Methadone Breakthrough: Ukraine to Independently Purchase Opioid Substitution Therapy

Patient receiving OST at Kremenchug drug treatment centre, Poltava region Source: kremenchug.ua

Author: Yana Kazmirenko, Ukraine

From 2018, opioid substitution therapy (OST) programme in Ukraine is financed by the Government. Activists are asking international organizations for a backup to prevent disruptions in the supply of life-saving medications.

The Government of Ukraine plans to independently procure substitution therapy programme medications in 2018. According to the World Health Organization (WHO), over 10 thousand people received therapy last year at 178 institutions throughout the country. It is planned to double the number of patients in 2018.

Ukraine wants to beat HIV

Ukraine can be proud of its implementation of OST because this is the largest-scale coverage programme in Eastern Europe and Central Asia. Since 2005, the programme to substitute opioids with methadone or buprenorphine was financed by the Global Fund. Patients under the care of a physician received syrup or pills.

“This is a major milestone for public health care in Ukraine,” says WHO representative Martin Donoghue. “For many years WHO and partners have worked with the Government and opioid substitution therapy received the endorsement and comprehensive financial support. This attests to the fact that Ukraine wants to beat HIV.”

People who inject drugs belong to key groups who are most at risk of HIV and its transmission. The numbers are a confirmation: HIV was diagnosed for 42% among OST programme participants in Ukraine, and 21.3% of new HIV cases account for the transmission through injecting drug use. Sexual transmission still remains to be the main way of transmission – 63.9%.

Financing doubts remain

WHO recommendations indicate that to control HIV/AIDS spread among people who inject drugs 20 thousand people shall receive therapy. Ukraine intends to reach these numbers by the end of 2018.

According to Director of charitable organization Meridian and Executive Director of All-Ukrainian union of people with drug addiction VOLNA Oleg Dymaretskiy, there are 368 thousand injecting drug users in the country. The majority uses several types of drugs, including medications from pharmacies. The activist has doubts regarding the timely supply of OST medications by the Government.

“I do not believe that transition to Government financing will be fully implemented in 2018. 13 mln. Ukrainian Hryvnyas a year ago were allocated for medications for 9.6 thousand patients, but they reached them only in December 2017,” says Dymaretskiy.

NGOs requested the Global Fund to back up the supply of medications, and, according to Dymaretskiy, received a positive response. To double the number of patients, the activist suggests increasing the number of OST offices along with prescribing therapy at the level of district poly-clinics.

OST will reach prisons

Our colleague told us about another initiative of VOLNA union – start-up of a programme on continuous treatment at institutions of detention, which will include detoxification and prescription of substitution therapy. Two thousand people withdraw from OST programme every year, one in ten – due to serving a sentence in prison.

“Substitution therapy changes lives of people who use drugs. It is the first step and acknowledgment: it is beyond my power to cope with addiction, but I will change the quality of living,” summarizes Dymaretskiy.

Starting Methadone after 18 Years of Using Drugs   

IMG_269244 years old Makhmad asked for support of the social workers of “Bridging the Gaps” program implemented in Qurghoonteppa city in Tajikistan after he experienced 18 years of injecting drugs and had several ineffective attempts of stopping using them. He was seeking for some assistance in his drugs dependence treatment.

“I have heard about methadone many times, but did not believe that it can help me, even though many of my “colleagues” in the streets were telling about its positive effects. During my communication with social workers of AFEW-Tajikistan, I received all the answers to my questions. They told me everything about opioid substitution therapy (OST) and all aspects of using of methadone. I decided to try this treatment myself,”– Makhmad says.

Before entering OST program, Makhmad faced many problems in his everyday life and with his family. “Frankly, I never thought about my family and my kids. All my thoughts were about how to find drugs”, – he says. Thanks to “Bridging the Gaps” program support, Makhmad passed medical observations, got needed tests and afterwards was included in OST program that was implemented by state detox center of Qurghoonteppa.

“After some time of participation in OST program I felt positive changes. First of all, I stopped to think about how and where to find my dose of heroin. Besides, my relations with family members improved. I have also found the job. I feel myself healthy and I can say it with a confidence that everything is good in my life. When I now see people I know who are still using drugs, I explain them that methadone is something that can really help us”, – Makhmad tells.

Social workers of AFEW-Tajikistan are continuing to provide assistance to Makhmad. In return, he does some volunteering work for AFEW, and together with the social workers Makhmad is informing people who use drugs about available services within “Bridging the Gaps” program in Qurghoonteppa.

“Bridging the Gaps: Health and Rights of key populations” project is funded by the Ministry of Foreign Affairs of the Netherlands is implementing in Qurghoonteppa by AFEW-Tajikistan Branch in Khatlon region. People who use drugs or are affected by HIV epidemic can receive client management and HIV prevention services including assistance in initiation and adherence to treatment. Only in the first half of 2016, 84 PUDs were provided by AFEW-Tajikistan’s assistance to pass needed medical observations on free of charge base and 16 of them finally were included in OST program.