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Saturday, January 21, 2017
- A pioneering drug substitution programme in conflict-wracked Afghanistan has been hailed as a resounding success as local doctors and international health organisations battle soaring heroin addiction rates and an HIV/AIDS epidemic.
Doctors on the programme, which gives patients controlled doses of methadone to help them control their heroin addiction, say its results show the benefit harm reduction treatment can have in tackling the spread of blood-borne diseases among injecting drug users and help often ostracised addicts reintegrate into society.
“In a setting like Afghanistan, where there are no referrals possible to a social worker or a psychosocial counsellor and where you need to integrate everything in the same programme, the results are quite impressive,” Dr. Zemaray Amin from the Medecins du Monde (MDM) health group which has headed the programme, told IPS.
“Drug addiction is growing in Afghanistan and health care implementers including harm reduction organisations and the health sector of the government have accepted the importance of comprehensive harm reduction including opiate substitution therapy as the backbone of treatment for drug addiction,” he added.
Dr. Amin is “completely optimistic that, in spite of many barriers, the success rate of our methadone treatment will lead to regular opiate substitution therapy in Afghanistan.”
Afghanistan is known as the global opium production centre, accounting for more than 90 percent of the world’s opium supply.
Injection of heroin has escalated in urban areas of the country. A survey on Drug Use in Afghanistan, issued on Jun. 21 last year by the United Nations Office on Drugs and Crime (UNODC) and the government of Afghanistan, pointed out that around one million Afghans between 15-64 years suffer from drug addiction. At eight per cent of the population, this rate is twice the global average.
Dr Amin said that heroin use was “even more alarming”. The MDM group said that in 2005, there were an estimated 50,000 heroin users in the country but that by 2009 that figure had jumped 140 percent to 120,000.
The exploding rates of injecting drug use have been accompanied by an HIV/AIDS epidemic. The prevalence of HIV among its highest risk group – injecting drug users – reached seven per cent in three cities in 2009, compared to three per cent in one city in 2006, according to MDM.
The prevalence of Hepatitis C also rose, jumping from 36.6 per cent in 2006 to 40.3 per cent in 2009.
The sharing of contaminated needles and syringes accounts for more than 80 per cent of all new HIV cases in Central Asia, according to the World Health Organisation (WHO).
In a recent joint survey between the Afghan Ministry of Health and UNODC more than 85 per cent of injecting drug users said they had shared a needle or syringe to inject drugs. Other surveys have showed that awareness of HIV/AIDS and its transmission among Afghanis is low to non-existent in many communities.
Until last year the only treatment option for heroin addicts was detoxification.
Local doctors and international health groups say that detoxification treatment is not as effective in helping drug addicts as harm reduction programmes such as the methadone substitution therapy run by the MDM.
“With detoxification, relapse rates for heroin injectors are very high,” Dr Amin told IPS.
But the current trial – the first major methadone drug substitution trial in Afghanistan – saw more than 70 patients travel for hours to Kabul to receive treatment.
The results, publicised at the International Harm Reduction Association’s annual conference in the Lebanese capital Beirut this week (starting Apr. 4), show that after six months the trial had a patient retention rate of 83 per cent.
Similar trials have, according to MDM, had rates closer to just over 75 per cent.
The trial also showed crime rates among patients dropped and their mental health also improved significantly.
International health experts say that the use of drug substitution therapy has been proven to help slow the spread of HIV/AIDS in epidemics fuelled by injection drug use. It has been endorsed by the U.N. and the WHO.
The UNODC has called on Afghani authorities to scale up their harm reduction programmes urgently as the best way to help tackle the epidemic.
The Afghan health ministry has backed the methadone trial, which is funded by the World Bank, but there are concerns over its future. The methadone used in the trial is imported and permission to do so is coordinated with the Ministry of Counter Narcotics.
Months into the trial there were problems with permission for importing the methadone, which for a period led to a drastic and potentially dangerous reduction in dosages for patients. In view of this, the Afghan Ministry for Counter Narcotics has called for an independent review of the results – despite what doctors agree reflect the trial’s success. A freeze has also been placed on adding new patients to the trial.
But the medical staff involved in the trial say that the testimonies of those involved as well as the results show the benefits it can bring to the growing numbers of injecting drug users in Afghanistan.
“The response of the patients and their families has been really positive. They have seen a positive change in their health status, reintegration into family and society as well as greater self-confidence and improvement in many aspects of their lives,” Dr Amin told IPS.
“Every day we receive many requests from people and their families who want to be included in our methadone programme,” he added.