Ingo Ilja Michels
Heino Stöver
Oleg Aizberg
Azizbek Boltaev
Opioid Agonist Treatment Treatment of Opioid Dependence HIV/Hepatitis prevention and treatment
Opioid Agonist Treatment for Opioid Use Disorder patients in Central Asia

In Central Asia approximately (only) 2,500 of dependent people (approximately 400,000) are in Opioid Agonist Treatment (OAT). In the Kyrgyz Republic 1,450, in Tajikistan 680 and in Kazakhstan 353. OAT in prisons is available in the Kyrgyz Republic or Republic of Tajikistan. Access is very patchy and the number of inmates in treatment is very limited. Nevertheless, OAT might play a substantial part in the health care system provided to drug users in Central Asia in the future, although there is still massive resistance against this evidence-based treatment. OAT can reduce substantially drug-related criminality and infection diseases (HIV, Hep C) and support effective treatment of additional health problems and dependence. The results of research studies and practical experiences clearly indicate that dependent patients benefit substantially from OAT with improvements in physical and psychological health. OAT proves successful in attaining high retention rates (65 % to 85 % in the first years, up to 50 % after more than seven years) and plays a major role in accessing and maintaining ongoing medical treatment for HIV and hepatitis. OAT is also seen as a vital factor in the process of social reintegration and it contributes to the reduction of drug related harms such as mortality and morbidity and to the prevention of infectious diseases. Some 10-20 % of OAT patients in European countries or USA become drug-free in the long run. Methadone is the only prescribed agonist opioid medication in Central Asia, although buprenorphine might attain rising importance (but too expensive, no experiences). In Turkmenistan no OAT is provided. In Uzbekistan OAT had been introduced, but was not continued. Access to OAT in rural areas is very patchy and still constitutes a problem. There are only few employment opportunities for patients participating in OAT, although regular employment is considered unanimously as a positive factor of treatment success.

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Danielle Parsons
Dave Burrows
Aisuluu Bolotbaeva
Advocating for opioid substitution therapy in Central Asia: Much still to be done

Opioid substitution therapy (OST) was first introduced in the formerly-Soviet Central Asian Republics as an HIV prevention intervention for people who inject drugs (PWID) in 2002. Presently, pilot programs function in Kazakhstan and Tajikistan, and Kyrgyzstan has scaled-up from the pilot phase to the operation of over 20 OST sites nation-wide. All three countries have taken steps towards lower-threshold programs, allowing clients to enroll regardless of HIV status, and, in some cases, without documentation of failure to complete other drug treatment programs. However, OST programs remain exclusively funded by inter-national donors, and political and societal opposition to these programs threaten their stability. In order to counter negative campaigns and political attacks on OST, organized advocacy efforts are needed. This commentary explores efforts undertaken by international donor partners supporting advocacy efforts to scale-up OST and assure a sustainable future for programming. It examines both proactive and reactive efforts, and the variety of target audiences that need to be reached to conduct effective advocacy. Ultimately we find that, while a range of tools are available for OST advocacy in the hostile environments of the former Soviet Union, the strengthening of advocacy groups is needed to assure an optimized platform exists for using the evidence and developing relevant materials in the appropriate languages (including, but not limited to, Russian) for both proactive and reactive efforts; and that more robust monitoring is desirable to bring sharper focus to replicable methods.

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