Treatment of stimulants addiction
in “the former Yugoslav Republic
of Macedonia”
M-r.d-r Lillian Ignjatova
Amphetamines
• In the Republic of Macedonia ecstasy
tablets appear in 1996/7.
• Their high cost ( 12 Euro for tablet), low
availability as well as their increasing
demand has led to amphetamine
appearing on the Macedonian market.
Amphetamine
• It was not clear until 2000 that the name of
ecstasy was used for various drug types based
on amphetamine.
• After recognizing amphetamine as a drug
different from ecstasy tablets, it started to be
sold as a powder substance.
Cocaine
• In this period cocaine use was low but stable.
• In 2009 in capital Skopje there were 138 registered
cocaine users from all 4476 registered drug users [1]
[1] Ministry of interior
First stimulants seizures in the Republic of
Macedonia
[2] Ministry of interior
1991
1992-1995
1996
1997
1998
1999
2000
2001
2002
Cocaine
(in kg)
39
/
/
0.011
0.040
2.955
4.689
5.860
0.342
Amphetamines Ecstasy
(Tabl.)
/
/
/
/
65
/
184
/
787
/
5532
/
280
/
45
/
7.15
159
Drug seizures in 2009 in the Republic of
Macedonia
4 cases - amphetamine
6 offenders( 5 Macedonians and 1 Albanian) for
Article 215 of the Penal Code: "llicit drug
production and release of narcotic drugs,
psychotropic substances and precursors")
96 tablets and 11,5 g powder amphetamine
1 case - methamphetamine
5 offenders
2263 tablets [3]
[3] Ministry of Interior
ESPAD 2008
• 3.2 % of students had used ecstasy
(3 times more compared to 1 % in 1999),
• 2.1 % having used it in the last 12 months
• 1.6 % in the last month;
• 1,7% of students had used amphetamine
(4 times more compared to 0,4% in 1999).
[4]ESPAD 2008
Stimulants users in needle exchange
program in Skopje
( N=1468)
Ever used drug
•
Cocaine
Creek
Amphetamine
Ecstasy
605
103
228
485
From total number of 1468 new clients in
needle exchange program - Skopje mainly
opiate users 605 ever used cocaine, 103
creek, 228 amphetamine, 485 ecstasy.
Stimulants users in needle
exchange program in Skopje
( N=1468)
Cocaine
70
More often used drug
Creek
Amphetamine
13
40
Ecstasy
104
• From total number of 1468 new clients in
needle exchange program - Skopje mainly
opiate users 70 use cocaine as more often used
drug, 13 creek,40 amphetamine, 104 ecstasy.
Combination with other drugs
• These drugs types are most often used in
combination with other drugs.
• Users combine drugs with opposite or similar
effects.
Combination with other drugs
According to them,
• rich people use
amphetamine and
cocaine,
while
• poorer people use
amphetamine and
heroin or methadone.
Never know???
• There are a number of cases when users believe
they buy cocaine, but they get amphetamine instead.
• In MMT programs some patients witch rapport
cocaine use are positive on amphetamine and
negative on cocaine screen tests.
Demand of treatment
• Their first contact with a medical institution is
- an urgent center due to heartbeat, higher
blood pressure or
- a psychiatric hospital due to certain
psychiatric disorders as a consequence of
stimulants use: fear of panic attack, anxiety, and
depression as well as acute psychotic disorders
in more difficult cases.
• Mainly persons with psychiatric disorders after
using amphetamine are hospitalized in
psychiatric hospitals in the country.
• So, a smaller percentage of these persons ask
for a dependence treatment.
Centers for prevention and
treatment of drug abuse
• Centers for prevention and treatment of drug
abuse are not attractive for users of only
cocaine, amphetamine or ecstasy.
Cocaine/amphetamine/ecstasy
users in MMT
• The number of cocaine/amphetamine/ecstasy users
who are polydrug users in MMT programs in the
Centers for treatment of drug addiction in Republic of
Macedonia is bigger, but there are no users of only
cocaine, amphetamine or ecstasy.
Stimulants users in MMT program
in Skopje
• Our research in The Center for prevention and
treatment of drug addiction in Skopje (capital)
showed that 55 of 102 patients in methadone
maintenance program used cocaine and 32
used other stimulants (amphetamine/ecstasy )
during the treatment[5].
[5]Ignjatova L., Spasovska Trajanovska A., Aleksovska N. 2005
DEFFERENT TYPES OF DRUGS OF USE IN
MMT PROGRAM
number of patients
60
55
50
40
32
30
20
10
0
coca.
other
stimul.
lifetime use
“Treatment with cocaine”
• Some of the patients in methadone maintenance
treatment in Skopje tried to “treat” their
methadone dependence by using cocaine or
amphetamines, so they become addicted of
cocaine or amphetamines.
Centers for treatment of drug
addiction in other cities and in
prisons
• There are 10 centers in the Republic of
Macedonia that are part of the psychiatric
department in the Town’s Hospital.
+
• There are 2 MMT programs in 2 Prisons in the
capital city Skopje.
Treatment of stimulants addiction in
Kumanovo
• In MMT program – total number of
patients is 91.
• There are no patients in MMT program
that used stimulants ????
• There is no request for treatment of
stimulants abuse in the hospital as
well.
• There is no treatment of stimulants
addiction.
Treatment of stimulants addiction in
Stip
• Treatment of stimulants abuse is focused on
treating symptoms in Day hospitals that is a part
of the psychiatric department in the HospitalStip.
• The patients drop out after 3 days on average.
• In MMT program – total number of patients is 42.
• In MMT program Stip – there are no patients
with stimulants addiction ????
• So there is no treatment of stimulants addiction.
Treatment of stimulants addiction in
Kavadarci
• In MMT program – total number of patients is 32.
• There is only one patient in MMT program who
used stimulants in his lifetime period, but he
uses methadone or heroin now.
• There is no request for treatment of stimulants
abuse in the hospital as well.
• There is no treatment of stimulants.
Treatment of stimulants addiction in
Strumica
• In MMT program – total
number of patients is 65
• There is a small number
of patients that used
stimulants in their lifetime
period, but they use
methadone or heroin
now.
• There is no treatment of
stimulants addiction.
Treatment of stimulants addiction in
Gevgelija
In MMT program – total number of patients is 72.
In lifetime period:
10 of them used ecstasy and cocaine
20 of them used ecstasy only at parties
Current use in 2010:
5 of them use ecstasy .
There is no request for treatment.
There is no treatment of stimulants addiction.
Treatment of stimulants addiction in
Tetovo
• In MMT program – total number of patients is 89.
• In lifetime period:
58 of them used cocaine
30 of them used ecstasy
11 of them used amphetamine
3 of them used creek.
Treatment of stimulants addiction in
Bitola
• In MMT program – total number of patients 104
In lifetime period:
20 of them used cocaine
12 of them used ecstasy
10 of them used amphetamine.
• During the treatment:
3 of them used cocaine
10 of them used ecstasy
3 of them used amphetamine.
There is no specific treatment for them.
Amphetamine users with psychosis are admitted in the
Hospital- psychiatric department.
Treatment of stimulants addiction in
Ohrid
Ohrid is town with a lot of tourists, lots of parties
and lots of youths during the summer.
In MMT program there are 112 patients.
During the treatment 1 patient used cocaine ????
There is no specific treatment for stimulants
abuse.
Discussion
• There are no specific treatment programs
for stimulants in Centers for prevention
and treatment of drug addiction and the
treatment is focused on treating
symptoms, without any specific focus on
various aspects and challenges that
various drugs bring with them.
Conclusion
• There are stimulants users.
• We have to attract them.
• A specialized treatment program for
stimulants users is needed and it is
necessary.
Thank you for your attention!
[email protected]