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

1. Macedonian Red Cross Harm reduction Programme Overdose a major cause of avoidable death ____________________________________ Elena Eftimovska, MD Health Coordinator in Macedonian RC HQ

2. Relevant information on the drug situation in Macedonia Total population 2. 022 547 Registered drug users 8618

4. 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.

5. Harm reduction programes Substitution treatment centers

7. Main goal of the harm reduction program Reducing the individual and community harm inflicted by drug use.

8. 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.

9. 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

13. 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.

14. 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.

15. 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.

16. Obstacles/Challenges - overdose prevention- • 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

17. 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

18. PARTICIPATORY TEAM WORK

20. 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