A pilot programme in Kyrgyzstan

In October 2008, the law enforcement sector of Kyrgyzstan asked WHO to assess the effectiveness of methadone substitution therapy among everyone receiving methadone in Kyrgyzstan. The outcomes of the WHO evaluation report were discussed at a Parliamentary Round Table in Kyrgyzstan, and recommendations were made based on these findings. Of the 729 people eligible for the study, 701 (96.2%) participated. The outcome of methadone substitution therapy showed remarkable results, with a huge decrease in illicit drug use, improved quality of life and an improved self-rated health.

Crime reduction and improved well-being

The main findings of the study show that significantly more of the people receiving treatment are working, and 54% have a job while in treatment. None of the people receiving therapy report any criminal activity during the past three months versus almost 30% before starting treatment. The quality of life and self-rated health improved significantly after treatment started. Before treatment, all study participants were injecting drugs; in treatment, the number decreased to 15% during recent months. Needle and syringe sharing also decreased from 18% to 4% during a three month period.

Recommendations by the Parliamentary Round Table

The Round Table made seven key recommendations:

  1. Efforts should be continued to increase the access of people who inject drugs to methadone substitution therapy to increase the impact on the prevention of HIV infection, hepatitis B and C, tuberculosis and sexually transmitted infections. It is recommended to further expand methadone substitution therapy in family medicine centres by building the capacity of existing staff.
  2. Comprehensive health care should be continually available in health care institutions, including infectious disease prevention and care and psychosocial support.
  3. The cooperation between drug treatment services and family physicians should be strengthened by encouraging people who inject drugs to use the services of family health centres. Including nongovernmental organizations in providing social and legal support for people receiving methadone substitution therapy should be continued at all levels.
  4. The capacity-building of the methadone substitution therapy staff, family physicians and infectious disease specialists should include providing basic and continuing training on methadone substitution therapy.
  5. A monitoring and evaluation plan for monitoring the treatment outcomes should be established.
  6. Based on the results of the evaluation of a pilot methadone substitution therapy programme in penitentiary institution No. 47 and SISO, it is recommended to consider the expansion of methadone substitution therapy in the penitentiary system.
  7. It is recommended to develop an information dissemination strategy on methadone substitution therapy among government employees, law enforcement officers and medical professionals to avoid misconceptions about methadone substitution therapy at all levels.