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					 Macedonian Red Cross

     Harm reduction
      Programme

          Overdose
         a major cause of
         avoidable death



____________________________________
Elena Eftimovska, MD
Health Coordinator in Macedonian RC HQ
    Relevant information on
the drug situation in Macedonia




                     Total population
                     2. 022 547




Registered drug
 users 8618
                             10000
                              9000                                                                                                                                 8.619
                                                                                                                                                           8.345
број на корисници на дрога




                                                                                                                                                   7.709
                              8000
                                                                                                                                           7.126
                              7000                                                                                                 6.583
                                                                                                                           6.034
                              6000
                                                                                                             5.030 5.222
                              5000                                                                   4.569

                              4000                                                           3.480
                                                                                     3.000
                              3000                                           2.566

                              2000                                   1.700
                                                             1.377
                                                       837
                              1000   357   395   457
                                 0
                                      1     2     3     4      5       6       7       8       9      10      11    12      13      14      15      16      17      18
                  Official data on drug-related deaths

Forensic Medicine Institute - Medical faculty in Skopje
Forensic medicine wards - general hospitals all over Macedonia

Possible quantity data inaccuracy - autopsies with a toxicology analysis are not always carried
out ( exp. religious reasons)

MAIN CONCLUSIONS:

1. In the period from 2002 to 2007 the total number of drug-related deaths is increasing among
the male population and decreasing among the female population.
             Total number in 2002 - 6 ( 4 males + 2 females)
             Total number in 2007 - 19 (all males)

2. Most common reason for drug-related death is opiate (mostly heroin) overdose - 78.9 %
           10,5 % methadone in combination with other drugs

3. Age distribution in drug-related deaths
           63,2 % - among the age group 25 - 29 years
           21% - among the age group 20 - 24 years

Although the overall number of overdose deaths in the EU remains very high, in
recent years a positive trend has been observed in some countries. Some new
Member States may face a development similar to the one observed in west
European countries at the beginning of the heroin epidemic.
Harm reduction programes
Substitution treatment centers
        Main goal of the harm reduction program

Reducing the individual and community harm inflicted by
                       drug use.
                      Specific goals

       To increase the availability of clean injecting equipment
and condoms among injecting drug users
       To establish contact with a greater number of injecting
drug users and provide them with information about overdose
prevention, health protection, HIV, STI prevention and
treatment opportunities.
       To increase the accessibility of injecting drug users to
health care, social and legal services
       To perform advocacy for public health approaches
towards injecting drug users and to reduce stigma and
discrimination associated with drug use.
             Services offered by our harm reduction program

Drop-in centres with needle exchange and condom distribution
program
Counselling and education of drug users about the consequences
of high-risk behaviour and overdose prevention
Voluntary counselling for HIV, blood borne diseases and STI and
referral and assistance
Publishing of drug-related informational and educational material
Basic medical services for drug users
Psychological support for drug users and their families
Assistance in obtaining social or health insurance
Legal counselling
Outreach activities
Collection of non-sterile drug injecting equipment from public
places
Collaborating with local partners and facilitating local capacity
building for drug prevention and harm reduction programmes
The aim is to increase knowledge and awareness
around the behaviors that increase users’ risk of
overdose.

The messages have been developed in four key
risk areas – purity, tolerance, drug half-life and
using alone. These messages target people who
use heroin and are designed to communicate safer
ways of using heroin.
                                  WHAT ARE RISK FACTORS
                                     FOR OVERDOSE?

• Loss of Tolerance: Regular use of opioids leads to greater tolerance, i.e. more is needed to achieve
the same effect (same high). Overdoses occur when people start using again following a period of not
using (abstinence) such as incarceration, detox or “drug free” drug treatment.

• Mixing Drugs: Mixing opioids with other drugs, especially depressants such as benzodiazepines or
alcohol can lead to an overdose. These combined drugs are “synergistic”, i.e., the effect of taking
mixed drugs is greater than the effect one would expect if taking the drugs separately.
Special note :Cocaine is a stimulant but in high doses it can also depress the urge to breath, so it too
can be particularly risky when combined with opiates.

• Variation in strength of ‘street’ drugs: Street drugs may vary in strength and effect based on the
purity of the heroin ( in Macedonia app. 6% in a single dose) and the amount of other ingredients
used to cut the drug. Users should use small amounts of new batches or inject slowly enough to get a
feel of the quality/strength of the drug (s).

• Serious illness: If users have a serious illness including HIV/AIDS, liver disease, diabetes and/or
heart disease, they are at greater risk for an overdose. Care should be taken when using to check the
strength of the drug, avoid mixing drugs and/or using alone.

Using Drugs Alone is a Risk Factor for Overdose Death
When using drugs alone, there is a particularly high risk that overdose death may occur, because
there is no one present to initiate rescue measures.
Individual overdose risk assessments should be done!

Drug users who have previously experienced a nonfatal overdose are at
very high risk of experiencing future overdoses.

The individual risky behaviors should be identified and addressed if
possible.
                    Obstacles/Challenges
                    - overdose prevention-


1) Unavailability of centres for substitution treatment in Prilep,
   Kicevo and Veles.
 the Macedonian Red Cross is advocating for this almost 2 years

2 ) Naloxone
 registered drug in Macedonia, but not widely available even to the
    Emergency Medical Services
 administration of Naloxone by a non-medical person is not legal

3) Undeveloped data collection, analysis and monitoring system for
   overdose related deaths
                     Future plans



According to the current situation and needs assessment, we
plan to expand the harm reduction programme in the
following:

•Training the stabilized former drug users as peer educators
on overdose prevention and first aid

•Monitoring of the behavioural change among clients
PARTICIPATORY TEAM WORK
A help in need, is a help indeed
 Thank you for your attention!


    Macedonian Red Cross| www.redcross.org.mk |
    Email : health@redcross.org.mk