Kazakhstan Risks Losing Opioid Maintenance Therapy Programs

The outcomes of the assessment of the opioid maintenance treatment (OMT) programs, initiated by the Government of the Republic of Kazakhstan in 2017, may lead to the complete halt of these programs in the country. Multiple violations of human rights were recorded during the assessment, it was conducted in breach of international bioethical standards. Based on that, the Eurasian Harm Reduction Association (EHRA) and Canadian HIV/AIDS Legal Network appealed to United Nations Committee on Economic, Social and Cultural Rights (CESCR) urging the Government of Kazakhstan to provide information on their plans to increase the availability of OMT as well as ensure the respect and protection of human rights of drug-dependent individuals and people living with HIV.

In 2017, only 2,69% of all injecting drug users on the outpatient register in Kazakhstan were receiving OMT, contrary to WHO’s recommendations of at least 20% coverage. OMT programs, initiated in Kazakhstan in 2008, under the recommendations from various international organisations, have not received unanimous support from politicians, law enforcement, and healthcare institutions. In June 2017, the Ministry of the Interior, backed by seven members of the parliament, requested immediate termination of OMT in Kazakhstan. The Prime Minister’s Office soon ordered an evaluation of the OMT programs, which was started at the end of September by the establishment of the Inter-Sectoral Working Group composed of 17 members. On 30 October 2017, the Working Group produced a Resolution with the conclusions that OMT is effective in Kazakhstan and it should be continued with some improvements regarding the accessibility and the quality of services.

However, some members of the Working Group were not satisfied with the positive recommendations and initiated an alternative research. With the help of the police, the new research was conducted without a proper methodology and gravely violating the rights of the OMT patients: a number of interviewed OMT patients were misinformed about the true aims of the research and were threatened or coerced into giving their statements, and they had to give urine for drug testing without the signing of consent forms.

At the end of December, the group provided its findings in a “Special Opinion”, the main conclusion of which was that OMT is not effective and should be terminated, asserting countries that have completely terminated OMT programs. Subsequently, the Ministry of the Interior issued information about the establishment of a new commission for additional assessment of the effectiveness of OMT with the participation of the National Security Committee and Foreign Intelligence Service. As a result, as of January 2018, the admission of new patients in the centers for methadone maintenance therapy was stopped.

“Despite the fact that OMT programs have proven to be one of the best means to decrease the spread of HIV, the Kazakh Government has taken a worrying step, which may have irreversible negative consequences for the livelihood of the country’s population. Primarily, it affects the OMT patients who are seeking alternatives to illicit drug use,” says Dasha Matyushina-Ocheret, EHRA’s Policy Reform Advisor. “The situation is particularly grave, since the Global Fund, which is the main financial donor for harm reduction programs in Kazakhstan, may stop the funding at the end of this year. Therefore, the decision was taken to present a parallel report on the access of people who inject drugs to drug dependence treatment in Kazakhstan to the CESCR as one of the means to help the people in need to continue receiving life-saving opioid substitution therapy.”

This is the second parallel submission by EHRA and Canadian HIV/AIDS Legal Network for the 62nd Pre-Sessional Working Group of the CESCR, which will take place in Geneva, on 3-6 April 2018. Last week, together with the Estonian organisation of people who use psychoactive substances LUNEST, they also tabled a report on the situation of women who use drugs in Estonia.

For more information, please read the Briefing Paper on the Access of People who Inject Drugs to Drug Dependence Treatment in Kazakhstan.