Montenegro

Unless otherwise referenced, data included in the following overview has been taken from EHRN country profiles and case studies, all of which are available from the Knowledge hub

Overview

Montenegro is a newly emerged sovereign state in Southeastern Europe. It declared independence on 3 June 2006 and in December 2010 was officially granted a candidate status for joining the European Union.

The country does not have national-level estimates of the size of the population of people who inject drugs (PWID).

Drug use and possession of small amounts of drugs for personal are not a criminal offence.

The community of PWUD is actively involved in advocacy efforts and lobbying that aim to mobilize resources for harm reduction activities, which significantly decreased as the Global Fund to Fight AIDS, Tuberculosis and Malaria grant ended in 2015.

Since international funding for HIV prevention withdrew from Montenegro, harm reduction services have experienced severe consequences of crises of sustainability and political indifference. Financial support to harm reduction services in Montenegro is insufficient to meet the needs of PWID at least at the level of previous years.  

Drug Use and Infectious Diseases

According to data from the national census conducted in 2011, the total population of Montenegro is 620,029 people, about 30% of whom (204,877 people) live in Podgorica, the capital city.

The country does not have national-level estimates of the size of the population of people who inject drugs (PWID). The available estimates of the number of PWID were conducted only for the capital city and nearby municipalities. According to these estimates, there were 1,282 PWID  in Podgorica in 2012 or 0.7% of the total population of the city.

There is a generally good epidemiological situation with regards to HIV among population of Montenegro (see Table 1). In 2014 HIV prevalence among adults (15-49 years old) was lower than 0.02%. The highest numbers of HIV cases were registered in the coastal region and Podgorica. Estimates of epidemiological situation with HIV, Hepatitis B and C among PWID were conducted only for Podgorica and nearby municipalities. According to these data, HIV prevalence among PWID in 2014 was relatively low — only 1.1%. At the same time, hepatitis C prevalence is high (53%), which indirectly indicates that risky behavior among PWID (e.g. sharing injecting equipment) is still common.

Table 1. Epidemiological data 

Indicator

Data

Year of estimate

Total number of HIV cases registered in the country

 

192

1989 – 1 December 2015

Cases of HIV among PWID

5

1989–2015

HIV prevalence among adults (15–49 years old)

<0.02%

2014

HIV prevalence among PWID

 

1.1% in Podgorica and nearby areas

2014

Hepatitis C prevalence among PWID

53% in Podgorica and nearby areas

2014

Hepatitis B prevalence among PWID

1.4% in Podgorica and nearby areas

2014

Policies

Over the last few years, Montenegro, as a relatively young independent European State, has been going through an active phase of legislative developments and changes. In 2011, drug use and possession of small amounts of drugs for personal use became only an administrative offence and is not sanctioned by the Penal Code any more. This was an important step towards decriminalization of drug use. Unfortunately, substance thresholds are not specified yet. Drug related offences are usually charged with fines of 30–2,000 EURO. If a person commits a criminal act under drug influence, he or she can be sent by the Court to obligatory treatment of drug addiction (it is a part of criminal sanction).

Harm reduction services in Montenegro are mentioned by a number of national programs: the National Strategic Response to Drugs 2008–2013, the Strategy of Montenegro for the Prevention of Drug Abuse 2013–2020, and a law on the prevention of abuse of psychoactive substances (2011). There were also three National AIDS Strategies (2005–2009, 2010–2014, and 2015–2019). There are no strategic documents on hepatitis C and B. Unfortunately, declarations in the documents often remain on paper only, and are not supported financially or politically.

Although the national strategy for drugs recognized harm reduction services provided by NGOs, they are not yet legalized in Montenegro and the very operation of these services requires a special permit from the police and the state prosecutor. There is still no official legal framework for the implementation of opiate substitution treatment (OST) in Montenegro too. Legislative changes are required to protect harm reduction service providers from criminalization and pressure from law enforcement authorities.

In 2015 there was only one community initiative group of people who use drugs (PWUD) in Montenegro, called LINK. The community of PWUD is actively involved in advocacy efforts and lobbying that aim to mobilize resources for harm reduction activities, which significantly decreased as the Global Fund to Fight AIDS, Tuberculosis and Malaria grant ended in 2015. As in other countries of the Balkan region, the issue of funding harm reduction services and medical services for PWUD is the highest priority for civil activists in Montenegro, but it is not a top political priority for decision-makers.  

Programs

For the last few years harm reduction programs in Montenegro have been declining, rather than developing, due to the lack of financial support from domestic sources and international donors. Access to harm reduction services has been severely restricted since the Global Fund financing ended in June 2015.

The first needles and syringes exchange program (NSP) in Montenegro was introduced in 2005 as a part of the Primary Health Care Center in Podgorica. Later on, these programs have been extended to the NGO sector, conducted through outreach work and the work of daily (drop in) centers run by NGOs Cazas (in Podgorica and Bar), and Juventas (Podgorica). In addition to the sterile injecting equipment, these centers also provided other services (preventive education, information and counseling on a variety of topics, basic medical care, condom distribution, psychosocial support, and referrals).  

In accordance to an integrated biological and behavioral surveillance (IBBS) survey, 53.5% of PWID in 2013 received clean syringes at drop-in centers for PWID, 17.9% from the needle exchange programs in state-funded primary health care centers, and 8% through the 11 outreach needle exchange programs. In 2014, Montenegro reported three needles and syringes programs in the country, covering 1,549 PWID, but the state-funded NSP within a Primary Health Care Center closed down. In 2015 the Global Fund’s grant also ended. Thus, since 30 June 2015 only one NSP — a drop-in center for PWID in the capital city — has continued to function. It operates at a minimal scale due to the lack of funds.

There is currently no national-level outreach work at all. Only in the Podgorica drop-in center are PWID involved as peer support workers. There are not enough NSPs to reach all PWID who are in need of services. Although no data on recent NSP service coverage are available, it is clear that coverage has dramatically decreased, as NSPs have been closed throughout the country. After the Global Fund left Montenegro, the government did not completely fulfill its obligations to fund NSPs.

Opioid substitution therapy (OST) was introduced in the country in 2004 in Podgorica. Since 2010 it has been extended to four more cities, and there were five functioning OST sites in 2015. OST is conducted with methadone. Although buprenorphine was introduced in the middle of 2015, it is still not used at the national level due to the absence of medical protocols. Since 2015 OST program is funded by the government.

There were 367 patients on OST in 2015 in Montenegro. Unfortunately, the capacity of existing OST services is not enough to address the demand in the country. For example, there are an estimated 1,292 PWID in Podgorica, but only 50 OST courses are available. There are waiting lists of patients who wish to start OST, but with the current level of funding it is not possible to increase the number of OST clients. There is no national coordinating body for OST services either. In late 2014 and several times in 2015, several methadone maintenance centers experienced shortages of methadone. This affected patients in prisons as well, as methadone is transported from the local methadone maintenance centers to the national prison.

OST Coverage*

Methadone substitution therapy is available in the penitentiary system to opiate-addicted prisoners, but only for those who were receiving substitution treatment prior to incarceration. There are no NSP services for the prison population, and no condom distribution.

There is no information available on programs designed for users of stimulants and ‘new drugs’ in Montenegro. There are also no overdose prevention programs and no naloxone distribution due to the lack of funding, experience and knowledge among professionals, as well as the absence of political will to support harm reduction initiatives.

*In order to reverse an HIV epidemic, WHO/UNODC/UNAIDS (2014) guidance recommends that 60% of all PWID should be reached regularly by NSP, while 40% of all opiate users should be enrolled in OST.

Funding

Information on the financial support for harm reduction services in Montenegro is rather ambiguous, as the situation was changing during 2015 and 2016 after the withdrawal of Global Fund support in June 2015.

According to information from the UNDP in 2015, harm reduction spending for PWID within the non-governmental organization (NGO) sector was USD98,974. This represented 68.3% of the overall national budget for harm reduction services. There was no funding of harm reduction for PWID from domestic sources, and all financial support came from international sources, basically the Global Fund grant. After 30 June 2015 the Global Fund support was over, and NSP services were no longer funded by international donors.

After the withdrawal of Global Fund support to Montenegro, the government did not take on the responsibility for funding all existing NSPs to ensure they continued. However, according to recent information, the government provides partial funding for one NSP. NGO Juventas’ Drop in Center in Podgorica has its costs partially covered from the state budget through the Ministry of Finances’ Fund for the distribution of revenues from games on chance (National Lottery Fund). In 2016 the National Lottery Fund will cover 27% of the total planned budget for NSP services.

Since 2015 OST and related medical services are covered by the government via the Health Insurance Fund. There is no information available on the amount of this support. 

Since international funding for HIV prevention withdrew from Montenegro, harm reduction services have experienced severe consequences of crises of sustainability and political indifference. Unfortunately, financial support to harm reduction services in Montenegro is insufficient to meet the needs of PWID at least at the level of previous years.

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