Our partner in Serbia
Ministry of Health of Serbia
11 000 Belgrade
Tel.: +381 113616244
Head of the focal point:
Ms Jelena Jankovic
The EMCDDA has been implementing technical cooperation projects in Serbia since 2007. Since 2015, the cooperation is carried out with the Serbian focal point within the Monitoring Centre for Drugs and Drug Addiction in the Ministry of Health. The work of the Centre is oriented to the collection and analysis of information related to the five key epidemiological indicators, supply indicators and the Early Warning System on new psychoactive substances.
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Drug use among the general population and young people
The sources of information on drug use among the general population and young people are health surveys that include questions about drug use and the European School Survey Project on Alcohol and other Drugs (ESPAD) studies.
In 2006, a national general population survey ‘Narcotics in Serbia’ was implemented in the framework of the project funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM). The study provides data on the lifetime, last year and last month prevalence of illegal drugs, inhalants and steroids. A stratified two-stage representative sample of 10 690 people (aged 15 to 59) was used and the survey instrument was a self-administered questionnaire (Strategic Marketing, 2006). A total of 10.9 % of respondents reported a lifetime prevalence of any illegal drug. Some 10.7 % reported a lifetime prevalence of cannabis, 1.9 % of ecstasy and 1.3 % of cocaine use. Last year prevalence reported for cannabis use was 3.4 % and last month was 1.9 %. The highest lifetime prevalence of any illegal drug among respondents was in the 15 to 34 age group (19.2 %). Lifetime cannabis use was reported by 18.9 %, while last month cannabis use was reported by 4.2 % of people aged 15 to 34. The average age of first-time illegal drug use was 18.6 (median 18.0).
The national health surveys were conducted twice (2000 and 2006) based on the same methodology and the next survey is planned for 2012. In the 2006 survey, a stratified two-stage representative sample was used. The survey instrument was a self-administered questionnaire developed in two versions for young people aged 12 to 19 and for adults over 20 years of age. Some 3.5 % of people over 20 years of age and 9.9 % of those aged 20 to 34 reported lifetime use of cannabis. Lifetime use of other illegal drugs was reported by a very small percentage. Although these results show lower prevalence in comparison with other surveys, and questions on the use of psychoactive substances were associated with a very low response rate, no statistically significant difference was observed in comparison with survey results from 2000 (Institute of Public Health of Serbia, 2000), when 3.2 % of people aged 20 to 75 and 8.7 % of those aged 20 to 34 reported lifetime cannabis use.
In the 2006 national health survey, some 14.3 % of young people aged 15 to 29 reported having tried illegal drugs (Ministry of Health, 2006). A regional distribution indicates that the highest proportion of young people who had tried drugs was in Belgrade (22.8 %), followed by Vojvodina (17.2 %), and the lowest rates were observed in Central Serbia (9.1 %). The highest prevalence of reported drug use was observed among those aged 25 to 29 (19.9 %). The proportion of 15- to 19-year-olds who had reported trying some psychoactive substances was 6.9 %, which is less than the 9.3 % reported in 2000.
In 2008, the first national ESPAD study was conducted by the Ministry of Health of the Republic of Serbia and the Institute of Public Health of Serbia, in close cooperation with the ESPAD international coordinator and the EMCDDA. According to the results, lifetime prevalence of illicit drug use was 8.0 % (this includes cannabis, amphetamines, cocaine, crack, ecstasy, LSD or other hallucinogens, heroin and GHB). Some 6.7 % of students had tried cannabis at least once during their lifetime (9 % boys and 5 % girls), 5.0 % reported cannabis or hashish use in past 12 months and 2.0 % during the last 30 days (3.0 % boys and 2.0 % girls). Some 7.5 % of respondents who had reported use of cannabis had used it 40 or more times during their lifetime. Apart from cannabis, 7.6 % of respondents reported using sedatives without a doctor’s prescription. The lifetime prevalence rate of illicit drugs other than cannabis or hashish was 3.0 % or lower (Ministry of Health of the Republic of Serbia, IPH of Serbia, 2008a).
In 2011, the second national ESPAD study was conducted with the support of the Implementation of the National Strategy of Drug Abuse (INSADA) project funded by the EU. It found that, as in 2008, a total of 8.0 % of students reported having consumed some illegal drug at least once in their lifetime. Some 7.0 % of respondents reported having tried marijuana at least once in their lifetime. Similar to the previous ESPAD survey, boys reported a higher prevalence of trying marijuana at least once in their lifetime than girls (9.0 % and 4.0 % respectively). Some 5.0 % of respondents reported marijuana use in the past year and 3.0 % had used cannabis in the last 30 days (4.0 % boys and 1.0 % girls). As in the 2008 survey, 7 % of respondents had used sedatives without a doctor’s prescription. Some 3.0 % of first-grade students reported they had used psychoactive substance other than marijuana or hashish. Apart from inhalants, which were used by 5.3 % of students, other drugs were used by less than 3.0 % of students (see Table 1).
Table 1: Use of psychoactive substances, ESPAD (%)
|Year ||Lifetime prevalence |
|Illicit drugs ||Cannabis ||Sedatives without doctor’s prescription ||Alcohol together with pills ||Cocaine ||Heroin ||Ecstasy |
|2008 ||8 ||7 ||8 ||3 ||1 ||1 ||2 |
|2011 ||8 ||7 ||7 ||2 ||1 ||1 ||1 |
The results from both surveys, conducted according to the ESPAD methodology, show a higher proportion of use among boys with regard to nearly all substances, except for non-prescribed sedatives.
Many institutions are active in the field of prevention, such as the Ministry of Health, Institute of Public Health (with a network of 23 district institutes), Ministry of Interior, Ministry of Youth and Sports, Ministry of Education, Red Cross of Serbia, special hospitals for drug addiction, local communities, international organisation, NGOs, etc.
The activities implemented in school settings, within families and in the community mostly take a universal prevention approach. Prevention of drug use is a part of regular elementary school curricula in Biology and Chemistry classes. In schools, the prevention activities are frequently carried out with support from the primary health care centres and also in partnership with the Ministry of Interior. Drug prevention is also included in each of eight national health promotion programmes designed for different target groups. Those programmes are implemented by the Institute of Public Health of Serbia and a network of 23 regional public health institutes. Health centre staff, education sector employees and community representatives work as a team to carry out health promotion activities in the community, kindergartens and schools. The activities mainly focus on information provision and awareness raising on topics related to drug use. All activities implemented under these programmes are regularly reported to the Institute of Public Health of Serbia, which coordinates the programmes, provides guidance and prepares reports for the Ministry of Health. The Institute of Public Health of Serbia has a monitoring system for some activities, specifically those conducted by health staff, but its capacity to monitor overall prevention activities needs to be strengthened.
The Institute for the Improvement of Education approves a list of in-service training programmes for teachers. Some of these programmes address drug prevention. Drug prevention programmes, which are conducted in schools, are part of a mandatory programme on prevention of violence, abuse and exclusion.
In 2010, a number of capacity building, training and institutional strengthening activities were conducted. In 2011 the Institute of Public Health of Serbia, within the programme for the prevention of drug use, conducted three seminars in cooperation with a network of 23 regional institutes of public health, medical staff from addiction treatment facilities and police. In 2011, some 374 representatives from regional institutes of public health, health centres, pharmacies, secondary and tertiary level health facilities, private health facilities, representatives of municipalities, the Ministry of Education and Red Cross were trained. In 2010, some 1 000 participants (partly supported by INSADA project) and in 2009, some 272 participants, were covered by similar workshops.
In 2010, INSADA supported the printing of approximately 200 000 information flyers for youth and 100 000 ‘Talk with your children’ booklets for parents. These were distributed through a network of public health institutes. Apart from support in the preparation and implementation of prevention activities and the national campaign on drug abuse, INSADA also supported a wide range of other activities within the national drug abuse prevention strategy, such as support in the field of legislation, and improving cooperation with the EMCDDA and the Pompidou Group. These activities also included a number of training workshops for public health professionals, treatment practitioners, and teachers’ representatives from local municipalities, NGO partners, the media and the private sector.
The United Nations Office on Drugs and Crime (UNODC) supported the programme ‘Prevention of drug use, HIV/AIDS, and crime among young people through family skills training programmes in low and middle income countries’, which was instigated in Serbia in May 2010. This project aims to implement evidence-based family skills training programmes to prevent drug use, HIV/AIDS and crime and delinquency among young people by strengthening and improving the capacity of families to take better care of children. It was conducted in Belgrade in two cycles in the municipality of Novi Beograd, from March to November 2011. Ten elementary schools and 195 families were involved, comprising 238 parents and 247 children, and 16 trainers were trained.
The Ministry of Youth and Sports and its network of local Offices for Youth are very important partners in drug prevention. In accordance with the National Strategy for Youth, they support the programmes and projects of the youth organisations in the health field, including the prevention of risky behaviour. In 2011 the Ministry of Youth and Sports allocated RSD 5 million to eight projects related to drug prevention run by different organisations (data from the Ministry of Youth and Sports Republic of Serbia).
The Ministry of Interior, with the support of the Organization for Security and Co-operation in Europe (OSCE), implemented a project to educate police on how to recognise signs of drug use in offenders.
Non-governmental organisations and international organisations, such as the Red Cross and the International Federation of Medical Students’ Associations – Serbia, have implemented a wide range of educational training activities targeting children and their parents, as well as students, mainly using interactive and participatory methods and peer education techniques.
As well as these projects, many smaller projects have been carried out in Serbia; however, selective and indicative prevention interventions are seldom carried out.
A wide range of activities are held that aim to raise public awareness on drug issue, such as expert conferences with press events (organised by the Institute of Public Health of Serbia and supported by UNODC and the World Health Organization), media campaigns, and public events held on the International Day Against Drug Abuse and Illicit Trafficking. Those public events are organised by a majority of district institutes of public health and their numerous partners from different sectors. Electronic resources (e.g. Facebook) are also used to reach the target audience.
Problem drug use
In 2008, the National HIV/AIDS Office estimated that there were 18 000 injecting drug users (IDUs) in Serbia in 2007 (95 % CI of 12 500–25 000). This estimate was calculated using the multiplier method. As a multiplier, a proportion of IDUs who reported HIV testing in the Special Hospital for Dependence Diseases in Belgrade in 2007 was used. The benchmark for this multiplier was programmatic data on numbers of unique IDUs who were tested for HIV. It provided an estimate of 6 000 IDUs in Belgrade, which was then extrapolated for the whole country based on information obtained from Ministry of Interior Affairs that approximately one-third of all IDUs in Serbia live in Belgrade.
In 2010/2011 estimates of the prevalence of people who use drugs by injecting were obtained using two methods, the multiplier method and a national survey related to drugs. Three multipliers were available from the Integrated Bio-behavioural Survey (IBBS) and relevant benchmarks were also available. The three available multipliers were the proportion of IDUs who reported using needle exchange services, the proportion of IDUs who reported HIV testing and finally the proportion of IDUs who reported being on detoxification treatment in the last year. The IDU population was defined as individuals aged between 18 and 49 years who have injected a drug for non-medical purposes within the last year. The chosen estimation was based on the detoxification data. As harm reduction interventions are limited to a few cities, this was seen as the most prudent choice. Based on this method, estimates were found to be 13 040 IDUs (9 5% CI of 10 867 to 16 300) for Belgrade, 1 640 IDUs (95 % CI of 845 to 27 333) for the region of Vojvodina (city of Novi Sad only) and 2 967 IDUs (95 % CI of 2 225 to 4 450) for the rest of Serbia (city of Nis only). A central national estimate was calculated as 30 383 IDUs aged between 15 and 59, within a range of possibly 12 682 to 48 083 IDUs in Serbia in 2009 (Comiskey et al., 2011). The estimated prevalence of IDUs in Serbia was 0.7 % of the population aged between 15 and 59.
It is interesting to note that the lower bound of the 95 % confidence interval (CI) derived from the national minimum estimate based on the 2006 population survey is similar to the sum of the lower bound of the 95 % CI of the estimate derived from the summation of the three city detoxification multipliers, which was 13 937 IDUs, which provides a measure of validation for the results. Furthermore, it must be remembered that estimates produced are for injecting drug users only and do not provide estimates of the number of non-injecting users of opiates or other drugs. Finally, a further limitation is the fact that the national estimate is based solely on data from three cities (Belgrade, Novi Sad and Nis).
This prevalence estimate is important as a benchmark for service provision — for example, the proportion of IDUs in contact with needle and exchange programmes is relatively low (8.6 %) and the proportion was even lower for methadone maintenance treatment. This has clear implications for policy action with regard to the risk of HIV and hepatitis infection incidence and spread.
The National HIV/AIDS Strategy has made provision for new estimates that are anticipated from the GFATM project in 2012 and 2014.
The national health information system regularly collects data on morbidity under ICD-10 from all levels of healthcare. The number of cases diagnosed/registered as F11–F19 (mental and behavioural disorders due to psychoactive substance use) in primary healthcare was 8 109 in 2011; 8 301 in 2010; 9 363 in 2009; 8 454 in 2008; and 8 002 in 2007. In secondary and tertiary healthcare, the number of people hospitalised due to F11–F19 was 1 987 in 2011; 2 447 in 2010; 2 518 in 2009; 2 630 in 2008; and 1 999 in 2007 (data from the Institute of Public Health of Serbia, Centre for Informatics and biostatistics).
A system for collecting data in accordance with the treatment demand indicator (TDI) protocol is still in the process of being implemented in the Institute of Public Health of Serbia. Up to now it has been partially implemented in four regional special drug treatment centres (in Belgrade, Novi Sad, Nis and Kragujevac). Data from the beginning of 2010 to the middle of 2011 was entered according to TDI protocol 2.0 for most newly treated opioid substitution treatment (OST) clients and for a larger group of clients who have already been included in the OST programme before 2010. In the second half of 2011 TDI protocol 3.0 was introduced in the centres. Data analysis for 2010 show that out of a group of 648 clients for whom the questionnaires were completed and data entered into the data base, 11 % were female and 89 % male, and 18.5 % were younger than 25 years of age. Of these clients, 36 % were being treated with OST for the first time in these centres.
According to a survey of the population most at risk of HIV/AIDS, carried out in 2008, about one-tenth of IDUs surveyed were on methadone treatment, a similar number as was estimated in Belgrade in 2005 (10 %, 95 % CI: 6–13 %) (Ministry of Health of the Republic of Serbia, IPH of Serbia, 2008b). In 2010, the survey confirmed that one-fifth of IDUs in Belgrade underwent detoxification in the last 12 months, and about 3.6 % were in a methadone substitution programme (Ministry of Health of Republic of Serbia, IPH of Serbia, 2010).
Drug-related infectious diseases
The data on drug-related infectious disease in Serbia comes from the national HIV and AIDS registers and bio-behavioural surveillance studies (in 2008 and 2010). From 1985 until the end of 2011 a total of 2 725 people were notified as HIV infected, of whom 1 594 (59 %) developed AIDS. Over the same period, 1 114 HIV-infected people died (1 027 from AIDS-related deaths) (data source: national HIV and AIDS registers). The majority of all HIV cases were registered in Belgrade (around 70 %). Of 1 594 reported AIDS cases, 637 (40 %) were reported among IDUs. From 1991 the trend in the percentage of IDUs among all newly diagnosed and reported HIV cases has been clearly decreasing year by year. However, an increasing trend of heterosexual or homo/bisexual transmission of HIV was registered in the same period.
- In 2011, out of 127 newly diagnosed HIV cases, 9 (7 %) were IDUs
- In 2010, out of 148 newly diagnosed HIV cases, 6 (around 4 %) were IDUs
- In 2009, out of 131 newly diagnosed HIV cases, 9 (7 %) were IDUs
- In 2008, out of 115 newly diagnosed HIV cases, 10 (8.7 %) were IDUs
- In 2007, out of 91 newly diagnosed HIV cases, 12 (13 %) were IDUs
- In 2006, out of 89 newly diagnosed HIV cases, 8 (8.9 %) were IDUs
According to the annual reports provided by the Department for Prevention and Control of Communicable Diseases of the Institute of Public Health of Serbia, 98 cases of acute hepatitis C infection were notified in 2011, compared to: 87 cases in 2010; 93 cases in 2009; 169 in 2008; 150 in 2007; 169 in 2006; and 202 in 2005. Moreover, 427 cases of chronic hepatitis C infection were reported in 2011, compared to: 462 cases in 2010; 503 in 2009; 540 in 2008; 573 in 2007; 444 in 2006; and 508 in 2005. There are no data related to the transmission category of reported cases of hepatitis C. The highest age-related notification rate among newly reported cases of acute hepatitis C in 2011 was registered in the age group 20 to 29 (3.38 per 100 000), which is higher than in 2010 (1.81 per 100 000) and 2009 (2.88 per 100 000). The rate was also higher in 2011 for the age group 30 to 39 (2.97 per 100 000) compared to those registered in 2010 (2.4 per 100 000) and in 2009 (2.31 per 100 000). Also, the highest age-related notification rate of chronic hepatitis C had been registered in the age group 30 to 39 (15.37 per 100 000 in 2011, up from 12.18 per 100 000 in 2010 and 13.38 per 100 000 in 2009). Among those aged 20 to 29 the notification rate of chronic hepatitis C had fallen to 11.35 per 100 000 in 2011, from 12.18 per 100 000 in 2010 and 14.93 per 100 000 in 2009.
Of 256 reported cases of acute hepatitis B infection in Serbia, in 2011 only 2 % were among IDUs (five cases), which is lower compared to 7 % in 2010 (18 out of 242 reported cases) and 5 % in 2009 (14 out of 287 reported cases) based on data from epidemiological investigation of notified cases. The highest age-related notification rate among all newly reported cases of acute hepatitis B infection in 2011 was registered in the age group 20 to 29 (7.98 per 100 000), which is higher compared to 2010 (5.34 per 100 000) and 2009 (6.96 per 100 000), but lower compared to 2008 (8.98 per 100 000).
In order to monitor and evaluate the trend of seroprevalence, risk behaviour, testing practice, using the harm reduction services, etc., in 2010 the second cycle of integrated cross-sectional bio-behavioural surveillance survey was carried out outside of health facilities among eligible IDUs aged 18 and over who injected drugs in the last month in Belgrade and Nis. A respondent-driven sampling methodology was used. The research tool was a structured questionnaire administered by trained field researchers. Testing of full blood samples for HIV, hepatitis C and syphilis was done using rapid tests, and with mandatory pre-test counselling given by trained counsellors, together with post-test counselling for those who wanted to know the results (around half of all participants). A total of 571 IDUs were included in the survey (371 in Belgrade and 200 in Nis). The results showed that prevalence of HIV infection in the sample was as low as 2.4 % in Belgrade and 4.5 % in Nis (in 2008 the figures were 4.7 % in Belgrade and 1.6 % in Nis). Prevalence of hepatitis C infection was 77.4 % in Belgrade and 60.5 % in Nis (74.8 % in Belgrade and 58.4 % in Nis in 2008). Prevalence of syphilis infection was extremely low (0.5 % among respondents in Belgrade aged 25 and over).
Regarding the socio-demographic characteristics of respondents, around 80 % of the sample was male, and 16 % of the respondents were aged 18 to 24. Some 75 % of respondents were unemployed. The median age of first injecting a drug was 21 years in Belgrade and 22 years in Nis. The practice of sharing needles and syringes with other users in the previous month was reported by 23 % of sampled IDUs in Belgrade and 15 % in Nis.
Risky sexual practice was observed amongst respondents — around one-third of respondents reported using a condom during their previous sexual intercourse among those who had sex in the month or in the 12 months prior to the survey, and the median number of sexual partners in the last year was two in Belgrade and three in Nis. More than one-third of respondents reported that their sexual partners do not inject drugs. One-third of respondents in Belgrade (33 %) and 19 % in Nis reported having been tested for HIV in the last 12 months, while 73 % of respondents from Belgrade and 57 % from Nis reported ever being tested for hepatitis C.
A very low rate of coverage of prevention programmes (needle exchange programmes and condom distribution) was found in both cities (20 % in Belgrade and 7 % in Nis).
Of the 67 % of respondents in Belgrade who reported trying to reduce their drug use in the last 12 months, 19 % reported being on a detoxification programme, while only 3.6 % were on a methadone maintenance treatment programme. Of 82 % respondents in Nis who reported trying to reduce their drug use in the last 12 months, 12 % reported being on a detoxification programme while only 5 % were on a methadone maintenance programme (Ministry of Health of the Republic of Serbia, IPH of Serbia, 2010).
Drug-induced deaths and mortality among drug users
The National Office for Statistic is the official source of data on drug deaths. According to data from the general mortality register (selection B of EMCDDA standard), there were 39 cases of drug-related deaths in 2011; 75 in 2010; 119 in 2009; and 117 in 2008. A majority of the deaths were associated with opiates. In 2011, four people under 25 years of age died from drug-related overdose. The majority of the deaths were in the age group 25 to 34 (22 out of 39). In 2010, some 42 out of 75 drug-related deaths were in the same age group (74 out of 119 in 2009, and 73 out of 117 in 2008). The majority of deceased were males (around 90 % annually).
The standard practice with unnatural deaths is that the investigating judge orders an autopsy. The death certificate is sent to the National Office for Statistic after autopsy and toxicology results.
A toxicological analysis of post-mortem samples is performed in the Medical Military Academy and in institutes of forensic medicine in Belgrade, Novi Sad, Nis and, partly, in Kragujevac. There is no common data collection system in place yet.
In Serbia, drug treatment is available in the form of diagnostic and therapeutic consultations and counselling; inpatient and outpatient withdrawal treatment; relapse prevention with pharmacotherapy or drug-free; opiate substitution treatment (OST); and individual, group and family psychotherapy and psychosocial support and integration. Drug addiction treatment is provided at all three healthcare levels.
At the primary level, general practitioners, psychiatrists, paediatricians or other outpatient specialists provide outpatient diagnostic procedures and medical treatment for drug users. At secondary level, inpatient and outpatient medical treatment is carried out by psychiatrists in general hospitals. Tertiary healthcare facilities are located in the four largest cities in Serbia (Belgrade, Niš, Novi Sad and Kragujevac). The specialised regional referral centres for drug addiction treatment are: (i) the Special Hospital for Addictions in Belgrade; (ii) the Clinic for Addiction Disease at the Institute of Psychiatry, Novi Sad; (iii) the Clinic for Mental Health in Nis; and (iv) the Clinic for Psychiatry, Kragujevac. These centres provide the highest level of health services for addiction treatment. The Special Hospital for Addictions in Belgrade (SHDA) is the oldest and largest institution for addiction treatment in Serbia, with 21 physicians and a 65-bed capacity for inpatients.
Drug treatment for substance use disorders (i.e. detoxification, methadone therapy, inpatient treatment of drug dependence and treatment of drug-induced psychoses) is financed through the national Health Insurance Fund.
Methadone was first introduced into Serbia at the end of the 1970s. By the middle of the 1980s more than 500 opiate addicts had been included in the OST programme. Nowadays, opiate substitution treatment is available in health facilities from primary to tertiary healthcare levels, and a majority of them are still functioning, with the support of the GFATM. During the 1990s, the drug-free naltrexone programme for heroin addicts was introduced. In March 2010, buprenorphine was registered at the National Drug Agency for the treatment of opiate addiction. In September 2010, implementation of buprenorphine detoxification and substitution treatment protocols began at the SHDA and other regional healthcare centres. Substitution treatment can be initiated in inpatient or outpatient health care and the decision to initiate the treatment should be made by a therapeutic team.
Based on the reports of 24 OST centres for 2011, sent to the National HIV/AIDS Office, the total number of drug users in the 24 GFATM-funded methadone centres from 1 January to 31 March 2011 was 1 435. There were 495 first-time clients, most of whom were males (82.8 %) (Institute of Public Health of Serbia, National HIV/AIDS Office).
According to the Ministry of Health Project Unit implementing the GFATM, the number of OST clients is even greater, as they identified 1 774 clients in total (1 520 in 2010, and 1 114 in 2009). GFTAM support the OST programmes through supplying urine test and providing information education, communication materials for the programme clients. In 2011, some 79 clients of SHDA received buprenorphine, of which 68 were first-time clients.
The healthcare system for drug addicts in prisons is improving. In 2009, voluntary and confidential counselling and testing for HIV and hepatitis C of all newly admitted patients, individual and group counselling on risk behaviour, HIV, HCV and overdosing were implemented in healthcare services in penal institutions. Methadone substitution therapy can be administered in penal institutions to opiate-addicted clients. In 2011, the number of registered drug addicts among prisoners was 4 929 (detained, convicted, juveniles, punished for minor offence); in 2010 there were 6 211. The number of people deprived of their liberty in Serbia as of 31 December 2011 was 11 094.
As of 31 December 2011, a total of 128 people were receiving substitution treatment while in prison. For 2010 and 2009 the numbers of OST clients in prison were 119 and 103 respectively. With the support of the Mission of the OSCE, drug-free units were opened at two penal correctional institutions: in Nis and the Special Prison Hospital in Belgrade. The prerequisite for prisoners to be at those units is their absolute abstinence from all psychoactive substances (Ministry of Justice Prison Administration, 2011).
The Serbian Orthodox Church has some rehabilitation centres. ‘Land of the living’ is a programme organised by the Serbian Orthodox Church in six centres. Approximately 150 IDUs per year enter the programme. Between 2006 and 2011 more than 600 people started the programme and over 60 successfully completed it. There are plans for opening more rehabilitation centres, although this would depend on the availability of financial resources.
As regards treatment of non-fatal poisonings, the Department for Reanimation and Triage of the National Centre for Poisoning Control in the Medical Military Academy treated 162 overdose cases in 2011 and 338 in 2010, The majority of patients (125 out of 162) were 19 to 40 years old (290 out of 338 in 2010) and more than 70 % were male in both years. In 2011, two people were under medical observation due to having transported illegal substances inside their body (‘body packers’), while in 2010 there were nine such individuals. The main substance in the majority of cases was heroin (data received from the Medical Military Academy).
Under the leadership of UNODC and the WHO, the ‘Programme on drug dependence treatment and care’ was implemented in May 2010. The TREATNET training package has been translated into Serbian and a ‘training of trainers’ event was carried out. This training package is also recognised and accredited by national accreditation schemes for the continuous education of medical professionals. In Serbia 551 practitioners have already been trained in the programme. Under this programme several other workshops and expert round tables on issues concerning drug dependence treatment were also implemented. A main focus of the programme is the improvement of services for so-called ‘hidden populations’. A grant agreement of USD 84 000 was signed with Public Health Centre institution DZ Savski Venac to support, improve and expand the drug dependence treatment and care services.
Harm reduction responses
The first assessment of harm reduction in Serbia was conducted in 2000 by Médecins du Monde (MdM), French harm reduction programme coordinators. The assessment confirmed a priority need for the implementation of a harm reduction project. On 29 July 2002, the MdM launched the first needle and syringe exchange project in Belgrade and the programme is currently operated by an NGO in Veza.
NGOs in Serbia operate drop-in centres and mobile units where education and care services to drug users are provided by a team of trained outreach workers. On average, the NGO sector provides support to 2 000 drug users annually. The mobile units and drop-in centres provide low-threshold care in a client-friendly environment. For those in need of medical and social assistance, a team of outreach workers provides care on a daily bases. At the same time, drug users can participate in a needle exchange programme (NEP). NEPs exist in Belgrade, Nis, Novi Sad and Kragujevac. The NEP in Belgrade started in 2002, managed by NGO Veza; in Nis it started in December 2004 and is managed by NGO Putokaz; in Novi Sad it started in 2006 and is managed by NGO Prevent; and in Kragujevac the NEP started in 2009 and is managed by Youth YAZAS Pozarevac in cooperation with Youth YAZAS Kragujevac. In 2005, the Government took the first step to integrating the harm reduction approach into the medical and social infrastructure of the country. The Ministry of Health offered systemic support by placing harm reduction on its agenda and securing budgetary funding and logistics for its implementation throughout the national health system (widening a network of health institutions eligible to treat drug addiction, and opening MMT centres).
The Ministry of Health project ‘Scaling up the national HIV/AIDS response by decentralising the delivery of key services’, funded from the GFATM grant, officially started on 1 June 2007. The grant sub-recipients are both governmental and non-governmental organisations, and include clinics for infectious diseases, psychiatric clinics, institutes for public health, primary healthcare centres, penitentiary institutions, homes for children without parental care, NGOs implementing outreach prevention programmes, faith-based organisations, associations of people living with HIV, etc.
Within the part of the project that was aimed at IDUs, the following activities were carried out:
- NGO staff/outreach workers received training in HIV prevention based on harm reduction principles;
- police officers received training and orientation on the principles of harm reduction;
- medical staff from all healthcare institutions and prisons included in the project received training on methadone maintenance therapy.
In July 2009 Serbia signed a second grant agreement with GFATM for the new project ‘Strengthening HIV prevention and care for the groups most vulnerable to HIV/AIDS’. Harm reduction activities within this project entail the opening of drop-in centres for IDUs and the extension of methadone maintenance treatment (MMT) in primary healthcare centres. The GFATM project includes training on harm reduction principles and sensitisation of medical professionals and police officers for work with injecting drug users. During 2007–10, approximately 525 health workers, 184 police officers and 42 outreach workers participated in training. In 2011 a total of 17 health workers were educated on MMT, and five outreach workers on harm reduction.
Based on the reports sent to the National HIV/AIDS Office by four NGOs that implement the NEP programme in Belgrade, Novi Sad, Nis and Kragujevac, in 2011 the number of newly reached IDU clients was 974. The minimum package of services provided to every new client consists of a risk assessment, counselling on risk reduction (based on the assessment), provision of sterile injecting equipment, condoms and information material, as well as referral to a local voluntarily counselling and testing (VCT) centre (IPHs, SHDA Belgrade, Institute for Students’ Health, Belgrade). The majority of new clients are older than 24 (80.5 %), while 4.1 % are younger than 20. Most (81.7 %) are male, which is in line with research findings showing that more than 70 % of new clients in Belgrade and Nis were male (Ministry of Health of the Republic of Serbia, IPH of Serbia, 2010).
According to the Project Implementation Unit at the Ministry of Health, in 2009 (from 1 June) 2 320 clients were served by NEPs, 2 695 clients in 2010, and 1 751 in 2011.
However, needle exchange programmes remain highly dependent on external funding in order to operate. In 2005–06, Imperial College conducted a study that confirmed that on average an IDU in Serbia injects 2.3 times per day, and therefore requires 840 needles per year, which totals over 9 million needles per year for Serbia as a whole.
VCT for HIV and HCV is also available at 22 IPHs, SHDA and Institute for Students’ Health, Belgrade. According to the report from the 24 VCT centres for HIV and sexually transmitted diseases (STDs) sent to the National HIV/AIDS Office, the total number of IDUs tested for HIV in 2011 was 1 000. The majority of them (650) were counselled on HIV and STDs and tested for HIV in SHDA. According to the same source, 414 counselled clients were tested for HCV and 420 for HBV and a majority in SHDA (353 HCV and HBV).
In order to prevent new HIV and hepatitis C cases more effectively by improving knowledge and skills and reducing risk behaviour amongst IDUs in Serbia, an expansion of harm reduction programmes and provision of a standardised minimum package of services in outreach activities and in drop-in centres has been planned.
Drug markets and drug-law offences
Smuggling and trafficking of heroin are the traditional forms of organised drug crime in Serbia. The presence of this type of narcotic is determined by the fact that Serbia is a transit area for the shortest terrestrial and other roads between the countries where heroin is produced, and west European countries where it is sold in drug markets.
Serbian territory is still being used for the transit of smuggled heroin from Turkey to western Europe. It is particularly evident in the summer season, when a large number of Turkish citizens who live and work in western Europe travel through Serbia during their summer holidays. Due to increased control of passengers at border crossing points, there are frequent seizures of heroin that is being smuggled in hollow parts of motor vehicles.
According to police data, supply and procurement of heroin for the Serbian market is mostly performed and directed through:
- organised criminal groups from the areas of Kosovo and Metohija;
- organised criminal groups of Albanians, for supply from the former Yugoslav Republic of Macedonia;
- the region of Bujanovac and Presevo;
- the region of Novi Pazar/Tutin, as well as North of Montenegro (Rozaje).
Often the supply of heroin is organised in relatively small quantities (1 to 3 kilos). One reason for this is safety, because even if a smuggling channel is dismantled and heroin is seized, it would be a relatively small quantity and the financial loss would be small. Bearing in mind that the distances between the regions in which heroin is procured are not large, contact between the people involved in drug trafficking is relatively quickly established through face-to-face meetings when smuggling routes are re-established.
The situation in Serbia and the surrounding region has significantly changed in recent years. Among the reasons for this are the accession of neighbouring countries — Bulgaria and Romania — to the EU, as well as the separation of Kosovo and Metohija. These events have significantly changed the heroin smuggling routes used by organised criminal groups. A heroin smuggling route was directed towards so-called Schengen borders and the route Bulgaria–Romania–Hungary became used for transport to west European countries. This enables traffickers to avoid transport through Serbia and the increased checks of passengers and goods on the border from the former Yugoslav Republic of Macedonia–Kosovo and Metohija.
These trends have had an influence on a significant decrease in the seizures of heroin in Serbia. According to information from the Ministry of Interior of the Republic of Serbia and from European police services, the territory of Kosovo and Metohija is being used for the storage of large quantities of heroin that is to be smuggled to west European countries via Albania (Durres harbour), Montenegro and Bosnia and Herzegovina.
Recently, the organised drug crime groups of Serbian origin have become more prominent in the trans-continental cocaine smuggling market from South America to European countries. As far as Serbia is concerned, cocaine enters the country in transit to Europe and in small quantities intended for selling on the local market. For cocaine smuggling, transatlantic cargo ships are mostly used.
Trends of increased smuggling of small quantities of cocaine have been also observed. This is related to individual cases when cocaine is smuggled on aeroplanes, concealed in suitcases or clothes. Having successfully completed their deliveries, these people then return to Serbia where they continue to live ordinary lives, and the money gained from cocaine smuggling is laundered mainly through the purchase and building of real estate. Individual cases of cocaine smuggling by post (DHL, etc.) have also been recorded. These trends were observed in 2008 and 2009, and continued in 2010, and therefore present a particular form of organised cocaine smuggling that is not detectable without timely and ongoing international cooperation.
Marijuana is still the commonest narcotic drug on the illegal market in Serbia. It is still being smuggled mostly from Albania via Montenegro, but there have recently been more and more cases of a modified type of marijuana, so-called ‘skunk’ or ‘super-marijuana’. Current trends indicate that there are cases of indoor cultivation of modified marijuana. In 2010 and early in 2011, laboratories that had been producing ‘skunk’ were detected in several locations. It is expected that the trend of indoor cultivation will continue and increase.
Regarding synthetic drugs and precursors, recent cases indicate that organised criminal groups will continue to invent modus operandi and find locations to smuggle and produce synthetic drugs in laboratories known as ‘kitchen models’. These laboratories are designed for the production of synthetic drugs, are usually installed in kitchens and utilise basic kitchen utensils and tools in the production process. One of the primary reasons for the use of ‘kitchen laboratories’ is the financial gain organised criminal groups achieve by producing various types of synthetic drugs themselves, instead of smuggling them from Scandinavia and western Europe, as was the case in the past. Producing them in Serbia reduces the risk related to trafficking and at the same time they achieve bigger profits. An increasing trend can be observed of synthetic narcotic drugs produced in Serbia being smuggled to markets in west European countries, such as Sweden, Denmark and Holland. This indicates that the direction of these narcotics has been changed only in the past 10 years. Illegal laboratories in Serbia use chemicals smuggled from the Middle East to produce synthetic drugs.
In 2010, two laboratories for the production of synthetic drugs were discovered. One of them produced amphetamine sulphate and the second produced benzyl-methyl-ketone (BMK). Both laboratories were installed in primitive so-called ‘kitchen conditions’ with little capacity for the local market. Since the laboratories were close to the border with Bulgaria, it can be assumed that the perpetrators had planned to smuggle the drugs from Serbia to Bulgaria.
Table 2: Number and quantities of seized drugs by year
|Year ||Number of seizures ||Total seized drugs (g) ||Heroin (g) ||Marijuana (g) ||Cocaine (g) ||Ecstasy (g) |
|2008 ||6 187 ||743 862.76 ||207 649.14 ||1 477 786.80 ||15 091.52 ||207.82 |
|2009 ||5 650 ||1 322 870.60 ||169 207.00 ||1 083 239.65 ||19 225.55 ||5 408.20 |
|2010 ||5 699 ||1 687 998.04 ||242 848 ||1 352 775.06 ||7 622.57 ||23 459.70 |
|2011 ||5 248 ||1 403 668.90 ||64 864.66 ||995 111.90 ||5 961.6 ||48 721.98 |
On the basis of operational activities on site and other intelligence information, in 2011 the prices were as follows:
- heroin: EUR 12–16 000 per kg
- cocaine: EUR 33–38 000 per kg
- ‘skunk’: EUR 1 500–3 000 per kg
- amphetamine: EUR 0.5–6 per pill
The street prices are: 1 g of heroin: EUR 20–25; 1 g of cocaine: EUR 50–110.
(All data are provided by the Ministry of Interior of the Republic of Serbia.)
In 2011, according to the National Office for Statistics, 3 588 adults were sentenced for unauthorised production, possession or enabling use of drugs, while in 2010, 3 940 adults were sentenced against this legal ground.
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