On September 25, 2014, a round table was held in Bishkek at the "Alpinist" hotel to discuss the achievements and problems in the implementation of the opioid substitution therapy (OST) program in Kyrgyzstan. The event included a report from the Public Fund "Alternative in Narcology" on the steps taken, a discussion of the current situation, and planning further actions to protect the OST program and its participants from discrimination. Decision-makers, representatives from the Ministry of Health of the Kyrgyz Republic, the Republican Center for Narcology, the city administration, law enforcement agencies, international organizations, and community activists, including relatives of people undergoing treatment for injection drug use (IDUs), were invited to participate in the round table.
The OST program is an alternative approach to treating heroin addiction. Medical professionals are joining forces in the fight against this ailment together with international and non-governmental organizations, as they provide additional resources for organizing prevention and treatment for drug addicts in Kyrgyzstan, of which there are officially more than 10,000 people. The consumption of injection drugs threatens the spread of HIV in the country. More than half of all registered cases of HIV infection in Kyrgyzstan are a result of injection drug use. The actions of all existing programs of the Ministry of Health of the Kyrgyz Republic and development partners (needle exchange, training of medical personnel and social workers, opioid substitution therapy, etc.) are primarily aimed at preventing HIV and reintegrating patients into a socially-oriented life.
According to the Republican Center for "AIDS," as of September 1, 2014, there were officially registered 5,537 cases of HIV infection in the Kyrgyz Republic, including 5,296 among citizens of the Kyrgyz Republic (3,608 men and 1,688 women), with 667 people diagnosed with AIDS. A total of 1,012 HIV-infected individuals have died, including 325 from AIDS.
In the first 8 months of 2014, 401 HIV-infected individuals were identified (216 men and 185 women), including 102 injection drug users. A positive aspect is that the number of identified cases of HIV infection is increasing each year; compared to the same period in 2013, it has increased by 20% (from 334 cases). Harm reduction programs contribute to increasing the adherence of HIV-infected IDUs to antiretroviral therapy and reducing dangerous injection practices.
Currently, there are 30 OST points operating in Kyrgyzstan: 6 in Bishkek, 7 in the Chui region, and 10 in the southern region, including 7 in correctional institutions. Up to 1,100 IDUs participate in this program.
Methadone is one of the main medications used in the treatment of heroin addiction. Opioid substitution therapy was introduced in Kyrgyzstan in 2002. Since the program's inception, about 4,000 people have passed through it.
Among the countries of the former USSR, OST is conducted in Lithuania, Latvia, Estonia, Moldova, Azerbaijan, Georgia, Ukraine, and Kyrgyzstan. Currently, about 1.5 million people worldwide are receiving it. OST is being implemented in all European Union countries. For example, in Italy, 27-29% of patients with opioid dependence receive substitution therapy; in Spain, this percentage ranges from 41 to 86%; in Germany, it ranges from 33 to 63%; and in the Netherlands, it ranges from 40 to 47%.
Despite ongoing attacks on the program, substitution therapy is functioning and helping many. Each client who comes to this program is a person in whose family peace and tranquility reign, who is not in places of deprivation of liberty because he does not commit crimes and has no need to seek money for another dose; he is a specialist who works for the benefit of his family and society.
Opioid substitution therapy is a method that minimizes the harm from drug use, prevents deaths from drug overdoses, and warns against the spread of dangerous diseases. According to specialists in HIV and drug dependence, the implementation of therapeutic and rehabilitation measures for drug addiction patients, conducting substitution therapy, and preventive programs for HIV/AIDS should be highlighted as independent areas of state policy in this sphere.
Participants of the round table reviewed the results of the activities of the Public Fund "Alternative in Narcology" over five years of existence. They noted that in recent years, considerable efforts have been made in Kyrgyzstan to promote programs for the prevention of HIV infection and to reduce the harm from injection drug use. Thanks to the political will of the country's leadership, the contributions and efforts of state, non-governmental, and international organizations, the Kyrgyz Republic remains a country with a low level of HIV infection spread.
Among the problems identified at the round table were: the absence of a law on drug prevention, the combined use of methadone with diphenhydramine, somnol, and other psychoactive substances, discrimination by law enforcement officers and medical professionals, the stigmatization of OST clients by active drug users, as well as various sects.
The substitution therapy program needs development and expansion of access to treatment in remote areas of the country where there is a need for OST, and in places of deprivation of liberty. According to the participants of the round table, it is also necessary to expand social assistance for OST users to help them adapt to life in society more quickly.
According to Irina Pugacheva, director of the Public Fund "Alternative in Narcology," her organization's activities are aimed at improving the quality of life for participants in the opioid substitution therapy program to facilitate their reintegration into the social life of the country. Currently, with the financial and technical support of the Soros Foundation-Kyrgyzstan, the Public Fund "Alternative in Narcology" is implementing the project "Advocacy of the OST Program and Rights of OST Clients."
One of the participants in the OST program, Alexander, shared his story about how he came to this program:
“I am 40 years old and I have two children. I started using drugs through injection, with a needle, since 1996. Before that, I just experimented, sniffed, and smoked. I injected until 2008. I knew about the methadone program, but I didn't believe in it; I only heard bad information. My wife brought me to the opioid substitution therapy program. She saw that we were always out of money, even though we had our own shop. Before methadone, I never thought about my family. Before falling asleep at night, I only thought about one thing: how to wake up in the morning and where to steal something, whom to beat up to get money for my next dose, because without it I was in withdrawal. From the first days on methadone, I realized that I could work freely; my relationships with my family improved. Of course, there were relapses when I didn't listen to the doctors and lost weight down to 49 kg. In recent years, I have always worked with Dr. Sabyr Sadykovich, who helped me get back on my feet and explained that my dose was initially set incorrectly. By following the doctor's clear recommendations, I started feeling better, and for the seventh year now, I have been working, regained my previous weight, and I have no thoughts of using again, even when offered. I know that if I relapse, I will ruin all my treatment.
What I miss the most is information. Many people, especially parents, think that methadone kills, that it causes teeth to fall out... Someone just poorly informed them. As you can see, I am healthy. We need to honestly tell more about methadone, how good it is, and what possible side effects there may be.
I came to Bishkek from Osh. Here, NGOs helped me. They helped me with documents, and I found a job. Currently, I work as a laborer in construction.
I also had hard days. I lived on the street for a week. It was then that I was taken to work in an NGO without any documents; they believed in me. I earned a little money, got dressed, and rented an apartment. The development of methadone points is a great help. It is also important that we, drug users, are not forgotten and that people do not say we are hopeless. Methadone helps pull us out of such trouble.
I am even afraid to talk to my children about this topic because it is a very great evil, and bad examples for children are always contagious. If, God forbid, this trouble touches my children, I simply will not survive it.”
