A fascinating insight into what can happen to the drug using community after a government is deposed and a region splits borders. Igor Kuzmenko, a member of Eurasian Network of People who Use Drugs, wrote this insightful article for sister organisation INPUD (International Network of People Who Use Drugs).
The recent events in Ukraine were watched by us all over the world. A president is deposed, and civil unrest spreads throughout the region. The Ukraine loses control of its western front in Crimea and by way of a rushed referendum supported by the people, has to hand the region back to Russia. Military personal appear in the streets and laws change overnight. But what happens to the drug users? At INPUD, our members know very well that while the Ukraine recently started giving methadone and buprenorphine (mainly buprenorphine) to its users, Russia on the other hand, deems both drugs illegal and will not entertain OST (Opiate Substitution Therapy) for any reasons whatsoever. So, to the Crimean drug users who had once been lining up outside the methadone clinic, what was going to happen? Igor Kuzmenko was there and has written a series of blogs for us to give readers an insight into life after The Russian Referendum.
Note: Igor Kuzmenko is an active member of INPUD’s sister organisation ENPUD, the Eurasian Network of People who Use Drugs / Click the link to find out about what is going on in the region (pages are translatable with Chrome) and if interested, if you can fill in their membership form.
RI.P. Crimean OST program, 2006
By Igor Kuzmenko
Part 1 (of 4) It just so happened that when that a life changing referendum was being held in March in the Crimea this year, the one which asked all Crimean citizens about whether our region should stay with the current government of Ukraine or return again to Russia, I was participating in the annual commission of Narcotic Drugs in Vienna. This meant I could only receive news from the Crimea via Skype or by phone. And the news was bad. For my own work as a social worker dispensing Opiate Substitution Treatment (OST), it really was bad news; a sharp decrease in dosages was followed by panic among the patients and low spirits of the medical personnel on the OST site. And then there was the strange armed people and large numbers of ‘unknown’ military equipment now appearing in the Crimea…
Almost nothing has changed in the Crimea on the surface. Except that instead of usual Ukrainian flags there are now Russian ones, and instead of traffic cops there are notorious “green little men” at the junctions. And at night you can sometimes hear the roar of military machines crossing the city.
“If, at the beginning buprenorphine was reduced by 2 mg a week, at the end of April and in May it was being reduced by 2 mg every other day. It was a very painful process.”
The OST site changed externally even less – the same people, the same fuss. But it was only externally. The fear started to grow. The doctors and nurses were afraid because legally, if the Crimea belongs to Russia and obeys Russian laws and they continue with methadone distribution on the site, they could be arrested for “distribution of drugs in especially large amounts performed in collusion by a group of people”. And you should agree, that’s no laughing matter.
OST clients were terrified because changes to prescriptions are always frightening. Their families were terrified too, because years of quiet living came to an end after the termination of OST.
Dosages decreased more and more. If, at the beginning buprenorphine was reduced by 2 mg a week, at the end of April and in May it was being reduced by 2 mg every other day. It was a very painful process. Of course, many patients tried to compensate for a lack drugs by using a large amount of barbiturates and those who could, also used street drugs. Thus the condition of patients constantly worsened: barbiturates helped to numb unpleasant feelings a little but not the pain, which was enfeebling you at the same time. I still remember people wandering about the site yard like ghosts, patients who had grown old in just a few days.
How OST Died
I want everyone to have a clear idea of how exactly OST died in the Crimea. There weren’t any documents issued by local authorities or from the Ukrainian or Russian side which could forbid, limit or in any other way have an effect on the situation with substitution therapy on the Crimean sites.
The reasons for the decrease in dosages were a limited quantity of pharmaceuticals in the Crimean warehouses and an impossibility to import methadone and buprenorphine from Ukraine to the Crimea.
It was difficult to import enough methadone and buprenorphine for a month into the Crimea even before the referendum because there wasn’t calm in Ukraine due to the Maiden* and, after March 16, all these difficulties were multiplied by the issues of state affiliation. We just weren’t allowed to import a new consignment of medicine. OST wasn’t banned in the Crimea, it was strangled.
“OST wasn’t banned in the Crimea, it was strangled”
OST wasn’t banned in the Crimea, it was strangled. Whose fault is this? It is difficult to tell. It seems to me that happiness of the patients wasn’t important for both sides. A patient on pills is a medical issue, and a suffering patient is political issue. We live in politically charged times and in my opinion, a political outcome was favorable to both parties: beneficial for Russia because methadone is not legal there, and Ukraine got its’ chance to once again confirm the inhumane actions of Russia.
In the meantime there were a lot of rumors spreading around. Rumors of absolutely fanatical methods of counter-drug operations by FDCS, (The Federal Drug Control Service of the Russian Federation) such as shooting out the wheels of suspected cars. Rumors about groups of young sporty looking people who had recently appeared in Simferopol to attack drug addicts and beat them almost to death in places where it is possible to buy drugs. Rumors about a shipload of heroin delivered to the Crimea from Russia. But there wasn’t any real confirmation of these rumors either.
But there was the death of a patient in Simferopol that was for real during that period. He just didn’t have any energy left to live with daily decreasing dose…. The fear of the future was for real too. And at the same time, there were high hopes. At that time very few people believed that OST, which everyone had gotten used to and without which nobody could imagine one’s life, would be banned and services closed all of the sudden.
The hope helps us to live.
* Maiden: The name of the city Square in Kiev. It has been the site of many important protests including The Orange Revolution but for many months in 2014 it became the place where Euro-centric activists protested, camping out and fighting back against authorities. After bloody battles, people power reigned and the Ukrainian president fled into Russia. The protest gained the name The EuroMaiden Revolution.
RI.P. Crimean OST program, 2006
Part 2 Igor Kuzmenko
Around April, during the period of intensive decreases in methadone and buprenorphine doses, one of the patients approached me in the OST site in Simferopol. He was an adult man, slightly over 50 years old. He had multiple diagnoses, including active form of tuberculosis (before the referendum he was admitted to the tuberculosis dispensary where he could get methadone, but after the referendum this opportunity didn’t exist anymore and he had to go the remaining OST site to get his methadone among healthy patients). He also suffered from Hepatitis C and HIV. He is an artist and looks like a true artist – he wears a raincoat and a long scarf. It was notable that he was extremely worried. Nervously taking a puff, he said:
“Igor, if sometimes you need my help, you can count on me. I have only one wish right now – to douse myself in gasoline and set myself on fire. If only it could do any good!”
Many of us didn’t want to sit back and do nothing. We organized a group. We didn’t set a task to change the political reality, obviously we were unable to do it, and we simply wanted to draw as much attention as possible to the stopping of the importation of OST medicine to the Crimea. So three of us paid a visit to the Ministry of Health of Ukraine, in Kiev.
Besides us, inhabitants of the Crimea, there was a large number of local activists and representatives of The Alliance Ukraine (an HIV/AIDS organisation) participating in a protest action. Unfortunately, we couldn’t meet the minister, but some officials from the civil service on HIV issues found a little bit of time for us.
“…It became absolutely clear to me that there will be no importation of OST medicines to the Crimea at all.”
I must admit that after this meeting in the Ministry of Health, it became absolutely clear to me that there will be no importation of OST medicines to the Crimea at all. Nobody was interested in that..
No Discontent Allowed
Meanwhile in Simferopol in the Crimea, our people tried to make a protest action near the headquarters of the Crimean government. And there we ran into surprise: all of us had gotten used to our liberal Ukrainian system regarding protest actions and meetings. It was rather simple to inform the city authorities of the time and place of a meeting in Ukraine. But as it became clear, in Russia, (and now in Crimea) it is impossible for more than two people to gather together to show any discontent. Therefore we had to drop any idea of setting a protest action in the center of Simferopol.
Parental support is also very effective in context of raising the profile of OST, not least for the reason that parents are not drug-dependent and the stigmatizing that is usual in such cases, doesn’t apply to them. Unfortunately however, we also failed to attract a lot of parents to our movement.
I have to admit that the OST patient community couldn’t find complete consensus either. Some of us considered the proximity of Russia as being a benefit, others rejoiced at the sudden opportunity to quit methadone, and someone didn’t care at all. Some patients even participated in the referendum and the self-defense groups (groups which promoted pro-Russian forces in the Crimea). Nevertheless the majority of us wanted the same: at the maximum – the resumption of Opiate Substitution Treatment, and at the minimum – importation of a monthly stock of methadone and buprenorphine.
I am very grateful to the medical personnel of OST sites in the Crimea. Not their chiefs but the ordinary physicians and nurses. All of them are courageous people. Just think of it: according to Russian laws every day they went to work to give out methadone to the patients, they were making criminal acts. Acts that can be characterized as “distribution of drugs in especially large amounts performed in collusion by a group of people“. It was a very courageous especially as all of them without exception knew perfectly well how it could turn out for them.
And there were some things and some people to be afraid of. Both the administration and numerous “guests” put unbearable pressure on them. But I will tell you about that and many other things next time…