Reimbursed Care Access in Republic of North Macedonia

Currently classified as a strictly controlled substance under national drug scheduling laws, with no authorized medical use outside of approved clinical research. Possession of small amounts is generally treated as an administrative offence punishable by a fine (reported local practice: low monetary fines for very small personal quantities), while larger quantities or supply/trafficking are criminal offences under the national Law on Control of Drugs and Psychotropic Substances. For government policy and the statutory basis for scheduling see the Law on Control of Drugs and Psychotropic Substances and Ministry guidance. # #.

Currently classified as a strictly controlled substance under national drug scheduling laws, with no authorized medical use outside of approved clinical research. Personal possession of very small quantities is commonly handled as an administrative offence (fine); distribution, supply, or trafficking carry criminal penalties. There is no public reimbursement pathway for MDMA‑assisted therapy in North Macedonia. # #.

Esketamine (commercial intranasal products such as Spravato) is not established as a reimbursed, standard psychiatric treatment in North Macedonia and—based on available national medicine‑authorization summaries and local pharmacy/healthcare guidance—there is no routine public reimbursement pathway equivalent to EU/North American listings. Ketamine (racemate) is used in the public health system primarily as an anaesthetic; however esketamine as a psychiatric product has no local marketing‑authorisation record accessible in public registries and would therefore only be available via clinical research, import authorisation, or exceptional/compassionate import procedures if prescribed. The competent national authority for marketing authorisations and reimbursement is the Ministry of Health (Министерство за здравство) together with the national medicines agency; any hospital or investigator‑led clinical trial would need Ministry and ethics committee approvals. # #.

Ketamine is an established, authorised medicinal product in North Macedonia for anaesthesia and acute medical use and is used within hospitals and clinical settings for surgical anaesthesia and other acute indications; this use is governed by national clinical practice and hospital formularies under the Ministry of Health. Clinical and regulatory oversight for ketamine as a licensed anaesthetic falls under the Ministry of Health and hospital pharmacy regulation; hospital purchase and inpatient administration are typically covered by hospital budgets or existing public hospital financing mechanisms rather than by a separate outpatient reimbursement route. While ketamine may be used off‑label in some countries for psychiatric indications (e.g., treatment‑resistant depression), there is no documented, country‑wide reimbursed outpatient ketamine‑for‑depression programme in North Macedonia at present; off‑label psychiatric use would be subject to local hospital/clinic policies, specialist prescription, and likely funded privately or via hospital discretionary budgets if provided. For the national legal/regulatory context and summaries of how ketamine is treated in the Macedonian system see local legal summaries and regional controlled‑substance reviews. # #.

Currently classified as a strictly controlled substance under national drug scheduling laws, with no authorized medical use outside of approved clinical research. Simple possession in very small amounts is frequently treated as an administrative offence with a fine; any supply/trafficking is criminal. There is no authorised or reimbursed medical pathway for DMT or DMT‑containing preparations in North Macedonia. # #.

Currently classified as a strictly controlled substance under national drug scheduling laws, with no authorized medical use outside of approved clinical research. There is no legal framework permitting outpatient therapeutic use or public reimbursement for 5‑MeO‑DMT. Possession and supply are governed by the Law on Control of Drugs and Psychotropic Substances. # #.

Currently classified as a strictly controlled substance under national drug scheduling laws, with no authorized medical use outside of approved clinical research. There is no recognised, reimbursed medical programme for ibogaine in North Macedonia; any importation or research would require explicit Ministry approval. # #.

Currently classified as a strictly controlled substance under national drug scheduling laws, with no authorized medical use outside of approved clinical research. DMT‑containing plant brews such as ayahuasca are treated under the same controls that apply to DMT; there is no authorised therapeutic pathway or reimbursement. # #.

Currently classified as a strictly controlled substance under national drug scheduling laws, with no authorized medical use outside of approved clinical research. Mescaline and mescaline‑containing cacti are not covered by any medical reimbursement programme and are treated as controlled substances for possession, supply, and trafficking. # #.

Currently classified as a strictly controlled substance under national drug scheduling laws, with no authorized medical use outside of approved clinical research. Designer phenethylamines (2C‑series) are controlled; there is no legal therapeutic framework or reimbursement for 2C‑X compounds. Possession can trigger administrative fines for very small amounts, with criminal sanctions for distribution or larger quantities. # #.