Delivery system for Substance Abuse Treatment: Ukraine Anatoliy M. Viyevskiy, M.D., Ph. D. The Head Narcologist of The MoH of Ukraine Istanbul, Turkey

Delivery system for Substance Delivery system for Substance Abuse Treatment:Abuse Treatment:

UkraineUkraine

Anatoliy M. Viyevskiy, M.D., Ph. D.Anatoliy M. Viyevskiy, M.D., Ph. D.

The Head Narcologist of The MoH of UkraineThe Head Narcologist of The MoH of Ukraine

Istanbul, TurkeyIstanbul, TurkeySeptember 2005September 2005

UKRAINEUKRAINE

Capital:Capital: KyivKyiv Estimated populationEstimated population 4747,,442442,,110000 Europe’s biggest country by sizeEurope’s biggest country by size

UKRAINEUKRAINE

GENERAL OVERVIEWGENERAL OVERVIEW

PopulationPopulation 4747,,442,1442,10000 Birth RateBirth Rate 8,7 births per 10008,7 births per 1000 Death RateDeath Rate 17,7 deaths per 100017,7 deaths per 1000 Average AgeAverage Age 39,5 years39,5 years Life ExpectancyLife Expectancy 68,24 years68,24 years

Age StructureAge Structure 0-14 years0-14 years 18,1%18,1%15-64 years15-64 years 58,0%58,0%>65 years>65 years 12%12%

Ethnic GroupsEthnic Groups

Ukrainians Ukrainians - 77,5% - 77,5% RussiansRussians - -

17,3%17,3% Others (Poles, Jews, Others (Poles, Jews, Tatars, Hungarians, Slovaks etc.) - 5,2%Tatars, Hungarians, Slovaks etc.) - 5,2%

LanguagesLanguages

UkrainianUkrainian 67,5%67,5% RussianRussian 29,6%29,6% OthersOthers 2,9%2,9%

Literacy:Literacy: 98,9% of the 98,9% of the population can population can read and writeread and write

Major ReligionsMajor Religions

The Orthodox Christian ChurchThe Orthodox Christian Church – – approx.approx. 15000 15000 religious religious communities all over the statecommunities all over the state

The Greek Catholic Church – 3468 The Greek Catholic Church – 3468 religious communitiesreligious communities The Baptist Church – 2461 The Baptist Church – 2461 religious communitiesreligious communities The Evangelic Christian Church –The Evangelic Christian Church – 1444 1444 religious religious

communitiescommunities The Roman Catholic Church – 991 The Roman Catholic Church – 991 religious communitiesreligious communities

etc.etc.

GenerallyGenerally 29785 29785 religious communities of the religious communities of the 55 55 religious religious confessions in the countryconfessions in the country

How religious Ukrainians are?How religious Ukrainians are?

52,8% 52,8% of Ukrainians are visiting churchesof Ukrainians are visiting churches (The National Inquiry)(The National Inquiry)

52,0% 52,0% of themof them are visiting churches just on are visiting churches just on holidaysholidays

GenerallyGenerally 39,9% 39,9% of the population of Ukraine of the population of Ukraine haven’t determined whether they believe in haven’t determined whether they believe in God.God.

EconomyEconomy

Labor ForceLabor Force 2222,,614,2614,20000 Unemployment Rate:Unemployment Rate: 4,2%4,2% Major Industries: mining, steel producing, Major Industries: mining, steel producing,

machinery construction, natural recourses, machinery construction, natural recourses, food industry.food industry.

Agricultural products: grains, corn, fruits, Agricultural products: grains, corn, fruits, vegetables, beef, pork, poultry. vegetables, beef, pork, poultry.

10 months ago different pictures from this place - Maidan were well known throughout the world

…The first polish Solidarity demonstrations participants adopted the ban on alcohol… The abstinence decision was one of the ways how to avoid violence. The same way have chosen the Ukrainian opposition in the fall of 2004 on the “orange” Maidan”. “Fighting for democracy is for sober people” – said one of the participants in the revolution campus.

(Robin Room)

The owners of the majority of bars, restaurants The owners of the majority of bars, restaurants and shops in the center of Kyiv stopped selling and shops in the center of Kyiv stopped selling

alcohol beverages for all weeks of alcohol beverages for all weeks of Orange Orange RevolutionRevolution absolutely voluntarily. absolutely voluntarily.

10 months later.10 months later.Ukraine after democratic revolution.Ukraine after democratic revolution.

What are the news for people with What are the news for people with substance abuse problems and their substance abuse problems and their

families?families?

Questions, questions, questions???…Questions, questions, questions???…

1.1. Drugs/alcohol… Are they the problem Drugs/alcohol… Are they the problem for new Ukraine in principle or not?for new Ukraine in principle or not?


2.2. Harm reduction philosophy and Harm reduction philosophy and biopsychosocial approach. biopsychosocial approach.

Is it good for Ukrainians? Is it good for Ukrainians?


3.3. What do we (Ukrainians) really want What do we (Ukrainians) really want to know about stigmas in our to know about stigmas in our society? society?

How are we going to deal with this How are we going to deal with this piece (if we are going to deal with it piece (if we are going to deal with it in general?)in general?)


4.4. HIV/AIDS… The virus is still doing HIV/AIDS… The virus is still doing it’s fatal job non reacting on our it’s fatal job non reacting on our post-Soviet moves.post-Soviet moves.

More and more people are dying More and more people are dying because of it. because of it.

What has to be done?What has to be done?


5.5. The monitoring of drug/alcohol situation. The monitoring of drug/alcohol situation. Where is Ukraine now? Where is Ukraine now?

Are we ready to know “the true figures”?Are we ready to know “the true figures”?

etc.etc.

Drug/alcohol… Are they the problem for new Drug/alcohol… Are they the problem for new Ukraine in principle?Ukraine in principle?

Tobacco - Tobacco - 35%35% of population of population >15 years old>15 years old are smoking are smoking every day,every day, 40%40% of population are smokers.of population are smokers.

Alcohol - estimated per capita useAlcohol - estimated per capita use - - 1111 litersliters

Alcohol addicts Alcohol addicts (registered)(registered) - - 655988655988

Drug use Drug use (Ukraine-British Council Inquiry)(Ukraine-British Council Inquiry) - - appr.appr. 500.000500.000 Heroin useHeroin use (registered)(registered) - - 7525475254 Meth/Amthetamine use Meth/Amthetamine use ((registered)registered) - - 17791779

Drug/alcohol… Are they the problem for new Drug/alcohol… Are they the problem for new Ukraine in principle? (cont.)Ukraine in principle? (cont.)

The poppy straw home-made extract is The poppy straw home-made extract is dominating all over the country. dominating all over the country.

Heroin is used approx. in Heroin is used approx. in 20-25%20-25% of cases only of cases only in big cities with more than 1 million of in big cities with more than 1 million of inhabitants – Kyiv, Odesa, Dnipropetrovs'k.inhabitants – Kyiv, Odesa, Dnipropetrovs'k.

The popularity of ecstasy and The popularity of ecstasy and amphetamine/methamphetamines is growing.amphetamine/methamphetamines is growing.

Cocaine is used in small number of cases.Cocaine is used in small number of cases.

Drug/alcohol… Are they the problem for new Drug/alcohol… Are they the problem for new Ukraine in principle? (cont.)Ukraine in principle? (cont.)

In April, 2005 The Draft of Drug & Alcohol In April, 2005 The Draft of Drug & Alcohol Policy (National Strategy) was elaborated Policy (National Strategy) was elaborated according to the Governmental Order. Now according to the Governmental Order. Now it passes the governmental discussion.it passes the governmental discussion.

Harm reduction philosophy and Harm reduction philosophy and biopsychosocial approach…biopsychosocial approach…

The draft of The Concept of State Drugs The draft of The Concept of State Drugs and Alcohol Policy is based on harm and Alcohol Policy is based on harm reduction philosophy and biopsychosocial reduction philosophy and biopsychosocial approach.approach.

Harm reduction philosophy and Harm reduction philosophy and biopsychosocial approach… biopsychosocial approach… (cont.)(cont.)

Some people in the law enforcement system and few Some people in the law enforcement system and few NGO’s (mostly those toughly oriented on the restoration NGO’s (mostly those toughly oriented on the restoration of Soviet Union) keep strong position against of Soviet Union) keep strong position against decriminalization of the drug situation. decriminalization of the drug situation.

They are the hottest opponents to substitution therapy They are the hottest opponents to substitution therapy programs implementation in Ukraine, first of all, they’re programs implementation in Ukraine, first of all, they’re against methadone maintenance. against methadone maintenance.

Harm reduction philosophy and Harm reduction philosophy and biopsychosocial approach… biopsychosocial approach… (cont.)(cont.)

The reform of substance abuse The reform of substance abuse treatment system is one of the goals treatment system is one of the goals of the new Concept.of the new Concept.

HIV/AIDS…?HIV/AIDS…?

Living with HIV/AIDS Living with HIV/AIDS (officially registered)(officially registered) - - 6236562365 childrenchildren - - 61856185

HIV/AIDS related deaths - HIV/AIDS related deaths - 35923592 The estimated number of HIV - infected ~ The estimated number of HIV - infected ~ 400,000400,000 IDU’s keep the lead among them - IDU’s keep the lead among them - 54%54%

(in 1998 - (in 1998 - 82%82%)) The speed of HIV epidemic in Ukraine is one of the The speed of HIV epidemic in Ukraine is one of the

highest in Europehighest in Europe

HIV/AIDS…? HIV/AIDS…? (cont.)(cont.)

Available Substance Abuse Treatment Available Substance Abuse Treatment

Inpatient detoxification Inpatient detoxification – all over the country– all over the country Outpatient detoxification Outpatient detoxification – the same – the same Physician counseling Physician counseling – the same – the same Buprenorphine substitution therapy – just 2 facilitiesBuprenorphine substitution therapy – just 2 facilities Outpatient counseling – just few placesOutpatient counseling – just few places Residential rehabilitation Residential rehabilitation – appr. 50 centers – appr. 50 centers Therapeutic communities Therapeutic communities – appr. 20 centers – appr. 20 centers Faith/religious – based treatment – appr. 40 centersFaith/religious – based treatment – appr. 40 centers Psychotherapy Psychotherapy – just 7 centers– just 7 centers


The new National coordinative mechanism The new National coordinative mechanism against HIV/AIDS is under quick construction against HIV/AIDS is under quick construction during last 6 months. It’s headed by The Vice-during last 6 months. It’s headed by The Vice-prime-minister of Ukraine. prime-minister of Ukraine. The very new feature – according to the The very new feature – according to the Governmental Order all branches of National Governmental Order all branches of National coordinative mechanism (it’s very new for coordinative mechanism (it’s very new for Ukraine) are managed by NGO’s people Ukraine) are managed by NGO’s people including The People Living with HIV National including The People Living with HIV National Network.Network.


The main problem: we are still too late.The main problem: we are still too late.

The monitoring of drug/alcohol The monitoring of drug/alcohol situationsituation

From November 2004 the creation of The From November 2004 the creation of The National Drug and Alcohol Observatory National Drug and Alcohol Observatory (NDAO) was initiated in joint UNDP-EU-(NDAO) was initiated in joint UNDP-EU-Ukraine project.Ukraine project.

The Official NDAO Mandate draft and the The Official NDAO Mandate draft and the NDAO Budget 2006 draft are elaborated NDAO Budget 2006 draft are elaborated already.already.

The monitoring of The monitoring of drug/alcohol situation drug/alcohol situation (cont.)(cont.)

Some of law enforcement people don’t Some of law enforcement people don’t want to support the Drug and Alcohol want to support the Drug and Alcohol Observatory idea. Observatory idea.

““Our information has not to be analyzed by Our information has not to be analyzed by public” – said one of the police top officials.public” – said one of the police top officials.

The governmental adoption of The Concept of The governmental adoption of The Concept of The State Drugs and Alcohol Policy and final The State Drugs and Alcohol Policy and final adoption of The National Drugs and Alcohol adoption of The National Drugs and Alcohol Observatory Official Mandate and the state Observatory Official Mandate and the state budgeting for Year 2006 could be the good sign budgeting for Year 2006 could be the good sign for people with drug/alcohol problems in Ukraine. for people with drug/alcohol problems in Ukraine.

This would mean that the deep turn to people This would mean that the deep turn to people needs in this field in Ukraine becomes real.needs in this field in Ukraine becomes real.

The point of challenge

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Delivery system for Substance Abuse Treatment: Ukraine Anatoliy M. Viyevskiy, M.D., Ph. D. The Head Narcologist of The MoH of Ukraine Istanbul, Turkey