1. ILLEGAL AND LEGAL SUBSTANCE ABUSE AMONGST HARM REDUCTION PROGRAM USERS - A CASE STUDY FROM CROATIA
Dalibor Dolezal, PhD
Anita Jandric Nisevic, PhD
University of Zagreb
Faculty of Education and Rehabilitation Sciences
Department of Criminology

2. Croatian Addiction Treatment Survey – CATS
Institution: Croatian Society for Alcoholism and Other Addictions (Croatian Medical Society)
Research goals:
To explore characteristics of the population of users of psychoactive substances and the specificity of addiction treatment in Croatia
To explore experiences in the treatment of opioid dependence by substitution therapy
To gain insight of the organization of opiate addicts treatment in order to evaluate the quality of treatment and present strategic recommendations for improvement.
Institutions involved:
Referral Centre for Drug Addiction of the Republic of Croatia
Centres for Treatment and Prevention of Addiction of the Croatian Institute for Public Health
NGO’s providing harm reduction treatment - Zagreb, Rijeka, Pula, Split and Osijek
Research was supported by the unrestrictive donation by Indivior. NO CONFLICT OF INTEREST

3. CROATIAN ADDICTION TREATMENT SURVEY
379 adult patients who are currently in the official substance abuse treatment program – CATS-PAC
237 adult users of psychoactive substances who in the last 6 months prior to the survey used at least one of the psychoactive substances mentioned in the questionnaire CATS-USE
30 doctors who have at least 5 patients and have at least 2 years of experience in substance abuse treatment – CATS- DOC
anonymous and completely voluntary
a special questionnaire for all three samples

4. CROATIAN ADDICTION TREATMENT SURVEY (CATS) – USE
Main goal: To explore characteristics of users of psychoactive substances who are using harm reduction services provided by the NGO’s
Institutions involved
NGO’s from Osijek, Zagreb, Rijeka, Pula and Split
Sample
237 adult users of psychoactive substances who in the last 6 months prior to the survey used at least one of the psychoactive substances mentioned in the questionnaire
Method
a special questionnaire with 26 questions – information on current consumption of illegal drugs and / or medicines; ways of consuming and purchasing illegal drugs and / or medicines; satisfaction with the use of medicines or drugs they have consumed; and data on current or prior treatment for substance abuse and reasons for not being involved in the official substance abuse treatment program

5. RESULTS GENERAL INFORMATION OF THE SAMPLE N = 237 Avg. Age = 37
Sex: 76% males; 24% females
Marital status: single 36,5%; living with someone 41,2%; married 12,4%; divorced 8,6%; widow/widower 1,3
Education degree: 73,1% high school, 18,4% primary school; 5,6% college, 3% unfinished primary school
Employment: 52,4% unemployed; 23,8% part-time employed; 16% fully employed; 5,6% retired; 2,2% student
Frequency of taking opiates (illegal or legal) = 61,4% on a daily basis; 17,4% 3-4 times a week

6. Please specify for how many years have you been taking each of the following substances? (Table shows the average number of years) (N = 202)

7. For which of the following conditions, if any, are you currently receiving official medical treatment? (N=187)

8. Are you currently taking any of medications that are prescribed by your doctor? (N=229)
Other = Enap, Normabel, Letrox, Praxiten, Olanzapin, Claritine, Emanera 20mg, Euthyral 100, Athyrazol, Controloc, Xanax, Reglinid, Atoris, Glucophage, Seroquel, Akineton, Apaurin, Q-pin, Cipralex, Calixta, Leponex, Helex te Tramal

9. Which substances that are not prescribed by your doctor are you currently taking regularly? (N = 205)

10. For each of the substances you are currently taking that are not prescribed for you, please indicate how do you consume it (N= 215)

11. Have you ever sold or gave away your substitution therapy?

12. Do you know what is the price of the following substances / medicines on the illegal market?
Substitution therapy N
Average price EUR
Methadone pills (5 mg - 1 pill)
152 2
Liquid methadone (vial)
134 17
buprenorphine (2 mg - 1 pill) 85
3,5
generic buprenorphines (2 mg - 1 pill) 59
2,8
generic buprenorphines (8 mg - 1 pill) 67 6
buprenorphine / naloxone (2 mg - 1 pill) 69
3,3
buprenorphine / naloxone (8 mg - 1 pill) 64
6,1
morphine pills 24
7,2
Revia (naltrexone) 3 54

13. Information about substance abuse possibilities in Croatia (N = 235)

14. Sources of information on medications that are used as substitution therapy (N = 232)

15. Reasons for not being in the official substance abuse treatment (N=95)
I'd still like to take drugs sometimes
I do not like what I hear about drug treatment programs
I'm worried that my family / friends / employer will find out
I do not want to stop taking drugs / I'm happy with my lifestyle
stigmatization

16. What would encourage you to start with the substance abuse treatment
What would encourage you to start with the substance abuse treatment? (N=98)
more flexible / elastic rules
lesser conditions or requirements for starting the treatment
nothing / I would not start treatment
greater access to treatment
more information on treatment options
other

17. Conclusion remarks mostly opiate addicts
61,4% currently receiving medical treatment – drug abuse
Type of treatment – pharmacotherapy – methadone
intentional abuse/misuse of substitution therapy
high availability and low cost of the substitution therapy on the illegal market
Lack of supervised substitute therapy distribution
Lack of communication between the specialists who are in charge of prescribing the substitution therapy and family doctors who are responsible for the distribution of the substitution therapy
Further ideas: why are they misusing the substitution therapy (and in a particular way); how is the substitution therapy actually distributed; why do they sell the substitution therapy….

18. Thank you for your attention!