Kazakhstan: Pilot Substitution Therapy Projects Launched


Dr. Anar Karazhanova

Ukrainian HIV/AIDS public awareness Web site “ZAPYTAY,” which was developed and is maintained by Rising Voices grantee Drop-In Center, has published an article about a pilot harm reduction project in Kazakhstan. In the past, we have covered the development of replacement therapy in Kazakhstan as it relates to the work of the non-profit organization Mental Health, which recently received a Rising Voices mini-grant.

This particular article states that in January 2009 experimental substitution therapy programs were launched in two Kazakh cities, Pavlograd and Temirtau. The programs currently involve 50 patients and have a budget of more than 7 million tenge ($500,000 U.S.), funded by the Global Fund to Fight HIV/AIDS.

Dr. Anar Karazhanova, director of the Clinical Narcology Department of the Republican Center of Medical and Social Issues, talks about the advantages of replacement therapy:

While receiving methadone, a patient does not get rid of a drug addiction (methadone is also a drug), but he starts to see the world with sober eyes…Consequently, a drug addict whose sense of life used to be about getting a dose, starts to think about his future — how to live, how to earn his living, how to settle his relationships with partners and relatives…

A patient of the program Juliana, age 42, says:

I have tried to quit drugs many times but failed. Every day I have woken up with one goal: to get money for a dose, so to avoid going cold turkey. When I was under the influence of a drug nothing mattered… Methadone allowed me to live without cold turkey syndrome, live a normal life like regular people, where you are able to make plans, solve problems…

To participate in the program, the patients must go through a pre-screening process and satisfy certain criteria. The substitution therapy programs in Kazakhstan are aimed to help drug addicts in mature age, so young drug users are not allowed to participate. Kazakh healthcare officials and doctors prescribe the substitution therapy only for patients who have failed to quit drugs through other rehabilitation programs.

The participants of the program sign a contract promising not to take any other drugs besides methadone. They are supposed to pass medical tests regularly to prove that they are not consuming any “street” drugs. If a participant breaks the contract, they can get expelled from the program immediately. At the same time, participants are not allowed to skip any doses of methadone. Dr. Karazhanova, also the curator of the program, elaborates:

The patients are supposed to receive the treatment once a day at a set time. The dose is prescribed for each person individually. It is defined based on many factors, but the main condition is having the patients feel comfortable. After receiving the dose of methadone syrup the patient has to feel well, not have abstinence syndrome, be able to sleep well, and have a good appetite. When people feel good and sober they can take care of their lives. Five people out of 25 participants have already found a job… Each of the 25 is re-establishing relations with his family. We can talk about certain successes in their re-socialization. This is a goal of our work. Our patients are still drug users, but at the same time they change. One more aspect of substitution therapy is legality. A drug addict does not need to hunt for money to buy a dose of a drug anymore. He does not need to commit a crime, to terrorize his relatives and to hide from police. He receives a stable dose everyday, which according to the doctors helps stabilize his physical condition.

The article also raises the issue of the future of participants in substitution therapy programs. Dr. Karazhanova says that there were quite a few cases when after being in methadone programs for 2 to 3 years, the patients significantly reduced their dose and were later able to quit taking drugs entirely.

However, the Kazakh Internet community has mixed feelings about the implementation of substitution therapy programs in their country. Some of the people are fairly critical and even aggressive. Below is a negative opinion from one of the Kazakh discussion boards:

It is time to help the drug addicts die; there is no sense in treating them. You can treat them now but in 2, 5, or 8 years they will return to drugs anyway. They bring so much pain to their families. When you chop the heads of 10 drug addicts the problem will be solved, nobody else will ever use drugs. When society is too human it leads to drug addiction, alcoholism, violence and thievery…

Other people fully support the opinions presented in the article, though. For example, here is what Zhenia says:

We need to introduce a law about substitution therapy as soon as possible. There is no other choice. This therapy can help many people addicted to drugs and can save many lives.

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