History of amphetamine's use and expansion in Macedonia

Amphetamine scene in Macedonia

Аmphetamine market and its availability in Macedonia

Risks of amphetamine use

Treatment of amphetamine users in Macedonia

Public education on amphetamine issue in Macedonia

Treatment of topics on amphetamine problem within Macedonian media

Stigma of amphethamine users

Legal aspects of amphetamine problem

History of amphetamine's use and expansion in Macedonia

In the Republic of Macedonia ecstasy tablets appear in 1997. Their high cost, low availability as well as their increasing demand has led to and dictated appearing of amphetamine on the Macedonian market. In that period, amphetamine appeared in tablets illegally transported from Bulgaria into Macedonia. Amphetamine, at first appeared, as a cheaper drug with high availability. Its rapid expansion on the market is due to above all the fact that its effect is of longer duration (8 to 20 hours) and causes stronger euphoric effect than ecstasy tablets. In the period between 1997 and 2000, there is an increase in popularity of drugs made on amphetamine basis, influenced by their low cost and thus, enabling its massive use. Amphetamine's early use was related to a certain music type, that is, electronic club scene. Its long duration effect corresponds to the also long duration of electronic music parties. It was drug users who provided the first pieces of information on this drug type to social anthropologists and social workers. It was not clear until 2000 that the name of ecstasy was used for various drug types based on amphetamine. Drug names are created according to various applications and picture imprinted on tablets' surface. In 2002 an expansion of amphetamine use has been detected, starting almost exclusively within the club scene to passing into everyday life.

While amphetamine was recognized only as a basis for some drugs (ecstasy tablets) in the beginning, later it was recognized as a drug type on its own. After recognizing amphetamine as a drug different than ecstasy tablets, it has started to be sold as a powder substance. Amphetamine powder is most commonly sold form of this type of drug. Therefore, most common is used by snorting, that is, nasal. Oral use, or mixed in a liquid, is rarer. Oral use is harder to be recognized as an act of drug use by the police. The least common way of its use is through injection or smoking it as a cigarette. Its injection differs from opiate injection because there is no need to use acid (lemon acid) to dissolve amphetamines or to heat the liquid in order to cause the chemical process.

back to top

Amphetamine scene in Macedonia

Amphetamine users share similar experiences. According to them, amphetamine scene in Macedonia is mostly consisted of young people, students or young businessmen. Sometimes and not so often, students use it before taking an exam for a “better” concentration while studying. Although the number of these users is very small, the curiosity about “amphetamine tens” among students is very big. Users think that men use it more often than women. In fact, it is hardly possible to exclusively speak about amphetamine scene in Macedonia because this drug type is most often used in combination with other drugs; therefore, there are almost no users of only amphetamine. All interviewed users said that they use amphetamine in combination with other drugs (simultaneously and/or successively). A portion of the users use not only amphetamine, but also marihuana, cocaine and ecstasy tablets. Users believe that the reasons for this lie in the lack of this drug, that is, insufficient development of amphetamine market. The remaining users combine drugs with opposite effect, for e.g., amphetamine with heroin, methadone, and diazepam. The difference that these remaining users noted is the phenomenon of getting “high” and “down”. The euphoria caused by amphetamine (upper) later seizes and it is replaced by the effect of the heroin or methadone (downer). Another division into two groups can be noted regarding the class segregation according to users’ narratives. According to them, wealthier people use amphetamine and cocaine, while poorer people use amphetamine and heroin or methadone.

back to top

Аmphetamine market and its availability in Macedonia

The majority of the interviewed users reported amphetamines have low availability. Its similarity with other drug types like cocaine and ecstasy tablets makes the latter more available replacement of amphetamine. However, there is a developed distribution network among youths.

Amphetamine’s quality is mainly poor, with a number of additives toxic to the body organism. Users claim that quality and cost depend on dealers. There are a number of cases when users believe they buy cocaine, but they get amphetamine instead. They also spoke about their relationship with dealers. That is, if you are close to the dealer or if he is “checked” one, then amphetamine will be of correct weight and proved quality. The dealers, they buy amphetamine from, almost never sell only amphetamine. Since amphetamine is of low availability, users buy ecstasy tablets or cocaine at the same dealer. Some of the users interviewed buy marihuana at the same dealers. Only one interviewed user said that the his amphetamine dealer does not sell other drug types. A third of the users interviewed use amphetamine once or twice per year; they use much more often other drugs. Another third of them use it once to twice per month, but they know dealers who provide it regularly and on time. One interviewee buys amphetamine from Bulgaria, as he says “in Macedonia, there are some periods when you can hardly find it.” The remaining part of the interviewees uses amphetamine once to twice weekly or ten times monthly. Some of them do not have any problem to find it on the market in Macedonia, while others use it regularly only when it is available on the market in Macedonia. The amphetamine cost is between 800 and 1200 denars per gram in Macedonia. Users find that the cost is too high when compared to markets outside our country and that the offer lacks quality or it might be of quality but then the weight is lower than what was promised.

Our research showed that the awareness of the problem of taking amphetamines is at the worst level when it comes about the part concerning the risks. Basic risk is the question of purity of amphetamines available at the illicit market. Users and their family members agreed that there is a need to have the possibility to check drug quality. In 2004 a harm reduction team concerning club drugs use was formed in Macedonia, whose aim, among other things, was to promote the need to test quality of amphetamine tablets. However, this initiative was not carried out.

back to top

Risks of amphetamine use

It is because of these other unknown substances contained in amphetamines that one can never be certain what caused unwanted consequences. In a direct way, amphetamine use can cause dehydration, brain problems, and psychic disorders (although it is a question whether those disorders are a direct consequence of amphetamines use or amphetamines act only as precursors). In an indirect way, people’s behavior change under amphetamine’s influence: alertness declines while health risks increase as well as social consequences of risky sex, careless driving and so forth. Half the users interviewed responded that they drive when they are under amphetamine’s influence, while the other half that they avoid to do so. The doctor, who participated in our research team, shared his experience that there were 3 to 4 situations where amphetamine users asked for help within the clinical psychiatric practice. These situations involved mainly persons with psychic problems after using amphetamine. Their dependence was detected during the procedures for obtaining data for creating disease history. While providing counseling within the NGO HOPS, this doctor most often met opiate users who tried to “treat” their dependence by using amphetamines (the syndrome of getting high and down). The majority of these persons do not see themselves as dependents of a psychoactive substance unless they experience any of the symptoms cause by its use. Their first contact with a medical institution is an intern medicine ambulance (due to heartbeat, higher blood pressure, breathing problems and so on) or a psychiatric hospital due to certain psychic experiences as a consequence of amphetamine use (fear of panic attack, anxiety, depression as a later consequence as well as acute psychotic decomposition in more difficult cases). So, a higher percentage of these persons address urgent services (Clinics for toxicology), while a smaller percentage ask for a dependence treatment. The profiles of those who usually treat these persons are mainly psychiatrists, psychologists, social workers, nurses as well as multidisciplinary teams in the really small number of treatment centers for these persons. Although no one of the users interviewed needed a help so far, however if they need it, they would ask for it at the urgent center, from friends or in the NGO HOPS. It happened so that nobody of their family members had any need to ask for a help for the users, however, if it is needed, they would ask for help at the Clinics for Toxicology or at a psychiatrist. These statements prove the lack of knowledge and information among public, amphetamine users and family members not only regarding possible risks, but also regarding help and treatment.

back to top

Treatment of amphetamine users in Macedonia

There are no harm reduction programs intended for amphetamine users. There are no dependence treatment programs in hospitals, and as it was already mentioned, the treatment is focused on treating symptoms, mainly treating depression and the excessive sympathetic activity stimulation. A specialized treatment for amphetamine users is needed and it is necessary.

The social anthropologist confirmed that efforts made to establish primary prevention were not welcomed because those who were in position to fund it were not interested for this kind of initiatives. Central Eastern European Harm Reduction Network (CEE HRN) made such an initiative, but after evaluating the situation in Macedonia, our country was excluded from further activities. It is a huge challenge to speak about specific treatment in our country considering the need for personnel trained in treating amphetamine users. Direct training of medical workers does not take place in Macedonian practice, while treatment deals only with symptoms. In addition, there are other drawbacks and shortcomings current in our country regarding amphetamine issue. It can be noted that there is a huge gap in risk awareness, not only among amphetamine users, but also among policy makers. Even international organizations dealing with these issues wait for “the fire to expand” then to come to “extinguish” it. The most common alibi for such negligence of this issue is the fact that there is a low prevalence; therefore, it is not financially justified. However, a high prevalence cannot be proved if there are no researches carried out. In his work practice, the social anthropologist has not come across any thoroughly conducted research related to amphetamine issue, except for some minor researches where primary focus was not on amphetamines, but drugs in general. It can be concluded that there is a big lack of specific policy, coping strategies and treatments. Instead, policies and strategies are only general, without any specific focus on various aspects and challenges that various drugs bring with.

back to top

Public education on amphetamine issue in Macedonia

Amphetamine users’ family members lack knowledge and information on this type of drug. They only know that it is a chemical one, that is, a synthetic drug sold in powder and costs less than cocaine. Maybe the biggest problem is the fact that many people consider that knowledge satisfactory. According to them, this drug is above all a re-creative drug and chances for becoming dependent are very low.

In addition to serious shortcomings detected by experts regarding this issue, education on amphetamines is at low level in Macedonia. In particular, there is an alarming poor education among youths considering the fact that amphetamine use mostly dominates among young population. Treating topics on amphetamines are not included in high school curricula. Teaching staff are not familiar with amphetamine issues, problem, influence, effect, use and risks. Some schools open drug topic once to twice per semester, but the emphasis is most often on marihuana at these classes. Those persons from the teaching staff interested in this problematics find information on the Internet and from brochures. A huge problem and drawback of this kind of informing is that often data and information are not relevant and treating topics on drugs and amphetamines through stereotypes and discrimination strategies. However, a preparation and a pilot stage of training program regarding drug issues is already taking place in three high schools in the moment. There are training and education sessions on drug issues in general in Macedonia, although in very small number, still they take place. So far and most often training sessions were aimed at students and not at teaching staff. In the curriculum within the subject of Psychology for high schools topics on drugs are treated, however, specific drug types are not studied but only “altered types of consciousness”. At the Institute for Social Work and Social Policy there are no topics on various drug types. Only within the subject of Mental Hygiene, the “dependence diseases” are treated, but without any specific focus on dependence on various drug types.

back to top

Treatment of topics on amphetamine problem within Macedonian media

Users most often obtain information on this drug type from their friends. According to their statements, in the media there are very rare, that is, almost never, there are topics on amphetamine. Some of the interviewed users provide informations about amphetamine above all from their dealer. There are almost no texts on amphetamine in Macedonian on the Internet. Information that can be found through the Internet is in English. Public and media’s silence regarding this drug can be interpreted as a generally accepted opinion that amphetamines are a harmless drug. On the other hand, amphetamine is only present in general topics on drugs in media, that is, only as a listed drug or in black chronicles when people are arrested for illicit amphetamine possession and trade. This shows that there are prejudices related to drug users. So far, Macedonia media presented only one coverage on this topic, while other mentions of amphetamine in media were only as an item in the drug list. There are reporters that have attended focus groups intended for media and marginalized groups with specific interest, just regarding one segment, that is, drug users, as well as they have attended training sessions on drug problems and drug users. The political correct speech although not regularly, but still in most cases, is preserved when reporting or treating topics on drug issue and drug users. There used to be more cases of discriminating drug users, but now things have improved. Problems regarding discriminative speech can be noted in the black chronicle pages where perpetrators of crime acts are defined as “addicts” or “narcomans”, although this fact is not related to the crime completed. According to the media expert interviewed, the problem of this kind of discrimination is caused above all due to the reports and announcements they receive by the Ministry of Interior. In those announcements, when the perpetrator of a crime act is a drug user or drug dependent, then this fact is emphasized, which is not the case with the remaining categories of people.

back to top

Stigma of amphethamine users

All amphetamine users inteviewed believe that drug users and their family members are stigmatized. People who use more often drugs are the most stigmatized. The interviewees hide the fact that they use amphetamine from their coworkers, professors, superiors, parents and so forth. They are most afraid of losing their job. However, they say that it is hard to recognize amphetamine users, and they indicated that the most stigmatized are opiate dependents. Amphetamine users in Macedonia are not recognized as some user group, thus, the stigma effects they experience is a part of the general stigma attached to all drug users. However, if they reveal their problem, they won’t escape stigma effects.

back to top

Legal aspects of amphetamine problem

The interviewed lawyer spoke about stigma of amphetamine users in the courts of the Republic of Macedonia. His experience shows that amphetamine users are called “narcomans” in courts and judicial system representatives treat this category of people worse than any other law offenders. The law of the Republic of Macedonia does not make any difference whether it is about possession, production or trafficking amphetamines. This fact is implied in the syntagm “opiate means, drugs, precursors”. The law of the Republic of Macedonia does not set a minimal dose allowed for possession. Users convicted due to possession of this drug are not sent to treatment but to serve their sentence.

back to top