BANGLADESH: Hoping to expand methadone treatment

Drug users in Dhaka are opting for injectable pharmaceuticals

I think [methadone treatment] is very important for Bangladesh. It has been very well received by the beneficiaries and the success rate is good, said Tasnim Azim, director of the HIV/AIDS Programme at the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b) in the capital, Dhaka.

Buprenorphine was intended to be used to wean injecting drug users, also known as people who inject drugs (PWID), from narcotics like heroin, but has itself become a substance of addiction, with users injecting a liquid form of it.

In Bangladesh, the buprenorphine available in the [illegal] drug market is only in the injectable form, said Kunal Kishore, project coordinator of the drug and HIV prevention programme at the South Asian office of UN Office on Drugs and Crime (UNODC) in New Delhi, India. In countries where buprenorphine is used as medication in Opioid Substitution Therapy (OST), it is available only at approved treatment centres, and only in tablet form.

Substitution therapy is used to wean users from the substance to which they are addicted by replacing it with a substance that has similar effects, under medical supervision.

The illegal use of pharmaceutical substances, mostly buprenorphine, is on the rise in Bangladesh, but drug users are also injecting cocktails of different pharmaceuticals, according to a 2010 World Health Organization report, which also noted that sharing needles and syringes appeared widespread among injecting drug users, and could fuel the spread of HIV.

The countrys 2012 progress report to the UN Joint HIV/AIDS Programme (UNAIDS), said there were 23,000 injecting drug users in 2009, when HIV prevalence among those living in Dhaka, the capital, was 5 percent compared to a national rate of less than one percent.

Since 2004 more than 20,000 PWID have had access to clean needles and syringes at 120 drop-in centres across the country, but it has only been since 2008 that the National Narcotics Control Board of Bangladesh approved OST to treat addicts with daily oral doses of methadone.

The icddr, b, the Department of Narcotics Control (DNC), and the National AIDS/ STD (sexually transmitted diseases) Programme opened the first methadone maintenance treatment (MMT) clinic in Dhaka in July 2010, with support from UNODC. By 2012, attendance at the clinic had grown to 179 PWID.

The icddrs Azim reported that 13 clients who had been unable to quit buprenorphine through conventional detoxification and rehabilitation services have been free from drugs for at least four months as a result of MMT.

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BANGLADESH: Hoping to expand methadone treatment