, it was registered
as an opioid drug of the frst category.
From March 14 to 16 2014, in Ohrid
a Conference was held on the topic
of Availability of Hepatitis C treat-
ment to drug users in the Republic
of Macedonia good practices and
challenges. In the focus of the Con-
ferences discussions were issues
related to the improvement of the
access and conditions for treatment
of Hepatitis C in people using drugs,
and who have the need for such
treatment. Representatives from
the public health sector, the private
health sector and the civil society
participated. The discussions were
supported by guest participants
Archil Talakvadze, deputy Justice
Minister of Georgia, and Paata Sab-
elashvili from the Georgian Harm
Reduction Network. The conference
was organized by HOPS Healthy
Options Project Skopje.
New Zealand is the frst country in
the world that has legally regulated
the production, sales and use of new
psychoactive substances (designer
drugs). From July 2013, all produc-
ers of new psychoactive substances
who will prove that their products are
harmless for the health and lives of
their users, with a permit from the
Government, may sell them freely in
specialized stores. According to ex-
periences so far, this policy enables
easier market control and protection
of the health of the users of these
new psychoactive substances.
On 26.03.2014, the District Court of
Lovech, Bulgaria, brought a liber-
ating verdict for a person who has
been charged for the possession and
growth of medical marihuana. Key to
the liberating verdict was the Report
from the triple expertise committee
which confrmed that the marihuana
helped the now free person cope with
his multiple sclerosis symptoms. This
is the frst liberating verdict in such a
case in Bulgaria, but there is a larger
probability that in the future it will ap-
ply to other cases.
The Uruguay president Jose Mujika
has been nominated for this years
Nobel Peace Prize for the legalization
of cannabis. The nomination was sup-
ported by his political party Frente
Amplio, from the Drugs Peace Insti-
tute, PlantaTuPlanta association and
the Latin American Coalition of Can-
nabis Activists. Uruguay legalized can-
nabis in December 2013.
The separation of Crimea from Ukraine
and its joining to Russia threatens
to negatively affect the treatment
of opioid dependent people there,
i.e. to terminate the distribution of
methadone and buprenorphine. Due
to blocked land roads to the Crimea
and Ukraine, but also due to Russias
conservative drugs policies, addiction
treatment centers may remain with-
out access to the pharmacotherapy
necessary for the treatment for treat-
ing opioid addictions.
CSHRMC
The Coalition Sexual and
Health Rights of Marginalized
Communities
HOPS
Healthy Options Project Skopje
www.hops.org.mk
Supported by:
and
Open Society Foundations
http://supportdontpunish.org

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