Macedonian Red Cross Harm reduction Programme Overdose a major cause of avoidable death

5. Macedonia has a relatively well developed network of NGOs that provide harm reduction services (11 harm reduction programs in the bigger cities, among which 3 are run by the Macedonian Red Cross) but the major challenge in the country is the unavailability of centres for substitution treatment (only 10% of the target population is in the substitution programme), which reduces the total impact of the harm reduction programs. The Red Cross traditionally was doing drug preventive educational activities, mainly with the youth and mainly during the traditional Week for fight against alcohol, drugs and smoking. This was merely sufficient to address the drug problem in the country and especially the needs of the vulnerable people who use drugs. This was primarily the reason for starting harm reduction programs parallel to the drug prevention activities aimed at youth population. Macedonia has a relatively well developed network of NGOs that provide harm reduction services (11 harm reduction programs in the bigger cities, among which 3 are run by the Macedonian Red Cross) but the major challenge in the country is the unavailability of centres for substitution treatment (only 10% of the target population is in the substitution programme), which reduces the total impact of the harm reduction programs. The Red Cross traditionally was doing drug preventive educational activities, mainly with the youth and mainly during the traditional Week for fight against alcohol, drugs and smoking. This was merely sufficient to address the drug problem in the country and especially the needs of the vulnerable people who use drugs. This was primarily the reason for starting harm reduction programs parallel to the drug prevention activities aimed at youth population.

9. Drop-in centres with needle exchange and condom distribution program The Drop-in centre premises in the three RC branches (Prilep, Veles and Kicevo) are open on a regularly basis five days per week, four working hours. The hours are adjusted to the request from the clients. The clients are provided with sterile injecting equipment, condoms and educational materials. Counselling and education of drug users about the consequences of high-risk behaviour and overdose prevention All the team members are trained and educated for counseling of the clients on high-risk behavior (needle sharing, reuse of equipment, unprotected sex etc), safer injecting and overdose prevention. Voluntary counselling for HIV, blood borne diseases and STI and referral and assistance Education and counselling on HIV, blood borne disease and STI is also provided for the clients, emphasising the importance of the taking precautious measures and regular testing. Information, referral and assistance in obtaining the tests in the local health institutions is provided. Since 2008, in collaboration with the Ministry of Health and another NGO, RC volunteers were trained in motivating and mobilizing the target groups in order to engage them in the new field testing services. Publishing of drug-related informational and educational material This is essential step I providing information on the services offered in our centres, safer injecting techniques, effect of various drugs, HIV, Hepatitis C and B information. MRC harm reduction manual will be published by the and of March 2009 Basic medical services for drug users The drop - in centers offer basic medical services for mainly skin and vein conditions related to long-term and improper injecting techniques. Psychological support for drug users and their families Psychological support is regularly provided in the drop-in centres and it not confined to the clients, but also the clients� next of kin. Assistance in obtaining social or health insurance The majority of our clients do not know their health and social rights and benefits offered by the relevant institutions. The social worker from the HR teams informs them and helps them prepare the necessary documentation. When necessary they are escorted in the process of obtaining social or health insurance. Legal counselling Legal counselling is also provided once a week for the clients informing them on their human rights and the legal procedures in the country. Outreach activities The outreach activities represent the real true �proactive� approach to offering services to our clients. Three times per week the outreach workers go to the clients, give them sterile injecting equipment, condoms and informational material. The key success in the outreach activities is the engagement of former stable drug users as a bridge to the target population. Collection of non-sterile drug injecting equipment from public places The unsafe disposal of injecting equipment poses a health hazard to the community. Parallel to the education of the clients on safe disposal of their equipment and returning of the used needles and syringes to the harm reduction centers, cleaning of the places were clients frequently inject is another activity of the local teams. Collaborating with local partners and facilitating local capacity building for drug prevention and harm reduction programmes In order to ensure a successful running of the harm reduction programe intensive contact and collaboration with various institutions and organizations were pursued: The Red Cross branches contacted the emergency departments in local hospitals and visited the general practitioners to discuss the acceptance of this kind of patients and their drug therapy as well as referral to secondary or tertiary treatment. Visits to local pharmacies, in particular to those that distribute methadone, and distribution of educational and informational material about the available services through the harm reduction programme. Regular contacts with local police authorities were made in order to ensure support for harm reduction activities. Regular contacts with local NGOs are made for joint actions in harm reduction activities. In collaboration with Roma NGOs, distribution of educational material and informational sessions are held in Roma settlements. Drop-in centres with needle exchange and condom distribution program The Drop-in centre premises in the three RC branches (Prilep, Veles and Kicevo) are open on a regularly basis five days per week, four working hours. The hours are adjusted to the request from the clients. The clients are provided with sterile injecting equipment, condoms and educational materials. Counselling and education of drug users about the consequences of high-risk behaviour and overdose prevention All the team members are trained and educated for counseling of the clients on high-risk behavior (needle sharing, reuse of equipment, unprotected sex etc), safer injecting and overdose prevention. Voluntary counselling for HIV, blood borne diseases and STI and referral and assistance Education and counselling on HIV, blood borne disease and STI is also provided for the clients, emphasising the importance of the taking precautious measures and regular testing. Information, referral and assistance in obtaining the tests in the local health institutions is provided. Since 2008, in collaboration with the Ministry of Health and another NGO, RC volunteers were trained in motivating and mobilizing the target groups in order to engage them in the new field testing services. Publishing of drug-related informational and educational material This is essential step I providing information on the services offered in our centres, safer injecting techniques, effect of various drugs, HIV, Hepatitis C and B information. MRC harm reduction manual will be published by the and of March 2009 Basic medical services for drug users The drop - in centers offer basic medical services for mainly skin and vein conditions related to long-term and improper injecting techniques. Psychological support for drug users and their families Psychological support is regularly provided in the drop-in centres and it not confined to the clients, but also the clients� next of kin. Assistance in obtaining social or health insurance The majority of our clients do not know their health and social rights and benefits offered by the relevant institutions. The social worker from the HR teams informs them and helps them prepare the necessary documentation. When necessary they are escorted in the process of obtaining social or health insurance. Legal counselling Legal counselling is also provided once a week for the clients informing them on their human rights and the legal procedures in the country. Outreach activities The outreach activities represent the real true �proactive� approach to offering services to our clients. Three times per week the outreach workers go to the clients, give them sterile injecting equipment, condoms and informational material. The key success in the outreach activities is the engagement of former stable drug users as a bridge to the target population. Collection of non-sterile drug injecting equipment from public places The unsafe disposal of injecting equipment poses a health hazard to the community. Parallel to the education of the clients on safe disposal of their equipment and returning of the used needles and syringes to the harm reduction centers, cleaning of the places were clients frequently inject is another activity of the local teams. Collaborating with local partners and facilitating local capacity building for drug prevention and harm reduction programmes In order to ensure a successful running of the harm reduction programe intensive contact and collaboration with various institutions and organizations were pursued: The Red Cross branches contacted the emergency departments in local hospitals and visited the general practitioners to discuss the acceptance of this kind of patients and their drug therapy as well as referral to secondary or tertiary treatment. Visits to local pharmacies, in particular to those that distribute methadone, and distribution of educational and informational material about the available services through the harm reduction programme. Regular contacts with local police authorities were made in order to ensure support for harm reduction activities. Regular contacts with local NGOs are made for joint actions in harm reduction activities. In collaboration with Roma NGOs, distribution of educational material and informational sessions are held in Roma settlements.

16. Research is needed to resolve important questions about peer-distribution of opiate antagonists (naloxone). New Member States and candidate countries may be at risk of an increasing trend in overdose deaths, similar to that observed in western Europe. If the new Member States are to avoid the �overdose epidemic� experienced by western Europe, then the implementation of a range of effective measures to reduce overdose risk is now urgently required.Research is needed to resolve important questions about peer-distribution of opiate antagonists (naloxone). New Member States and candidate countries may be at risk of an increasing trend in overdose deaths, similar to that observed in western Europe. If the new Member States are to avoid the �overdose epidemic� experienced by western Europe, then the implementation of a range of effective measures to reduce overdose risk is now urgently required.

17. There is a need to improve drug users� skills to recognize overdoses in their peers and how to react appropriately. This includes providing basic first aid, such as placing victims in the recovery position and waiting with the victim until the ambulance arrives.There is a need to improve drug users� skills to recognize overdoses in their peers and how to react appropriately. This includes providing basic first aid, such as placing victims in the recovery position and waiting with the victim until the ambulance arrives.