MONITORING THE METHADONE DELIVERY IN BULGARIA

1. MONITORING THE METHADONE DELIVERY IN BULGARIA

2. 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.

3. 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.

4. 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.

5. 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;

6. 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.

7. 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.

8. 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.

9. 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.

10. 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.

11. 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.

12. 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.

13. OURRESPONSE 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.

14. 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.

15. THANK YOU !