Drug abuse in Serbia

Law enforcement response is just one part of the fight against drugs puzzle, prevention is other. It is necessary to reduce drug supply and demand, improve early warning systems and testing services, and reduce harm. Adopting a new strategy to prevent drug abuse in Serbia is a genuine opportunity for change. The article reveals drug use, purity, prices and consequences of drug use, and the fight against drugs in Serbia. It could help shape a new drug strategy.??

At the end of 2021, many girls in Serbia testified on social networks about drink spiking and date rape drugs. At the same time, some media reported that a young man mixed alcohol and drugs with his friends in nightclubs before disappearing in Belgrade around New Year. After such disturbing events, public polemic starts on various questions. How many people consume drugs? Which groups are at the most significant risk? Which drugs are most often used and how much do they cost? What are the health consequences and how to reduce harm? The article answers these questions, which can also be used for a new drug strategy. The validity of the old one expired in 2021.

Drug use

Cannabis is a mainly consumed drug in Serbia. The use of synthetic drugs and cocaine is growing, while heroin is declining. Some of the substitutes prescribed for drug treatment, as methadone, buprenorphine, and accompanying drugs (flormidal, rivotril, bensedin, lorazepam, and bromazepam) are resold on the street to buy illegal drugs. Adolescents use drugs more than adults. Men consume more drugs than women, but the difference is not as drastic as before. Cocaine is more preferred by men than women, who use psychedelic drugs more. Drugs are primarily consumed in urban places, such as Belgrade, Novi Sad and Nis. However, there is still no in-depth research on drug use in rural areas.

Over 4 per cent of Serbian citizens over the age of 15 have tried drugs at least once in their lives, according to the Institute of Public Health Dr Milan Jovanovic Batut research from 2019. Harm Reduction International, a leading international non-governmental organisation dedicated to reducing the negative health, social and legal impacts of drug use, noted 20 500 people in Serbia that inject drugs. According to the European survey on alcohol and drug use from 2019, almost 9 per cent of young people aged 15 to 16 have tried drugs, more in urban than rural areas. Table 1 show lifetime prevalence rates of illegal drug use in Serbia from various studies since 2008.

That young person and Belgrade are especially at risk also show recent research among Belgrade high school students (15-19 years old). Nearly 18 per cent of high school students said they use drugs based on research conducted on a representative sample of 1 287 respondents by Ivana Radovanovi? from the University of Criminal Investigation and Police Studies. Girls use more drugs than boys, but they are the first to stop consuming. Cannabis is the most popular drug among Belgrade high school students (55%), followed by cocaine (13%), speed and ecstasy (8%) and heroin (7%).

Purity, prices and drug use consequences

In Serbia, it is difficult to assess the purity of drugs if you are outside the police structures. That doesn't mean it's not possible. There are tests used by civil society in the region and worldwide at music festivals and clubs to determine the composition of drugs and thus reduce damage to participants' health. However, such testing in Serbia is a criminal offence, so civil society initiatives to allow these services remain unanswered. Impressions of people who use drugs are sources of information because the police in Serbia do not publish data on the composition of seized drugs (but on the quantity and type), which is often intended for foreign markets. Moreover, the police records do not contain such data, as they say in the response from November 2021, although sometimes the statements point out that high-purity drugs were seized.

Impressions are that the quality of cannabis has dropped recently. Moreover, it is challenging to procure cannabis grown outdoors because the market mainly offers cannabis produced in makeshift laboratories. For example, police recently found 343 pots containing cannabis stalks in an apartment building in Zemun, Belgrade municipality. The price of cannabis grown outdoors is higher because there is only one harvest per year, while four to eight in artificial conditions. The purity of cocaine depends on the price—if the price is higher, it is believed to be cleaner and better. The impression of the low purity of heroin in Serbia has been valid among users for a long time.

Cannabis from the laboratory is sprayed with synthetic opiates and stimulants, while cocaine is most often mixed with creatine, ephedrine, anabolics (steroids), painkillers, lidocaine, procaine and benzocaine. Painkillers, lactose, powder, paracetamol, and sometimes even lime or gypsum are added to heroin. The goal is to increase the impact of drugs on consumers (which is sometimes dangerous to health depending on what it is mixed with) or their quantity, reducing the purity of narcotics sold in retail. Unofficially, the purity of the seized cocaine is higher than 20 per cent, heroin from 10 to 15 per cent, and the level of THC in cannabis is 15 per cent or less.

The retail prices of narcotics in Serbia are different, as shown in Table 2. The cheapest is cannabis, followed by synthetic drugs. In the middle is heroin, while cocaine is the most expensive and is still considered the drug of the rich. The price per gram is reduced if it is bought in bulk so that the "bomb" (4-5 grams of heroin) costs around 30-40 euros in Belgrade. It is easy to get drugs if the individual moves in circles where drugs are consumed or knows someone from that environment. Drugs in Serbia are most often procured by phone calls or sending messages via applications such as Messenger, WhatsApp or Viber. The use of social networks, communication groups or the darknet is rare, but there are sporadic cases.

There are no rules in the frequency of drug consumption, but it depends on social and economic factors, i.e. in what society an individual moves and how much money they have. Cannabis and heroin are most often used daily, while cocaine and synthetic drugs are used once a week, mostly on weekends. Domestic cannabis and synthetic drugs (speed and ecstasy) can be found in Serbia. At the same time, cocaine from Latin America enters Serbia, mainly from Montenegro, Croatia and Hungary, and heroin to Afghanistan via Iran, Turkey and Bulgaria. Also, synthetic drugs arrive in Serbia from Western Europe (the Netherlands and the Czech Republic), and cannabis from Albania, Montenegro and North Macedonia.

Fatal overdoses, hepatitis c, mental disorders and mental illness are the main consequences of drug-related problems. From 2008 to 2019, 735 people died due to drug use, the most in 2008 (117) and 2009 (119), according to the Drug Policy Network Southeast Europe study. From 2017 to 2019, there was a slight increase in drug-induced deaths, as shown in Chart 1. However, there is a dilemma that official data do not show accurate estimates because it does not go deeper into examination, for example, why young people die from heart disease. The consequence is registered but not the cause.

Cocaine use is mainly associated with heart problems, while liver disease and hepatitis c are associated with opiates. Heroin users in Serbia often have abscesses and thrombophlebitis, while hepatitis c is widespread. Mental health and drug use are correlated. Depression is associated with abusing all illegal drugs, while psychosis is associated with stimulants. Recently, there have been examples where parents call civil society service providers that their children use cannabis as a strong sedative, so young people cannot physically function and sleep without cannabis, especially in the evening.

Fight against drugs

Most often, the amount of seized drugs and the number of detected crimes, indictments, and verdicts are used to argue how successful the institutions are in the fight against drugs. However, the repressive response is only part of the complex puzzle of the fight against drugs. It is necessary to reduce supply and demand, improve early warning systems and drug testing services, and reduce and mitigate the harmful effects of drug addiction.

The police in Serbia are increasing and breaking records of drug seizures yearly. In contrast, the number of detected criminal offences related to drugs does not change drastically—on average, about 10 000 from 2018 to 2020. At the meeting of the Police Directorate in November last year, it was pointed out that the police seized almost eight tons of drugs in the first ten months of 2021, which is a record in the last ten years. Such data indicates that there are more drugs on the streets of Serbia or that the police are doing their job better. Cannabis is the drug Serbian police seize the most, while cocaine is the least.

According to the Institute for Criminological and Sociological Research, one-third of prisoners in Serbia have been convicted of drug-related crimes. It is often associated with property crimes, i.e. thefts and robberies. Official statistics show that the number of crimes committed by under 18 is stagnating. However, the increase in the number of perpetrators in the group of 19 to 30 is worrying. Young people who use drugs typically turn to their peers for help and less to institutions.

Drug treatment and harm reduction programs (usually needle exchange) and user support programs are available in Serbia. The most recognisable programs are the Special Hospital for Addiction Diseases, known as Dreiser's in Belgrade, and replacement programs for needles and syringes offered by civil society organisations such as Prevent from Novi Sad, which also operates in Belgrade. Organisations such as Restart from Novi Sad and Neostart from Belgrade offer support to drug users. Regeneration from Belgrade is committed to safer night environments and reducing harm with recreational drug use.

However, all these programs are not enough to cover the whole country. They are mainly focused on opiate users (heroin), and there is no adequate monitoring and evaluation of the program's quality. The main focus is a physical addiction, which, although successful initially, produces poor results in the long run without psychological help.

Detoxification, substitution therapy, extended psycho-social support (more than two weeks) are services provided by state health institutions in Serbia (primary health care centres, general hospitals, clinical centres, special and prison hospitals). In Serbia, individual counselling and supportive therapy are the most common forms of extended psycho-social support. There are no state institutions with dedicated services to help women, providing sterile injection equipment for intravenous drug users and field services for street drug users. In addition, there are private addiction clinics offering services such as Vorobljev and Lorien and religious groups such as the Reto Centre, the Rainbow Centre, or the Land of the Living. There are no secular groups.

Look to the future

At the end of 2021, the validity of the strategy on drug abuse prevention expired. Its evaluation is ongoing. The new plan in Serbia should be in line with the European Union's 2020 strategy and involve all relevant actors equally—from the Office for Combating Drugs through the police and civil society to health institutions. Government should reactivate the commission for the prevention of drug addiction in schools.

Serbia's public drug policies should focus on young people, locally-oriented (not the same situation in Belgrade and Backa Palanka, for example), and be directed concerning gender and types of drugs. Support for women is different from men, while the consequences for health are different if an individual uses heroin or synthetic drugs, and thus therapy and treatment. It is necessary to talk openly about drug use in the nightlife. It is crucial to initiate a public debate on decriminalising drug possession for one's own needs, which would relieve the prison system and legalise cannabis. It is necessary to find a solution to the abuse of buprenorphine and other substitute substances.

It is crucial to support civil society in programs and services offered to drug users, enable them to test drugs, and improve cooperation with state institutions, especially health and police. The work of state institutions should be more transparent. The Office for Combating Drugs should be more visible and provided with resources and mechanisms to do its job better. Police cooperation in the Balkans must be better. Serbian police should consider redirecting resources to seizures of narcotic drugs that are more harmful to health than cannabis, especially synthetic drugs and cocaine. In addition to traditional educational channels (schools, television and media), prevention campaigns should also be implemented through messaging applications.

Adopting a new strategy to prevent drug abuse is a real opportunity to change the situation and correct old mistakes.

Weekly magazine Vreme originally published this article on 27 January 2022 in Serbian.