An OST patient in Simferopol, Crimea. OST programmes are to finish soon following annexation of the region by Russia. Credit: HIV/AIDS Alliance Ukraine.
KIEV, Apr 16 2014 (IPS) – As local authorities prepare to put an end to opioid substitution treatment (OST) programmes in the newly annexed Crimean peninsula, drug users there say they are being forced to choose between a return to addiction and becoming refugees.
OST – where methadone and buprenorphine are given to opioid addicts under medical supervision – has been available in Ukraine for almost a decade.
But Russian law forbids its provision, and Russian government officials have said they intend to close OST services in the region by the end of this month.”We don’t know what the future holds. Without substitution therapy, I will die.”
Organisations working to provide services to drug users on the peninsula say this has put the future health of more than 800 people receiving OST in the region in doubt.
They say that distances to the nearest facilities in Ukraine offering the treatment mean it would be impossible for drug users to access OST services without leaving Crimea permanently.
Without this lifeline treatment, they warn, many users will turn back to dangerous drug habits, reverting to crime or prostitution to support their addiction, and sharing contaminated needles.
Anton Basenko, a member of the All Ukrainian Association of OST Participants, told IPS: “Many of these people, just like me, have HIV, hepatitis C and other chronic diseases complementing their drug dependence. Stopping substitution therapy for the majority of them is the same as denying them oxygen to breathe. They are being thrown back to crime and despair.”
Drug users in Crimea who spoke to IPS said they were dreading their futures without OST.
One 32-year-old drug user from Sevastopol, a mother of one who gave her name only as Ludmila, told IPS: “I am hoping to start a full-time job in a few weeks but this will be impossible for me if I cannot receive OST. My husband, who also receives OST, currently has a job but he will lose it if he stops getting his treatment. Ending these programmes will be a disaster for this whole family.”
Another, who gave his name only as Vitaliy, told IPS he had been helped by the OST he had been receiving for the last four years. He said he did not want to leave his home in Sevastopol but was afraid of what might happen to him if he did not.
The 27-year-old said: “I don’t want to go but at the same time I don’t want to return to injection drug use.”
A 37-year-old man who asked to be called ‘Yevgeny Kovalenko’ (not his real name), who has been receiving OST in Simferopol since 2008, said he faced a stark choice.
He told IPS: “I am scared, my friends are scared. We don’t know what the future holds. Without substitution therapy, I will die. And that is not me just being dramatic or using a figure of speech, I will literally die. So will many others.”
Groups such as the say some drug users have already left Crimea to ensure they can continue to access OST. The Alliance is preparing for hundreds to arrive in Kiev looking for help when the programmes close in Crimea.
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But while those who make it to Kiev will be able to get help, those that cannot, or choose not to leave their homes in Crimea, will be left to deal with their addiction in a region where local authorities will be enforcing repressive Russian policies on drugs.
Under Russian legislation, minor drug offences are punished severely with, for example, convictions for possession of even the smallest amounts of heroin – including residue in a syringe. Such offences carry lengthy jail sentences.
Russia has one of the world’s fastest growing HIV/AIDS epidemics, which UNAIDS and other bodies say has been historically driven by injection drug use.
Ukraine, which also has a serious HIV/AIDS epidemic, has recently reduced the rate of new HIV infections – a success put down to the widespread implementation of harm reduction programmes.
It is unclear at the moment what effect Crimea becoming part of Russia will have on the provision of harm reduction services other than the OST programmes.
Ukrainian groups working with drug users say there are more than 14,000 people in Crimea who access such services, and that any threat to their provision could have devastating consequences for their health and create a serious public health threat in Crimea.
Meanwhile, drug users in Kiev are calling on the Ukrainian Ministry of Health to act.
They say that, even if they cannot persuade authorities in Crimea to allow the extension of OST programmes at least until January next year, when all legislation in the peninsula should be brought fully into line with that of the rest of Russia, the ministry should be setting up facilities for OST programmes in other parts of Ukraine.
Basenko told IPS: “Practical steps need to be taken to organise the accommodation of these refugees, these patients from Crimea, so they can continue their treatment in Ukraine.
“Drugs available in Ukraine must be redistributed and additional OST facilities need to be set up to meet the needs of these patients.”