COVID-19 Curfews, Supply Shortages and Take-Home Prescriptions: How OST is Being Administered in the EECA Region
The Eurasian Network of People who Use Drugs (ENPUD) have gathered information about opioid substitution therapy (OST) access in Belarus, Georgia, Moldova, Kazakhstan, Kyrgyzstan and Ukraine during the COVID-19 pandemic.
The WHO recommends that for “people with opioid dependency, who are clients of legally administered substitution therapy programmes, it it crucial to create conditions to reduce risks of COVID-19 infection and transmission: ensure take-home drug prescriptions, drug delivery, as well as access ot OST programmes for people who were not programme clients before the epidemic, but require daily dose of opioids”.
*Information as of March 29, 2020
Belarus: “Your chance” NGO
Quarantine in Belarus is still not officially declared. There is no practice of take-home prescriptions of OST drugs established in the country. During the last two days we have been working closely with the Ministry of Health in Belarus about the changes to existing clinical protocol of OST administration, which aims to improve access to the .
On February 5, we filed a request to the first deputy Minister of Health about the need to adopt new regulations and clinical protocol for buprenorphine supply and administration. Now we have about 700 OST programme clients. The programme started in 2013 from 1048 patients, however, since 2015 the programme has been state-funded and the number of clients decreases every year.
The key problems we are currently facing: long waiting lines at the OST sites; in some cases methadone is not transported to the local hospitals. There are no take-home OST prescriptions, the risk of losing one’s driving license and parental rights for being an OST patient is relatively high.
In Belarus things still look normal - we go to work and kids still attend schools. It would make much more sense to use this time to ensure access to OST by prescriptions, in the hospitals and in prisons
Sergey Kryzhevich, OST patient for 11 years, member of the National Coordination Council
Georgia: GeNPUD, members of the “Phoenix 2009” network, “Rubiconi”, and “New Vector” NGOs
On March 18th, all patients received OST drugs on-site, the first time everyone received drugs for 5 days. There has been no regular practice of at-home drug administration before.
Activists have been negotiating with the Centre of Mental Health and Drug Use Prevention, which is in charge of all OST programme management in the country. Thanks to active cooperation of the PUD (people who use drugs) community and experts, people received their medication for home use.
We are not going to stop here and continue to join advocacy efforts to prevent COVID-19 spread within the PUD community on one hand and to make current strict regulations more accessible.
Konstantin Labartkava, GeNPUD, member of the National Coordination Council
Moldova: Members of the “Together” community in Chisinau and “Pulse” initiative from Balti
In the cities of Chisinau, Balti, Falesti and Ungheni all OST patients receive one week supply of methadone for home use. In Chisinau patients also receive buprenorphine for 5 and more days of home use. OST sites work two times a week in Chisinau - starting March 23 - and in Balti since March 27. Patients are divided into two groups to minimize overcrowding at OST facilities. The PUD community continues close cooperation with medical staff.
Shortage of the Methadone supply: quarantine has revealed the problem of medication supply shortage. Currently there is only enough medication in stock till the end of April. Tender has been conducted and the Italian company, because of the coronavirus epidemic can not ship the medication. After the community’s active involvement, the situation has been solved by signing the emergency contract with the Ukrainian producer company. The local provider Sanfarm-Prim and the Ukrainian company still had to prepare necessary documentation to the medication shipping, which could have taken additional one and a half months. However, the working group has been created from the national OST programme representatives, Ministry of health officials, UN Office on Drugs and Crime experts. The necessary documents will be finalized during the next few days and OST medication will be shipped by plane from Ukraine to Moldova early in April.
“In 2007, we ran out of methadone for 21 days. We lived through very tough moments then, which today, in the situation of lockdown can become much worse for the patients left without their essential drugs” — says Petr Us, from “Together” initiative, Chisinau, Moldova.
Michel Kazatchkine and other international partners have been playing an active role to resolve this situation in Moldova. EHRA also filed an official appeal to the Chief Narcology doctor in Moldova.
Vitaliy Rabinchuk, Head of the National Key Populations Platform of Moldova
Kyrgyzstan: Kyrgyzstan Association of Harm Reduction (АССВ).
Kyrgyzstan has established a curfew and transportation is limited between the cities. Currently there are around 1000 OST patients, including 300 incarcerated people. The National Narcological Centre adopted a decree allowing all OST patients to receive their medication during any further coronavirus limitations, including a state of emergency.
Since March 25, all OST programme clients received methadone for home use for 5 days, sites are open once a week. However, EHRA continues to receive applications from patients, who are not allowed to travel to another town to get their medication, and/or do not have a place to store it due to homelessness.
Social workers provide support to homeless OST patients, assisting in getting release forms for travelling. UNDP provides vehicles to transport ART and anti-tuberculosis therapy as well as methadone to remote towns. In prisons, OST is administered as usual, but the family meetups have been banned and some disinfection practices established.
Serhey Bessonov, Deputy Head of the National Coordination Council, ENPUD Coordination Council member.
Kazakhstan: PUD Forum Kazakhstan (Форум ЛУН Казахстан)
There are 300 OST patients in the country, 13 OST sites in 13 cities. There is no take-home prescription practice. 9 programme clients live in the city of Temirtau and have to travel to get their medicine.
Activists have declared a critical situation with OST in Kazakhstan due to the COVID-19 pandemic.
Since March 11 OST patients have had to travel from Timertau to Karaganda city, because their site is being closed for renovation, the local drug control department did not agree to keep the OST site in another building during the renovation. So far, activists have only managed to cover travel costs for OST patients. Two patients have already dropped out.
OST site working hours have been expanded and since March 27 a vehicle has been located to give OST patients a ride to and from the site in another city. When the quarantine travel ban is established, this car will need to get permission for transportation.
On March 24, activists from the PUD Forum Kazakhstan filed an appeal to local officials demanding to establish take-home medication practice during the lockdown. Such changes will be discussed and coordinated with local law enforcement agencies.
On March 27 the National AIDS Centre filed a letter to Regional AIDS Centres about the need to ensure continuity of access to OST by implementing take-home prescription for OST patients.
As of April 1 in the key large cities of the country, a strict transportation ban will be established. Local officials plan to provide release forms for OST patients to receive their medication on-site, however, it is much more efficient to establish a take-home practice.
PUD Forum continues its advocacy efforts to make sure OST patients get their essential drugs for home use and at in-patients medical facilities.
Valentina Mankieva, PUD Forum Kazakhstan Secretary
Ukraine: National network of PUD “the Wave” (ВОЛНА)
There are 12 000 OST patients in the country. Prior to the pandemic, around 500 received their medication by take-home prescriptions. Regional network representatives are currently helping local medical staff to establish take home prescriptions for all OST patients during the quarantine.
Currently at the national level the “Wave” PUD network, the “Vona” network of Women who Use Drugs in cooperation with the Public Health Alliance and the “Hope and Trust” NGO are actively advocating for changes into Ministerial Decree #200, which envisage take home prescription practice for up to 15 days and changes into the Cabinet of Ministers Decree #333, which envisage take home prescription practice for up to 30 days.
Oleg Dymaretsky, The Wave Director, member of ENPUD Coordination Council
The above information has been gathered and updated by the Euroasian Network of People who Use Drugs (ENPUD) Secretary, Olga Belyaeva. Please contact her at firstname.lastname@example.org