- September 3, 2020
- Posted by: Admin
- Category: Publications
Modern medicine treats opioid dependence or opioid addiction as a chronic disease with remissions (clear periods) and relapses (exacerbations). There are various treatments for this disease, which are grouped into two main groups: drug-free life-oriented therapy and agonist supportive therapy or replacement therapy. The most acceptable treatment methods for the community and especially for the family members and relatives of addicts are those that are focused on stopping taking drugs from the very beginning. Unfortunately, many years of international experience have shown that the effectiveness of such treatments is not very high. With this in mind, a different method of treatment has been developed by international organizations – the so-called. Agonist supportive therapy, or replacement therapy, that involves giving a patient a replacement drug over a long period of time. It is desirable that such treatment be carried out in combination with psychosocial support measures. To date, agonist-assisted therapy is considered by international experts to be the most effective way to treat opioid addicts, decriminalize, integrate, and reduce the harm caused by the use of “street drugs.” The main value of substitution therapy is that the beneficiaries do not have to use different methods on a daily basis, including criminalizing money, buying drugs on the black market. Replacement therapy is not qualitatively a therapeutic component and its main factor is not time; The main purpose is to replace “street drugs” with legal drugs.
Replacement therapy was first introduced in the United States in the 1960s and is now widely introduced worldwide. The widespread spread of this program has been given a special impetus by the HIV / AIDS epidemic, as this treatment is one of the main means of limiting the spread of HIV / AIDS and hepatitis in injecting drug users.
The replacement therapy program in Georgia was first implemented in 2004 with funding from the Global Fund. The program was designed for several dozen patients and was fully funded by the Global Fund. Due to the effectiveness of the program, after a certain period of time, a methadone replacement therapy program was launched in our country in 2008, which was implemented on the principle of co-financing within the state program (with the participation of the patient and the state). The methadone replacement therapy program has never been a private program, it has always been implemented by the Ministry of Health. The principle of co-financing was abolished in the summer of 2017 and the state program became absolutely free for patients. This decision by the state was reasonable, timely and result-oriented, so the number of beneficiaries involved in the program increased instantly, and it should be emphasized that it increased not at the expense of novice drug users but through those with long experience who could not use the program due to lack of funds.
One of the criteria for the effectiveness of the program, according to international experience, is the ratio of drug users and drug addicts in the country to the beneficiaries involved in the program. According to unofficial data, for years, the number of addicts in our country has reached 50,000, and the more users involved in the program, the more justified will be the state’s drug policy in relation to substitution therapy.
As for the main criteria for enrollment in the program, a person must be over 21 years of age, at least three doctors must be confirmed by a medical commission consisting of a narcologist to depend on opioid drugs. Non-opioid (eg marijuana, amphetamine, etc.) addicts will not be included in the program. Methadone hydrochloride syrup, solution or pills are used for supportive therapy. The medicine is taken in a specialized institution or department under the direct supervision of medical staff, which excludes the possibility of methadone entering the “black market” from a medical institution. After taking the drug, the container in which the beneficiary received the medication is placed in a specially designated place for disposal. The beneficiary is obliged to verbally say goodbye to the security guard when leaving.
Patients undergo regular urination testing for narcotic / psychotropic substances to prevent “street” drugs. In case of violation of the treatment regimen by the patient, including taking drugs without a doctor’s prescription, he will be asked to leave the program.
Methadone is a long-acting (24-36 hours) synthetic drug. It is an opioid agonist, which means that it acts similarly to morphine and similar drugs. Methadone, when used in appropriate doses for supportive therapy, significantly reduces the need for drugs and eliminates the signs of withdrawal syndrome (so-called “Lomki”) without producing a narcotic effect (so-called “fun”).
When treated with methadone under the supervision of a physician, the patient is usually adequate and able to work. This method allows an opioid addict to improve his physical and mental health, to give up criminal life, to study effectively, to work, to become a full member of his family or community. For some patients, an agonist support program helps them, including drugs, including substitutes, eventually give up and start living a completely drug-free life.
At present, up to 12 thousand beneficiaries benefit from the Georgian replacement therapy program, the average daily dose of each of them does not exceed 70 milligrams; The patient can, together with the narcologist, make an individual dosing schedule and, after successfully overcoming the addiction, voluntarily leave the program. In 2019, about 5,000 beneficiaries left the program (since 2008, the program has served a total of 18,808 citizens), most of them voluntarily, although there have been cases of expulsion of beneficiaries from the program due to regime violations.
The Replacement Therapy Program operates in 21 departments throughout Georgia, with no departments or offices located near the educational institution. First of all, it has a positive effect on the economic and social conditions of patients.
Today substitution therapy remains the most loyal and effective program among drug addicts in the world.