MONITORING THE METHADONE DELIVERY IN BULGARIA

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MONITORING THE METHADONE DELIVERY IN BULGARIA
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METHADONE IN BULGARIA

• The MMT has been existing in Bulgaria since 1995
  but still the methadone is not included in the
  list of the official medicines, which deprives
  anyone but the Ministry of Health, of the
  possibility to operate with it.
• As a monopolist the Ministry, respectively the
  officials in the Ministry, have the power to
  license and authorize anybody they choose to open
  a MMP, which is a powerful premise for
  corruption.

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• In Bulgaria there are 3 state MMP with 700
  patients altogether and 2 private MMP with 250
  patients altogether and extremely limited number
  of narcologists, who are allowed to operate with
  methadone.
• In the view of 30,000 addicted heroin users,
  according to the data of the NCA, these numbers
  are far way from sufficient.
• Unfortunately, the professionals, who are
  licensed to treat with methadone and run private
  MMP, support only the enlargement of the slots in
  the private MMP, and even are against the free
  state programs.

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THE STATE MMP

• There is one state MMP in Sofia (now with 500
  patients), one in Varna (with 150 patients), and
  one in Plovdiv (with 50 patients), which have
  saved hundreds of young lives.
• The lack of slots in these programs is so big
  that people have to wait for months and even for
  years to be included in the treatment.
• In spite of the vital need of such programs, this
  year the Ministry of Health stopped their
  financial support.

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• Bulgaria has one of the most harsh laws on drugs
  in Europe
• The options for treatment of drug addictions are
  extremely limited
• A lawsuit of the court of the first instance
  costs to the taxpayers at least EUR 500, a while
  a patient of a MMP costs only EUR 12 per month
• The narcologists licensed to treat with methadone
  do their best to expand the numbers of and the
  slots in their private MMP, not to admit the
  licensing of new narcologists, and to prevent the
  enlargement and the increase of the state MMP

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THE PRIVATE MMP

• There are two private MMP, both of which are in
  Sofia the first of them is for 100 patients,
  and the second is for 150 patient.
• In the view of EUR 75 minimal salary and EUR 150
  real average salary in Bulgaria, the minimal
  price of the treatment in the first program is
  EUR 175, and in the second EUR 75 per month
  with EUR 150 initial tax.
• Both programs discharge patients without an
  acceptable dose reduction if the patient misses a
  month payment.

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• The narcologists, licensed to run private
  practices, severely defend the status quo and try
  to prevent the enlargement of the slots in the
  existing MMP, besides in their own , the opening
  of new ones, and the admitting of new
  professionals to their community
• Besides, part of the narcologists work in state
  programs and run private practices at the same
  time and use their state service to direct
  patients to their private clinics
• Just at the moment there are at least two
  prosecutions in progress against narcologists who
  have abused with their professional authority and
  have acted like drug dealers.

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ARE BULGARIAN NARCOLGISTS DRUG DEALERS

• First, not all of the Bulgarian narcologists are
  corrupted but pretty good part of them are. The
  facts
• People who can not pay the tax for the treatment
  are immediately discharged from the program, even
  without an acceptable dose reduction
• DU, who are well known as patients of another
  program, receive without a problem a receipt or a
  narcotic substance, they practically get from
  another treatment program, if they can afford pay
  for the exam.

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ANOTHER BOTHERING FACTS

• According to the results of an inquiry we made
  among the patients of one of the private MMP 71
  of them have to commit crimes to be able to pay
  for their treatment. By crimes I mean mostly
  selling their medicine.
• The society as a whole is against the MMP because
  they compare it with another drug addiction. This
  will make the opening of new MMP quite difficult.

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• Even the founder of the methadone treatment in
  Bulgaria called the MMP PASSING A CUP THROUGH A
  CUPBOARD, because all of the other necessary
  services are not covered sufficiently. One of the
  private MMP is an exclusion but its price is so
  high that no average Bulgarian family can the
  treatment.
• At the moment Bulgaria faces the threat of
  outburst of HIV epidemics. The efforts the
  licensed narcologists make to stop the opening of
  new MMP is almost crime.

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THE GOOD THINGS

• MMP already exist in Bulgaria and there is no
  chance any more to forbid them like in Russia
• Gradually the people get convinced in the use of
  the maintaining treatment
• This year the state MMP began to expand the
  number of their patients and we believe that this
  process will continue in future
• The staff of the MMP both the state and the
  private is gradually exchanged with better
  professionals.

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THE FUTURE

• According to the bigger part of the narcologists
  there should be only private treatment programs
  in Bulgaria from now on. Even the Ministry of
  Health stopped the finances of the state MMP.
• According to us there should be enough options
  and opportunities for everyone who needs a
  treatment.
• In reality we lack both state and private
  treatment programs.

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OUR RESPONSE TO THE SITUATION

• As you see the situation in Bulgaria is far away
  from perfect. The things we do, in attempt to
  contribute to the improvement of the MMP, are
• - Take part in any public debate we are admitted
  to and acquaint the other participants with our
  needs, point of view, and the best world
  practices in the area
• - Regular participation in media broadcastings
• - Personal meetings with professionals,
  politicians, and local authorities.

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• Via our Internet site and the news letter we
  issue, we try to acquaint users, decision-makers
  and the society at large with the use of the MMP
  and the maintaining treatment as a whole
• We run a consulting office every one who is
  interested cam hear our opinion on the topic.

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• THANK YOU !