Bioethical Differences Between Drug Addiction Treatment Professionals Inside and Outside the Russian Federation Mendelevich

Bioethical differences between drug addiction treatment professionals inside and outside the Russian Federation Mendelevich Mendelevich Harm Reduction Journal 2011, 8:15 http://www.harmreductionjournal.com/content/8/1/15 (10 June 2011) Mendelevich Harm Reduction Journal 2011, 8:15 http://www.harmreductionjournal.com/content/8/1/15 RESEARCH Open Access Bioethical differences between drug addiction treatment professionals inside and outside the Russian Federation Vladimir D Mendelevich Abstract This article provides an overview of a sociological study of the views of 338 drug addiction treatment professionals. A comparison is drawn between the bioethical approaches of Russian and foreign experts from 18 countries. It is concluded that the bioethical priorities of Russian and foreign experts differ significantly. Differences involve attitudes toward confidentiality, informed consent, compulsory treatment, opioid agonist therapy, mandatory testing of students for psychoactive substances, the prevention of mental patients from having children, harm reduction programs (needle and syringe exchange), euthanasia, and abortion. It is proposed that the cardinal dissimilarity between models for providing drug treatment in the Russian Federation versus the majority of the countries of the world stems from differing bioethical attitudes among drug addiction treatment experts. Introduction deontological norms [6,10]. Although there have been Russian and international narcology (addiction medi- calls for adherence to the principles of medical ethics, cine) began to develop along divergent paths during the the procedures put into practicecontinuetobeincom- second half of the twentieth century. Indeed, Russian patible with these principles. Drug addicts still have narcology has ceased to be a part of international nar- even fewer patient rights than the mentally ill. They cology. There are cardinal differences in current scienti- have been exposed to discrimination and stigmatization ficviewsonthenatureofdependency,its both in society and within drug treatment facilities. neurobiological or psychopathological bases, and on They have quite often been perceived by physicians as standards of therapy and how best to organize narcolo- deviants or criminals, since during the Soviet period gical care [1-9]. In 1976 Soviet narcology cut “the umbi- they were subject to measures of compulsion, isolation lical cord” connecting it with psychiatry and began to be and re-education. seen as an independent discipline. No longer was it con- Contemporary Russian narcology is one of the few sidered necessary for experts to seek an underlying psy- medical specialities in which doctors’ and health care chiatric cause to addiction. In contrast, in the vast workers’ ethical and deontological priorities still guide majority of countries, narcology evolved within the the processes of diagnosis, therapy and rehabilitation boundaries of psychiatry. There is evidence to suggest [11]. It is not unusual for an adolescent who has been that a principal cause of the current differences between caught taking drugs to be forced to register with a nar- Russian and international narcology is the distance cology clinic and deprived of rights. The choice of what placed between Soviet narcology and psychiatry, a therapeutic or rehabilitative approach to use (including breach that paved the way toward repressive measures those that involve compulsion) is often made on the against patients. false premise that drug addiction is not a disease, but a In parallel with these trends in Russian narcology form of deviant behavior. In spite of the fact that narcol- there has been a gradual assessment of bioethical and ogy has a psychiatric component, the standards of bioethics and medical law that are observed in psychiatry [12-17] are not always applied to it. The legitimacy Correspondence: [email protected] and expediency of applying the norms dictated by the Kazan State Medical University, Department of Medical and General Psychology, 49 Butlerova Street, Kazan 420012, Russia Russian Federation law “Concerning Psychiatric Care © 2011 Mendelevich; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Mendelevich Harm Reduction Journal 2011, 8:15 Page 2 of 6 http://www.harmreductionjournal.com/content/8/1/15 and Guaranteeing Patient Rights” [18] to drug addicts psychiatry, narcology, and psychotherapy in the coun- are still being debated today [19,20]. try’s medical universities, and also to addiction, psychia- Thiscanprobablybeseenasstemmingfromthevery tric, and medical associations, university departments of different attitudes doctors have toward mental illness psychiatry, and addiction treatment centers located in and the disease of drug addiction and, as a consequence, various countries. In total, more than 1000 question- toward observing standard bioethical principles. Accord- naires were distributed (700 across the Russian Federa- ing to sociological research [5], a large number (almost tion and nearly 300 internationally). A total of 264 half) of Russian psychiatrists working in the area of nar- completed Russian-language questionnaires and 92 Eng- cology unequivocally believe that drug dependence and lish-language questionnaires were returned by respon- alcoholism are not mental disorders or diseases but are dents to researchers. Completed questionnaires were rather caused by “dissoluteness.” Probably for this rea- received from 18 countries: Australia, Belgium, Brazil, son 54.5% of experts in drug addiction treatment iden- Great Britain, Vietnam, Germany, Israel, Italy, Canada, tify religion as “the most effective method for treating China, Latvia, Macedonia, the Netherlands, the United drug addiction.” States, Thailand, France, Croatia, and Montenegro. All The hypothesis underlying the present study is that 246 Russian and 92 English questionnaires appeared to Russian and foreign drug treatment professionals config- be correctly completed and were therefore submitted for ure their bioethical priorities very differently. In this statistical processing. The study sample consisted of 338 connection, its method applied a sociological approach persons: 138 men (40.8%) and 200 women (59.2%). to studying the specific attitudes held by Russian and Tenure in the field ranged from 1 to 30 years. Results foreign specialists working in drug treatment toward were accepted on a non-selective basis. various actual questions of contemporary bioethics and medical law. Some of the questions had to do with con- Results and discussion tentious issues of bioethics in general and some were respondent attitudes toward the various controversial specific to psychiatry and narcology. Among the former topics of bioethics and the medical law - were distribu- were questions relating to euthanasia, abortions, gender ted as follows (Table 1). reassignment operations, cloning, the use of placental Survey findings indicate that attitudes toward the stem cells, organ transplantation, placebo-controlled majority of bioethical questions (12 of 19) among Rus- clinical trials, the responsibility of HIV+ patients for sian and foreign experts differ significantly. Despite the their own illness, and Harm Reduction programs (the fact that respondents were in agreement in seeing “drug exchange of needles and syringes, recommendations addiction [as] an illness requiring medical treatment about condom use). Among the latter were questions (like other illnesses),” instead of “a deviant behavior that connected with respondent attitudes toward compulsory requires rehabilitation,” which would seem to suggest treatment in narcology, compulsory (obligatory) testing that they would also share attitudes toward the impor- of students and schoolchildren for the use of psychoac- tance of observing principles of bioethics, this is not tive substances, opioid substitution therapy, the permis- reflected in practice. sibility of disclosing confidential information or Significantly different attitudes on the part of Russian infringing the principle of informed consent in psychia- and foreign drug addiction treatment professionals try and narcology, and the permissibility of preventing toward bioethical problems confronted in narcology the mentally ill from having children. were identified in regard to: the need to observe confi- To carry out the study, a questionnaire consisting of dentiality; informed consent; the permissibility of com- 19 questions both a Russian and English version (I pulsory treatment; and substitution therapy. More than would like to express my gratitude to IHRD for help half (55.7%) of the Russian specialists surveyed as com- translating the questionnaire) was created. Research was pared to 24% of foreign specialists (p < 0.01) felt that conducted anonymously. The respondents were profes- information about mentally ill patients and drug addicts sionals actively engaged in providing narcological care could be given to law enforcement services “in order to (psychiatrists, experts in drug addiction treatment) who support safety in the community.” This suggests that wished to take part in the study. (Under the circum- one of the tendencies in Russian narcology is to permit stances, it was not deemed necessary to obtain informed infringement of the principle of confidentiality

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