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Kicking the habit

As more heroin users seek help, city treatment centers are filled to capacity

By Markéta Hulpachová
Staff Writer, The Prague Post
January 23rd, 2008 issue

Jan Přerovský/THE PRAGUE POST
Miroslav Weiss, 45, receives liquid methadone doses at one of Prague's largest clinics.
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Jan Přerovský/THE PRAGUE POST
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Jan Přerovský/THE PRAGUE POST
Drop-In officially stopped accepting new patients as of Jan. 1, and has more than 30 people waiting to receive substitution treatment.
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It’s a typical weekday morning, and the door buzzer at Drop-In, Prague’s largest substitution treatment clinic for recovering opiate addicts, has not stopped screeching. Every minute, newcomers shuffle in to join the queue that snakes through the small room, waiting for their turn to approach the nurse behind the glass partition. When she hands them a plastic cup of clear liquid, the patients gulp it down and turn to socialize with other clients, who are sprawled on the chairs lining the room’s drab, yellowed walls.
Despite its somber appearance, the atmosphere in the waiting room is upbeat as patients young and old exchange greetings and small talk. Because the program requires daily attendance, many of them are old friends. Some, like 45-year-old Miroslav Weiss, have been coming here for eight years.
“I don’t feel so hot, but that’s probably because I skipped a dose yesterday,” he said, motioning to the partition. “I’ll feel a lot better
once I get my ‘drink.’ ”
One of four substitution treatment clinics in the city, Drop-In provides recovering heroin users like Weiss with supervised daily doses of methadone, a legal opiate that blocks out the effects of street opiates, such as heroin, and eliminates withdrawal symptoms.
Currently, 250 Prague patients are kicking their addiction with the help of methadone and other substitution drugs. But with the clinics filled well past capacity since the beginning of the year, new patients seeking this type of treatment are out of luck. Drop-In, for example, officially stopped accepting new patients as of Jan. 1.
“The situation is unusual,” said Prague City drug prevention coordinator Nina Janyšková. “Prague has never before registered such a significant shortage.”
With more than 30 patients waiting to receive substitution treatment at its two clinics, Drop-In suffers from the most significant overcrowding.
A not-for-profit organization providing counseling and various types of treatment for drug users, Drop-In’s first substitution treatment clinic was launched in 2000 by Dr. Jiří Presl, who was inspired by the walk-in treatment centers in the United States, where such clinics have operated since the 1970s.
“When a patient decides to seek methadone treatment, the risks associated with heroin use drop dramatically,” Presl said. “For one, he is no longer injecting the drug, since methadone is administered orally.”
Because methadone is given free of charge, the treatment also improves the social position of heroin users, who are otherwise compelled to obtain drug money through illegal and often degrading means.
“Many of our clients steal or prostitute themselves to pay for their drugs,” Presl said. “We get them off the street and help them re-integrate. After a few months of methadone treatment, many of them return to work.”
Despite such improvements, few succeed in kicking drug dependency altogether.
“While it is possible to wean oneself off of methadone,” Presl said, “many patients end up taking it for the rest of their lives.”
Road to recovery
Before getting accepted and registered in the substitution treatment program, clients must first undergo a screening at Drop-In’s low-threshold ambulatory care center in Prague 1, where drug users “go to collect clean needles and make their first contact with our services,” Presl said.
To meet the criteria for substitution treatment, potential patients must demonstrate a severe addiction of at least two years to an injected street opiate — most commonly heroin — and a repeated failure at detoxifying through abstinence.
“It’s not a miracle cure. Methadone is just a part of other treatments,” Presl said.
Patients with serious conditions, such as a history of drug-related crimes, HIV and hepatitis C infection or pregnancy, are given preference at Drop-In. “When assessing treatment, substitution is not the first option we offer, but rather the last,” Presl said.
A typical methadone patient is male, at least 28 years old and suffers from problems associated with long-term intravenous drug use, he added.
Weiss, a native of Prague 3–Žižkov, is one such patient. At 13, he started experimenting with braun, a “traditional” local street drug concocted from prescription opiates.
“I’m one of the few people left who know how to cook it,” he said. “But, because of methadone, I don’t have to.”
Female patients, like 29-year-old Kristýna, have other reasons for seeking substitution treatment. “I was pregnant, I had no money, and I was sick of being on the street,” she said. Today, Kristýna is the mother of a healthy 6-year-old boy. “If I hadn’t gotten treatment, I probably would have miscarried,” she said.
According to Presl, up to 12 pregnant drug users seek treatment at Drop-In annually.
Growing need
While she admits the waiting list of patients is frustrating, Janyšková said the increased interest in substitution treatment is a positive development.
“It’s undoubtedly the result of a well-implemented anti-drug strategy in Prague,” she said. “A well-established network of high-quality services exists here — clients receive information about all possible treatment options through street-work programs and walk-in centers.”
With drugs like Subutex available to anyone with a prescription, the popularity of substitution treatment is on the rise among drug users, Janyšková said. “In any case, the opportunities to stop using heroin are amazing.”
If the increased demand for substitution treatment proves long-term, Presl plans to collaborate with the city to open a new clinic. “The city has promised to help fund a new clinic if necessary,” he said. “This should help solve the problem, at least temporarily.”

Markéta Hulpachová can be reached at mhulpachova@praguepost.com


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