Life Goes on In Crimea, (unless your on methadone…)

Life Goes On in Russia’s Crimea

Here are the final 2 blogs in the series of 4, from Igor Kuzmenko’s personal blogs of Crimea, in particular, life for those who once lived under Ukraine law and received Opiate Substitution Treatment (OST) such as methadone only to lose their new found stability after the region’s Referendum when the majority voted to go back to Russian governance. This effectively closed the doors for good on OST leaving over 800 people in shock and despair. So what is a person withdrawing from treatment supposed to do? What would you do if your access to methadone or buprenorphine was cut off almost overnight…? Igor gives us a frighteningly honest account of what happened to the OST community in Crimea..Here is part 3 and part 4.

NOTE: Part one and two are a bit further down this blog and the whole series has been reprinted here courtesy of INPUD’s blog and you can also read them in Russian at ENPUD’s website /blog. Thanks to Igor for a fascinating insight into Crimea for the drug using community, and INPUD for reprinting.

 

RIP Crimean OST Program, 2006

small_igor (1)

Igor Kuzmenko

Part 3

Meanwhile life in the Crimea went on. As spring approached, people continued to go to work, and students proceeded to attend their studies. Very few inhabitants of the Crimea understood that 806 people of the region’s  population, were literally on the way out.

 

Death From Abstinence

As I  wrote previously, the first patient in Simferopol died around the beginning of April. He was about 50, was seriously ill and couldn’t move at all. Everything was good with him before the March events; the doctor wrote a prescription for him so he could get liquid methadone and he continued to use Opiate Substitution Therapy without leaving the apartment. But after March 16, everything changed and the prescription form of OST was suspended in Crimea. It goes without saying that any coroner wouldn’t determine a cause of death as ‘death from abstinency’. But something tells me that if he continued to have the opportunity to receive methadone, he would be still alive.

 

 But after March 16, everything changed and the prescription form of OST was suspended in Crimea.

 

Bupe Not Methadone

Actually,  there were not so many people receiving OST on a prescription basis in the Crimea. And there were a few reasons for that. First,  the prescription form is possible only for those people who receive buprenorphine in Ukraine. There are cities where all clients of the buprenorphine program constantly receive it using a prescription. But everything is much more difficult when dealing with methadone.

ukrainianmethadone

The medicine used in a Ukrainian methadone OST program – known as ‘Metadict’ and ‘Metadole’ – are both made in Germany or Canada. Both of them are in the form of tablets, not syrup. They come in blister packs of 10 tablets: 25 mg each, (total 250mg)  or in bottles of 500 mg. But it is impossible to get it using a prescription because according to the laws of Ukraine a single prescription dose of any narcotic substance mustn’t exceed 112 mg. The blister packs are not allowed to be cut up or tablets prescribed separately from the packaging. There were individual cases when patients could receive a liquid methadone on prescription, but only on a commercial basis and it is very expensive.

 

Methadone Not Bupe

In the Crimea, it is different. Slightly more than 50 people out of 806 patients received buprenorphine, the others got methadone. About 10 people out of those 50 had the opportunity to receive buprenorphine on prescription though not on a constant basis. They got it occasionally – because of a business trip, illness or going on a holiday.

ukrainian-methadone-metadol

Ukrainian methadone; Metadol

 

There is also one more reason for prescriptions being shut down in the Crimea after “the referendum”. Doctors were afraid to write out prescriptions on both of these substances because they are actually illegal in Russia and so employees of drugstores in turn, were afraid to sell the medications and fill  these prescriptions.

 

May 20th – D Day

May 20 was the last day when people could use the OST program in the Crimea, so after that each of the 806 person’s who were prescribed had to make one’s own choices of what to do. There were only four options:

  1. String oneself up to stop using drugs forever
  2. Go to Russian local rehabilitation centers praised by numerous Russian “guests”;
  3. Continue using OST by moving to Ukraine;
  4. Go back to using “street” drugs.

According to my knowledge, no more than 20-30 people went to Russia for rehab. Many of them couldn’t undergo an entire “rehabilitation course” till the end and ran away. However, some stayed in rehab for the whole term. One OST client from Simferopol died in St. Petersburg during the rehabilitation process. He died of an overdose.

Slightly less than 60 people risked going to Ukraine. This option was, undoubtedly, the most realistic of all. For example, in many cases it was necessary to buy tickets at ones’ own expense to go to Russia, but in Ukraine both tickets, accommodation and food were paid for you.

 

Should I Stay or Should I Go?

Nevertheless, as you can see by the number of people who went to Ukraine, it didn’t become a mass phenomenon. Partly, this was due to mass media propaganda which colourfully described the various ‘atrocities’ of Ukrainians in relation to the inhabitants of the Crimea who risked leaving and facing the ‘mockeries’ of the Ukrainian border guards who were taking away passports on the border and other nonsense. The other reason that many of inhabitants of the Crimea never left for Ukraine, was they had neither friends, nor relatives there and simply couldn’t imagine where they were supposed to go.

Now many of the clients of OST who had gone to Ukraine, already found a job there, and all without exception found rented accommodation and received some financial support from the project MBF “Renaissance”.

 

“It turns out that more than 600 people started taking street drugs again.”

 

From those people with whom I was in contact no more than 10 people could finally stop taking drugs of any kind.    If you make simple arithmetic operation, it turns out the following:

806 (total number of clients in the Crimea OST program) minus 20 (number of those who undergone “rehabilitation” in Russia), minus 60 (left to Ukraine), minus 50 (suppose not 10, but 50 people stopped taking drugs) = 676.

About 30 already died out of that number of people. It turns out that more than 600 people started taking street drugs again. And many of them during many years of using the OST program found work, started a family and gave birth to children.  Now it’s all over.

 Igor Kuzmenko

Below is the final part of Igor Kuzmenko’s series on Crimea. Please feel free to add your thoughts and comments and let us know if you have a story to tell from your country.

 RIP Crimean OST Program, 2006

 

Igor Kuzmenko

Igor Kuzmenko

Part 4

How to reach those people who made decisions on the issues of Opiate Substitution Therapy (OST)  in the Crimea? Which words should be found to explain to them that situation where 800 drug users under constant medical and psychological control, employed and reintegrated, is much better than 800 people coming back to being criminalised in the drug trade? How could one explain what the blue sky is to the person born blind? How it is possible to explain to a mother, whose son quietly had been using OST for several years, stopped breaking the law, started a family and found a job, why he has died of an overdose during the rehabilitation? Who benefits from it?

“What we had been created for several years was destroyed in two and a half months.”

Probably, for those people who have nothing to do with OST and don’t have the slightest idea of what this therapy actually is, it is only a “change of the dealer” – earlier I bought drugs on the street and now I get them free of charge from the doctor. But actually OST is a difficult system in which the process of taking methadone or buprenorphine is only a small part of the whole process. OST is a complex of actions that allow the person to live a more or less productive life. Many elements of this scheme, such as the ART (Anti Retroviral Therapy*), anti-tubercular therapy, are strongly connected with OST. There is no point in pretending otherwise, many people started to use ART and to look after their health only after they visited the OST site.

 

Irina, a client from the OST program

Irina, a client from the OST program


Stability and the Street

What we had been created for several years was destroyed in two and a half months.

So, more than 600 former people from the OST programs have taken part in the illicit drug scene again since May. What do our people use to medicate themselves with now?

Lyrica. This beautiful and romantic word is actually the name for one of the biggest problems of the Crimean drug scene nowadays. Lyrica (active agent – Pregabalin). An antiepileptic and anticonvulsive medical product made by Pfizer Company. Many ex-OST patients are suffering from its over-use today. It has excellent medical qualities if you take it on prescription, but it causes terrible side effects and dependence for those people who try to combat withdrawal syndrome with its help. It is sold freely in any drugstore in the Crimea and costs not so much.

Only a total deficiency of any medical products in local drugstores is saving others from the serious consequences of pharmaceutical drug dependence in the Crimea.

“Now I hear from people who were full of vim and vigor, who had plans for the future just two months ago, that they want to die.”

Checks. “Checks” is how people name portions of raw opium from which it is possible to extract heroin, if you add acetic anhydride to it.

“Checks” existed in the Crimea as far back as I can remember. It is a good reliable way to quickly recover from withdrawal syndrome. You could get “checks” quite easily at any time. But after the OST programs were closed, hundreds of drug users suddenly entered the market (more than 200 people just in Simferopol! ) and devastated all the opium reserves in the Crimea. Moreover, new anti-narcotic structures represented by the Russian police (all police officers came to the Crimea from the Russian cities – Perm, Kazan, Moscow, there are not any local representatives in police) and by Federal Service on Control of the Drug trafficking (FDCS) – the nightmare of the Russian drug users. The increase in number of “checks” users led to a decrease in its supply and importing from Ukraine became a big problem.

By hearsay, so as not to suddenly miss an opportunity to increase profits, dealers began to add foreign substances to their product, it could be harmless substances or hard shit like home-made methadone. New police forces and new circumstances around buying drugs has led to the situation where purchasing “checks” poses a big problem now.

Heroin. I often hear from people in the Crimea that there is lot of cheap heroin here now. But I couldn’t find even one person who saw or tried that heroin. So I can draw a conclusion that there is not and there was not any heroin in the Crimea.

Krokodil. I assure you that if it wasn’t for a deficiency of medical products in drugstores, including codeine-containing ones, “krokodil” would now be problem No. 1 in the Crimea. But every cloud has a silver lining.  People just can’t find the substance that you should use to make this poison, and that’s why krokodil isn’t present in the Crimean drug scene.

“Well, this is how it goes.”

Well, this is how it goes.

Now I hear from people who were full of vim and vigor, who had plans for the future just two months ago that they want to die. Former patients aren’t able to go to work because they suffer from never-ending withdrawal syndrome. Their families suffer as much as they do.

I am an optimist.  My glass is always half full. But I can’t see anything optimistic in the future of those from the last OST programme in Crimea.

Well, who knows, maybe I’m mistaken.

Written by Igor Kuzmenko

*ART: Anti Retroviral Therapy is a medical treatment for HIV/AIDS

 

All 4 parts in the Crimean OST series has been written by Igor Kuzmenko and here’s a massive public thank you to him for his really honest and personal insights into what it has been like for our peers in the region, and answering many of our questions too, I’m sure. The blogs were translated from Russian into English by the very professional Daria Mighty, and we are indebted to her speed and accuracy, thank you Daria! (The Russian version is available atENPUD)
If you want to find out more about the drug using community and its issues in the region of Eurasia, or you are living in that part of the world, check out INPUD’s sister organisation on their website ENPUD (The Eurasian Network of People who Use Drugs). You can become a member, read other blogs from Igor and others and find out the news and views on drug issues and politics.

Andrey Rylkov Foundation’s website shut down in Russia

Here is an article from our friends at Harm Reduction International, writing about a truly appalling situation (another one) to emerge from Russia -affecting our dear friends and peer activists at Andrey Rylkov Foundation.  This courageous HIV/AIDS, drug and human rights organisation has consistently raised their head above the parapet (in a country where it can be literally be beaten off), and given people much needed health and harm reduction information in a climate of fear and intimidation.  One can only imagine what that must be like, to work every day knowing that you could be arrested, imprisoned, fitted up on a trumped up charge (which has happened repeatedly to other HIV and human rights activists) while thousands upon thousands of people are desperate for the sterile syringes that you give out, and the HIV information you impart. Last World AIDS day, December 1st 2011, ARF were instrumental in supporting us at BP (and INPUD) to coordinate the global Russian embassy protest, an attempt to shame Russian officials about their inaction and lack of response to the HIV catastrophe unfolding in their country. We are deeply concerned at this latest attempt by the Russian government to silence anyone or any organisations that discuss methadone in what is an ” ongoing assault on HIV prevention” taking things to the “next level by moving to silence public health advocates whose only infraction has been to spread life-saving information online and to criticize the government for its own failures.” We will keep you posted of developments. Catch ARF on facebook, and join to keep up to date with what is looking to be a highly charged time in Russian life and politics.

 

 

 

Authors:  

Vladimir Putin wrote a recent column praising the potential for “internet-based democracy”. But the Russian government adopts rules allowing for websites to be shut down on a

Vladimir Putin

Vladimir Putin's iron grip on power continues to circumvent free speech in Russia, as yet again, HIV & drug organisations like ARF are targeted.

whim, and has used those rules to close down HIV prevention sites.

He talked about free medical care being one of the priorities of Russian citizens. But that care denied to millions of Russian people.

While Prime Minister Putin spoke glowingly of digital democracy, his anti-drugs agency is censoring websites for writing about WHO essential medicine.

“[It’s over] methadone, plain and simple” said Anya Sarang, President of the Andrey Rylkov Foundation, which had its website shut down over the weekend.

The government’s anti-drugs agency, FSKN Moscow Department demanded that the Andrey Rylkov Foundation’s service provider block their website, utilizing new rules adopted last year. The notification states it was due to “placement of materials which propagandize (advertise) the use of drugs, information about distribution, purchasing of drugs and inciting the use of drugs”

What the Foundation was doing was spreading the word about basic HIV prevention measures and commenting on the Russian government’s policies.

Amidst pro-democracy protests, the Russian authorities have taken what is an ongoing assault on HIV prevention to the next level by moving to silence public health advocates whose only infraction has been to spread life-saving information online and to criticize the government for its own failures.

Russia is home to one of the biggest populations of injecting drug users, and one of the fastest growing HIV epidemics in the world. It is estimated that there are just under two million injecting drug users in Russia. In some regions, more than 80 percent of people living with HIV in the country contracted the virus through injecting with contaminated equipment.

According to the World Health Organization, methadone is an essential medicine, for treating heroin dependence and for preventing HIV transmission by reducing the practice of injecting. Multiple scientific studies back this up.

But the Russian government’s ‘zero tolerance’ approach to illicit drugs is well known and has resulted in the outright denial of methadone (or ‘opioid substitution therapy’). It is illegal in Russia.

The net result of these policies is a massive increase in the number of people living with HIV in the country over the last decade.

According to UNAIDS, “In Eastern Europe and Central Asia, there was a 250% increase in the number of people living with HIV from 2001 to 2010. The Russian Federation and Ukraine account for almost 90% of the Eastern Europe and Central Asia region’s epidemic. Injecting drug use remains the leading cause of HIV infection in this region”.

“People all over the world take this medication for granted” says Sarang, “but here in Russia it’s central to our struggle against HIV and it’s banned. Now, even our speaking about it seems to be banned.”

This is not the first time Russia has attempted to censor civil society voices for public health. At the UN General Assembly talk on HIV last March the Russian delegation tried to stop a Ukrainian drug user from speaking about HIV prevention. Fortunately, others were not happy with such censorship and the effort failed.

“The right to information is essential to realizing the right to health,” said Agnes Callamard, Executive Director of ARTICLE 19, in a statement. “A government agency such as Federal Drug Control Service should not have the ability to ban websites at the whim of a bureaucrat. This is particularly so when considering the impact of censoring discussions relating to drug addiction or HIV/AIDS.”

For years, human rights advocates like the Andrey Rylkov Foundation have argued that Russia’s colossal failure to provide vital services is a breach of its obligation under international law to respect, protect and fulfill the right to health. The government’s latest crackdown against public health activists has turned the matter into an issue of freedom of expression.

Mr. Putin says that democracy needs “efficient channels for dialogue… communication and feedback,” while the government’s actions silence people fighting to raise issues the government is refusing to face. This silences the spread of information. It silences the democratic process.

Source of publication: http://www.huffingtonpost.com

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Users Unite Around the Globe in Support of their Russian Peers -an overview

Posted on December 5, 2011
New York City Kicked off the global protest on the eve of World AIDS Day, and were followed by 12 other cities

New York City Kicked off the global protest on the eve of World AIDS Day, and were followed by 12 other cities

POST Press Release (please feel free to share this post on your website, but remember to link it back to here! Thanks!)

On World Aids Day, 2011, just a few short days ago, harm reduction organisations led by people who use drugs and supported by the International Network of People who Use Drugs(INPUD) gathered outside Russian embassies in cities across the world in the largest ever global show of solidarity by and for people who use drugs.

The protests, entitled ‘Shame Russia Shame’, was directed at Russia’s highly controversial drug policies which are believed to be driving the EEC regions HIV and TB epidemics. Injecting drugs with contaminated equipment is driving Russia’s HIV epidemic, now the fastest growing in the world and it is reflected in the numbers; as many as 80% of new infections are occurring amongst people who inject drugs (PWID), in a total HIV positive population of approx 1.3million. With this in mind, recent projections forecast an additional 5 million people could become infected with HIV in the near future, unless Russia drastically transforms the way it is dealing with its HIV pandemic.

INPUD member Erin O'Mara says Russia's drug policies are 'brutalising' INPUD member Erin O’Mara says Russia’s drug policies are ‘brutalising’

Erin O’Mara, (editor of UK’s Black Poppy Magazine and INPUD member) who coordinated the global protest said the human catastrophe unfolding in Russia is almost indescribable in its brutality and neglect.”Russia has more heroin users than anywhere in the world yet because they offer no safe alternatives such as methadone or buprenorphine, and corruption has driven the price of heroin above what many Russian users can afford, new home made concoctions like desomorphine (nicknamed krokodil) are gaining ground, with devastating health consequences for the user”. Erin adds, “To scratch the surface of Russian drug policies, you find some of the most brutalizing policies in the world; where their should be harm reduction, regulation, treatment and support, there is neglect, abuse, imprisonment, disease and death.”

New York City groups Harm Reduction Coalition and Vocal NY, led the first of the World Aids Day demos, reading speeches and presenting a statement of demands to the Russian Embassy, which included the demand for Opiate Substitution Therapies (OST) such as methadone to be both legal and accessible to the 2 million or more injecting drug users in Russia.

Mexico lays its candlelight vigil in memory of those who have died of AIDS.

Mexico soon followed, again on the eve of World AIDS Day, with their protest led by Espolea, an organisation who’s young people delivered their heartfelt candlelight vigil to remember those who have died of AIDS and those with HIV facing so much oppression in the Russian Federation. It was a very generous tribute from our young colleagues in Mexico at a time in the drugs war when they are facing such enormous troubles of their own. (see video below).

As December 1st -and World AIDS Day dawned,  the global domino effect began and cities from Canberra, Edinburgh, Barcelona, Berlin, Bucharest, London, Paris, Porto, Stockholm, Tblisi, Toronto, delivered their protests, and a unified SHAME RUSSIA SHAME rang out in front of Russian Embassies across the world.

Londons’ Russian Embassy Protest

Speeches were given and a statement of demands were delivered to the Embassies which included demands to see the introduction of Opiate Substitution therapy (OST) and the scale up of needle and syringe programmes, which although currently funded by outside NGO’s and not by the Russian Government, numbers of services are still shockingly inadequate, with around 50 odd for the entire Russian Federation.

The city of Tblisi also took a brave step and protested outside their Swiss Embassy, which currently stands in for the Russian embassy which has been removed from Georgia for political reasons. Nevertheless, Georgians who have also seen the emergence of the drug Krokodil from across the Russian border were keen to show solidarity with their Russian drug using peers, as history has meant they were very aware of the might of the Russian police forces and their attitudes towards drug users. Georgians took a huge risk protesting in Tblisi but seemed buoyed by recent workshops in drug user organising and empowerment and peerwork with INPUD.

New Vector, in Tblisi in support of their Russian peers, and raising awareness of krokodil

Demonstrators had the special opportunity to read out a letter from Russia, from an INPUD member and drug user activist named Alex, who spoke directly to his peers across the world about Russia’s indifference and the strength he gains from a unified drug using community.

Alex writes: “To my despair, I live in a country where the means don’t justify the ends Where it’s easier to save the lives of healthy people by destroying those who are sick. Where ethics and humanity have given way to contempt and cruelty. Where they evaluate prevention not in terms of possibilities and outcomes but dollars and popularity. I express my deepest gratitude to all of you who share my protest.  For me, World AIDS Day does not exist in Russia. For me World AIDS Day in Russia means white carnations and condolence cards.I’m alive today thanks to your help and your faith in our united strength. I wish us resilient spirits, and that love fills all of our homes. I’m with you today.”

The white slippers and carnations outside the Russian Embassy in Canberra, Australia

Demonstrators from the LGBT community also joined London’s embassy protest to add their voices against Russia’s recently passed St Petersberg bill, which, having already passed the first hearing, would severely further restrict the rights of the LGBT community. The oppression and marginalisation of the LGBT community also adds to a difficult environment to disseminate HIV prevention/treatment information. (click here for more info on this issue.)

 

The global protest was an exciting, moving and empowering event for all concerned, however everyone was acutely aware that Russian themselves were simply not safe enough to protest on World AIDS Day, no matter how peacefully. Although this protest had its roots in Moscow in 2009 on International Drug User Day, when 5 Russian activists were arrested after trying to lay red carnations and white slippers (the Russian symbol for the dead) at the steps of the Drug Control Service, the protest expanded on International Remembrance Day 2011. People in three countries took part, Budapest, Berlin and Barcelona and remembered their peers outside Russian embassies, again laying the symbols of the protest. This world AIDS Day,was a call out to the world that we will not let our Russian peers be forgotten -that we will stand side by side them as we all fight to ensure that Russian citizens have the right to humane, evidenced based, enlightened drug policies and treatment.

For more information and/or quotes from INPUD members and city organisers, please do not hesitate to get in touch with INPUD.

Contact: INPUD Deputy Project Co-ordinatorL eliotalbers@inpud.net who can put you in touch with the right person or answer your questions. For more articles on this issue see the protest website at http://russianembassyprotest.wordpress.com 

NOTE: A huge thank you to the global coordinators based in London – Women of Substance, Black Poppy Magazine, and Ava Project (London)– -and our partners in Eastern Europe: Andrey Rylkov Foundation, Eurasian Harm Reduction Network and all those organisations who took part in this event. INPUD members;  Plataforma Drogologica (Barcelona), Deutsch AIDS Hilfe (Berlin), Harm Reduction Coalition, Vocal NY (New York City) ,ASUD, Cannabis Sans Frontiere (Paris), AIVL, NUAA, CAHMA(Canberra)  CASOP (Porto) Association Intergration (Bucharest),Svenska Brukarforeningen (Stockholm), New Vector (Tblisi), CounterFit (Toronto) Chemical Reaction (Edinburgh) , Espolea (Mexico City)

Dec 1st Russian Embassy Protest -Be there!

The Red ribbon is a symbol for solidarity with...

WORLD AIDS DAY

On Dec 1st, 2011, World Aids day, people in 8 countries around the world will descend on Russian Embassies -To protest at the criminal treatment of people who use drugs – in the biggest catastrophe in the history of HIV in recent times. (See below for where and when).

In Russia today, we are bearing witness to one of the biggest, avoidable catastrophes in the history of HIV – the lack of response to the epidemic in Russia. We must point directly to the specific responsibility that Russian medical and public health officials bear for creating and sustaining this disastrous situation. Of particular concern are Russia’s, brutalising drug policies and its recently revised Total War on Drugs, which has resulted in further pushing people who use drugs into hiding, prison, and enforced detention, and severely compromising efforts from the international community to revert the trajectory of HIV/AIDS. The world is approaching a crossroads; a strong and decisive downward trajectory in the epidemic is possible in all countries -but it will only happen if the people who are most vulnerable to infection are supported and their human rights realised. Governments have legal obligations to act. Indeed, the implementation of harm reduction measures is consistant with and required by states obligations under international human rights law. 1,2.

Injecting drugs with contaminated equipment is driving Russia’s HIV epidemic, now the fastest growing in the world and it is reflected in the numbers; as many as 80% of new infections are occurring amongst people who inject drugs (PWID), in a total HIV positive population of approx 1million. With this in mind, recent projections forecast an additional 5 million people could become infected with HIV in the near future, unless Russia transforms the way it is dealing with its HIV pandemic.6

Russian authorities have repeatedly come in for fierce international criticism over their policy towards the treatment of drug dependence, which relies almost completely on the promotion of abstinence to the exclusion of harm reduction.  Russian officials claim, incorrectly, that the effectiveness of opiate substitution therapy (such as providing methadone and buprenorphine) has not been adequately demonstrated, and as such it is prohibited by law. Yet, despite the addition in 2005 of these two drugs to WHO’s list of essential medicines, and multiple position papers by international experts calling for substitution treatment as a critical element in the response to HIV (IOM, 2006; UNODC, UNAIDS, and WHO, 2005), methadone or buprenorphine remain prohibited by law in Russia and promotion of its use – punishable by a jail sentence.
Compare this legitimate injection kit obtained...

Sterile needles and syringes are proven ways to prevent the spread of HIV

With over 30,000 people dying from drug overdoses every year, numbers that can be shown to markedly reduce with the implementation of OST, and 150 becoming infected with HIV each day (2/3rds of which are injecting drug users), also evidenced to drastically reduce with the roll out of Needle and Syringe Programmes (NSP), it is upon everyone who cares about humanity, to demand an immediate transformational shift in Russia’s approach to HIV prevention and its treatment of drug users.  Access to NSP and OST is in itself, a human right;  UN Ruman Rights Monitors have specifically stated harm reduction interventions as necessary for states to comply with the right to health. 5)

Consistent evidence from around the world shows that treatment for opiate dependence works most effectively when the exclusive goal of abstinence is widened to foster multiple outcomes – including reduction in use of illicit opiates, exposures to blood-borne infections such as HIV and hepatitis, reduction in drug overdoses, better management of existing health problems etc. Evidence has repeatedly shown the clear benefits to the individual and society as a whole when drug dependence is viewed as a public health issue, as opposed to a criminal one. Evidence also shows OST, combined with a range of harm reduction measures such NSP, leads to a drastic reduction in the spread of new HIV infections in countries across the globe; none of this more clearly demonstrated today, than in Netherlands, a world leader in harm reduction where in 2010, only ONE injecting drug user contracted HIV. In the UK, another country that has harm reduction at the centre of its HIV prevention strategy, prevalence of HIV amongst drug injectors is at 1.5%, this against a Russian HIV prevalence backdrop of 30-35%. The evidence on harm reduction has been in for years. Why does Russia continue to turn its back?
The Russian government‘s estimated annual expenditure related to drug law enforcement) equal approx 100 million US  dollars. 7. This amount does not include the money spent on detention and imprisonment. In stark comparison, only 20 million US dollars was allocated to HIV and hepatitis B and C  prevention combined, among all population groups in 2011. By 2013, amounts spent will be three times less. Considering the context and tendencies in the development of the HIV epidemic in Russia, clearly such policies are not leading to any positive results. No money at all is allocated towards HIV prevention among the injecting drug using population.6Such punitive and torturous approaches to tackling drug use are not only fuelling the HIV epidemic in the region, but also the stigma, hate and ignorance of drugs, and of people who use drugs.  The insistence by both the Russian government and medical profession to treat drug users as criminals that need imprisonment at worst, and at best – enforced detention, has meant harm-reduction programs, including needle exchange, are officially accused of propagandizing drug use and activists have been arrested, harrassed and imprisoned for promoting harm reduction measures. Demonstrators who have protested and spoken out against the Russian response to HIV/AIDS are also regularly arrested and detained, including HIV positive people calling for access to ARV’s (drugs to treat HIV) and an end to treatment interruption fuelling drug resistant strains of HIV.This World Aids Day, December 1st 2011, we will echo the urgent voices of Russian drug users who are living and dying in the grip of an HIV and TB pandemic with almost no recourse or chance to engage in or promote an effective response.  . We will gather at Russian embassies around the world to demand Russia to change it current course towards death and disease. We want to see inappropriately aggressive, state sponsored hostility to drug users replaced by enlightened, scientifically driven attitudes and more equitable societal responses” 3 We demand our own countries to apply pressure wherever and whenever they can, voicing publicly our concerns about human rights abuses in the Russian response to drug use and HIV.
Sound, evidenced based and cost effective harm reduction solutions stand at the forefront of what has been shown to effectively prevent HIV infection in the drug using community. The personal narratives of people who use drugs and their allies on the front line of human right struggles must be recognised and remain a key part of today’s growing evidence base. People who use drugs must be seen as central players in the search for solutions rather than being framed and targeted as the problem.
Nothing About Us Without Us  www.inpud.net
Dec 1st at Russian Embassies in London, Stockholm, Berlin, Bucharest, New York, Sydney/Canberra, Spain (?), and Toronto. Dec 1st
 for times and locations follow updates at http://russianembassyprotest.wordpress.com or (add your email/website)

1) UNIDCP Flexibility of Treaty positions as regards harm redcution approaches, decision 74/10 Geneva UN 2002 ,
2) UNODC World Drug Report Vienna 2009
3) Lancet July 2010 HIV in people who use Drugs
4) The right to the highest attainable standard of health; Article 12, comment 14  International Covenent on  Economic, Cultural and Social Rights 2000
5) Barrett D et al;  Harm Reduction and Human Rights, the Global response to drug related HIV Epidemics. London, HRI, 2009
6) News Release, Oct 7th 2011, Risk of HIV Hitting Catastrophic Levels; from the Canadian HIV/AIDS Legal Network; Eurasian Harm Reduction Network; Harm Reduction International;
7) Articles 228-233 of the Russian Criminal Code

Krokodil- Home made heroin of the very worst kind

Viktor Ivanov, the head of Russia's Drug Contr...

Viktor Ivanov, the head of Russia’s Drug Control Agency

 

 

I am reprinting here an Independent article from June on what is perhaps one of the most disturbing issues to confront the drug using community in years. Home made heroin – desomorphine (also called Krokodil because of what it does to the skin) is becoming more and more common in Russia, affecting the poorest heroin users and having the most horrendous effects on the body. The Russian government continues to look the other way, refusing to provide methadone or subutex or humane and evidenced based treatments. Their lame attempt at banning one of the ingredients (over the counter sales of codeine)will do little to circumvent what is fast becoming an epidemic of home made drugs of dire quality. Please read this article and check out our videos down the right hand side of the page on the effects of desomorphine.Note: desomorphine was apparently invented in the USA in 1923 as a pharmaceutical preparation and was used in Switzerland under the trade name Permonid (strong opiate, fast onset, short duration). Krokodil and desomorphine as home made in Russia, seems more to pertain to the extremely hazardous way it is made, using ingrdients as mentioned below – and not in the sterile pharmy environment that desomorphine could in fact be made, without all the added human health problems associated with it. Worrying, Krokodil, the ‘home made’ desomorphine, has recently spread to Germany. Unless someone makes Russia listen soon and implement harm reduction such as OST, Needle exchange, etc -we are going to see this death and destruction of lives continue to spread further than Russia.

Krokodil: The drug that eats junkies  (Click link for the original Independant article June 22nd 2011)

A home-made heroin substitute is having a horrific effect on thousands of Russia’s drug addicts

By Shaun Walker

Oleg glances furtively around him and, confident that nobody is watching, slips inside the entrance to a decaying Soviet-era block of flats, where Sasha is waiting for him. Ensconced in the dingy kitchen of one of the apartments, they empty the contents of a blue carrier bag that Oleg has brought with him – painkillers, iodine, lighter fluid, industrial cleaning oil, and an array of vials, syringes, and cooking implements.

Half an hour later, after much boiling, distilling, mixing and shaking, what remains is a caramel-coloured gunge held in the end of a syringe, and the acrid smell of burnt iodine in the air. Sasha fixes a dirty needle to the syringe and looks for a vein in his bruised forearm. After some time, he finds a suitable place, and hands the syringe to Oleg, telling him to inject the fluid. He closes his eyes, and takes the hit.

Russia has more heroin users than any other country in the world – up to two million, according to unofficial estimates. For most, their lot is a life of crime, stints in prison, probable contraction of HIV and hepatitis C, and an early death. As efforts to stem the flow of Afghan heroin into Russia bring some limited success, and the street price of the drug goes up, for those addicts who can’t afford their next hit, an even more terrifying spectre has raised its head.

(See video on vod pod – bottom right column)

The home-made drug that Oleg and Sasha inject is known as krokodil, or “crocodile”. It is desomorphine, a synthetic opiate many times more powerful than heroin that is created from a complex chain of mixing and chemical reactions, which the addicts perform from memory several times a day. While heroin costs from £20 to £60 per dose, desomorphine can be “cooked” from codeine-based headache pills that cost £2 per pack, and other household ingredients available cheaply from the markets.

It is a drug for the poor, and its effects are horrific. It was given its reptilian name because its poisonous ingredients quickly turn the skin scaly. Worse follows. Oleg and Sasha have not been using for long, but Oleg has rotting sores on the back of his neck.

“If you miss the vein, that’s an abscess straight away,” says Sasha. Essentially, they are injecting poison directly into their flesh. One of their friends, in a neighbouring apartment block, is further down the line.

“She won’t go to hospital, she just keeps injecting. Her flesh is falling off and she can hardly move anymore,” says Sasha. Photographs of late-stage krokodil addicts are disturbing in the extreme. Flesh goes grey and peels away to leave bones exposed. People literally rot to death.

Russian heroin addicts first discovered how to make krokodil around four years ago, and there has been a steady rise in consumption, with a sudden peak in recent months. “Over the past five years, sales of codeine-based tablets have grown by dozens of times,” says Viktor Ivanov, the head of Russia’s Drug Control Agency. “It’s pretty obvious that it’s not because everyone has suddenly developed headaches.”

Heroin addiction kills 30,000 people per year in Russia – a third of global deaths from the drug – but now there is the added problem of krokodil. Mr Ivanov recalled a recent visit to a drug-treatment centre in Western Siberia. “They told me that two years ago almost all their drug users used heroin,” said the drugs tsar. “Now, more than half of them are on desomorphine.”

He estimates that overall, around 5 per cent of Russian drug users are on krokodil and other home-made drugs, which works out at about 100,000 people. It’s a huge, hidden epidemic – worse in the really isolated parts of Russia where supplies of heroin are patchy – but palpable even in cities such as Tver.

It has a population of half a million, and is a couple of hours by train from Moscow, en route to St Petersburg. Its city centre, sat on the River Volga, is lined with pretty, Tsarist-era buildings, but the suburbs are miserable. People sit on cracked wooden benches in a weed-infested “park”, gulping cans of Jaguar, an alcoholic energy drink. In the background, there are rows of crumbling apartment blocks. The shops and restaurants of Moscow are a world away; for a treat, people take the bus to the McDonald’s by the train station.

 

In the city’s main drug treatment centre, Artyom Yegorov talks of the devastation that krokodil is causing. “Desomorphine causes the strongest levels of addiction, and is the hardest to cure,” says the young doctor, sitting in a treatment room in the scruffy clinic, below a picture of Hugh Laurie as Dr House.

“With heroin withdrawal, the main symptoms last for five to 10 days. After that there is still a big danger of relapse but the physical pain will be gone. With krokodil, the pain can last up to a month, and it’s unbearable. They have to be injected with extremely strong tranquilisers just to keep them from passing out from the pain.”

Dr Yegorov says krokodil users are instantly identifiable because of their smell. “It’s that smell of iodine that infuses all their clothes,” he says. “There’s no way to wash it out, all you can do is burn the clothes. Any flat that has been used as a krokodil cooking house is best forgotten about as a place to live. You’ll never get that smell out of the flat.”

Addicts in Tver say they never have any problems buying the key ingredient for krokodil – codeine pills, which are sold without prescription. “Once I was trying to buy four packs, and the woman told me they could only sell two to any one person,” recalls one, with a laugh. “So I bought two packs, then came back five minutes later and bought another two. Other than that, they never refuse to sell it to us, even though they know what we’re going to do with it.” The solution, to many, is obvious: ban the sale of codeine tablets, or at least make them prescription-only. But despite the authorities being aware of the problem for well over a year, nothing has been done.

President Dmitry Medvedev has called for websites which explain how to make krokodil to be closed down, but he has not ordered the banning of the pills. Last month, a spokesman for the ministry of health said that there were plans to make codeine-based tablets available only on prescription, but that it was impossible to introduce the measure quickly. Opponents claim lobbying by pharmaceutical companies has caused the inaction.

“A year ago we said that we need to introduce prescriptions,” says Mr Ivanov. “These tablets don’t cost much but the profit margins are high. Some pharmacies make up to 25 per cent of their profits from the sale of these tablets. It’s not in the interests of pharmaceutical companies or pharmacies themselves to stop this, so the government needs to use its power to regulate their sale.”

In addition to krokodil, there are reports of drug users injecting other artificial mixes, and the latest street drug is tropicamide. Used as eye drops by ophthalmologists to dilate the pupils during eye examinations, Dr Yegorov says patients have no trouble getting hold of capsules of it for about £2 per vial. Injected, the drug has severe psychiatric effects and brings on suicidal feelings.

“Addicts are being sold drugs by normal Russian women working in pharmacies, who know exactly what they’ll be used for,” said Yevgeny Roizman, an anti-drugs activist who was one of the first to talk publicly about the krokodil issue earlier this year. “Selling them to boys the same age as their own sons. Russians are killing Russians.”

Zhenya, quietly spoken and wearing dark glasses, agrees to tell his story while I sit in the back of his car in a lay-by on the outskirts of Tver. He managed to kick the habit, after spending weeks at a detox clinic ,experiencing horrendous withdrawal symptoms that included seizures, a 40-degree temperature and vomiting. He lost 14 teeth after his gums rotted away, and contracted hepatitis C.

But his fate is essentially a miraculous escape – after all, he’s still alive. Zhenya is from a small town outside Tver, and was a heroin addict for a decade before he moved onto krokodil a year ago. Of the ten friends he started injecting heroin with a decade ago, seven are dead.

Unlike heroin, where the hit can last for several hours, a krokodil high only lasts between 90 minutes and two hours, says Zhenya. Given that the “cooking” process takes at least half an hour, being a krokodil addict is basically a full-time job.

“I remember one day, we cooked for three days straight,” says one of Zhenya’s friends. “You don’t sleep much when you’re on krokodil, as you need to wake up every couple of hours for another hit. At the time we were cooking it at our place, and loads of people came round and pitched in. For three days we just kept on making it. By the end, we all staggered out yellow, exhausted and stinking of iodine.”

In Tver, most krokodil users inject the drug only when they run out of money for heroin. As soon as they earn or steal enough, they go back to heroin. In other more isolated regions of Russia, where heroin is more expensive and people are poorer, the problem is worse. People become full-time krokodil addicts, giving them a life expectancy of less than a year.

Zhenya says every single addict he knows in his town has moved from heroin to krokodil, because it’s cheaper and easier to get hold of. “You can feel how disgusting it is when you’re doing it,” he recalls. “You’re dreaming of heroin, of something that feels clean and not like poison. But you can’t afford it, so you keep doing the krokodil. Until you die.”

Some of the names in this story have been changed

With each and every day Russia loses more of the plot, and takes the lives and hopes of people who use drugs, with it…

Please.DO NOT MISS THIS ARTICLE. people around the world must learn more and more about the barbaric, lunacy Russia inflicts on people who use drugs. Brothers, sisters, fathers, cousins,children,mums…dragged away from their families to a Russian prison full of disease and death. No methadone, no Hepatitis C treatment, only one in 5 who need it get ARV treatment (which is stopped in prison) , people locked up for supplying clean needles and syringes, distributing harm reduction information, (especially users), and for distributing methadone. The EECA region is at the.centre of megaepidemics in the IDU Community, for reasons of ignorance, arrogance,.corruption and vested interests. Follow the story, and do what u can to pick it up and tell the world. This must not continue for another minute.
EO.

http://m.guardian.co.uk/world/2011/jun/08/russia-total-war-on-drugs?cat=world&type=article

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