For the purposes of IDPC’s regional work, South East Europe (SEE) includes: Albania, Bosnia-Herzegovina, Bulgaria, Croatia, the Former Yugoslav Republic (FYR) of Macedonia, Greece, Kosovo, Montenegro, Romania, Serbia and Slovenia.
SEE is not a major drug producer. Local cannabis production for domestic use is increasing in Albania, Bulgaria and Romania. Albania also produces small amounts of opium, while Bulgaria produces relatively small quantities of chemical precursors.
The region is an important trans-shipment area for heroin from Afghanistan to Western Europe. The northern Balkan route passes through Turkey, Bulgaria, Romania and Hungary en route to Austria and the rest of Western Europe. The Southern Balkan route leads to Italy through Greece, FYR Macedonia and Albania. An increasing number of cocaine shipments from South America are transported to Eastern European countries and subsequently through the Balkan routes to Western Europe. Traffic in precursors, on the other hand, follows the Balkan routes in the opposite direction towards Turkey and Afghanistan. Declining heroin seizures were reported in 2010 in most countries while cocaine seizures in the region tripled. Increased demand could be one factor underlying this increase; organised crime groups shifting from heroin to cocaine trafficking could be another (World Drug Report 2013).
Authorities in Serbia, Montenegro, Croatia and Bosnia and Herzegovina explain the lower seizures and availability of heroin in their countries by the fact that the Balkan route has undergone a number of internal shifts since Romania and Bulgaria became members of the European Union (EU). From Bulgaria, traffickers reportedly go through Romania because of less rigorous border checks compared to when using the route going eastwards through Serbia, Croatia and Bosnia and Herzegovina (Drug Situation Analysis Report. 2011).
Cannabis remains the most widely used drug in SEE. An increase in the consumption of Amphetamine Type Stimulants (ATS) has been reported in the region, while cocaine and opioid use has remained stable. Nevertheless, the estimated annual prevalence of opioid use (commonly injected heroin) in the region remains higher than the global average, at 1.2% of the adult population.
The use of new psychoactive substances, commonly called “legal highs”, is increasing in the region and they are progressively becoming popular drugs in some countries – in particular Serbia and Romania – because of their availability and legal status. In Romania, the use of legal highs boomed in 2009. During 2010-2012, legal highs have reportedly replaced heroin in Bucharest, with increasing injection rates (as the substances have to be injected more often than heroin). In turn, this exacerbated the risk of an HIV epidemic in the country. In order to respond to this trend, Romanian authorities criminalised 44 plants and substances in 2010 and closed the “smart shops” where the substances were being sold. These measures have led to the legal highs trade moving online and potentially more harmful patterns of use (read more).
A new illicit drug appeared in Greece, under the street name “sisa” (gr. σισα). The drug is compared by users to cocaine and it can be obtained from ingredients that are legally available on the streets.
Finally, the illicit use of sedatives and tranquilizers is common in several SEE countries, such as Romania. However, the topic is undocumented and needs more attention from policy makers and service providers.
Legislation and policies around drugs are being updated and harmonised with European Union standards as part of the pre-accession process for candidate countries, such as Serbia, Montenegro and FYR Macedonia. Albania, Bosnia and Herzegovina and Kosovo are also potential EU candidates and therefore have an interest in reconfiguring their drug policies in line with the EU Drug Strategy for 2013-2020 and upcoming action plans (Drug Situation Analysis Report). This involves the adoption of a balanced approach incorporating both demand and supply reduction activities.
Most SEE countries’ drug law enforcement strategies tend to focus on arresting people for drug use or possession of small amounts of drugs for personal use. Excepting for Montenegro, Croatia and Slovenia, all SEE countries punish the possession of illicit drugs for personal use. The so-called fight against “micro-trafficking” consists in arresting petty sellers and users in order to get them to provide information about the suppliers and distribution chains. Prison overcrowding might be a direct consequence of this strategy. Programmes aimed at improving the living conditions in prisons, and the rehabilitation and reintegration of prisoners are scarce. People who use drugs have limited to no access to medical care: under various conditions and regulations, opiate substitution treatment in prisons is available only in FYR Macedonia, Montenegro and Romania, while syringe exchange programmes are only available in Romania.
Post-release programmes are greatly needed but still unavailable in most of the SEE countries.
In the case of Greece, for instance, although penalties for possession of drugs for personal use have been gradually reduced (the current sentence applied of between 10 days and one year of imprisonment) a strict regime of punishment still applies for any type of supply – even sharing. Greek legislation provides for incarceration of between 8 and 20 years for drug trafficking and up to 300,000 €, and imposes a life sentence for aggravated ones (read more).
Police custody units are even tougher settings for prisoners: limited access to fresh air, natural light and lack of hygiene are added to overcrowding. The only exception is Montenegro where conditions in these units responded to quality standards.
While countries like Albania are implementing tougher law enforcement actions against cannabis growers and traffickers (see the recently approved National Drugs Strategy 2012-2016) others, are trying a different approach: in 2012, the Croatian parliament decriminalised the possession of small amounts of controlled drugs (World Drug Report 2012).
Heroin use is the primary cause of drug-related deaths in the region, and is responsible for most drug-related problems, especially among young people and vulnerable groups. The rise in legal highs use in SEE can lead to an increased number of drug-related deaths, but these deaths are more difficult to document since the symptoms are very diverse and lab analyses are often confusing. None of the SEE countries reported high rates of fatal overdose. Data collection methodologies and systems can be improved all over the region.
Reported HIV rates among people who inject drugs are low for most of the countries where data is available. However, both Romania and Greece have reported a sharp increase in HIV prevalence among people who inject drugs. In Romania, 28 new HIV cases were registered during 2007-2010. HIV increased sharply starting with 2011, totalling 507 cases until July 2013. In Romania, this is the second HIV epidemic wave, following a massive HIV spread among newborns in late 1980s-early 1990s. This time it is mostly affecting people who inject drugs and it is connected to changes in using patterns (legal highs injection) and harm reduction scale back as a consequence of international funding coming to an end (read more).
Greece had also reported an outbreak of new HIV infections among people who inject drugs: 161 cases in the first 8 months of 2011 and 314 cases until September 2012. In Greece, this situation coincides with the economic crisis in the country, cuts in the health system, the deteriorating socio-economic environment in cities like Athens, and changes in injecting behaviours among people who inject drugs (read more).
Hepatitis C rates among people who inject drugs are generally high, reaching 70% in FYR Macedonia and 82.9% in Romania. There is a growing concern that injecting drug use is increasing across the region and that the age of initiation for drug injection in the region is getting lower. There are also concerns regarding drug use among the Roma communities in the region. These communities already face major barriers in accessing mainstream health services and are considered to be at particular risk from HIV and other blood-borne viruses.
The coverage of NSPs in the region is poor, and there are only a few OST sites available, with most countries having less than 10 OST facilities (Global State of Harm Reduction 2012). In many cases, OST is as yet only available to a small number of patients, is not gender- or age-sensitive, and most SEE countries cannot cover the demand through existing services. People who use drugs are therefore placed in long waiting lists before they can enter an OST programme. Although most countries in the region officially support harm reduction measures some have not yet changed their drug laws to allow harm reduction services: in Bosnia and Herzegovina and Montenegro for example, police can arrest outreach workers for collecting used syringes on grounds of illicit drug possession (Drug policies and harm reduction in South East Europe, IDPC briefing paper). In addition, most of the harm reduction programmes in the SEE countries were developed with international support and limited to no involvement of national authorities. For this reason, most services are unsustainable in the mid- and long-term.
Law enforcement and supply reduction
In order to respond to supply issues, countries in the region have developed close regional coordination through police cooperation and actions plans. SEE countries are signatories of several multilateral treaties such as the Police Cooperation Convention for Southeast Europe (PCC SEE), and have signed extradition treaties and bilateral police cooperation agreements. These have resulted in enhanced cooperation in regional supply reduction actions (Drug Situation Analysis Report, 2011).
Organised crime and violence
SEE, particularly the Western Balkans, suffered serious armed conflicts during the 1990s. Although the level of violence has largely decreased since that period, organised crime continues to affect the region, and insecurity persists. The large amount of drugs, tobacco, arms and humans trafficked through the Balkans produces massive profits for organised crime, and generates high rates of corruption. Weak governments, corruption and little border control create conditions that foster the growth of organised transnational crime (A Real and Persistent Danger: Assessing Armed Violence in the Caucasus, Eastern Europe and South- Eastern Europe, 2008).
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