მოცემული პრეზენტაცია მოიცავს ზიანის შემცირების პროგრამების მიმოხილვას, როგორიცაა: შპრიცების გაცვლის პროგრამა, ნებაყოფლობითი კონსულტირება-ტესტირება შიდსზე, მეთადონით ჩანაცვლებითი/მხარდამჭერი მკურნალობა

1. zianis Semcirebazianis Semcirebazianis Semcirebazianis Semcireba
narkotikuli saSualebebis moxmarebiT gamowveuli
mavne Sedegebis Tavidan acileba / minimumamde
dayvana da am movlenis srulad aRmofxvrisTvis
xelsayreli niadagis momzadeba.
mocemuli politika, strategiebi Tu qmedebebi ar
isaxavs aucilebel miznad narkotikis moxmarebis
Sewyvetas.

2. vinvinvinvin arisarisarisaris zianiszianiszianiszianis SemcirebisSemcirebisSemcirebisSemcirebis programebisTvisprogramebisTvisprogramebisTvisprogramebisTvis
narkotikebisnarkotikebisnarkotikebisnarkotikebis ineqciuriineqciuriineqciuriineqciuri momxmarebelimomxmarebelimomxmarebelimomxmarebeli????
l adamiani, romelsac Tavad SeuZlia damoukideblad
miiRos gadawyvetileba ra gaakeTos da rogor
icxovros;
l kompetenturi adamiani;
l mas eZleva saSualeba Tavad gadawyvitos ra jobia
misTvis mocemul momentSi.
l CvenCvenCvenCven arararar vebrZviTvebrZviTvebrZviTvebrZviT,,,, arararar vmbrZaneblobTvmbrZaneblobTvmbrZaneblobTvmbrZaneblobT,,,, arararar vkarnaxobTvkarnaxobTvkarnaxobTvkarnaxobT dadadada
arararar mivuTiTebTmivuTiTebTmivuTiTebTmivuTiTebT vinmesvinmesvinmesvinmes,,,, TuTuTuTu,,,, rogorrogorrogorrogor undaundaundaunda moiqcesmoiqcesmoiqcesmoiqces....

3. SpricebisSpricebisSpricebisSpricebis gacvlisgacvlisgacvlisgacvlis programaprogramaprogramaprograma
aris aiv/Sidsis gavrcelebis profilaqtikuriaiv/Sidsis gavrcelebis profilaqtikuriaiv/Sidsis gavrcelebis profilaqtikuriaiv/Sidsis gavrcelebis profilaqtikuri programa,
romelic inieqciuri
narkotikebis
momxmareblebisTvis
steriluri Spricebisa da
nemsebis advilad
xelmisawvdomobas
Uzrunvelyofs.
(erTjeradi steriluri saineqcio masalebi (sxvadasxva zomis
Spricebi, nemsebi, e.w. peplebi); erTjeradi spirtiani
tamponebi; venebis mosavleli saSualebebi; naloqsoni;
prezervativebi; sainformacio-saganmanaTleblo masalebi).

4. Spricebis gacvla, nebayoflobiTi
testireba da konsultireba

6. • stacionarulistacionarulistacionarulistacionaruli –––– momsaxurebamomsaxurebamomsaxurebamomsaxureba specialur
dawesebulebaSi an ofisSi, sadac narkotikebis
ineqciur momxmarebels naxmari sainieqcio
mowyobilobis sanacvlod SeuZlia axali miiRos;
• mobilurimobilurimobilurimobiluri _ momsaxureba furgonis an avtobusis
meSveobiT, romelic dadgenili marSrutiT
moZraobs da gansazRvrul adgilebze Cerdeba;
• auTriCi/beqpeki (auTriCi/beqpeki (auTriCi/beqpeki (auTriCi/beqpeki (backpack)))) – muSakebi dadian quCebsa
da sxva adgilebSi (mag. binebSi), arigeben sufTa
nemsebsa da Spricebs da agroveben naxmar
sainieqcio mowyobilobas, romelsac Semdeg
anadgureben.
• gamanawilebeli avtomati (aparati)gamanawilebeli avtomati (aparati)gamanawilebeli avtomati (aparati)gamanawilebeli avtomati (aparati) – garkveul
adgilebSi damontaJebulia nemsebisa da Spricebis
gamanawilebeli aparatebi. nebismier msurvels
SeuZlia simbolur fasad iyidos an usasyidlod
miiRos sasurveli zomis Sprici an nemsi, xolo
naxmari _ iqve mdgom konteinerSi Caagdos.

7. nebayoflobiTinebayoflobiTinebayoflobiTinebayoflobiTi konsultirebakonsultirebakonsultirebakonsultireba
dadadada testirebatestirebatestirebatestireba
l nebayoflobiTi konsultireba da
testireba aiv infeqciis prevenciis
erT-erT saukeTeso gzad aris miCneuli;
l yvelas aqvs ufleba miiRos informacia
aiv-infeqciis Sesaxeb da Semdeg Tavad
miiRos gadawyvetileba, Caitaros testireba Tu ara;
l testireba aiv infeqciaze nebayoflobiTi, anonimuri da
konfidencialuria; aseve SesaZlebelia msurvels Cautardes
testireba B da C hepatitebze.
l konsultanti atarebs testis wina da Semdgom konsultaciebs.
romlis ZiriTadi mizania pirovnebisTvis aiv-infeqciaze
informaciis miwodeba, misi movlisa da mkurnalobis sakiTxebis
gaumjobeseba;
l specialistTa (infeqcionisti, narkologi, qirurgi, iuristi,
fsiqoTerapevti) konsultaciebi;.

8. usafrTxo ineqciis oTaxebi

9. narkotikebis usafrTxo
gamoyenebis oTaxebi

10. CanacvlebiTiCanacvlebiTiCanacvlebiTiCanacvlebiTi TerapiaTerapiaTerapiaTerapia
• gulisxmobs, garkveuli samkurnalo
miznebis misaRwevad, wamaldamokidebuli
piris mier damokidebulebis gamomwvevi
nivTierebebis miRebas eqimis
meTvalyureobis qveS.
• narkotikuli saSualebebis momxmarebels
janmrTelobisTvis naklebad saziano
preparatebs ZiriTadad meTadons da
buprenorfins (subuteqsi), sTavazoben.
Tumca aseve gamoiyeneba: morfini, heroini,
LAAM-i da sxva.

11. meTadoni da buprenorfini
• aRniSnuli preparatebi specifikuri
TvisebebiT xasiaTdeba: xangrZlivi
moqmedeba, naklebad maeiforizebeli efeqti
da sxva, amitom organizmze stabilur
zemoqmedebas axdenen, dRe-Ramis
ganmavlobaSi pacientis guneba-ganwyobisa
da zogadi mdgomareobis mkveTri
cvlilebis gareSe.
• es ki, programebSi arsebul fsiqo-
socialur da samedicino intervenciebTan
erTad, xelsayrel niadags qmnis imisTvis,
rom pacienti normaluri cxovrebis reJims
daubrundes.

12. CanacvlebiTiCanacvlebiTiCanacvlebiTiCanacvlebiTi TerapiaTerapiaTerapiaTerapia
• CanacvlebiTi programebis ZiriTad
miznebs ganekuTvneba agreTve: opioidebze
damokidebul pirTa dekriminalizacia da
samedicino-fsiqo-socialuri
reabilitacia.
• CanacvlebiTi TerapiisTvis gamoyenebuli
saSualebebi sirofebis an abebis saxiT
mzaddeba, rac intravenuri
manipulaciebis Semcirebas uwyobs xels
da inficirebis risks mkveTrad amcirebs.

13. mosalodneli Sedegebi
• zogadi janmrTelobis gaumjebeseba;
• aralegaluri narkotikebis moxmarebis
Sewyveta;
• infeqciuri daavadebebis (hepatitebi,
aiv/Sidsi) gadadebis riskis Semcireba;
• aralegalur saqmianobaSi CarTulobis
Semcireba;
• dasaqmebis meti saSualeba;

14. !"#$"!%&'()"*+,-#!#")"./*+!!
• 1+2-3(4-!5/36)-#!%"2"*-413,!73#"8*3,3*-"!
/)"9+4,!(+%!!"%.-(3,",!2"%+&3:/",!.3%"!!"!#9/"!
:-;-#!"(""!"%-")'(-!!"#$"!%-<)3'*-"!
)"(&+:-&3,-#!%+%9%"(3,*-#!“2"%+#=+(3,-#”!!
3(4%3(4!21"!.!!
• 4'%.",!%("/"*=*-")-!2"%+.!-*3,"!"</3)3,#,!
(+%!"(")"-(-!!"#$",!!"%.-(3,"!!"!)"(&+:-&-#!
%+%9"(3,-#!&(-%-)"*-13,"!"(!"%.-(3,#,!
%+9%"(3,-#!%"</3)3,*3,#.!!

15. 17Photos: JimmyPhotos: Jimmy DorabjeeDorabjee, Burnett Centre for Harm, Burnett Centre for Harm
ReductionReduction

16. 18
HUMILIATION AS TREATMENTHUMILIATION AS TREATMENT

17. 19
No Chains – no Gains

18. zianiszianiszianiszianis SemcirebisSemcirebisSemcirebisSemcirebis
principebiprincipebiprincipebiprincipebi dadadada praqtikapraqtikapraqtikapraqtika
• qcevisqcevisqcevisqcevis cvlilebiscvlilebiscvlilebiscvlilebis xelSewyobaxelSewyobaxelSewyobaxelSewyoba
• jansaRijansaRijansaRijansaRi qcevisqcevisqcevisqcevis xelSewyobaxelSewyobaxelSewyobaxelSewyoba
- informirebulobis donis amaRleba
janmrTelobis riskis saxeebis Sesaxeb;
- sarisko qmedebebisgan Tavis
SekavebisTvis saWiro cvlilebebis
xelSewyoba;
- pozitiuri qceviTi cvlilebis
SenarCuneba.

19. faqtorebifaqtorebifaqtorebifaqtorebi,,,, romlebicromlebicromlebicromlebic gavlenasgavlenasgavlenasgavlenas
axdenenaxdenenaxdenenaxdenen qcevisqcevisqcevisqcevis cvlilebazecvlilebazecvlilebazecvlilebaze
• individualuriindividualuriindividualuriindividualuri
• interpersonaluriinterpersonaluriinterpersonaluriinterpersonaluri
• sazogadoebrivisazogadoebrivisazogadoebrivisazogadoebrivi
• socialursocialursocialursocialur----politikuripolitikuripolitikuripolitikuri garemogaremogaremogaremo

20. ierarqiuli miznebi
• avaridoT adamianebs narkotikuli
saSualebebis moxmarebis dawyeba;
• avaridoT adamianebs narkotikuli
saSualebebis inieqciis gziT miReba;
• xeli SevuwyoT narkotikuli
saSualebebis moxmarebis, gansakuTrebiT
ki inieqciuri moxmarebis Sewyvetas;
• minimumamde daviyvanoT narkotikuli
saSualebebis moxmarebiT gamowveuli
ziani.

21. p vinaidan damokidebulebis mqone pirTa
umravlesoba, xanmokle mkurnalobis (detoqsis)
kursis Semdeg, kvlav ubrundeboda aralegaluri
narkotikebis moxmarebas, 20-e saukunis dasawyisSi
gaCnda opioiduri damokidebulebis Camanacvlebeli
preparatiT mkurnalobis idea. rac praqtikaSi
pirveli CanacvlebiTi Terapiis dawyebiT
ganxorcielda me-20 saukunis 60-ian wlebSi (douli
da nisvanderi).
p meTadonis miReba sinTezuri gziT pirvelad
moxda - 1939 wels germaniaSi.
CanacvlebiTi Terapiis ideuri
sawyisebi

22. pirveli meTadoniT CanacvlebiTi Terapiis
programebi saqarTveloSi
p "SidsTan, tuberkulozTan da malariasTan
brZolis globaluri fondis" finansuri
mxardaWeriT daiwyo;
p TbilisSi 2005 wlis dekemberSi narkologiis
s/k institutis bazaze;
p 2006 wels centri “urantis” bazaze;
p 2007 wlis dasawyisSi baTumSi respublikuri
narkologiuri centris bazaze;

23. CanacvlebiTiCanacvlebiTiCanacvlebiTiCanacvlebiTi mkurnalobismkurnalobismkurnalobismkurnalobis pozitiuripozitiuripozitiuripozitiuri mxareebimxareebimxareebimxareebi
p opioidebze damokidebul pirTa socialuri
reabilitacia da dekriminalizacia;
p cxovrebis stilis stabiluroba;
p socialuri funqcionirebis gaumjobeseba;
p fsiqoTerapiuli Carevis SesaZlebloba;
p aralegaluri narkotikebis moxmarebis minimumamde
dayvana / Sewyveta;
p kriminaluri / aralegaluri saqmianobis minimumade
dayvana / Sewyveta;
p narkotikebis moxmarebiT gamowveuli zedozirebis
riskis Semcireba;
p dasaqmebis meti saSualeba;
p infeqciuri (B /C hepatitebi, aiv-infeqcia da sxva
sisxliT gadamdebi) daavadebebis gadadebis riskis
Semcireba;
p fizikuri da fsiqikuri janmrTelobis gaumjobeseba;
p da sxva

24. CanacvlebiTiCanacvlebiTiCanacvlebiTiCanacvlebiTi TerapiisTerapiisTerapiisTerapiis negatiurinegatiurinegatiurinegatiuri mxareebimxareebimxareebimxareebi
p damokidebulebis ganviTareba narkotikul
Camanacvlebel preparatze;
p Camancvlebeli preparatebis specifiuri
gverdiTi movlenebi;
p qalqidan qalaqSi (sxvagan) gadaadgilebis
SezRuduli saSualeba;
p cxovreba grafikiT!
p saWesTan jdomis SezRudva;
p piradi monacemebis registrireba;

25. p CanacvlebiTi mxardamWeri Terapia aris opioiduri
damokidebulebis mkurnalobis efeqturi, usafrTxo da
ekonomikurad gamarTlebuli meTodi.
p am meTodis mravalricxovanma da mkacrma Sefasebebma naTlad
aCvena, rom aris opioiduri damokidebulebis mqone pacientTa
mkurnalobis efeqturi da ineqciuri narkotikebis
momxmarebelTa Soris aiv-inficirebis prevenciis Rirebuli da
mniSvnelovani komponenti.
p CanacvlebiT mxardamWer Terapias moaqvs sargebeli opioiduri
damokidebulebis mqone pirebisTvis, axdens maTi mdgomarobis
stabilizacias, aumjobesebs zogad janmrTelobas da
socialur funqcionirebas.
p Sesabamisad SesaZlebelia maTi cxovrebis fizikuri, emociuri
mxaris da sxva adamianebTan urTierTobebis mniSvnelovani
gaumjobeseba.
p izrdeba maTi unari Seitanon mniSvnelovani wvlili
garSemomyofTa da mTlianad sazogadoebriv cxovrebaSi.
UNAIDS - gaerTianebuli erebis aiv/Sidsis erTiani programisgaerTianebuli erebis aiv/Sidsis erTiani programisgaerTianebuli erebis aiv/Sidsis erTiani programisgaerTianebuli erebis aiv/Sidsis erTiani programis
WHO - jandacvis msoflio organizacia;jandacvis msoflio organizacia;jandacvis msoflio organizacia;jandacvis msoflio organizacia;
UNODC - gaerTianebuli erebis organizaciis narkotikebTan da kriminalTangaerTianebuli erebis organizaciis narkotikebTan da kriminalTangaerTianebuli erebis organizaciis narkotikebTan da kriminalTangaerTianebuli erebis organizaciis narkotikebTan da kriminalTan
brZolis biuro;brZolis biuro;brZolis biuro;brZolis biuro;

26. CanacvlebiTiCanacvlebiTiCanacvlebiTiCanacvlebiTi TerapiisTvisTerapiisTvisTerapiisTvisTerapiisTvis
gamoyenebuligamoyenebuligamoyenebuligamoyenebuli preparatebipreparatebipreparatebipreparatebi
• buprenorfinibuprenorfinibuprenorfinibuprenorfini ////subuteqsisubuteqsisubuteqsisubuteqsi
• meTadonimeTadonimeTadonimeTadoni
• LAAM
• heroiniheroiniheroiniheroini
• subuqsonisubuqsonisubuqsonisubuqsoni
• dadadada sxvasxvasxvasxva........

27. ratom meTadoni?
p meTadonis mimarT tolerantoba Zalian
nela formirdeba, rac saSualebas
iZleva xangrZlivi drois ganmavlobaSi
pacienti iyos erTsa da imave dozaze.
p yovelive aRniSnuli ganapirobebs
meTadonis stabilur moqmedebas dRe-
Ramis ganmavlobaSi guneb-ganwyobisa da
zogadi mdgomareobis mkveTri
meryeobebis gareSe.

28. meTadonis gverdiTi efeqtebi
p oflianoba;
p yabzoba;
p Zilis darRvevebi
p sqesobrivi ltolvis daqveiTeba.
es arasasurveli gverdiTi efeqtebi SeiZleba xangrZlivad SenarCundes
samedicino Carevis gareSe da vlindeba pacientTa 20%-Si.
meTadonis Warbi dozis miRebis dros vlindeba:
p sunTqvis daTrgunva;
p Zilianoba;
p ConCx-kunTovani sistemis sisuste;
p bradikardia;
p hipotenzia.
mwvave zedozirebisas, gansakuTrebiT i/v miRebisas, SeiZlebamwvave zedozirebisas, gansakuTrebiT i/v miRebisas, SeiZlebamwvave zedozirebisas, gansakuTrebiT i/v miRebisas, SeiZlebamwvave zedozirebisas, gansakuTrebiT i/v miRebisas, SeiZleba
ganviTardes apnoe, gulganviTardes apnoe, gulganviTardes apnoe, gulganviTardes apnoe, gul----sisxlZarRvTa ukmarisoba da sikvdili.sisxlZarRvTa ukmarisoba da sikvdili.sisxlZarRvTa ukmarisoba da sikvdili.sisxlZarRvTa ukmarisoba da sikvdili.

29. CanacvlebiTi
Terapiis centrebi

30. CineTiCineTi

31. honkongihonkongi

32. -)!+34-!

33. meTadonimeTadoni

34. indoeTiindoeTiindoeTiindoeTiindoeTiindoeTiindoeTiindoeTi

35. iraniirani

36. 3/(+;"!

37. ("%!3)-!9")-!')!"!-%&'()"*+#!
)"(&+:-&3,-#!%+%9%"(3,3*%"?!
• %&'()"*+,-#!9")2(8*-/+,-#!2")#"1>/("!
-)!-/-!'"*'(".!!
• 1+2"!"!,!%&'()"*+,"%(3",-*-:".-"!2(83*!3,"!-%!3)!
9")#,!("%!3)-.!#"?-(+"!-%-#4/-#,!(+%!%->=3'*-!-5)"#!
,"*")#-.!!
• "%3(-&-#!="%"*!"%+&-!3,'*3,-#!-)#:-:':-#!4")"9%"!!!
90!!>3%!3!"%,'*":+(-'*-!4'!(31-!3):'*-!
%&'()"*+,"!)"&*3,!3@35:-")-"!!"!73#","%-#"!!%3:-!
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73!32-#!%9"(!"#"?3("!.!!%"2.:!%34"!+)-#!<")"./*3,-4-!
43(";--#4/-#!12!4/3!%-<)3'*-"!%&'()"*+,-#!
%-)-%"*'(!9")2(8*-/+,"!.!!
• 1+2-3(4#!"#34-!%&'()"*+,-4!;+1-:-'(-!73!323,-#!
%-#">3,"!!=*3,-!#?-(!3,".!!
=6"(+:!h-p://www.drugabuse.gov/publica>ons/principles%drug%addic>on%treatment%
research%based%guide%third%edi>on!

38. !"#$#%&'())*+,)*!-.'.#/)!
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0&*&3&!0.&0$&4&:!!
).!5)"+&6#,!2011.!4&0.5)4#/23#/)*!
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