Russia’s annexation of Crimea earlier this year is having a painful effect on the peninsula’s 806 registered heroin addicts, who until the takeover were receiving opioid substitution therapies (OST), such as methadone treatment. The international community had previously commended the former Ukrainian republic for its innovative schemes, including OST and needle exchange programs, which drastically reduced drug-related crime and fatalities. Most significantly, they were also applauded for reducing HIV transmission. Since May 1, however, the region has been forced to adopt Russia’s archaic drug laws and, in turn, abandon working policies.
The International Aids Alliance in Ukraine reported in July that at least 20 people have died since these programs were withdrawn. Some users have fled to the mainland to continue treatment, while others, without the means to travel, have been jailed for substance abuse. From these 20 deaths, there have been at least three suicides, of which one included a patient trying to escape a Russian detox facility.
'Dozens more will die before the end of the year.'
Pavlo Skala, the program manager for the International Aids Alliance in mainland Ukraine, is currently hosting and treating 56 Crimean patients. Skala told VICE News that he expects about 70 percent of these people will have to return to Crimea as they don’t have the income or ability to stay.
“Dozens more will die before the end of the year,” Skala said, blaming Russia’s detoxification and rehabilitation policies, which teach complete and immediate abstinence from drug use, regardless of a patient’s physical dependence. Skala explained that these policies are rarely successful and, according to his own research, 90 percent of patients relapse after treatment. As he explains though, that information is doggedly suppressed. “[Russian authorities] are very unhappy with us for disclosing this information,” Skala said. “They like to claim that all patients are happy, but it is a completely different story in reality.”
One example of an unhappy patient is 35-year-old Oksana, who called Radio Liberty Ukraine, to give her account of the situation. As she told the radio host, she was fortunate enough to leave for Kiev after the closure of the Simferopol OST clinic, but she didn’t think there was an alternative.
"When I learned that our program was being shut down in Crimea, it was a huge shock for me. I didn't know what to do and was hysterical. I might have died if I remained in Crimea without medicine. I am disabled. I have had a stroke and I know very well how it feels to be left without therapy and help. The former patients in Crimea, who do not have an opportunity to move, are in a terrible condition. Many of them are thinking of suicide, and several have already tried.”
Despite the success of OST in Ukraine, and 55 other countries internationally, Russian officials have remained ideologically opposed. Viktor Ivanov, the head of Russia’s Federal Anti-Narcotics Agency, is one such official leading the charge against OST.
'There’s no drug treatment protocol that’s been better studied than methadone maintenance treatment.'
“Methadone is not a cure. Practically all methadone supplies in Ukraine were circulating on the secondary market and distributed as a narcotic drug in the absence of proper control. As a result, it spread to the shadow market and traded there at much higher prices. It became a source of criminal incomes,” Ivanov said as he announced on March 26 that Russia would ban methadone in Crimea.
Ivanov argued in 2011 that there are “no clinical trials to prove the effectiveness of the method.”
This position has been unanimously dismissed by the general scientific community, as well as organizations such as the UN and the World Health Organization, which states that OST is “one of the most effective treatment options for opioid dependence.”
Scott Burris, director of the Center for Health Law, Policy and Practice in Philadelphia, responded directly to Ivanov, describing his claims as “sheer fantasy, if not outright mendacity.” According to Burris: “There’s no drug treatment protocol that’s been better studied than methadone maintenance treatment. It consistently performed well not only on its own terms, but also in comparison with other forms of drug treatment.”
Meanwhile, back in Ukraine, the reinstatement of OST programs has become a top priority for the activist group Eurasian Network of People Using Drugs. They’ve started staging protests in Kiev, calling for the national government to act.
The International HIV/Aids Alliance is also campaigning for Russia’s drug policies to be repealed, saying that the former program lowered the rates of HIV, tuberculosis, and Hepatitis C infections. And while Ukraine has managed to reduce these numbers, Russia’s reactionary drug policy has contributed to HIV cases increasing from 170,000 in 2004 to 1.2 million today, with injecting drug users being the most at risk.
Unfortunately, the Russian government seems content in their policies that foster neglect, stigmatization, and ostracism. And while drug dependency is arguably a result of choice, the spread of transmissible diseases shouldn’t be.
Image via Flickr