July 24, 2014

Australia’s success in methadone treatment could guide Russia, UN says

Written by Melissa Davey

Australia’s experience with methadone programs means it can explain why they should be reinstated in Crimea, UN envoy says

This post originally appeared on The Guardian. View the original here.

Australia could prove critical in convincing Russia to change laws preventing heroin addicts from accessing opiate treatment programs, the UN secretary general’s special envoy for Aids in eastern Europe and central Asia said.

Michel Kazatchkine, who has been involved in the global response to Aids for three decades, said 20 people had died in Crimea through being unable to access methadone treatment, after Kremlin-backed forces seized control of the region earlier this year.

“There were 800 people on methadone in Crimea, which we know is the most effective way of preventing HIV spread in people who use drugs, in combination with needle exchange programs,” Kazatchkine said.

“Within days following the change of authorities in Crimea, it was said that opioid substitution therapy would be discontinued.”

Under Russian law, methadone is illegal. Until Kremlin forces gained control of Crimea, Ukraine had been making significant progress in implementing methadone treatment programs and expanding needle exchange programs.

“Now it has stopped and 20 people, at least, have died, and they are just the cases I have confirmed,” Kazatchkine said. “What we know for sure is forcing the discontinuation of methadone treatment is unjustifiable by all human rights and scientific means, and that the consequences are hugely tragic.”

Opiate withdrawal was extremely painful and a form of torture, Kazatchkine said, and had driven some people unable to access methadone to suicide. Others had overdosed on heroin, returning to the drug because they could no longer access the substitute.

Methadone is manufactured, and is used as a substitute for people addicted to heroin and other opioids because its effects last longer than heroin. When in a treatment program, people are less likely to inject illegal drugs which expose them to risk of catching diseases and entering the criminal system.

Kazatchkine said he had spoken in front of the Russian health minister about the dangerous situation and the need for methadone programs to continue in Crimea to help curb the spread of HIV, but to no avail. A scheduled meeting with Russian authorities about the issue had been cancelled, he said.

Russia favoured psychological treatment programs, believing methadone treatment programs used taxpayer money to “entertain” drug use by substituting one form of opiate with another, Kazatchkine said. He said Australia should now step in.

“The voice of Australia as one of the first countries to successfully implement harm reduction programs like methadone to curb the HIV epidemic among people who use drugs, to me is extremely important,” Kazatchkine told Guardian Australia at the Aids 2014 conference in Melbourne.

“Australia has science, it has evidence , and it is only on those grounds that we can open the debate with Russia – not on political or ideological ground.”

According to the National opioid pharmacotherapy statistics 2013 approximately 47,000 people in Australia received pharmacotherapy treatment for their opioid dependence in 2013.

“While Russia is not the only country that does not believe in methadone as a harm reduction strategy, Russia is where there is a huge HIV epidemic largely driven by drug use, and where means that we know can stop that epidemic are not being implemented, so the epidemic there is absolutely acute,” Kazatchkine said.

Former high court judge Michael Kirby used his plenary address at the Aids 2014 conference on Sunday night to call on Tony Abbott to set an example to other countries in the fight against the HIV and Aids epidemic.

Kirby told conference delegates that the Australian prime minister could use his political conservatism to appeal to other conservative world leaders who had been slow to take action on HIV/Aids. On Tuesday, he echoed Kazatchkine’s comments about the importance of Australia in the global HIV fight.

“Mr Abbott is the first prime minister of Australia ever to acknowledge that the war on drugs is being lost,” Kirby said. “The inference that could be drawn from that is new policies should be adopted and international laws on the global war on drugs should be reformed.”

A Ukrainian living in Crimea and forced off methadone recorded a video for conference delegates, her face blacked out for fear of retribution.

“A minister from the Russian health department met with us and promised us treatment, but we did not receive anything,” she said. “Now we are are dying, and many users in Crimea have relapsed.

“Maybe for some people they will continue to inject heroin if they can afford it, but for me, I just want it to be all over. It’s so, so painful. I do not want to even breathe.”