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Country overview: Bosnia and Herzegovina

  • Situation summary

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The drug situation in Bosnia and Herzegovina should be viewed in the context of the overall socio-economic and demographic changes in the last two decades, and in particular the war and its ongoing impact. The war’s effect has been widely felt — in personal and social trauma, the time it has taken to make the transition to peacetime, damage to the economy, the impact on social and moral values, and increased rates of unemployment and poverty.

The population groups at higher risk of developing problems with drug use include war invalids, persons suffering from post-traumatic stress disorder, demobilised defenders/fighters, socially disadvantaged persons, the unemployed, children and adolescents.

The location of Bosnia and Herzegovina on the Balkan route of drug trafficking and the permeability of its borders both contribute to an increased availability of drugs in the country. The country faces a number of major problems in tackling problem drug use, including: too few centres for drug addiction treatment including those providing substitution therapy; an insufficient number of professionals; a lack of prevention programmes at local levels; a newly adopted state drug strategy which remains, as yet, unimplemented; a lack of technology (e.g. laboratory equipment); and a drug information system which is still under development.

Key figures
  Year Bosnia and Herzegovina EU (27 countries) Source
Surface area 2009 51 209.2 sq km 4 200 000 sq km CIA — The World Factbook
Population 2009 3 844 000 501 105 661 p 1
Eurostat
GDP per capita in PPS (Purchasing Power Standards) 2 2009 30 100 3 Eurostat
Inequality of income distribution 4 2008 N/A 4.9 3 Eurostat
Unemployment rate 5 2009 24.1 % 9.6 % 1 Eurostat
Prison population 2009 3 200 persons   Ministry of Justice BiH

1 2010 Eurostat.

2 Gross Domestic Product (GDP) is a measure of economic activity. It is defined as the value of all goods and services produced less the value of any goods or services used in their creation. The volume index of GDP per capita in Purchasing Power Standards (PPS) is expressed in relation to the European Union (EU-27) average set to equal 100. If the index of a country is higher than 10, this country’s level of GDP per head is higher than the EU average and vice versa.

3 2010 Eurostat (value for 2009).

4 The ratio of total income received by the 20 % of the population with the highest income (top quintile) to that received by the 20 % of the population with the lowest income (lowest quintile). Income must be understood as equivalised disposable income.

5 Unemployment rates represent unemployed persons as a percentage of the labour force. The labour force is the total number of people employed and unemployed. Unemployed persons comprise persons aged 15 to 74 who were: (a) without work during the reference week, (b) currently available for work, (c) actively seeking work.

p Eurostat provisional value.


Bosnia and Herzegovina is situated in the western part of the Balkan Peninsula. It shares its borders with Serbia and Montenegro to the east, and the Republic of Croatia to the north, west and south. Bosnia and Herzegovina is divided into two entities, the Federation of Bosnia and Herzegovina (FBiH) with 2 327 000 inhabitants and  Republika Srpska (RS) with 1 437 500 inhabitants (1).

The Federation of Bosnia and Herzegovina is administratively divided into 10 cantons/districts. These cantons are further divided into 79 municipalities. Republika Srpska is administratively divided into 62 municipalities. Brcko City is a separate administrative unit (a district) with 79 500 inhabitants.

The structure of the population in Bosnia and Herzegovina is divided between Bosnians, Serbs, Croats and others. The official languages are: Bosnian, Croatian and Serbian, and two alphabets (Latin and Cyrillic) are used.

The capital city of Bosnia and Herzegovina and also the Federation of Bosnia and Herzegovina is Sarajevo with 361 700 inhabitants. Other large cities are: Banja Luka (225 100 inhabitants) is the capital city of Republika Srpska, Tuzla (131 600), Zenica (127 100), Bijeljina (108 300), Mostar (111 200), Travnik (55 100).

(1) Population data of entities and cities refers to year 2008. Source: Agency for Statistics Bosnia and Herzegovina.

Drug use among the general population and young people

Drug use in the adult population

Two questionnaire studies were carried out in 2001 and 2006 among university students (18–25 years of age) showed a lifetime prevalence of the use of illicit drugs (cannabis, ecstasy, inhalants, LSD, cocaine) of 22.5 % in 2001, and 31 % in 2006.

Drug use among young people

Several surveys were carried out among young people in Bosnia and Herzegovina in 2001–07. Although the full methodological information is not available for most of the studies and the design, methodology and format of analysis might not always be comparable with European standards, the results suggest that the lifetime prevalence of any illegal drug use among primary school pupils (aged up to 15 years) is up to 1 %. The lifetime prevalence of any illegal drug among students in secondary schools varies between 5 % and 15 %, depending on the age range of the sample and the particular study; cannabis, inhalants and ecstasy in descending order, are the most common drugs.

In Banja Luka, the lifetime prevalence of any illegal drug use among young people aged 12–30 years is estimated to be approximately 10 %. According to a survey conducted in the Republika Srpska in 2003, about 16 % of males and 7 % of females aged 16–25 have consumed cannabis in their life.

In 2008, the first European School Survey Project on Alcohol and Other Drugs (ESPAD) was carried out in the Federation of Bosnia and Herzegovina (May–June 2008) and in Republika Srpska (November–December 2008).

In the Federation of Bosnia and Herzegovina, the sample consisted of 2 973 first-grade secondary school students (born in 1992 and aged 15 or 16 years at the time of the survey) residing in urban areas. Rural schools were not included in the study, which may bias its results. In Republika Srpska, a stratified random sampling from the entire territory of Republika Srpska was performed and the sample consisted of 6 181 first grade secondary school students (see Table 1).

Table 1: Lifetime prevalence of drug use, by gender in the Federation of Bosnia and Herzegovina (FBiH) and Republika Srpska (RS), 2008 ESPAD survey (percentages)

Drug FBiH RS
Males Females Total Males Female Total
Cannabis 20.3 9.6 14.6 11.6 2.5 4.9
Opiates (heroin) 4.0 2.0 3.0 n.a. n.a. n.a.
Volatile substances 12.4 10.4 11.3 3.2 1.7 2.5
Cocaine (including crack) 4.9 2.5 3.6 n.a. n.a. n.a.
Amphetamines 9.6 4.3 6.8 2.9 0.7 1.8
Ecstasy 8.5 4.4 6.4 2.7 0.7 1.7
LSD 4.3 2.6 3.4 n.a. n.a. n.a.
Magic mushrooms 2.6 1.1 1.8 n.a. n.a. n.a.
Sedatives 11.6 16.2 14.1 2.8 5.3 4.0
Medicaments together with alcohol 5.4 5.2 5.3 3.9 3.2 3.6
Anabolic steroids 3.2 0.4 1.7 n.a. n.a. n.a.
Injecting drug use 2.7 1.6 2.2 n.a. n.a. n.a.

Source: ESPAD surveys in FBiH and RS, 2008.

n.a.: not available.

In 2002, the Health Behaviour of School Children (HBSC) survey was conducted among 12-, 13- and 15-year-old students in the Federation of Bosnia and Herzegovina and Republika Srpska. In Republika Srpska, questions on the consumption of other drugs apart from cannabis were added to the standard questionnaire. However, the drug use prevalence rates were found to be very low — the lifetime prevalence rate of cannabis was 2.4 %; for ecstasy and amphetamines, it was below 0.5 %.

Drug use among children without parental care

In 2008, UNICEF in Bosnia and Herzegovina conducted a study on the risk behaviour of children in institutions with collective accommodation. The aim of this study was to investigate and establish the prevalence of different forms of risky behaviour (use of tobacco, alcohol and drugs, and risky sexual behaviour) among this vulnerable group. The study included 392 children and adolescents (209 boys and 183 girls) aged between 12 and 20 years (most frequently 15–17 year olds) living in institutions or with foster parents. Some 5 % of respondents reported using cannabis in their life, while 0.5 % had used amphetamines. Prevalence rates were higher for males and children living in institutions as compared with those living with foster parents. About two-thirds of those who had tried cannabis had done so for the first time at the age of 15–16 years. The results showed that cannabis was readily available: 72 % of respondents noted that it could be easily purchased on the street, 61 % at school, 56 % in clubs and bars and 22 % from dealers at their homes (UNICEF, 2008).

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Prevention

In Bosnia and Herzegovina, school prevention programmes are formulated and instigated by Ministries of Education and Health at the entity level, at cantonal level in the Federation of Bosnia and Herzegovina, and at the local level in municipalities. There is no continuous prevention programme being implemented in school curricula or embedded in the school system in Bosnia and Herzegovina. Non-governmental organisations (NGOs) are also involved in the implementation of prevention programmes in elementary and secondary schools and also in extracurricular activities (peer programmes, workshops).

A network of Mental Health Centres is involved in drug prevention programmes on an irregular basis.

The Programme for Prevention of Addictions of Canton Sarajevo is a good example of coordinated preventive activities supported jointly by the Ministry of Health and the Government of the Canton of Sarajevo and implemented by the multidisciplinary professional team — The Council for the implementation of the programme. This programme has been running since 1999 and its latest revision was adopted for 2008–10.

In Banja Luka (RS), the Association Victoria (NGO) has implemented a number of prevention activities in recent years. A prevention programme called ‘Stop Drugs’ included prevention lectures for parents and more than 2 000 students in primary and secondary schools in 2009. Between December 2007 and March 2008, the Association implemented a prevention project called ‘It is not worth giving up life’ funded by the administration of the city of Banja Luka. The project included lecturing on drug abuse and its consequences in primary schools, the presentation of a documentary film and the distribution of printed educational materials.

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Problem drug use

Estimates of numbers of problem drug users

In 2009, a second sero-behavioural study among injecting drug users (IDUs) conducted by UNICEF in three major cities of Bosnia and Herzegovina (Sarajevo, Banja Luka and Zenica) (2) (3). The first such study was conducted two years earlier. In 2007, the number of sampled IDUs was 780 but in 2009, 781 IDUs were sampled. The aim of the studies was to determine the prevalence of HIV and viral hepatitis among IDUs and to monitor behavioural risk factors related to drug injecting. IDUs’ population-size estimates in above-mentioned cities were also performed within the 2009 study, using a multiplier method.

The estimated number of IDUs in Sarajevo was 889 (95 % CI: 703–1 075), in Banja Luka 534 (95 % CI: 354–717) and in Zenica 852 (95 % CI: 809–895). These results were extrapolated to entity and state levels and thus, in 2009, the estimated population of IDUs in the Federation of Bosnia and Herzegovina is 4 900 persons, and in all Bosnia and Herzegovina (i.e. including both entities — the Federation of Bosnia and Herzegovina and the Republika Srpska), amounts to 7 500 persons. 

In 2009, experts estimated that the number of IDUs in Bosnia and Herzegovina (4) ranges from 3 000 to 8 000. Although in 2008, NGO experts suggested there could be as many as 15 000 IDUs (5).

Characteristics of problem drug users

In 2009, the sample of the sero-behavioural study conducted by UNICEF consisted of 261 IDUs from Sarajevo, 260 from Banja Luka, and 260 from Zenica. The respondents were selected using respondent-driven sampling. Data were collected from October to December 2009. The standard questionnaire had 142 questions and it was administered during face-to-face interviews. The average age of respondents was 29–30 years, men made up 90 % of the sample in all three cities. A majority of respondents had completed secondary education, had part-time employment or were financially supported by their families. The average age of first drug injection was 21–22 years among the sampled IDUs; the majority had been in contact with police. Thus, 49 % of respondents in Sarajevo, 43 % in Zenica and 39 % in Banja Luka had been arrested or detained during the last year.

According to the 2007 UNICEF survey in Sarajevo, Banja Luka and Zenica among a sample of 780 injecting drug users (260 in each city), approximately 95 % of IDUs injected heroin in the last month. The majority of them were aged 25–34, and men formed 90 % of the sample. Approximately 80 % of the sample was unemployed. About one half of IDUs reported that they had been arrested by police during the last year, although the proportion was almost 70 % in Sarajevo.

(2) UNICEF Bosnia and Herzegovina (2007), ‘Biological and behavioural survey among injection drug users, Bosnia and Herzegovina’, UNICEF, Sarajevo.

(3) UNICEF Bosnia and Herzegovina (2010), ‘Report on behavioral and biological surveillance among injection drug users in Bosnia and Herzegovina, 2009: A respondent-driven sampling survey’, UNICEF, Sarajevo/Banja Luka.

(4) The Global Fund to Fight AIDS, Tuberculosis and Malaria (GF) consensus workshop, Sarajevo, May 2009 (consensus between NGOs and GOs (governmental organisations)).

(5) NGO Margina during EMCDDA/CARDS assessment mission, May 2008.

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Treatment demand

In February 2010, the Ministry of Civil Affairs of Bosnia and Herzegovina, the Federal Ministry of Health of Bosnia and Herzegovina, the Ministry of Health and Social Welfare of Republika Srpska, and the Department of Health and other services of Brcko District signed a ‘Protocol on Cooperation for the implementation of the Law on the Prevention and Combat of the Abuse of Narcotics — The evidence of drug addicts and abusers’. The protocol defines mutual rights and obligations of the participants to collect, to report and to share information. A unique drug treatment demand registration form which is in line with EMCDDA standards was published in the Official Gazette No 73/09. This form is mandatory for all legal bodies (state, NGO, private) that provide detoxification, drug treatment, rehabilitation, religion-based rehabilitation and other forms of drug treatment.

The Ministry of Civil Affairs, together with the Institute of Public Health of the Federation of Bosnia and Herzegovina, the Institute of Public Health of Republika Srpska and the Department of Health and other services in the Brcko District, coordinates this information system. Data collection started in November 2010; the first results will be available at the beginning of 2011.

As of today, treatment demand data from clients of the methadone maintenance treatment (MMT) and specialised drug treatment centres are available.

In 2008, there were 680 heroin users in MMT in Bosnia and Herzegovina: 250 in Sarajevo, 200 in Zenica, 170 in Mostar, 36 in Sanski Most and 28 in Doboj. The majority of clients were in the 24–30 age group, and 80–90 % were males.

In 2010, there were approximately 800 heroin users in MMT in Bosnia and Herzegovina (in Sarajevo, Banja Luka, Zenica, Mostar, Sanski Most and Doboj).

In 2009, the Institute for Alcoholism and Substance Abuse in Sarajevo Canton registered 118 first-time diagnosed drug users, which is a 20 % increase when compared with 2008. In 2009, approximately 9 303 visits were registered in both the counselling centre and outpatient unit. In 2010, 73 persons were registered as newly diagnosed drug users, while the number of visits to both units was 8 839. The majority of clients (90 %) are male, with primary use of cannabis, followed by heroin and psycho-stimulants; 70–80 % of them are IDUs.

In 2009, the MMT programme of the Institute had 349 clients (60 % more than in 2008), and the same number of clients was recorded in MMT in 2010 (of which 26 were female). In addition, 138 and 126 clients participated in a detoxification programme with methadone in 2009 and in 2010 respectively. In 2010, the majority of MMT clients were male (92 %); with the mean age 33.5 ± 5.9 years (age range 23–50 years). The mean age of the first drug use for the clients was 17.8 ± 2.3 years; that for heroin use was 20.7 ± 2.5 years. The majority of addicts contacted the Institute for the first time at the age range 22–25 years.

In addition to the above-mentioned addiction treatment interventions, approximately 15 000 counselling sessions were administered in the Institute in 2010, which is a 42.3 % increase in comparison with 2009, when 8 752 such interventions were administered. The counselling is mainly administered to persons in experimentation or in the early stage of drug addiction and these persons constitute the main target group of the Programme for Prevention of Addictions in Canton Sarajevo.

In July 2009, the Detoxification and Methadone Centre in the Clinic for Psychiatry of the Clinical Centre in Banja Luka was officially opened. Since the opening of the MMT programme, 93 clients have been treated and 23 clients were undergoing the MMT in November 2010; 20 males and 3 females among them. From July 2009–November 2010, 64 drug users were treated in the detoxification centre, 56 males and 8 females. The majority were in the 21–30 age group although some clients were older. All clients were heroin/opiate users and 95 % of them injected drugs.

Drug treatment has not been implemented in the prison setting so far, but there are plans to implement drug treatment in prisons within the current national drug strategy.

See also the summary of treatment responses in Bosnia and Herzegovina below.

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Drug-related infectious diseases

Bosnia and Herzegovina has recorded AIDS statistics since 1986/87, and HIV infection has also been included since 2003. By the end of 2009, the total number of registered HIV-positive individuals was 163 (of that number, 129 were males). In 2009, six new cases, all among males, were recorded. The route of transmission is predominantly heterosexual; 21 IDUs were recorded or 13 % of the total. Of the total 21 infected IDUs, 19 were male. In 2007–09, no new HIV infection was reported in IDUs (6).

No regular statistics on reported incidence of hepatitis B and hepatitis C related to drug use have been maintained.

The prevalence data of HIV and hepatitis C (HCV) among IDUs in Bosnia and Herzegovina is based on two sero-behavioural surveys conducted by UNICEF in 2007 and 2009 in Sarajevo, Banja Luka and Zenica. The prevalence of HIV among IDUs in Bosnia and Herzegovina appears to be very low in both surveys, however, the results of the studies suggest an increase in HCV prevalence among IDUs between 2007 and 2009 (Table 2).

Table 2: HIV and HCV prevalence among IDUs in Sarajevo, Banja Luka and Zenica in 2007 and 2009

City HIV (abs. number/sample size) HCV (% (95% CI))
2007 2009 2007 2009
Sarajevo 1/260 1/261 46.2 (37.8–54.0) 49.7 (40.9–58.2)
Banja Luka 1/260 2/260 43.4 (35.8–51.5) 50.6 (42.8–59.0)
Zenica 0/260 0/260 18.9 (12.9–27.4) 19.5 (12.3–27.2)

Source: UNICEF BiH, 2007a and 2010.

Use of sterile injection equipment during the last injection was reported by 86 % of IDUs in Sarajevo, 74 % in Banja Luka and 78 % in Zenica. However, one-third of respondents in 2009 had within the last month, injected with needles or syringes already used by someone else, and nearly one-third of respondents had given their used needles and syringes to one or more other persons in the past month. In the month preceding the survey, pharmacies were a more common source of sterile needles and/or syringes than harm reduction services.

However, the 2009 study also found a positive trend in the extent of provision of harm reduction interventions, as well as an increase of safe injection practices and sexual behaviour compared with 2007. There was an increase in the proportion of IDUs using condoms with casual sex partners, decreased sharing of injecting equipment and an increase in HIV testing among IDUs. Greater awareness of risk factors and increased use of local harm reduction services were also observed. The proportion of IDUs who received sterile injecting equipment in harm reduction services increased between 2007 and 2009 from 1 % in 2007 to 14 % in 2009 in Banja Luka, from 6 % to 39 % in Sarajevo and from 8 % to 41 % in Zenica.

In 2010, NGO Viktorija conducted a survey on HIV and HCV prevalence in prisons through administration of testing to 143 persons in Tunjice prison. Among those tested, 42 were IDUs, 78 other prisoners and 23 were employees. Approximately 50 % of IDUs tested positive for HCV. One percent of other (non-IDU) prisoners and none of employees tested positive for HCV. No case of HIV infection was detected.

(6) European Centre for Disease Prevention and Control (ECDC)/WHO Regional Office for Europe. HIV/AIDS surveillance in Europe 2009. Stockholm: ECDC; 2010.

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Drug-related deaths

In Bosnia and Herzegovina, there are two forensic medical institutes — the Institute for Forensic Medicine of Republic of Srpska in Banja Luka and the Institute of Forensic Medicine, Medical Faculty of Sarajevo University in the Federation of Bosnia and Herzegovina. The individual forensic pathologists are located in Tuzla, East Sarajevo, Mostar, Bihac and Trebinje.

To date, no data on direct drug-related death have been systematically collected in Bosnia and Herzegovina. Procedures for autopsy and toxicological analysis have not been standardised, and thus they vary across the country and entities.

In 2010, the Commission on Drugs of the Council of Ministers adopted a proposal to form two reference forensic toxicological laboratories in Bosnia and Herzegovina in above-mentioned forensic medical institutes. The proposed Law on the Prevention and Suppression of Drug Abuse, which is awaiting adoption by the parliament, also specifies that in all drug-related death cases, an autopsy and toxicological analysis of body fluids and internal organs shall be performed.

In December 2010, the first forensic toxicological laboratory opened in the Department of the Institute for Occupational Medicine of Canton Sarajevo allowing for quantitative analysis of psychoactive substances in biological samples (blood, urine, tissues and hair) using the GC-MS method; until that, the samples of biological material taken from cadavers were sent for analysis to neighbouring countries.

Since 2009, data on drug-induced deaths is available from Sarajevo Canton, Una-Sana Canton in the Federation of Bosnia and Herzegovina and Banja Luka in Republika Srpska. These regions represent approximately one quarter of the total population of Bosnia and Herzegovina aged 15–64 years. In these three regions, 16 drug-induced deaths were identified in 2009; of 11 with known gender and age, six were male and five were female, aged from 16 to 50 years. Five cases were identified in Banja Luka, all of them among registered drug users. (A complete autopsy was performed in one case, external examination was performed in four cases, but toxicological analysis was not undertaken in any of these five cases). Nine cases (five males, four females, aged 17–50) were reported in Sarajevo out of a total of 247 examinations and autopsies performed in 2009 (two fatal poisonings by antidepressants and three confirmed case of heroin overdose; in the other cases, toxicological analysis was not performed), and two fatal heroin overdoses were reported from Una-Sana Canton (a 16-year-old female and a 36-year-old male). However, it is worthwhile to note that the available data may be incomplete, and therefore do not provide a complete view of drug-related mortality in Bosnia and Herzegovina. After extrapolating those 16 deaths to the total population of Bosnia and Herzegovina, the overdose-related mortality rate in the country in 2009 can be estimated as 25.5 deaths per million population, aged 15–64.

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Treatment responses

Medical treatment

In the post-war period, the Ministries of Health in the Federation of Bosnia and Herzegovina, Republika Srpska and Brcko District, with the assistance of the World Health Organization (WHO), the World Bank, Swedish SIDA and Holland HealthNet International, reformed the Mental Health System through deinstitutionalisation of — at that time — the existing mental health system and its reorientation towards the community of psychiatry.

There are 40 community mental health centres (MHCs) in 10 cantons in the Federation of Bosnia and Herzegovina, 18 MHCs in Republika Srpska, and one in Brcko District. They provide outpatient treatment and counselling for drug users, though drug users are not their only target group.

In Sarajevo, the Public Institute for Alcoholism and Substance Abuse of Canton Sarajevo is a specialised institution for prevention, treatment and rehabilitation of disorders related to drug use and addiction. The Institute has two departments — one for alcoholism and another one for drug addiction. The department for drug addiction has an inpatient detoxification unit with 10 beds and an outpatient unit for the MMT programme. The Institute also has two counselling units.

At the Psychiatric Clinic in Banja Luka, the department for treatment of addiction has the MMT programme and a unit for detoxification.

Six centres provide methadone maintenance treatment in Bosnia and Herzegovina: four in the Federation of Bosnia and Herzegovina (Sarajevo, Zenica, Mostar, Sanski Most), and two in Republika Srpska (Banja Luka and Doboj). In 2009, maintenance treatment with buprenorphine (Suboxone) started in Tuzla (the Federation of Bosnia and Herzegovina), but in 2010, it started in Sarajevo.

The MMT programmes in Sarajevo and Zenica use the liquid form of methadone. In other cantons of the Federation of Bosnia and Herzegovina (Mostar and Sanski Most), tablets are prescribed which increases its misuse risk. The MMT centre in Banja Luka also uses liquid methadone.  Methadone tablets are available on prescription in (some) pharmacies in some cities of Republika Srpska. The average dose of methadone in the Sarajevo centre is 50.5 mg/day, in Banja Luka, 70 mg/day.

In the Sarajevo Canton, the criteria for the provision of MMT are stipulated in the Cantonal Addiction Prevention Programme (the other cantons have no officially defined criteria). Criteria for inclusion are that clients must: be over 18; have used opiates for more than two years; exhibit symptoms of addiction according to ICD-10; and have been treated at least twice at hospital-based institutions previously. The programme foresees that the treatment can be provided only through certified health institutions. The same inclusion criteria are used in the MMT in Banja Luka. The MMT programme can be short term (up to six months) or long term (more than six months, sometimes for a lifetime).

A methadone detoxification programme is implemented in inpatient wards in Sarajevo, Zenica and Banja Luka. Detoxification can be long-term (reducing the dose within a period longer than one month) or short term (one month and less).

In 2009, UNICEF supported the sero-behavioural study which also explored IDUs’ contact with treatment facilities. An estimated 70 % of the IDU population in Sarajevo, 50 % in Banja Luka and 48 % in Zenica has undergone drug treatment in their lifetime. Out of those who have ever been treated, 28 % in Banja Luka and 63 % in Zenica are currently in treatment. In Sarajevo and Zenica, a large majority (97 % and 79 %, respectively) of those who are currently treated are undergoing MMT, while in Banja Luka 47 % are trying to treat addiction on their own. The survey also found that access to and utilisation of healthcare services by female IDUs is limited.

Therapeutic communities for drug users

There are 11 therapeutic communities in Bosnia and Herzegovina, some operated by religious communities, others by NGOs and one governmental (Campus Rakovica — Sarajevo). Three therapeutic communities (in Aleksandrovac — Banja Luka, in Banja Luka, and in Majčino selo — Medjugorje) accept female users.

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Harm reduction responses

Four NGOs work in the area of harm reduction, employing low-threshold and outreach approaches. Three implement needle and syringe programmes (NSP):

  • the Association for Assisting Drug Addicts (UG PROI) operates a drop-in centre and outreach programme in Sarajevo;
  • the Association Margina operates outreach programmes in Tuzla, Zenica, Mostar, Sarajevo in the Federation of Bosnia and Herzegovina and Doboj in the Republika Srpska;
  • the Association Poenta operates a drop-in centre and outreach programme in Banja Luka;
  • the Association Viktorija provides low threshold services, except a needle and syringe programme, including a therapeutic community in Banja Luka. 

In the framework of the programme ‘Coordinated national response to HIV/AIDS and tuberculosis in war-torn and highly stigmatised settings, between 2006–08’, 4 326 contacts with IDUs (out of which 825 were new contacts) were registered; 44 247 needles, 26 405 syringes, 9 215 condoms and 690 items of information material were distributed in the Federation of Bosnia and Herzegovina. In the framework of the above-mentioned programme, 1 980 contacts with IDUs were reported (out of which 400 were new contacts), 25 241 condoms and 20 991 items of information material were distributed in Republika Srspska during the same period of time.

In 2009, 46 000 harm reduction kits, 145 604 needles (133 537 in the Federation of Bosnia and Herzegovina and 12 067 in Republika Srpska), and 96 040 syringes (88 640 in the Federation of Bosnia and Herzegovina and 7 400 in Republika Srpska) were distributed in Zenica, Sarajevo, and Banja Luka.

There is a network of 19 Information, voluntary counselling and testing centres (VCTCs) in Bosnia and Herzegovina located at departments for infectious diseases or public health institutes in major cities. They provide anonymous and free-of-charge HIV testing and pre-test and post-test counselling on the basis of informal consent. In 2010, approximately 7 194 clients were tested (15 were found to be HIV positive), 7 068 pre-test and 6 361 post-test counselling sessions were performed, 22 197 condoms and 12 227 information materials were distributed to clients of VCTCs.

See also information on the utilisation of harm reduction services in the chapter on Drug-related infectious diseases.

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Drug markets and drug-law offences

Bosnia and Herzegovina has a strategic location on the Balkan route, which connects drug production centres in Asia and the markets in western Europe. The country has thus become a regional traffic centre for international trafficking of narcotics in Europe.

There are two (sub)routes for trafficking of heroin from Turkey to Croatia (via Serbia and also via Kosovo and Montenegro) and three (sub)routes for trafficking of herbal cannabis (one from Serbia and two from Albania to Croatia).

The purity of seized drugs is not investigated at the moment in Bosnia and Herzegovina.

According to police data, the street prices of narcotic drugs varies by city (see Table 3). The seizure data for 2008–10 are provided in Table 4.

Table 3: Street prices of drugs in euros in the three cities of Bosnia and Herzegovina in the first semester 2010

Drug Street price, 2010 (EUR)
Sarajevo Banja Luka Mostar
Heroin (1 g) 25 15–25 25
Herbal cannabis (1 g) 1–7 2–3 1.5
Cocaine (1 g) 25–50 40–60 50
Ecstasy (1 tbl.) 2.5 2.5–5 1.5–5
Amphetamine (1 g) 10 7.5 10

Source: Ministry of Security BiH.

Table 4: Seizures of drugs in Bosnia and Herzegovina, 2008–10

Drug 2008 2009 I-VI 2010
Heroin 18 000 g 27 921 g 14 170 g
Cocaine 1 000 g 3 991 g 2 135 g
Ecstasy 11 039 pcs 543 pcs + 225 g 16 821 pcs
Amphetamine 3 583 g 769 g 1 080 g
Herbal cannabis 275 000 g 90 000 g 106 934 g
Skunk n.a. n.a. 244 225 g
Cannabis resin 238 g 17 g 3 g
Cannabis plants 2 718 pcs + 649 g 3 812 pcs 2 472 pcs
Cannabis seeds 443 pcs + 3 000 g 3 597 pcs + 460 g 2 923 pcs + 64 g
Heptanon (methadone pills) 75 pcs 110 pcs 29 pcs

 Source: Ministry of Security BiH.

Due to a large number of law enforcement agencies and their decentralised character, the data collection system on police arrests for drug crime is not integrated at the state level. This is also the case with the judicial system in Bosnia and Herzegovina. However, the Ministry of Justice has, since 2006, maintained the first centralised database on drug law offences. In the first six months of 2010, there were 617 criminal offences related to narcotic drugs in Bosnia and Herzegovina, a 11.5 % decrease compared to the same period in 2009.

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National drug laws

The Law on Prevention and Combat against the Abuse of Narcotics in Bosnia-Herzegovina came into force on 15 February 2006. The Law’s implementation involves the participation of the four state-level ministries — the Ministry of Civil Affairs, the Ministry of Security, the Ministry of Trade and Economic Relations, and the Ministry of Finance and Treasury, Ministry of Justice, Agency for Medicines and Medical Devices of BiH. The Ministry of Security set up a department specifically to work on the implementation of the Law within its area of responsibility and to monitor an implementation of the Law in other ministries.

The Law’s adoption has significantly improved the coordination of drug-related law enforcement and demand-reduction measures in Bosnia and Herzegovina. Its adoption has been integrated at the State level: thus specific state-level ministries have been put in charge of its implementation and the adoption of a system of measures, that lower levels of government are obligated to implement (in both the entities and the Brcko District). The law on drugs as lex specialis in combating the abuse of drugs provides for:

  • the establishment of special bodies in charge of combating drug crime and the drug use (7);
  • the classification of plants and substances as narcotics, psychotropic substances, plants from which one may obtain drugs or precursors, according to the regime of bans or controls that are applied against them, and according to their types and characteristics;
  • the purpose and conditions allowed for growing plants from which one may obtain drugs, and the conditions for the production, transport and possession of drugs, psychotropic substances and  plants from which one may obtain drugs and precursors;
  • framework measures for combating drug crime.

The criminal codes of Bosnia and Herzegovina and of the entities (including Brcko District) addresses trafficking and unauthorised production, possession and sale of narcotic and psychotropic substances as well as the promotion of drug use. Police forces do not make allowances for possessions for personal use or possession in small quantities. This causes problems when harm reduction such as provision of needles and syringes are implemented, as possession of dirty syringes might be considered as misdemeanour in Republika Srpska and as a crime in the Federation.

(7) Abuse of narcotic drug or illicit drug use is by law defined as the cultivation of the plant from which a narcotic drug could be obtained, possession of the means for the manufacture of a narcotic drug and manufacture, traffic in and possession of a narcotic drug, psychotropic substances, plants or the part of the plant from which a narcotic drug could be obtained or precursors, as well as the use of narcotic drugs outside therapeutic indications, in excessive dose levels, or over an unjustified period of time (Source: Law on prevention and suppression of the abuse of narcotic drugs).

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Coordination mechanism in the field of drugs

Tackling the abuse of narcotics in Bosnia and Herzegovina is addressed in the Law on the Prevention and Combat of the Abuse of Narcotics. This Law defines the bodies responsible for the coordination of the state drug policy as well as operational bodies directly tackling the drug problem. Responsibility is divided among several bodies:

  • The Independent Commission for Drugs coordinates the activities of ministries, independent administrative organisations involved in implementing the Law, which is the basis for action by authorities, institutions, associations and other legal and natural persons. The Commission for Drugs has been established by the Council of Ministers, and the members are: the Ministries of Health (the Federation of Bosnia and Herzegovina, Republika Srpska and Brcko District), the Deputy Minister of Finance and Treasury, the Deputy Minister of Foreign Trade and Economic Relations, the Deputy Minister of Security and the Deputy Minister of Justice and the Head of Department for Drugs from the Ministry of Security. It is chaired by the Minister of Civil Affairs.
  • The Department for Prevention of Abuse of Narcotics at the Ministry of Security is in charge of the systematic gathering of data and monitoring of the phenomena, of collecting and processing data required for preventing and combating illicit drug trafficking and other criminal offences related to the abuse of narcotics, and coordination of activities conducted by the police, customs and other bodies in the fight against the abuse of narcotics. It also works on international cooperation with the countries of the region and with representatives of the European Union in the domain of security, and monitors the implementation of the Law on the Prevention and Combat of the Abuse of Narcotics. This Department performs tasks assigned by the Commission for Drugs. It also maintains a database on the import and export of narcotic substances and plants from which one may obtain narcotic drugs and precursors and cooperates with operational police forces in this regard.
  • The Agency for Medicines and Medical Equipment, pursuant to the Law on the Prevention and Combat of the Abuse of Narcotics, is responsible for the authorisation of narcotic and psychotropic substances for legal (medical) purposes in Bosnia and Herzegovina.
  • The Ministry of Trade and Economic Relations is responsible for control of plants containing narcotic and psychotropic substances.
  • Customs and the Border Police are responsible for controlling the import and export of drugs and precursors.

The National Strategy adopted by the Parliament in March 2009 provides for the establishment of a central Office for Drugs at the State level, which will take over most of the competencies in the coordination of drug policy. In September 2009, the Council of Ministers of Bosnia and Herzegovina adopted the National Action Plan for the Fight against the Abuse of Narcotic Drugs for the period 2009–13. An evaluation of the implementation of the Action Plan in 2009 is in progress. The Commission for the Destruction of Confiscated Narcotic Drugs was established in 2009.

In 2011, the Draft Law on Amendments to the Law on the Prevention and Combat of the Abuse of Narcotic Drugs will be submitted for adoption and it envisages the following main changes:

  • clear division of responsibilities among bodies involved in supervision of production and trade of narcotic drugs and precursors in Bosnia and Herzegovina;
  • clarification of procedures in the destruction of seized drugs;
  • introduction of the requirement for autopsy and toxicological analysis of the post-mortem biological samples in all cases of suspected or obvious drug-related deaths;
  • setting-up the register of drug-related deaths in the Ministry of Civil Affairs;
  • establishment of the Office for Drugs, a professional multidisciplinary team of experts responsible for the coordination and supervision of all activities envisaged under the Drug Strategy and its Action Plan, especially in the field of prevention, medical treatment, rehabilitation and social reintegration, training, statistics and research as well as evaluation of interventions.

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References

Cerić, I., Loga, S., Sinanovic, O. et al. (2001), ‘Reconstruction of Mental Health Services in Bosnia and Herzegovina’, Medicinski Arhiv, Volume 55(1) suppl. 1, pp. 5–23. 

Cerić, I., Mehić-Basara, N., Oruč, L., Salihović, H. (2007), ‘Zloupotreba psihoaktivnih supstanci i lijekova’, Medicinski fakultet, Sarajevo.

European Centre for Disease Prevention and Control (ECDC)/WHO Regional Office for Europe, (2009), HIV/AIDS surveillance in Europe 2009, ECDC Stockholm, 2010.

Hasečić, H., Mehić-Basara, N., Pokrajac, M., Marjanović-Čengić, S., Selman, S., Ploskić, S., Ramić, L., Balić, A., Grabovica, M., Havić, E., Šukurović, N. (2003), ‘Iskustva primjene metadonske terapije u Zavodu za alkoholizam i druge toksikomanije Kantona Sarajevo’, Medicinski Arhiv, Volume 57 (5–6, supl.1).

Hudolin, V. (1982), ‘Istina o drogama’, Jugoslavenska medicinska naklada, JUMENA, Zagreb.

Loga, S. et al. (1999), Klinička Psihijatrija, Medicinski fakultet u Sarajevu i Tuzli.

Mehić-Basara, N. (2007), ‘Efekti primjene metadonskog tretmana kod ovisnika o opijatima, magistarski rad’, Univerzitet u Sarajevu, Medicinski fakultet, 2007.

Ministarstvo zdravstva Kantona Sarajevo (2008), Inovirani Program prevencije narkomanije, alkoholizma i drugih ovisnosti, za period 2008—12, godine, Kanton Sarajevo, Ministarstvo zdravstva, Sarajevo.

Pekić, S., Smailbegović, T. (2006), Priručnik za multdisciplinarni pristup prevenciji  zloupotrebe psihoaktvnih supstanci, Udruženje za prevenciju ovisnost i smanjenje štete LINK, Sarajevo.

Public Health Institute of Federation of Bosnia and Herzegovina (2008), ESPAD 08 — The European School Survey Project on Alcohol and Other Drugs, Federation of Bosnia and Herzegovina Country Report, Public Health Institute of FBIH, Sarajevo.

Public Health Institute of Federation of Bosnia and Herzegovina (2002), The Health Behaviour of School Children (HBSC) — Federation of Bosnia and Herzegovina, Public Health Institute of FBIH, Sarajevo.

Siljak, S., Stojisavljevic, D., Niskanovic, J. (2008), ‘European Investigation on Use of Drugs, Tobacco and Alcohol Among Secondary School Students’, Report for Republic of Srpska, 2008, Public Health Institute of Republic of Srpska, Banja Luka.

UNDP Bosnia and Herzegovina (2008), The curricula of HIV/AIDS courses, training for medical staff in primary health care.

UNICEF Bosnia and Herzegovina (2007a), ‘Biological and Behavioural Survey among Injection Drug Users, Bosnia and Herzegovina’, UNICEF, Sarajevo.

UNICEF Bosnia and Herzegovina (2007b), ‘Review of legislation, policies and practices, access to adolescents to information and health services with regard to HIV/AIDS and SPIs’, UNICEF, Sarajevo/Banja Luka.

UNICEF Bosnia and Herzegovina (2008), ‘Behavioural research among adolescents in collective accommodation in BiH’, UNICEF, Sarajevo/Banja Luka.

UNICEF Bosnia and Herzegovina (2010), ‘Report on behavioural and biological surveillance among injection drug users in Bosnia and Herzegovina, 2009: A respondent-driven sampling survey’, UNICEF/UNDP, Sarajevo/Banja Luka.

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Working group of the Country overview report

Milana Škipina
coordinator CO, Commission for Drugs, Ministry of Security BiH

Sabina Šahman–Salihbegović
Ministry of Civil Affairs BiH

Jasmin Pljevljak
Ministry of Security BiH

Dr Nermana Mehić–Basara
Federal Ministry of Health FBiH

Jelena Niškanović
Institute for Public Health RS

Dr Nera Zivlak-Radulovic
Ministry of Health RS

Dr Nermin Sarajlic
Institute for Forensic Medicine and Forensic Toxicology FBiH

Dr Aida Pilav
Ministry of Health FBiH

Under the supervision of:

Viktor Mravcik
Head of the Czech National Focal Point for Drugs and Drug Addiction

Alan Lodwick
Head of the UK National Focal Point for Drugs and Drug Addiction

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Page last updated: Monday, 03 March 2014