Opioid maintenance therapy (OMT) in Belarus and Switzerland – a multistep project to enhance methodological knowledge and strengthen competencies in the further education of young scientists and physicians in the area of OMT

In the 1980s the consumption of illegal psychotropic substances, especially heroin, increased massively in Switzerland. The intervention methods, which were considered revolutionary at the time, included a harm reduction approach with the introduction of low threshold opioid maintenance programs (OMT) even in special settings like prisons. In addition to methadone and buprenorphine, heroin assisted treatment (HAT) was introduced for severely addicted patients who continued to use “street heroin”. That Swiss drug policy – based on a four-pillar drug approach – is considered a success. The main elements of this success are a c. 50% reduction in overdose deaths since 1991, a c. 80% reduction in incipient heroin use, a c. 65% reduction in HIV infections, plus a reduction of drug-related delinquency in cities and in nuisance from open drug scenes. Belarus has recently made methadone substitution treatment for opioid-dependent people possible under very different economic and legal conditions compared to those in Switzerland. In this endeavor Belarus was supported by several NGOs. Today the treatment costs for patients are covered by an initiative of the Global Fund, which is set to expire. According to data from the Ministry of Health, 66,500 people were listed in an official state register as addicted to illegal psychotropic substances at the end of 2016. The number of opiate addicts is estimated to be around 18,500, about 1/3 of whom are women. Since the regular introduction of OMT in 2009 a significant amount of clinical-practical competence has developed in Belarus. The aim of this project is to extend these practical competences by adding scientific methodological knowledge and by strengthening competencies in the field of further education of young scientists and physicians in the area of OMT. Switzerland and the University of Bern can contribute here, particularly in view of their decades of experience in these areas. A multi-step approach is planned to achieve these aims: 1. To hold one seminar each in Belarus and Switzerland in order to gain an initial insight into the institutions, and to familiarize participants with concrete practical-clinical as well as educational procedures and to discover any political and legal boundaries. 2. To implement an annually recurring exchange between young researchers in the form of a visiting research fellowship in order to strengthen scientific cooperation. 3. To develop a continuing education curriculum that meets the needs of patients and health professionals in Belarus in the area of OMT. To this end, a mixed methods study is to be conducted in Belarus over the next two years, which will identify perceptions, expectations, possibilities and limits of OMT in Belarus. The results of this study will be published in an international journal, e.g. Frontiers in Psychiatry, Plos One or Harm Reduction Journal. Within the framework of the proposed project, not only can the University of Bern and the Belarus State Medical University benefit generally from deepened scientific cooperation, but even more the heavily burdened and stigmatized group of opioid-dependent patients.