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vehicle,’ he says. ‘We’ve had a specially designed, heated bus with a counselling
room for about two years now.’ All of the service users’ files at the centre are also
managed by social workers rather than clinicians, which leaves the doctors free to
concentrate on treatment. ‘We find it’s a big advantage, compared to the earlier
practice when the physician was taking responsibility for the patient,’ he says.
Things haven’t always been easy, however, with attempts to close down his
service as recently as 2005. ‘At that time there was an attack from some politicians in
the parliament who were very strongly against harm reduction,’ he explains. ‘But the
programmes survived, and the funding was always available from the Ministry of
Health, so there has been a mixed attitude. The ministry was always supportive of
harm reduction and opioid substitution therapy, and the government’s drug control
offices were also always supportive of these interventions, but from time to time
there were politicians who expressed negative opinions about harm reduction –
there were discussions in the media, as well as between agencies and so on.’
It all depends on the political climate, ‘the same as anywhere else in Europe’, he
states. ‘We have conservative politicians who are critical of harm reduction, and
more progressive politicians who are more accepting.’
Unlike many places, however, there has been very little resistance to the
implementation of harm reduction interventions from the public, he says. ‘I would
say the general public is largely neutral. Some years ago there was a formal survey
on attitudes towards opioid substitution therapy, and it found positive opinions.
The police are also quite supportive of opioid substitution therapy and harm
reduction because they’re disillusioned about the ability of law enforcement alone
to suppress the drug trade.’
RIGHT TIME, RIGHT PLACE
FROMTHE OPENING SESSION, THE CONFERENCE STRESSED THE NEED
FOR MEANINGFUL PARTICIPATION OF PEOPLEWHO USE DRUGS
‘The conference is taking place at the right time and at the right place,’ executive
director of the Eurasian Harm Reduction Network, Sergey Votyagov told delegates.
Despite increasing wealth, most governments in the former Soviet region still
did not invest in harm reduction programmes, he said, with international donors
often the only ones providing ‘the financial and moral’ support. ‘So this is the right
region to hold the conference, although regrettably for the wrong reasons,’ he said.
‘Lack of investment in harm reduction costs lives.’ Lack of money was not the only
structural barrier, however. ‘Money follows priorities and the money is spent on a
16 |
drinkanddrugsnews
| July 2013
Harm Reduction International |
Vilnius, 2013
www.drinkanddrugsnews.com
IN THE VANGUARD
THE VILNIUS CENTRE FOR ADDICTIVE DISORDERS WAS HOME TO
THE FIRST METHADONE PROGRAMME IN A FORMER SOVIET
COUNTRY, AS ITS DIRECTOR DR EMILIS SUBATA EXPLAINS
At this year’s conference, Dr Emilis Subata prescribed opioid substitution therapy
(OST) in the form of methadone and buprenorphine to delegates who were unable
to export medication from their own country.
Dr Subata has led the Vilnius Centre for Addictive Disorders for more than 20
years. A psychiatrist by training, he has been an expert consultant for the World
Health Organization (WHO), the United Nations Office on Drugs and Crime
(UNODC) and United Nations Development Programme (UNDP) among others,
and is also an associate professor at Vilnius University, itself a WHO collaborating
centre for harm reduction.
While Eastern Europe has struggled with a well-documented HIV problem, it
was at his treatment centre that the very first methadone programme in a former
Soviet country was established, in October 1995 – something which may help to
explain why Lithuania’s HIV rates are among the lowest in the region.
‘One of the reasons for that is that we implemented opioid substitution therapy
in the three biggest cities in Lithuania before HIV had really appeared among
injecting drug users,’ he says. ‘It wasn’t a reaction to HIV cases among IDUs – it was
prior to the first cases among IDUs. In those three cities, quite a large number of
IDUs with long histories of injecting were able to access treatment programmes,
and needle exchange programmes were introduced quite early as well – starting
around 1996 in the sea port of Klaip
ė
da and then in Vilnius in 1997. So we started
harm reduction programmes much earlier than in Latvia or Estonia, for instance.’
Rates of HIV transmission through injecting drug use have fallen substantially
in recent years, but it remains the case that HIV testing is not always easily
accessible. ‘It’s done mostly by NGOs with external funding, so we might not have
the most exact data,’ he acknowledges.
Most of Lithuania’s major population centres now have needle exchange
programmes, however, and the ten largest cities have opioid substitution therapy,
accessible free of charge. ‘In most of the cities there are no waiting lists, although
we do have some in Vilnius,’ says Dr Subata.
His clinic also operates a mobile needle and syringe exchange service, which
means that the service is accessible to drug users throughout the city. ‘We used to
have a mobile van – the “blue bus” – but we’ve replaced it with a more advanced
‘The conference is taking place
at the right time and at the
right place...’
SERGEY VOTYAGOV
‘The police are disillusioned about
the ability of law enforcement
alone to suppress the drug trade.’
DR EMILIS SUBATA