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Drop-In Center: Addressing the Health Needs of Drug Users

Activists of "Drop-in Center"

Activists of Drop-In Center

Pavel Kutsev, a co-founder of the Ukrainian organization “Drop-In Center,” raises the issue on his Web blog about the specific health needs of people living with a drug addiction.

A patient of methadone substitution therapy himself, Pavel makes the point that the current substitution therapy system makes it difficult for a patient to receive medical care associated a hospital stay. Ukrainian law requires patients to come to methadone sites every day personally to receive the therapy, which makes it a challenge to receive extended medical care at a different site. There is only one hospital in the city of Kiev that is authorized to give patients methadone. Sometimes it's even hard to get qualified medical care at this hospital that would incorporate the specific needs of drug users.

A few days ago Pavel shared the story of one of his friends who died due to the fatal error of medical personnel at this hospital. Below are the excerpts from the story:

When my medical tests were ready I was literally half dead. My body temperature was almost 41C (115.8 F) and my liver probes showed that my liver was almost in coma. This describes my health condition… But we did not even consider the option of going to a hospital…as we are drug addicts, two out of a few thousand patients of the Ukrainian substitution therapy program. We could not afford to miss a dose of methadone, the drug we need like an air. For our bodies, the bodies of the drug addicts, methadone is needed to support the immune system. Without the drug our bodies just stop fighting infections…Only after taking a dose of methadone can other medications prescribed by doctors be effective. And only after taking a dose of methadone can I get a few hours of sleep…

My doctor advised me to get a course of liver treatment in the hospital where I can received methadone. The only hospital where methadone was provided was AIDS Center…I knew that like others, my problem was time. I had to handle all the issues associated with my hospitalization, including all medical tests, in 24 hours. This is the time I could survive without a dose of methadone. Usually I start to not feel well at 4 a.m. and if I do not consume my methadone between 10 a.m. and 11 a.m. I just can not live…

While standing in line at the methadone site to receive my dose, I heard the story of another patient. A girl named Lida, who was also married and had symptoms similar to mine: asthenia, very high temperature, fever, fainting… She did not ask for medical help as she was afraid that she would not get methadone in the hospital and would not be able to survive without it….One day she started to feel so bad that she was taken to the AIDS Center right away from a methadone site. Lida has been on substitution therapy for almost six months and, like all of us, could not live a single day without the medication.

When she arrived at the AIDS Center she was delirious because of her high body temperature…When the doctors learned that she had come from a methadone site, they immediately gave her a medication that is used to deal with an overdose of an opiate drug, and this medication may have killed her…Even a small amount of opiate in the blood of a drug addict helps the body function. Without the drug, an addict starts to suffocate, vomit and have convulsions…The medication Lida was given was for the rapid excretion of opiates out of the body. For a user with a long history of opiate consumption this medication provokes the abstinence syndrome, which leads to liver and coronary insufficiency. After the injection of this medication Lida fell into a coma and died the next day. As autopsy showed that she died because of pneumonia. Her death was aggravated by the absence of opiates in her body as a result of the treatment she received…

Later on we heard that the doctors from AIDS Center contacted the personnel of our site to make sure that Lida did not receive an overdose of methadone. Our doctor said it was impossible… Perhaps, the AIDS Center people first made the anti-overdose injection that killed her and only then asked…

Everybody who deals with narcology knows that for a drug addict the only and most important medication is a drug that contains opiates. That is why none of us who participates in the replacement therapy program will ever miss an intake of the mediation, that is why we are ready to stand in lines under any weather conditions. We just need to avoid going in a delirious state so that we do not get this “anti-overdose injection.”

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