Interruption in essential medication (methadone) supply in Moldova.

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As organizations concerned with HIV prevention and treatment among injecting drug users (IDUs), we call upon the international agencies and mechanisms – UNAIDS, UNODC, WHO and the Global Fund to Fight AIDS, Tuberculosis and Malaria to immediately react to the current interruption in supply of opioid substitution medication (methadone) in Moldova, and to take action to assess the reasons of this disturbance in order to ensure that a similar situation does not occur again either in this country or in other countries of the world.

RE: Interruption in essential medication (methadone) supply in Moldova.

As organizations concerned with HIV prevention and treatment among injecting drug users (IDUs), we call upon the international agencies and mechanisms – UNAIDS, UNODC, WHO and the Global Fund to Fight AIDS, Tuberculosis and Malaria to immediately react to the current interruption in supply of opioid substitution medication (methadone) in Moldova, and to take action to assess the reasons of this disturbance in order to ensure that a similar situation does not occur again either in this country or in other countries of the world. Supply interruptions or threat of them has disrupted methadone provision in Kyrgyzstan and Azerbaijan, and can undo years of work to build patient and provider confidence in this essential intervention.

Currently 32 methadone clients in Moldova have not received their medication from August 21. Reports from the country indicate that medication will be made available only around September 6 or 9. Doctors are trying to support patients: some people are treated in hospitals; others are being provided with tramadol, a medication not used in substitution therapy and which is not recommended for this purpose by guidelines in the major European countries, the US, or Canada.

The current situation brings suffering to people who are left without essential, lifesaving medications. The interruption is a step back from positive results of the program that were shown in WHO’s expert evaluation report published in July. The disruption also fosters mistrust by people who use drugs of the ability of government programs to deliver client-sensitive services to IDUs.

While Moldova’s positive experience in developing services has served as an example for neighboring countries, especially in terms of drug treatment services in the prison setting, the current service interruption endangers progress in the country, and underscores the need for international actors to do more to ensure supply and assess barriers to substitution treatment access. Addition of methadone and buprenorphine to WHO’s Model List of Essential Medicines, or GFATM support of substitution treatment, are both welcome, but insufficient.

We ask you to urge your partners in Moldova and help them to resolve the current crisis immediately. We call you to thoroughly investigate the causes of stoppage in supplies, identify prevention measures and set a plan for assistance to countries with a newly developing substitution therapy programs. The technical assistance plan should prioritize building national capacity for providing effective substitution treatment programs, including registration of medicines, procurement and supply management, national standards of treatment delivery to the clients. All these steps should be implemented with a meaningful involvement of affected community representatives.

We kindly ask you to contact Ms Raminta Stuikyte at [email protected] in the further communication and inform about the outcomes of your response to the interruption in Moldova. From our side, we are ready to assist you in identifying experts in procurement and supply of narcotic medicines, organization of piloting and scaling up of effective substitution treatment programs.

Action by the Global Fund and UN partners have been essential in introducing and scaling up the substitution therapy in Moldova and many other countries. Your further actions can help to ensure continuous progress in this area.

Kind regards,

Kaleria Lavrova, on behalf of Central and Eastern European Harm Reduction Network Gerry Stimson, on behalf of International Harm Reduction Association Stijn Goosens, on behalf of International Network of People Who Use Drugs Wim Vandevelde, on behalf of European AIDS Treatment Group Balazs Denes, on behalf of Hungarian Civil Liberties Union Kasia Malinowska-Sempruch, Director, International Harm Reduction Program of the Open Society Institute Milena Naydenova, Hope Sofia, Bulgaria David Ananiashvili, Director, Georgian Positive Group Guy Pierre Lévesque, methadone users association Méta d’Âme, Montreal, Canada Konstantin Zverkov, head of self-group ‘Era Miloserdiya’ (Era of Charity), Odessa, Ukraine Nick Bartlett, IHRD, OSI & PHD student in the University of California San Francisco

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