Treatment Options Georgian Addicts Have
National Centre for Disease Control and Public Health (NCDC) plans to construct rehabilitation-treatment center for drug addicts in Bazaleti. Though, before the center is ready patients can try either drug free treatment or substitution therapy.
The new complex will cover 4000 square meters and will host 50-80 patients simultaneously. According to Irakli Gamkrelidze, the manager of state program of substitution treatment at NCDC, the land was bought with money saved by efficient management of the state program. The center will include wards, training centers, sport halls, living cottages, in other words, “everything that might be needed for patients’ complete curing.” Addicts will have opportunity to stay there from one to six months and even live with their family members in the center if necessary. Patients will be able to take medical treatment followed by rehabilitation programs like labor therapy or they might prefer to detoxify somewhere else and move to Bazaleti center only for psycho-social rehabilitation.
“It is not determined yet how much the treatment will cost. It might be funded by donors, state, international organizations or paid by patients. The more sources, the better” – said Irakli Gamkrelidze.
However, the initiative faces to one important obstacle – absence of a sponsor. In Gamkrelidze’s words, negotiations with international organizations are in process and he counts on their assistance. In case getting enough funds the center will start functioning in a year.
As the center does not exist yet, addicts can participate in Opioid Substitution Treatment (OST) program which means replacing street illegal drugs with methadone, legal drug prescribed and provided by special methadone centers located in eleven medical institutions in Georgia. Six of them are located in Tbilisi - Blood Bank, Georgian Research Institute on Addiction, Airport Polyclinic, Edemi Ltd, Urant and 30th Polyclinic.
According to 2010 report about drug situation in Georgia, which is not published yet, prepared by Georgian addictologists with international partners, there are 15 programs operating throughout 8 regions of the country (one OST was established in the penitentiary institution - #8 strict regimen prison) providing treatment to about 1200 patients. The figures include both Global Fund and state programs. Those funded by The Global Fund are totally free. But the number of its patients is limited unlike state programs. The latter is co-funded by government and each patient has to pay 150 GEL per month which is about 35-40% of total price. The government covers expenses of the drug and salaries of the medical staff.
Substitution therapy does not have fixed terms. Treatment may last as long as patient wants or needs because its priority goal is not to make patient live without drugs but to help him/her return to normal life. As Khatuna Todadze, addictologist at Georgian Research Institute on Addiction, said substitution treatment does not mean giving only methadone to patients. The process also comprises medicines for healing organs damaged by drug usage and social assistance. Apart from positive impact on the addict’s lifestyle, substitution therapy reduces harm to both the patient and the society as it hampers spreading HIV viruses, Hepatitis B and C and other inflectional diseases which are quite frequent among injecting drug users.
State and Global Fund programs have their own criteria for choosing patients. The order of Minister of Labor, Health and Social Affairs of Georgia defines the state program criteria among which is a demand that patient must be at least 25 years old because Methadone treatment revealed negative effects on younger people. And also s/he must have official announcement about his/her attempt to quit using drugs at least once. In addition to these requirements, Global Fund gives high priority to HIV infected addicts and pays great attention to social condition.
As the program operating in N8 prison in Gldani, Tbilisi, is successful, the same service is required in western Georgia, too. Todadze supposes that similar program will be started in Kutaisi prison in 2011. However, the manager of OST program does not confirm it. He speaks only about two new points - one in Tbilisi and the second either in Rustavi or Telavi.
Methadone is not the only drug used in substitution therapy in Georgia. NCDC started piloting a new program in only one OST center in the beginning of 2010. Street drugs are substituted with Subuxone which is weaker than Methadone and it gives opportunity to lower age line from 25 to 21. The program is initiated and implemented by the state and 70 patients are being treated at present. According to Irakli Gamkrelidze, the treatment reveals positive tendencies.
The drug demand reduction program consists of three components – prevention, treatment and harm reduction. Doctors have different views about substitution therapy.
“Methadone and Subuxone programs can be considered as both treatment and harm reduction but World Health Organization (WHO) considers it as treatment” – said Davit Otiashvili, M.D., Director of Addiction Research Center, Alternative Georgia.
Addicts have another choice – drug free treatment. One of the clinics is Georgian Narcologic Dispensary that offers detoxification – symptomatic treatment which means that a patient starts with transfusion to eliminate drugs from the body. Later he/she takes analgesic, antidepressant pills as well as tranquilizers. The clinic provides patients with psychotherapist, too. Treatment with pills lasts approximately 10 days which is followed by another 10 while patients and their psychologists fight against psychological remains. At the end of the process recovered patient gets anti-drug injection which works for a year. As Tamaz Sabauri, addictologist, says, former addict might cause life threatening problems if he/she still uses drug even once. The clinic tries to keep in touch with its patients even after the medical treatment. Total price depends on the drug to which patient was addicted but an average price is 1700 GEL. No state programs operate in the dispensary.
Clinic Bemoni founded by former drug addict is another hospital where addicts can recover. The process is based on 12-stage-program. It starts with preparation period when the patient realizes that he/she needs help. Later, detoxification process starts followed by treatment with medicines. The last stage is re-socialization. Clinic assists its patients to solve their problems with family members, at their jobs, etc. Thus, patient restarts normal life. Nikoloz Beliashvili, the manager of the clinic, spends most of his time in the clinic and personally participates in treatment process.
“I have already been through this and I try to do my best to lighten their problems. “ – said Beliashvili.
Bemoni does not have fixed price of treatment. It depends how complex patient’s condition is.
Georgian Research Institute on Addiction offers detoxification service, too. Psycho-medical-social drug free treatment lasts 10-14 days after which patient needs rehabilitation program. It’s the second year since government started funding but it covers only the expenses of detoxification. The patient has to pay for rehabilitation course which might last from two weeks to a year. Without state assistance the total price of the treatment is about 2000-2500 GEL.
After detoxification addicts can address to Georgian Patriarchy which supervises several rehabilitation centers in Georgian monasteries where the rehab course is totally free. One of the centers is on Tabori Mountain in Tbilisi. There are no doctors in the center. Addicts have regular meetings with psychologists and priests. These rehab centers also use the above mentioned 12-stage-program.
Georgia does not have a focal point which will monitor drug situation in the state and make records and statistics of addicts. For drug users can be classified as problem drug users and those who tried narcotic even once, addictologists counted approximate amount of problematic users which is 40 000 of the population aged 15-64. “It is generally assumed that in Georgia, virtually all problem drug users are injectors”. (National Report, 2010). As for the non-problematic ones, there is no information about their numbers. Based on international experience, Gamkrelidze suggests that their amount should be 5 times higher, about 200 000.
NGO Alternative Georgia conducted research about “How Effective Street Drug Testing Is?”It turned out that the total annual cost of drug testing and consecutive legal procedures and measures constituted about 18 million GEL in 2008. 500 people who were tested in 2008 were interviewed. Study results showed that punishment and imprisonment of drug users in Georgia has no or little influence on the drug related behavior.

