Off the rails again!

It's happened!  I'd been afraid it would and it has… What only yesterday seemed like a nightmare has now become real:  the monster has grown and got stronger and I'm drowning in the smells and feelings of drug-induced sweat and grey ash.  The self-destruction programme has kicked in big time: I'm crushed, in bits, crucified on a heroin cross and nailed to the pillar of shame with syringes.  I'm afraid to sleep, afraid to wake up.  I can't put on a tee shirt because my arms are a mass of fresh track marks. I'm terrified of the sticky, all-engulfing horror which is the only thing left alive in my soul.  But what I fear most of all is losing my nearest and dearest: people who believe me and in me, who are suffering with me, though realising bitterly that they can't help me.  I had lost my family ties, but thanks to them I realised that my dear ones are not bound by family connections, but people who were once strangers and now do everything they can to save me from myself.

Why are there no anti-retroviral drugs in Russia?

I live in a country where human life and dignity count for nothing.  A country where 100,000 young people die of overdoses every year and even more of AIDS and tuberculosis, which are untreatable because Russia offers them no opportunity to be treated for the most terrible affliction – drug dependency.  I've buried so many wonderfully talented people – even a war wouldn't kill so many.  I have the whole bouquet: HIV, hepatitis and tuberculosis, and you can take it from me that when I'm rattling, I don't give a stuff for their treatment.  I don't care about anything. 

"I don't consider myself weak or cowardly. When I was in the prison camp I fought tooth and nail for ARV therapy. I nearly died, but I got it! Now I would do anything to get access to replacement therapy (ORT), but it seems I was born in the wrong country"

One more interruption to the highly active antiretroviral therapy (HAART).  I didn't have time to go to the AIDS Centre for the medication, but this time (luckily) only for one week.  This is the third time it's happened – because of heroin.  I'm probably already pretty resistent to many of the drugs, so I don't have much choice for the future.  Given the situation in Russia with antiretroviral drugs (ARV), I don't have much of a a choice anyway.   

I'm so sick of living hounded into a corner.  I want some spiritual peace – I don't even need money, as I've long since learnt to manage without it and when I get it, it all goes on drugs.  Even the laptop I proudly bought from the money I earned with my articles has gone now.

Rehab or replacement therapy?

So the Russian government Drugs Tsar, Evgeny Bryun, wants to cure me with his treatment?  He doesn't get it… I'm terrified of the Russian rehabilitation centres with their work therapy and bullying.  If I ended up in one, with my freedom-loving nature I'd kill either my tormentors or myself.  No one hits as hard or humiliates with such impunity as they do in those rehab centres.  I spent 16 years in that system, so it must be time I was cured, but I seem fated to be one of the chronically drug dependent.  Only a complete idiot could think that my benders are the result of a craving for pleasure or that I could come off drugs if I wanted to.  Is this really the life I would choose for myself?  I'm talented, able, in demand and loved…yet I end up homeless, broke and hungry.  And with no friends….

I don't consider myself weak or cowardly.  When I was in the prison camp I fought tooth and nail for ARV therapy.  I nearly died, but I got it!  Now I would do anything to get access to opioid replacement therapy (ORT), but I was born in the wrong country.  I'm sick of being a zombie:  I love life, people, laughter!  I've stopped laughing, which is awful, and am terrified that I shall become superfluous to requirements for my friends.  You only live because you're needed by someone, after all.  I'd only just started finding people who were dear to me and to whom I was precious…

Recent successes

Not so very long ago everything was so good it seemed like a dream.  I had acquired status, a name, friends and fellow-thinkers;  I had started earning quite good money, thanks to my writing abilities.  Many people were very surprised by the rapid improvement in my circumstances, but I wasn't.  I have always known that I could get anything I set my heart on and no one can stop me doing it.  But what people don't know is that I'm my own worst enemy…or, rather, my addiction is.  I know that it kicks in at the most unsuitable time and rips through everything I have so carefully set up and constructed.  It's a ticking time bomb and my life is a minefield – you never know when it'll blow up, but when it does……

There are millions like me in Russia and it would be so simple to put an end to their sufferings that thinking about why the government won't do it makes me feel sick.  Is it the principle of planned annihilation – the quicker they drop, the better?  Some may 'drop' by the wayside i.e. die, but there'll always be others to take their place.  The simple solution is to replace illegal street drugs with legal medication.  One tablet of Buprenorphine a day and you can live a normal life and be no threat to others.  The government would benefit too!  The demography would improve, as would the number of able-bodied working people ;  there would be fewer epidemics of socially dangerous diseases and crime levels would fall.

Replacement therapy outside Russia

The first time I saw a completely happy drug addict was in Ukraine.  My friend Olga Belyaeva has been on the ORT programme for 5 years.  She's a new person.  How I would love it if I and my friends in Russia were able to go to sleep and wake up knowing that the morning would bring the right dose from the doctor.  I decided I was going to try this for myself.  Now I think of what Aesop said,  “Be careful what you wish for, lest it come true”.

In November 2010 I was elected to the Steering Committee of the Eurasian Harm Reduction Network (EHRN).  The first meeting was in Vilnius.  I had had a stressful 3 months before that, taking part in training sessions and protests against disruptions to ARV therapy and living out of a suitcase.  When I came home to Kaliningrad I used heroin to relax and, most importantly, to top up the endorphins in my system.  When I was travelling, I was absolutely happy – I had a job to do, a place in society and wonderful people to work with.  Home was something else: a place in a hostel, surrounded by puffy, sexless creatures, most of them chronic alcoholics.  What saved me was the internet and my correspondence with friends.

EHRN welcomes drug addicts as part of the decision taking process, so I was brave enough to say to the management that I needed ORT while I was at the meeting.  This all went through very easily and EHRN management agreed to pay for Buprenorphine for the 7 days I was in Vilnius.  I couldn't believe my luck.

"The worst part was going home. As we got nearer to Kaliningrad I was already on the phone, ordering heroin".  All photos of Kaliningrad by flickr/joli soleil

Vilnius

I was planning to stay with Raminta, one of the EHRN people, for a couple of days, and then join the rest of the conference team in a hotel.  I arrived late, but Raminta immediately took me to the clinic and, wonder of wonders, I was treated like a human being!  I was given a staggered 7-day programme, careful instructions and the medication.  The doctor told me that if I had any problems or questions I should come back to him.  His final suggestion really knocked me off my perch:  he offered to put me on ORT in Lithuania, if I could come and pick the tablets up, then get them back over the border (it's 5 hours by bus from Kaliningrad to Vilnius). 

I couldn't wait to get started and took the first tablet in the taxi.  Knowing that the medication can produce nausea, Raminta took the trouble to give me something to eat at the station.  This was completely new for me: I only knew her from the internet, but she was so considerate and caring about what I might feel like on a high.

At first there was no particular result, but when we got back to Raminta's I began to feel the euphoria I so love, when colours are brighter and you are filled with feelings of benevolence towards the whole universe.  Raminta smiled slightly, but there was no revulsion or irritation….how can this be?  I didn't sleep at all: I smoked, wrote and enjoyed my (legal) high.  The next morning Raminta went to the gym and came back with a bunch of roses to congratulate me on starting ORT.  Lithuania was apparently the first of the former CIS countries that introduced this therapy, some 15 years ago, so there's no surprise about it – it's a disease like any other.

All week I got day and night muddled and I have only the vaguest memories of the meeting, but my colleagues regarded this as quite normal.  They are all drug addiction specialists from European and Central Asian countries with ORT programmes and used to working with people like me.  I met Olga Belyaeva again, as she too is on the Steering Committee of EHRN, and was once more so impressed by her that I decided I would stop at nothing to get my country to adopt ORT.

Back home

The worst part was going back to Kaliningrad.  I knew what would happen and that it would be a big one:  not just a ripple in the pond, but a tsunami.  The last 7 days had been such a fairytale that the thought of going back to the addicts' hang-out with its peeling wallpaper, mattresses on the floor and the police kicking down the door every morning was unbearable after the 5* hotel and legal drugs.  As we got nearer to Kaliningrad I was already on the phone, ordering heroin.  Perhaps if my nearest and dearest had not actually been so far away, I would have been all right, but they all live in other cities, so I was left alone with my overworked emotions and memories, and my addict 'friends'.  

I have nothing – no money, food or laptop – but I do have what is most precious:  the people to whom I dedicate this article, who are prepared to fight alongside me to the end to get ORT in Russia, so that drug addicts can see how you can live a real life, even with our disease.  For these people, whose respect I don't want to lose, I won't give up on the quest half way.  The millions of people who suffer in addicts' shelters with no clue that there is such a thing as ORT will be my inspiration and motivation to get myself out of this situation.  I can and I will!  People you love are, after all, the strongest drug – it's taken me all this time, but I have now managed to grasp that.

A longer version of Irina's cri de coeur was emailed to a list of people and posted on the website of the Andrei Rylkov Foundation, for which she has been working. 

Comments to the original article 

….. your articles are disgusting rubbish, what have you ever done for Russia, that she should do anything for you? Why don't you just go somewhere else, if things are so bad here?

... when I read your article, I cried.... You can do it, you'll manage it ... we believe in you and love you!

…your approach to ORT is positively messianic.  As if when we get that, then everything'll be OK.  It must be part of a more complex approach.  Why don't you give Narcotics Anonymous a try?  Non-judgmental, no one gets kicked out….We've offered help several times, but you never take it up.

…if you only believe in ORT, then you'll never try anything else.

... I don't know you, but there is a tear when I read every line, every word and every letter.  

…. since ORT is like a red rag to a bull in Russia, why not change tactics somewhat and stop actually pushing for it? The new goal could be, say, the registration of Suboxone and other such drugs.  There can be no question of pure Buprenorphine, because you can't be 'cured' on it.  

... Ira, we don't know each other, but I just wanted to say you're a fighter. Keep strong, please, fight on! I'm sure you'll be successful, because fighters do not know defeat. 

….the Lithuanians were behaving unethically in giving you ORT when there was no possibility of going on with it.  Who has Russia found to represent our country in EHRN?   A woman who is off the wall during most of the meeting!  I can just imagine the sort of decisions that must have been taken there!

…I have worked in the field for some time.  I studied harm reduction and ORT in Switzerland and am convinced that it can only be effective in conjunction with a multi-agency social programme of support and that it is very dangerous if this does not happen.  So often the addict is both jobless and homeless (or at least one of them);  the family, if there is one, and friends have frequently got to the end of their tether and withdrawn support.  The addict is completely isolated and is therefore very unlikely to be able to derive proper and lasting benefit from any harm reduction programme.  In an ideal world (!), the government would offer this support programme, involving housing, work, family input AND proper monitoring or follow-up.

Most important, I feel, is that all harm reduction, ORT and, indeed, any other therapy can only, nay must, depend on the personal motivation of the addict.  Being done unto is not an option, or not one that will work, and this is what lets down so many of the programmes in Russia.