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.
In Zentralasien befinden sich ungefähr (nur) 2.500 von ca. 400.000 Opioidabhängigen in Behandlung mit Opioidagonisten (OST) (weitgehend Methadon). In der Kirgisischen Republik 1.450, in Tadschikistan 680 und in Kasachstan 353. OST in Gefängnissen gibt es in der Kirgisische Republik und in Tadschikistan. Der Zugang ist sehr lückenhaft und die Anzahl der Insassen in Behandlung ist sehr begrenzt. Dennoch könnte OST eine wesentliche Rolle im Gesundheitssystem spielen, obwohl es immer noch massiven Widerstand gegen diese evidenzbasierte Behandlung gibt.
Methadone Maintenance Treatment (MMT) is widely recognized as one of the most effective ways of reducing risk of overdose, arrest, and transmission of blood-borne viruses like HIV and HCV among people that use opioids. Yet, MMT’s use of restrictive take-home dose policies that force most patients to attend their clinic on a daily, or near-daily, basis may be unpopular with many patients and lead to low rates of treatment uptake and retention. In response, this article examines how clinics’ take-home dosing policies have affected patients’ experiences of treatment and lives in general.
The difficulty of access to opioid treatment services and the mental health problems accompanying opioid use disorders are the two main challenges to maintaining accessible and effective opioid treatment. Many countries and institutions issued guidance and recommendations to address these challenges. General coping strategies, loosening of policies, telemedicine, and depot buprenorphine are four main strategies to cope with the challenges posed by the pandemic.
Summary: There were considerable obstacles to maintaining opioid intervention programs during the COVID-19 pandemic. Strategies addressing the obstacles are identified. Research in this area needs to be strengthened.
After a long and controversial debate Agonist Opioid Treatment (AOT) was first introduced in Germany in 1987. The number of patients in AOT – first low because of strict admission criteria – increased considerably since the 1990s up to 79,700 at the end of 2019. Currently 2,600 GPs are prescribing AOT medications. Psychosocial care should be made available to all AOT patients.
Background and Objectives: The COVID‐19 pandemic and control measures may have increased the risk of abusing addictive substances as well as addictive behaviors.
Methods: We present an initial online survey in 6416 Chinese about the relation between the COVID‐19 pandemic and addictive behavior in China.
Results: During the COVID‐19 pandemic, 46.8% of the subjects reported increased dependence on internet use, and 16.6% had longer hours of internet use. The prevalence (4.3%) of severe internet dependence rose up to 23% than that (3.5%) before the COVID‐19 pandemic occurred, and their dependence degree rose 20 times more often than being declined (60% vs 3%). Relapses to abuse from alcohol and smoking abstinence were relatively common at 19% and 25%, respectively. Similarly, 32% of regular alcohol drinkers and 20% of regular smokers increased their usage amount during the pandemic.
Conclusion and Scientific Significance: These three coping behaviors (internet, alcohol, and smoking) during this COVID‐19‐ related crisis appear to have increased the risk for substance use disorders and internet addiction.
HCV (Hepatitis C virus) is a prevalent chronic disease with potentially deadly consequences, especially for drug users. However, there are no special HCV or HIV (human immunodeficiency virus)-related intervention programs that are tailored for drug users in China; to fill this gap, the purpose of this study was to explore HCV and HIV-related knowledge among drug users in MMT (methadone maintenance treatment) sites of China and to investigate the effectiveness of HCV and HIV-related education for improving the knowledge of IDUs (injection drug users) and their awareness of infection.
This study was to characterize the Methadone Maintenance Treatment (MMT) in Shanghai, China, and to explore factors associated with the decline of patients in MMT during 2005–2016.
Both qualitative and quantitative methods were used in this study. Based on the data from Shanghai Centers for Disease Control (CDC), we described the changes in the number of patients who received MMT, and new enrollment each year from 2005 to 2016. Focus groups were conducted with 22 patients, and in-depth interviews were conducted with 9 service providers.
2 .Цели и задачи
3. Методология оценки
4. Результаты оценки
I. Нормативная база
II. Описание услуг
III. Качество услуг ОЗТ
IV. Исход вмешательства
In Hong Kong, methadone maintenance treatment (MMT) was launched in the 1970s, almost 30 years before the counterpart programme’s inauguration in Mainland China. Both were established in response to perceived public crises—addiction-related crime and HIV outbreak, respectively—and both are now regular services under two systems in the same country.
•для лечебно-профилактических учреждений пенитенциарной системы, оказывающие медицинские услуги спец контингенту с опиоидной зависимостью в Республике Таджикистан.
•Утверждено Приказом МЗ и СЗ РТ от «25» ноября 2015 г. №19/55.
•Согласованно с Главным управлением по исполнению уголовных наказаний Министерства юстиции Республики Таджикистан от «03» марта 2015 г.
•Согласовано с АКН при Президенте РТ «29» января 2016 г.
Background: Methadone maintenance treatment (MMT) is an effective measure to control drug abuse, prevent AIDS, and improve family and social functions among those with heroin addiction. Relevant surveys in recent years show that the number of outpatients receiving MMT has a downward trend.
Aims: To understand variation in maintenance treatment rates and causes of withdrawal for outpatients receiving MMT in Shanghai since initiation of this program.
Method: This study was a retrospective investigation, with data from the AIDS Comprehensive Prevention and Control Data Information Management System of the China AIDS Prevention and Control Center. Descriptive statistics were used to describe demographic data, treatment maintenance rate, and number of new outpatients receiving MMT in Shanghai From May 2005 to June 2016. The causes of withdrawal were summarized and analyzed.
In Central Asia, there is a need to update information about the situation of people who use (opioid) drugs (PWUD), especially regarding their access to and utilization of health care services. The aim of the study was to gather information about two different groups of drug users in Kazakhstan and Kyrgyzstan.
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.
The purpose of this paper is to provide an upto- date overview of the state of OST service provision in Eurasia, with a particular focus on access and quality issues. It is based on data collected by the Eurasian Harm Reduction Network between August and November 2011, and is therefore intended to capture some of the most recent developments that took place in the region since the release of the 2010 global update. The paper will begin by providing essential information on OST in all 29 countries of the region. The subsequent sections of the 2 paper are structured around three distinct sets of countries, which, following initial pilots, either
Globally an estimated 15.9 million people inject drugs, and 3 million of them have been infected with HIV. In addition to being vulnerable to HIV, people who inject drugs are also vulnerable to viral hepatitis and tuberculosis, sexually transmitted infections, other bacterial infections and death by overdose. Universally the coverage and quality of services available to drug users remain low. In the countries of Central Asia, injection drug use (mostly opiates) with unsterile injection equipment is the main route of transmission of HIV (ECDC, WHO, 2009). In addition many heterosexual HIV cases are associated with injecting drug use, particularly among the non-injecting female sexual partners of drug injectors.
An evaluation of the Opioid Substitution Therapy programme in the Kyrgyz Republic took place from the 13th to the 17th October 2008. A delegation from World Health Organization Regional Office for Europe met with representatives of the Government, Drug Control Agency, Ministry of Health, Ministry of Justice, UN agencies; international NGOs, staff of drug treatment services and NGOs. Focus group discussions and one to one interviews were conducted with injecting drug users (IDU) at several OST programmes.
The Kyrgyz Republic has successfully created a decentralized system of provision of Opioid Substitution Therapy both in specialized institutions and family medicine centers. Opioid Substitution Therapy is provided by the team of specialists in a comprehensive way and with links to the external sources of support provided by NGOs. Provision of Opioid Substitution Therapy through family medicine centers offers a potential of further integration of drug treatment of IDU with family medicine and further reduction of their stigma.
In most of the Former Soviet Union (FSU) countries, drug dependency treatment is government-funded. The treatment systems include inpatient and outpatient care facilities, data collection and administrative functions. Most centers focus their treatment efforts on total abstinence. Some centers also have harm reduction programs, including needle and syringe exchange programs and methadone substitution therapy.
Over the last several years, HIV infection has been on the rise among injecting drug users in Eastern Europe and Central Asia.