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Drop-In Center: Small Changes, Big Victories

Harm Reduction Awarness Press-Conference, Kyiv (Pavel Kutsev is second from the right)

Harm reduction awareness press conference, Kiev (Pavel Kutsev is second from the right).

Pavel Kutsev, leader of the Ukrainian non-profit Drop-In Center, sums up his organization's main achievements in defending the rights of opiate replacement therapy patients. A former drug addict and patient of substitution therapy himself, Pavel uses his leadership position and his blog to advocate for the very specific needs of people like him.

Here is what Pavel had to say about the organization's recent efforts:

Slowly, step by step, we were able to achieve three victories.

  1. No more obligatory participation in religious group therapy, which used to be mandatory to stay in a substitution therapy program.
  2. No more grinding of pills – only if a patient asks for this.
  3. The chief doctor [of the methadone site] promised to provide a room of 5 square meters, which will serve as a day care center for replacement therapy patients.

One might say that these accomplishments are very small, but I would argue against this. The methadone program in Kiev has existed for only one year, but I already know four patients who have died since it has started.

Karman died because of gullet bleeding,  caused by methadone pills which should have been taken as a whole piece but been ground into powder by medical personel.

The other guy died right on the site. He ran away from a hospital the morning after he had surgery to receive methadone pills at the site.

The biggest issue, according to Pavel, is a rule that substitution therapy patients have to come personally to a methadone site to receive medication. Since patients can't get methadone at any other medical establishment, except the methadone site, this poses a challenge for patients who receive medical care that requires staying at a hospital. This is what Pavel posted about the issue:

It really hurts. We understand that this is our fault and we have made this choice ourselves… But why are they so cruel with us now that we have become substitution therapy patients? I wonder why nobody even tries to solve this problem. You just need an agreement with a hospital where replacement therapy patients can get medical examinations and treatments, as well as replacement medications. Patients cannot solve this issue by themselves. They need support from medical personnel, who for some reason seem to be indifferent to our needs.

In mid-August, Pavel submitted a program report to Rising Voices, who have provided Drop-In Center with a micro grant. In the report Pavel highlighted a few more of the organization's accomplishments.

One of these accomplishments relates to the type of drug being used in substitution therapy programs. During the past few months, Pavel has been arguing with Ukrainian health care officials on his Web blog about the medications being purchased by the government. He believes that the medications don't fit the needs of substitution therapy patients since they have a fairly short time of excretion from the body. Patients can only receive these medications once during a 24-hour period, which means they have to go through the pain of withdrawal for few hours a day, since the drugs don't stay in the body long enough. Pavel's voice has been heard by officials, though, as he was invited to represent patients in procuring a new drug for Ukrainian replacement therapy programs.

In addition, in his report Pavel mentions that blogging has helped him gain respect from the public health community. He has been invited to join a few expert groups working on harm reduction issues, and even the police have invited him to talk about the problem.

Every day Drop-In Center receives many phone calls from people living with drug addictions. Pavel and his fellow activists are always available to help with advice and to provide support. They consider the trust the organization has earned among drug users to be their highest achievement yet.

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