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Walter Armstrong Walter Armstrong

Drug Users Plan to Flee Crimea as Russia Blocks Harm Reduction Programs


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Today, Crimea’s Russian-backed government formally declared its independence from Ukraine and asked Russia for annexation. Drug users there are verging on panic, according to a coalition of advocacy groups called the International Network of People who Use Drugs (INPUD).

In an announcement released this morning, INPUD warns that the Russian military occupation of Crimea poses grave health risks to opioid users, as new shipments from Ukraine of opioid-substitution therapy (OST)—methadone and buprenorphine—are being blocked by Russian-affiliated  troops. Existing clinics report that they have supplies sufficient for only a few more weeks. One clinic is already decreasing the daily patient dose.

Since highways into Crimea are blocked by armed men, medicines supply is impossible (narcotic drugs must be attended by an armed police squad). —Alliance Ukraine

Ukraine enjoys a progressive European-style health policy of harm reduction, with plentiful opiate-replacement clinics and clean-needle ops. Alliance Ukraine, a national HIV/AIDS advocacy group, works closely with the the health ministry to promote evidence-based services (albeit controversial in conservative Crimea). By contrast, Russia persists in a punitive approach, with only abstinence-based treatment legal while syringe swaps are tolerated but with scarce funds.

In the likely event of Crimea’s shutdown of these life-saving services, the region’s estimated 800 drug users face a desperate future, including relapse, overdose, HIV and hepatitis C infection, and imprisonment. Some are already making plans to flee Crimea, according to INDUP. Others are bracing for the worst.

Drug users are likely to be among the first refugees from Crimea and, if they cannot leave, will experience immediate breaches of their human rights and a decline in their health. —INDUP

INDUP is calling on WHO and UNAIDS, which have long deemed the provision of clean needles and OST “essential medicines,” and their denial a violation of human rights, to “make public statements” urging Russia to allow the continuation of these programs in Crimea.

No one imagines that Vladimir Putin will be deterred by public statements. But INDUP’s warning today is at least a first step toward publicizing the potential catastrophe that drug users, typically ignored, face. Whether a powerful alliance of international agencies and advocacy organizations can unite on behalf of the 800 drug users in dire straits in Crimea remains to be seen.