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The Western Balkans is often labelled as a transit region for the trafficking of drugs like cannabis, cocaine and heroin. But there are signs that the region is also a producer of synthetic drugs, as well as a growing consumer market. The main synthetic drugs being smuggled into the Western Balkans are amphetamines, methamphetamine and ecstasy MDMA , as well as new synthetic versions of cannabis and opioids like heroin. In addition, local production appears to be increasing, particularly in North Macedonia and Serbia. Between and , police in Serbia uncovered over illicit drug laboratories, mostly on residential premises. Nevertheless, only people were convicted — an average of less than two people per illegal laboratory uncovered. In , most seizures of synthetic drugs in Serbia were made either in Belgrade and Novi Sad or close to the border with Hungary, for example at the Horgos border crossing point. Seizures were also made in Kragujevac and Bor. The problem is not limited to Serbia. In December , police discovered illegal drug labs in the village of Batinci and in a home near Tetovo in North Macedonia. The main suspect, Milan Zarubica, had previously been convicted in relation to a lab in Stara Pazova, Serbia. A few months later, Macedonian police found yet another laboratory used to illegally manufacture synthetic drugs. In addition to trafficking and production, there seems to be a growing local market for synthetic drugs. In Serbia and North Macedonia, prices for synthetic drugs are relatively low, which is a major factor in their increasing market share compared to plant-based drugs. The drug is usually sold on the black market in the form of pills or capsules, but can also be mixed with ecstasy. Synthetic drugs are easily accessible, particularly in large cities. Methamphetamine is less present in Serbia. It is unclear how COVID has affected the synthetic drug market in the Western Balkans, but there is a sense that the market is relatively resilient, with some synthetic drugs being used as a substitute for heroin. Although heroin remains the main cause of the approximately 50 drug-related deaths in Serbia every year, 19 increased access to and use of synthetic drugs have heightened health concerns in the country and led to the tragic drug-related deaths of young people. After a year-old girl died in November in the small town of Arandjelovac after taking ecstasy for the first time at a party, locals organized a series of protests calling for better prevention measures. In , four young people aged 17 to 21 died after taking ecstasy, while between and more than fifty people died in the country from different synthetic drugs. While the focus on drugs in the Western Balkans has usually been on the transit of plant-based substances like cocaine, heroin and cannabis, it is also important to keep an eye on the production and use of synthetic drugs. Interview with a former police officer from the Belgrade anti-drug unit, Belgrade, November Interview with a police officer, Belgrade, December Interview with a professor of criminology, Belgrade, December Interview with a civil society activist, Belgrade, November Interview with a former police officer, Belgrade, December Based on an analysis of various interior ministry press statements, mup. See also: Siracusa Institute, op. Interviews with civil society activists in Belgrade, November , and Podgorica, December Synthetic drugs in the Western Balkans The Western Balkans is often labelled as a transit region for the trafficking of drugs like cannabis, cocaine and heroin. Troubled waters: smuggling migrants across the Adriatic. Risk Bulletins. Tap or select text, and then tap the bookmark icon to save a bookmark. Bookmarks are saved in your browser cache. Clearing your cache will remove them. Your last visit. The last time you visited, you stopped reading here. Acknowledgements About Risk Bulletins.

When cure becomes an illness—abuse of addictive prescription medicines

Kragujevac buying MDMA pills

Official websites use. Share sensitive information only on official, secure websites. This article was submitted to Pharmaceutical Medicine and Outcomes Research, a section of the journal Frontiers in Pharmacology. Keywords: addiction, drugs of abuse, pharmaceutical market, expenditure, trend, costs. The use, distribution or reproduction in other forums is permitted, provided the original author s or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. Psychoactive substance addiction presents a challenging public health issue worldwide particularly targeting vulnerable adolescent population Babor et al. The illegal market turnover of the controlled substances is very difficult to trace and intervene timely among the young in the early stage of illness Inciardi et al. Contrary to this one, legally regulated pharmaceuticals pose another dangerous threat that is more accessible to the authorities. In order to combat substance dependence the national strategies should specially emphasize prescription medicines with proven potential of abuse and addiction Compton and Volkow, Serbia as the largest Western Balkans market and a typical Eastern European transitional health system might serve as an appropriate example of medicines abuse in the EU borderlands Jakovljevic, The results of local research in , showed that The national survey on life styles of citizens in Serbia in about substance use and gambling addiction reported that in the past 12 months In the last 12 months 5. A large number of respondents said that they had purchased these drugs in the pharmacies prescribed by their physicians — Various studies have shown that drug addiction disorders are related to personality disorders, anxiety disorders and a considerably higher suicide rate Regier et al. Further consequences of drug addiction are: education Yamada et al. The treatment system for substance use disorders is accompanied by high public and private expenses Jovanovic and Jakovljevic, The national health care system of Serbia is financed by mandatory tax contributions by employers and employees alike to the National Health Insurance Fund. The health care system of Serbia similar to Eastern European countries, have undergone profound transitional reforms with different degrees of success in different areas of medical service provision and outcomes Jakovljevic et al. Over the last 20 years, pharmaceutical and total health care expenditures were growing more rapidly than gross domestic product GDP in many world regions Getzen, The Sudden expansion in the market led to the increase of Serbia's public debt and accumulated debt of wholesalers toward brand industry in the entire region Jakovljevic et al. These developments eventually led to the crisis of financial sustainability and serious market shortages of even some fundamental medicines Jakovljevic, Preventive public health measures and early screening procedures remain an ongoing weakness of the most regional health systems and Serbia is no exception. In the long run, the evolution of prosperity diseases and accelerated population aging are most likely to persist as the core challenges in the broader Balkans region Jakovljevic and Laaser, Published trials from late s provide clear-cut evidence of upward trend in the consumption of psychiatric drugs in Serbia and Montenegro Miljkovic and Djukic, The Utilization of all drugs acting on the nervous system inclusive of psychiatric drugs grew from Among the causes of this growth, the most frequently cited are increased incidence of psychiatric disorders, post-war syndromes that followed the Yugoslav civil wars and higher accessibility of prescription medicines at the time Divac et al. Contemporary policy, since the early s, is that majority of approved and marketed potentially addictive medicines are assigned to the positive list and completely reimbursed within the basic health insurance premium. In Table 1 we can remark DDDs and value base turnover of six selected ATC Anatomical Therapeutic Chemical Classification System 1 code groups of such medicines: anesthetics, opioids, anxiolytics, hypnotics and sedatives, psychostimulants, agents used for ADHD Attention deficit hyperactivity disorder , nootropics and drugs used in addictive disorders. The consumption of psychostimulants, agents used for ADHD and nootropics grew tremendously from 0. The consumption of hypnotics and sedatives has almost doubled from 2. A promising sign is the rise of prescription of drugs used to treat addictive disorders from 0. Among these ATC code groups, the most frequent consumption was recorded in the case of agents that are indicated in opioid dependence. Pharmaceutical spending related to all of the aforementioned groups of medicines has strongly increased during the same time span. This finding is wholly justified by previous findings on heavily increased anxiety levels among resident addicts in the former Yugoslav region compared to traditional EU market economies Jakovljevic et al. Although the situation appears to implicate an extensive public debate in this region, we should be aware of the fact that a large portion of reported consumption is clinically justified with basic mental illness. It would be highly difficult and demanding rigorous methodological approach to exactly identify the proportion of overutilization of these drugs that is attributed to abuse and addiction. Nevertheless, vast net quantity gains in consumed addictive medications in definite ATC groups by far surpass extended burden of associated psychiatric morbidity in recent years Ristic-Ignjatovic et al. Therefore, this insight gives grounds for serious concerns about widespread patient abuse of addictive medicines in this country and beyond. The abuse of potentially addictive medicines correlates with clinicians' decision making principles Bendtsen et al. Citizens' possibility to purchase these medicines without medical prescription has been proven as another major driver of abuse potential Lessenger and Feinberg, It is reported that up to 4. This amounts to an overall population of ,—, regular users of sedatives and hypnotics among population aged from 18 to This phenomena might have a difficult and concerning extent among the small Balkan nations Divac et al. Similar life styles reported in public health surveys across EU might indicate that the abuse of potentially addictive medicines could have the far reaching consequences in the European continent United Nations Office on Drugs and Crime, There are several possible tactics to cope with this challenge for overprescribing pattern and irrational consumption of these medicines could be partially controlled by paying more attention to potentially susceptible patients during regular check-ups Khan et al. Strengthening of the regulatory framework in marketing approval and reimbursement could impose more strict legal control to the over-the-counter sales of this medicines. Software based good clinical practice guidelines have already confirmed strong benefits in terms of patient outcomes and cost savings in a local clinical setting Jakovljevic et al. Health education program development targeted for addictive patients' needs Wolde et al. The experience of the successful implementation of alternative and complementary medicine methods attained in many countries, might serve as an additional example of exit strategies probably to bring relief to this vulnerable patient population. Publication of results was not contingent to Ministry's censorship or approval. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. As a library, NLM provides access to scientific literature. Find articles by Mihajlo Michael Jakovljevic. Find articles by Marija Lazarevic. Find articles by Milena Jurisevic. Find articles by Mirjana R Jovanovic. Received Jul 29; Accepted Aug 25; Collection date Open in a new tab. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel. N02AX Other opioids mostly tramadol based preparations. N05AH Diazepines, oxazepines, thiazepines, and oxepines. R01AA Sympathomimetics, plain mostly ephedrine based preparations. R06AB Substituted alkylamines mostly pheniramine derivatives.

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