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Crisis Looms for Addicts as Russia Bans Methadone in Crimea

Things are about to get harder for opiate users in Crimea, the former Ukrainian province now annexed by Russia. While Ukraine has embraced a harm reduction approach to hard drug use, Russia rejects such an approach and has some of the most repressive drug laws in the world.

Oberleitungsbusbahnhof in Simferopol (user Cmapm via Wikimedia)
Russia does not support efficient programs for preventing HIV and Hepatitis C among its drug using population, and harm reduction measures like needle exchanges and opiate substitution therapy (OST), of which methadone maintenance is a subset, are illegal.

Now, the concrete consequences of Crimea's reincorporation into the ample bosom of Mother Russia are coming home for drug users there. On Wednesday, Russian "drug czar" Viktor Ivanov -- one of 31 allies of Pres. Vladimir Putin sanctioned by the US government this month -- announced that Russia will ban the use of methadone in Crimea. That comes after vows a week before that he would move away from harm reduction practices in general in Crimea.

"Methadone is not a cure," Ivanov claimed. "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," he said.

Whatever Ivanov says, cutting off methadone for an estimated 800 patients will be a disaster, the International HIV/AIDS Alliance warned. And the threat of a broader rejection of harm reduction measures puts an estimated 14,000 Crimean injection drug users at risk.

"When the supply of these medicines is interrupted or stopped, a medical emergency will ensue as hundreds of OST patients go into withdrawal, which will inevitably lead to a drastic increase in both acute illness as well as increases in injecting as people seek to self-medicate," said the alliance's Ukraine director, Andriy Klepikov.

"Any interruption to harm reduction programming is a disaster for health, human rights and the HIV epidemic in the region and we urge the authorities in Crimea to step in and ensure that critical supply chains are not disrupted and lives not put at risk as a result of territorial politicking," Klepikov added.

Ukraine has practiced methadone maintenance (or OST) therapy in Crimea since 2005. Patients in Simferopol, Sevastopol, Yalta, Eupatoria, Feodosia, Kerch and other cities receive daily treatment at local healthcare facilities.

The AIDS alliance is not the only group raising the alarm. The International Network of People who Use Drugs (INPUD) has issued an urgent appeal to UN rapporteurs on the Crimea "calling upon you all to issue a public statement making clear the imminent risk that this population faces of losing access to essential medicines, we are requesting that you raise the issue with the Russian government urging them not to close down the currently running opiate substitution programs; and we are calling upon you to raise the issue with utmost urgency with the Human Rights Council with a view to ensuring continued access to the programs."

When it comes to drug policy and harm reduction, Crimea would seem to be worse off as part of Russia than as part of Ukraine. As the AIDS alliance's Klepikov put it:

"The Russian Federation has extremely repressive drug laws and its punitive approach to people who use drugs means that it now experiences one of the highest rates of new HIV infections in the world. Injecting drug users represent nearly 80% of all HIV cases in the country."

Russia
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Bad policy

While I am no friend of methadone,I know that the only thing worse than having a methadone program is not having one.While I would much prefer that heroin maintenance was used in it's stead.Methadone is better than being at the mercy of the black market.Russia has one of the worst heroin addiction problems in the world.While methadone is just another addictive drug and it's use in curing addiction is suspect.It does provide users a source of a legal alternative to heroin,which can be life saving for not only the addicts,but for the people who would become victims of their desperate quest for the next fix.The Russian attitude is exactly what the attitude was here for many years.We finally came to the realisation that providing a legal substitute was far less costly than leaving addicts to their own devices to maintain their drug habit.While there are still many people who don't understand that for some addicts there is no cure.There are others that have reached the conclusion that the best and most cost effective way to deal with addiction is to give the addict their drug of choice and hope that they will come to the knowledge that they are wasting their lives.It's far cheaper to give addicts their drugs than to arrest,convict and imprison them over and over again.Who's to say which is a bigger waste of lives?The claim that the methadone has found it's way into the black market is a total red herring.That's something that can be easily controlled.If there was really a solution to the problems of addiction.We would surely have discovered it by now.

program

It's amusing how Sergei Kislov "voted enthusiastically" for Crimea to join Russia, but is now complaining that the doctors are following Russia's dictates by quickly ending the methadone program. kamille

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