Global health centre
20 January 2015

Why drug policies matter: the case of Crimea

Staunch drug policies in Crimea have led to the deaths of nearly one hundred drug users since the territory was annexed by Russia in March 2014, Global Health Programme Senior Fellow Michel Kazatchkine told journalists this week. Before annexation, 805 people in Crimea were receiving opioid substitution therapy (OST) using methadone or Buprenorphine, an internationally supported treatment that offers drug users a decriminalised and safe method of taking drugs without exposing themselves to HIV and other transmissible diseases through injection.

In place in Ukraine since 2005, OST programs were halted within a month of Russia’s annexation of Crimea, far too quickly for many users to be safely weaned off the drugs.  “This is discontinuing a treatment recommended by the World Health Organisation and UNAIDS; a standard international treatment that is evidence based,” said Kazatchkine. “People had to go abruptly from a state of physical, psychological and social stability in their lives to going back to the hell of street drugs, in a particularly difficult context.”

As a result, an estimated 10% of those formerly in OST programs have died, largely due to overdose and suicide, according to Kazatchkine, who is the United Nations Secretary-General's Special Envoy for AIDS in Eastern Europe and Central Asia. "This is the region where, firstly, the AIDS epidemic continues to grow and secondly, where the AIDS epidemic is largely dependent on people who use drugs," he said.

OST programs are banned in Russia, which operates stringent detoxification programs. Kazatchkine remarked that dialogue with Russian authorities regarding their position on OST has been “hugely difficult”. Moreover, due to the ongoing conflict in eastern Ukraine, the estimated 550 patients on OST therapy in this region also risk having their treatment interrupted as Ukraine stops providing drugs to rebel-held territory. "With the border now blocked, major stockouts (shortages) of antiretroviral drugs, OST and other life-saving treatments are anticipated by the end of February," explained Kazatchkine. These public health concerns, already directly affecting the lives of drug users in the region, will be included in a report to be given by Kazatchkine to UN Secretary General Ban Ki-moon.