UNODC Regional Office for Central Asia together with the UNODC Prevention, Treatment and Rehabilitation Section (PTRS), hosted a training for practitioners on "Treatnet Family" for youth with drug use disorders including those in contact or at risk of contact with the criminal justice system. The event was held in a hybrid format in Ashgabat, Turkmenistan from 12-16 April 2021 and 27 local service providers working with youth and their families from drug treatment centres, juvenile facilities, and NGOs, participated. The training aimed to prepare social service providers to pilot community-based social services for youth at risk and their families. While the very focus of the training was to build capacity of social workers and disseminate evidence-based training materials to also benefit families in resource-limited settings, this initiative at the same time contributed towards the creation of societies more resilient to drugs and crime – starting at the community level.

Ms. Anja Busse, PTRS Programme Officer at UNODC HQ stated at the opening of the event that “The teenage years are a critical window of vulnerability to substance use disorders, because the young person’s brain is still developing, and some brain areas are less mature than others. Many factors influence whether an adolescent tries drugs, including the availability of drugs within the neighbourhood, community, and school and whether the adolescent’s friends are using them. The family environment is also important: adverse childhood experiences such as violence, physical or emotional abuse, mental illness, or drug use in the household increase the likelihood an adolescent will use drugs.”

This activity was implemented under Sub-Programme 3: Prevention, Treatment, Reintegration and Prevention of HIV of the UNODC Program for Central Asia 2015-2021.

UNODC has originally developed the "Treatnet Family" training materials thanks to the support of the Government of Japan.

The Nationwide Competition “Expert on the Development of Life and Family Skills” was organized online in January-April 2021 by the Ministry of Public Education of the Republic of Uzbekistan jointly with the United Nations Office on Drugs and Crime (UNODC) in three stages via @psyforum telegram channel.

The competition was aimed at disseminating best practices, as well as improving the skills of psychologists and teachers in the public education system in achieving psychological resilience in schools and families by teaching young people life skills, healthy lifestyles, positive relationships between parents and children, and building resilience to bad habits and stress.

At the first stage of the competition, the participants tested their knowledge based on the training programme "Strong family - Happy school", implemented in secondary schools. At the second stage, based on the materials of the programme, the participants gained experience by working with adolescents and their parents for three weeks and demonstrated the results of their activities in the form of presentations. The presentations of the contestants were evaluated by the national trainers of the program “Strong family - Happy school”, and 13 strongest participants received tickets to the 3rd stage. The final stage of the competition took place in the form of a practical test based on the materials of the "Strong family - Happy school" programme.

The first stage of the competition was attended by about 2,000 teachers and psychologists from all over the country, of which 100 participated in the second stage, and 13 in the final third stage. The organizers identified the three winners and awarded a mobile tablet for the 1st place, a smartphone for the 2nd place, a smart watch and a diploma for the 3rd place, and all the other finalists were awarded with souvenirs and certificates of honor.

This activity was implemented under Sub-Programme 3: Prevention, Treatment, Reintegration and Prevention of HIV of the UNODC Program for Central Asia 2015-2021 with the support of the Prevention, Treatment and Rehabilitation Section of UNODC HQ. The UNODC Regional Office for Central Asia works closely with the Ministry of Public Education of Uzbekistan.

4 March 2021, Online Consultation on initiation of the Survey in Kazakhstan on High-Risk Drug Use took place via Zoom Teleconference Platform.

More than 25 representatives of governmental, non-governmental stakeholders in the Republic of Kazakhstan and international organizations, including the Ministry of Health, Ministry of Interior, Republican Mental Health Centre, Kazakh National Centre of Dermatology and Infectious Diseases, Law Enforcement Academy of the General Prosecutor’s Office, non-governmental organizations, research institutions, Global Fund to fight AIDS, Tuberculosis and Malaria, WHO, UNAIDS and UNODC converged around a virtual table to discuss the concept of the survey.

The webinar was officially opened by Mr. Nikolay Negay, Director of the Republican Mental Health Centre under the Ministry of Health of the Republic of Kazakhstan, Mr. John Dudley, Head of INL, US Embassy in Nur-Sultan and Mr. Naweed Riaz, Head of UNODC Programme Office in Kazakhstan.

As part of the webinar, Mr. Kamran Niaz, Epidemiologist of Drug Research Section at Research and Trend Analysis Branch of UNODC Vienna, presented the experience of other countries with drug use surveys. In his turn, Mr. Nikolay Negay, the Director of the Republican Mental Health Centre, presented on drug-use-related situation in Kazakhstan and current tendencies. In particular, in his presentation Mr. Negay mentioned that during 2016-2020 number of people with NPS dependency have increased 60-fold.

Ms. Gulnur Bolyspayeva, UNODC National Programme Officer, presented the concept, plan and timeframes of the high-risk drug survey. During the discussion, parties also agreed on the objectives, functions and composition of the National Coordination Group that would comprise senior representatives of the relevant national and international stakeholders and provide the overall policy support and guidance for the implementation of the survey.

The survey results are expected to identify the extent, type, patterns, and trends of high-risk drug use with its related social and health problems at selected localities and at national level to inform policies and programmes in cooperation with relevant national and international stakeholders to further address drug demand reduction efforts in the country.

The consultation was held as part of Sub-programme 3: Drug prevention, treatment and reintegration and HIV prevention of the UNODC Programme for Central Asia for 2015-2021 with financial support from U.S. Department of State’s Bureau of International Narcotics and Law Enforcement Affairs.

New psychoactive substances (NPS) are spreading at an unprecedented rate and are becoming a serious health threat and a real problem in drug policy in Central Asian countries. Little is known about the negative impact of NPS on human health and the harm they cause to society, and this significantly complicates prevention and treatment. To effectively counter this new problem, it is necessary to ensure constant monitoring of the drug situation, exchange of information and raise awareness of the risks.

In order to consider the possibility of multisectoral partnerships between government agencies, nongovernmental organizations, academic institutions and research centers on studying the situation with NPS and improving the availability and efficiency of services for people who use NPS, the UNODC Program Office in the Kyrgyz Republic, together with the Harm Reduction Network Association, the Plus Center Public Foundation, the Institute for Global Research (GLORI) and financial support from UNAIDS Country Envelopes Fund held a conference “Finding Effective Solutions to the Problem of New Psychoactive Substances in Kyrgyzstan: An Online Review of Multisectoral Partnerships of Communities, Scientists and Practitioners”.

Some 46 experts, specialists and representatives of international organizations of Central Asia countries learned on the NPS situation in the country and in region as well as discussed issues on improving access to treatment and effective services for drug users.

In the Kyrgyz Republic, first cases of synthetic drug use were recorded in 2013. Back then synthetic cannabinoids appeared on the market - smoking mixtures known as “spice”, the use of which was widespread, especially among young people. Only in 2015, Kyrgyzstan adopted a law prohibiting the abuse of synthetic drugs, including "spice" and other smoking mixtures. But the emergence of new synthetic drugs such as "salts", "bath salts" and "crystals" requires their inclusion into the list of illegal substances. In 2014, more than 400 NPS were identified, and in 2020 there are already more than 800.

“During the conference, I would like to focus on a very important point: the legality of NPS,” said Mr. Timur Isakov, Executive Secretary of the State Coordination Committee for the control over narcotic drugs, psychotropic substances and precursors (SCCDC). “Currently, these substances exist in the form of new psychoactive substances, they are legal and cannot be withdrawn from a citizen or organization. Their distribution is legal. Let us, in legal terms, say not that they need to be seized, but that they need to be identified. "

Considering the situation, in 2015 an interdepartmental working group under the SCCDC was established, which resulted in introducing additional substances into the prohibited lists. “You can control the spread of NPS in a different way. First, at the global level. But this system is not fast. Therefore, a number of states have started to group NPS as forbidden substances. But in the country, we do not adhere to this position, since in Kyrgyzstan there is a very strict law on NPS. In this regard, we form lists of analogues, now we are also doing such work in order to comply with the norms that are laid down in the Criminal Procedure Code and the Criminal Code of the Kyrgyz Republic. The main task is to identify new psychotropic substances”, concluded Mr. Timur Isakov.

The head of the Harm Reduction Network Association, Mr. Sergei Bessonov, raised the issue of the distribution of NPS in the territory of Kyrgyzstan. In his opinion, the appearance of NPS on the country's market was influenced by a number of factors: close borders with China and Afghanistan, their availability, contactless distribution through instant messengers: Telegrams and Internet resources. He concluded that “traditional prevention programs will not work on people who abuses NPS. Provision of prevention services/treatment over the Internet is the future for a new generation of drug abusers”.

To organize the provision of medical, psychological and social assistance to NPS abusers from the moment of suspicion or diagnosis, in 2019 UNODC initiated a study, which resulted in the development of the Clinical Guidelines for Assisting Adult Abusers of New Psychoactive Substances and a new Clinical Protocol on NPS, which in the near future will be introduced into the work of medical institutions.

“I hope this clinical guide will be a useful practical tool for our physicians. We launched all this on time, as I see alarming signals - young people in Central Asia are beginning to quite actively switch to new psychoactive substances, especially Mephedrone. This substance is a synthetic psychostimulant - an analogue of amphetamine. And the problem is that now there is no way to help with such addiction”, said Mr. Kubanychbek Ormushev, Coordinator of the Drug Prevention Program at the UNODC Program Office in the Kyrgyz Republic.

Mr. Danil Nikitin, director of the Institute for Global Research (GLORI), said that during focus groups meetings, drug addicted girls and women complained that their relatives, friends did not notice that they had been addicted for a long time. When this happens, their relatives begin to treat them in every possible way. And sometimes this treatment can be attributed to domestic violence. In this regard, the WINGS model, which began to be applied back in New York, is indicative. There, drug addicted women themselves were able to mobilize and develop for themselves some kind of motivation and goal setting.

The result of the conference was the conclusion that the trend of the spread of NPS in the Kyrgyz Republic and Central Asia, in general, continues to grow, overshadowing traditional drugs. However, this creates a problem of ineffectiveness of the existing prevention measures for drug dependence as well as their treatment. And these issues require a separate study.

The event was conducted as part of the UNODC Program Office in the Kyrgyz Republic initiative "Assessment of the needs and accessibility of HIV prevention and treatment services for people in Kyrgyzstan who abuse new psychoactive substances and stimulants" implemented by Sub-program 3: Prevention, treatment, reintegration and prevention of HIV infections of the UNODC Program for Central Asia for 2015-2021.

The Regional Mission in Central Asia of the UN Office on Drugs and Crime (UNODC) together with the Ministry of Public Education of the Republic of Uzbekistan launched an online competition "Expert on the Development of Family and Life Skills."

The main purpose of the competition is to disseminate best practices, as well as to improve the skills of psychologists and educators in the public education system, especially classroom leaders, in achieving psychological stability in school and family by teaching young people life skills, healthy lifestyles, positive relationships between parents and children, as well as how to say no to bad habits and how to cope with stress.

The competition will be organized online in three stages through the tv channel @psyforum for school psychologists and teachers and will be based on the materials of the family life skills training program "Close Family - Happy School", which is successfully implemented in the country's schools by the Ministry of Public Education in cooperation with UNODC.

Stages of the competition

Participants will use the curriculum and handouts of the "Close Family - Happy School" training program, which are available on the @psyforum TV channel. They had to be familiarized and tried to use the opportunities in practice until January 10, 2021.

The first stage of the competition will be held in the second decade of January 2021 in the form of an online test on the program "Close Family - Happy School" and its handouts. 100 participants who passed the test with the best results will advance to the second stage.

In the second stage, participants will conduct independent trainings in their educational institutions, where they will work for a month on the basis of the program "Close Family - Happy School" and its handouts in order to apply in practice in their psychological or pedagogical activities. They are expected to present a presentation of 10 slides on their life skills development experience for students and their parents through the Close Family -Happy School program and distributions until 25 February 2021.

Presentations will be posted on the @psyforum TV channel and will be reviewed for evaluation by an expert panel formed by the organizers on a 50-point scale based on criteria such as best use of the program as an additional method, practicality and usefulness, creativity, compliance with the requirements of the program (training in families for three weeks according to the rules and methodology of the program), clarity and promotion. The 13 participants with the highest number of points will be finalists.

In the first decade of March 2021, the finalists will take part in online testing under the program "Close Family - Happy School" and its handouts, and the winners will be determined by the results of testing and the second stage.

Awarding winners

Winners who took the first three places will be awarded with valuable gifts and diplomas "Specialist in the development of family and life skills." The remaining 10 participants will also be awarded with souvenirs and certificates.

Pros

By organizing this competition, the Ministry of Public Education provides an unprecedented opportunity to re-launch the UNODC programme across the country in 2021, encouraging and motivating schoolteachers and psychologists. This competition is more relevant than ever, as the new school semester begins in the new year, proclaimed by the President of the country the Year of Youth Support in Uzbekistan. UNODC's Central Asia Office is pleased to support the Ministry of Public Education in this endeavour and looks forward to the positive results of the competition for schoolchildren and their families, who will be able to start the new year with important new life and family skills that we hope will benefit them and help them to move forward with confidence and happiness.

This event is supported by UNODC's 2015-2021 programme: Prevention, Treatment, Reintegration and Prevention of HIV Infection of the UNODC Programme for Central Asia for 2015-2021 and UNODC's global PROJECT GLOK01 "Preventing Substance Abuse, HIV/AIDS and Youth Crime in Low- and Middle Income Countries through Family Life Training Programs" with support from the UNP/ Prevention, Treatment and Rehabilitation Headquarters.

Online regional training for trainers (ToT) on Course 10 “Managing Medication-Assisted Treatment Programs” (30 November – 3 December 2020) of the Advanced Level of the Universal Treatment Curriculum for Substance Use Disorders (UTC training package) launched on 30 November 2020.

The main purpose of the training series is to prepare the team of national trainers who will be able to independently train professionals, working in the field of drug dependence treatment and prevention in their own countries in the future. The training was conducted by Dr. Yuriy Rossinskiy (Kazakhstan) and Dr. Oleg Yussopov (Kazakhstan), highly qualified Regional Master Trainers of the International Center for Credentialing and Education of Addiction Professionals.

The participants of the regional training were practicing addiction professionals and members of national teams of trainers from Kyrgyz Republic (9 participants), Tajikistan (5 participants) and Uzbekistan (10 participants), who hold credentials of International Certified Addiction Professionals Level One (ICAP I).

In his opening speech, Borikhan Shaumarov, UNODC Regional Program Coordinator talked on the importance of UTC training package and called on to the participants inviting them to start conducting workshops for addiction professionals in their home countries to pass on the knowledge. He also encouraged them to join the International Society of Substance Use Professionals (ISSUP) to expand their own horizons of professional knowledge sharing.

The main objectives of the training were to provide a comprehensive understanding of the role of pharmacotherapy and pharmacological interventions on a continuum of recovery-oriented interventions and to present ways of integrating medication-assisted treatment (MAT) services into a comprehensive system of care (e.g., program setting, management issues).

For four days regional master trainers informed the participants on the role of pharmacotherapy on a continuum of recovery-oriented interventions and systems of care, identify the phases of care involved in all Medication-Assisted Treatment (MAT) programs, explain the psychosocial benefits of MAT and describe specific types of pharmacological interventions.

This training was organized within the framework of UNODC global project GLOJ71 “Treating drug dependence and its health consequences: Treatnet II” in collaboration with Prevention, Treatment and Rehabilitation Section of UNODC HQ with financial support from U.S. Department of State’s Bureau of International Narcotics and Law Enforcement Affairs.

As covid-19 becomes the "new reality" and the number of positive cases, although not as high as the last, we must remain vigilant, especially when it comes to those who are most vulnerable to possible negative consequences.

The statement we can hear on any flight on an airplane is: "In case of danger, first put the mask on your own, then put it on the child." The purpose of this statement is that without protecting yourself in the first place, you will not be able to help those who need it most. The same principle applies to drafting during the COVID-19 pandemic.

Those whose job it is to help the most vulnerable groups in their needs must first be protected.

In November 2020, UNODC provided the UNAIDS National Aids Protection Centre (SIS) with a total value of $5,000. The transferred personal protective equipment included antiseptic fluids, medical masks, gloves, respirators, disposable protective suits and protective masks.

Individual protective items were also provided to the Drug Enforcement Service of the Republic of Uzbekistan with support from the U.S. Department of State's Bureau of Drug Control and Enforcement (INL), totalling $5,000 for faster distribution to the following institutions: Tashkent City Regional Drug Dispensary, Tashkent Regional Drug Dispensary , Djizak Regional Drug Dispensary, Samarkand Regional Drug Dispensary, Syrdarinsky Regional Drug Dispensary, Syrdarinsky Regional Drug Dispensary,

These articles were provided at the request of the Ministry of Health of the Republic of Uzbekistan and the Republican AIDS Centre as part of UNODC's support for the national response to COVID-19 in Uzbekistan.

Nargiza Kenjaeva of the Samarcande Regional Medicines Dispensary shared the following message of thanks: "At this difficult time globally, when all medical services lack personal protection, UNODC's Central Asia Regional Office has reached out and unselfish support for Uzbekistan's health system. Donations have helped protect and prevent the spread of coronavirus infection in a timely manner among vulnerable groups, such as patients treated in a drug hospital and pharmaceutical health workers. The Samarkand Health Authority and the Medicines Clinic sincerely thank the UNODC Regional Office for their continued support and assistance during such a difficult period with the wishes of well-being, development and health.

Adham Ropijanov, of the Djizak Regional Medicines Dispensary, said: "The disposable hygiene items provided to us by the UNODC Regional Office in Central Asia provided a great deal of assistance during the pandemic. These products have helped to strengthen the protection of medical personnel and improve the effectiveness of preventing the spread of coronavirus infection.

This support for the national response to COVID-19 in Uzbekistan was provided under the sub-programme 3 "Prevention and Treatment of Addiction, Reintegration and Prevention of HIV" by UNODC's 2015-2020 Programme for Prevention, Treatment and Health Effects, with support from UNODC's Department of Prevention, Treatment and Rehabilitation. The United Nations Office on Drugs and Crime (UNODC) in Central Asia in Uzbekistan is working closely with drug treatment agencies and the Republican AIDS Centre to ensure access to health services for drug addicts and people living with HIV.

As COVID-19 becomes a “new norm” and the number of positive cases is not as high as it used to be, we still need to stay alert especially when it comes to those who are the most vulnerable to the possible negative consequences.

The statement that we can hear during any airplane flight is “In case of emergency, put on the mask on YOURSELF first, and then put it on your child.” The meaning of this instruction is that without protecting yourself first, you might not be able to help those who need it most. The same principle applies to the frontline staff during the COVID-19 pandemic.

Those, whose work is to help the most vulnerable populations in their needs, need to be protected first.

In November 2020 UNODC provided personal protection equipment (PPE) to the Republican AIDS Center with the support from UNAIDS, for the amount of 5,000 USD. The handed over PPE items included antiseptic liquids, medical masks, gloves, respirators, disposable covers and face shields.

PPE items have also been handed over to Narcological Service of the Republic of Uzbekistan with support from U.S. Department of State’s Bureau of International Narcotics and Law Enforcement Affairs (INL) for the total amount of 5,000 USD for further dissemination to the Tashkent City Narcological Dispensary, Tashkent Regional Narcological Dispensary, Djizakh Regional Narcological Dispensary, Samarkand Regional Narcological Dispensary, Syrdarya Regional Narcological Dispensary and Republican Specialized Scientific and Practical Medical Center of Narcology.

This PPE was provided on request from the Ministry of Health of the Republic of Uzbekistan and the Republican AIDS Center, as part of UNODC support to national COVID-19 response in Uzbekistan.

Nargiza Kenjaeva from Samarkand Regional Narcological Dispensary shared the following appreciation message: “In this difficult time on a global scale, when all medical services are experiencing shortage of PPE items, UNODC Regional Office for Central Asia extended a helping hand and selfless support to the health care system of Uzbekistan. The donated items helped to timely protect and prevent the spread of coronavirus infection among vulnerable groups, such as patients undergoing treatment in a narcological hospital and medical workers of drug treatment services. Samarkand Regional Department of Health and Narcological Dispensary express its sincere gratitude for the ongoing support and assistance to the UNODC Regional Office for Central Asia in such a difficult period with the wishes of prosperity, development and health”.

Adham Ropijanov from Djizakh Regional Narcological Dispensary noted, “The disposable hygiene items provided to us by UNODC Regional Office for Central Asia have been a great help during the pandemic. These products helped to further enhance the protection of medical personnel and increase the effectiveness of prevention of the spread of coronavirus infection.”

This support to national COVID-19 response in Uzbekistan was provided within the Sub-Programme 3 “Drug Prevention, Treatment, Reintegration, and HIV prevention” of the UNODC Programme for Central Asia for 2015-2020 and UNODC global project GLOJ71 “Treating drug dependence and its health consequences: Treatnet II” with support from Prevention, Treatment and Rehabilitation Section of UNODC HQ. United Nations Office on Drugs and Crime (UNODC) Regional Office for Central Asia in Uzbekistan works closely with drug treatment facilities and the Republican AIDS Center to ensure access to medical services by people who use drugs and people living with HIV.

Pandemics and health emergencies like the current COVID-10 outbreak, can cost many lives and pose additional risks to the global economy and overall security and stability. Ensuring continued access to health care during a pandemic, including services for people who use drugs and treatment of drug use disorders, are key not only to protect the health of populations, but also key to security and stability.

Drug use disorders are frequently accompanied by somatic conditions such as HIV/AIDS, hepatitis B and/or C and tuberculosis, lung or cardiovascular disease, stroke, cancer and injuries and traumas among others. Moreover, people with drug use disorders, especially those who inject drugs, may have a compromised immune system. Finally, stigma and discrimination linked to drug use and drug use disorders often result in limited access to basic resources such as housing, employment, health care and social support. For all these reasons, it may be more difficult for people who use drugs and with drug use disorders to protect themselves and they may be particularly at risk of developing COVID-19.

These days Almaty-based Republican Mental Health Centre, one of UNODC’s primary national counterparts in Kazakhstan, and its Pavlodar-based affiliation are at the coronavirus frontline providing emergency medical help to people with the mental health problems and drug use disorders – the most dysfunctional in the epidemiological sense population. Their health conditions most of the time are aggravated with the proneness to vagrancy, failure to comply with quarantine measures, and numerous contacts with people.

On the wake of the pandemic in Kazakhstan in August this year and following the urgent request from the Republican Mental Health Centre, United Nations Office on Drugs and Crime (UNODC) Programme office in the Republic of Kazakhstan, purchased personal protection equipment and bactericidal equipment for the “dirty zone” for the total amount of  12 000 US dollars. Two global UNODC programmes – “UNODC-WHO joint programme on drug dependence treatment and care” and “HIV/AIDS prevention, treatment, care and support for people who use drugs and people in prison settings” – have provided funding for this timely initiative. 

”In order to ensure the safety of medical workers who are at the coronavirus frontline now, proving emergency medical help to people with the mental health problems and drug use disorders, and to prevent the spread of COVID-19 in clinical departments, we organized separate, isolation units in the “dirty zone”  where newly arrived patients are waiting for the results of their COVID-19 tests”, said Mr. Nikolay Negay, head of the Republican Mental Health Centre. 

“We do not stop treatment of people in dirty zones thus reusable anti-plague suits, medical goggles, gloves and masks, shoe covers, and bactericidal irradiators-re-circulators will serve as a good protection to our medical workers”, he highlighted.

As elsewhere, in Kazakhstan the situation has become more complicated with regard to access to harm reduction and drug treatment programmes, and it has become more difficult for people who use drugs to receive health-retention services as the healthcare system is more focused on combating COVID-19. Although respondents of the UNODC ROCA produced report “Brief overview of COVID-19 impact on drug use situation as well as on the operations of the drug treatment services and harm reduction programmes in Central Asia”  report reduced overdose cases, it should be predicted that in the shortest term, the use of synthetic drugs, poor quality substances, and mixed substances may lead to serious consequences for the somatic and mental health of PWUD. Consequently, the demand for healthcare services may increase significantly among this population group in Kazakhstan.

Countries reported widespread disruption of many kinds of critical mental health services:

Over 60% reported disruptions to mental health services for vulnerable people, including children and adolescents (72%), older adults (70%), and women requiring antenatal or postnatal services (61%).

67% saw disruptions to counseling and psychotherapy; 65% to critical harm reduction services; and 45% to opioid agonist maintenance treatment for opioid dependence.

More than a third (35%) reported disruptions to emergency interventions, including those for people experiencing prolonged seizures; severe substance use withdrawal syndromes; and delirium, often a sign of a serious underlying medical condition.

30% reported disruptions to access for medications for mental, neurological and substance use disorders.

Around three-quarters reported at least partial disruptions to school and workplace mental health services (78% and 75% respectively).

“The Impact of COVID – 19 on mental, neurological and substance use services: result of a rapid assessment”, WHO, 2020

The support was provided within the framework of Sub-programme 3 - “Drug prevention, treatment and reintegration and HIV prevention” of the UNODC Programme for Central Asia 2015-2020 and UNODC Global Project GLOK32 “UNODC-WHO Joint Programme on drug dependence treatment and care”.

Пандемия, и связанные с ней ограничения, принесли перемены в жизни практически каждого жителя планеты. Однако, немногие задумываются о том, как изменилась жизнь лиц с расстройствами, вызванными употреблением наркотиков, являющихся одними из самых уязвимых и нуждающихся в постоянной помощи. С одной стороны, закрытие границ во время карантина, привело к резкому сокращению доступа к наркотическим веществам; с другой стороны, стала распространенной проблема потери дохода, к тому же, многие виды зависимости сопровождаются различными заболеваниями и слабым иммунитетом, что делает лиц с зависимостью подверженными риску осложнений при заражении COVID-19.

Мы побеседовали с одним из практикующих психотерапевтов наркологического диспансера, c первых дней пандемии адаптировавшихся к новым условиям ограничений, связанных с COVID-19 для обеспечения непрерывного доступа пациентов с зависимостью к прямой психологической и терапевтической помощи.

Что изменилось с начала пандемии

 «С приходом пандемии COVID-19, мы стали жить как на пороховой бочке», говорит психотерапевт Ташкентского городского наркологического диспансера, Татьяна Соборницкая. «Поступление больных с зависимостью от наркотиков и психотропных веществ сократилось с введением карантина. При этом был отмечен рост поступления больных с алкогольной зависимостью. Как мы выявили позже, часть наркозависимых переключились на алкоголь. Со слов пациентов это связано с тем, что стало труднее достать наркотики».

Среди сложностей, связанных с новым режимом работы можно отметить следующие: необходимость находиться в специальном костюме в течение дня и во время работы с пациентами; трудности сбора данных о том, был ли пациент с зависимостью, поступивший по скорой помощи, в контакте с инфицированными COVID-19; необходимость поиска симптомов коронавирусной инфекции, помимо диагностики наркологической патологии.

В июле в диспансере был выявлен случай стационарного заражения больных, некоторых сотрудников, включая саму Татьяну. «Было очень сложно. Две недели я жила в отделении», рассказывает Татьяна. «Помимо психотерапии, мне нужно было еще и заниматься лечением больных, помещенных в диспансер, с постоянным контактом с эпидемиологами. Различная информация, поступавшая извне, способствовала повышению тревожности и страху у пациентов. Поэтому, вдобавок к лечению, появилась необходимость в проведении ряда рациональных бесед, была подобрана необходимая терапия, которая помогла больным справиться с заболеванием».

С июля по сентябрь в стационар поступило 306 больных, из них наркозависимых – 89.

Положительные моменты

«Больные легко раскрывались и шли на контакт в этой непривычной обстановке», отметила доктор Соборницкая.

Еще один положительный момент заключается в удобстве онлайн-коммуникации с лицами с зависимостью. «Онлайн-коммуникация, оказалась удобной и простой», - отмечает Татьяна, «я веду телеграм-канал для наблюдаемых, они выходят на связь при необходимости».

В результате приверженной работы Татьяны во время пандемии, ей было доверено возглавить наркологическое стационарное отделение Ташкентского городского наркологического диспансера.

Медико-социальная реабилитация

Следует отметить, что Реабилитационное отделение Ташкентского городского наркологического диспансера оказывает квалифицированную бесплатную медицинскую и психологическую помощь лицам, оказавшимся в трудной ситуации. При наличии желания у пациента вылечиться, всю необходимую помощь ему готовы оказать в диспансере.

Универсальная программа обучения по вопросам лечения расстройств, вызванных потреблением психоактивных веществ

Региональное представительство УНП ООН в Центральной Азии в рамках программы по «Профилактике, лечению наркозависимости, а также реинтеграции и профилактике ВИЧ»  и глобального проекта УНП ООН GLOJ71 «Лечение наркозависимости и её последствий для здоровья: Тритнет II» осуществляет меры по развитию потенциала в области ухода и лечения наркозависимости, направленные на расширение возможностей государств-членов в области лечения расстройств, вызванных потреблением наркотиков, а также реинтеграции и ухода, включая сопутствующие психические и соматические расстройства в частности посредством Универсальной программы обучения по вопросам лечения расстройств, вызванных потреблением психоактивных веществ (UTC), разработанной при финансовой поддержке Государственного департамента США. Общая цель этой серии тренингов заключается в снижении остроты медицинских, социальных и экономических проблем, связанных с расстройствами, вызванными потреблением психоактивных веществ (ПАВ), путём развития международного потенциала посредством обучения, повышения профессионального мастерства и увеличения кадрового потенциала на глобальном уровне. Тренинг готовит наркологов к профессиональной сертификации, предоставляя самую последнюю информацию о расстройствах, вызванных потреблением ПАВ, и лечении, а также помогая новым специалистам обучаться на практике для развития навыков и уверенности в себе.

Доктор Соборницкая входит в состав команды национальных тренеров Узбекистана, успешно прошла все 9 курсов базового уровня Универсальной программы обучения по вопросам лечения расстройств, вызванных потреблением психоактивных веществ (UTC) и получила статус «Международного сертифицированного специалиста по зависимости 1-уровня».

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.

Silver Linings

"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.

Medico-social rehabilitation

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).

A Regional three-day training for trainers (ToT) on Course 9 “Advanced Pharmacology and Substance Use Disorders” of the Advanced Level of the Universal Treatment Curriculum for Substance Use Disorders (UTC training package) was launched via online video conference platform on 16 November 2020.

The main purpose of the training was to prepare the team of national trainers who in the future will be able to independently train professionals, working in the field of drug dependence treatment and prevention. The training was conducted by highly qualified Regional Master Trainers of the International Center for Credentialing and Education of Addiction Professionals: Dr. Yuriy Rossinskiy (Kazakhstan) and Dr. Oleg Yussopov (Kazakhstan).

The participants of the training are practicing doctors and members of national teams of trainers from Kyrgyz Republic (9 participants), Tajikistan (5 participants) and Uzbekistan (10 participants), who hold credentials of International Certified Addiction Professionals Level One (ICAP I).

For three days the participants received up-to-date information on psychoactive substances, the science of addiction and medications for substance use disorders from the regional master trainers. The training was designed to provide the participants with comprehensive understanding of the pharmacology of psychoactive substances, in-depth knowledge of the neurochemical processes involved in the development of addiction, as well as an overview of the medications for treatment of Substance Use Disorders.

Dr. Borikhan Shaumarov, UNODC Regional Project Coordinator, noted, “The pandemic has put everyone under certain pressure, but we have no time to lose. We need to adapt to the “new norm”, we adapt the training modules to the online format, we try and use mixed formats wherever possible. We have one aim – to leave no one behind and provide the best possible support to those who need it, those who have to struggle with dependence. These teams of trainers will pass on the knowledge to the professionals working drug dependence across their countries.”

This training was organized within the framework of UNODC global project GLOJ71 “Treating drug dependence and its health consequences: Treatnet” with financial support from U.S. Department of State’s Bureau of International Narcotics and Law Enforcement Affairs (INL).

A new report published by the World Health Organisation presents the Commonwealth of Independent States (CIS) countries – Armenia, Azerbaijan, Belarus, Kazakhstan, Kyrgyzstan, the Republic of Moldova, the Russian Federation, Tajikistan, Turkmenistan and Uzbekistan – as leaders in implementing the most cost-effective policies to reduce alcohol intake and alcohol-attributable harm in the WHO European Region.

The report highlights the quick direct action the region has taken to reduce the harm that alcohol can cause to individuals and broader society.

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The five-day regional online training on the skills of UNODC/WHO assessment experts on quality drug treatment has begun on 12 October 2020. The aim of the training is to strengthen institutional support to ensure the successful implementation of the UNODC/WHO drug treatment services in Central Asia and to promote a scientific approach to the quality of drug treatment and drug care services.

Following the launch of the International Standards for the Treatment of Drug Disorders, WHO/UN/UN resolution 59/4 by the Commission on Drugs (which calls for the development and dissemination of international standards for the treatment of drug-related disorders) and urges UNODC to support a systematic process of national adaptation and the adoption of national quality standards for accreditation of services under national law), the need for new globally applicable tools based on a coherent distribution strategy has been proposed to ensure a qualified and effective response to drug-related disorders around the world.

The development of such standards for the quality of drug treatment services is necessary to be able to evaluate best practices based on scientific and ethical principles. Quality standards also help to ensure that quality standards and opportunities for drug addicts are maintained by the health system for anyone with any other chronic disease.

A regional online refresher course for national assessor experts and other national experts involved in the development of national quality standards will focus on the following actions related to the continued implementation of quality standards in Central Asia:

• Presentation of achievements in Central Asia based on the results of pilot initiatives;
• Update on WHO/UNODC International Standards 2020 and a new set of service quality control tools from UNODC/WHO and Consensus Standards.
• Discussion of quality control standards with an emphasis on what is currently lacking in Central Asia.
• Focus on how to evaluate and plan improvements.
• Identify the changes needed in each country after pilot projects and the next steps to adopt international quality standards and develop national quality standards

Ms. Ashita Mittal, UNODC Regional Representative for Central Asia, stressed that "these standards must be globally applicable and consistent with the International Standards for the Treatment of Disorders Caused by UNODC and WHO, as well as to support politicians, health service managers and practitioners to enhance their capacity to provide quality services for drug treatment and care for drug addicts." She also took the opportunity to thank national partners for their commitment to implementing UNODC quality standards and tools by establishing working groups to adapt and test UNODC quality standards and tools for drug treatment services in 2019.

This training is part of UNODC's GLOBAL GLOJ71 Project "Treatment of Drug Addiction and Its Health Effects: Treatnet II"

Five-day online regional refresher training for assessors on UNODC-WHO quality assurance (QA) tools for drug dependency treatment launched on 12 October 2020. The purpose of the training is to consolidate the institutional support to ensure the successful implementation of the UNODC-WHO QA mechanism of drug treatment services in Central Asia and promote the scientific understanding of quality drug use disorder treatment and care services.

For the five days, the participants from Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan will have a unique opportunity to discuss important issues related to the development and institutionalization of a drug treatment services QA mechanism to improve the quality of drug use disorder treatment in Central Asia.

Following the launch of UNODC-WHO International Standards of Treatment of drug use disorders and the approval of resolution 59/4 by the Commission on Narcotic Drugs (which calls for the development and dissemination of International Standards for Treatment of Drug Use Disorders and urges UNODC to support a systematic process of national adaptation and the adoption of national QA standards for the accreditation of services in accordance with national legislation), the need for new globally applicable tools based on an agreed dissemination strategy was proposed in order to ensure a qualified and effective response to drug use disorders around the world.

The development of such quality standards on drug use disorder treatment services is necessary in order to evaluate good practices informed by science and ethical principles. The quality standards also help to guarantee the same quality standards and opportunities for drug-dependent people that are provided by the health system for any other chronic disease.

The online regional refresher training for the national expert assessors and other experts involved in the development of national QA standards will focus on following actions related to continuing introducing QA standards in Central Asian countries:

• Reflections on the achievements in Central Asia based on the findings of pilot initiatives
• Updates on ‘International Standards’ WHO-UNODC 2020 and new UNODC-WHO Services QA Toolkit and the Consensus Standards.
• Run-through on QA Standards areas with a focus on what is currently missing in Central Asia.
• Focus on assessment methods and improvement planning.
• Identifying changes required in each country following the pilots and next steps in adopting the International QA Standards and developing National QA Standards.

Ms. Ashita Mittal, UNODC Regional Representative for Central Asia, highlighted “that these standards need to be globally applicable and aligned with the UNODC-WHO International Standards for Treatment of Drug Use Disorders and serve the purpose of supporting policymakers, treatment services managers and practitioners to improve their capacity to deliver quality drug use disorder treatment and care services”. She also used this opportunity to thank the national counterparts for their commitment to introduce UNODC QA standards and tools by supporting the establishment of Working Groups on adaptation and piloting of the 2019 version of the UNODC QA standards and tools for drug treatment services.

This training is organized within the framework of UNODC global project GLOJ71 “Treating drug dependence and its health consequences: Treatnet II”.