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Drop-in Center: Major Russian Paper Wrote about Ukrainian Experience in Harm Reduction

Pavel Kutsev taking medication

Pavel Kutsev taking medication

A week ago Rising Voices published a story about a visit of a delegation from Russia harm reduction activists to Ukraine and methadone site in Kiev. As it was mentioned, a journalist from one of the biggest Russian news paper Moskovskiy Komsomolets, Anastasia Kuzina was a member of the delegation.

After a visit Anastasia wrote a detailed report about the implementation of substitution therapy programs in Ukraine, concluding that such programs could help to stop HIV/AIDS and the TB epidemic in Russia. The leader of Drop-in Center, Pavel Kutsev featured her article.

Here is what Anastasia wrote about the visit on the Methadone site:

10 AM. There is a short line next to entrance of the pharmacology clinic called “Sociotherapy”. I see a poster on the wall in Ukrainian: “Not all people are alcoholics or drug addicts, but all alcoholics and drug addicts are people”. This is “the site” – a place where patients of substitution therapy receive pills of Methadone and Buprenorphine.

There are no very young people in line. Most of them are in their 30's, but there are a few of 40's and older. Each person has a story. There is a person with crutch, a mother holding a small child …

I am entering the site together with Pavel Kutsev. He is a journalist. He is 48 and he is an opiate addict. He and his wife Yanina, the editor-in chief for a newsletter for drug addicts “Motylek” has been in the program for a year and a half.

“Sometimes I hear that substitution therapy is a legalization of drugs” says Pavel. “No, it is the legalization of drug addicts. Addiction is a snowball of problems. Starting substitution therapy you start dealing with them. Later on you can start thinking about givin drugs up completely.”

“What are the most common associations that people have about drugs?” asked Pavel “Everybody would say: death, crime, children without parents, infections, asocial lifestyle. Now let's take a person taking substitute medications. He will not die because of drug overdose. He does not participate in criminal activity. He re-establishes relations with the family. He is able to treat HIV, TB and hepatitis. Moreover, he stops taking drugs intravenously, thus reduces risks of spreading infection. Substitution therapy reduces the most dangerous consequence of the drug addiction.”

A nurse is greeting us. She has to assess the health of the patient, provide the medication, and make sure the patient has taken it (sometimes she crushes the pill with a glass) and make proper records. The nurse is taking three pills from a bottle and, with a piece of folded paper, put them directly to Pavel’s mouth. He is swallowing them up with a bit of water and showing his tongue to the nurse. There is nothing in the mouth. The nurse is nodding and the next person enters the site.

A significant part of Anastasia’s article focused on analyses of whether it would be useful to implement harm reduction programs in Russia. She writes:

In Russia, Methadone is perceived with bewilderment and indignation. But this is because just a few people know how it works.

All over the world there is a category of people with drug addiction which can not be treated by traditional therapy or rehabilitation. Among the reasons are age and the lifestyle of a person. Here I have the statistics on Ukrainian participants of substitution therapy.

Kiev – 55 people, average age – 32, years on drug – 13, all 55 are HIV positive, 53 are positive on hepatitis B and C, 18 have TB.

Odessa – 55 people, average age – 40, years on drugs – 20, HIV positive -38, positive on hepatitis – 20, TB – 12…

With such medical records a person will not be accepted in any rehab program. Substitution therapy is right for them – for people who were rejected by all clinics and hospitals. For 10-20 years they have been living in a circle “to get money – to inject – to get money –to inject”. But “to get money” means to steal, “to inject” means to transfer infections or receive an overdose of drugs…

When a person comes to the program for the first time, doctors select a dose which fits him/her, a dose which allows a normal life rather than looking for street drugs. Taking opiate medication excludes even the possibility of taking street drugs as they just stop working – they do not have any effect any more.

The journalist continues her article with an overview of the situation with substitution therapy in the world. She wrote:

A person has to choose. That is why all over the world the substitution therapy exists together with prevention programs, clinics and rehab centers as well as a group therapy. In many countries only 20 to 40 percent of the drug addicts go for substitution therapy …

Substitution therapy is not just a tool to stop the HIV epidemic; it also helps revive one's own life: get back personal documents, a family, a job; receive a social security and legal assistance. Substitution therapy can be used to increasing motivation in the treatment of HIV and TB. Normally substitution therapy patients have high levels of adherence to the treatment – they do not miss intake of medications and tests.

Anastasia finishes her story quoting a professor from Kazan State University (Russia) and WHO expert Mr. Vladimir Mendelevich. He said:

A drug addict normally pays 30-50 dollars for a drug. While participating in substitution therapy people stop buying drugs thus taking away millions of dollars from the drug market. The cost of the treatment of one patient is $480 a year. That is why a million of people participate in substitution therapy in many countries, including Muslim countries such as Iran and Afghanistan. There are 500 Methadone centers in China alone.

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