Reduction of drug related harm in Montenegro

Evaluation of a century of international efforts invested in controlling drugs, done by UNODC, showed that the system of drugs controlling and its application had some sideffects. One of these is lack of investments solving the question of harmfull consequences for public health caused by drug use. With global acceptance of the fact that drug dependence is a chronical, but preventable disease, but also a disease that one can be cured or recovered from, a widely accepted standing point is that measures and interventions directed towards achieving apstinence and recovery have to be accompanied by measures that can significantly contribute to decrease of risks and harmfull consequences of drug use. Today, interventions in the area of risk prevention and harm reduction are considered fundamental and necessary, due to the fact that there is a wide scope of evidences that can prevent disease, save lives and protect the community. On a global level we have a highly present tendency that the practice of drug use harmful consequences’ reduction is being spread and finds its application in the area of illegal, but also legal psychoactive substances use, as well as in the work of the law enforcement services. In the same time the concept of harm reduction became a mean to achieving golas of the public health policies, policies in the area of community security, policies of social protection aiming to decrease social, legal and economic problems related to psychoactive substances use.

Harm reduction approach and interventions derived from it have been introduced on a larger basis, principally as a response to a high number of overdose cases as well as fast spread of HIV&AIDS and other STIs due to intrevenous drug use. From the perspective of public health, subpopulations with a high infections burden have direct and indirect onerous effect on the society, and prevention can substantially limit these effects. The first effect is direct morbidity due to heavy forms of chronical infections, having high treatment expenses as a result. The second is reflected in the lost of human productivity, which increases social expenses. The third is high prevalence of diseases among persons who use drugs, which, especially if sustained a long period of time, can increase the risk in the wider population. Practice shows that harm reduction measures represent a noteworthy input to the conventional public health approach, can have a strong effect on spreading blood-borne and other infections among people who inject drugs, therefore the society in general. Prevention is feasible and effective if populations most at risk of acquiring infection have been provided with adequate services, in an adequate manner, in their own surrounding and in the adequate time.

Harm reduction measures, i.e. prevention and reduction of mortality, reduction of health and social risks and harms, as well as general feeling of insecurity of the community due to drug use,in most countries of Europe and world represent an integral part of national strategies and policies of fight against drugs, applied in different scope and combinations, dependant to drug policies’ goals. All European and international refferent organizations and bodies strongly support harm reduction as an efficient, evidence based approach to prevention of infective diseases transmition and treatment of persons who use drugs.

Harm reduction approach has been supported by the “Strategy of Montenegro for prevention of drug abuse 2013 – 2020”, but there is no unique national doctrine, i.e bylaws that regulates this particular area. Although there are the most important harm reduction services set in place, which proved their worth and necessity on multiple occasions, ending of a nine year long donation program of the Global Fund for Fight against AIDS, Tuberculosis and Malaria in July 2015, brought the sustainability of certain services into question and the same are facing closure. This is especially related to service functioning within the NGO sector, without which the harm reduction approach in a certain country can not be neither complete nor efficient, daily centers i.e. drop in centers for people who inject drugs and outreach work with most at risk populations in respect to HIV, Hepatitis C and B. In order to make services mentioned mentainable and developed according to growing needs, it is necessary to permanently secure their functioning and sustainability. Due to all things mentioned it is necessary to adopt this document as a referent conceptual and practical framework for further development and improvement of the national policy in the domain of reduction of harm caused by drug use in Montenegro, according to strategic goals set. Drug users’ access to adequate treatment must not be a priviledge, but a right coming from the fundamental right to health, as well as an obligation of every responsible system. Likewise, the possibility of access to programs and measures of decreasing drug related harm represents the right of every individual, which must be recognized as such.

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