Slovenia

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

The Republic of Slovenia (Slovenia) is a European Union Member State located in the southern part of Central Europe. In 2015 the population of Slovenia was 2,068,000 people.According to the latest available estimates, there were 6,100 PWID in Slovenia in 2011. HIV prevalence among PWID is 1.4%? hepatitis C is 32.1% and hepatitis B is 5.6%. 

Drug use was decriminalized in Slovenia in 2000. Purchasing drugs for private use is not considered a criminal offence.

The legal environment for implementing harm reduction programs in Slovenia is highly favorable, because drug use is not criminalized. These programs operate nationwide, providing sterile injecting equipment, information and counseling at nine fixed sites and 178 different outreach locations across the country. The major recent development in NSPs is the piloting of a drug consumption room program in Ljubljana in 2015.

Opioid substitution therapy (OST) is currently being provided at 19 sites. There are different treatment options to address different needs of OST clients and their health status. The overall OST coverage in 2013 was 65% of opioid users, which is higher than the minimum World Health Organization (WHO) recommendation (40%).

The main funder of the Slovenian HIV response and harm reduction programs is the country’s government. The high levels of service coverage and accessibility for PWID imply that the financial support from the government is sufficient to ensure the continuity and sustainability of harm reduction programs.

Drug Use and Diseases

According to national experts, the most recent estimate of the number of people who inject drugs (PWID) in the country was made in 2011: approximately 6,100 PWID (a range of 5,580–6,750) or 4.37 (4.00–4.84) per 1,000 people aged 15–64.  

HIV prevalence is not particularly high in Slovenia (see Table 1), indicating a generally favorable epidemiological situation. HIV prevalence among adults aged 15–49 is less than 0.1% according to the UNAIDS country profile. However, there is an alternative estimate that HIV prevalence among adults might be approximately 4.37%. HIV prevalence among PWID is also relatively low — just 1.4% in 2013. The situation regarding hepatitis C and B among PWID is better in Slovenia than in other countries in the Balkan region.

Table 1. Epidemiological data 

Indicator

Data

Year of estimate

Total number of HIV cases registered in the country

683

2014

HIV prevalence among adults (aged 15–49)

<0.1% (UNAIDS)

4.37% (local experts)

2014

HIV prevalence among PWID

1.4% 

2013

Hepatitis C prevalence among PWID

32.1%

2013

Hepatitis B prevalence among PWID

5.6% 

2013

Policies

Drug use was decriminalized in Slovenia in 2000. Purchasing drugs for private use is not considered a criminal offence. The Penal Code, adopted in 2008, defines two drug-related criminal offences: the manufacture and trafficking of illicit drugs (Article 186), and facilitating the consumption of illicit drugs (Article 187). According to the legislation, offenders are required to pay a fine. Individuals may be subject to more lenient punishment if they voluntarily enroll in a drug treatment or social security program approved by the Health Council at the Ministry of Health or by the Drugs Council at the Ministry of Labour.

It seems that the legal environment for implementing harm reduction programs in Slovenia is highly favorable, because drug use is not criminalized. However, it is noteworthy that despite the positive changes in the national legislation, in real life the situation is different. There are penalties for drug users, in both major and minor cases, and criminalization of personal drug use is still very common.

Reduction of drug-related harm has been included in national strategic documents addressing drug use since 2004, including the National Program on Drugs, the National Strategy for HIV Prevention and Control and the National Viral Hepatitis Program.

On 2 April 2014 Slovenia’s National Assembly adopted a new resolution on the National Program on Drugs for 2014–2020. The new National Program is a follow-up to the previous strategy. The main emphasis in the new National Program is placed on the development of integrated and balanced measures, programs and activities that help to solve the illicit drug problem in Slovenia. Since this issue involves several ministerial departments and various disciplines, the National Program includes drug supply reduction measures and relevant prevention, treatment and social care services. The National Strategy for HIV Prevention and Control is currently under review for the next five-year period.  

Programs

According to the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Slovenia has more than 20 years of experience in the field of harm reduction. Many new programs have been developed at the local level, mainly targeting injecting drug users and people using drugs in recreational settings. 

Needle and syringe programs (NSP) were introduced in Slovenia in 1995. The EMCDDA reported 10 NSPs (including four mobile units) in Slovenia in 2013. These programs for PWID operate nationwide, providing sterile injecting equipment, information and counseling at nine fixed sites and 178 different outreach locations across the country, including the capital city of Ljubljana and other regions and cities (the Maribor region, the Koper region, the cities of Celje, Ilirska Bistrica etc.).

The major recent development in NSPs is the piloting of a drug consumption room program in Ljubljana in 2015.

Injecting equipment for NSPs is centrally purchased and distributed by the Koper Regional Unit of the National Institute for Public Health and funded by the Slovenian Health Insurance Institute. Syringes and other injecting paraphernalia are usually distributed through day centers, and outreach and mobile services, but they are also available at five pharmacy-based exchange sites. In 2013, around 513,000 syringes were distributed nationwide. The EMCDDA estimated that around 121,000 syringes were sold to drug users through pharmacies in 2012.

NSP Coverage*

Programs for PWID in Slovenia also include distribution of targeted information, educational materials and condoms. There are no specific overdose prevention programs in the country. In response to the recently emerging use of unknown substances sold as drugs, programs are being implemented in recreational settings, where such substances are likely to be sold and consumed.

Opioid substitution therapy (OST) programs were introduced in Slovenia in 1990. OST is currently being provided at 19 Centers for the Prevention and Treatment of Drug Addiction (CPTDAs). There are different treatment options to address different needs of OST clients and their health status. OST is conducted with methadone, buprenorphine (registered in 2004) and slow-release morphine (registered in 2005). Treatment with naltrexone is also available. The buprenorphine/naloxone combination was introduced in 2007.  

In 2013 there were 3,261 OST clients. Among them 2,024 received methadone maintenance treatment, while others received either buprenorphine-based substitution treatment, suboxone or slow-release morphine. The overall OST coverage in 2013 was 65% of opioid users, which is higher than the minimum World Health Organization (WHO) recommendation (40%). OST is almost completely supported by the government. Drug-related treatment is available free of charge within the framework of the national public health service network.

OST Coverage*

OST is available in the penitentiary system to opiate-addicted clients, but only to those who were receiving substitution treatment prior to their incarceration. Antiretroviral therapy (ART) is available in prisons to people living with HIV. There is also access to TB diagnosis and treatment in prisons. Unfortunately, no NSP services are available for inmates, nor are there any condom distribution programs for them.

*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

The main funder of the Slovenian HIV response and harm reduction programs is the country’s government. There is very little information about the structure of financial support, and no information is available about funding from other sources. In 2012 the total harm reduction spending for PWID amounted to USD5,362,814.04, which came from the Health Insurance Institute of Slovenia. In 2013 the harm reduction spending for PWID from domestic sources accounted for 0.03% of the country’s gross domestic product (GDP). The high levels of service coverage and accessibility for PWID imply that the financial support from the government is sufficient to ensure the continuity and sustainability of harm reduction programs as well as relevant medical services in the country.

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