project was designed to last
approximately one year based on: periodic results; initial cases;
evaluation of supervisors; the monitoring group report; and
different families' reports. The results of the project have been
promising and the trust of donors and international consultants has
been justified. Methadone Maintenance Therapy (MMT) is financed by
SOROS Foundation (IHRD) with the support of the Ministry of Health
and the Institute of Public Health (IPH) of Albania.
The project started in
August 2005 with five patients who were supported by dedicated staff
at Aksion Plus. Within 25 days, the number of patients exceeded 100.
Patients were given a medium dose of Methadone of 80mg.
Vital to the projects
success has been the help of Bob Newman and Holly Catania (USA),
Andrej Kastelic (Slovenia) and Silva Bino (ISHP), who all intervened
in the initial stages of the project, and whose help has been
The work load of staff at Aksion Plus has been immense. This is
because of the following reasons:
The project of MMT
was a natural outgrowth of the Harm Reduction program
implemented from Aksion Plus since year 2000. This program
assisted almost 1200 injecting drug users with counseling,
training, and information, provision of condoms, syringes and
referral to other services.
From the beginning
of the project, there have been a high number of requests from
offer little or no services for drug users.
There is a high
level of stigma and discrimination. Yet the health structures
are abstinence oriented toward drug use.
Aksion Plus offers
Methadone therapy through close consultation with the expertise of
B. Newman (SHBA) and A Kastelic (Slovenia).
For these reasons:
Since the beginning of
the project, staff at Aksion Plus has undertaken a wider initiative
of meeting with the siblings of drug users. The aim of this was to
establish a partnership and agreement with parents that would
continue through out the project. Parents of drug users are able to
talk about, and debate drug issues with staff at Aksion Plus in a
discreet manner. Staff state that the maximum dosage of Methadone
that can be given to each patient is 80-90 mg.
The provision of
Methadone therapy at Aksion Plus has highlighted many problems
relating to the limited provision of Methadone therapy in other
cities across Albania. Some drug users enrolled in the program
travel a long distance to receive Methadone and have requested that
they be allowed to take Methadone home with them. This creates other
difficulties; primarily that trust must be established between the
drug user and Aksion Plus, and secondly that the capacities and
resources of Aksion Plus are limited. At the time of writing, it is
not possible to receive further help from the Albanian Government
for further extension of MMT.
MMT in prisons –
drug users who commit crimes
Many patients of the
centre have been stopped by the police
and some of them have been imprisoned. Most of these drug users live
in miserable conditions when they are denied Methadone or Heroin.
Aksion Plus is only able to provide drug users with Methadone in
prisons for a limited number of days.
On the 26th June 2006 after a long campaign by Aksion Plus, a
historical agreement was signed by the Ministry of Justice that
allows the delivery of Methadone in prisons and in police stations
for drug users. Aksion Plus implemented a pilot program in three
prisons (September 2006-March 2007) with a grant from the Canada
Fund. Aksion Plus has high expectations to expand the project with
help from the Global Fund Against AIDS, TB and Malaria (GFATM).
interventions that took place in prisons:
Training of health
personnel working in prisons about health issues such as:
HIV/AIDS; drug abuse; harm reduction for injecting drug users;
reproductive health; peer educators etc.
information and services for prisoners like: leaflets,
education, training, condoms.
Methadone, reducing risks such as: HIV/AIDS;
Hepatitis; drug overdose; other infections; abuse with
drugs and crime.
voluntary testing for HIV/AIDS
exchange of information with similar programs in neighboring
countries that offer services of harm reduction in prisons.
support, and individual and group counseling with prisoners who
are drug users.
imitation of symptoms with psychosomatic origin
Particularly with new patients there have been some reluctant
reactions in relation to MMT. Some of these reactions were based in
myths about Methadone they have heard from their peers.
Methadone is worse
There is a high
risk to long term Methadone users
the heart and the bones
can feel worse
Aksion Plus works with
individuals to: remove their fears about Methadone therapy; help
those who invent symptoms, and work closely with parents who have
From the interviews collected from drug users at the center, results
show that no drug users have serious abstinence symptoms after
taking the first 30 mg of Methadone. Their main symptoms consist of
insomnia and perspiration. Doses of Methadone are increased
gradually during treatment, but Aksion Plus’ main role is to support
drug users in a familiar environment.
The first signs of
of dose and therapy.
improvement with family relations and society.
in urine test.
10% of our patients
belong to the Roma community whilst 7-8% are sex workers and
Transvestites. In the beginning of the project it was difficult for
these clients to come to the centre to receive treatment because
they faced discrimination by other clients. However, staff
intervened and solved these problems by holding an open meeting with
everyone. At present all patients can receive therapy together
without any discrimination. For this target group (our poorest
clients) we provide daily snacks and vitamins. Aksion Plus also
helps Roma patients to access medical treatment at hospitals by
contacting doctors and medical staff.
We often hear parents
say that they are happy because their child’s relationship with
others “is better than before”. This is shown through the
improvement of the patient’s relationship with their family; their
reduction of criminal activities, and increased desire to
participate in different activities such as schools, different
courses, work etc. Aksion Plus has also helped to reconcile family
conflicts where drug users have been expelled from their family
From these 295
30 people have
successfully completed the therapy (For most patients there is
insufficient information relating to their welfare post therapy)
Six patients have
been expelled for staff abuse and breaching of the MMT
have been readmitted after the relapse
Ten patients have
left with no explanation and notification about their withdrawal
We consider counseling
our weakest aspect of our work.
The reasons are
users won’t accept counseling or psychotherapy. They don’t
like to talk about their problems with a counselor.
lacks drug addiction counselors. Through out Albania,
similar problems exist.
premises do not have the facilities needed to offer
confidential counseling on a wider scale.
their parents lack the desire to create a counseling group.
Outside the capital
MMT is a privilege for
Tirana. Despite politicians are being elected with the votes of drug
users and their families, they fail to help them. This problem
exists across Albania. Aksion Plus cannot convey the pain and
suffering of families whose relatives use drugs. Our program is
unable to help many families because they live too far away from the
capital. The plight of these families has been highlighted by Aksion
Plus with the help of the media many times. Despite this, however,
there continues to be insufficient services located outside Tirana
that offer help to drug users and their families.
Weak points of MMT
We could improve our
services by making sure that patients don’t meet each other, or
arrive and depart all together. Currently we have no way to solve
this problem. We also need to address the problem of allowing drug
users to take Methadone home. Staff at Aksion Plus is campaigning to
allow family doctors in other towns to give and supervise treatment.
We have also learnt by experience that parents are more trustworthy
with prescribing the correct dosage of Methadone. Methadone can
prove fatal if a drug user takes too much, or mixes Methadone with
other street drugs.