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Heroin Addiction and Related Clinical Problems: 2021, 23, N1 (pages: 33 - 46)

Opioid Agonist Treatment for Opioid Use Disorder Patients in Central Asia

Michels I.I., Stöver H., Aizberg O., and Boltaev A.

Summary: In Central Asia approximately (only) 2,500 of dependent people (approximately 400,000) are in Opioid Agonist Treatment (OAT). In the Kyrgyz Republic 1,450, in Tajikistan 680 and in Kazakhstan 353. OAT in prisons is available in the Kyrgyz Republic or Republic of Tajikistan. Access is very patchy and the number of inmates in treatment is very limited. Nevertheless, OAT might play a substantial part in the health care system provided to drug users in Central Asia in the future, although there is still massive resistance against this evidence-based treatment. OAT can reduce substantially drug-related criminality and infection diseases (HIV, Hep C) and support effective treatment of additional health problems and dependence. The results of research studies and practical experiences clearly indicate that dependent patients benefit substantially from OAT with improvements in physical and psychological health. OAT proves successful in attaining high retention rates (65 % to 85 % in the first years, up to 50 % after more than seven years) and plays a major role in accessing and maintaining ongoing medical treatment for HIV and hepatitis. OAT is also seen as a vital factor in the process of social reintegration and it contributes to the reduction of drug related harms such as mortality and morbidity and to the prevention of infectious diseases. Some 10-20 % of OAT patients in European countries or USA become drug-free in the long run. Methadone is the only prescribed agonist opioid medication in Central Asia, although buprenorphine might attain rising importance (but too expensive, no experiences). In Turkmenistan no OAT is provided. In Uzbekistan OAT had been introduced, but was not continued. Access to OAT in rural areas is very patchy and still constitutes a problem. There are only few employment opportunities for patients participating in OAT, although regular employment is considered unanimously as a positive factor of treatment success.