Kazakh doctors support methodone therapy inspite opposition

Opioid substitution therapy (OST) is back on the agenda in Kazakhstan with the National Scientific and Practical Center on Medical and Social Problems of Drug Abuse standing in favor of a full scale government program, Tengrinews reports.

The acting head of psychotherapy and rehabilitation department of the Center Madi Tokanov said that he was sure that Kazakhstan needed a methadone therapy program.

He became especially convinced after an international conference on HIV/AIDS in Astana. “Representatives from Iran, Kyrgyzstan, Tajikistan, Ukraine, Afghanistan, and Kazakhstan spoke highly about OST. The program has established itself in good light,” Tokanov said.

However, he stressed that no final decision on introducing a state-suppored OST program had been made in Kazakhstan.

Currently, the program is fully sponsored by the Global fund, meaning that no state money is involved. About 200 people are receiving treatment is part of the project. Should a state program be introduced, this number will increase dramatically and make thousands because according to the official statistics there are about 38,000 drug addicts in Kazakhstan, while the unofficial number is five times greater.

Tokanov said, however, that OST did not envision 100% coverage of all the drug addicts. “The program is intended solely for patients with severe addiction, who had unsuccessful attempts of medical treatment and rehabilitation, detoxification; who lead an antisocial lifestyle. These are patients the replacement therapy was invented for,” he said.

According to Tokanov, methadone was undergoing registration in Kazakhstan, which was expected to be completed by the end of the year 2014.

Today the drug can be obtained only from a narcologist, who prescribes it as treatment if all else fails. The treatment is made under supervision of a team of doctors, including a psychologist.

The drug abuse expert also said that implementation of the project on a small scale in Kazakhstan had borne good results. According to him, 2 women, who underwent OST, gave birth to healthy children. Other 32 patients started families, 20 pursued education - they had a quality remission, 167 got employed, 32 patients began receiving treatment for HIV positive, and 102 patients completed the program after reducing dosages. All of the participants of the program acknowledged that they stopped thinking about finding drugs and their family relations improved.

Currently, the project runs in 10 cities of Kazakhstan: Pavlodar, Ekibastuz, Karaganda, Temirtau, Taraz, Kostanay, Aktobe, Uralsk, Semey and Ust-Kamenogorsk. As of June 1, 2014, the project involved 192 people. Of them, 144 were men and 48 were women. 117 were formally employed. There were 53 HIV-positive addicts among the patients.

As for the widespread conviction about negative side effects of the program, in particular irritability and aggression, the doctor said that it was a common occurrence during withdrawal periods for all drug addicts. In addition, he denied all the rumors about methadone overdoses and said that they found no confirmations to such claims.

"Opponents of the replacement therapy said that about 100,000 physicians were against this method of treatment, who wrote letters asking why the project was being implemented. We have tried to answer these letters, we wrote and sent a letter to the address they specified as return addresses, but the letters were returning as of these people never existed, everything was invented, including the addresses. So, we do not understand what the purpose of all this was," Tokanov said.

The doctor claimed that he personally had seen the positive effect of the treatment and that OST was recommended by the World Health Organization and a majority of experts in the world.

"Previously, our opponents said that the United States was lobbying [for the methadone program] – to this I say unequivocal “no”. Experts from Iran showed a presentation saying that 100,000 people were undergoing OST there and that it was successful," he said.

In fact, the American government has been assisting Kazakhstan in fighting drug abuse and funded various projects to achieve the goal. Most of them were welcome.

Nevertheless, some in Kazakhstan claimed that there was active lobbying of expansion of the methadone therapy program in Kazakhstan. The question whether this was true remains.

Methadone therapy started as a pilot project in Kazakhstan in 2008. Back then, two cities chosen for the project were Pavlodar and Temirtau. Stopping the spread of HIV and AIDS were named as the main goals of the project. By 2013, the program grew to involve 273 patients and 10 cities.

Nevertheless, in August of the same year, the Kazakh Health Ministry declared that it would not expand the program any further. A natural question which arose was: why would one curb the program that had proved to be successful?

Two Kazakhstan’s neighbors - Russia and Uzbekistan – had refused to use OST. They cited longer withdrawal period from methadone in comparison to heroin and the concept of treatment itself – substituting one drug for another - was not an answer to the problem, they said.

It emerged later that the desire to limit OST in Kazakhstan did not go without an opposition from the U.S. government. One letter sent three years ago shed some light on this.

The letter in question was sent in 2011 and signed by former U.S. Ambassador to Kazakhstan Richard Hoagland. It was sent to Kazakhstan's Minister of Healthcare Saidar Kairbekova. A copy of this letter was directed by the Head of the Civil Commission for Human Rights group Natalya Shadrina to Tengrinews editorial office.

The sentences in the last paragraph are of particular interest: “I strongly urge you to expand medication assisted therapy activities. Reversal of the initial decision to scale-up medication assisted therapy activities in Kazakhstan will have considerable public health consequences for the citizens of Kazakhstan and will endanger the approval of any future grants from the Global Fund…”



Commenting on the letter, President of the National Medical Association Aizhan Sadykova said that the United States were pushing Kazakhstan to continue the methadone program. However, Minister Kairbekova, to whom the letter was addressed, denied she had been blackmailed by the U.S. Ambassador.

The U.S. Embassy also denied the allegations and said that the word “methadone” was not used in the letter.

Aizhan Sadykova, however, stood firm on her position that the U.S. was pressing Kazakhstan to continue methodone therapy. “The U.S. sponsored methadone promotion plan involves creation of methadone distribution points in every rehab and hospital, in NGOs, AIDS centers, TBC dispensaries and jails by 2014,” she said. She also confirmed that the National Medical Association started talking about closing the pilot project of methadone promotion in 2011, the same year the letter was sent.

“The Global Fund’s OST program will finish in 2014. After that our country will have to buy the drug (methadone) at its own expense. The calculations raise some concerns as well. Kazakhstan spends $5 per day per one methadone users, while the neighboring Kyrgyzstan spends only $1,” she said.

“Back then it was discovered that methadone was promoted in violation of the country's legislation, as according to the International Convention, it is banned from use for medical purposes. Despite that, the pilot project on implementation of methadone as opioid substitution therapy was launched. The decree on expanding of the OST program was issued in 2010,” Sadykova said.

"There was a case when methadone was not delivered on time to Temirtau town (near Karaganda), and the aggression of the addicts was so strong that doctors were barely managing to keep the situation under control,” Sadykova said.

The Kazakh Ministry of Healthcare does not agree with this view to this day. They say that OST program helps achieving long abstinence from drugs. “We consider that OST is acceptable as one of the methods to treat drug addiction,” the Ministry said.

By Dinara Urazova (Renat Tashkinbayev contributed to the story)