Sunday, July 12, 2009

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, 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.


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

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