Treatment of Addiction: Serbia on bottom of list!
2 heart transplantations in 2012 - SERBIA
43 heart transplantations in 2012 - CROATIA
Transplantation and Addiction as worst problem
The worst statistics in health-care system, when number of done transplantation is taken into consideration, Serbia is on the bottom of list with only 2-3 transplantation done. Heart transplantation is something that Serbian people have highest need for. This type of transplantation is done twice a year, due the lack of specific doctors, and due the lack of regulations.
- Heart donors, as well as other donors, have to go and give some type of special permision that they are volunteering and participating in transplantation. So, in case of hard car-crash, Serbian doctors cannot take the needed and good heart - because person haven't signed several papers.
Huge administration, is the main thing. The neighbor-country, Croatia, has resolved this problem by excluding signature. Excluding signature means that only patients that have signed that they do NOT want to have their body parts transplanted to the other patient that have the highest need.
- So, with simple change of regulations - where only patients that have signed that they want to be excluded from the "volunteering transplantation" are the ones that aren't taken into consideration in case of accidental brain-death, etc...
- More than 20.000 heroin addicts untreated, and it's estimated that more 20.000 intravenous drug users are out there; making total of 40.000 opiate addicts untreated!
- Patients with serious side-effects of methadone do not have choice of secondary medicine, don't have alternative.
- Because of the upper-fact ~40.000 heroin addicts are unmotivated to sign-up for treatment as they know that in case of side-effects, or in case of methadone maintenance being ineffective they don't have any other type of treatment offered.
- Buprenorphine has been registered, and introduced in March 2010 - until day today's patients, addicts on recovery - cannot get prescription for this medicine!
- RISING NUMBER OF OPIATE ADDICTS
- RISING NUMBER OF OVERDOSES
Addiction - worst "wound" of health care system after transplantation
After horrible systematic solutions for organ transplantation, second horribly systematically done thing in Serbian health care - negatively criticized by all prestigious health-professionals - is treatment of addiction.
Serbian health-care is suffering from a lot of system-corruption, but even worse than that is treating addiction as the current solution is violating Convention (of Human Rights) as well as patient rights.
From estimated 160.000 drug users, about 2000 of them is on some type of treatment!
Available treatments in Serbia, do NOT cover demand for treatment. By statistics from EMCDDA, Serbia has about 160.000 drug users, where some 25.000 are opiate/heroin addicts.
- Serbia is now, as it has visa-liberal regime and being close to open EU per-accession talks in June this year, is one of the main drug-trafficking routes recently. That is why the Serbian Border Police seizures are bigger and bigger. Drug that's mainly trafficking is heroin, from Kosovo and Bulgaria. Kosovo became the "Europe's Colombia" actually the "Europe's Afghanistan".
Opiate Addicts in Serbia
- Opiate addicts in Serbia are mostly heroin addicts, as systematic check of prescribing controlled substances such as Tramadol, Methadone, Fentanyl, Morphine... that have been abused a lot in past (90's)- became rigid. Tramadol and Methadone are the most abused controlled substances in Serbia. Most of addicts start with Tramadol, continue to heroin, and then mix heroin and methadone; until they reach first treatment.
Addicts are treated in Regional Clinic Centers, on secondary health-care level. Most common centers where addicts go onto detox are Clinical Center of Vojvodina, Department for Social Psychiatry. The methadone daily clinics, has become recently an independent health-care institution, independent from Clinical Center of Vojvodina in Novi Sad. (Klinički Centar "Vojvodina").
- The medical practice, in Serbia, when it comes to detoxification and after-treatment of patients is the worse and it became unacceptable for most of the patients. Patients, in order to get into process of treatment- being maintained with certain medicine- must pass the process of detoxification, where they receive Tramadol capsules. In lack of buprenorphine, that has been used when F.Y.R Macedonia donated Serbia with "Buprenorphine Alkaloid®" sublivingnal tablets of 2,4 and 8 milligram. That donation have lasted for couple of months, maybe three months, and after that patients that are in process of detoxification; across the Serbia; started receiving Tramadol capsules of 50mg 3x3 first three days. After that, one capsule per day is taken from the process. Process lasts for 12 days, after which patients are going under opiate antagonist treatment (drug-free treatment).
- To get the picture worst, all patients are treated with Tramadol capsules - which in 99% of cases aren't suitable. Also >75% of patients, are misdiagnosed - being prescribed after process, the long-lasting opiate antagonist "Naltrexone®". Basically, everyone under 20 years, and without being treated with antagonist at least one time, cannot undergo/ trough O.R.T applying "METADON" liquid solution (10mg/ml) which is only possible medication that patients can get via prescription.
- So, what you get is next. You have 25.000 of heroin addicts. Only 2000 of them, more or less 200, are being treated.
About 1600 patients are included into O.R.T (Opiate Replacement Treatment) with Methadone.
- To get the things worse, Ministry of Health within Agency for Medicines and Medical Devices registered 3 manufactures of Methadone liquid solutions, where just one company - "Hemofarm", the domestic one - is having absolute monopoly. Only "METADON" (methadone hydrochloride liquid solution, 10mg/ml) medicine, from "Hemofarm" manufacturer is on the shelves of pharmacies. Recently, more and more patients are complaining on side-effects, ineffectiveness, and on the fact that patients that need methadone for maintenance cannot find any other methadone solution then the one from "Hemofarm" company.