5. DRUG-RELATED TREATMENT

5.1. Treatment System

The Ministry of Health aimed to enhance the quality and quantity of the settings providing drug-related treatment in order to prevent the use of narcotic drugs, to treat the drug users and enable rehabilitation, to prevent these persons from urging others to use drugs and thus to reduce drug demand in the country. The current structure allows for the treatment of drug users demanding treatment mostly, however it is planned to disseminate the drug-related treatment services all over the country to make the services more easily accessible.

In this context, in addition to the AMATEM operating under Istanbul Ord. Prof. Mazhar Osman Bakirkdy Mental Health and Diseases Education and Research Hospital, AMATEMs were opened under Elazig, Samsun, Manisa Mental Health and Diseases Hospitals in 1997, under Adana Men-tal Health and Diseases Hospital and Denizli State Hospital in 2000, Ankara Numune Education and Research Hospital in 2004.

"Research and Treatment Center for Volatile Substance Addiction" (UMATEM — later the na-me changed to ÇEMATEM.) established under the body of the Istanbul Ord. Prof. Dr. Mazhar Os-man Bakirkdy Mental Health and Diseases Education and Research Hospital to render services to children using volatile substances has been successfully continuing its activities in this field. Furt-hermore, treatment services are rendered to drug using children and adolescents by Ege University Alcohol and Drug Addiction Research and Implementation Center for Children and Adolescents (EGEBAM) established under the body of Ege University, Faculty of Medicine in Izmir in the year 2003 through the cooperation and support of public bodies and agencies to treat only child patients and in a section of AMATEM under the body of Ankara Numune Education and Research Hospital.

Apart from the drug-related treatment centres affiliated to the Ministry of Health, drug-related treatment services are also provided by the Faculties of Medicine of Ankara University, Gazi Uni-versity, Istanbul University, Ege University and Dokuz Eyliil University as well as a private hospital in Istanbul province. Since the year 2005, treatment services have been rendered in 15 centres, two of which focus on children and adolescents, with a capacity of 483 beds. Establishment of new cen-tres in Diyarbakir, Gaziantep, Istanbul, Izmir and Mersin is planned in the forthcoming years.

Mental problems related to drug use are researched and treatment for such problems is pro-vided under the scope of the services rendered to children and adolescents using volatile substan-ces. The reasons of drug use, social structure and family structure of the young people are researc-hed and the method for the drug-related treatment is identified. The young people are informed abo-ut the drugs they use and their influences and are taught what they should do in order to avoid star-ting drug use again. Use of volatile substances is a relatively new incident in the world (a problem that occurred in the last 20 years); it poses a huge problem only in a small number of countries and there is no sufficient accumulation of scientific knowledge; thus the success level in other drug-re-lated treatments has not been achieved in treatment of volatile substance use.

The general treatment system is established in three levels of health services. General prac-titioners work at the primary level of health services where patients should first get in contact for the-ir health problems. Primary level refers the patients to secondary and tertiary services. Drug related treatment facilities include both inpatient and outpatient settings for addicts in general. Drug free tre-atment is the method of choice. Both psychotherapeutic and supportive methods are used including systemic therapies, socioeducative treatment and motivational interviewing. It takes long time. With-drawal treatment is done both in inpatient and outpatient settings.

5.1.1. Aim of the Treatment

Generally the treatments provided in the centres aim at reduction or total withdrawal of drug use, elimination of poverty related problems, prevention of starting drug use again and improving psychological and social functionality.

As a rule, it is not allowed to practise medical practices towards drug-related treatment servi-ces outside the treatment centres in various units established with different purposes (like training, sheltering, social purposes) with the support of the health personnel. The "Regulation on Drug-Re-lated Treatment Centres" enacted and published in the Official Gazette on February 2, 2004 stipu-lated that the drug-related treatment will be provided solely by centres having licence/permit gran-ted by the Ministry of Health.

This regulation;

Stipulates that Scientific Commission on Drug-Related Treatment Procedures will be establis-hed in the first place.

Provides some arrangements regarding the establishment, building status of these centres and the application, licence and permit documents along with the sections to be formed within the centre and the tools and equipment to be available, personnel status and registry declaration system.

5.1.2. Substitution Treatment

Drug-related treatment has gained a new dimension with the incorporation of Methadone, Buprenorphine, Noloxane, Naltrexone, LAAM and similar opiate agonists, antagonists, partial agonists and partial antagonists, the use of which in drug-related treatment is the case in many European Union countries but is illegal in Turkey, into the treatment.

Procedures and principles related to the use of methadone, buprenorphine and similar medi-cines in drug-related treatment have not been identified yet, thus these medicines have not yet be-en brought into Turkey and administered to the patients. However, the Scientific Commission has been working towards preparing the diagnosis and treatment protocols according to the types of drug use. Once the necessary arrangements have been finalized, the medicines in question are planned to be used in substitution treatment practices.

Drug use is defined as a disease within the context of this regulation. Furthermore article 191 of the Turkish Penal Code foresees that courts may rule on probation rather than legal action abo-ut those drug users who agree to undergo drug-related treatment. Moving from the approach that regards drug use as a disease; the expenses related to diagnosis and drug-related treatment of tho-se drug users are borne by the social security institution they are registered to and the diagnosis and treatment expenses of those drug users without any social security are borne by the Ministry of Health.

A communiqué governing the training programs and the exams for certification of the doctors, psychologists and nurses to be employed in the centres has been published as a result of the works carried out by the Scientific Commission on Drug-Related Treatment Procedures. Moreover a gui-de on the diagnosis and treatment criteria to be employed is being prepared and this guide will al-so be used as the training curriculum.

5.1.3. Non-Substitution Treatment

Both inpatient and outpatient treatment is provided in Turkey. However, access to outpatient treatment data is not easy, thus data on inpatient treatment have been utilized.