Methadone substitution therapy starts in Ukraine
23 May 2008
Following the success of Alliance Ukraine’s campaigning to introduce methadone substitution maintenance therapy for injecting drug users, the rollout of methadone to patients in Kyiv, Odesa and Zaporizhzhya started this month.
By the end of September 2008 an estimated 2,220 patients will be receiving methadone substitution treatment through 38 healthcare facilities across Ukraine. The programmes are being implemented by the Alliance in Ukraine and funded by the Global Fund to fight AIDS, Tuberculosis and Malaria. More patients than ever will be accessing life-saving services.
Substitution maintenance therapy (SMT) treats chronic opiate drug dependency by prescribing the patient a non-injectable substitute drug – usually methadone or buprenorphine – which is taken on a long-term basis. It helps prevent the spread of HIV, by reducing high risk behaviours, as well as hepatitis B and C among injecting drug users.
SMT is currently being used in 60 countries with 1 million patients able to access it. Ukraine has an estimated 323-425,000 injecting drug users and one of the fastest growing HIV epidemics in Europe. The roll out of SMT is crucial for an effective response to the HIV epidemic in the country.
“Finally methadone SMT evidence-based therapy will be implemented and scaled up in Ukraine,” announced Andriy Klepikov, Executive Director of Alliance Ukraine.
It has been a battle. Since 2003 international donors, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and civil society led by Alliance Ukraine, have been calling for the government to introduce methadone-based substitution therapy.
In 2005 Ukraine started SMT pilot programmes in a number of regions using buprenorphine. The results of a 12-month study conducted by the Ukrainian Institute on Public Health, Alliance Ukraine and World Health Organisation European Office clearly showed that successful implementation of opiate substitution treatment in Ukraine is feasible.
The study proved that SMT is highly efficient in reducing illicit drug use and associated HIV risk behaviour. The treatment has a significant positive effect on the general health of patients and leads to a reduction of criminal behaviour as well as increased social integration.
Methadone is significantly cheaper than buprenorphine. One monthly course costs just $14. A monthly course of buprenorphine costs $244. The cost savings mean methadone programmes can enrol a larger number of patients.
“Substitution therapy is one of the most important HIV prevention methods and is a necessary condition for the implementation of antiretroviral therapy [for drug users]. Ukraine has a positive experience of implementing buprenorphine based SMT. We receive positive feedback from patients and their parents,” commented Anatoliy Vievskiy, chief narcologist from the Ministry of Health.
A history of SMT in Ukraine, Substitution Maintenance Therapy in Ukraine: can the community respond effectively to the challenges of HIV and AIDS has been written by Alliance Ukraine and describes the successes and challenges of the pilot programmes, outlines recommendations for the introduction of SMT implementation and tells the stories of some of the patients.
“My old life rotated around drugs: find or steal money to buy drugs, find money for tomorrow and so on and so forth. Buprenorphine set me free from this ceaseless merry-go-round.”
Oleg Voynarenko, 29, SMT programme client, Kherson, Ukraine
