Originally this 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 invaluable.

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 other towns.

• State structures 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).

Activities and 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.

• Providing information and services for prisoners like: leaflets, education, training, condoms.

• Provision of Methadone, reducing risks such as: HIV/AIDS; Hepatitis; drug overdose; other infections; abuse with drugs and crime.

• Counseling and voluntary testing for HIV/AIDS

• Networking and exchange of information with similar programs in neighboring countries that offer services of harm reduction in prisons.

• Psycho-social support, and individual and group counseling with prisoners who are drug users.

Phenomena of 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 than Heroin

• There is a high risk to long term Methadone users

• Methadone damages the heart and the bones

• Methadone users 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 concerns.

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 success are:

• Fast stabilization of dose and therapy.

• Reports of improvement with family relations and society.

• Negative results in urine test.

Treating vulnerable groups.

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.

Improvement of Social Functioning.

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 homes.

Throughout this year:

• We treated 295 patients in total

From these 295 patients:

• 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 regulation

• Seventeen patients have been readmitted after the relapse

• Ten patients have left with no explanation and notification about their withdrawal from therapy

Counseling

We consider counseling our weakest aspect of our work.

The reasons are because:

• Many drug users won’t accept counseling or psychotherapy. They don’t like to talk about their problems with a counselor.

• Aksion Plus lacks drug addiction counselors. Through out Albania, similar problems exist.

• Aksion Plus’ premises do not have the facilities needed to offer confidential counseling on a wider scale.

• Patients and 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.