IMPACT OF COVID-19 ON TREATMENT AND CARE OF PEOPLE THAT USE DRUGS IN REPUBLIC OF NORTH MACEDONIA

Abstract

The CОVID-19 pandemic has affected the entire population and overall living, but this impact is strongest on marginalized groups. Experience to date has taught us that all restrictions in every sense (financial, availability of treatment and etc.), although affecting all, are particularly strong on marginalized groups. This study discusses the impact of COVID-19 on drug users in the Republic of North Macedonia. Patient conditions were analyzed in 11 OST’s in society, 2 OST’s in Prison, 2 harm reduction programs of which one for sex workers, and 2 prevention programs for the period January-June 2020. During this period, several changes occurred that reflected on the treatment and care of drug users. The centralized treatment with buprenorphine from the Clinic for Urgent Medicine and Toxicology in the capital was transferred to OST’s throughout the country. Patients from some closed cities and municipalities receive treatment through psychiatrists at their local hospital. These two things have proven to be good practices but training of the staff is needed. Unfortunately, there have been such cases, where transportation to regional centers has been difficult due to the existing restrictive measures, so number of patients in some OST’s has decreased. In some OST’s the number of patients remained unchanged, but in most centers, the number of admissions has increased for several reasons: returned patients from other countries, difficult supply with drugs regarding restrictive measures, continuation of treatment after being released from prison, decentralization of buprenorphine treatment in regional centers. Psychosocial interventions have been drastically reduced, but pharmacotherapy has taken place without interruption in the OST’s. Staff was fully present at work most of the time. There were no cases of overdose, and suicides in the OST’s. No one was diagnosed with Covid-19, but patients were not tested for detection of possible asymptomatic cases. New admitted patients received therapy daily or 2-3 times a week and other patients received take home therapy for one week. Visits, examinations and delivery of therapy to the people who were quarantined were made by the staff from OST’s. In some cases the organization "Red Cross" delivered the therapy. The country's largest prison also had no case of COVID thanks to isolation measures and regular monitoring of the condition of newcomers. Treatment with OAT in prisons continued as before the COVID -19 period, nor overdose or suicide. Harm Reduction centers were closed resulting in decreased number of served people by outreach work that continued. Harm reduction program for sex workers does not show a slight increase. Counseling centers for young people were closed but counseling was provided on line, resulting in decreased number of served people. At the end of May they have been open and face-to-face counseling together with on line counseling continue. From the results it can be concluded that the COVID-19 pandemic has an impact on drug-related conditions and the treatment and care of drug users. While some changes have proven to be good practices, others can have repercussions for the target group and the community as a whole.