1 / 10

Barriers to Methadone in Afghanistan

Abstract no. Barriers to Methadone in Afghanistan. Authors: Olivier Maguet, responsible of MdM Harm Reduction program in Afghanistan – olivier.maguet@medecinsdumonde.net Abdul Raheem Mohammad, Afghan Drug Users Group, Kabul – afghandun@yahoo.com

tomas
Download Presentation

Barriers to Methadone in Afghanistan

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Abstract no. Barriers to Methadone in Afghanistan Authors: Olivier Maguet, responsible of MdM Harm Reduction program in Afghanistan – olivier.maguet@medecinsdumonde.net Abdul Raheem Mohammad, Afghan Drug Users Group, Kabul – afghandun@yahoo.com Ernst Wisse, medical coordinator, Kabul – medco.afghanistan@medecinsdumonde.net Mélanie Quétier, general coordinator, Kabul – genco.afghanistan@medecinsdumonde.net www.afghan-harm-reduction.org

  2. Afghan setting • Production • First country producing opium in the world (UNODC, Afghanistan opium survey, 2011) • Opium/heroin (manufactured in Afghanistan) widely available + purity • Demand • Increasing number of people who use drugs (UNODC, 2009): • Any drugs: 8% of population aged 15-64 years • 230,000 opium users (+ 53% since last 2005 survey) • 120,000 heroin users (+140% since last 2005 survey) • Growing trend of injection practices • Blood Born Viruses • HIV: from 3% among IDUs (2005) to 7% (2009)

  3. The rise of HR in Afghanistan (1) • June 2005: Exploratory mission in Kabul MdM • No Harm Reduction interventions • Detoxification not based on good practices • 2006: program implementation in Kabul / 2 major components • Introducing and customizing HR services in Afghanistan (DIC & Care Centre + outreach) • disseminating through capacity building (National Training and Resource Centre) • Milestones for HR services • 2006: NSP and condoms provision, community-based IEC, primary health care interventions • 2007: testing and counselling (HIV, HBV, HCV, STI), opportunistic infections treatment and prevention • 2008: STIs treatment and TB referal • 2009: ART, peer-based naloxone distribution • 2010: methadone • Dissemination: • National TRC established in 2009 (on behalf of the model program) • 20 Afghan HR NGOs trained • 10 police sessions • Religious leaders • MPs (health commission) • Media campaigns and demonstrations World AIDS dayDec 2011 /Letter to MoPH

  4. The rise of HR in Afghanistan (2) • OST advocacyprocess: • April 2007: first workshop on OST • November 2007: National Consensus Conference on “Opioid Substitution Therapy: an Essential Service for Harm Reduction in Afghanistan” (MoPH lead) • Endorses OST (methadone, buprenorphine and opium tincture) • Refers to Afghan laws, regulations and international treaties to promote OST • 2008: OST protocol (approved by MoPH) / Choice of methadone for introducing OST • 2009: OST policy (approved by MoPH) • 2008-2009: design of methadone importation process • 2009: contract with MoPH to implement the first pilot methadone program • February 2010, 20: first methadone intake in Afghanistan • August 2010: national workshop on methadone first results More information on methadone results: Wednesday poster exhibition (WEPE232)

  5. Dream story? • September 2010: politicalblockagefromMinistry of Counter-Narcotics → request for a third part evaluation → Inclusion blockedat 70 patients instead of 200 patients scheduled per contract • November 2010: methadoneshortage due to “administrative” postpone in methadone importation certificate • Februarry 2011: methadoneshortage + break (3 days) due to second “administrative” postpone in methadone importation certificate → 6 patients dead → April 2011: meetings in IHRA Beirutconference to try to solve out the issue

  6. The challenge of Scale up • April-May 2011: emergency evaluationfrom WHO • strong effectiveness of methadone in Afghanistan: 1 year retention rate = 76%; 1 year opiate urine tests = 86% negative • Report also states that OST is appropriate for the country as it enjoys strong satisfaction of patients, family members and community. • Cost effectiveness: “among the lowest cost of methadone maintenance therapy worldwide”. • Conclusion; recommend to scale up methadone based treatment, mentioning that there is good Afghan capacity for expanding OST in large cities. • September 2012: OST awareness workshop (Pr Wodakkeypanelist) • July 2012: draft report fromthird part evaluation • Despite local evidence, impossible to disseminate and scale up (Afghan MoPH, PUD, NGOs and Healthprofesionals are requesting for) • 70 OST patients out of 120,000 heroinusers→ 0.0006% coverage rate • Political future Afghanistan uncertain > 2014 →Therefore critical to implement now

  7. Twoexamples Mortality HIV development Consider 20,000 heroin injectors (95% male-5% female) Average of 7% HIV prevalence in IDUs → Concrete numbers: Assumed 1,330 HIV+ male and 70 HIV+ female If each HIV+ DU has sexual relationship with one non DU/month → 16.800 acts of discordant sexual intercourse/year Assume 0.1% HIV transmission rate = 17 new HIV infections in general population/year • Conservative estimate of 20,000 injectors • Usualy 1% deaths per year among injectors → 200 deaths • Usually 0.2% deaths per year among patients on methadone treatment → 40 deaths per year = currently saving 160 deaths per year

  8. Barriers?? • Opponents: Ministry of Contra-Narcotics • Corruption / “Conflict of Interest” • Lack of knowledge and skill on OST + global lack of commitment • Business: the detoxification market → 50 millions USD versus 0.2 million USD) / $ 100 to 50 $/day versus 2$/ day • Policy: INL lead on drug policy in Aghanistan • “Friends” • MoPH = weak political body • MENAHRA: supporting Iran Knowlewdge Hub / No interaction (counteraction?) with the national program for capacity building in an Afghan setting + networking • MdM • Ethnicity: majority of beneficiaries are native from demographic and social minorities (Hazaras people) • Low literate/social level among MdM staffs (<community based) • Lack in establishing alliances with other human right and social justice CSOs in Afghanistan

  9. Way forward • Go on strenghteningMoPHversusMoCN • Advocacy toward INL (country level / HQ in US) • “Afghanization process” /MdM will leave the country by the end of 2012: OHRA (Organization for HR in Afghanistan) + ADUG (Afghan Drug Users Group) • Alliances with local CSOs • Global advocacy: Afghanistan as a core laboratory of war on drugs consequences

  10. Meet Médecins du Monde / Doctors of the World Everydayat Booth n°21 / Hall C

More Related