Dear Editor,

 

I am currently involved in work in the city of Svetlogorsk in the former Soviet Republic of Belarus. I have been part of a team dealing with a very serious HIV epidemic related to injecting drug use. Currently there are at least 5000 regular injectors in an overall

population of 73000. Between 70 and 90% of them are HIV positive. There is currently virtually no treatment provision, either medical or psychosocial for opiate dependency or HIV symptomatic illness.

In terms of treatment for drug users, there is a needle exchange with WHO funding which can provide clean injecting equipment (1 clean syringe) to 500 of the 5000 users daily. There is also a day centre to provide informal advice, information and support about safer injecting and health related issues which is open 3 days a week and is attended by about 20 clients a day. There is a limited amount of literature available for clients regarding safer injecting.

75% of the crime in the city is drug related. I am currently looking at possibilities to develop a trial methadone programme in the city. Methadone is currently illegal in the state but the possibility of using methadone is being greeted with considerable interest both amongst

health workers and the militia. Any trial would need to be small initially, perhaps monitoring 100 clients over a 12-month period looking at key changes in drug use, social circumstances, health status and psychological adjustment within the group. If the evidence were to show changes in these areas it may be that methadone treatment would be more widely

considered. I do not feel that the government in Minsk is likely to consider a change in the legal status of methadone without evidence of change within their own society.

I am wondering whether you are aware of any proposals for trials of methadone programmes having been written elsewhere, the format and ideally, results of which I would be able to access. I would appreciate any help and co-operation you might be able to offer with this problem.

 

Nick Ross

 

Somerset Drug Service

13 King Square

Bridgewater

Somerset, United Kingdom