4.Strategies of Fighting against Drugs
4.1 The National Anti Drug Strategy 2013-2020
A set of eight main principles governs this strategy:
- The principle of priority – where the drug problem is of central importance in the Romanian society;
- The principle of continuity – where actions to reduce drug demand/supply take place without interruption, and the design of these actions is based on the analysis of past experiences;
- The principle of a global, unitary, multidisciplinary and balanced approach – meaning that the NAS actions are in agreement with the international concept of anti-drug measures;
- The principle of coordination – a person is responsible for establishing action plans of the NAS, but without violating the autonomy of the coordinated institutions/organizations;
- The principle of cooperation – between all public institutions with a role in the implementation of NAS;
- The principle of legality – the NAS measures are under the Romanian Constitution, with the national legislation in the field of drugs, as well as with the international treaties to which Romania has acceded;
- The principle of confidentiality – regarding the personal data of drug users or persons (non-users) who access drug demand reduction services;
- The principle of complementarity and transparency – ensured through participation and involvement of the civil society in the implementation of NAS.
The strategy develops the national policy framework, aiming to address drug, alcohol and tobacco use and drug trafficking. The document was developed following a comprehensive consultation process with all relevant institutional actors at a national level. It closely reflected the objectives and priorities of the European Anti-Drug Strategy 2013-2020. Thus, the national strategy is part of the European and national regulatory framework and respects the European Union’s fundamental principles: respect for human dignity, freedom, democracy, equality and the rule of law. At the same time, it proposes an integrated, balanced, scientifically grounded approach to the new problems facing Romanian society from the perspective of the drug phenomenon:
- multi-drug use, including drug and alcohol combinations;
- rapid expansion of consumption of new substances with psychoactive properties;
- the dynamics of the drug market, generated including the use of the Internet as a means of drug distribution;
- drug abuse;
- diversion of drug precursors;
- the quality of demand reduction services;
- the incidence of Hepatitis C among injecting drug users and the risk of an HIV epidemic and other associated diseases.
The general directions of action in this field are reflected at a practical level in 5 significant areas of intervention:
– Reducing the demand for drugs, by strengthening the integrated national system of prevention and assistance, following scientific evidence, which includes all universal, selective and indicated prevention programs, projects and interventions implemented in school, family and community, as well as identification interventions, attracting and motivating drug users to provide specialized assistance services.
– Reducing the supply of drugs by identifying and destroying trafficking networks, reducing the availability of drugs on the market and the efficient use of the law enforcement system, while developing institutional monitoring and control mechanisms, coordinated and adapted to the current needs and the actual situation of the phenomenon and to support the measures to combat it sustainably.
– Coordination in the field of drugs aims to ensure a unitary concept of action in drugs and traffickers, monitoring the implementation of national policies in the field of drugs, efficient use of resources and maximizing the results of interventions.
– In the field of international cooperation, the aim is to reaffirm Romania’s commitment, assumed through international and bilateral or multilateral documents to which our country is a party and to strengthen its position as an active partner in the global effort to reduce drug demand and supply as well as precursor trafficking.
– Improving the level of knowledge of drug issues at the national level based on scientific evidence through research, evaluation, information.
With the establishment of the National Anti-Drug Agency in 2003, the first National Anti-Drug Strategy (for the period 2003-2004) was approved. At the moment, we are at the third National Anti-Drug Strategy, the strategy in the force being applicable from 2013 to 2020 and is implemented through two plans of action, each of them lasting four years: 2013-2016 and 2017-2020.
At the national level, two treatment networks provide (in the community) assistance for the drug users:
- outpatient treatment network, consisting of Prevention and Evaluation Centers and Anti-Drug Counseling (structures subordinated to the National Anti-Drug Agency), Centers of Integrated Addiction Assistance (treatment centers private or developed by NGOs) and Mental Health Centers (treatment units developed by the Ministry of Health),
- the residential treatment network, consisting of the Ministry of Health’s medical departments and therapeutic communities developed by NGOs. Also, at the level of the penitentiary system, assistance services have been developed, granted by the specialists of the National Administration of Penitentiaries, but also by the staff of
The Centers for Prevention, Evaluation and Anti-drug Counseling, within the 34 penitentiary units, four re-education centers, three therapeutic communities and six penitentiary hospitals. In 2019, 4283 people received integrated drug assistance, which means maintaining the number of people assisted at the same level as the previous year. Most admissions aimed to provide specific treatment for cannabis use (54.5%), the number of requests for this type of drug remaining at the level of the year previously (increase by only 0.7% compared to the previous year). Moreover, this year, it turns out that the trend is given by the number of people requesting treatment as a result of the consumption of cannabis. Thus, the list of drugs for which specialised assistance is requested in Romania maintains its distribution generated by the legislative amendment of 2014. Thanks to whom drug users who have committed drug offences are sent to evaluate inclusion in specific assistance programs, most of them being cannabis users. Thus, the stagnation of the number of people who are cannabis users seeking specialised assistance determines the maintenance of the number of admissions due to drug use at a level similar to that recorded previously. Regarding the demand for treatment for opioid use, the trend previously observed increase, although the growth rate is meagre, respectively + 3.7%. Orders for this type of consumption remain high in the picture drugs for which specialised assistance is requested in Romania. These represent about a quarter (25.4%) of the total number of those admitted for treatment for consumption of drugs in 2019. Regarding admissions to treatment due to problems caused by the consumption of new psychoactive substances, after several years in which there were slight variations in the number of requests, in 2019, there is a downward trend (-21.3% compared to the previous year, from 662 cases to 521 cases; reaching 12.2% of the total admissions). To implement the national anti-drug policies, in 2015, were approved by the Government decisions, two programs in the field of drug demand reduction: The Program of national prevention and medical, psychological and social assistance for consumers of drugs for the period 2015–2018 (approved by Government Decision no. 684/2015) and The Program of national interest for prevention and medical, psychological and social assistance of drug users 2015–2018 (approved by Government Decision no. 659/2015). These programs aim at continuing and finalising combat projects drug use started in previous years while facilitating the National Anti-Drug Strategy’s achievement, 2013-2020.
National Program for prevention and medical, psychological and social assistance for drug users for the period 2015–2018 is implemented exclusively by the National Anti-Drug Agency and the Program of National Interest for Prevention and Assistance medical, psychological and social development of drug users 2015–2018 will be implemented by non-governmental organisations specialised in drug demand reduction, which will receive funding from the National Anti-Drug Agency, based on a selection procedure of projects submitted by them.
Within the National Program for prevention and medical, psychological and social assistance for drug users for the period 2015–2018, two were structured subprogrammes specific to integrated assistance, as follows: By Decision no. 292 of May 3, 2018, published in the Official Gazette no. 409 of May 14, 2018, the periods of implementation of the Program of national interest for prevention and medical, psychological and social assistance for drug users 2015-2018, respectively of the National Program for prevention and medical assistance, psychological and social development of drug users 2015-2018 is extended until 2020.
- subprogram IV. Integrated support level I – a network of reduction services the risks and consequences associated with drug use
- subprogramme V. Integrated assistance level II and III – network development and consolidation of integrated support services for drug users.
Sub-program IV aims, on the one hand, to strengthen the services of exchange – type programs syringes in the community and deprivation of liberty systems, to reduce risks and the negative consequences associated with drug use and, on the other hand, the increase the level of information, education and awareness of drug users, as well as developing appropriate interventions to prevent deaths or infectious diseases associated with drug use.
Subprogramme V aims to adapt the services within the integrated assistance circuit to individual consumer needs and consumption patterns, with a focus on polyconsumption, combined substance use, over-the-counter medication, consumption of non-opioid substances, as well as consumption of new psychoactive substances, but also developing integrated inter-institutional services for drug users who have committed criminal acts with low social danger to include them in the circuit integrated support.
The second Program, “The Program of national interest for prevention and health care, psychological and social development of drug users 2015 – 2018”, proposes a series of objectives and directions of action and transformation (with time horizon 2018), meant to advance the general purposes of the institutional strategic vision, in the context of the need for a response adequate and adapted to the dynamics of the phenomenon in terms of education, health, social inclusion and public order. This Program aims to pilot and promote good models practices in the field of drug demand reduction, according to European standards and international measures in the area, the measures provided for it to increase the availability, accessibility and coverage of services within the integrated circuit of assistance consumers and drug addicts, through development and implementation of appropriate and necessary policies. By completing the network of risk reduction services and the negative consequences associated with drug use adapted to the needs of consumers of drugs that have not accessed the benefits of the care system, it is desired both to identify, attracting, motivating and sending them to services with a high level of specialisation, as well as addressing basic social and medical needs, correlated with existing resources in integrated circuit assistance. By developing shelter services for consumers, social centre services for homeless children, outreach services in the community, sheltered housing, and by promoting these services, it is pursued empowering the integrated care system for drug users so that, through implicit development of methodologies and operating rules to ensure consistency with medical and social systems, thus achieving a maximum community impact at the level of policies in the field.
Compared to the two programs mentioned above, the Ministry of Health runs the Program of National Mental Health Center, which provides for the following activities:
They provide substitution treatment with opiate agonists and antagonists for individuals with drug addiction and testing drug metabolites in urine to introduce treatment and monitor treatment. Outpatient treatment networks for drug addiction are part of the Centers for Drug Prevention, Evaluation and Counseling (structures subordinated to the National Agency Anti – Drugs), Integrated Addiction Assistance Centers (private treatment centers or developed by NGOs) and Mental Health Centers (facilities developed by the Ministry of Health).
Of these, only the National Anti-Drug Agency centers provide national coverage, being developed in the 41 county residences and the six sectors of Bucharest. The National Anti-Drug Agency centers and those developed by the Ministry of Health offer free services for drug users. Within Romania’s penitentiary system, for drug users in detention, medical, psychological and social assistance services are provided by joint teams within the Centers for Prevention, Evaluation and Drug Counseling. These services are provided in the 34 penitentiary units and the four re-education centers.
Also, starting with 2016, the specialists from the Prevention Centers, Drug Evaluation and Counseling provides medical, psychological and social assistance services to drug users in police custody. Other aspects of the provision and use of treatment for addiction outpatient drugs.
Number of beneficiaries
The requests addressed to the outpatient assistance services know a decrease of 6.8% compared to the previous year. This was determined particularly by the evolution of the demand for treatment due to opioid consumption (-25.2%) and that determined by the use of NSP (-23.1%).
Unlike the previous year, when a preponderance of requests for assistance in the outpatient system compared to those registered in the inpatient network, in the reference year, the share of outpatient requests in the total admissions to treatment is 67.7% (compared to 72.9% in 2018). This brings us back to the situation observed in 2015-2017 when stabilisation of the relationship between applications was observed addressed in the outpatient system and those registered in the hospitalisation network (65.5% in 2017).
Gender and age of beneficiaries
Concerning age and sex, the characteristics of the beneficiaries in the treatment system are similar to those observed in previous years, as follows:
- 88.5% (2567 people) of the beneficiaries registered at the treatment centers outpatients are male. The average age of those who used the services of outpatient care is 27.6 years, which is lower in the case of
women (27.2 years for women, 27.7 years for men);
- the majority (80.4% – 2331 beneficiaries) are people under the age of 34, 19.2% (559 beneficiaries) are people aged between 35 and 54, and the rest (0.3% – 9 beneficiaries) are persons over the age of 54;
- in the case of both men and women, the age category that registers the largest share of cases is the group of 20-29 years (51% – men, 43.4% women);
- for the beneficiaries of outpatient treatment centers, the average age of onset in drug use was 20.5 years, while the average age at the first hospitalisation was 27.1.
The primary drug of consumption and the route of administration
The primary drug for which assistance was mainly requested in 2019 in the system outpatient treatment is cannabis – 66.5% (n = 1927). Compared to the previous year, although it maintains approximately the same share of people to receive integrated care problems caused by cannabis use (in 2018 – 63.4%), the number of beneficiaries has a slight decrease of 2.3% (in 2018 – 1972 beneficiaries).
In Romania, the outpatient care system for drug users consists mainly of specialised care centers, which have multidisciplinary teams consisting of: doctors, psychologists and social workers, with specific training in providing treatment for drug users in their psycho-social reintegration. These teams offer, first of all, psycho-social treatment and implement case management for drug users. Identification services are provided to a lesser extent and attracting drug users to specialised treatment programs.
Residential treatment services
The residential treatment network in Romania provides specialised services (medical, psychological and social) to the psycho-social reintegration of drug users. Of these, the most important are detox programs and psychiatric medical services. The detox program is available to all drug users and is carried out in particular in the Ministry of Health’s health units. They can continue the therapeutic process in psychiatric wards, therapeutic communities or private centers, where they benefit from psycho-social counselling and management services.
The primary providers of opiate addiction treatment (OST)
Methadone maintenance treatment is a recognised therapeutic approach at the national and international level as an effective method of treating opiate addiction, contributing to reducing individual and social damage. The development of a methadone maintenance treatment program has a chance of success if it is accessible. The inclusion in the assistance is made as soon as possible, and retention in treatment is not conditioned for a certain period of time. Factors that may influence the participation of beneficiaries in such a program are:
-the number or location of the centers providing such services, the work schedule of
-the centre, the evaluation procedures, and the degree of training of the specialists in the field of medical, psychological and social view.
Following the legislation in force in the field of reference, the substitute treatment of opioid addiction is available in health facilities and treatment centers for drug users. This treatment is implemented, both outpatient and residential, being also available in the penitentiary system.
The primary providers of opiate addiction replacement treatment are:
-National Anti-Drug Agency. The substitution treatment programs developed by the National Anti-Drug Agency were available in 2017 only in Bucharest. These services have been carried out through 3 Drug Prevention, Evaluation and Counseling Centers. By 2015, the services of Substitute treatment was also available in the county seat municipalities of Oradea and Iasi. Starting in 2016, the National Anti-Drug Agency specialists granted methadone substitution treatment services in the Romanian Police detention sections. Within the Mental Health Program, substitution treatment with agonists are provided and opiate antagonists for people with drug addiction nationwide. Nine hospitals run the program in the network of the Ministry of Health.
-National Administration of Penitentiaries
People deprived of their liberty benefit from substitution treatment with agonists and opiate antagonists for people with drug addiction. This program is included in The mental health program implemented by the Ministry of Health and is running in 11 penitentiary units, namely: Bucharest Rahova Penitentiary-Hospital, Penitentiary. Bucharest-Rahova, Bucharest-Jilava Penitentiary-Hospital, Bucharest-Jilava Penitentiary, Constanţa-Poarta Albă Penitentiary, Craiova Penitentiary, Mioveni Penitentiary, Giurgiu Penitentiary, Iaşi Penitentiary, Ploieşti Penitentiary – Târgșorul Nou and Mărgineni Penitentiary.
-Private suppliers / NGOs.The leading private providers / NGOs that implement substitution treatment programs with opioids are available in Bucharest. Of these, three are private, and NGOs develop one
– Increasing the level of information, education and awareness of the school population in the view of non – initiation of drug use in school, extracurricular and school programs spending free time;
– Increasing the level of information, sensitization and awareness of the school population in order to avoid the transformation of experimental and occasional consumption into regular consumption, in within the school, extracurricular and leisure programs.
– Increasing the level of awareness and responsibility of families in order to provide positive role models for children in information, education and awareness programs with on the effects of drug use;
– Developing the proactive role of families in children’s lives for training or strengthening skills to increase the influence of protective factors.
- Prevention in the community:
– Reducing the influence of risk factors and developing the influence of protective factors within vulnerable groups, correlated with their needs and particularities;
– Reducing the influence of risk factors and developing the influence of protection factors at occupational categories that are prone to drug use, correlated with the level of social responsibility and their particularities;
– Adopt a healthy lifestyle at the general population level as an alternative to drug use in leisure programs.
- Drug demand reduction campaigns:
– Increasing the level of information and awareness of the general population and the population at risk on the effects, risks and negative consequences of drug use in the view of not starting or delaying the onset of drug use.
- The national project “MY ANTI-DRUG MESSAGE” is one of the traditional projects among school population in middle and high school education from all counties of the country and Bucharest and implements annually, since the establishment of ANA, in 2003.
- The national project “UNCENSORED” aims to develop life skills necessary for informed, correct and responsible consumption decisions tobacco, alcohol and drugs among students aged 12-14 and is structured into two categories distinct from direct beneficiaries: students and parents.
- The national project “HOW TO GROW HEALTHY” aimed at training healthy living habits among preschool and young school children (preparatory class), emphasizing the importance of adopting a healthy lifestyle (diet, hygiene, exercise), healthy behaviours (no cigarettes, alcohol and over-the-counter medications) .