Arguments over the benefits of opiate substitution therapy versus abstinence as the most successful way of dealing with drug addiction are not confined to one country. But in Russia the attitudes of both professionals and society to addiction are harsh and uncompromising, as well as an infringement of their human rights, says Irina Teplinskaya.
I was born 44 years ago in the Soviet Union and had my first encounter with opium at 14. My family was well placed and I could have had a bright future, but that future never came. For 16 years I was in and out of prison and never off drugs for long. Use of dirty needles meant I contracted HIV and Hepatitis C and in 2007 I developed AIDS and TB, but, miraculously almost, this proved a turning point. I took a number of training courses and started working in an AIDS organisation, though my addiction made it difficult for me to work and by 2010 my life had reached an impasse. Everything changed that year when I became a member of the Andrei Rylkov Foundation Working Group advocating the introduction of OST in Russia.
I have, therefore, only recently found a voice to speak up on behalf of all Russian drug users, a community that is marginalised, socially isolated and deprived of human rights. HIV treatment may be guaranteed by the Russian government, but the officials responsible for delivering it more often than not have little professional expertise, are negligent and narrow-minded, and their prejudices reflect Russian society’s attitude to drug addiction.
Dozens of young people in Russia die every year because the law prohibits opiate substitution therapy (OST) with Methadone and Buprenorphine, tried and tested in developed countries throughout the world and advocated by the UN.
Dozens of young people in Russia die every year because the law prohibits opiate substitution therapy (OST) with Methadone and Buprenorphine, tried and tested in developed countries throughout the world and advocated by the UN. Needle and syringe programmes have recently been banned in Russia, too, although, these are considered a major component of comprehensive HIV prevention programmes among people who inject drugs. Even scientific discussions of issues related to the use of Methadone – one of the essential medicines recommended by the World Health Organisation – is considered illegal and can be classified as promoting drug use in Russia.
Russia’s official approach to the treatment of drug addiction is based on forced abstinence. It both humiliates drug users and deprives them of their rights. In a much-publicised recent case, one regional organisation, City without Drugs, offered drug addiction treatment services based on the use of such ‘methods’ as kidnapping, handcuffing, starving, beating and torturing drug addicts. There was considerable public support for this approach: even human rights organisations made no protest and some activists actually expressed their approval.
The stigma attached to drug use is such that even professionals in the human rights field often fail to consider us as human beings with the same undeniable rights as other people. Pregnant women are not given any specialised assistance to manage their drug habit: they have either to terminate their pregnancy or continue using illegal drugs till they give birth. In countries where OST is available, drug-addicted women can have their babies, nurse and raise them without risking their health or lives. In Russia there are no specialised crisis centres for women addicts with children who want treatment to get off drugs.
In October 2010 I approached Anand Grover, the UN Special Rapporteur on the right of everyone to the highest attainable standard of physical and mental health. I lodged a complaint against Russia and asked for an international decision or other measures to compel the authorities to provide proper treatment for drug users. I am currently preparing similar appeals to the Constitutional Court of the Russian Federation and the European Court of Human Rights.
My actions have been widely reported in the Russian media. Stories have appeared in many papers and I talked about my initiative in interviews. Almost all the interviewers asked the same question: “So, you want a European Court decision to get Russia to pay you compensation? You don’t want treatment to get off drugs, but you expect the government to provide you with drugs paid for by the taxpayer?”
No, I don’t want compensation! Thousands of my friends have died of AIDS, tuberculosis or overdoses. I have lost my health, my family and any hope of a home or future. How can this be assessed in financial terms?
I have a chronic disease and am trying to see that my right to health, which is guaranteed by the Constitution of the Russian Federation, and the rights of 5 million drug users in Russia, are respected!
I want access to sterile syringes. I want to prevent thousands of young people annually from getting infected with HIV through contaminated needles.
I want my friends to have access to treatment for HIV, tuberculosis and hepatitis, diseases few people die of in the developed world today.
I want my female friends to have no need to sell sex for drugs, I want them to be protected against violence and to be able to have healthy babies and raise their children.
I do not want hundreds of thousands lives to be ruined every year in prisons for minor drug-related offences.
I want the health officials to give us treatment and not to bar us from a normal life!
Russia’s refusal to use OST programmes is absolutely without foundation and not evidence-based; moreover, it results in the violation of our human rights. In October 2010 UN Secretary General Ban Ki-moon visited a Methadone clinic in Cambodia, thus demonstrating to the world that Methadone maintenance therapy programmes are lawful, important and should be available to people with drug-related problems. In Russia we are also human beings with universal human rights. We also have the right to live!
In February 2011 the UN High Commissioner for Human Rights, Navi Pillay, made an official visit to Russia. At her meeting with representatives of Russian human rights organisations, I had the privilege of speaking to her on behalf of Russian drug users. I asked for her intervention to protect their human rights, particularly their right to health. I handed the Commissioner a letter to the same effect signed by 17 international organisations working in the field of HIV/AIDS and harm reduction. Following our meeting, the UN High Commissioner for Human Rights delivered two recommendations to the Russian government:
1) legal restrictions should be removed and OST pilot programmes launched in Russia;
2) needle and syringe programmes should receive political and financial support, comprehensive measures for the prevention of HIV should be introduced, and the participation of drug users in health programmes funded and monitored.
The Russian government response was swift. The next day, a number of federal newspapers published interviews with the Minister of Health Tatiana Golikova, and the Head of Rospotrebnazor (Federal Service for the Protection of Consumer Rights and Welfare), Gennady Onischenko.
The government officials declared that, according to their data, there is no proof that OST is effective; it is not a proper treatment, as it simply replaces one drug with another; and pilot syringe programmes, run in some regions of Russia, have all failed to reduce the transmission of HIV among people injecting drugs, and had no influence on HIV statistics.
Russian officials are used to lying and breaking their promises, because they are perfectly sure they can get away with it. So I decided I could not remain silent. I’m not going to wait till I die of AIDS or an overdose. I’m sick of being frightened, of going through withdrawals, of hunting for the money to get illegal drugs, of failing to adhere to HIV treatment programmes... I’ve had enough and I’m ready to fight for my rights till the bitter end!
I’m not going to wait till I die of AIDS or an overdose. I’m sick of being frightened, of going through withdrawals, of hunting for the money to get illegal drugs, of failing to adhere to HIV treatment programmes... I’ve had enough and I’m ready to fight for my rights till the bitter end!
I realise that it might still be too early to hope that my complaints and appeals will influence the official position of the Russian government. But my supporters among drug users in Russia are increasing and I’m glad because that means my example has inspired people to see that any discrimination on the basis of illness is illegal. Two other Russian drug users have followed my example and made individual complaints to the UN Special Rapporteur Anand Grover, and to the European Court of Human Rights. I think this is a great achievement.
In November 2010 I was elected to the Eurasian Harm Reduction Network (EHRN) Steering Committee from the sub-region of Russia, which gives me more opportunity to fight for the human rights of drug users. Currently, with the support from the International Network of People who Use Drugs, we are working on setting up a similar Eurasian network. I passionately believe this is just the beginning, the first stage in the empowerment of Russian drug users; that people will finally overcome their fears, unite and stand up to defend their rights – we have nothing to lose!
This article is a shortened version of the speech given by Irina Teplinskaya at the International Harm Reduction Conference in Beirut (April 2011).