Protest against plans to close substitution treatment programs in Crimea – April 30, 2014

Chairman of Supreme Council of the Autonomous Republic of Crimea KONSTANTINOV Vladimir Andreyevich

Chairman of the Commission of SC ARC on Social Matters, Public Health and Veterans` Affairs ZAPOROZHETS Pyotr Petrovich

95000, Autonomous Republic of Crimea, Simferopol, str. Marx, 18,

Protest against plans to close substitution treatment programs in Crimea

We would like to bring your attention to the problem of substitution treatment in Crimea. Russia’s annexation of Crimea may lead to substitution treatment being discontinued on the peninsula.

Viktor Ivanov, head of Russia's Federal Drug Control Service, has already announced on television that the termination of methadone treatment in the Crimea was one of his most important tasks. Ivanov says that the methadone is not a medicine and that substitution programs do not have any therapeutic effect. ( http://mir24.tv/news/society/10105992 ). Recently, some Russian officials tried to prevent a Ukrainian activist from making a presentation during the UN session on AIDS (http://www.ihra.net/print/1038).

In Russia, where the number of HIV-infected people is estimated at 1.3 million, for many years the authorities have consistently rejected proven tools that could effectively combat the AIDS epidemic among injecting drug users who constitute the vast majority of those living with HIV. For many years, in both Ukraine and in Russia, the HIV epidemic has been driven by infections related to injecting drug use. Several years ago, the Ukrainian authorities decided to introduce opioid maintenance therapy and it started to successfully slow down the spread of HIV in the country.

The situation in Russia is different. Here the use of methadone is being constantly prohibited. President Putin introduced anti-gay laws and bans the effective treatment for drug dependent persons, thus opposing moral superiority of Russian culture to "disintegration of values in the West". His position enjoys strong support among Russian officials and psychiatrists-narcologists.

Polish Drug Policy Network, 85 Marszałkowska Street, 00-683 ,

Protest against plans to close substitution treatment programs in Crimea – April 30, 2014

In recent years we have witnessed Ukraine's efforts in the implementation of rational methods in the field of HIV and drug dependence treatment, especially the treatment of to heroin and other opiates. Only in Crimea, about 800 people could return to healthier life and normal functioning thanks to treatment based on methadone or buprenorphine substitution. In place of pseudoscientific approach of narcologists, one of the most promising treatment programs in the region was created in Crimea. Instead of being constantly blamed for weakness, opiate dependent persons are provided professional medical and pharmacological care, as well as psychological support relevant to their situation. In the Russian system, it would be impossible, as its canons of treatment are determined by decrees from Moscow and the medical treatment of addiction does not take into account the facts and scientific evidence. The staff clinic in Simferopol is professionally trained and prepared for an open discussion on how the provision of services and care for substance dependent patients should be shaped. Nurses who used to visit homes of drug dependent persons to make them undergo compulsory testing, are now trained and become part of educators' teams. Today, their home visits are related to the prevention of overdoses and provision of medical aid, instead of state supervision over whether someone abstains from drug use.

Interestingly, patients and their families together repaired the building in Simferopol, which serves as an informal community center, offering rest to those who have to travel from more distant regions of the peninsula to get their methadone. There doctors (not necessarily dressed in white uniforms) willingly exchange views with patients and their families. However, it may soon be impossible to continue. What will happen to patients treated with methadone and buprenorphine? How will HIV prevention be for drug users in Crimea? Will the Russians, completely unable to cope with the HIV epidemic in their own territory, waste years of efforts of Ukrainian medical services? These questions have become a nightmare for the patients and the international community is increasingly concerned.

A few years ago we had here a foretaste of today's situation, when the pro-Russian politicians tried to limit methadone treatment. However, the strong attitude of the community, in this case a group of mothers of drug dependent persons who protested outside the offices of the local authorities, led to the anti-substitution proposal being abolished. Perhaps this kind of participation of citizens in public life makes substitution treatment something unacceptable for the Russian authorities. Officials and narcologists do not recognize the public debate around the treatment which would involve patients and their families.

Meanwhile, in Russia, where substitution therapy is constantly criticized, treatment of those dependent on opiates is mainly based on a model of long-term detoxification using high doses of sedatives, anxiolytics, and often neuroleptics.

Polish Drug Policy Network, 85 Marszałkowska Street, 00-683 Warsaw, Poland

Protest against plans to close substitution treatment programs in Crimea – April 30, 2014

However, the fact that the Russian approach is not very effective in reducing drug use or the number of HIV infections seems to matter little. After all, morality should be a sufficient remedy to HIV and drug dependence.

We are strongly against plans to close substitution treatment programs in Crimea. We believe that this way of treatment is necessary and should still be available for addicted people in Crimea.

By Grzegorz Wodowski

Sources  Russia bans methadone in Crimea (ITAR TASS)  Richard Elovich: "ReSovietizing Crimea? What the Vote Means for the Twin Epidemics of Drug Use and HIV ",  Simeon Bennett: "Methadone Clinics Help Ukraine Succeed on HIV Prevention."

Signers:

1. Agnieszka Sieniawska Poland 2. Grazyna Konieczny Poland 3. Jacek Charmast Poland 4. Marek Zygadło Poland 5. Marta Gaszynska Poland 6. Mirka Straburzyńska Poland 7. Jerzy Vetulani Poland 8. Krzysztof Krajewski Poland 9. Marek Balicki Poland 10. Ewa Wojdyłło Poland 11. Ewa Wanat Poland 12. Piotr Pacewicz Poland 13. Kasia Malinowska-Sempruch Poland 14. Magdalena Dabkowska Poland 15. Stowarzyszenie Program STACJA 16. Siedleckie Stowarzyszenie na Rzecz Osób Uzależnionych "Powrót z U" 17. Robert Podniesiński - terapeuta uzależnień 18. Marianna Podniesińska, Prezes Zarządu Stowarzyszenia "Powrót z U" 19. Narkopolityka / Krytyka Polityczna 20. Krzysztof Hajdas Poland 21. Arild Knutsen Norway 22. Jamie Bridge United Kingdom 23. Jane Thompson United Kingdom 24. Richard Elliott Canada 25. Pal Norway

Polish Drug Policy Network, 85 Marszałkowska Street, 00-683 Warsaw, Poland

Protest against plans to close substitution treatment programs in Crimea – April 30, 2014

26. Ruth Birgin Australia 27. shane Moore Australia 28. Kristian Aagaard Norway 29. Luciana Boiteux Brazil 30. Luiz Paulo Guanabara Brazil 31. Mike Trace United Kingdom 32. Erik Reitan Norway 33. nathalie rose Mauritius 34. WALGER Stephane Mauritius 35. Trine Irene Bjarkoy Norway 36. JahSon Taff Mauritius 37. Jo Ekgren Norway 38. Yuliya Georgieva Bulgaria 39. Marie− Louise Dyhrberg Denmark 40. Oeyvind Christensen Norway 41. Gunn Marit Berentsen Norway 42. April Stella-Maris Sweden 43. Mary Jack Norway 44. Jan Poland 45. Raymond Karlsen Norway 46. Nanna W. Gotfredsen Denmark 47. Janko Slovenia 48. Johan Hultman Sweden 49. Marie Nougier United Kingdom 50. jenny Kelsall Australia 51. Christopher Hallam United Kingdom 52. Thanasis Apostolou Greece 53. Katarzyna Łozińska Poland 54. Tom Christensen Norway 55. Heather of America 56. Thomas Berglund Sweden 57. beatrice stambul France 58. Bente Kristine Eck Norway 59. Rune helgesen Norway 60. Veslemoy Kristine Talmo Norway 61. tulla samuelsen Norway 62. Ellen Indal Norway 63. Jerry Dorey France 64. Aud Karine Kamphaug Koc Norway 65. Astrid Renland Norway 66. Ruben Solvang Norway 67. Marie France 68. Erik Steppat Denmark

Polish Drug Policy Network, 85 Marszałkowska Street, 00-683 Warsaw, Poland

Protest against plans to close substitution treatment programs in Crimea – April 30, 2014

69. Alfred Askeljung Sweden 70. ronny bjornestad Norway 71. Giselle Amador Munoz Costa Rica 72. Daniel Lean Honduras 73. Joe Rawlinson United Kingdom 74. Morten Soreng Norway 75. Paweł Świdergał Poland 76. majka Denmark 77. Jakob Sporre Sweden 78. Jakub Kubiak Poland 79. Johanne Norvig Denmark 80. Brage Wollnick Norway 81. evgeni Bulgaria 82. signe wiik Norway 83. Jesper Lauritzen Denmark 84. Sasa Mijovic Montenegro 85. Therese Svensson Sweden 86. Bjorg Wedin Sweden 87. Luna Boldsen Denmark 88. CJT Boleyn Sweden 89. Lars-Andre S. Norway 90. Bjorn Ottosson Sweden 91. Belén López Spain 92. Zara Mexico 93. birgitte Clausen Denmark 94. Ida Kristine olsen Norway 95. jeanette ringdal Norway 96. Frank Hult Norway 97. Poul-Erik Juhl Denmark 98. Michael Larsson Sweden 99. Oscar Andersson Sweden 100. Juan Machín Mexico 101. Basina velbak Denmark 102. Carmen Martínez Perza Spain 103. Magdalena Bartnik Poland 104. Hagar Bull Norway 105. Katherine Thompson United Kingdom 106. Tina Sander Sweden 107. Anke van Dam Netherlands 108. Linda Halset Norway 109. Mattias Hultkvist Sweden 110. jan erik torres Norway 111. Maureen United States of America

Polish Drug Policy Network, 85 Marszałkowska Street, 00-683 Warsaw, Poland

Protest against plans to close substitution treatment programs in Crimea – April 30, 2014

112. merete velbak Denmark 113. Janne-Mette Johansson Sweden 114. Katarina Sundin Sweden 115. Nela Ivanova Bulgaria 116. Marinette Sjöholm Sweden 117. Gloria Thailand 118. Edward Fox United Kingdom 119. Fiona Louise Australia 120. Sylvia Ayon Kenya 121. Jean Croisier Switzerland 122. Chris Ford United Kingdom 123. Betty Aldworth United States of America 124. Borqna Tosheva Bulgaria 125. Sheila Vakharia United States of America 126. Valentin Gyurov Bulgaria 127. Michail Okoliyski Bulgaria 128. Kjell Johansson Sweden 129. Freja Nina Lund Denmark 130. Mette Kostow Denmark 131. Kath Bingham Australia 132. Niels Larsen Denmark 133. Anja Plesner Bloch Denmark 134. Linda Denmark 135. Heidi Sandal Denmark 136. Camilla-Kenya Denmark 137. Annette Svae Norway 138. Kenneth Denmark 139. Thomas Kjosnes Norway 140. Susan Holmen Sweden 141. Mona Victoria Helena Fagertun Norway 142. thomas n Denmark 143. carl eliassen Norway 144. Joan Warming Denmark 145. Michelle Alexandra Norway 146. Randi Margrethe Karlsen Norway 147. cathrin larsen Norway 148. Kicki Liden Sweden 149. Kurt Bakken Norway 150. Petra Stahl Sweden 151. Erik Fernquist Sweden 152. Vegard Haugen Norway 153. Deidre Ezetouni United Kingdom 154. Eric Gold Norway

Polish Drug Policy Network, 85 Marszałkowska Street, 00-683 Warsaw, Poland

Protest against plans to close substitution treatment programs in Crimea – April 30, 2014

155. Siw-Christine Brandt Norway 156. Kristin Svanasbakken Norway 157. Frida Einebrant Sweden 158. Mona Fagertun Norway 159. Angela Brooke Bramlett United States of America 160. Jaclyn United States of America 161. Elizabeth McKenna United States of America 162. Lars Nilsson Sweden 163. Mathew Rewcastle New Zealand 164. Jerzy Afanasjew Poland 165. mariusz Poland 166. Bogdan Poland 167. Maciej Poland 168. Anna Poland 169. Paweł Świdergał Poland 170. Mateusz Pliczko Poland 171. Natalia Magreta Poland 172. Eryk Aleksy Poland 173. Marek Poland 174. Mateusz Bralski Poland 175. Agnieszka Walendzik-Ostrowska Poland 176. Marcin Chalupka Poland 177. Magdalena Bartnik Poland 178. Robert Trzos Poland 179. Andrzej Poland 180. Maciej Poland 181. Radosław Mełnicki Poland 182. Kuba Poland 183. Marta Poland 184. Aleksandra Stańczak-Wiercioch Poland 185. Aga Poland 186. karol zalewski Poland 187. Żaneta Łyczywek Poland 188. Paweł Poland 189. Marrio Dziubek Lakota Poland 190. Beata Poland 191. Maciek United Kingdom 192. Aleksandra Poland 193. Weronika Poland 194. Kasia Rżanek Poland 195. Anna Poland 196. Maciek Kępka Poland 197. Ola Poland

Polish Drug Policy Network, 85 Marszałkowska Street, 00-683 Warsaw, Poland

Protest against plans to close substitution treatment programs in Crimea – April 30, 2014

198. Piotr Poland 199. Monika Poland 200. Krzysztof Poland 201. anka Poland 202. Paulina Poland 203. Mariusz Poland 204. Stanisław Poland 205. Katarzyna Kałuska Poland 206. Anna Sasin Poland 207. Joanna Poland

Polish Drug Policy Network, 85 Marszałkowska Street, 00-683 Warsaw, Poland