Kyrgyz Lawmakers Learn about Iranian Harm Reduction Practices

Five members of the Kyrgyz Parliament visited Iran on a study tour from 11th to 14th June 2012 to get acquainted with Iranian practices of harm reduction, particularly with methadone maintenance treatment among people who use drugs. The tour was organised in the framework of the project“Bridging the Gaps: Health and Rights of Key Populations” of the AIDS Foundation East-West (AFEW), with the financial support from UNODC and CARHAP.

With a population over 75 million, Iran counts around 2 million people who use drugs. Up to 50% of them receive methadone maintenance treatment, which is available at 2,000 sites and in prison settings. Other harm reduction programmes are also available for people with drug dependency: needle and syringe exchange programmes, rehabilitation and drop-in-centres. While drug use (as well as drug trafficking) is a criminal offense in Iran, people who use drugs receive a special certificate, which serves as a safeguard against criminal responsibility.

Members of the Kyrgyz Parliament had the opportunity to visit a number of state-run and non-governmental institutions and private clinics that work with people who use drugs. Within these institutions there is a well maintained and financially supported research component, which comprehensively analyses the effect of methadone treatment on behavioural, physical and psychological state of the patient. In this regard Iranian research institutions closely cooperate with, and follow the recommendations of, the World Health Organisation.

Nearly 30% of patients drop out of the programme due to violations of treatment conditions, but they are immediately referred to other harm reduction programmes to prevent relapse into drug use. OST costs US$50-70 per month but the price can decrease depending on the patient’s motivation. People with a lower income can have a price reduction or be redirected to free treatment facilities. Paid programmes usually provide a better service – doctors’ consultations are more intensive and can be given online and on weekends. Paid private clinics can also provide client management services and organise self-help groups.

Before the trip, Parliament representatives were rather negative about OST because of the lack of trustworthy national information about it, even though OST is partially implemented in some of Kyrgyzstan’s prisons. The goal of the trip was to demonstrate the effectiveness of OST programmes in an Islamic country and eventually identify opportunities for drafting a new law on OST implementation in Kyrgyzstan. For the past 10 years Kyrgyzstan has been implementing OST as a pilot project, without any legal basis for its full implementation.

For the past 6 years the Kyrgyz Parliament has also been trying to pass a law on “Provision of narcological support”, which would legalise the use of methadone and other substitution medicines, but no consensus was yet reached on the issue. With this study tour, AFEW hopes to get support among Parliament representatives to move forward on the issue.

Dastan Bekeshev, member of the Kygyz Parliament:

“After this trip many things have become much clearer. We heard the views of doctors saying that the effect of substitution therapy is positive, we saw how to operate methadone centres, spoke to participants of such programmes. There are, however, many questions remaining. For example, how would we pay for the implementation of such programs? What will be the implementation mechanisms in our conditions, would it not be abused?”

Mr. Bekeshev’s study tour report “Methadone therapy. Iranian experience” was published in News Agency “24.kg” and is available in Russian language.

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