Update on the situation in Uzbekistan regarding the suspension of substitution treatment

Dear Colleagues:

I am passing on a thank you to those of you who signed on to the attached letter to the President of Uzbekistan regarding the suspension of substitution treatment in that country. The list of signatories is an impressive group of professionals from around the world. There is also an update about the situation there and what people might do to support the improvement of treatment for opiate dependent people in that nation.

I think it is very important that American professionals participate in international efforts to improve the treatment of substance using patients as well as contribute to such efforts at home. I thank you for your efforts as well. Andrew Tatarsky, PhD Harm Reduction Psychotherapy and Training Associates

• Click for PDF Version of Letter to President Karimonv (English)
  
• Click for PDF Version of Letter to President Karimonv (Russian)
  

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Dear colleagues,

EHRN is thankful for your support to substitution treatment in Uzbekistan, and for your help to its initiative aiming to inform the President and Government of Uzbekistan about the negative consequences of closing the OST program. EHRN sent the attached letter to its addressees, and we will inform you once we receive feedback.

Meanwhile, we thought we should provide a brief update based on our discussions with local specialists and EHRN Director Raminta Stuikyte's visit to the country:

According to the Ministry of Health of Uzbekistan, the opioid substitution therapy program there was a pilot program which had come to conclusion and which had been evaluated. Following the evaluation, the pilot program was not extended and no new ‘non-pilot’ program is set up. According to information gathered through a series of meetings with local stakeholders, international organizations and local NGOs were not consulted and the decision was made without them. Local NGOs and international organizations recognize that the pilot program had to address quality issues, including illegal drug use by clients, however, general appreciation of the substitution pilot was expressed during the EHRN’s Director visit to Uzbekistan last week. According to anecdotal information, the program's 200 patients are currently undergoing other treatment options or have ceased to have contact with health settings.

Although the Ministry of Health communicated openness to gathering further evidence around substitution therapy, it is unlikely that their decision to fend the pilot and not to start implementing substitution therapy in the health system can be reversed in the near future. One opportunity to return to this discussion is to conduct an assessment of OST implementation in Uzbekistan, demonstrating that the problems were related to the particular program rather than the method itself.

AIDS NGOs and other stakeholders met by the EHRN Director during her visit to Uzbekistan last week are rather pessimistic about the future of OST and also about other harm reduction services in the country. Current funding for low threshold programs is coming to end and the last three attempts to get support from the Global Fund were not successful. Additionally, a national program around spiritual and moral values which was recently approved by the Uzbek AIDS Commission might have impact on harm reduction developments and operations of more than 200 low threshold sites for drug users operating in the country. Two major harm reduction NGOs: the local branch of World Vision running one service site; and CARHAP providing methodological, technical and other support, are both closing their operations around harm reduction. However, an Uzbek NGO consortium is planned to be a principal recipient in a new RCC application to the Global Fund (to extend the current GF-funded program with similar or larger levels of funding) and take over responsibility for all services and advocacy work around vulnerable groups, including injecting drug users. The draft proposal excludes OST. Some problems of existing low threshold programs exist and, for example, a service site visited in Tashkent did not have needles for the last one or two months and as waiting for procurement from the GF project management. Thus more investment into the Uzbekistan’s harm reduction with a solid capacity building element is needed. The governmental commission is currently doing some review of data on low-threshold programs.

The country is closed and rather isolated. There is a need for more support for harm reduction capacity on the ground, however this should be implemented through a dialogue with governmental institutions, respecting their competence and understanding limited role of international agencies.

Thank you again, and we hope that you will continue to support EHRN initiatives and public health programs in the region of Central and Eastern Europe and Central Asia. Best regards, Alec Khachatrian EHRN consultant

• Click for PDF Version of Letter to President Karimonv (English)
  
• Click for PDF Version of Letter to President Karimonv (Russian)

Call Congress Today to Protect Peer Review and HIV/AIDS Prevention Research

We Need Your Help!

On Friday, July 24th, the House of Representatives is expected to begin debating the FY 2010 Labor, Health and Human Services and Education Appropriations bill, which funds the National Institutes of Health (NIH). While the current legislation provides a $941.8 million increase to the NIH, it is expected that Rep. Darrell Issa (R-CA) will offer an amendment to the bill that would rescind funding from three currently funded, peer-reviewed grants that focus on HIV/AIDS prevention, as an example of wasteful spending.

Take Action:

Please call your member of Congress today and urge him/her to vote NO on this amendment. http://capwiz.com/apapolicy/home/

Background:

NIH's peer review process is the gold standard for determining the quality and relevance of grant proposals. Scientists from universities across the country with expertise in their fields of research make independent and objective evaluations of each proposal submitted to the NIH. Advisory councils with public representation also approve studies before NIH funds them. Efforts to restrict peer-reviewed research would undermine one of the core principles of the research enterprise.

Given that HIV/AIDS is a global epidemic that has already killed more than 25 million men, women, and children and 33 million are currently living with HIV, it is clear that prevention of HIV infection should be a priority area of research funding.

The research is easy to ridicule if it is taken out of its public health context. The fact is, scientists need to explore a range of research avenues in vulnerable populations around the world to learn the best ways to control the transmission of HIV. In response to previous congressional concerns about whether sexual health research should be funded by the agency, NIH reviewed the entire NIH sexuality portfolio in 2004.

That investigation found that all of the NIH grants in areas of sexual health met the rigorous standards of scientific and ethical quality, that they were not funded out of proportion to the public health burden of these diseases, and that the merit review system had been followed.

Targeted Research Projects:

1. Substance Abuse Use and HIV Risk Among Thai Women Grant Number: 1R21DA026324-01A1
   
   The proposed collaboration study between Ms. Usaneya Perngparn, Chulalongkorn University, Thailand and Dr. Nemoto, Public Health Institute, California, will investigate the sociocultural contexts of HIV risk behaviors and drug use among Thai female and male-to-female transgender (kathoey) sex workers in Bangkok. Research is currently needed to develop and adapt HIV prevention models that take into account sociocultural factors so that the further transmission of HIV and sexually transmitted infections can be averted. Participation in these types of studies also can provide a way for persons suffering from the health consequences of illicit sexual activity to receive treatment while contributing to our knowledge of prevention and treatment outcomes in these populations.
   
2. HIV Prevention for Hospitalized Russian Alcoholics Grant Number: 5R01AA016059-03
   
   Investigators are adapting a prevention approach that has been demonstrated to be effective in decreasing high-risk HIV related behaviors in the U.S. for use in Russia, a country with a rapidly expanding incidence of HIV.C2 The approach, called Health Relationships Intervention, involves the development of a plan of action for each client to increase social support and reduce high-risk behaviors. This includes the disclosure of information to family and friends on the client's health, social needs and condition thereby assisting the client in maintaining low risk behaviors.
   
3. Venue-based HIV and Alcohol Use Risk Reduction Among Female Sex Workers in China Grant Number: 1R01AA018090-01
   
   Research has provided evidence linking alcohol-related, high risk sexual behavior with HIV and other sexually-transmitted infections. Research has also provided rich descriptions of social, cultural, and economic contexts in which people engage in alcohol-related sexual risk behaviors. More specifically, alcohol use characteristics (e.g., binge drinking) have been linked with sexual risk-taking that occurs in a range of high risk environments. The investigators have proposed a 5-year study to develop, implement, and evaluate a theory-guided, multiple components, and venue-based HIV and alcohol use risk reduction intervention among commercial sex workers (FSWs) in China.

Analysis Identifies Effective College Drinking Interventions

July 21, 2009
http://www.jointogether.org/news/research/summaries/2009/analysis-identifies-effective.html

Research Summary

Internet and face-to-face individuals counseling were most effective in curbing college drinking, whereas mail and group feedback did little to change drinking habits, according to a systematic review of previously published research on college alcohol use.

HealthDay News reported July 20 that researchers from Oxford Brookes University in England reviewed 22 past studies and found that 62 percent of students receiving Internet-based interventions reported reductions in their drinking, as did 65 percent of students who received in-person, one-on-one counseling.

The researchers expressed support for social-norms prevention focused on perception of alcohol consumption, saying that students might drink less if they knew that their friends weren't drinking as much as they did. However, one expert also expressed surprise that group interventions were found to be ineffective.

"By providing normative information to a group, I would have expected that it would provide a level of social support for refusal," said Jeanie Alter, program manager and lead evaluator of the Indiana Prevention Resource Center at Indiana University's School of Health, Physical Education and Recreation. "A similarly minded group usually would back you up in your decision not to use."

The review was published in the June 19, 2009 issue of the Cochrane Library.

3rd Annual "Horizons: Perspectives on Psychedelics" Conference

Judson Memorial Church
55 Washington Square South
New York, NY 10012
Learn more: horizonsnyc.org

Questions? Want to volunteer? info@horizonsnyc.org

Tickets are on sale now! http://horizonsnyc.org/tickets.php

Background and 2009 Speakers

Horizons is an annual forum for learning about psychedelics, hosted by Judson Memorial Church in New York City. Its goal is to open a fresh dialogue about psychedelics and rethink their role in medicine, culture, history, spirituality and art.

Psychedelics are a unique class of psychoactive drugs that have been used by humans for thousands of years. In the 1950s and early 1960s, academic research with psychedelics yielded important discoveries in psychology and neuroscience. Just a few years later, they entered popular culture across North America, Europe and the world. Questions about their safety, medical value, history and implications in politics and culture were unfortunately answered with numerous myths spread by both their users and the media. The millennial rave fever brought a similar wave of popularity and hysteria.

Recently, a renaissance in psychedelic research and dialog has taken shape. Horizons objective is to bring together the brightest minds and boldest voices of this movement to share their insights and dreams for the future.

News from the NYSPA Division on Addictions July 2009

Dear Colleagues:

I have attached and copied below the July 2009 Newsletter of the Addiction Division of the New York State Psychological Association of which I am a member of the executive board. The Division has been in existence for about 20 years. Over this time we have been a home for psychologists working with problematic substance use and other addictive problems. We have also been committed to creating contexts for ongoing dialogue and exploration to advance the understanding and treatment of people with addictive problems. We have done this by holding regular professional conferences, workshops and other activites. Past conferences have looked at the the state of the art of addiction treatment at various points in time, the relationship between trauma and addiction, the intersection of harm reduction and abstinence based treatments and addiction treatment being in a period of ongoing metamorphosis, among others. We are currently considering how to best create a conference to explore how political issues such as race, class and the stigmatization of substance users impact on substance using patients and their treatment.

We welcome the participation of all workers who have an interest in the issues we address. We invite participation in our conferences, member listserve and newsletters. The Newletterwill give you a more of a sense of what we are about. I invite you to join us in our activites and contribute to the evolution of this important field. Contact information is at the end of the newsletter. Feel free to be in touch.

Best,
Andrew Tatarsky, PhD

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Page 1 of the NYSPA Divison on Addictions - July 09 Newsletter

Letter from the President
Gayna Havens, PhD

I’m very pleased and honored to be serving as the current president of the Addiction Division of NYSPA. And I want to thank our past president, Bryan Fallon, PhD, for the wonderful and steady work he did during the past year. Among other things, his leadership allowed us to put together another well-attended conference this past November, which explored the interplay between trauma and addiction. We already have several exciting ideas for our next conference, and are in the early planning stages. We will keep you informed when a date is established for the next conference.

With the change of the administration at the national level, we have noticed some excitement about what this may bring to the field of working with individuals with addictions. Andrew Tatarsky, PhD, took a characteristically active role and drafted a letter to President Obama urging him to appoint a Drug Czar that has a record of supporting legislation that advocates treatment innovation and sentencing reform. Dr. Tatarsky’s letter received significant circulation and recognition. Gil Kerlikowske , the Police Chief of
Seattle, was confirmed as the new drug czar. Mr. Kerlikowske is known as someone who allows needle exchange programs and supports drug treatment for low-level offenders as an alternative to prison. And more recently, President Obama named Thomas McLellan, PhD, to the post of Deputy Director of the Office of National Drug Control Policy. Dr. McLellan is a prominent researcher who is expected to bring this important voice to the dialogue. (Division members may remember that Dr. McLellan was the invited speaker at our 2006 conference.)

Dr. Tatarsky has also spearheaded the circulation of a letter to President Obama regarding the choice of a director of the Substance Abuse and Mental Health Services Administration (SAMHSA). We have included the letter in this issue of our Newsletter in an effort to spark discussion, debate and action.

There have also been recent changes in our own state of New York. The legislative leaders in Albany recently announced that they had reached an agreement to repeal the mandatory sentencing laws, or the Rockefeller laws, for low-level drug offenders. This would allow judges the discretion to send people to treatment instead of prison when the situation warrants this course of action. The plan still needs to be approved by the Assembly and the Senate, but is expected to allow judges to send first-time nonviolent offenders who plead guilty to drug charges to treatment. If treatment were not successfully completed, the judge would then have the option of imposing a prison sentence.

Click here for entire newsletter PDF

Improving the Quality of Harm Reduction Programs - Trainings by Dr. Tatarsky in Kiev, Ukraine

JULY 27-29, 2009

IMPROVING THE QUALITY OF HARM REDUCTION PROGRAMS

Dr. Tatarsky will conduct a three-day training in counseling for psychologists and social workers in harm reduction projects.

International HIV/AIDS Alliance in Ukraine
Kiev, Ukraine

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JULY 30-AUGUST 1, 2009

IMPROVING THE QUALITY OF HARM REDUCTION PROGRAMS

Dr. Tatarsky will conduct a three-day training in counseling for psychologists and narcologists working in substitution treatment.

International HIV/AIDS Alliance in Ukraine
Kiev, Ukraine

Introductory One-Day Training Workshops on Integrative Harm Reduction Psychotherapy by Dr. Andrew Tatarsky in the Fall, 2009 in NYC

NOVEMBER 21, 2009

TREATING DRUG AND ALCOHOL USERS IN YOUR PRACTICE: RATIONALE, THEORY AND TECHNIQUE OF INTEGRATIVE HARM REDUCTION PSYCHOTHERAPY

Dr. Tatarsky will conduct a one-day introductory workshop

The Training Institute for Mental Health
115 West 27th Street
New York, NY

For information and registration call: 212-627-8181

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DECEMBER 11, 2009

EFFECTIVE PSYCHOTHERAPY WITH DRUG AND ALCOHOL USERS IN YOUR PRACTICE: RATIONALE, THEORY AND TECHNIQUE OF INTEGRATIVE HARM REDUCTION PSYCHOTHERAPY

Dr. Tatarsky will conduct a one day introductory workshop

The Albert Ellis Institute
45 East 65th Street
New York, NY

For information and registration call 212-535-0822

Letter to Uzbek authorities re abrupt cessation of methadone and buprenorphine.

Letter to Uzbek authorities re abrupt cessation of methadone and buprenorphine.

Dear Colleagues—

In the early days after the recent election, nearly 500 mental health and substance use professionals in the US and abroad took a public stance with the new administration about the selection of the new Drug Czar. Our collective voice may have had a hand in the selection of Gil Kerlikowske as the director of the Office of National Drug Control Policy and Dr. Tom McLellan as his deputy. These are two professionals who meet many of the criteria that we called for and support many of the policies that we advocate for including a greater emphasis on treatment rather than incarceration for drug users who need it and support for evidence based practices such as substitution treatment, syringe exchange and motivational approaches. Their selection signals a very positive turn at the federal level toward a more rational drug policy that is good for drug users and the country at large.

Lets consider the potential for our collective voice to continue to have an impact on national and international policies that affect our substance using patients and fellow citizens.

I have copied below an appeal from the Eurasian Harm Reduction Network to the government of Uzbekistan, which has announced that it will cease provision of methadone and buprenorphine.

If you are able to sign, please send your name and organizational affiliation to Andrew Tatarsky, info@andrewtatarsky.com and cc me. If you agree with this effort please forward this note to one or more friends or colleagues and encourage them to sign on. The matter is urgent, so your prompt attention appreciated.

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To the President of Republic Uzbekistan

Mr. Islam Karimov

Dear Mr. President!

We express our deep respect to you and would like to address the following issue:

As we became aware, in the near future, following a decision by Government, Uzbekistan plans to close its Buprenorphine and Methadone Substitution Therapy Programs.

As specialists working in the field of drug addiction and prevention and treatment of HIV, we would like to note that Buprenorphine and Methadone Substitution Therapy is a scientifically proven method. Its effectiveness has been repeatedly noted in WHO, UNODC and UNAIDS documents. The role of Substitution Therapy is unique in reducing the spread of HIV and other blood-borne diseases, and criminality, as well as in creating opportunities to involve patients in treatment of such diseases as AIDS and Tuberculosis. That is why in 2005, WHO included Methadone and Buprenorphine to its List of Essential Medicines. Substitution Therapy is successful in such culturally diverse countries as the EU, USA, and countries of Asia (China, Iran, Malaysia, Kyrgyzstan, Azerbaijan, Kazakhstan, etc. ).

Regardless of the reasons for bringing the Substitution Therapy programs to stop, we know that among its inevitable consequences will be worsening of the HIV situation, growth in criminality and in drug traffickers' profits, as well as other negative repercussions. It has been established that in absence of treatment access, the majority of patients of Substitution Therapy programs return to the use of street drugs, which increases the risk of infection through non-sterile injecting equipment, death from overdoses and increase in criminal activity. All these consequences threaten not only the 200 patients of the programs, but also the rest of the country's citizens.

Dear Mr. President!

Being aware of the degree of responsibility that you bear for safety and well-being of the citizens of Uzbekistan, we appeal to you for suspending the decision on closing Substitution Therapy programs and establishing a qualified commission involving international experts and practitioners with long-term experience in implementation of such programs, that would be able to suggest necessary steps for their strengthening in Republic Uzbekistan.

Yours Truly