Narcologist Zura Sikharulidze has strongly criticized the Georgian government's decision to ban private substitution therapy programs, warning that the move will deepen stigma against drug users, reduce access to quality care, and tighten state control over addiction treatment.
In a detailed social media post, Sikharulidze responded to recent statements by Prime Minister Irakli Kobakhidze, who announced that only the state will be authorized to implement opioid substitution therapy as part of the government’s broader strategy in the "fight against drug addiction."
“The closure of private services, where patients were protected from stigma, received high-quality treatment, and paid for it themselves, only worsens the situation. The state didn’t even bear the financial burden of these services,” Sikharulidze wrote.
Sikharulidze listed several critical issues with the current direction of drug policy:
- Loss of rights for users, including employment and driver's licenses
- Mandatory treatment measures
- Dismantling private clinics, which he says offered stigma-free, higher-quality care
- Portraying substitution therapy as a form of drug addiction
- Relocating state-run therapy to rural areas, increasing marginalization
He emphasized that although the state spends around GEL 7 million annually on substitution programs, plus GEL 1 million for medications, these services are not “free,” as they are paid for by taxpayers.
- Currently, the state program operates through 21 departments, serving around 14,000 patients.
- Only 2,500 patients are enrolled in private programs, which use buprenorphine + naloxone, a non-narcotic, internationally accepted combination that reduces overdose risk.
- The state finances detoxification for only 250 patients per year, while psychorehabilitation receives a meager GEL 100,000 annually, leaving the rest to the private sector.
“Now, 11 private substitution therapy programs are being shut down. The burden will shift entirely to the state, yet private clinics were still bound by strict state regulations,” Sikharulidze noted.
He concluded by stating that reducing demand and “fighting addiction” are not the same, and warned that the government’s current path risks worsening public health outcomes under the pretext of reform.
