On his Web blog Pavel Kutsev, leader of the nonprofit Drop-In Center, covers topics that impact the lives of people living with drug addictions in Ukraine. He devotes special attention to the recent bans of methadone therapy in municipal hospitals. These bans have been introduced by the city councils of a few Ukrainian municipalities. According to expert opinion, though, the bans were mostly motivated by political reasons, rather than medical ones.
Substitution therapy has been welcomed by the current Ukrainian president,
Victor Yushchenko. So although it's not allowed in municipal hospitals, substitution therapy is still provided in federal medical establishments. Some politicians believe that discrediting the programs that Yushchenko supports will also discredit him.
The substitution therapy bans could be a reason to start a massive public awareness campaign. If we keep silent, we might be shut off everywhere at some point…
What can we do? Write a petition? Collect signatures of supporters? Or is it the right time to start TV debates? If donors would support us financially we could conduct TV talk shows involving professionals, patients and their parents. We could film a video that would touch everyone…
We have to organize a grandiose event. Something like …a march of substitution therapy patients, medical personnel and all the supporters. Actually, to do this we need a week of preparation and a hundred people who are ready to march in support of a human right that is part of the Constitution — to be able to select a medical treatment. At the same time, this march can serve as our protest against those who slow down the development of methadone programs.
Through this public awareness campaign we could tell people the truth about substitution therapy with statistics, facts and data. We should start an open and professional dialogue. We should fight for our rights and not become victims of these local “Sabbaths.”
Although this strategy seems to have many advantages, Pavel also mentions a few risks that should be taken into account.
There is a risk that by organizing a big public awareness event in Kiev we could raise the local issues of Donetsk and Sevastopol [cities that banned the methadone programs] to a national level. This could backfire now, at the onset of the presidential elections, because it might just stimulate a politician's desire to get extra public attention by commenting on the issue. “How can you talk about free drugs for drug addicts in a time of crisis, when the local currency has depreciated, when people are losing their jobs?” they might say.
Yes, there is a serious chance that after starting the public awareness campaign we will hear something like this: “How can we pay for free drugs for these addicts when we cannot provide a decent life for our elderly?” At the same time, I have been listening to these arguments since I started this work.
Up until 1959 opiate drug addicts in the Soviet Union were able to buy morphine for personal use in a drugstore if they had a prescription. Pavel refers to this historical fact and asks his community to take action:
In 1945, right after the end of World War II, the situation in this country was much worse: poverty, devastation, a very high level of criminality, millions of people in Stalin's camps. But all the issues with the availability of morphine were solved.
I do understand that advocacy means addressing all parts of diplomacy, but I do not think that we can postpone being proactive until the elections are over and all the elderly are fed. Every TV channel, for the past few weeks, has been discussing whether or not our police minister was drunk in a German airport. How does this impact the life of the elderly or the rate of HIV/AIDS?
Dear friends, we should move to radical and well thought out action, without regard to any “end of the world omens.” Substitution therapy is one of the most effective tools to stop the epidemic of HIV/AIDS and it is legal — this is the message we should deliver to society. If we succeed, we would significantly improve the lives of those living with HIV and drug addictions. Then smart politicians will even be able to gain votes by supporting our programs and our ideas.
Pavel is absolutely right about the media circus that tends to follow politics and campaigns. It tends to only obscure the real policy discussions that should be taking place, and that should be based on scientific study. There should be academic research comparing intravenous HIV transmission in Sevastopol, for instance, and Kyiv.