Only a small number of people struggling with drug addiction and alcoholism get to the last stage of treatment. Addiction is their worst enemy. "Winter in Rehab" documentary is set in one of the rehabilitation centers near Pavlodar, where those who found the strength to fight are rescued. When they get back to their regular lives, after a long rehabilitation, they often relapse and have to start treatment all over again. Every time their path leads them back to Asar, where this documentary unfolds.
Illicit drug use disorders are the most stigmatised health conditions worldwide, and stigma acts as a meaningful barrier to treatment entry and treatment provision. In the context of dramatically rising opioid-related harms, it is critical that we understand the drivers of stigma and how it affects opioid use disorder treatment and policy. The aim of this narrative review is to discuss how opioid-related stigma impacts treatment provision and harm reduction, and provide potential strategies to reduce stigma at a social and structural level. We used the Framework for Integrating Normative Influences on Stigma (FINIS) to identify sources of opioid-related stigma at the macro (structural stigma), meso (public stigma) and micro (internalised stigma) levels. Reducing stigma requires strategies that target multiple levels, however addressing inequity in the laws, regulations, and rules that segregate people with opioid and other substance use disorders from mainstream society is essential.
Despite the high financial and human costs, mounting evidence of human rights violations, and failure to produce sustained public health outcomes, compulsory detention in the name of drug treatment remains a steadfast practice across East and Southeast Asia.
International consensus has shifted to the need for a comprehensive and integrated continuum of voluntary services implemented in the community that are person-centred and encompass drug dependence treatment, harm reduction and social support services. These must be informed by universal human rights obligations and scientific evidence that demonstrates what works and what does not. This approach is considered keystone for addressing drug use and dependence and has shown positive effects on public safety and health.
Presentation delivered at THE INTERNATIONAL SCIENTIFIC AND PRACTICAL CONFERENCE ON "SOCIAL SERVICE FOR THE ELDERLY AND DISABLED PERSONS IN THE REPUBLIC OF TAJIKISTAN: PROBLEMS AND THEIR SOLUTIONS" - Dushanbe 27 October 2021
Due to the availability and coverage of large numbers of patients, emergency care has the potential to be used to reduce the risk from problem drinking.The most effective approach to preventing drunkenness and alcoholism is an approach aimed at gradually changing traditions in society, with an emphasis on the possibility of adjusting individual behavior under the influence of others. A full motivational interview should be conducted with patients, including family relatives, who tolerate harmful and dangerous drinking and are hesitant to change their drinking habits.
UNODC-WHO Informal Scientific Network Statement 2021: Recommendations on Prevention, Treatment, and Care of Substance Use Disorders in Times of COVID-19.
Individuals with substance use disorders are at increased risk of contracting COVID-19 and if infected are more likely to experience negative outcomes. This vulnerability reflects both the adverse effects of the non-medical use of psychoactive substances on health, as well as associated psychosocial and structural factors, including poverty and stigma. Therefore, individuals with substance use disorders should be prioritized for COVID-19 screening and vaccination. Resources necessary to prevent infection, provide correct information, and ensure treatment, should be made available to this population. Governments need to build capacities to collect timely data on substance use and substance use disorders during the COVID-19 pandemic. Evidence-based treatment of substance use disorders, including mental health and physical comorbidities, should be considered essential, and integrated into existing health care services.
От имени делегации Республики Казахстан разрешите поприветствовать участников 64-ей сессии и выразить признательность за высокий уровень организации, несмотря на непростую для всего мирового сообщества ситуацию, связанную с COVID-19.
Пандемия COVID-19 оказывает крайне негативное воздействие на мировую проблему наркотиков и борьбу с нею.
Follow-up to the implementation at the national, regional and international levels of all commitments, as reflected in the Ministerial Declaration of 2019, to address and counter the world drug problem.
Follow-up to the implementation at the national, regional and international levels of all commitments, as reflected in the Ministerial Declaration of 2019, to address and counter the world drug problem.
Canada: draft resolution.
Objectives: The relationship between past drug use trajectory and long-term relapse risk after rehabilitation among heroin-dependent patients remain understudied. The primary objectives were to identify longitudinal heroin use patterns of heroin-dependent patients, to determine the associative factors with trajectories and to investigate the impact of trajectory groups on relapse after finishing compulsory rehabilitation programs.
Materials and methods: A total of 564 heroin-dependent patients were recruited from 4 compulsory rehabilitation facilities in Shanghai, China between 2007 and 2008. The baseline data was linked to participants’ follow-up data on relapse from official records. Group-based trajectory model was used to identify distinctive drug use trajectory groups. The association between the identified group and heroin relapse risk was then analyzed to understand the role of past drug use trajectory on relapse.
Results: Five trajectory groups were identified in this cohort: (1) Rapid Decrease (9.9%); (2) Persistent High (32.0%); (3) Slow Decrease (34.1%); (4) Gradual Increase (4.5%); (5) Persistent Low (19.5%). Gender, age, education, and impulsivity were found to be different between the five groups. During the 5 years after discharged from the compulsory program, 291 (59.0%) individuals relapsed. Multivariate logistic regression analysis showed that the persistent high group (OR: 2.77 [1.46–5.24]), slow decrease group (OR: 2.31 [1.32–4.06]) and gradual increase group (OR: 3.50 [1.18–10.39]) was positively associated with the heroin relapse risk when compared to the persistent low group. Conclusions: Heroin use trajectories vary among heroin-dependent patients in China. The trajectories of heroin use before compulsory rehabilitation are associated with subsequent long-term relapse risk.
People start to use heroin in different patterns. This study identified three initial heroin use patterns in a heroin use cohort: No-factor initial pattern (with no factors of initial heroin use), Single-factor initial pattern (with 1 of 3 factors of initial heroin use), and Multiple-factor initial pattern (with 2 or 3 factors of initial heroin use). The cumulative heroin relapse rate was 53.3%, 62.4%, and 72.7% respectively for Nofactor, Single-factor, and Multiple-factor initial patterns during the 5-year follow-up. The adjusted hazard ratio (AHR) was 1.401 (95% CI: 1.091–1.799, p = 0.008) in Single-factor initial pattern and 2.381 (95% CI: 1.546–3.668, p < 0.001) in Multiplefactor initial pattern compared to No-factor initial pattern. This study added new evidence to the impact of initial heroin use on long-term relapse risk, which suggested that initial heroin use patterns should not be neglected.
Настоящий документ, «Международные стандарты лечения расстройств, связанных с употреблением наркотических средств» (далее Стандарты), является результатом совместной работы УНП ООН и ВОЗ по поддержке государств-членов в их усилиях по разработке и продвижению эффективных, основанных на фактических данных и соответствующих принципам этики методов лечения расстройств, связанных с употреблением наркотических средств.
Стандарты предназначены для всех, кто участвует в формировании политики, планировании, финансировании, осуществлении, мониторинге и оценке вмешательств и услуг по лечению расстройств, связанных с употреблением наркотических средств.
Настоящий документ основан на имеющихся в настоящее время научных данных в отношении лечения расстройств, связанных с употреблением наркотических веществ, и является основой для применения Стандартов в соответствии с принципами общественного здравоохранения. Стандарты определяют основные компоненты и характеристики эффективных систем лечения расстройств, связанных с употреблением наркотических средств. Методы лечения и вмешательства, отвечающие потребностям людей на различных этапах и при разной степени тяжести расстройств, связанных с употреблением наркотических средств, описываются так же, как описывается лечение любого хронического заболевания или нарушения здоровья.
Стандарты носят рекомендательный характер, и, следовательно, национальным и местным терапевтическим службам или системам не следует пытаться обеспечить осуществление всех содержащихся в этом документе стандартов и рекомендаций одновременно. Тем не менее, с течением времени и с учетом постоянно улучшающегося качества в целях «научно обоснованной и соответствующей этическим принципам практики» можно и следует ожидать формирования более четко организованных, более эффективных и лучше соответствующих принципам этики систем и служб оказания помощи людям с расстройствами, связанными с употреблением наркотических средств.
УНП ООН и ВОЗ предлагают всем, что отвечает за формирование, планирование, финансирование, осуществление и мониторинг местной и национальной политики, а также тем, кто отвечает за оценку лечения расстройств, связанных с употреблением наркотических средств, сопоставить местные системы и услуги по лечению таких расстройств с положениями Стандартов. Цель состоит в том, чтобы выявить пробелы и области, которые не соответствуют Стандартам, и совместно с соответствующими заинтересованными сторонами провести работу по совершенствованию систем и услуг. Хотя многие принципы и разделы Стандартов могут быть применены к лечению других психических расстройств и расстройств, связанных с употреблением психоактивных веществ (например вызванных употреблением алкоголя или табака), основной приоритетной областью Стандартов являются расстройства, связанные с употреблением наркотических средств.
Dr Fadi Meroueh, Prof Adrian Dunlop and Dr Steve Conroy have come together to share their experiences of treating opioid dependence in prison. Should you have any questions please email [email protected] Please note that this inbox will close on 29 November 2020 (one month from the live date).
This webinar has been funded through an unrestricted educational grant from Camurus AB. Camurus AB had no role in the selection of faculty or the development of any content. Content was developed by the speakers.
The Standards are intended for all those involved in the policy development, planning, funding, delivery, monitoring and evaluation of treatment services and interventions for drug use disorders.
This document is based on currently available scientific evidence on treatment for drug use disorders and sets out a framework for the implementation of the Standards, in line with principles of public health care. The Standards identify major components and features of effective systems for the treatment of drug use disorders. They describe treatment modalities and interventions to match the needs of people at different stages and severities of drug use disorders, in a manner consistent with the treatment of any chronic disease or health condition.
The Standards are aspirational, and such, national or local treatment services or systems need
not attempt to meet all the standards and recommendations made in this document all at once.
However over time, progressive quality improvement, with ‘evidence-based and ethical practice’
as an objective, can and should be expected to achieve better organized, more effective and
ethical systems and services for people with drug use disorders.
Aims To describe the polysubstance use patterns of heroin-dependent patients and to understand the impact of polysubstance use patterns on relapse during the 5 years after completing compulsory rehabilitation programmes. Design In this secondary analysis, the baseline data of 503 heroin-dependent patients were linked with their 5-year follow-up data from official records. Setting Four compulsory rehabilitation centres in Shanghai, China.
Participants A total of 564 heroin-dependent patients who were discharged from Shanghai compulsory rehabilitation facilities in 2007 and 2008 were recruited. Among these, 503 patients with available follow-up records were included in this analysis.
Measurements The baseline measurements included the Addiction Severity Index, the Temperament and Character Inventory and the Medical Outcomes Study Social Support Scale. Relapses after discharge from the compulsory rehabilitation centres were extracted monthly from the official electronic record system. Latent class analysis was used to identify different polysubstance use patterns. Associations between the identified latent classes and heroin use and the factors related to relapse during the 5-year follow-up were analysed with the Cox regression model.
Findings Three latent classes were identified in this cohort: (1) alcohol polydrug users (APU; 13.7%), (2) low polydrug users (LPU; 76.5%) and (3) amphetamine-type stimulant polydrug users (ASPU; 9.7%). During the 5-year follow-up, 298 heroin patients relapsed, and the three groups showed different relapse rates (ASPU 69.4 versus LPU 60.5 versus APU 44.9%, P = 0.02). The average durations of abstinence for the three groups differed (ASPU 31.27 ± 3.41 months versus LPU 36.77 ± 1.19 months versus APU 42.46 ± 2.81months, P = 0.02). Multivariate Cox regression analyses found that the LPU [hazard ratio (HR) = 1.63, 1.06–2.51] and ASPU (HR = 2.10, 1.24–3.56) classes were positively associated with the risk of heroin relapse. Conclusion Polydrug use patterns differ among heroin-dependent patients in compulsory rehabilitation programmes in China. A history of polydrug use may predict heroin relapse risk among patients in those compulsory rehabilitation programmes.
Purpose of review
This article reviews the role of methadone maintenance treatment (MMT) clinics in minimizing the harms caused by opioid dependence, as well as China’s current challenges in this area. In addition, we aim to discuss the treatment strategies for opioid dependence within the international community in the current global situation of serious abuse of opioids.
Like other countries facing the opioid crisis, China is actively working on revising policy, improving the addiction treatment system and promotion of MMT clinics to cope with the risks of opioid abuse. As they provide one of the most effective opioid agonist treatments for opioid dependence, MMT clinics play an extremely important role in this campaign. The MMT programme in China has had a significant beneficial effect on reduction of opioid use and the prevalence rate of HIV/AIDS.
The efficacy of MMT for patients with opioid dependence in China is confirmed by the present review. However, several important challenges still need to be resolved. China’s treatment experience also provides a reference for other countries facing the danger of opioid dependence.
Background: People who inject drugs (PWID) in Kazakhstan face many barriers to HIV testing as well as to accessing HIV care, to retention in HIV care, and to initiating and adhering to anti-retroviral treatment (ART). Needle and syringe programs (NSPs) are an opportune setting for integrated interventions to link PWID to HIV care.
Methods: This Hybrid Type II study employs a stepped-wedge design to evaluate both effectiveness and implementation outcomes of Bridge, an intervention to identify, test, and link HIV-positive PWID to HIV care. The study is conducted at 24 NSPs in three different regions of Kazakhstan, to assess outcomes on the individual, organizational, and policy levels.
Discussion: This trial responds to an identified need for new models of HIV service delivery for PWID through harm reduction settings.
The master's degree in “Addiction Therapy and Social Management in Addiction Help” qualifies graduates to work independently as group and individual therapists in the medical rehabilitation of addicts. In addition, it leads to the competence to take on the leadership of project teams and facilities. Furthermore, scientific competencies are deepened and the graduates are enabled to independently develop, carry out and present results of research projects.
Stress could increase risk of heroin addiction and relapse. Genetic factors that associated with stress may be involved in this process. To explore the relationship between stress pathway gene (CRHR1nCRHBP) polymorphisms and heroin dependence, nine tag single nucleotide polymorphisms (CRHR1 rs12953076, rs4458044, rs242924, rs17689966; CRHBP rs1715751, rs3792738, rs32897, rs10062367, rs1875999) of stress related genes were genotyped by TaqMan SNP genotyping assay for 524 heroin-dependent patients who were abstinent and 489 normal controls. The patients were followed up for 5 years to determine whether relapse or not. Life stress was assessed by Perceived Stress Scale (PSS) at baseline and within 12 months just discharged. No differences were found in the frequencies of genotypes and alleles in nine loci of stress pathway genes between case and control groups (p > 0.0 5), but there were significant discrepancy in perceived stress scores in genotype distributions. Multivariate regression analysis revealed that CRHBP gene polymorphism rs3792738 had interactions with life stress during predicting the risk of heroin relapse. It was concluded that the predictive value of a genetic interaction with the stress axis for the risk of heroin relapse may be useful for future preventive and individualized therapeutic strategies.
Число вновь обнаруженных новых веществ является лишь одной из нескольких мер, используемых Европейским центром мониторинга наркотиков и наркомании. Например, 423 (почти 70%) из 620 контролируемых в настоящее время новых психоактивных веществ были обнаружены на рынке наркотиков в 2015 году, в отличие от 365 в 2014 году и 299 в 2013 году. Это показывает, насколько сложным стал рынок в это время.
This practice guideline was based on substance-specific studies and designed to enable better care for those affected and give a surer hand to caregivers when taking action in clinical practice.
Implementation of the Political Declaration and Plan of Action on International Cooperation towards an Integrated and Balanced Strategy to Counter the World Drug Problem: follow-up to the high-level review by the Commission on Narcotic Drugs, in view of the special session of the General Assembly on the world drug problem to be held in 2016.
Studies on recovery patterns and how baseline factors influence recovery consequences among heroin dependent patients have shown mixed results. This study is aimed at describing the gender differences in long-term recovery patterns and exploring the predictors of negative recovery consequences by gender among heroin dependent patients in Shanghai, China. At baseline, this study recruited 503 heroin dependent patients discharged from Shanghai compulsory rehabilitation facilities in 2007 and 2008. In this cohort study, the baseline data was then linked with participants’ 5-year follow-up data from official records. Generalized Estimating Equations (GEE) were used to compare males with females in terms of the presence of negative consequences (incarceration, or readmission to compulsory treatment, or both), in the subsequent 5-years after their discharge from compulsory treatment. Ordinary least squares (OLS) regression was used to explore factors associated to the time length of negative consequences in 5 years after the discharge for males and females separately. Our findings indicate that female heroin dependent patients tend to have less negative recovery outcomes than male patients. Male patients with a life-time history of poly drug use and female patients with borderline personality disorder are especially at risk of incarceration and readmission into compulsory treatment programs.
Relapse is a typical feature of heroin addiction and rooted in genetic and psychological determinants. The aim of this study was to evaluate the effect of personality traits, impulsivity, and COMT gene polymorphism (rs4680) on relapse to heroin use during 5-year follow up. 564 heroin dependent patients were enrolled in compulsory drug rehabilitation center. 12 months prior to their release, personality traits were measured by BIS-11 (Barratt Impulsiveness Scale-11) and Temperament and Character Inventory (TCI). The COMT gene rs4680 polymorphism was genotyped using a DNA sequence detection system. The heroin use status was evaluated for 5 years after discharged. Among the 564 heroin-dependent patients, 500 were followed for 5 years after discharge and 53.0% (n¼265) were considered as relapsed to heroin use according to a strict monitor system. Univariate analysis showed that age, having ever been in methadone maintenance treatment (MMT), the total scores and nonplanning scores of BIS-11, and the COMT rs4680 gene variants were different between relapse and abstinent groups. Logistic regression analysis showed higher BIS total score, having ever been inMMTand younger first heroin use age are the predictors of relapse to heroin use during 5 years follow-up, and theCOMT rs4680 gene had an interaction with BIS scores. Our findings indicated that the impulsive personality traits, methadone use history, and onset age could predict relapse in heroin-dependent patients during 5 year’s follow up. The COMT gene showed a moderational effect in part the relationship of impulsivity with heroin relapse.
China is faced with the challenge of community rehabilitation of persons with opioid use disorders. A 1-year comprehensive psychosocial intervention (CPI) was developed, and its effectiveness was assessed in terms of its ability to improve community rehabilitation of persons with opioid use disorders after their release from detention in compulsory treatment centers in Shanghai, China.
These guidelines are intended to be read by those involved in providing psychosocially assisted pharmacological treatments at any level. The readership falls into three broad groups: