ROLE OF STRUCTURAL FACTORS
IN DEVELOPMENT OF MMT IN POLAND

JACEK MOSKALEWICZ

INSTITUTE OF PSYCHIATRY

AND NEUROLOGY, WARSAW, POLAND

METHADONE MAINTENANCE TREATMENT IS NOT ONE
OF MANY TREATMENT APPROACHES

    

    UNLIKE OTHER TREATMENT OPTIONS

    ITS INTRODUCTION AND IMPLEMENTATION IS NOT INDEPENDENT OF NUMEROUS POLITICAL, ECONOMIC AND SOCIAL FACTORS

STRUCTURAL LEVELS

•      INTERNATIONAL LEVEL

 

•      NATIONAL LEVEL

 

•      HEALTH CARE SYSTEM LEVEL

 

•      LOCAL COMMUNITY LEVEL

 

INTERNATIONAL LEVEL

POLICY OF INTERNATIONAL

ORGANIZATIONS: WHO, UNODC, UNAIDS

 

POLICY OF NEIGHBOURING COUNTRIES

 

POLICY OF INTERNATIONAL NGO’S

 

POLICY OF SUPERNATIONAL

PHARMACEUTICAL COMPANIES

  

NATIONAL LEVEL

•      NATIONAL LEGISLATION AND POLICY

 

•      PUBLIC DEFINITIONS/ATTITUDES

 

•      DRUG/HIV EPIDEMICS

 

•      SOCIAL EXCLUSION

 

NATIONAL LEVEL

HEALTH CARE SYSTEM LEVEL

LOCAL COMMUNITY LEVEL

FIRST EVER MMT IN POLAND IPiN 1992

 

NATIONAL LEVEL

 

•       LEGISLATION – LIBERAL

•       SOCIAL EXCLUSION – LOW

•       PUBLIC DEFINITION - HEALTH PROBLEM

•       ATTITUDES – TOLERANT, CARING

•       HIV EPIDEMIC – RISING

 

HEALTH CARE SYSTEM LEVEL

 

•       HEALTH DISCOURSE – PRAGMATIC

•       OTHER DRUG TREATMENT - COMPLEMENTARY

    

FIRST LOCAL COMMUNITY MMP
IN POLAND, STARACHOWICE 1995

INTERNATIONAL LEVEL

•      SUPPORT FROM EU

HEALTH CARE SYSTEM

•      NO COMPETITIVE OPTIONS

•      NO VESTED INTERESTS

COMMUNITY LEVEL

•      PART OF DRUG POLICY PACKAGE

•      SUPPORTIVE PUBLIC ATTITUDES

•      NO HIDDEN POPULATION

•      ADDICTS AS ACTIVE ACTORS

INSATISFACTORY DEVELOPMENT OF MMT IN POLAND. NATIONAL LEVEL

 

•      LEGISLATION – PROHIBITIVE

•      PUBLIC DEFINITION – CRIME PROBLEM

•      HIV EPIDEMIC – STABLE

•      SOCIAL EXCLUSION – RISING

•      GROWING HIDDEN POPULATION

        

 

        

INSATISFACTORY DEVELOPMENT OF MMT IN POLAND. HEALTH SYSTEM LEVEL

 

•      HEALTH DISCOURSE - POLITICAL,

   MORAL

•      OTHER TREATMENT OPTIONS

  – COMPETITIVE

•      VESTED INTEREST - POWERFUL