Evaluating Methadone Substitution Therapy In Kyrgyzstan

Ruzanna Harutyunyan's picture

Both internationally and in Kyrgyzstan, the Methadone Substitution Therapy Programme has proved its effectiveness in reducing illicit drug use, risk behaviour (needle and syringe sharing) and criminal activity. Furthermore, it has proven to increase self-registered state of health and social functioning including increasing the employment rate. 0ver 60 delegates are invited to attend a Parliamentary Round Table on 15 May to establish a basis for developing national recommendations for expanding MST in Kyrgyzstan. The meeting is hosted by the UN Theme Group on HIV/AIDS.

The need for a rapid assessment

In October 2008, the law enforcement sector of the Kyrgyz Republic, asked WHO to assess the effectiveness of Methadone Substitution Therapy (MST) in all patients receiving methadone in Kyrgyzstan. The outcomes of the WHO evaluation report were discussed at the Parliamentary Round Table and recommendations based on these findings. 701 out of 729 (96.2%) patients participated in the study.

Crime reduction and improved well-being

The main findings of the study show that significantly more patients in treatment are working and 53.6% of the patients have a job when in treatment. None of the patients in treatment report any criminal activity during the last three months where almost 30% committed crime before starting treatment. The quality of life and self-reported health have been significantly improved after starting treatment. Before treatment all patients were injecting drugs, in treatment the number decreased to 14.5% during the last months. Needle and syringe sharing also decreased from 18.2% to 3.6% during a three month period.

The aims of substitution treatment are:

* to assist people in remaining healthy until, with the appropriate care and support, they can achieve a drug-free life or, if they cannot or want to quit the programme, be in treatment for years or even for their lifetime;

* to reduce the use of illicit or non-prescribed drugs;

* to deal with problems related to drug misuse;

* to reduce the dangers associated with drug misuse, particularly the risk of transmitting HIV, hepatitis B and C virus and other blood-borne infections from injecting and sharing injecting paraphernalia;

* to reduce the duration of episodes of drug misuse;

* to reduce the chances of future relapse to drug misuse;

* to reduce the need for criminal activity to finance drug misuse;

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* to stabilize the person where appropriate on a substitute medication to alleviate withdrawal symptoms; and

* to improve overall personal, social and family functioning.

The Methadone Substitution Therapy Programme has proved its effectiveness in:

* reducing illicit drug use;

* reducing risk behaviour (needle and syringe sharing) and criminal activity;

* increasing self-registered state of health and social functioning including increasing employment rate.

Recommendations by Parliamentary Round Table

The Round Table will adhere to seven key recommendations:

1. Efforts should be continued to increase access of injecting drug users to methadone substitution therapy (MST) in order to increase impact on the prevention of HIV, hepatitis B and C, Tuberculosis and sexually transmitted infections. It is recommended to further expand MST in Family Medicine Centers with capacity building of existing staff.

2. Comprehensive health care should be continuously available in health care institutions, including infectious disease prevention and care, psychosocial support.

3. Cooperation of drug treatment service with family physicians should be strengthened by encouraging patients to use the services of Family Health Centers. Inclusion of NGOs in providing social and legal support for MST patients should be continued at all levels.

4. Capacity building of the MST staff, family physicians, and infectious disease specialists should include provision of basic and continuous training on MST.

5. The monitoring and evaluation plan to monitor the treatment outcomes should be established.

6. Based on the results of the evaluation of pilot MST in penitentiary institution No 47 and SISO it is recommended to consider the expansion of MST in penitentiary system.

7. It is recommended to develop an information dissemination strategy on MST among government employees, law enforcement officers, and medical professionals to avoid misconception about MST at all levels.