This week, diplomats gathered at the United Nations in New York will adopt a document outlining the future of global drug policy — a text that may have been better in the eyes of many advocates if it weren't for one country: Russia. Moscow's rise as the most vocal proponent of the drug war not only affects the pace of change worldwide, it has also created a domestic HIV crisis, and coincided with allegations of corruption among top Russian drug officials.
The outcome document of the UN General Assembly's Special Session on Drugs (UNGASS) was drafted in Vienna last month. There, at the UN's Commission on Narcotic Drugs, amid little media scrutiny, Russia was again able to employ the outsized influence, and the ability to meddle, that it has long enjoyed. VICE News spoke with nearly a dozen diplomats and national officials, and nearly all of them mentioned specific examples of Russian intransigence during negotiations, or alluded to the pall it cast over the consensus-based drafting process, a setup that effectively gave Russia a veto in many areas.
Central to Russia's interventions was an insistence that the words "harm reduction" not be included in the document. Since the last time the General Assembly met for a special session on drugs, in 1998 — when countries convened under the risible slogan "A Drug Free World - We Can Do It" — harm reduction methods, including needle exchange programs and opioid substitution therapies such as methadone, have become mainstream in many parts of the world, backed by countless studies showing their efficacy. Relevant UN agencies endorse the term, including the World Health Organization (WHO), which says it "strongly supports harm reduction as an evidence-based approach to HIV prevention, treatment and care for people who inject drugs."
"They postponed all negotiations about any changes in terms of effective treatment and effective intervention until the last minute… they said, 'This is too complicated, at this moment it's not acceptable,'" said one senior European drug official, who spoke on condition of anonymity in order to discuss the negotiations. "They deny evidence that we learned decades ago, that what you have to do is just introduce replacement therapy. They bullied everyone."
In the end, the outcome document did reference several aspects of harm reduction, including both needle exchange and substitution therapy, but the term itself was out. Conservative countries, including Russia, pushed for the inclusion of language that deferred to "national legislation" — a carveout that appears 18 times in the document — effectively giving member states the room to ignore what the document actually suggests.
Many countries will continue implementing the tenets of harm reduction regardless of the language member states choose. But for Russians themselves, Moscow's hardline drug policies have already had deadly repercussions.
Drug use in Russia exploded after the fall of the Soviet Union, though heroin addiction had already begun to grow among soldiers returning from Moscow's ill-fated invasion of Afghanistan, currently the world's largest producer of opium. Today, Russian officials estimate there are more than a million heroin users, though experts say the true number could be double, if not higher. Drug users are stigmatized and often turned away from hospitals. After flirting with decriminalizing small amounts of drugs, Russian law enforcement returned to locking up users, going so far as to raid nightclubs and urine-test everyone inside.
Much of the heroin in Russia today originates in Afghanistan, and Russian drug officials have repeatedly blamed the US and its NATO allies for destabilizing Afghanistan, which led poppy production in the country to soar.
"Over the past 14 years, since the start of Operation Enduring Freedom, Afghan heroin has killed more than 1 million people in Eurasia, including at least half a million Russian citizens," Russian drug czar Viktor Ivanov said in 2014. The Kremlin has blamed foreigners for both drug trafficking in the country and drug use by Russians.
Owing in large part to Russia's refusal to offer harm reduction programs, the country is now experiencing a full-blown crisis of HIV and other communicable diseases. In January, Russia passed a grim milestone, registering its millionth HIV-positive patient. The true number is likely at least 50 percent higher, according to the country's top HIV expert, who warned that 3 million people — more than 2 percent of Russia's population — could be infected within five years. According to the Andrey Rylkov Foundation, a Russian organization that advocates for changes to drug policy, up to 90 percent of injecting drug users in some cities are infected with Hepatitis C.
'They deny evidence that we learned decades ago… They bullied everyone.'
Vladim Pokrovsky, chief of Russia's federal AIDS center, has reported that 20 percent of drug users are HIV positive, as well as 10 percent of gay people. According to the UN, half of Russia's 100,000 new HIV cases last year were among injecting drug users. As rates increase, Pokrovsky warns that HIV could evolve into a generalized epidemic infecting all parts of Russian society.
In comparison, Western European countries that employ harm reduction have all but stopped HIV transmission among drug users, including those that inject substances like heroin, who traditionally have been most at risk. But Russia remains steadfast in its refusal to use substitution treatments like methadone or buprenorphine, both drugs considered "essential medicines" by the WHO for treatment of opioid addiction.
"To the Russians, these treatments implicitly mean you can go on using drugs, so it is incompatible with a world without drugs," said Michel Kazatchkine, the UNs Special Envoy for HIV/AIDS in Eastern Europe and Central Asia.
"Of course, the answer for me is that first, health should be the priority, health of the individual, and public health," said Kazatchkine. "Even if you feel that you are somehow in contradiction with some of your internal laws and policies, you should revise those policies and laws because of public health emergencies, not the opposite. But in Russia we end up with a strategy that is not an answer to the current epidemic."
In Vienna, Russia's opposition went far beyond simply excising the term harm reduction from the outcome document. Russian diplomats raised objections over references to the fast-acting opioid overdose drug Naloxone, and they continued to insist that the UN reference "scientific" evidence in its drug policy, instead of "evidence-based" findings. The distinction appears innocuous at first, but it reflects Moscow's privileging of "Narcology," its own controversial approach to drug use that dates to the Soviet Union, over research conducted by advocacy and human rights groups.
"Russian approaches to drug dependence are in contradiction to virtually all international scientific standards," said Daniel Wolfe, director of the International Harm Reduction Development Program at the Open Society Foundations. "Russian narcologists — their version of drug dependence specialists — have practiced such therapies as hypnotizing patients and telling them that something in their body will explode if they use drugs, 'flogging' therapy, and putting patients into comas and administering electric shocks. There is no evidence base or reputable science on any of these approaches."
'Russian narcologists — their version of drug dependence specialists — have practiced such therapies as hypnotizing patients and telling them that something in their body will explode if they use drugs.'
Though three quarters of the world's countries have insufficient access to controlled medicines for pain relief — in India alone, a half million cancer patients die every year with essentially no respite from pain — Russia pushed back in Vienna against language on allowing wider access to opioid painkillers, including cheaply produced morphine, for the dying. During negotiations over a separate resolution aimed at elevating gender in drug policy, Russia even objected to a reference to the UN's women's agency.
Mikhail Golichenko, a former legal officer at the UN's Office on Drugs and Crime (UNODC) in Russia, says Moscow's stance internationally reflects deep-seated domestic politics, rooted in nationalist rhetoric, and cast against what is seen as a West bent on allowing greater access to drugs.
"In a way the lack of effective drug treatment works as prevention for drug use, I heard this from many Russian drug officials during my time working with UNODC in Moscow," said Golichenko, who has litigated on behalf of Russian drug users at the European Court of Human Rights. "They say, 'These people are useless for society so it's better to sacrifice them and let them die.' The devastating condition of those that use drugs is a good lesson to society, to see how quickly they are decomposing."
When Russia invaded and annexed Crimea in March 2014, one of its first moves was to end the region's harm reduction programs, which had provided opioid substitution regimes to some 800 users. Faced with the singular option of abstinence-based treatment, many patients returned to the streets and began injecting heroin again. "Patients have been taken hostage in Crimea," said Kazatchkine. Within a year, 80 to 100 people — up to 10 percent of those who had received substitution therapy — died, many of them from overdoses.
"The core point of the Russian drug policy is zero tolerance to drug use, and to prohibit any drug use even for drug treatment," said Golichenko. "We're in a situation where people using drugs have only one choice — either stop using drugs and come back to society, or continue using drugs and this case they will very fast reach an inevitable death from overdose or HIV or tuberculosis."
Russia is by no means the only country to push back against progressive drug policy language in UN texts. But even member states that are often mentioned alongside Russia, including China, and Iran, where hundreds of drug offenders are executed every year, do employ harm reduction. In its total opposition, Russia stands alone among the permanent five Security Council members, including the US, which has slowly attempted to shed its former status as top enforcer of drug war.
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Among European officials, Russia's hard-line approach and the exploding number of drug users overlap with darker theories about the Kremlin's top leadership. After the polonium poisoning of ex-Russian intelligence officer Alexander Litvinenko in London in 2006, it emerged that he had been contracted to arrange several due diligence reports vetting Russian individuals for a UK firm.
One of those reports, completed by another former intelligence officer and passed to Litvinenko less than two months before his death and just weeks before an initial attempt to poison him, concerned Ivanov, the soon to be Russian drug czar and longtime confidant of Russian President Vladimir Putin. The dossier alleged that Ivanov had links to mafia connections in St. Petersburg at a time when drug trafficking was rife at the city's port, and that these connections helped his rise under Putin. The report allegedly ended a promising business deal in Russia involving Ivanov.
The official British inquiry into Litvinenko's death, issued earlier this year, concluded "there is reason to think that this report might have found its way back to Mr. Ivanov and others in the Kremlin, together with the fact that Mr. Litvinenko had been responsible for preparing it." At the time of Litvinenko's death, Russia's ambassador to the United Kingdom was Yuri Fedotov, the current head of the UN's Office on Drugs and Crime.
Ivanov called the dossier "absolute nonsense," denied that it scuttled any deal, and said he had no hand in Litvinenko's death. The British inquiry found that the two men who poisoned Litvinenko in London were acting under the guidance of Russia's Federal Security Service — successor to the KGB — and said Putin "probably" approved the assassination.
'This is like climate change denialists hosting a look at global warming.'
The murky history of Russia's top drug official and his alleged ties to organized crime have convinced some European officials that Moscow's drug and crime officials are profiting from the domestic explosion in drug addiction.
"This is an enormous source of money — why would you destroy it by [legalizing] methadone?" asked the same top European drug official who referenced Russia's stonewalling during the Vienna negotiations.
Experts have also said that Russia's security services, including the Federal Drug Control Service of Russia (FSKN), which coordinates Russia's limited rehabilitation programs, are rife with corruption
"Not only are many gangs associated with, or paying of, the local police, Federal Security Service (FSB), or FSKN, there are also elements within the security apparatus that are directly involved," NYU professor Mark Galeotti wrote in a recent study on nationalism and drug policy in Russia, published by the Brookings Institution.
However, there are signs that the Kremlin is perturbed by the current drug control regime in light of corruption allegations. Earlier this month, Putin issued a decree that abolished the FSKN, transferring its responsibilities to the Ministry of Internal Affairs. Ivanov's leadership of the FSKN saw an increasingly security-based approach to the country's drug epidemic, and Ivanov himself took Russia's views on the global stage. It remains unclear where he will land after the domestic shakeup.
"The dissolution gives hope that Russia will start learning from best practices of European states and stop bringing pseudoscience and inhumane drug policy to foreign nations," said Golichenko.
Kazatchkine, the UN envoy, said things already seem to be improving in Russia in some ways. After many years of appearing to underestimate the number of HIV infections in the country, Russian data now concurs with the UN's own figures. But harm reduction remains a third rail in the national discourse.
"I believe the evidence [in favor of harm reduction] there is comprehensive, compelling and indisputable," said Kazatchkine. "But that evidence is not acceptable to the Russian Federation."
That dynamic makes two events this week in New York on the sidelines of UNGASS curious occurrences. Both sponsored by Russia, the gatherings each pertain to "the importance of dialogue between the international and scientific community in dealing with the world drug problem."
"This is like climate change denialists hosting a look at global warming," said Wolfe.
Follow Samuel Oakford on Twitter: @samueloakford