Drug users in Crimea are facing disaster as they watch the stock piles of methadone and buprenorphine – medications that allow them to live normal and productive lives – run out in front of them, likely for good.
Those following the situation in Crimea have undoubtedly heard the concerns of the Tatars, the Jewish community, and even the affluent middle class, but the group in the most immediate danger of having life as they know it turned on its head – 803 drug users in opiate substitution therapy (OST) programs – have, as is often the case, received little attention.
Ironically, the March 16 referendum in Crimea took place at the same time as representatives from nearly every country met at the United Nations (UN) in Vienna to discuss the world drug problem at the annual meeting of the Commission on Narcotic Drugs (CND). For individuals like myself who are part of the drug policy reform community and were present at the CND, the outcome of the referendum was viewed through the lens of drug policy. Crimea, a region with progressive drug policies, had voted to be integrated into the Russian Federation, a nation that falls on the opposite end of the drug policy spectrum.
Since 2006, Ukraine has been in leader in harm reduction in Eastern Europe, implementing programs that reduce the harms associated with problematic drug use, such as OST. Beyond enabling drug users to participate in society by making them feel well or normal, such programs have also been credited with the dramatic decline in the HIV infection rate amongst drug injectors in Ukraine, who went from accounting for 62% of new HIV infections in 2002 to 33% in 2013. Another key benefit of OST is that it acts as a gateway for sick and marginalized people to access health services, such as treatment for HIV/AIDS, hepatitis, and tuberculosis.
Russia takes a “war on drugs” approach to drug policy, recommending that addicts quit cold turkey, banning the use of methadone and many other harm reduction programs, and imposing severe punishments for even minor drug offences. These strategies are blamed for the 11% increase in the number of people registered as HIV positive in Russia in 2013. On March 20, the head of the Russian Federal Drug Control Service, Viktor Ivanov, announced his intention to shut down OST programs in Crimea as his first priority. This came as a surprise to patients, who had been assured by local doctors prior to the referendum that the OST programs would be extended to at least the end of the year, and many of which had voted to join Russia.
However, even before Crimea has been integrated into the Russian Federation, the effects of Russia’s approach to drug policy have already seeped into the region. Roads to the peninsula have been under the control of Russian law enforcement for weeks, making the supply of drugs to the OST programs in Crimea impossible. Any hope for future supplies was squandered when the Ukrainian health minister stated that Ukraine would not be sending any more methadone or buprenorphine to Crimea, and that patients should move to the mainland if they wish to continue their OST programs. OST programs in Crimea have at most enough drug supplies to last till mid-April, and have already begun cutting back patient doses to ensure the supplies last as long as possible.
The abrupt end of the OST programs in Crimea means three things for patients. First, extreme withdrawal symptoms will interrupt the lives of drug dependent patients, leading to increases in acute illness and the number of patients reverting to self medicate through the illegal market. Second, Crimea is at risk of a rapid growth in the HIV infection rate, potentially to Russian levels, which would irreversibly undermine years of effort to reduce the spread of AIDS in Crimea. Third, patients will lose accessible health facilities that provide them with essential treatment for HIV/AIDS, hepatitis, and tuberculosis. Unless they leave their homes and relocate their lives, this is the bleak and immediate future of OST program patients in Crimea.
In case you are not already outraged by the blatant disregard for the human, and particularly health, security of Crimean OST patients, it is worth remembering that both methadone and buprenorphine are included in the World Health Organization (WHO) Model List of Essential Medicines and OST programs are recognized by the WHO and by UN agencies as an essential response to preventing HIV amongst drug users. Despite all of this, the efforts of the drug policy reform community, particularly organizations representing people who use drugs such as INPUD and ENPUD, have been fruitless. Methadone and buprenorphine stocks continue to diminish and the continuation of OST programs in Crimea seems a remote possibility. Fear runs high in Crimea, as OST patients know that any dose could be their last.
Check out this video by ENPUD to hear what Crimean OST patients have to say for themselves.