ADVANCE: Advocacy and Assessment of Naloxone in Central Asia Project 

The new project on advocacy and assessment of Naloxone administration in opioid overdose is the first regional initiative covering Central Asian countries, Kazakhstan, Kyrgyzstan, and Tajikistan. The project is called ADVANCE – Advocacy (ADVocacy) and Assessment (Assessment) of Naloxone (Naloxone) in Central (CEntral) Asia, and is funded by the Open Society Institute, New York.

Naloxone is a full antagonist of opium-group preparations, and is used mainly for acute intoxication with narcotic analgesics and in some cases by paramedics for alcoholic coma. Every minute is critical after potentially fatal overdoses, and sometimes neither ambulance can respond quickly enough, nor can peers provide sufficient medical aid. In such cases, Naloxone could be safely injected intramuscularly by someone present at the scene to arrest the intoxication and prevent death.

Central Asia is located at an intersection of drug trafficking coming from Afghanistan and going to Russia, Eastern Europe and Northern America. Unfortunately, opioid overdose is a major cause of the high mortality rate. Overdose treatment is limited in Central Asia by access to naloxone. For example, naloxone is registered in Kazakhstan as a life-saving drug, but may only be provided by emergency doctors and not paramedics, pharmacies, or harm reduction organization. In Kyrgyzstan and Tajikistan, naloxone is not publically available due to problems with registration. Moreover, in all Central Asian countries, there are few statistics on overdose cases, provision of first aid, Naloxone administration, and overdose reversal. 

The project goal is to help regional partners to build local capacity for evidence-based advocacy in the countries participating in the project, as well as in the whole region. The project provides technical support to regional initiatives to expand access to naloxone among opiate users’ communities and social networks in Kazakhstan, Kyrgyzstan, and Tajikistan by providing training to local partners in advanced technologies of data collection and certification to work with human subjects.

Moreover, the project is focused at expansion of partnerships with governmental agencies and donors on procurement and wide distribution of Naloxone among different medical facilities, non-governmental organizations (NGOs), and trust points. The Global Health Research Center of Central Asia (GHRCCA) has conducted the needs assessment and developed the database on overdose cases and use of naloxone in Central Asian countries. This data will help to identify and overcome barriers to wide dissemination and use of Naloxone at micro- and macro-levels, and to guide future advocacy efforts. Data was presented at the regional stakeholders’ conference in Almaty in 2011 and at the international AIDS conference in Washington DC in 2012.

The project results:

During 2011, there were data collected from 212 IDUs and 5 local NGOs in Kazakhstan, Kyrgyzstan and Tajikistan:

  • 188 (94.7%) cases of naloxone administration were analyzed and demonstrated effectiveness in reversing overdose experienced by IDUs;
  • 24 (13%) did not use naloxone after receiving it (1 case in Tajikistan, 7 cases in Kazakhstan, and 16 cases in Kyrgyzstan);
  • 98 (52%) recovered without additional medical aid;
  • 80 cases (42.6%) recovered after ambulance was called;
  •  2 cases (1.1%) were taken to the hospital by ambulance and survived;
  •   5 cases of missing data;
  •   3 cases (1.6%) in which people died due to late injection of naloxone or a heavy mix of alcohol.

The work is being continued in 2012-2013 in the following directions:

 Education:

  • Training the local NGOs on prevention, management, administration and first aid during the opioid overdose;
  • Development of protocols and manuals on conducting seminars for local NGOs;
  • Development of informational educational materials for IDUs with step by step resuscitation from  opioid overdose;

 

Technical assistance:

  • Development the e-library resources on overdose cases and administration of naloxone, results of research internationally and in the region;
  • Technical assistance to local NGOs implementing peer distribution of naloxone to IDUs and their close environment in Kazakhstan and Kyrgyzstan;

 

Advocacy:

  • Conducting round tables on advocating free access of IDUs to naloxone as a life saving medicine in primary health care.

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