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Crimea annexation to signal harm reduction crisis
Fears are growing over the future health and wellbeing of up to 14,000 drug users in the Crimea region following its annexation from Russia. The head of the Russian Federal Drug Control Agency, Viktor Ivanov, stated that the closing down of opioid substitution therapy (OST) clinics in the region was an immediate priority for the agency. The International HIV/AIDS Alliance and the International Network of People who Use Drugs (INPUD) have both issued statements regarding their concerns about repressive Russian drug policy, and the impending health crisis that would ensue if drug users were abruptly cut off from services.
Maintenance therapy, or OST, involves the provision of methadone or buprenorphine to drug users as a way of minimising the risks associated with injecting. These programmes aim to curb needle sharing, the use of contaminated street drugs, overdoses, and crimes associated with funding drug addiction. Both Russia and the Ukraine have large injecting drug user populations, with the majority of HIV infections a result of injecting drug use. However, Russia is vehemently opposed to the provision of OST, instead preferring detoxification and psychotherapy programmes. This is despite the fact that OST is included in the World Health Organisation Essential Medicines Selection, and is scientifically proven as effective in reducing HIV infections. Other harm reduction initiatives such as needle exchange programmes (NSPs) are also largely inadequate in Russia.
On the other hand, the Ukraine has benefited from an active civil society that delivers extensive harm reduction programmes across the country. In particular, the International HIV/AIDS Alliance in Ukraine (Alliance Ukraine) and their partners reach 196,000 people with HIV prevention services across the country, which has resulted in a year-on-year decrease in new HIV infections among people who inject drugs since 2007.
Andriy Klepikov, Executive Director of Alliance Ukraine, is particularly worried about the 800 patients currently on OST in Crimea. He stated: “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.”
The INPUD, the Alliance and a coalition of other international advocate organisations are calling on the UN and the WHO to support the provision of harm reduction in Crimea, and to call on Russia to desist from closing down these services, both from a public health and human rights perspective.