Kyrgyzstan: Methadone Debate Puts Program At Risk

By David Trilling

“I’ll be the first corpse,” says Sveta Filatova when asked about initiatives to terminate Kyrgyzstan’s methadone programs. A heroin addict for 10 years, Filatova has been taking the opioid substitute for three and says it’s changed her life, enabled her to reconnect with family, and hold a job.

Filatova is one of about 200 methadone patients who come to Bishkek’s Clinic No. 6 every day. The process lasts about a minute: In a little room accessible through a backdoor to the hospital, a dedicated nurse takes patients’ signatures before double-checking the doses and pouring the clear liquid in a disposable cup. Many patients come early in the morning, before work.

Addicts say the hardest part of kicking heroin is the physical pain of withdrawal. Methadone, a synthetic analgesic, helps kill the pain, but doesn’t give a high. “With methadone you don’t need heroin. You feel okay without it. It’s simple, it’s free, it’s accessible, you take it and feel clear in the head and can work,” Filatova, 42, told EurasiaNet.org.

Since 2002, opioid substitution therapy (OST) has helped combat Kyrgyzstan’s soaring heroin and HIV epidemic, which is being fueled by cheap and accessible Afghan narcotics. As the number of injecting drug users grows, so do cases of HIV. Though no reliable statistics exist, health experts believe there are between 25,000 and 55,000 injecting drug users in the country.

Today, about 1,100 people are using methadone, which is paid for by the Global Fund to Fight AIDS, Tuberculosis and Malaria. Though health experts consider OST a modest success, and note that it has inspired pilot projects in neighboring Kazakhstan and Tajikistan, uninformed attacks on the program are increasing.

The origins of the current debate can be traced to a 2011 film titled “The Trap,” which presents a dire view of methadone treatment. Director Ernest Abdyzhaparov is quoted as saying by local media outlets that he made “The Trap” because he fears “methadone can become a new kind of drug. It may lead to a new methadone-sale business.” In an interview with the 24.kg news agency, Abdyzhaparov acknowledged an affinity for principles espoused by the Church of Scientology, which opposes methadone treatment as something that merely replaces one addiction with another. “Scientology is a technique, a spiritual discipline,” Abdyzhaparov said. “I use it in my work.”

A Health Ministry spokeswoman told local journalists that Abdyzhaparov didn’t bother interviewing one doctor who works with drug users and bashed the film as “biased.” But the damage was done. Since the film was released last fall, a debate has simmered, and has found its way into parliament.

In June, MP Kurmanbek Osmonov of the nationalist Ata-Jurt Party leveled one typical attack. Perhaps appealing to the growing number of Kyrgyzstanis concerned about the spread of foreign influences in Kyrgyzstan, he told a legislative session that “Western countries” have an “abundance” of methadone and don’t use it themselves, so are “trying to dispose of it in countries like Kyrgyzstan.”

Other deputies have said methadone is addictive and should be banned; one said, falsely, that “methadone is banned everywhere else in the world.” They were reacting to a proposal by one deputy to strengthen legislation ensuring the methadone programs continue.

“It all started with this film, ‘The Trap,’” said Olga Ochneva, advocacy coordinator at Asteria, a shelter that helps female drug users.

“Many of our women are using methadone therapy,” Ochneva told EurasiaNet.org. “We are concerned. If methadone therapy is stopped in Kyrgyzstan, it will strongly affect these women,” many of whom have babies.

Because methadone is not used in Russia, a country many Kyrgyzstanis see as a role model, people are suspicious, says Aisuluu Bolotbaeva, a regional HIV expert based in Bishkek who is developing outreach programs to help educate society at large about the benefits of OST.

Among OST patients, foreign experts, and medical professionals, the belief is widespread that some police officers are lobbying against methadone because it’s bad for business. A number of well-informed sources privately told EurasiaNet.org that some corrupt police officers actively deal heroin.

One described cases where police blackmailed users to continue buying heroin, even when the users were trying to quit. Another said some police even take orders over the phone, “just like ordering a pizza.”

Such allegations do not come as a surprise in Kyrgyzstan, where police are regularly implicated in the narcotics trade. On July 31, Kolbay Musayev, head of the Defense, Security and Emergency Situations Department within the government apparatus (known by its Russian acronym GUBNON), said that, in the first six months of this year, 87 police from a special anti-narcotics squad had been implicated in 281 drug-related violations in three provinces. On August 13, Kyrgyzstan’s new anti-drugs czar, Keneshbek Dushebayev, said $6 billion worth of narcotics pass through the country annually, KyrTAG reported. That’s more than Kyrgyzstan’s official GDP.

“Selling heroin is how the police make money, so [the existence of] methadone users mean the police are losing money,” says Slavic Andreev, a social worker with Narcology Alternatives, an non-governmental organization that helps drug users access OST. “An average dose is one gram a day. A gram is 1,000 som [about $21]. Do the math.”

Inside Clinic No. 6, Olga Lyachina, a nurse and the coordinator of the needle exchange program, agrees: “The problem is the police.”

Chief Inspector Ermes Osmonbayev at the Interior Ministry’s press service called these allegations “completely absurd” and said that anyone who sees police dealing drugs should call an appropriate law enforcement agency.

Whether or not the police are fueling hostility to methadone, for recovering addicts like Nelia, the debate is distressing. Thanks to methadone, after injecting heroin for 12 years she has reconnected with her children, gone back to work, and her health has improved. “I sold my house, my car, everything I had. I lost everything to heroin,” she told EurasiaNet.org.

Nelia, who is 45 and asked her last name not be printed for fear of embarrassing her relatives, has been an OST patient for four years. “Methadone really helps me,” she said. “My head is clear. I can do my job. I can reconnect with my family.”

David Trilling is EurasiaNet’’s Central Asia editor.