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Kazakhstan is Ready to Adopt a State Program on Substitution Therapy

Kazakh doctors are in favour of expanding the use of substitution therapy in the country through the adoption of a state program. “If the Ministry of Health in the near future makes a positive decision to continue the opioid substitution therapy project in Kazakhstan, then in 2017 we plan to open substitution therapy sites in 16 cities of Kazakhstan,” Sagat Altynbekov, chief psychiatrist-narcologist of the Ministry of Health and Social Development of Kazakhstan, told KazTAG.

“The effect of reducing the spread of HIV will be observed when 50% of people who inject drugs are covered by OST. We plan to cover about 500-600 drug addicts with OST in 2017, and every year we will increase this number,” Altynbekov clarified the program development plans.

According to Elena Bilokon, Kazakh activist of the ENPUD network, representatives of the country’s drug user community consider the process of introducing the state program for substitution therapy a breakthrough, since in addition to political promises, the authorities of Kazakhstan have already adopted all the necessary regulatory grounds for the transition of the OST program to state funding: the Ministry of Justice of Kazakhstan has registered a legal act regulating the procedure for issuing a substitution drug, a clinical treatment protocol has been adopted in the country, and Methadone has been registered. “All this gives us confidence that the decision will be implemented and funding for OST programs will be secured,” says Elena.

Currently, 10 sites are operating in Kazakhstan, and it is planned to open three more sites in areas where there are no maintenance substitution therapy points. The service will be provided to all those in need. Funding for the expansion of programs is planned from the local budget – each region allocates money after consideration at meetings of local authorities (maslikhats). The exact amount from the state budget allocated for OST programs has not been announced yet. So far, the OST program is 100 percent sponsored by the Global Fund, that is, no money is allocated for it from the republican budget. In Kazakhstan, methadone therapy has been practiced as an experiment since 2008. A pilot project of a new method of treatment with the support of the Global Fund started then in the cities of Pavlodar and Temirtau.

Today in Kazakhstan, 309 people are participating in the substitution therapy program, of which 72 are with HIV. In 79.5% of patients, the experience of injecting drug use is more than 10 years. According to official data, there are 38 thousand drug addicts in Kazakhstan, according to unofficial data – 5 times more.

“One drug addict spends about 5,000-6,000 tenge a day to buy heroin, while the maximum daily dose of methadone costs only 200 tenge, which is 6,000 tenge a month,” said chief narcologist Altynbekov. At the same time, the daily stay and treatment of a drug addict in a hospital is 8-10 thousand tenge, Soz.kz writes.

According to Altynbekov, the cost of maintaining a methadone distribution point at drug dispensaries with 50 patients receiving substitution therapy will amount to 3 million tenge per year. “Today, the annual budget of regional drug dispensaries is about 300 million tenge, so only 1% of the budget will be spent on this project,” the narcologist said. 

“I personally saw the positive aspects of this method of treatment, only positive aspects. Because it is scientifically based, it is recommended by the World Health Organization, most of the world’s experts, experience is great. Some countries do not use this method of treatment, but they do not use it yet, as our international colleagues,” Acting Head of the Department of Psychotherapy and Rehabilitation of the Republican Scientific and Practical Center for Medical and Social Problems of Drug Addiction Madi Tokanov told TengriNews.kz and emphasizes that there is a need for this drug in Kazakhstan.

The Ministry of Health of Kazakhstan, in turn, stated that OST allows for long-term abstinence from drug use. Patients can return to a normal lifestyle while taking continuous maintenance doses of methadone. “We consider the existence of OST as one of the methods of drug addiction treatment possible,” the Ministry of Health said earlier.

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