Health and human rights crisis looming for people who use drugs in the Crimea

The International Network of People who Use Drugs (INPUD) and the Eurasian Network of People who use Drugs (ENPUD) wish to call the attention of civil society, the United Nations, and member states to a largely overlooked aspect of the catastrophic situation currently unfolding in the Crimea.

As has been widely reported, the Crimean peninsula, currently an autonomous region of Ukraine is under military occupation by unidentified armed men who are widely believed to be members of the armed forces of the Russian Federation. Should the Crimea become assimilated to the Russian Federation the latter’s highly repressive drug laws and deeply punitive approach to people who use drugs will come into immediate effect.

The aspect of this crisis that most concerns us is the situation that will be faced by the drug using community and the more than eight hundred clients of opiate substitution programmes, currently in receipt of either methadone or buprenorphine.

Methadone and buprenorphine are commonly prescribed to opiate dependent people and both are included in the WHO Model List of Essential Medicines. The provision of opiate substitution therapy is recognised by WHO, UNAIDS and UNODC as an essential part of an effective response to HIV amongst people who use opiates and is a key element of the package of internationally recognised harm reduction interventions. In spite of this international guidance, the provision of opiate substitution therapy is illegal in the Russian Federation. Denial of access to such essential medicines defies the internationally accepted scientific consensus and is a fundamental breach of human rights, principally that of the right to the highest attainable standard of health. Denial of opiate substitution therapy has been described by the Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment, Juan E. Méndez, as a “particular form of ill-treatment and possibly torture of drug users”.

Current supplies of methadone and buprenorphine in the Crimea are expected to last for at most another month, and in some cities, for only two weeks, and in preparation for the likelihood that the region will become a possession of the Russian Federation, doctors working in opiate substitution programmes have already begun reducing the doses of their clients. Members of the drug using community, and in particular clients of the OST programmes are likely therefore to be amongst the first refugees from Crimea should the territory come under Russian control, and if they cannot leave will experience immediate and wide ranging breaches of their human rights and a decline in their health.

The Ukraine has been a regional leader in the provision of harm reduction programming, most notably the provision of OST and needle and syringe programmes (NSP). The latter too, whilst not illegal in the Russian Federation, are barely supported by the government and only exist in a very limited number of sites. Like OST, the provision of NSP is recognised to be an effective and essential component of any comprehensive approach to preventing HIV and hepatitis C transmission amongst people who inject drugs.

The sudden cessation of these two essential programmes will be a public health and human rights catastrophe for the drug using community of Crimea, consequently we call upon the international community to put pressure on the government of the Russian Federation to respect internationally accepted human rights compliant, public health approaches for people who use drugs and allow for the currently running OST and NSP programmes to continue to run in the Crimea.

We call upon the Executive Directors of UNODC and UNAIDS, and the Director-General of the WHO to make public statements expressing their support for the continuation of existing harm reduction programmes in the Crimea and to call upon the government of the Russian Federation to cease and desist from any attempts to close them down, a move that will have immediate disastrous impacts on HIV and hepatitis C transmission as well as the wider health and human rights of people who inject drugs in the Crimea.

Supported by:
International Network of People who Use Drugs (INPUD)
Eurasian Network of People who Use Drugs (ENPUD)
All-Ukrainian Network of PLWH
Association of Substitution Treatment Advocates of Ukraine (ASTAU)
Eurasian Harm Reduction Network (EHRN)
International HIV/AIDS Alliance in Ukraine
Andrey Rylkov Foundation for Health and Social Justice, Moscow
Intercambios Civil Association
International Drug Policy Consortium (IDPC)
Hungarian Civil Liberties Union (HCLU)
Asia-Pacific Network of Sex Workers
Harm Reduction Coalition (HRC)
Harm Reduction International (HRI)
Asian Network of People who Use Drugs (ANPUD)
Indian Drug Users’ Forum (IDUF)

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