Methadone as a Human Right

“We are people and we have the right to live.”

With this clear message at the forefront, Russian activist Irina Teplinskaya on Sunday appealed to UN High Commissioner for Human Rights Navi Pillay to push the Russian government to legalize methadone and buprenorphine, the world's most widely used and effective opiate substitution treatments (OST). According to the World Health Organization (WHO), Russia has more than three million people who regularly use heroin, yet the country’s leaders have routinely refused to finance basic harm reduction services, including needle exchange or substitution therapies, a stance that has fueled one of the world’s fastest-growing HIV/AIDS epidemics. WHO research concludes OST remains perhaps the clearest means of curbing this deadly trend.

“Tens of thousands of young Russians die every year because the law in this country forbids the use of substitution therapy, as recommended by the UN and successfully used in all the world’s developed countries,” Teplinskaya told Pillay in their meeting Sunday. “These programs help to stabilize the lives of drug-dependent people, improve their health condition, and help prevent HIV infection and lower crime rates.”

Pillay is in Russia this week to conduct high-level meetings with President Dmitry Medvedev and other government officials, as well as human rights actors and civil society leaders. The Open Society Public Health Program, International Harm Reduction Association, and 14 other advocacy organizations worldwide—many of whom are Open Society grantees—signed on to a joint letter to Pillay asking that she use her visit to address the need for additional HIV prevention measures in Russia, including harm reduction and OST.

Teplinskaya used her own personal story to illustrate why Pillay should make this issue a human rights priority: already infected with HIV and Hepatitis C through used syringes, Teplinskaya went on to contract tuberculosis while imprisoned in 2007 but was still denied essential medications. "I have had several unsuccessful attempts at treatment in different clinics, but continue to return to drugs," she said, adding, “In order for me to receive the life-saving treatment for HIV that should be guaranteed to me by the state, I was forced to go on hunger strike and cut open my veins.”

Now a vocal advocate in Moscow for fellow drug users as a volunteer for PHP grantee Andrey Rylkov Foundation, Teplinskaya has also filed a complaint against Russia for its lack of effective drug treatment with the U.N. Special Rapporteur on Health Rights and is in the process of preparing a similar complaint with the European Court of Human Rights. A Reuters article on Pillay’s visit Friday called Teplinskaya “a symbol of Russia’s drug woes.”

The full text of Teplinskaya’s speech to the High Commissioner as well as more details on her personal story can be found in English and Russian on the Andrey Rylkov Foundation website.

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I am a doc. Currently I work for Dr.Vorobiev Drug Clinic in Belgrade. Before I worked for many years in Russia. I know the problem from inside. From my own experience I very doubt that OST is a good solution for Russia. From medical position Methadone is a very controversial medicine. By itself Methadone due to its opioid nature is a very addictive substance ( addictive potential is much higher than that of heroine)+ withdrawal from Methadone is so hard that it is almost impossible to kick Methadone addiction without special detox procedure. It is very possible that with introducing Methadone program we run the risk of developing another, much harder addiction in scale of a whole country without solving Heroin addiction. Then the situation with OST in countries where it exists for long time is far away from ideal. It looks that Methadone suits very well financial interests of pharmaceutical companies ( Russia is a perspective market) and government needs by parking heroin users in Methadone addiction for years. So personally I am against Methadone. May be we should think about Buprenorphine as a mean of OST, but not Methadone for sure.

Thank you for your note. While you are absolutely correct that buprenorphine is a preferable treatment for certain patients, buprenorphine remains prohibitively expensive in many countries. We, of course, would also encourage efforts to make buprenorphine more accessible and affordable to patients worldwide.

I have been asked to respond to this post as the Research Coordinator for the Sw’Equity cooperative venture and a founding partner in MATH Not METH.

If you use the gravitational well that remains the North American bias towards the treatment of Addiction as the reference for expanding the use of Methadone, then, I suggest that premise is flawed. The fact is proven through twenty years of on the ground experience; it is more effective and much more economically prudent to detox a heroin addict [18-21 Days on average] than a Methadone addict [100 Days minimum]. The other factor is, at least in the Canadian context, voluntary accession to a Methadone program equates to voluntary custody tying the addict to a triangular path between the Clinic, the Distributing Pharmacy and his/her residence, if they have one. The fact is also that heroin maintenance is far more effective as it take the ‘Game of the Get’ out of the addiction cycle.

Best Regards

Martin G. Smith Ph.D - Research Coordinator
MATH Not METH - Camp One
Initiative Coordinator - Selkirk Light-Train
Chief Squid - Sw'Equity One

Collaborative Initiatives of RedSeven Services/ABOTA*

*[A Bridge Over The Abyss]

The Russian government denying subtitution therapy to its own people equates to violation of human rights of the citizen seeking treatment. OST such as Buprenorphine proves to be effective and beneficial to the treatment seeker. Why not grant it. That three million statistic alone is alarming. There should be freedom of choice for treatment and this is not to get dependent again but to be well.

(My comment closed before I was finished.)

Methadone treatment has been used for 60 years and it works the best for the majority. This does not mean that other medications can also work better for some patients. Patients along with a trained physician should make the decision as to which medication they should take. The decision should be informed because many patients are not told that they cannot take a pain medication with should they need it. Therefore buprenorphine is not a good medication for any patient in their 50s that may need pain medications in the future.

Hundreds of thousands of patients throughout the world have had their lives restored because of methadone. Addicts have a right to have access to the best medications to treat their condition whether it is methadone, buprenorphine, naltrexone, heroin or ibogaine. And every patient has a right to be informed about the medication. Denying an addict effective treatment is criminal.

Since its beginning methadone treatment has been demonstrated to be the most effective treatment for narcotic addiction, resulting in the termination of heroin use and of criminal behavior. In spite of this success, methadone treatment is often disparaged as a “substitute drug” by those who ignore the positive benefits that it has clearly brought to society. These attitudes negatively impact on opiate treatment programs in a variety of ways, but it is the methadone patients themselves who are particularly stigmatized and harmed. With the introduction of buprenorphine it was hoped that the public would gain a greater understanding of opiate addiction and treatment. However, this has not occurred and rather than improving the situation buprenorphine patients experience the same discrimination and stigma as patients receiving methadone. The atmosphere will not change as long as there is no organization or formal mechanism for patients receiving Medication Assisted Treatment (MAT i.e. methadone and buprenorphine) to voice their own needs and to form a strong unified public presence on their own behalf. As the premier national advocacy organization for MAT the National Alliance for Medication Assisted Recovery* (NAMA Recovery) will actively respond to the issues that affect the daily lives of MAT patients and work towards the day when they can take pride in their accomplishments.

Joycelyn Woods
Executive Director
NAMA Recovery
Together we can make a difference.

Three million users of heroin in Russia is a huge number. If that is the case, then, the government must act on it. Provisions or laws must be defined in order to address the said issue. But as an argument, there are also other medications which can work better to provide detox treatment to opiate addicts. Therefore, legalizing the use of buprenorphine and methadone to treat opiate addiction must be reviewed carefully.

I'm ex heroin user from Belgrade, I start with heroin 1998 because during that period Slobodan Milosevic and their regime sell heroin to own people and finance his wars against other nations on Balkan. I stop when I start Methadone Treatment because anything fail before that. It's terrible when people who finished school to become doctors don't understand how Methadone effect and when one addict need to explain them how that treatment is effective. In that period it was impossible to start Methadone Treatment except for people who will die very soon. Only 150-200 people get Methadone and on that way Serbia avoid critics that No Methadone, but we know that starting Methadone without HIV infections was IMPOSSIBLE. Government was involved in drug trafficking and they equip police and secret service from people who buy heroin. In that period everyone used addicts and their money and almost all opponent of Methadone Treatment had some profit if Methadone was not available. Among them strongest was private doctors who stop registration of Naltrexone only to sell him on black market for 10 times higher price, Serbian Orthodox Church who force addicts in bad condition on hard work, Russian Private Clinic Vorojbev who earn hundreds of thousands dollars on their not effective "miracle" treatments. People mostly hate that clinic because employers there lie as dogs. It's terrible when someone say you will not feel nothing only to addicts pay 4-5000$ and than patients survive hell like they are at home. Now Serbia need to support Methadone as candidate for EU Membership but we will start these days petition because Methadone quality is bad and we think that Russian hands are in that problem. They actively advice Serbia to abandon Methadone but now that was not possible because political reason because of that they fight against Methadone with bad medicine formulation, we will present that to EU.Now situation is little better when they hear that people are together agree that something must be done even they go to the court because want to Serbia respect original Methadone formula as we get 20 years. It's terrible to look what happen in Russia because they relation with addicts I only can see as genocide. Methadone will work in any situation, only is problem because someone need to pay that. And country where hospitals are in terrible condition and military in better it's obvious of character of such nation, repressive. It's not only problem with addicts, Russia is cruel country, people with cancer die there in pure agony. I think on planet earth most painful situation is cancer in Russian Federation and many people who glorify Putin will curse him one day because that could happen to anyone. Problem is mentality of people who used to sacrifice self for nothing. Parents there are not capable to see that only because Putin and their ideology it's much bigger chance to their kid become heroin user than kid in Switzerland or Germany. In USA mostly black people, poor, homeless, Latinos and similar are infected with HIV, in Russia white people, from good educated families are infected only because they become addicts and Russia not understand that sometimes is priority to stop with heroin, prevent infection and crimes and save someone life, not to live without any medication. Russian approach is sick, there are not other words for scientific denialism and confrontation of whole world. If we look results on field there are more need to whole world start Heroin Assisted Treatment as Swiss not to repeat Russian mass murder. I don't understand world, country who can show only fail in fight against drug and addiction need to be stopped to give advice to other nations if except if everyone want progress of AIDS and dead and misery. Mortality of addicts in Russia is far worse than in country who give heroin to addicts and they have no rights to show up on meetings for fight against drug. Three million users was 2011, now 2016 situation is same and number is more than five millions, they learned nothing and now we can say if heroin gone tomorrow more people will die from heroin in Russia than number of Jews killed in Nazi camps.I don't understand who listen them, who believe to them and who allow them to talk further while in Moscow people live without hands and legs because desperately try to stop withdrawal symptoms. Crocodile drug is found only because they didn't had effective opiate therapy. I think they spend more on amputation and treating wounds from Crocodile drug than cost of Methadone clinic. I'm glad if people from Crimea get chance to continue Methadone in Ukraine. Even China change their zero tolerance and dead squad for Methadone clinics, Russia can't say nothing to them because China don't like to someone give them advice, they start pilot project, they saw it's effective and continue to build more and more clinics, they have no such self destruction as Russian and Orthodox countries who still believe in Russian lies. Russia start own little war against Methadone and use any chance to show that they are against Methadone, problem is only because in that war only victims are their own people, but they are blind. Methadone prohibition killed more Russians I think than war with any county could kill for same time. They will mobilize three million people less if something happen thanks to Methadone prohibition.

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