Now methadone substitution treatment programs are operating throughout Western Europe, in many Eastern European countries and most CIS countries. However, there are some states that are opposed to the treatment of opiate addiction with methadone. Moral arguments about the humane treatment of drug addicts are often cited in defense of such therapy, but it is not difficult to prove its effectiveness from the economic point of view. How does substitution therapy help to save budget funds and what is needed to stop the HIV epidemic? Read about it in our piece on BBgate.
According to UNAIDS definition, transmission of the virus among people who use psychoactive substances is enhanced by: criminalization and punitive laws, lack of or inadequate prevention, widespread social stigma, and lack of funding. According to the UNAIDS global targets set as early as 2020 («90-90-90 strategy»):
According to UNAIDS definition, transmission of the virus among people who use psychoactive substances is enhanced by: criminalization and punitive laws, lack of or inadequate prevention, widespread social stigma, and lack of funding. According to the UNAIDS global targets set as early as 2020 («90-90-90 strategy»):
- 90% of people living with HIV should know their diagnosis
- 90% of people who know their diagnosis should be on ART
- 90% of people on ART should achieve viral suppression
Harm reduction is a range of interventions, programs and policies aimed at reducing the negative consequences of drug use for specific individuals, social groups and society as a whole.
The most important are:
- Opioid agonist treatment
- Needle and syringe exchange programs
- Antiretroviral therapy
Opioid agonist treatment is an evidence-based treatment that can reduce drug overdose deaths, reduce the transmission of blood-borne viruses and improve HIV treatment outcomes. HIV medical care can also be improved with such therapy: if patients maintain contact with a health-care provider, they are more likely to receive HIV counselling and testing and to receive treatment.
Savings for every dollar invested
In 2002, Kyrgyzstan became the first country in Central Asia to legalize methadone treatment on its territory. Methadone is included in the list of vital medicines of the Kyrgyz Republic. In late 2008, scientists studied the effectiveness of this program and interviewed 701 patients. It turned out that «all indicators of health, social responsibility, drug use, risky behavior and crime improved during treatment».
Savings for every dollar invested
In 2002, Kyrgyzstan became the first country in Central Asia to legalize methadone treatment on its territory. Methadone is included in the list of vital medicines of the Kyrgyz Republic. In late 2008, scientists studied the effectiveness of this program and interviewed 701 patients. It turned out that «all indicators of health, social responsibility, drug use, risky behavior and crime improved during treatment».
The cost of methadone treatment per patient per year was only $1.
If the same patient were infected with HIV, the state would have to spend $600 a year on antiretroviral therapy alone, excluding other direct and indirect costs.
In addition, there is a risk of opportunistic infections or co-infections. Thus, in the case of infections, costs may increase by an average of 2.5 to 3 times if opioid substitution therapy is not used.
At the same time, researchers from the Economist wrote that according to the National Drug Registry of Kyrgyzstan, 13.7% of prisoners (1,353 people) were opioid dependent in 2015. In the same year, only 400 prisoners in Kyrgyzstan were treated with opioid agonists. It can be assumed that about 953 opioid-dependent prisoners remained untreated with opioid agonists.
At the same time, researchers in the Economist write that according to the World Drug Registry in 2022, about 17.5% of prisoners had an opioid addiction, and only 2% of them were treated with opioid agonists.
If the same patient were infected with HIV, the state would have to spend $600 a year on antiretroviral therapy alone, excluding other direct and indirect costs.
In addition, there is a risk of opportunistic infections or co-infections. Thus, in the case of infections, costs may increase by an average of 2.5 to 3 times if opioid substitution therapy is not used.
At the same time, researchers from the Economist wrote that according to the National Drug Registry of Kyrgyzstan, 13.7% of prisoners (1,353 people) were opioid dependent in 2015. In the same year, only 400 prisoners in Kyrgyzstan were treated with opioid agonists. It can be assumed that about 953 opioid-dependent prisoners remained untreated with opioid agonists.
At the same time, researchers in the Economist write that according to the World Drug Registry in 2022, about 17.5% of prisoners had an opioid addiction, and only 2% of them were treated with opioid agonists.
Der Spiegel, for example, states that in 2021 in Germany, every dollar invested by the state in a methadone substitution treatment program saves the state $8 that would otherwise have to be spent on dealing with the consequences of drug addiction. These calculations include savings on health care due to the reduced rate of HIV infection and the absence of prison costs.
After the introduction of methadone treatment, the number of petty thefts also decreased in the country: bicycles and baby strollers, navigators and handbags from cars.
Moreover, the people who used to be involved in these thefts got jobs and started to fill the treasury with taxes.
After the introduction of methadone treatment, the number of petty thefts also decreased in the country: bicycles and baby strollers, navigators and handbags from cars.
Moreover, the people who used to be involved in these thefts got jobs and started to fill the treasury with taxes.
«I did not tell my parents that I went to the program, however, since I live in a small town, about a month later, there were «well-wishers» who told them. My mom, surprisingly, reacted calmly. She saw how I had changed, how my attitude to life had changed: I stopped asking her for money, quickly found a job, started to buy myself some things... And before that, I spent all the money I got by honest and dishonest means only on drugs. I wanted to be in constant motion. I just walked the streets, went shopping, just to get something to do. And after just one week, I was put on probation at a company»
— the patient shared with Der Spiegel.
— the patient shared with Der Spiegel.
«Unfortunately there are countries where drugs and alcohol are more accessible than harm reduction»
According to a report in The Economist, incarceration for drug-related offenses is one of the main factors that increase the prison population. When the cost of running prisons and policing is taken into account, criminalizing drug users is a very expensive strategy.
When people who inject drugs are released from prison, there is little or no support available to help them avoid reoffending.
Alcoholism and unemployment are widespread among this population. The result is a return to opioid addiction and death by overdose.
One study estimates that if policymakers redirected to harm reduction at least 2.5% of the $100 billion spent annually on drug control worldwide, it would reduce new HIV infections among people who inject drugs by 78% by 2030.
According to a report in The Economist, incarceration for drug-related offenses is one of the main factors that increase the prison population. When the cost of running prisons and policing is taken into account, criminalizing drug users is a very expensive strategy.
When people who inject drugs are released from prison, there is little or no support available to help them avoid reoffending.
Alcoholism and unemployment are widespread among this population. The result is a return to opioid addiction and death by overdose.
One study estimates that if policymakers redirected to harm reduction at least 2.5% of the $100 billion spent annually on drug control worldwide, it would reduce new HIV infections among people who inject drugs by 78% by 2030.
How can we avoid high rates of HIV infections?
The findings on the cost-effectiveness of methadone treatment are supported by researchers from various countries. For example, in 2019, a group of researchers from universities in China and Australia analyzed the effectiveness of methadone treatment, which by then had been in effect in China for 15 years.
Between 2004 and 2015, the Chinese government invested $1.037 million dollars in opioid agonist treatment. The number of people receiving methadone treatment peaked at 208,000 in 2008 and then declined to 187,000 by 2015, accounting for 6% of the total number of registered drug users in China.
It is estimated that 13,327 fewer HIV cases were diagnosed when methadone substitution treatment was available. Consequently, 8,306 HIV-related deaths were averted.
The findings on the cost-effectiveness of methadone treatment are supported by researchers from various countries. For example, in 2019, a group of researchers from universities in China and Australia analyzed the effectiveness of methadone treatment, which by then had been in effect in China for 15 years.
Between 2004 and 2015, the Chinese government invested $1.037 million dollars in opioid agonist treatment. The number of people receiving methadone treatment peaked at 208,000 in 2008 and then declined to 187,000 by 2015, accounting for 6% of the total number of registered drug users in China.
It is estimated that 13,327 fewer HIV cases were diagnosed when methadone substitution treatment was available. Consequently, 8,306 HIV-related deaths were averted.
Preventing HIV infection cost the government an average of $35,206 per case, and preventing a person from using the drug cost $1,134. Researchers say that China's opioid agonist treatment program saved an average of $35,206 per dollar invested:
- 0.03 dollars on HIV treatment costs
- $0.3 on hepatitis C treatment costs
- 6.4 dollars in drug-related harm reduction
The Economist has built a mathematical model that shows that a harm reduction approach, compared to criminalizing drug use, has a stronger effect on reducing the spread of HIV infection and generally increasing life expectancy. The model uses detailed data on epidemiology, incarceration rates of people who inject drugs, pretrial and detention costs, and a range of other factors.
The key conclusion of this small publication is that helping drug addicts is not only the humane thing to do, but also the rational and cost-effective thing to do. Methadone treatment saves countries a lot of money, and the treatment itself does not need to have an additional budget: it just needs to reduce repression of drug users. Substitution therapy reduces the spread of the HIV epidemic and saves tens of thousands of lives.
The key conclusion of this small publication is that helping drug addicts is not only the humane thing to do, but also the rational and cost-effective thing to do. Methadone treatment saves countries a lot of money, and the treatment itself does not need to have an additional budget: it just needs to reduce repression of drug users. Substitution therapy reduces the spread of the HIV epidemic and saves tens of thousands of lives.