narkomaniis Sesaxeb
narkomaniis Sesaxeb
narkomaniis Sesaxeb
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Temas uZRvebian<br />
narkologiis centri `urantis~ xelmZRvaneli, eqimi-narkologi zurab sixaruliZe<br />
eqimi-narkologi, med. mecn. doqtori, profesori gela leJava<br />
eqimi-narkologi, med. mecn. kandidati xaTuna TodaZe<br />
# 13<br />
<strong>narkomaniis</strong><br />
<strong>Sesaxeb</strong>
<strong>narkomaniis</strong> <strong>Sesaxeb</strong><br />
2<br />
ratom hqvia narkomanias<br />
`damokidebulebis daavadeba”?<br />
narkotikul nivTierebebs gaaCniaT Tviseba,<br />
ise imoqmedon adamianze, rom gamoiwvion<br />
fsiqikuri da fizikuri miCveva _<br />
damokidebuleba.<br />
fsiqologiuri TvalsazrisiT, adamiani<br />
`zarmacdeba” _ mas aRar sWirdeba garemoSi<br />
eZios siamovnebis momtani axali movlenebi<br />
Tu urTierTobebi, iyos interesiani da mizandasaxuli.<br />
am yvelafers mas `kaifi” da<br />
narkotikis morigi doza ucvlis, romlis<br />
mopovebac TavisTavad iqceva cxovrebis<br />
mTavar miznad.<br />
fizikur damokidebulebas ki im neiroqimiuri<br />
da fiziologiuri meqanizmebis darRveva<br />
ganapirobebs, romelic uzrunvelyofen<br />
siamovnebis bunebriv process.<br />
saboloo jamSi narkomanis cxovrebas<br />
mTlianad narkotiki gansazRvravs.<br />
ra simptomebi aqvs narkomanias?<br />
mTavari simptomi, romelic daavadebis<br />
uSualo winamorbedia da yuradRebis miqcevas<br />
saWiroebs qcevis cvlilebaa. rogorc<br />
wesi, am dros adamiani icvlis megobrebis<br />
Cveul wres, interesebs, Cndeba tyuili,<br />
`saidumlo” zarebi, saqmeebi, da a.S.<br />
Tavad daavadebis simptomebi mniSvnelovnad<br />
damokidebulia moxmarebuli narkotikis<br />
saxeze. zogierTi iwvevs halucinaciebs,<br />
zogierTi gabruebasa da eiforias, aris<br />
damamSvidebeli, an mastimulirebeli nivTierebebic.<br />
daavadebis simptomebis simZafreze<br />
moqmedebs moxmarebis xangrZlivoba<br />
(`staJi”) da Tavad momxmareblis pirovnuli<br />
Taviseburebebi. rac ufro xangrZlivia<br />
moxmarebis `staJi”, miT ufro Rrma da<br />
Seuqcevadia narkotikebiT gamowveuli is<br />
cvlilebebi, romelTac adamiani, bolosdabolos,<br />
socialur, fsiqologiur da fizi<br />
kur invalidobamde mihyavT.<br />
vis mivmarToT?<br />
narkotikebTan problemis gaCenisas dauyonebliv<br />
unda mimarToT specialists<br />
_ eqim-narkologs. igi gagiwevT saWiro<br />
konsultacias daavadebis, misi mkurnalobis<br />
meTodebis, SesaZlo garTulebebis da<br />
maTi Tavidan acilebis gzebis <strong>Sesaxeb</strong>. amis<br />
Semdeg Tqven geqnebaT saSualeba, specialistTan<br />
erTad dagegmoT Semdgomi mkurnaloba,<br />
romelic maqsimalurad efeqturi<br />
da misaRebi iqneba TqvenTvis.<br />
saqarTveloSi am sferoSi muSaoben specializebuli<br />
saxelmwifo da kerZo samedicino<br />
dawesebulebebi, arasamTavrobo<br />
organizaciebi; qarTul marTlmadideblur<br />
eklesias gaaCnia specialuri samsaxuri,<br />
romelic <strong>narkomaniis</strong> problemiTaa dakavebuli.<br />
ase, rom Tu adamians gaaCnia survili<br />
da mtkice gadawyvetileba, is aucileblad<br />
ipovis daxmarebas.<br />
unda gaxsovdeT, rom narkomania qronikuli<br />
daavadebaa. igi azianebs ara marto<br />
adamianis fizikur, aramed fsiqikur janmr-<br />
Telobas, socialur unarebsa da kavSirebs.
aqedan gamomdinare cxadia, rom mkurnalobis<br />
procesSi maqsimalurad unda iyos Car-<br />
Tuli iseTi elementebi, rogoricaa fsiqologiuri,<br />
socialuri, sulieri daxmareba<br />
da sxva.<br />
warmatebuli mkurnalobis SemTxvevaSi<br />
nu dakargavT kontaqts mkurnal eqimTan,<br />
raTa droulad moxdes recidivis profilaqtika.<br />
reintegracia sazogadoebaSi<br />
da sazogadoebis<br />
damokidebuleba.<br />
farTo gagebiT mkurnalobis saboloo,<br />
sasurvel Sedegs sazogadoebaSi adamianis<br />
reintegracia warmoadgens. swored es aris<br />
qarTuli realobisTvis yvelaze `susti wertili”,<br />
imis gamo, rom am procesSi specialistebis<br />
garda, mniSvnelovan rols ojaxi,<br />
mTliani sazogadoeba da saxelmwifo unda<br />
asrulebdes. CvenSi ki samive es komponenti<br />
gardaqmnisa da Camoyalibebis procesSia da<br />
sabWoTa warsulisa, Tu fsevdo-erovnuli<br />
tradiciebisgan jer ar ganTavisuflebula.<br />
ojaxi narkomaniiT daavadebuls `sircxvilad”<br />
aRiqvavs, sazogadoeba _ `cud biWad<br />
(gogod)”, saxelmwifo _ kriminalad, da arc<br />
erTs ar awyobs maTi gamomJRavneba. aseTi<br />
damokidebulebis `damsaxurebacaa”, rom<br />
miCqmaluli daavadeba sul ufro metad<br />
iZens epidemiisaTvis damaxasiaTebel niSnebs.<br />
amitom, problemis daZlevisaTvis mimarTuli<br />
RonisZiebebi unda emsaxurebodes<br />
sazogadoebrivi tabus moxsnas, socialuri<br />
samsaxurebis Camoyalibebas, am sferos moqmedi<br />
kanonmdeblobis Zirfesvian, da ara<br />
kosmetikur cvlilebebs.<br />
mTavari rCevebi.<br />
3<br />
miuxedavad imisa, rom narkomania qronikuli<br />
daavadebaa, saSveli arsebobs, da<br />
daavadebis rac ufro adreul etapze mimarTavT<br />
specialists, miT ukeTesi iqneba<br />
Sedegi.<br />
rCeva momxmarebels:<br />
1. Sewyveta yovelTvis SesaZlebelia, Tu<br />
ki namdvilad gsurs da mtkice arCevans<br />
gaakeTeb fxizeli cxovrebis sasargeblod.<br />
2. Tu ver axerxeb Sewyvetas, mimarTe specialists,<br />
romelic dagexmareba naklebi<br />
ziani miayeno sakuTar Tavs da gar-<br />
Semomyofebs, sazogadoebas.<br />
rCeva axloblebs:<br />
1. iyaviT yuradRebiani da droze SeniSneT<br />
is cvlilebebi, romelic SeiZleba<br />
narkotikma gamoiwvios momxmareblis<br />
fizikur da emociur mdgomareobaSi,<br />
qcevaSi Sin da gareT.<br />
2. daexmareT momxmarebels problemis<br />
gacnobierebaSi da izruneT, rom maqsimalurad<br />
swrafad mimarTos specialists.<br />
3. daexmareT momxmarebels problemis gadaWraSi,<br />
magram nu SeecdebiT problemis<br />
mis magier gadaWras.<br />
eqimi-narkologi zurab sixaruliZe.<br />
<strong>narkomaniis</strong> <strong>Sesaxeb</strong>
<strong>narkomaniis</strong> <strong>Sesaxeb</strong><br />
4<br />
metadoniT CanacvlebiTi<br />
Terapia<br />
ra aris opioiduri<br />
narkomania?<br />
opioidebze damokidebuleba, anu opioiduri<br />
narkomania qronikuli daavadebaa, romelic<br />
recidivebiT, anu gamwvavebebiT mimdinareobs.<br />
am daavadebas iwvevs iseTi narkotikuli<br />
saSualebebis moxmareba, rogoricaa<br />
opiumi, heroini, morfini, subuteqsi da sxva.<br />
opioiduri narkomania, Cveulebriv, Zalian<br />
swrafad yalibdeba da Zalzed mZime daavadebas<br />
warmoadgens. igi xasiaTdeba narkotikisadmi<br />
fsiqikuri da fizikuri damokidebulebis<br />
CamoyalibebiT. damokidebuli adamianis<br />
mier narkotikis moxmarebis Sewyveta<br />
iwvevs umZimes aRkveTis mdgomareobas, anu<br />
e.w.”lomkas”. Tumca damokidebulebis mqone<br />
pirisTvis yvelaze ufro mZime TviT `lomka”<br />
ki ar aris, aramed misi gadalaxvis Semdeg<br />
fsiqikur ltolvasTan gamklaveba da narkotikis<br />
miRebisgan Tavis Sekaveba.<br />
ramdenad efeqturia<br />
opioiduri <strong>narkomaniis</strong><br />
mkurnaloba?<br />
arsebobs am daavadebis mkurnalobisadmi<br />
sxvadasxva midgoma. opioiduri damokidebulebis<br />
mkurnalobis universaluri efeqturi<br />
meTodi jerjerobiT SemuSavebuli<br />
ar aris. optimalurad aRiarebulia mkurnalobis<br />
iseTi meTodebi, romlebic Tavidanve<br />
orientirebulia narkotikebis miRebis<br />
Sewyvetaze. magram, samwuxarod, rogorc<br />
mravalwlianma saerTaSoriso gamocdilebam<br />
aCvena, dRes arsebuli sxvadasxva saxis<br />
mkurnalobis efeqturoba arc ise maRalia.<br />
pacientTa umravlesoba mkurnalobidan<br />
garkveuli drois Semdeg kvlav ubrundeba<br />
narkotikebs. Tumca arsebobs bevri adamiani,<br />
romelmac SeZlo narkotikebze samudamod<br />
uaris Tqma. Cven amas gamojanmrTelebas<br />
vuwodebT. magram aseTma adamianebma kargad<br />
ician, rom opioidebze damokidebuli piri,<br />
praqtikulad, mTeli cxovrebis manZilze<br />
daavadebulad rCeba, vinaidan igi gamudmebiT<br />
imyofeba narkotikebis miRebis ganaxlebis<br />
maRali riskis qveS. aseTi adamianebis-<br />
Tvis jansaRi mdgomareobis SenarCunebis piroba<br />
aris narkotikebis Tundac epizoduri<br />
moxmarebisgan samudamod uaris Tqma.<br />
ra aris opioidebze<br />
damokidebulebis<br />
CanacvlebiTi Terapia?<br />
CanacvlebiTi Terapia opioiduri <strong>narkomaniis</strong><br />
mkurnalobis erT-erTi meTodia. igi<br />
pirvelad SemoRebul iqna aSS-Si 1960-ian<br />
wlebSi da amJamad msoflios mraval qveyanaSia<br />
danergili. mas warmatebiT iyeneben<br />
iseT qveynebSi, rogoricaa aSS, safrangeTi,<br />
germania, didi britaneTi, belgia, italia,<br />
espaneTi, holandia, poloneTi, CexeTi, litva,<br />
azerbaijani, irani, CineTi da sxv. amas-<br />
Tan, yovelwliurad izrdeba am programeb-<br />
Si CarTul pirTa ricxvi. CanacvlebiTi<br />
programebis farTod gavrcelebas gansaku-<br />
Trebuli biZgi misca aiv/Sidsis epidemiam,<br />
vinaidan CanacvlebiTi Terapia narkotikebze<br />
damokidebul pirebSi ineqciuri gziT<br />
aiv/Sidsisa da hepatitebis gavrcelebis<br />
SezRudvis erTerTi ZiriTadi saSualebaa.
CanacvlebiTi Terapia mkurnalobis gansxvavebuli<br />
meTodia. is gulisxmobs SedarebiT<br />
xangrZlivi vadis manZilze pacientisaTvis<br />
Camanacvlebeli narkotikuli saSualebis<br />
micemas, rac sasurvelia xorcieldebodes<br />
fsiqo-socialuri reabilitaciis<br />
RonisZiebebTan kompleqsSi. dResdReobiT,<br />
CanacvlebiTi Terapia opioidebze damokidebul<br />
pirTa mkurnalobis, dekriminalizaciis,<br />
socialuri integraciisa da `quCis<br />
narkotikebis” moxmarebiT gamowveuli zianis<br />
Semcirebis (maT Soris Sidsisa da hepatitebis<br />
virusebiT dainficirebis) yvelaze<br />
efeqturi da iafi saSualebaa.<br />
ra aris Camanacvlebeli<br />
preparati?<br />
opioiduri damokidebulebis CanacvlebiTi<br />
mkurnalobisTvis gamoiyeneba Camanacvlebeli<br />
opioiduri preparati _ samkurnalwamlo<br />
saSualeba, romelic miekuTvneba<br />
opioidTa jgufs. amJamad CanacvlebiTi<br />
TerapiisTvis, Tavisi specifiuri samkurnalo<br />
Tvisebebis gamo ZiriTadad gamoiyeneba<br />
metadoni. Tumca ukanasknel wlebSi sul<br />
ufro xSirad iyeneben SedarebiT naklebad<br />
narkogenul preparat buprenorfinsac.<br />
ra aris metadoni?<br />
metadoni xangrZlivi moqmedebis sinTezuri<br />
narkotikuli saSualebaa. igi opioidebis<br />
`agonistia”, rac imas niSnavs, rom is<br />
morfinisa da misi msgavsi sxva narkotikuli<br />
saSualebebis analogiurad moqmedebs.<br />
metadoni pirvelad damokidebul pirTa CanacvlebiTi<br />
mkurnalobisTvis gamoyenebul<br />
iqna XX saukunis 60-ian wlebSi. rodesac<br />
metadoni Sesabamisi dozebiT gamoiyeneba<br />
5<br />
CanacvlebiTi TerapiisTvis, ar iwvevs eiforiis<br />
da sedaciis gancdas, koordinaciisa<br />
Tu yuradRebis darRvevas. amave dros,<br />
adeqvaturi doza narkotikuli efeqtis<br />
warmoqmnis gareSe aRmofxvris narkotikebis<br />
moTxovnilebas da aRkveTis sindromis<br />
(e.w.”lomkis”) niSnebs. rogorc wesi,<br />
eqimis meTvalyureobis qveS metadoniT<br />
mkurnalobisas pacienti Tavs normalurad<br />
grZnobs, adeqvaturi da Sromisunariania.<br />
opioiduri damokidebulebis Canacvlebi-<br />
Ti Terapia rekomendebulia jandacvis msoflio<br />
organizaciis mier. amave organizaciis<br />
mier metadonis hidroqloridi Setanilia<br />
ZiriTad medikamentTa CamonaTvalSi.<br />
rogoria saqarTveloSi<br />
CanacvlebiTi Terapiis<br />
danergvis saWiroeba da<br />
perspeqtiva?<br />
dRes saqarTveloSi, rodesac aseTi ma-<br />
Ralia <strong>narkomaniis</strong> gavrceleba, sasurvelia<br />
danergili iyos mkurnalobis yvela meTodi,<br />
romelTa efeqturobac mecnierulad<br />
aris dadgenili. amgvar meTodebs miekuTvneba<br />
CanacvlebiTi Terapiac. marTalia, es<br />
meTodi panacea ar aris, magram pacientTa<br />
garkveuli procentisTvis Sedegiania.<br />
2005 wlidan TbilisSi, narkologiis samecniero-kvleviTi<br />
institutis bazaze amoqmedda<br />
metadoniT CanacvlebiTi Terapiis<br />
pirveli programa. es programa finansdeba<br />
SidsTan, tuberkulozTan da malariasTan<br />
brZolis globaluri fondis mier. igi<br />
emsaxureba 60 pacients. wlis bolomde<br />
gaixsneba kidev ori centri (Tbilissa da<br />
baTumSi). samive centri umkurnalebs 200mde<br />
pacients.<br />
<strong>narkomaniis</strong> <strong>Sesaxeb</strong>
<strong>narkomaniis</strong> <strong>Sesaxeb</strong><br />
6<br />
vin SeiZleba CaerTos<br />
metadoniT CanacvlebiTi<br />
mkurnalobis programaSi?<br />
metadonuri programebi yvela pacientisTvis<br />
ar aris rekomendebuli. metadoni<br />
sakmaod Zlieri narkotikia da Tavad iwvevs<br />
da mokidebulebis Camoyalibebas. amitom,<br />
ase Ti mkurnaloba ar aris rekomendebuli<br />
SedarebiT axalbeda narkotikebze damokidebuli<br />
pirebisTvis. es meTodi ufro<br />
ise Ti pacientebisTvis aris gankuTvnili,<br />
romlebmac ramdenjerme ukve scades unarkotiko<br />
meTodebiT mkurnaloba, magram sasurvel<br />
Sedegs ver miaRwies.<br />
amitom, metadoniT CanacvlebiTi mkurnalobis<br />
programaSi pacientTa CarTvis kriteriumebi<br />
specialurad aris gansazRvruli<br />
jandacvis ministris `opioiduri damokidebulebis<br />
CanacvlebiTi mkurnalobis<br />
programebis ganxorcielebis meTodikiT”.<br />
kriteriumebi Semdegia:<br />
1. opioidebze damokidebulebis sindromis<br />
(aqtiuri damokidebuleba) diagnozisa<br />
da masTan erTad me-2 punqtSi<br />
aRniSnul kriteriumTagan aranakleb<br />
erT-erTis arseboba;<br />
2. a) aranakleb 25 wlis asakisa; opioiduri<br />
jgufis narkotikuli nivTierebebis<br />
moxmarebis minimum 3 wlis, amasTan,<br />
intravenuri moxmarebis, sul mcire, 1<br />
wlis staJis arseboba; opioiduri damokidebulebis<br />
sxva meTodebiT warumatebeli<br />
mkurnalobis, minimum, ori<br />
SemTxveva.<br />
b) aiv/inficireba, SidsiT daavadeba;<br />
g) fexmZimoba;<br />
d) sxva gansakuTrebuli klinikur-socialuri<br />
maCveneblebis SemTxvevaSi, ga-<br />
monaklisis saxiT, eqspertTa sabWos<br />
gadawyvetileba.<br />
rogor xdeba pacientebis<br />
mier `quCis” narkotikebis<br />
miRebis Tavidan acileba?<br />
`quCis” narkotikebis miRebis Tavidan acilebis<br />
mizniT pacientebs regularulad<br />
utardebaT Sardis qimio-toqsikologiuri<br />
kontroli narkotikuli/fsiqotropuli niv<br />
Tierebebis Semcvelobaze. pacientis mier<br />
mkurnalobis reJimis darRvevis, maT Soris<br />
eqimis daniSnulebis gareSe narkotikebis mi-<br />
Rebis SemTxvevaSi, igi gairicxeba samkurnalo<br />
programidan. eqimis daniSnulebis ga reSe<br />
narkotikis miRebis SemTxvevaSi, CanacvlebiTi<br />
Terapiis programaSi yofna ar aTavisuflebs<br />
pacients kanonis winaSe pasuxismgeblobisgan.<br />
ras isaxavs miznad<br />
aRniSnuli programa?<br />
programis ZiriTadi mizani aris opioidebze<br />
damokidebuli pacientebis fsiqikuri<br />
da fizikuri janmrTelobis gaumjobeseba,<br />
maTi Camocileba narkotikebTan dakavSirebuli<br />
kriminaluri saqmianobisagan, sazogadoebaSi<br />
integrireba, aiv/Sidsis da hepatitebis<br />
gavrcelebis SezRudva. pacientebTan<br />
muSaobs specialistTa gundi, romlebSic<br />
eqimebisa da eqTnebis garda Sedian fsiqologebi<br />
da socialuri muSaki. programis<br />
saboloo mizania pacientebis sruli ga-<br />
Tavisufleba narkotikebisgan, maT Soris<br />
metadonisgan.<br />
eqimi-narkologi, med. mecn. doqtori,<br />
profesori gela leJava<br />
eqimi-narkologi, med. mecn. kandidati<br />
xaTuna TodaZe.
uyureT gadacemas<br />
`Tqveni eqimi”, kviras 13:15 imedis arxze<br />
7<br />
<strong>narkomaniis</strong> <strong>Sesaxeb</strong>
<strong>narkomaniis</strong> <strong>Sesaxeb</strong>
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