The program, in which free methadone is dispensed to addicts, was initiated at the end of November 2007 with the aid of the United Nations Office on Drugs and Crime (UNODC) primarily to control transmission of AIDS through intravenous drug use. But the government does not seem to have any long term plan to continue with it.
“The government just accepted UNODC’s proposal and has no policy and plans whatsoever regarding it,” says Bishnu Sharma, Patron of Recovery Nepal and Program Manager of the Richmond Fellowship Nepal.
The program basically focuses on the control of AIDS and its high risk of transmission through injecting drug users. “The data of the Central Bureau of Statistics (CBS) says 61% of the 46,309 drug users in Nepal use syringes, and 35% among those using syringes are HIV infected,”says Associate Professor at the Tribhuvan University Teaching Hospital (TUTH) Dr Saroj Prasad Ojha.
Methadone is a synthetic opioid (compound extracted from opium) which is permitted for treatment of opioid dependence by the World Health Organization (WHO) as part of Opioid Substitution Therapy (OST). Although methadone is chemically different from morphine and heroin, it acts on opioid receptors in the brain to produce similar effects to those of morphine and heroin, and can be used as a substitute for these drugs.
TUTH dispensed free methadone to 100 addicts in the first year, while it now distributes daily doses to 150. Recipients must consume the syrup in front of staff. Methadone is also now distributed to around 15 at the Gandaki Hospital in Pokhara. Methadone is currently distributed under the Technical Working Group (TWG) formed by the Home Ministry, which includes the National Center for AIDS and STD Control (NCASC), Health Ministry, Teaching Hospital, WHO, UNODC and other stakeholders.
The UNODC currently provides methadone for free distribution and renews its contract annually. “They (UNODC) have provided verbal commitment to continue the project until 2011, but we are requesting they extend it by five years. The government has to make a national action plan and distribute methadone itself thereafter,” says Dr Ojha, also in the TWG.
But the government has no contingency plan if the UNODC stops providing methadone, Dr Ojha says. Those who stop taking the drug suffer severe withdrawal symptoms. Moreover, sudden discontinuation of methadone can even prove fatal. “It should not be stopped at any cost,” Dr. Ojha warns.
Dr. Ojha says methadone treatment has helped 15–20 patients become clean through gradually decreasing the dose given. But there have always been arguments as to whether it is ethical to provide people with legal substitutes for drugs which may, in turn, make them addicted to the new drug.
Even if ethics are ignored for the greater cause of AIDS control, there are many loopholes in the MMTP. There is no proper system of monitoring whether a subscriber of methadone injects drugs after taking methadone. “Almost 25% of the methadone subscribers are estimated to be taking injections, which defeats the reason of giving methadone itself,” Bishnu Sharma believes.
There is provision for a social unit at TUTH to help monitor this, but monitoring is largely ineffective. “We have screening programs. We check their body parts for needle marks and also counsel them,” assures coordinator of the social unit Ravi Shrestha.
Shrestha concedes there have been instances of methadone subscribers taking injections but claims this is on the decline now.
There is also the threat of leakage of methadone to the public and it becoming available to non-addicts.
Police found methadone on Kiran Prabhat Nepali and Adarsha Joshi when arresting them for possession of heroin on September 25, 2008. “Adarsha Joshi later confessed that he has bought the methadone for Rs 1,500 from one Dilip Maharjan, who was subscribing it from TUTH,” says Inspector Surendra Bahadur Chand at the Narcotic Drug Control Law Enforcement Unit.
Dr Ojha says the leakage may have occurred due to the practice of giving take-home doses to those leaving town or falling ill, and informs that they have ceased giving take-home doses since.
“The government has to revise the seven–year–old guidelines and set protocols for methadone to make it effective,” Dr. Ojha feels.
There are numerous people waiting in the wings to take methadone, hoping it may eventually help them to quit drugs, Ravi Shrestha reveals. But government apathy threatens to derail the MMTP itself instead of broadening the program.
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