The COVID-19 pandemic and the restrictions associated with it have changed people’s lives in almost all countries. However, very few realize how the lives of people with drug use disorders – who are among the most vulnerable and in need of ongoing care – have changed. On the one hand, the closure of borders during quarantine has led to a dramatic reduction in access to narcotic drugs. On the other hand, loss of income has become a problem for people with many forms of dependence accompanied by various diseases. Exposure to COVID-19 can also lead to complications due to their weak immunity.
We interviewed one of the psychotherapy practitioners in drug treatment facilities of Uzbekistan, who, since the onset of the pandemic, has adapted activities to the new constraints posed by COVID-19 in order to help ensure continued access to direct psychological and therapeutic care for patients with drug dependence.
What has changed since the pandemic outbreak?
"Since the COVID-19 pandemic outbreak, we lived like on a powder keg", says Tatyana Sobornitskaya, a psychotherapist at the Tashkent City Narcological Dispensary. "Admission of patients with drug and psychotropic substance dependence sharply decreased with introduction of lockdown. At the same time, an increase in the number of patients admitted with alcohol dependence was observed. Later we discovered that some people with drug and psychotropic substance dependence have switched to alcohol due to drug shortages.”
Challenges associated with the new working regime included: the need to wear protective equipment (PPE) during the day and while working with patients; challenges with identifying whether a patient with drug dependence admitted via ambulance was in contact with anyone infected with COVID-19; and the need to look for symptoms of coronavirus infection in addition to the diagnosis of narcological pathology.
In July 2020, cases of infection were detected in the facility, among patients and some employees, including Tatyana herself. "It was very hard. I stayed in the department for two weeks,” says Tatyana. "In addition to psychotherapy, I also had to deal with the treatment of patients admitted to the facility, with constant contacts and in close consultation with epidemiologists. On top of that, different kinds of information coming from outside made patients scared and anxious. This led to a need for a series of balancing conversations in addition to treatment. Thanks to the support of the Chief Clinician and well-coordinated work of staff, the necessary medication-assisted therapy was selected, which helped patients to cope with the disease.”
From July to September 2020, 306 patients – including 89 people with drug dependence – were admitted to in-patient treatment.
"Nevertheless, on the bright side, during these two weeks, patients were very well acceptive with regards to information about their drug dependence, they opened up easily under such unusual circumstances", mentioned Dr. Sobornitskaya.
Another positive aspect was the convenience of online communication with persons with dependence. "Online communication turned out to be convenient and simple", says Tatyana. "I run a Telegram channel for patients, and they get in touch when necessary".
Following Tatyana's dedicated work during the pandemic, she was entrusted to head the in-patient drug treatment department of the Tashkent City Narcological Dispensary.
It should be noted that the Rehabilitation Department of the Tashkent City Narcological Dispensary provides qualified free medical and psychological care to those who found themselves in a difficult situation. Upon the patient's desire to be supported, the Dispensary staff stand ready to provide all necessary care.
Universal Treatment Curriculum for Substance Use Disorders
The UNODC Regional Office for Central Asia under UNODC Global Project GLOJ71 "Treating drug dependence and its health consequences: TREATNET II" delivers capacity-building activities in the field of drug dependence treatment and care. It aims to enhance the Member States’ capacities on drug use disorder treatment, reintegration and care. This includes related mental and medical disorders. In particular, the capacity-building activities are facilitated through the Universal Treatment Curriculum for Substance Use Disorders (UTC) developed with the U.S. Department of State’s (INL) financial support. The overall goal of the training activities is to reduce the medical, social, and economic problems associated with substance use disorders by developing the international treatment capacity through training, enhancing skills, and expanding the global treatment workforce. The training prepares addiction specialists for professional certification by providing the latest information about substance use disorders and treatment. It facilitates hands-on activities to develop their skills and confidence.
Dr. Sobornitskaya, a member of a team of national trainers from Uzbekistan, has successfully completed all nine courses of the Basic Level Universal Treatment Curriculum for Substance Use Disorders (UTC) and received the status of the "International Certified Addiction Professional Level 1" (ICAP I).