central asia drug action programme (cadap) phase 6

CENTRAL ASIA DRUG ACTION PROGRAMME (CADAP) Phase 6

presentation: ‘The Situation of Harm Reduction and Treatment of Drug Use

Disorders in Public Health and in Prison System in Central Asia’.

3rd Lisbon Addiction Conference 23-25 October 2019

Heino Stöver / Ingo Ilja Michels

Component Leader / Coordinator

The Programme is funded by the European Union (EU)

The Programme is implemented by a Consortium of EU Member States led by Deutsche Gesellschaft für InternationaleZusammenarbeit (GIZ) GmbH

No conflict of interests.

Component 4: TREATMENT

Objective of Component 4: To support CA

countries in their treatment and harm reduction

programmes and actions employing European

best practices and international standards

Output

All the trainings had been based on current best practice models

of treatment of drug use disorders used by professionals in

Europe

Key expected results

Component 4:

• Health care and social responses for tackling

drug use in the region are increased

• Best practices and better quality services for

drug users are consolidated

�Did we achieve these objectives?

Key activities

� Members of National Working Groups (45-50 in total) (professionals

involved in the subject such as practitioners, psychologists, social workers,

members of NGOs and other professionals of the different Ministries) had

been trained in the techniques used at the international level to treat drug

use disorders and associated diseases.

� Trainings had been conducted on opioid addiction, guidelines on opioid

substitution, opioid substitution in special situation (pregnancy, comorbid

psychiatric disorders, comorbid HIV), abstinence-oriented treatment

(detoxification, psychotherapy, self-help, opioid antagonists). Discussion

on actual situation with New Psychoactive Substances NPS and

psychopathological and somatic consequences of its use had been

organized.

� Participants dealt during the seminars very intensively with the skills and

needs

� professionals involved in the subject such Narcologists,

psychologists, social workers, members of NGOs and other

professionals improved their skills and are able to use them in

the clinical work with clients

� Training participants are able to use their knowledge to

educate other professionals in the CA countries

� Guidelines and training material in Russian language can be

used for own trainings

� Implementation of International Standards of treatment of

drug use disorders is on the way

We used the experiences and competencies of a team of trainers

(in CADAP 5 and 6), who knows already the Central Asia political

and sociocultural environment and many of our partners. • Heino Stöver, Professor for Social Scientific Addiction Research at Frankfurt University of Applied Sciences,

• Gerhard Eckstein, Psychologists, Psychotherapist Augsburg

• Inga Hart, Socialpaedagogue, München

• Oleg Aizberg, Assistenzt Professor, Belarus Medical University Minsk

• Irina Zelyeni, Medical Doctor, Psychistrist, Addiction Clinic Hanover

• Katharina Schoett, Medical Doctor, Psychistrist, Clinic Mühlhausen

• Prof. Jörg Pont. Medical University, Vienna

• Ludger Schmidt, German AIDS Help, Berlin

• Dirk Schaeffer, German AIDS Help, Berlin

• Ingo Ilja Michels, Sociologist, Frankfurt University of Applied Sciences

Central Asia Drug Action Programme

Phase 6 (CADAP)


Several trainings had already been conducted


Phase 6 (CADAP)

UNGASS Outcome Dcument


• Promote and implement treatment ofdrug use disorders developed by the United Nations Office on Drugs and Crime and theWorld Health Organization and other relevant international standards,(…) and provideguidance, assistance and training to

health professionals on their

appropriate use, and consider

developing standards and accreditation

for services at the domestic level to

ensure qualified and scientific

evidencebased responses


Phase 6 (CADAP)Component 4: TREATMENT

Trainings on UNODC/WHO International Standards of the

Treatment of Drug Use Disorders

Dr. med. Katharina Schoett

Fachärztin für Psychiatrie / Psychotherapie


Phase 6 (CADAP)


Additional trainings had been conducted on implementation of

International Standards in Bishkek, Astana and Dushanbe

Procurements provided

• One medical dispensary in Tajikistan,

equipped

• and 2 medical dispensaries in Uzbekistan,

equipped with 2 haemotology analyzers

provide enhanced services to drug user

Key outputs

A Study Visit to Berlin from 24-27 September 2019 had been

successfully conducted. Exchange of experience was fruitful.

Key activities

� Several social mediators (NGO members) had been trained in

‘outreach work’ in at 3 countries (KG, TJ, KAZ)

� NGO social workers need pragmatic knowledge for immediate

client contact. They have no formal social work training. A

cardset as dissemination tool to be used by social

workers/NGO members for HIV prevention and treatment for

addiction had been produced in close cooperation with NGOs

� In KAZ trainings in specific “techniques” of getting access to

clients (“Motivational Interviewing”) had been conducted

• Cardsets on HIV Prevention


Phase 6 (CADAP)

• Key outputs

• Cardsets on HIV Prevention

Key activities

� Trainings had been delivered to personnel of penitentiary institutions,

judges, prosecutors, NGOs and professionals working in the field of drugs

(15 - 20 persons per country)

• The majority of participants was attentive, participated interactively in

discussions and group work and contributed to proposals for a “road map”

• Participants were invited to amend the proposed agenda according to

their needs if necessary and to strive for producing proposals for a “road

map” of further development of healthcare for drug dependent prisoners

at the end of the workshop

• ‘Road Maps’ components are i.e. establishing/improving continuity of care

for released drug dependent prisoners

Key outputs

�Drafts roadmaps for improvement of helath of

prisoners had been developpeld

�A new Clean Zone at Women Prison near

Bishkek had been built and opened

The Visibility of CADAP had been strengthened on a European

and International level

• UNODC Paris Pact & CADAP VI Workshop Bishkek 23-27 June 2016

• 10 years of the EU Strategy for Central Asia: the way forward Conference

organised by the Estonian EU Presidency and Germany; Brussels, 12 September

2017

• German Addiction Congress; Luebeck, 17 September 2017

• EU Central Drug Action Midtderm Review; Brussels, 11 October 2017

• German akzept Congress; Hamburg, 11-12 October 2018

• 4th European Harm Reduction Conference; Bukarest, 20-23 November 2018

• German Addiction Congress; Mainz; 16-18 September 2019

• The Visibility of CADAP had been strengthened on a European and

International level

Development of treatment and

harm reduction

• In Central Asia, above all types of

treatment, short-term withdrawal

treatment is offered. Long-term

inpatient care and outpatient

treatment are generally hardly

available

• OST is establish in 3 of 5 CA countries

• Staff of Narcological clinics is

qualified and highly motivated

• Syringe and Needle Exchange

Programmes are established

• Opiate substitution treatment in Central Asia

Opiat Substitutions Treatmnent in Central Asia

2017 (CADAP 6)

Opiat Substitution Treatment in Central Asia

2017 (CADAP 6)

• OST sites in Kazakhstan

on realization programs of the supporting replacement therapy of persons, suffering from opioid dependence in the Republic of Kazakhstan for 2019-2020, PMZ No. 196 of May 8, 2019 is approved

Road Map

� organizational actions for implementation of the OST

program (OST expansion, opening of 6 additional sites);

opening OST sites in the sites operating according a “Single

Window “program with additional delivery of antitubercular

drugs and drugs ARV of therapy according to indications;

� Changing of restrictive policy which lead to low retention

rates;

� improvement of regulation of effective implementation of

the OST program;

� intersectoral cooperation for successful realization of OST

(strengthening of cooperation with the international

organizations, with profile NGO, etc

• OST sites in Tajikistan

Further steps for improvement

� introduction of buprenorphine in practice of OST

� Organization of mobile van of delivery of methadone (in remote areas)

� The solution of a question of delivery of daily doses of Methadone/Buprenorphine (“take home”)

� Availability improvement OST (sites)

� Repeated assessment of the OST program

� Change of criteria of admission of patients in the program

� Strengthening of the OST system

� Treatment of a viral hepatitis on the basis of the OST sites

� Reorganization and institutionalization of the OST sides as offices for out-patient services

OST sites in Kyrgyz Republic

Bishkek (5)(3-OZ, 1 – IK, 1-

SIZO)

Chui (12)(6 – OZ,

5 – IK, 1-KP)

Zh-Abad (1)(1-OZ)

Osh (3)(2-OZ, 1-SIZO)

Batken (1)(OZ) Osh oblast

(2) (OZ)

15 sites of OST9 sites in prisons

Successful Strategy of OST program

� Decentralization of OST: introduction of the program in

institutions of primary level of health care and in stationary

institutions (i.e. municipal antitubercular hospital);

� Introduction of OST in institutions of penal system for continuity

of provision of services;

� At stable remission or in special cases give to patients or members

of their family a five-day dose of methadone (take home);

� At hospitalization of patients in OST subsequent reception by the

patient for the entire period of stay it in a hospital;

� Participation of community among patients of OST is actively

involved;

� Mobile sites for rural areas

TREATMENT Gaps & Bottlenecks

� Exclusion of IDU‘s from Health Care System other than narcology

� Only limited access of IDU‘s to treatment of drug addiction or prevention of drug adddiction

� Only limited access to treatment of IDU‘s with HIV/Hep C

� Only limited number of social workers, psychologists or psychotherapists

� No accreditation system for psychotherapy

� Only very limited access to Opiate Substitution Treatment

� Limited co-operation of HIV and Hepatitis prevention among drug users and offeringtreatment within the rehabilitation centres

� Need for further qualification and trainings in psychotherapeutic methods for briefinterventions, motivational interviewing, relapse prevention and social rehabilitation and Medication Assisted Treatment and treatmentof HIV, Hepatitis C or TB of IDU‘s

• CONTACTS

Prof. Dr. Heino Stöver

Dr. Ingo Ilja Michels

Frankfurt University of Applied Sciences

Nibelungenplatz 1

D-60318 Frankfurt am Main

Tel.: (069) 1533-2823 / -2610

Fax: (069) 1533-2809

Skype: hstoever

[email protected]

central asia drug action programme (cadap) phase 6

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