When Two Means Thousands

In a recent online talk show hosted by the Russian service of Voice of America, Tatyana Klimenko, an advisor to the Russian Minister of Health, was asked why the medicines methadone and buprenorphine—known as opioid substitution treatment (OST)—are banned in Russia despite libraries of scientific evidence proving their effectiveness in preventing HIV and reducing heroin use. “Only two patients are demanding OST in Russia, Alexey Kurmanayevsky and Irina Teplinskaya,” Klimenko dismissively responded, so the solution was a no-brainer: why don’t they simply travel to Ukraine, where OST has been available since 2004 (you can watch the broadcast in Russian here).

Irina Teplinskaya and Alexey Kurmanaevsky became infamous to Russian officials after they went to the European Court of Human Rights (ECHR) to demand their right to evidence-based, safe, and internationally recognized drug treatment for their opioid addiction. So far Russia has failed to provide. Both Irina and Alexey have spent large parts of their lives in and out of the ineffective and antiquated detox programs that Russia advertises as drug treatment, in an attempt to get their heroin addiction under control. After an especially grave relapse a few months ago, friends helped Irina – by then a mere shadow of herself – to enroll into an OST program in Ukraine. It is a miracle—and no thanks to Russian policies—that she is still alive. It is not clear whether or when she will be able to return to Russia, to her friends, or to her work.

Irina was lucky. How many people will never make it to Ukraine? Think of Alexey, who has a job, a wife, and two young children whom he cannot leave behind. OST is also needed by Dimitry Polushkin, who in June 2012 submitted his complaint about denial of treatment to the ECHR. Ivan Anoshkin in February 2011 complained to the Special Rapporteur on the Right to Health on the lack of methadone treatment in Russia. The list of people who are suing for the right to OST in Russia (rather than go to Ukraine, Canada, or Iran, as Russian authorities would have it), would be much longer, but those who need the medicines rarely have time to go to courts. Dealing with their addiction takes all the time they’ve got.

Russian health officials would probably appreciate knowing that twelve days after Dmitry Polushkin went to his local department of health with a request for methadone treatment, he was arrested for possessing drugs for personal use. Dmitry submitted his complaint to ECHR while being held in pretrial detention, preparing for his criminal trial. In the end he was sentenced to five years in prison for not being able to abstain from using drugs, which is a symptom of his illness—and the sickness of the Russian system. His request for methadone treatment was denied.

On April 11, 2012, Ivan Anoshkin appealed to his local department of health with the same plea for life-saving OST. On the very next day, he was detained for carrying desomorphine for personal use.

Like Klimenko, the Russian government doesn’t want to offer an honest account of the human toll of their policies. Approximately one in six Russian inmates is behind bars for non-violent drug related crimes. Many of these need OST. A real assessment would also count those who have already died of a drug overdose or other detrimental consequences of heroin, or the often toxic, homemade desomorphine. These Russians would have benefitted from OST as well, though  being dead prevents them from going to court or moving to Ukraine.

In Russian government-speak, two means thousands—of lives lost, HIV infections, and people denied life-saving medicine in the name of drug control.