Country example: methadone substitution therapy in Kyrgyzstan
Methadone substitution treatment (MST) reduces heroin use and is more effective in retaining drug users in treatment than detoxification on its own. The approach has many benefits, including stabilizing drug users, interrupting chaotic lifestyles and improving the levels of social functioning and employment. It offers opportunities for improving the delivery of antiretroviral treatment to drug users living with HIV/AIDS, and there is good evidence that MST improves the overall health status of drug users infected with HIV.
Kyrgyzstan has created a decentralized system of provision of methadone substitution therapy in both specialized institutions and family medicine centres.As part of this programme, a pilot study was conducted in two penitentiary institutions. The programme has proved its effectiveness in reducing illicit drug use, risk behaviour (needle and syringe sharing) and criminal activity.
The aims of MST 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, to help them remainin treatment for years or even for their lifetimes;
- 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 bloodborne infections from injecting and sharing injecting paraphernalia;
- to reduce the duration of episodes of drug misuse, the chances of future relapse to drug misuse and the need for criminal activity to finance drug misuse;
- to stabilize the person where appropriate on a substitute medication to alleviate withdrawal symptoms; and
- to improve overall personal, social and family functioning.
Programme assessment
In October 2008, the law enforcement sector of Kyrgyzstan asked WHO to assess the effectiveness of MST in all patients receiving methadone in Kyrgyzstan. The main findings show that significantly more patients in treatment are working and 53.6% of the patients had jobs while in treatment. None of the patients reported any criminal activity during the last three months, while almost 30% had committed crimes before starting treatment. The quality of life and self-reported health significantly improved after starting treatment. Before treatment all patients were injecting drugs; in treatment the proportion fell to 14.5% during the last months. Needle and syringe sharing also decreased from 18.2% to 3.6% during a three-month period.
Recommendations
The outcomes of the WHO evaluation report and recommendations for expanding MST in Kyrgyzstan were discussed at a parliamentary round-table on 15 May 2009. The delegates agreed on the following key recommendations.
- Efforts should be continued to increase access of injecting drug users to MST 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 centres with capacity building of existing staff.
- Comprehensive health care should be continuously available in health care institutions, including infectious disease prevention and care, psychosocial support.
- Based on the results of the evaluation of pilot MST in penitentiary institution no. 47 and in pre-trial detention, expansion of MST in the penitentiary system should be considered.
- Cooperation of drug treatment service with family physicians should be strengthened by encouraging patients to use the services of family health centres. Inclusion of nongovernmental organizations (NGOs) in providing social and legal support for MST patients should be continued at all levels.
- Capacity building of the MST staff, family physicians, and infectious disease specialists should include provision of basic and continuous training on MST.
- A monitoring and evaluation plan to monitor the treatment outcomes should be established.
- A strategy should be developed to disseminate information on MST to government employees, law enforcement officers and medical professionals to avoid misconceptions.
“to promote, enable and strengthen widespread introduction and expansion of evidence-based targeted interventions for vulnerable/high-risk groups, such as prevention, treatment and harm reduction programmes (e.g. expanded needle and syringe programmes, bleach and condom distribution, voluntary HIV counselling and testing, substitution drug therapy, [sexually transmitted infection (STI)] diagnosis and treatment) in all affected communities, including prisons, in line with national policies.”
