Drug-Free Strategy in Treatment of Opiate Addiction in Russia

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1 National Research Center on Addictions Russian Federation Ministry of Health Drug-Free Strategy in Treatment of Opiate Addiction in Russia Stanislav Mokhnachev,, M.D., Ph.D. Head of Drug Addiction Clinical Research Unit

2 System of Alcohol and Drug Treatment Services (ADTS) in the Russian Federation Hospital or Dispensary Inpatient departments Day hospital Dispensary Rehabilitation centers or units Toxicological laboratories Anonymous help rooms Offices for substance abuse counselors Adolescent rooms Intoxication Assessment offices Methodic department

3 Officially registered at ADTS Alcohol dependency, excl. delirium tremens Delirium tremens Alcohol harmful use Drug addiction Drug harmful use Addiction disorders total

4 Prevalence of drug addiction in the Russian Federation Drug Addiction Opioids

5 Prevalence of drug addiction in the Russian Federation in (per 100,000 population) 250,5 252,2 245, ,3 240,

6 Incidence of drug addiction in the Russian Federation in (per 100,000 population) 20,8 16,0 14,7 17,2 19,1 18,

7 IDUs among the total number of registered drug addicts 100% 80% 29,1% 27,4% 60% 40% 70,9% 72,6% 20% 0% injectors non-injectors

8 HIV-infected IDUs among the total number of hospital admissions 100% 80% 60% 88,2% 88,1% 40% 20% 11,8% 11,9% 0% HIV-infected IDUs Non-infected IDUs

9 Treatment of alcohol and drug addiction in the Russian Federation is regulated and based on the documents: Federal Law on Psychiatric Care (1992) Standards (Protocols) of Diagnostics and Treatment for Addiction Patients (1998) Standards of Treatment for Patients with Mental and Behavioural Disorders Due to Psychoactive Substance Use (2007) not approved

10 Main principles of treatment Voluntariness Multiple Treatment Approaches Individual Approach Drug-Free State during treatment and remission

11 Drug-Free State Total refusal from any kind of narcotic drugs at all stages of the treatment and rehabilitation process This principle is violated by: Substitution therapy Harm reduction programs «Ecology» of drug use (safe use recommendations) All these approaches admit continuing use of opiates

12 Treatment Goals: The Main Goal of Treatment: Remission stabilization, relapse and recidive prevention Clinical level: Withdrawal Craving for drugs Toxic consequences Biological level: Methabolic and neuromediatoric failure Social level: Co-dependency

13 Craving for drugs Multiple manifestations Sequence of attacks and relieves Total dominating in behaviour and personality Absence of self-critics and reflection

14 Opiate addiction treatment 1. Psychopharmacology: (influence on catecholaminic neuromediation) Neuroleptics Antidepressants Neuropeptides Anticonvulsants Tranquillizers Nootropic drugs Opioids antagonists 2. Psychotherapy 3. Social therapy

15 Stages of opiate addiction treatment Detoxification Post-withdrawal period Formation of remission Relapse and recidive prevention

16 Detoxification Total and immediate deprivation from opiates Pathogenetic approach Individual approach: duration of opiate abuse, dosage of opiates consumed, related psychopathologic disorders Symptomatic corrections

17 Medications used during withdrawal period 1. Analgesics: Tramadol short term use NAD (Non-steroid antiinflammatory drugs) 2. Clonidine 3. Tranquillizers (Benzodiazepines) 4. Symptomatic medications Neuroleptics are recommended only for severe behavioral disorders (such as aggression)

18 Post-withdrawal period Craving for drug Psychopathological disorders Majority of inpatient treatment drop-outs outs occur during the PW period

19 Psychopathology during the post- withdrawal period Affective disorders, affective lability Anxiety Dysphoria Animosity Restlessness, agitation Hypochondria, pharmacophylia Insomnia

20 Medications used during the post-withdrawal period Neuroleptics Antidepressants Nootropics Hepatoprotectors Vitamins Symptomatic medications

21 Formation of remission, relapse r and recidive prevention Revealing the main psychic dependence symptom complex (i.e. psychopathological expression) and goal-directed therapy Analysis and elimination of basic factors of craving exacerbation Above mentioned needs to predict duration and quality of remission

22 Remission maintenance and anti-relapsing treatment Opiate antagonists (naltrexon( naltrexon, prodetoxon) Mild neuroleptics Antidepressants Teturam (vicarious alcohol abuse) Psychotherapy Rehabilitation

23 Therapy of addiction Detoxification if not followed-up, results in low effectiveness Craving is the most fundamental syndrome Success of treatment depends on craving relief Psychotherapy and social rehabilitation is necessary

24 Results of inpatient treatment Compliance and retention in treatment program Relief of craving for drugs Mood stabilization Reduction of behavioral disorders Absence of relapses during follow-up Remission duration Quality of life during remission Remissions from 6 to 12 months about 30% of all hospital admissions (NRCA)

25 Effectiveness of ADTS among drug addicts remission from 1 to 2 years (%) 6,9 7,1 8,2 9,1 9,3 9,2 8,6 8,5 remission more than 2 years (%) 4,0 3,8 5,1 7,0 8,2 8,3 8,0 7,9

26 State rehabilitation programs regulated and based on the documents: Rehabilitation Concept of Addicts in Public Health Institutions Protocol of Drug Addicts Rehabilitation Federal Standard of Rehabilitation Basic Program of Addiction Rehabilitation Centers Activity

27 Problems 1. Imperfect and incomplete existing system of rehabilitation 2. Insufficient funding, especially of rehabilitation programs 3. Ongoing reforms of Russian medical system 4. Insufficiency of young professionals and professional training 5. Treatment effectiveness assessment: instruments to assess quality of life among drug addicts are needed 6. Inter-agency interaction and collaboration have to be improved

28 Perspectives Development and improvement of the existing treatment and rehabilitation programs Clinical trials of medications able to reduce craving and prevent relapses Genetic studies able to reveal the risk of addiction diseases Prevention: further studies of risk groups, development of prevention and anti-drug programs for children and teenagers, as well as parents and educators.

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