In 2023, Egypt celebrated one year of initiating Opioid Agonist Therapy (OAT, also known as Substitution Therapy) services for the first time in the country. The Middle East Harm Reduction Association (MENAHRA) shared in this celebration by organising the first Training of Trainers (TOT) for OAT providers to build on these successes, as well as the second ever training session for OAT service providers in the country.
A story of lost opportunities
Establishing OAT services in Egypt was not an easy journey, but rather a culmination of years of work and dedication. Although Egyptian substance use treatment services have existed since the 1980s as part of a national action plan on HIV/AIDS, OAT lagged behind; discussions for its introduction only began in 2010. After negotiations between international agencies including the United Nations Office on Drugs and Crime (UNODC) and the World Health Organisation (WHO), the Egyptian government agreed to begin the programme by supplying OAT in prisons for incarcerated people using drugs. The project was aborted after the Egyptian revolution in January 2011, and took years to be approached again.
In 2015, there was another attempt to introduce OAT to the Egyptian medical community, thanks to a UNODC-sponsored feasibility study, in collaboration with the Egyptian Ministry of Health and Population (MOHP). The study’s authors highlighted the need for at least two OAT programmes to be implemented in Cairo and Alexandria – the two largest cities.
The report mentioned that “it was expressly agreed that [OAT] is going to be a governmental project and thus organized in public hospitals.” Since this recommendation was issued, no public efforts were made to put it in place.
Better late than never
In 2020, the dream came into reality. The MOHP’s Ministerial Resolution No. 640 of 2020 finally integrated OAT within the nation’s therapeutic programmes for opioid addiction treatment. Since its authorisation, MENAHRA has worked to ensure it is properly implemented and disseminated to all people using opioids that want and require treatment.
In 2021, MENAHRA sponsored the first ever OAT training in Egypt. As a first touch point, these training sessions targeted Egyptian psychiatrists working in government hospitals, bringing in international expertise to develop knowledge in its provision, and improve their confidence on the efficacy of the treatment in preventing further harms and saving lives.
Training of the Trainers after one year of OAT
Another round of training on OAT was conducted in July 2024, again sponsored by MENAHRA: this “training of trainers” five-day session focused on the principles of OAT, how to engage with communities of psychiatrists, as well as advanced clinical knowledge and practice of providing OAT. A total of 24 medical professionals working in OAT services participated in the training, building on their knowledge from the first training session from 2021 and their years of experience. This cohort was gender-balanced and brought together specialists from eight Egyptian governates.
Having followed the development of OAT in Egypt over these years, we were struck by the improvement and maturity in participants’ skills and knowledge in the field; all the attendants were keen to share their experiences, bridge knowledge gaps and plan how they would expand OAT services. Through workgroups, brainstorming, presentations, case studies and role-play, participants highlighted the uniqueness of their work.
“I am so proud that I am the first physician to prescribe methadone in Egypt” one of the participants said. “I enriched my knowledge in this training course, and I hope that soon I will be able to share my experience with my colleagues in Egypt, the Middle East and Africa”, he added.
With no need to prove the efficacy of OAT in the first place, these medical professionals explored recommendations on how services could be tailored in the future to more targeted populations, like pregnant women, people living with HIV, refugees, migrants and other marginalised communities.
Coaching future OAT advocates
With a focus on training trainers, the July session was focused on assessing all participants’ training skills, including how to run ice-breakers to delivering harm reduction strategies to patients.
“The training is a very important step in the long way forward,” Dr Raghda Algamil, the Director of the MOHP’s General Secretariat of Mental Health said.
“We are going to supply buprenorphine in the near future in Egypt, and thanks to MENAHRA, now we are more ready for this step,” she added.
With an opening for harm reduction to move quickly into Egypt, challenges are on the horizon. While Egypt is moving fast on the way of harm reduction especially OAT, many challenges are looming in the horizon. Egypt has almost 800,000 formally registered refugees from other 62 nations. Drug prevalence and addiction rates are still poorly mapped across the country; prisons and communities are still under-served in terms of OAT access. However, these past successes are hopefully signs of a future path of progress.
