In 2019, there were 2,144 prisoners in North Macedonia of which 257 were incarcerated for drug law offences [1] which can carry a term of imprisonment from 3 months to up to 10 years [2]. As of 2017, HIV prevalence among prisoners had not been detected [3], although antiretroviral therapy (ART) is reportedly available to them [4]. Both opioid substitution therapy (OST) and needle/syringe programmes (NSP) are also reported to be available in the prisons of North Macedonia [5].
The cost of keeping one person in prison in North Macedonia was €8,103 per year, or €22.20 per day, in 2018 [6].
There were estimated to be 6,756 people who inject drugs in North Macedonia in 2017 (range from 5,206 to 10,377) with no HIV detected [7]. NSP costs around €75.30 per client, per year, and OST costs around €409 per client, per year [8]. The unemployment benefit is €124 per person for one month, but the duration of the benefit depends upon the time that the insured person has been previously employed and has been paying insurance contributions [9].
Therefore, the cost of supporting a person injecting opioid drugs in community settings is €608 per year, or €50,66 per month, compared with €8,103 per year, or €675.25 per month, to keep that same person in prison. Consequently, the Government of North Macedonia could save €7,495 per drug user, per year, by decriminalising drug use and possession.
[1] Aebi MF, Tiago MM. SPACE I – 2019 – Council of Europe Annual Penal Statistics: Prison populations. Strasbourg; Council of Europe, 2020. https://wp.unil.ch/space/files/2021/02/200405_FinalReport_SPACE_I_2019.pdf (accessed 4 August 2021).
[2] Ministry of Health. North Macedonia: A summary of the national drug situation. European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). Lisbon; September 2013. http://www.emcdda.europa.eu/countries/former-yugoslav-republic-of-macedonia (accessed 9 August 2021).
[3] Joint United Nations Programme on HIV and AIDS (UNAIDS). The Key Populations Atlas. Geneva; UNAIDS. https://kpatlas.unaids.org/dashboard (accessed 3 August 2021).
[4] Harm Reduction International (HRI). Global State of Harm Reduction 2020, Regional Overview 2.2 Eurasia. London; HRI, 2021. https://www.hri.global/files/2020/10/26/Global_State_HRI_2020_2_2_Eurasia_FA_WEB.pdf (accessed 3 August 2021).
[5] Ibid.
[6] Aebi MF, et al, Ibid.
[7] Mikikj V, Kuzmanovska G, Kochinski D. Report on the Bio-Behavioural Study and Population Size Estimates of People who Inject Drugs in Skopje, Republic of Macedonia, 2017. Skopje; Institute of Public Health of the Republic of Macedonia, 2018. http://iph.mk/wp-content/uploads/2019/03/RDS-LID-2018.pdf (accessed 9 August 2021).
[8] Information submitted by national partners.
[9] Mutual Information System on Social Protection of the Council of Europe (MISSCEO). Unemployment – Applicable statutory basis. Strasbourg; Council of Europe, 2018. https://rm.coe.int/en-10-summary-2018/1680931403 (accessed 9 August 2021).