Substitution maintenance treatment during quarantine

In the difficult period of the COVID-19 epidemic, it is important that the state authorities respond promptly to the needs of the community of people who use drugs, while observing all international recommendations
Valya Mankieva Secretary of the PWUD Forum in Kazakhstan

Task

Patients of substitution maintanance treatment (PST) in Temirtau, Karaganda region (Kazakhstan) have limited access to the treatment of a chronic disease guaranteed by them by the state. In Kazakhstan, participants in SMT programs are taking the medication at mental health centers under the direct supervision of medical personnel. From mid-March 2020, the building of Temirtau Narcology Clinic was reallocated to the hospital for patients with COVID – 19. Program participants are forced to receive treatment in Karaganda. The quarantine restrictions introduced on March 18, including restrictions on the movement or cancellation of public transport services, make it very difficult to receive daily treatment for SMT patients residing in Temirtau. These restrictions put them at risk of being fined for violation. In turn, patients with SMT cannot fully comply with the recommendations on self-isolation to effectively protect themselves and their loved ones from  COVID – 19.  

Solution 

Activists of the Forum of People Who Use Drugs of Kazakhstan published a post on Facebook  calling all the stakeholders to pay attention to the critical situation in Temirtau. After negotiations with the head of the regional narcological clinic, the situation changed. Civil activists were supported by the Eurasian Network of People Who Use Drugs and the Kazakhstan Union of People Living with HIV.

In order to unite efforts, a working group was created with the participation of international organizations – UNAIDS, the United Nations Office on Drugs and Crime in Kazakhstan. Letters calling for urgent action were sent to K. Tokaev, the President of the Republic of Kazakhstan, and E. Birtanov, the Minister of Health of the Republic of Kazakhstan.

Result 

People on SMT received special permits issued by the regional health department, which allow them to visit the medical center without fear of being fined. A car has been allocated to patients with SMT for transportation to the site. Program participants can access  inpatient hospitalization in the addiction department for the period of quarantine.

Today, community activists are seeking to restore access to SMT in  Temirtau with the possibility of enrolling new patients, and in the whole country the possibility of handing out take home medicine.